0
One Step at a Time
Mark Frisse, MD
HIMSS NW Technology & Education Symposium
14 October, 2013

© 2013, Mark Frisse
the

Program
KN: Frisse


Big Data/Analytics






Biz Case

ICD-10

Skill Sets







Population Mgmt

OR / WA HIE...
Analytics
KN: Frisse


Big Data/Analytics






Biz Case

ICD-10

Skill Sets







Population Mgmt

OR / WA HIE

A...
Sustainability
KN: Frisse


Big Data/Analytics






Biz Case

ICD-10

Skill Sets







Population Mgmt

OR / WA H...
Systems
KN: Frisse


Big Data/Analytics






Biz Case

ICD-10

Skill Sets







Population Mgmt

OR / WA HIE

ACO...
Analytics, sustainability, & systems
KN: Frisse


Big Data/Analytics






Biz Case

ICD-10

Skill Sets







Popu...
Keynote: Four parts…
The

Turbulence

•

Forces driving change

The

Confusion

•

Uncertainties & immature markets

Some ...
the

Turbulence

characterized by conflict, disorder, or
confusion; not controlled or calm;
unsteady movement

© 2013, Mar...
Turbulence: decades in the making
Sick

Inadequately
prepared
Cost
Complexity
Opacity

Expectation
Entitlement
Moral Hazar...
HITECH: a stimulus effort

source: http://dashboard.healthit.gov/onc/

© 2013, Mark Frisse
The initiatives before us
EHR
HIE
Care Transitions

Meaningful
Use

Finances

Workforce
And we have given ourselves limited time

Source: Halamka JD. The Future of Standards.

© 2013, Mark Frisse
So we face local & national challenges

© 2013, Mark Frisse
Even some supporters of the Affordable Care Act worry that the flaws in the system, if
not quickly fixed, could threaten t...
The relationship of policy and technology
1997 (Paul Starr)

When [Clinton health care] reform collapsed,
so did the momen...
We are in the Northwest

© 2013, Mark Frisse
Summary: Turbulence

Titanic demographic and economic
circumstances urge action….but how
fast can culture change?

© 2013,...
the

Confusion

lack of understanding; uncertainty;
the state of being bewildered
Con-fusion: melting down and
recreating
...
Remarkable adoption of office-based EHRs

Office-based provider adoption: basic EHRs
http://dashboard.healthit.gov/HITAdop...
Remarkable adoption of hospital systems

Urban: 47.7%
Rural: 33.5%

http://dashboard.healthit.gov/HITAdoption/

© 2013, Ma...
MU: Penalty adjustments to PFS

Meaningful Use: Penalty adjustments to Medicare Physician Fee Schedule (PFS)
© 2013, Mark ...
Mixed results for HITECH state HIE

Tripathi to HIT Policy Committee: State HIE
program Status
© 2013, Mark Frisse
Some Pioneer ACOs are opting out

7 – Medicare Shared Savings
2 – Opting out entirely

source: Advisory Board, September 2...
Inconsistent privacy policy implementation
If the interpretation of any privacy policy is excessively risk-averse, authori...
Concerns rise from all quarters (as expected)
• Interoperability
• Sustainability
• ICD-10
• Certification
• Quality metri...
The “hospital” mentality is pervasive

A

B

C

© 2013, Mark Frisse

D
Ambulatory care is more fragmented
C
D

B
?
A

Medicare beneficiaries see at least five different physicians
and many more...
How fragmented is ambulatory care?

Slide: David Kibbe. http://www.directtrust.org/
© 2013, Mark Frisse
Summary: Confusion

What works in some places does not
easily work everywhere
Progress is unevenly distributed

© 2013, Ma...
some vital Elements

a part of aspect of something –
especially one that is essential or
characteristic

© 2013, Mark Fris...
Change begins with us
•
•
•
•
•
•
•
•

Patients & families
Providers
Plans
States
Federal Government
Vendors (broadly defi...
Widespread agreement on many remedies

Lewin JC, Atkins G, McNeely L. The Elusive Path to Health Care Sustainability. JAMA...
HIE can create a single record
Data are made available to those who require access

C
D

B

A

© 2013, Mark Frisse
Sophisticated planning systems exist

© 2013, Mark Frisse

© Mia Levy, 2013
Collaborative planning systems
Analysis

Plan

Activation

Task
Management
Task
Performance
© 2013, Mark Frisse

© Mia Lev...
A single record; a single plan
a single, personalized plan of care for the individual

measurable
outcomes

© 2013, Mark F...
Our search for effective analytics

source: https://www.explorys.com/docs/data-sheets/explorys-overview.pdf NOT a product ...
Summary: Elements

We have components and new markets for
HIE (e.g., ACOs, CINS, bundles)
Planning paradigms can advance
i...
an Emergence

the process of coming into being, or
becoming important or prominent

© 2013, Mark Frisse
Task: A new model for regional HIE?
Frisse’s Hunch:
• A number of “hub & spoke” HIE efforts
formed as a result of partners...
Task: “Push” only to respond to “pull”

PRACTICES

DESIGNS

NEEDS

Value-based payment
Aligned incentives
Efficient admini...
Task: Solid foundations (Version 1.0)

• A systems view
• Governance
• Authentication & authorization
• Directories
• Reco...
Task: Improve provider quality of life

• A realistic near-term vision
• Quick wins
• First, do one or two things well
• M...
Task: Design for population management

•
•
•
•
•
•
•

Early, demonstrable benefits
Governance & data use
Low-cost, secure...
Summary: Emergence

Progress through renewed emphasis on our
critical goals combined with a componentbased, systems approa...
Summarizing…
Turbulence
• Demographics make this inevitable
Confusion
• Uncertainty is a by-product of change
Elements
• W...
Frisse ME. Health Affairs 28.2 (2009): w379-w384.
© 2013, Mark Frisse
Frisse  - One Step at a Time
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HIMSS NW Conference Keynote - Mark Frisse, MD, Accenture Professor Biomedical Informatics, Vanderbilt University

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  1. 1. One Step at a Time Mark Frisse, MD HIMSS NW Technology & Education Symposium 14 October, 2013 © 2013, Mark Frisse
  2. 2. the Program KN: Frisse  Big Data/Analytics    Biz Case ICD-10 Skill Sets    Population Mgmt OR / WA HIE ACO Value KN: Global to Local    Clin Analytics State, Fed, Local EHR Replacements    Analytics/ Pop Hlth OHSU Security  KN: Risk-Based Pop Mgmt
  3. 3. Analytics KN: Frisse  Big Data/Analytics    Biz Case ICD-10 Skill Sets    Population Mgmt OR / WA HIE ACO Value KN: Global to Local    Clin Analytics State, Fed, Local EHR Replacements    Analytics/ Pop Hlth OHSU Security  KN: Risk-Based Pop Mgmt
  4. 4. Sustainability KN: Frisse  Big Data/Analytics    Biz Case ICD-10 Skill Sets    Population Mgmt OR / WA HIE ACO Value KN: Global to Local    Clin Analytics State, Fed, Local EHR Replacements    Analytics/ Pop Hlth OHSU Security  KN: Risk-Based Pop Mgmt
  5. 5. Systems KN: Frisse  Big Data/Analytics    Biz Case ICD-10 Skill Sets    Population Mgmt OR / WA HIE ACO Value KN: Global to Local    Clin Analytics State, Fed, Local EHR Replacements    Analytics/ Pop Hlth OHSU Security  KN: Risk-Based Pop Mgmt
  6. 6. Analytics, sustainability, & systems KN: Frisse  Big Data/Analytics    Biz Case ICD-10 Skill Sets    Population Mgmt OR / WA HIE ACO Value KN: Global to Local    Clin Analytics State, Fed, Local EHR Replacements    Analytics/ Pop Hlth OHSU Security  KN: Risk-Based Pop Mgmt
  7. 7. Keynote: Four parts… The Turbulence • Forces driving change The Confusion • Uncertainties & immature markets Some vital • An • Elements Components for forging solutions emergence Reaching our goals – one step at a time © 2013, Mark Frisse
  8. 8. the Turbulence characterized by conflict, disorder, or confusion; not controlled or calm; unsteady movement © 2013, Mark Frisse
  9. 9. Turbulence: decades in the making Sick Inadequately prepared Cost Complexity Opacity Expectation Entitlement Moral Hazard
  10. 10. HITECH: a stimulus effort source: http://dashboard.healthit.gov/onc/ © 2013, Mark Frisse
  11. 11. The initiatives before us EHR HIE Care Transitions Meaningful Use Finances Workforce
  12. 12. And we have given ourselves limited time Source: Halamka JD. The Future of Standards. © 2013, Mark Frisse
  13. 13. So we face local & national challenges © 2013, Mark Frisse
  14. 14. Even some supporters of the Affordable Care Act worry that the flaws in the system, if not quickly fixed, could threaten the fiscal health of the insurance initiative, which depends on throngs of customers to spread the risk and keep prices low. © 2013, Mark Frisse
  15. 15. The relationship of policy and technology 1997 (Paul Starr) When [Clinton health care] reform collapsed, so did the momentum to build an information infrastructure for a new system. Today (2013) Is it possible that inadequate execution of HIT systems will place needed health care reforms at risk? Starr, P., Smart technology, stunted policy: developing health information networks. Health Affairs (Millwood), 1997. 16(3): 91-105. © 2013, Mark Frisse
  16. 16. We are in the Northwest © 2013, Mark Frisse
  17. 17. Summary: Turbulence Titanic demographic and economic circumstances urge action….but how fast can culture change? © 2013, Mark Frisse
  18. 18. the Confusion lack of understanding; uncertainty; the state of being bewildered Con-fusion: melting down and recreating © 2013, Mark Frisse
  19. 19. Remarkable adoption of office-based EHRs Office-based provider adoption: basic EHRs http://dashboard.healthit.gov/HITAdoption/ © 2013, Mark Frisse
  20. 20. Remarkable adoption of hospital systems Urban: 47.7% Rural: 33.5% http://dashboard.healthit.gov/HITAdoption/ © 2013, Mark Frisse
  21. 21. MU: Penalty adjustments to PFS Meaningful Use: Penalty adjustments to Medicare Physician Fee Schedule (PFS) © 2013, Mark Frisse Image source: Acumen Physician Solutions. http://www.acumenmd.com/avoiding-the-approaching-meaningful-use-penalty/
  22. 22. Mixed results for HITECH state HIE Tripathi to HIT Policy Committee: State HIE program Status © 2013, Mark Frisse
  23. 23. Some Pioneer ACOs are opting out 7 – Medicare Shared Savings 2 – Opting out entirely source: Advisory Board, September 2013. The population Health Leaders Reading List © 2013, Mark Frisse
  24. 24. Inconsistent privacy policy implementation If the interpretation of any privacy policy is excessively risk-averse, authorized health information may not be transmitted Institution Policies Contracts State Law {A} Federal Law {B} CONSENT: - Context - Information - Roles - Relationships - Terms USE: - Context - Information - Roles - Relationships - Terms © 2013, Mark Frisse
  25. 25. Concerns rise from all quarters (as expected) • Interoperability • Sustainability • ICD-10 • Certification • Quality metric simplification • HIPAA • Oversight & fraud • Government shut-down © 2013, Mark Frisse
  26. 26. The “hospital” mentality is pervasive A B C © 2013, Mark Frisse D
  27. 27. Ambulatory care is more fragmented C D B ? A Medicare beneficiaries see at least five different physicians and many more pharmacists, therapists, and other clinicians. source: Pham, H.H., et al., Care patterns in Medicare and their implications for pay for performance. N Engl J Med, 2007. 356(11): p. 1130-9. © 2013, Mark Frisse
  28. 28. How fragmented is ambulatory care? Slide: David Kibbe. http://www.directtrust.org/ © 2013, Mark Frisse
  29. 29. Summary: Confusion What works in some places does not easily work everywhere Progress is unevenly distributed © 2013, Mark Frisse
  30. 30. some vital Elements a part of aspect of something – especially one that is essential or characteristic © 2013, Mark Frisse
  31. 31. Change begins with us • • • • • • • • Patients & families Providers Plans States Federal Government Vendors (broadly defined) Integration & analytics groups Quality bodies © 2013, Mark Frisse
  32. 32. Widespread agreement on many remedies Lewin JC, Atkins G, McNeely L. The Elusive Path to Health Care Sustainability. JAMA. 2013;():-. doi:10.1001/jama.2013.280147. © 2013, Mark Frisse
  33. 33. HIE can create a single record Data are made available to those who require access C D B A © 2013, Mark Frisse
  34. 34. Sophisticated planning systems exist © 2013, Mark Frisse © Mia Levy, 2013
  35. 35. Collaborative planning systems Analysis Plan Activation Task Management Task Performance © 2013, Mark Frisse © Mia Levy, 2013
  36. 36. A single record; a single plan a single, personalized plan of care for the individual measurable outcomes © 2013, Mark Frisse
  37. 37. Our search for effective analytics source: https://www.explorys.com/docs/data-sheets/explorys-overview.pdf NOT a product endorsement © 2013, Mark Frisse
  38. 38. Summary: Elements We have components and new markets for HIE (e.g., ACOs, CINS, bundles) Planning paradigms can advance incrementally © 2013, Mark Frisse
  39. 39. an Emergence the process of coming into being, or becoming important or prominent © 2013, Mark Frisse
  40. 40. Task: A new model for regional HIE? Frisse’s Hunch: • A number of “hub & spoke” HIE efforts formed as a result of partnerships, ACO or CIN relationships • Some MDs will belong to multiple clouds • Some MDs communicate only via Direct Direct or other HIE services © 2013, Mark Frisse
  41. 41. Task: “Push” only to respond to “pull” PRACTICES DESIGNS NEEDS Value-based payment Aligned incentives Efficient administration Aligned CMS and health plans Connectivity Systems thinking Engineered approaches Analytics & decision support Patient / consumer engagement Iterative cycles of systems-based interventions © 2013, Mark Frisse
  42. 42. Task: Solid foundations (Version 1.0) • A systems view • Governance • Authentication & authorization • Directories • Record linkages • Simple messaging • Engineered privacy • Effective & efficient audit logs © 2013, Mark Frisse
  43. 43. Task: Improve provider quality of life • A realistic near-term vision • Quick wins • First, do one or two things well • Minimize administrative burdens • No inaccurate / unnecessary documentation • Automate simple quality reporting • Make fraud almost impossible © 2013, Mark Frisse
  44. 44. Task: Design for population management • • • • • • • Early, demonstrable benefits Governance & data use Low-cost, secure connectivity Meaningful metrics Effective analytics Consumer engagement Incentives & behavioral economics © 2013, Mark Frisse
  45. 45. Summary: Emergence Progress through renewed emphasis on our critical goals combined with a componentbased, systems approach incrementally executed with tangible early results © 2013, Mark Frisse
  46. 46. Summarizing… Turbulence • Demographics make this inevitable Confusion • Uncertainty is a by-product of change Elements • We have some components. Must focus on gaps Emergence • We are proceeding …….. one step at a time © 2013, Mark Frisse
  47. 47. Frisse ME. Health Affairs 28.2 (2009): w379-w384. © 2013, Mark Frisse
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