Changing the paradigm in healthcare information technology
SAP Thought LeadershipHealthcareChanging the Paradigm inHealthcare Information TechnologyBecoming Proactive and Movinginto the Home
In a program integrating disease management and wellness or prevention management,patients learn how to improve the quality of their health, manage their chronic disease,take responsibility for their health, and avert preventable complications.
CONTENT 4 Executive Summary 5 Taking Healthcare to the Next Level 6 Focusing on Prevention and Proactive Integration of Care 6 Integrate Wellness and Disease Management in the Home 7 Proactively Manage Episodes of Care 7 Integrate Telecommunication and Home Devices 9 Improving Patient Safety and Operational Efficiency 9 Use Analytics 0 Aggregate, Standardize, and Centralize Quality Data1 0 Identify and Act on Problem and Risk Areas1 0 Enhance Treatment Quality1 1 Comply with Government Reporting Mandates1 2 Extending Medication Safety1 2 Extension of Medication Safety1 3 Benefitting from an Event-Based Solution1 3 For More Information1About the AuthorsThe following authors are from SAP:• ohn Papandrea, senior vice president and global J healthcare sector head• Andy De, senior marketing director, healthcare global industry marketing• Chris Christy, healthcare industry principal, North America• ohn Murray, solution manager, healthcare industry J business unit
Executive SummaryTHE PARADIGM SHIFTHealthcare systems are going through a difficult transition.As populations age and require more from the healthcaresystem, traditional payers (insurers) are trying to identifyinnovative ways of coping with funding this increasingdemand. In many cases, individuals and families are leftwithout coverage or are required to make choices aboutpursuing treatments not covered by their insurers. Chronicdiseases are increasingly common, and their managementrequires more active participation by consumers than everbefore. Individuals must take more responsibility for theirown care whether they are willing to or not.A paradigm shift must occur across the healthcare eco-system to support a sustainable approach to improvingand integrating high-quality patient care across multiplestakeholders. It is incumbent on providers to lead theseinitiatives by being proactive, reaching out to their patientbase, and facilitating care in the home. Information tech-nology can enable this paradigm shift.4 SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology
Taking Healthcare to theNext LevelUsing Technology to ImprovePatient CareUnder the concept of a “medical home,” a patient has Ongoing efforts to integrate PHRs with HIEs have allowed patient-entereda personal physician and is part of a physician-directed data to be shared by healthcare provid-medical practice that is responsible for the coordination ers (see Figure 1). However, the fre- quency and accuracy of data enteredand integration of care. Medical homes are expected to by patients raises concerns about thereduce costs directly by avoiding redundant or unneeded integrity of patient clinical data. To take healthcare delivery to the next level,tests, imaging, procedures, and medications; these re you need an IT solution that facilitatesductions are expected to be large enough to offset any the following: • Increased focus on preventionincreased spending on medical home services. and preventive integration • Improved patient safety, quality,Over the past 15 years, there have to provide physician office electronic and operational efficiencybeen numerous efforts to improve the medical records (POEMRs) for the indi- • Enhanced medication safetyuse of information technology to aid vidual use of physicians in their offices.healthcare workers in the identification Inpatient clinical Inpatient clinicaland treatment of acute disease. The Personal health records (PHRs), some systems clinical Inpatient systems systemsmajor focus worldwide has been within of which are provided free to patientsthe walls of the hospital, where exten- by some vendors, enable patientssive, year-long-plus implementations to gather their own healthcare data,of complex and expensive software which can then be used to better treat Inpatient clinical systems Healthprograms have been and are still under illnesses. PHRs in isolation, however, Ambulatory systems informationway. Despite significant investments, create another island of patient infor- electronic exchangesfew hospitals see the originally prom- mation that may not be shared with medical recordsised benefits of financial and operation- healthcare providers.al efficiency. Inpatient clinical Inpatient clinical The challenge with these multiple systems office Physician systems electronicAdditionally, there has been a focus systems is that they are often neither medical recordson implementation of ambulatory integrated nor interoperable, resultingelectronic medical records (AEMRs) in in isolated patient data in a variety ofclinics associated with hospitals or hos- systems. Health information exchanges Personal healthpital groups. In some instances, these (HIEs) are designed to address this recordAEMRs have been integrated with the lack of continuity of data, facilitatingexisting inpatient solutions. Moreover, sharing across the variety of touch Figure 1: The Basic HIE Foundation forthe relaxation of the physician self- points where the patient may come into Proactive and Interactive Care of Patientsreferral “Stark” regulations has also contact with the healthcare system.allowed some healthcare organizations SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology 5
Focusing on Prevention andProactive Integration of CareIntegrating Healthcare in theCommunityIn many communities, physician practic- care. Only when this is realized can consolidate outreach, communication,es, hospitals, and other providers are you achieve proactive integration of intervention, transitions, reporting,poorly integrated with respect to cul- care into the community and execute a and assessment across a wide portionture, organization, and financing. While focus on prevention with the needed of the continuum of care.these independent arrangements may impact.offer some benefits, such as broad- In a program integrating disease man-ened patient choice, the flip side of Integrate Wellness and Disease agement and wellness or preventionindependence is fragmentation – Management in the Home management, patients learn how toacross care sites, among providers, improve the quality of their health, man-and in the clinical decision-making pro- According to Continua Health Alliance, age their chronic disease, take respon-cess. The HIE initiative promotes stan- 860 million people worldwide have at sibility for their health, and avert pre-dards for a connected and interopera- least one chronic condition, and this ventable complications. To realize thisble healthcare infrastructure – one of number continues to grow. To illustrate, vision of participatory healthcare, thethe most significant efforts within the by 2020, the prevalence of diabetes is next generation of applications needslast several years to foster data integra- expected to double, and heart disease to bring together the following aspectstion. It provides a way to identify and stroke will account for more than of healthcare:patients and share documents among 20 million deaths a year. Nearly 75% • Traditional disease managementdisparate healthcare organizations. of all deaths worldwide will eventually processes result from chronic conditions.1 • A personal health recordWhile the HIE initiative provides an • The ability for a patient to track hisinfrastructure for the sharing of infor- Traditionally, disease management, or her healthcare progress with othermation, it does not facilitate actionable wellness, or prevention programs were healthcare professionalsand orchestrated information so that promoted by individual stakeholderseach member in the continuum under- within the healthcare continuum. Pre- SAP® applications let you leverage HIEstands and has insight into the appro- vention and proactive integration of networks and your integrated clinicalpriate next steps for managing patient care requires integrated programs that systems implementations to integrate and share disease and wellness pro- cesses, patient portals, and patientFocus on Prevention and Proactive • Enables seamless connectivity self-tracking with multiple stakeholders.Integration of Care: to in-home devices for the auto- The patient portal in the SAP Collabor-• Integrates wellness, disease man- mated capture of patient clinical ative E-Care Management application agement, and postacute care in the information provides self-service by enabling a sin- home, as a natural component of • Supports integration of telecom- gle point of entry into the healthcare healthcare munication functionalities for system. Population identification and• Creates an approach that proac- notification of parties interested stratification processing allow your tively manages episodes of care as in a patient’s healthcare status or healthcare organization to target the patient interacts with multiple changes in status (for example, groups or individuals for which addition- providers across the healthcare text messages, e-mail, work list, al intervention may be required. Sup- continuum; provides “events” to telephone, and video) port for evidence-based practice guide- inform providers about the status lines and care plans provide a vehicle of a patient at any given time, no for dialogue and collaboration between matter where the patient is located the patient and the appropriate (hospital, doctor’s office, home, caregivers. and so on) 1. Information from Continua Health Alliance, Keeping Fit to Stay Healthy (http://continua-alliance.com/static/binary /cms_workspace/5.04-CH1-CC-401 -Continua_flyers.pdf), page 3.
Proactively Manage Episodes The potential of medical homes to improve the timeliness and accuracyof Care improve quality and reduce costs is lim- of data that is sourced from patients ited without effective mechanisms for managing their own health.The patient experience begins long exchanging clinical information that is Tele-health applications have provedbefore a patient walks through the hos- actionable by patients and providers that you can monitor many healthpital door and continues long after the regardless of where a healthcare event conditions remotely. These systemspatient returns home. The traditional occurs. SAP BusinessObjects™ Event have demonstrated that regular moni-focus in the industry is on what hap- Insight software enables you to collect, toring, and prompt intervention whenpens in the hospital. The payer commu- filter, manage, aggregate, propagate, necessary, helps maintain patientnity has implemented transaction sets and publish healthcare events in a health and prevent the exacerbationfrom the health insurance portability consistent, contextual way in an open of chronic conditions while avertingand accountability act, or HIPAA, for and comprehensive framework, across costly hospital stays and ER visits.authorizations, referral, eligibility, and servers, locations, and healthcare orga-service reviews. These allow payers nizations. It allows you to proactively Many of the earlier tele-health integra-and providers to interact before and and automatically manage healthcare tion attempts were limited by theduring a hospital stay. Providers have events regardless of the source, technology available, which was veryreengineered hospital workflows to whether you are a payer or primary or expensive, highly confining to theimprove patient safety and reinforce acute provider (see Figure 2). patient, and restricted to a limitedproductive steps while the patient is subset of patients in a reactive mode.in the hospital. Both of these attempts Integrate Telecommunication However, new applications can facili-do not move care beyond the walls of and Home Devices tate direct capture of blood pressure,the hospital. Even using HIE profiles glucose, vital signs, or other measuresfor anatomic pathology, cardiology, lab- Patient data entry into either PHRs from the patient location anywhere inoratory, patient care coordination, or or electronic medical records is a the world via Bluetooth devices thatpatient care devices to exchange spe- concern. Direct capture of clinical are connected to the cellular telephonecific data within provider communities information from medical devices can network.does not enable you to proactivelymanage episodes of care.To solve these problems, the industryhas now focused on the concept of a“medical home.” Under this concept, Portala patient has a personal physician and Telephone Videois part of a patient-centered. physician-directed medical practice that is Live Enterprise SAP® BusinessObjects™ Event Insightresponsible for the coordination andintegration of care. Medical homes are Customer relationship managementexpected to reduce costs directly byavoiding redundant or unneeded tests, Healthcare information exchangeimaging, procedures, and medications;these reductions are expected to be Patient health Physician office Inpatient clinical Ambulatory electroniclarge enough to offset any increased electronic information record medical record medical record systemspending on medical home services. Figure 2: Integrated Solution for Proactive Patient Management SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology 7
With the advent of the Continua Health Alliance, software and hardware com- panies are committed to establishing interoperability guidelines that allow systems and sensory devices to work together, facilitating a more efficient exchange of information. SAP BusinessObjects Event Insight allows actionable and orchestrated heath event management at any time. It does not matter where the patient is located (hospital, doctor’s office, or home) or what type of device is required (smart phones; weight, glucose level, and blood pressure devices; or security systems). As a care provider, interaction with medical devices that can alert you of a change in a patient’s status is likely to improve speed to care and facilitate Solutions from the SAP BusinessObjects portfolio healthier maintenance of patients with chronic illnesses. This can result in help you transform fragmented data-collection activi- reduction of acute episodes associated ties into a streamlined, automated business flow that with chronic diseases, improve quality of care and quality of life, and reduce supports useful insight. The tools automatically pull the cost of providing care to the data from existing systems, standardize it, and use it community. to populate a multidimensional database that enables rapid, flexible data analysis.8 SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology
Improving Patient Safetyand Operational EfficiencyUsing Enterprise BusinessIntelligenceIn an effort to improve patient safety typically a time-consuming, people- ity, safety, and efficiency under whichand reduce healthcare costs, govern- intensive process fraught with potential you currently operate. Additionally, youment bodies worldwide are mandating errors and likely to cause reporting need to maximize clinical transparencythat hospitals track and report on core delays or inaccurate data. In addition, and derive timely business insightsmeasures of quality and use them to hospitals tend to discover medical care from clinical and administrative data.improve processes and patient out- and patient safety issues many months Finally, to maintain your investment incomes. For example, since 2009 the after services have been rendered – far existing transactional systems, youCenters for Medicare and Medicaid too late to take proactive, swift, impact- must source patient and clinical dataServices (CMS) in the United States ful action. from back-end legacy systems, aggre-has required that hospitals track an gate it, summarize it, and present itincreasing number of quality measures. Use Analytics in custom real-time, on-demand dash-This is a massive undertaking, given boards to meet diverse needs. Thisthe complexities associated with care Although HIEs can help improve the gives your hospital a consolidateddelivery for U.S. citizens. quality of patient care, unless you put view of patient care across the entire analytics in place within the HIE, the organization. Armed with the ability toAs governments increase the number specific value of the HIE is difficult to identify and address quality or businessof quality measurement requirements, measure. HIEs, community collabora- process issues, your organization canhospitals are finding it even harder to tion, and the deployment of POEMRs improve outcomes, reduce risks tocomply. Most quality improvement and AEMRs must incorporate analytics patient safety, and understand opera-departments are small teams with out- in order to demonstrate value. Patients tional effectiveness. You can alsodated legacy systems and spread- require information regarding the quali- report core metrics to governmentsheets, which are useful for tracking ty of care they receive, not only from bodies with greater accuracy andand analysis but cannot support predic- hospitals, but also from physicians timeliness.tive modeling or what-if analysis. Data who treat patients outside the hospitalcollection processes used on the front setting. Applications such as those fromlines of patient care may be paper- the SAP BusinessObjects portfoliobased or fragmented across depart- To address any patient safety or quality intelligently aggregate and summarizements and locations. As a result, matters, your healthcare organization core measures. This enables youraggregating and standardizing data is must first understand the levels of qual- hospital or healthcare organization to Improved Patient Safety, Quality, Leveraging Business Intelligence • Problem and risk identification – and Operational Efficiency: to Improve Quality: Proactively identify risks and drill • Encourages implementation of • Data aggregation and quality down to understand root causes in enterprise business intelligence management – Aggregate and order to improve patient care within each hospital or healthcare standardize data from back-end outcomes system systems and populate a prebuilt • Enhanced treatment quality – • Turns islands of data, or data in a data model designed for health- Track and trend changes in quality health information exchange, into care facilities and quickly bring about any needed information that can be leveraged interventions for actionable insights to improve • Compliance – Automatically pull quality of care relevant data for various reporting needs
understand and swiftly address the Because each system stores data in Identify and Act on Problem androot causes of problems – and ultimate- different formats, your staffers need Risk Areasly improve patient care and safety. SAP to manually gather, interpret, and inputhas compiled a series of interactive data into a spreadsheet or database Quality and management solutionsdashboards supported by an integrated for each core measure. This is a time- from SAP help your organization keepand predefined data model to assist consuming, error-prone process that track of the most important key perfor-healthcare organizations in leveraging makes it impossible to have real-time mance indicators (KPIs) by supportingbusiness intelligence (BI) to improve (or even near-real-time) insight into personalized dashboards that make thequality of care. This software helps patient care. KPIs clearly visible to the right people.your organization achieve your quality Leveraging prebuilt data models, yougoals in a standard, interactive, and Solutions from the SAP can instantly view data at the facility orreal-time manner. The preconfigured BusinessObjects portfolio help you department level as well as horizontallysoftware enables you to proactively transform fragmented data-collection across functional areas such asmanage patient data. activities into a streamlined, automated finance, quality, and operations. For business flow that supports useful example, your hospital can automatical-Aggregate, Standardize, and insight. The tools automatically pull ly track performance of staff; identifyCentralize Quality Data data from existing systems, standardize trends and potential problems; and it, and use it to populate a multidimen- implement standards, policies, andFor many management and quality sional database that enables rapid, procedures that can help boost perfor-departments, pulling together the mas- flexible data analysis. The database mance. The solutions also track com-sive amounts of patient information uses a prebuilt data model specifically mon risk management issues found inrequired to compile quality measures designed to support the unique way in hospitals, such as patient falls, medica-is a monumental task. Your team needs which hospitals operate. Multiple drill- tion errors, hospital-acquired infections,to mine a wide variety of systems for down functions built into the solutions and hospital-acquired conditions thatmeaningful data – such as financial, enable user insight at the level of detail not only threaten patient well-being butadmission, and lab – as well as patient required (see Figure 3). also lead to medical and financialinformation in various departments. liabilities. Enhance Treatment Quality In most cases, by the time the medical professionals involved in the problem are pinpointed, it is difficult to recall specifics about why a quality measure was not followed. By identifying these variances early, you can implement changes that optimize the patient care process. You can instantly access up- to-date information and insights and detect problems earlier, investigate root causes quicker, and proactively address issues to minimize their impact.Figure 3: Using SAP® BusinessObjects™ Solutions to Drill Down into Patient Data10 SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology
To change the paradigm of healthcare IT, you need a community-wide implementation of an event-based solution that facilitates proactive care and engages with patients as well as the care providers involved with treating a given patient. Coordination of care in the community and use of smart medical devices and status monitoring for the chronically ill is a must in order to improve quality while decreasing the cost of healthcare.To do this effectively, you need access Comply with Government reporting requirements can lead to pen-to better and more understandable Reporting Mandates alties. SAP BusinessObjects solutionsinformation to make informed choices. enable you to facilitate better compli-Patients today are looking to their pro- With recent changes in legislation, ance by automatically pulling the rele-viders for data about the outcomes of hospitals are increasingly obligated vant data required for various reportingprocedures. Forward-thinking hospitals to provide more and more data to the needs. Visibility into the source of thethat proactively provide this information CMS about outcomes and cost. In data gives you confidence that it isas a basis for differentiation will be the turn, you then publish this data and complete and accurate.winners going forward. To have these make it available to prospectivepublicized KPIs benefit your hospital, patients so they can make informedyou need to ensure that the perfor- decisions about the quality and cost ofmance numbers reflect a consistent, their planned care. Failure to complyhigh-quality patient experience, as well with this and other governmentalas operational excellence from theprovider. SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology 11
Extending Medication SafetyAvoiding RiskFollowing the “five rights” of medica- Counterfeits risk harming human life by Just as serialization can be applied totion administration (right drug, right containing incorrect active ingredients pharmaceuticals, it can also be used todose, right route, right patient, and or even no active ingredients at all. If track medical devices, includingright time), bedside medication admin- allowed to flourish in the healthcare implantable medical devices. Once aistration is supported by inpatient clini- supply chain, these substandard prod- device is implanted in a patient, youcal processes and clinical information ucts can damage the brand and reputa- can use the same technologies to tracksystems. One major assumption, tion of the authentic manufacturer. The the functioning of the device, as well ashowever, is that the medication being issue of diversions can be equally dam- the health of the patient. Should thereadministered is actually what it says it aging as certain markets are denied be any failures of the device, SAPis – and not a fraud. their medications, while middlemen and BusinessObjects Event Insight would traders enjoy profit by selling them. It instantly send a notification (as appro-Counterfeit medications, medical devices, is impossible to do more than provide priate) – for example, to the manufac-and medical disposables are increasing rough estimates of the full impact of turer, physician, hospital, and patient’sproblems across the globe. Currently counterfeits and diversions, but they relatives – of a change in the patient’simplemented inpatient clinical informa- run into billions of dollars each year and health status. This would facilitatetion systems do not protect patients impact thousands of lives. prompt action to treat the patient.against counterfeit or fraudulent medi-cations that frequently are difficult to It is critical to ensure the integrity ofdistinguish from the original. Systems the entire supply chain – from plant toimplemented in a typical retail pharma- patient – to maximize patient care. Bycy also lack this important safety implementing serialization and trackmechanism. It is a major challenge and trace for pharmaceutical products,to account for the movement of all which extend beyond the retail pharma-products from the time of manufacture cy into the hospital pharmacy, manufac-to the patient – and to prevent diver- turers can reinforce their brands. Theysions and counterfeits. can build a stronger relationship with physicians and can assure patients and health workers of the authenticity ofExtension of Medication Safety their medication. When used through- out the hospital (from the pharmacy toThe healthcare community must the patient bedside), serialization andextend medication safety outside the track and trace technologies can signif-walls of the hospital to address any icantly lower errors with medication.potential risks associated with coun- They can also help reduce associatedterfeits and authenticate the medica- adverse drug events, improve levels oftion as genuine in the hospital or patient safety, and reinforce medicationretail pharmacy. compliance.
Benefitting from anEvent-Based SolutionLeveraging New TechnologiesIt is critical to ensure the integrity of the entire supplychain – from plant to patient – to maximize patient care.By implementing serialization and track and trace forpharmaceutical products, which extend beyond the retailpharmacy into the hospital pharmacy, manufacturers canreinforce their brands. They can build a stronger relation-ship with physicians and can assure patients and healthworkers of the authenticity of their medication.The healthcare industry has been a To change the paradigm of healthcare reducing reimbursement, is forcingrelatively slow adopter of information IT, you need a community-wide imple- providers to augment their traditionalsystems. Complex processes, regula- mentation of an event-based solution business models.tions, change management, and other that facilitates proactive care andissues have contributed to this slower engages with patients as well as the For More Informationadoption. Over the past several years, care providers involved with treating ahospitals and healthcare systems have given patient. Coordination of care in To learn more, call your SAP represen-started implementing third-generation the community and use of smart medi- tative today or visit us on the Web atinpatient clinical systems, as well as cal devices and status monitoring for www.sap.com/industries/healthcareAEMRs. In addition, physicians have the chronically ill is a must in order to /index.epx.been strongly encouraged to imple- improve quality while decreasing thement POEMRs, and there has been cost of healthcare.minor adoption of PHRs. Starting in2009, the U.S. federal government, as To understand the current quality ofwell as various governments in the EU, care and improvements that you canLatin America, and Asia Pacific, has achieve by implementing HIEs and oth-provided funding for the implementation er technologies, you must use BI notand adoption of information technology only to monitor community-wide carein healthcare. HIEs have emerged as a processes but also to continuouslyway to share patient and clinical data improve quality of care. You can do thisacross various stakeholders in the all while increasing efficiency, transpar-healthcare provider industry. While the ency, and effectiveness of care provid-ability exists to produce increasing ed to patients. It is incumbent forquantities of clinical data, the ability to healthcare providers to leverage newtranslate this into actionable informa- technologies to maintain viability andtion to improve patient care is critical. become active participants in the con-The impact of an HIE is limited to the sumerism of healthcare. The reductionextent that it provides reactive data to of Medicare and Medicaid reimburse-care providers. ments, along with traditional insurers SAP Thought Leadership – Changing the Paradigm in Healthcare Information Technology 13