technology, patient engagement and population health...

Patient Engagement, Population Health Management and the Required Technology

Envisioning the Optimal System Ellis “Mac” Knight, SVP | CMO

Jeffery Daigrepont, SVP Coker Group

One doctor’s musings….

• What if I were free to design the perfect IT system that would facilitate patient engagement and population health management?

• What would that system look like, how would it operate, what would it do?

• What possibilities could I imagine for the blending of technology and clinical care delivery in this very important area of the healthcare system?

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Population Health Management • The key processes and procedures

– Patient outreach

– Health risk appraisal

– Risk stratification

– Care coordination

– Preventive care

– Wellness and health maintenance

– Disease management

– Acute episodic care

– Home care

– End of life care

* Note: Patient engagement plays a role in all of these processes

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Key Characteristics of the Ideal Technology

• Connected

– Facilitates provider – patient communication through the use of

• Mobile technology – smart phones and other mobile technology to connect with patients wherever they are

• Social media – much easier to find people on Facebook than in the phonebook

– Asynchrony – no dealing with busy signals or “no longer at this address”

– Non-threatening – “Is that the collection agency calling?”

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Key Characteristics of the Ideal Technology (cont’d)

• Interconnected

– Pulls in information from a variety of relevant sources such as

• Clinical information systems – EMR (inpatient and outpatient), Lab, Pharmacy, Home Health, Rehab, Wellness, Care Management, Imaging

• Business information systems – Accounting (especially cost accounting), billing, registration, scheduling

• External healthcare provider systems – Hospitals, commercial pharmacies, physician practices, free-standing imaging, ED, urgent care centers, labs etc. via health information exchange (HIE)

• Patient monitoring systems – Useful data from self-monitoring or home monitoring devices. Vital signs, blood sugars, falls, medication compliance, video

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• Patient – centered – Automated patient services that are

• Non-threatening: Acquisition of sensitive information

• Easy to understand: Advice and instructions in a simple but non-condescending format

• Engaging: Coaching and encouragement with incentives and rewards

• Individualized: Services that are uniquely tailored for each individual

• Affordable: Not everyone can afford a concierge practice

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• Directed

– Provides useful data that is

• Reliable: Accurate and properly attributed

• Appropriately sourced: Clinical data from CIS, financial data from billing or accounting system

• Timely: As near real-time as possible

• Simple: Measures that don’t require a degree in statistics to interpret

• Accessible: Data can be easily analyzed to answer relevant questions

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• Focused

– Data analytic system that converts data into actionable knowledge in a way that is

• Simple: Front-line providers can query data themselves

• Timely: Reports can be run at the pace of clinical care delivery

• Customizable: Data queries and reports unique to each provider’s questions

• Descriptive and predictive: Can reflect past and project future picture of individual and population health

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Conclusion

• Patient engagement is an essential element in all aspects of effective population health management (PHM)

• Effective PHM will significantly depend on the availability of IT systems, with the characteristics outlined above.

• HCIT developers, vendors and operators have a great challenge and a large opportunity to deliver providers the kind of technology that can move true PHM from a concept into a reality.

• This one doctor looks forward to seeing that happen!!

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The IT Side of Patient Communication

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Today…

• Healthcare providers, patients, communities, and hospitals are in the process of reinventing how they collaborate.

• Population health management has become a critical component of collaborative care and a key component needed to improve care quality in today’s world of shared risk.

• Integrated IT protocol-based systems will be used to empower providers to succeed in every aspect of collaborative care.

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HIE vs. PHM vs. Patient Portal

• Health Information Exchanges – Enable fragmented data to be shared across multiple systems in use by care givers and stakeholders.

• Population Health Management – PHM is a relatively new

innovation within healthcare. – Overarching system of care that encompasses HIE and transforms

actionable data into meaningful insights for patient care. – Used for preventive care, evidence-based disease management,

population health management, physician alignment, clinical integration, and participation in various reimbursement programs

• Patient Portal – Is the tool used by patients to connect with their caregivers electronically and its frequently used as the viewer for all of the other data being stored and collected related to patient care, collections and scheduling.

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• Public vs. Private

– Private HIEs are now in the lead. (State run HIEs have not been financially sustainable)

• Pure Play vs. Vendor add-on Module

• Home Grown vs. Co-Develop (Geisinger + IBM + GE Medical+ EPIC)

– ProHealth Navigator

• Office of the National Coordinator for Health Information Technology (ONC) names DirectTrust and EHR/HIE Interoperability workgroup to oversee HIE compliance & privacy challenges

• Space still emerging – No clear market leader

• 88 operational HIEs according to KLAS 2011

• Virtually every HIE operates exclusively on a local community or state level

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Health Information Exchanges (HIEs)

Types of HIEs

Community Health Record

Core HIE

Advanced HIE

Clinical HIE Portal Notifications CCD Exchange Send to my EHR (CCD) Direct Secure Messaging Single Sign-On EHR Privacy and Consent

Case Management Meaningful Use

Dashboards HIE Utilization Analytics Public Health Reporting eHealth Exchange

(nationwide HI network)

Patient Portal EHR Lite Diagnostic Orders ePrescribe Embed Tele-Health Enterprise Imaging

Radiology Cardiology Dermatology Ophthalmology

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Health Information Exchanges

16 Source: MediExchange

• Relatively new innovation within healthcare.

• Overarching system of care that encompasses HIE and transforms actionable data into meaningful insights for patient care.

• Information is used for preventive care, evidence-based disease management, population health management, physician alignment, clinical integration, and participation in various reimbursement programs.

• Lynchpin for truly improving clinical outcomes for individual patients, patient populations, and entire communities.

• PHM is at the core of the theme of “accountable care” era structures.

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Population Health Management (PHM)

Population Health Management

18 Source: WellCentive

Patient Portal Having a patient portal makes care and communication easier—for you, your practice, and patients. Benefits include:

• Better engage your patients, while measuring success. Improve clinical and

financial outcomes. Meet ever-changing industry demands. If it is NextGen/TSI’s Patient Portal, then it will be fully integrated with the EHR and practice management system. Which will provide the added benefits of – Enable patients to self-serve online (payments, scheduling, and more) – Provide patients with access to their personal health record – Automatically chart in your EHR, directly from your inbox – Track patient satisfaction and minimize staff disruptions

• Not only can a Patient Portal help you meet patient engagement objectives but it is also a requirement for Meaningful Use stage 2.

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Patient Portal can Boost Revenue and Profits

• Recent study in JAMA shows that patients with on-line access schedule more visits.

• Allowing patients to pay their bills on-line will reduce days in A/R and speed up payment.

• Requesting appointment and prescriptions on-line means less volume of phone calls.

• Allowing patients to have access to their results will improve compliance and patient care. It will also reduce phone calls and phone tag when calling back patients, reduce postage.

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Source: Association of Online Patient Access to Clinicians and Medical Records with Use of Clinical Services. Ted E. Palen, MD, PhD, MSPH; Colleen Ross, MS, MPH; J. David Powers, MS; Stanley Xu, PhD. JAMA. 2012;308(19):2012-2019. doi:10.1001/jama.2012.14126

Where Do Companies like TSI Fit in

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Next Steps

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Strength in Numbers

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Knowledge Sharing • Vendor Demonstration Tools

– Score Cards

– Demo Scenarios

– Scribe my exam

• Specialty Specific RFPs

• Reference Check Tools

• Site Visit Tools

• Tools for Comparing cost, including recurring cost

• HCIT User Conferences/Summits/Forums

• HCIT workshops in conjunction with Annual Meeting

• Formal Strategies

• Displacement Guidance

• Hospital Alignment

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Guidance on How to Negotiate an IT Contract Like a Pro

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What to Negotiate

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• Initial costs • Hardware cost • Software cost • Communications cost • Installation cost • Ongoing support cost • Implementation cost • Support cost • Technical support cost • Integration costs • Interface cost • Entitlement to new releases/bug fixes • The cost of tailoring • Future upgrades and releases (This should always be at no additional cost)

Modifying the Contract

• Source code • Acceptance period (hardware & software) • Implementation caveats • No front loading of support fees • No front loading the purchase terms • Assignment • Future upgrades and new releases • Copyright infringements • Warranties • Termination • Future providers and fees (recurring cost)

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Final Thought

FIVE STAGES OF IT ADOPTION

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From Death and Dying by Elizabeth Kubler-Ross

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1st Stage: Denial

• Occurs from time of purchase until first few days of go-live

• Sees only benefits of EMRs

• Denial of any difficulties

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2nd Stage: Anger

• Typically lasts one month

• Angry because of reduced patient volumes

• Staff upset with new system

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3rd Stage: Bargaining

• Lasts 2-4 weeks

• Plead with vendor to make program work

• Will do anything

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4th Stage: Depression

• Lasts 3-6 months

• Assume program will not work

• Can’t abandon it since it costs so much

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5th Stage: Acceptance

• It all starts to fall into place

• See benefits from the system

• You and every one else live happily ever after!

• Cause for celebration

SOLUTIONS FROM TSI HEALTHCARE

NextGen® Patient Portal

Appointment Scheduling & Reminders

Secure Messaging

Online Statements

Bill Payment

Online Forms (Templates)

Prescription Refill Requests

Upload Lab Results, Documents, and Images

Patient Education Resources

• Your patient's “Medical Home” on the web • NextGen Patient Portal connects patients and providers

online... conveniently, safely, and securely.

Patient Portal & Meaningful Use

– Stage 1 Measure Electronic Access (Enrollment)

> 50% of patients seen must have electronic access to Personal Health Information (PHI)

– Stage 2 Measures Electronic Access (Enrollment)

> 50% of patients seen must have electronic access to Personal Health Information (PHI)

View/Download PHI > 5% of patients seen must view, download, share their information

electronically

Send Secure Messages > 5% of patients seen must send a secure message to practice staff

“helping physicians and computers work better together”™

800.354.4205 | [email protected] | www.tsihealthcare.com

NextGen® Population Health

• Mines patient data through direct integration with NextGen EHR, EPM, and other modules

• Engages patients through automated communications

• Drives quality & preventative care management

• Engages care team through automated tasking & alerts

• Creates additional revenue by driving new patient encounters



NextGen® Population Health Example: Diabetic Foot Exam

• Data Aggregation: – Identifies all diabetics (in EHR) whom have not been

seen in over one year (in EPM) and are due for a diabetic foot exam (in EHR or EPM)

• Patient Engagement:

– Automatically determines patient’s preferred communication method (or practice default if not available)

– Adjusts the message based on delivery method to address HIPAA compliance

– Contacts the patient and encourages scheduling of appointment

• Care Management & Provider Engagement:

– Documents the executed reminder – Sets EPM chart alert should patient call for other

matters (optional) – Creates a note in the patient’s EHR record for care team

should patient visit for other reasons (optional) – Creates automated tasks as necessary (optional)

More Information On NextGen® Modules

Visit

tsihealthcare.com/patientportal

tsihealthcare.com/populationhealth

Or email

[email protected]



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CONTACT INFORMATION Ellis “Mac” Knight, MD, MBA

Chief Medical Officer

Senior Vice President

O: 678-783-5582

C: 803-518-4099

[email protected]

Jeffery Daigrepont, SVP

Senior Vice President

O: 678-832-2006

C: 770-597-0590

[email protected]

Atlanta

2400 Lakeview Parkway; Suite 400 Alpharetta, Georgia 30009

www.CokerGroup.com

____________

mailto:[email protected]

mailto:[email protected]

http://www.cokergroup.com/