Blatt e collaborative himss 2012 finalPresentation Transcript
Collaborative Care: An EconomicImperative for Care Delivery Systems Mark Blatt MD Worldwide Medical Director Intel Corporation February 2012
Collaborative Care: An EconomicImperative for Care Delivery SystemsAgendaCurrent TrendsThe Evidence for Care CoordinationGoing mobile to Coordinate care• Right Device for Right task• Collaborative workflows• Compute Model matters• Secure Mobile computingSummary2
Is Solo Practice a failed Business model ?
Has Fee for Service meet its Limits?
Hi-Tech Breach Notification • Mandatory penalties. State AGs sue in civil court – Starting at $100 per violation ($25k/yr) going up to $50,000 repeat violations w/ “willful Neglect” ($1.5M/ yr) Breach Notifications Week of June 1 • Projected PHI is essentially ”encrypted PHI” • Mandatory Reporting with 60 days and publication at HHS Breach site for violations >500 http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/postedbreaches.html 2. HiTech Act, Division A Title XII, Subtitle D Part 1 Sections 13401-11
Hospital Readmissions (We Don’t Do a Good Job Here) Almost one fifth (19.6%) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days 34.0% were rehospitalized within 90 days 50.2% of the patients who were rehospitalized within 30 days after a medical discharge to the community, there was no bill for a visit to a physician’s office between the time of discharge and rehospitalization Among patients who were rehospitalized within 30 days after a surgical discharge, 70.5% were rehospitalized for a medical condition About 10% of rehospitalizations were likely to have been planned The average stay of rehospitalized patients was 0.6 day longer than that of patients in the same diagnosis-related group whose most recent hospitalization had been at least 6 months previously Authors estimate that the cost to Medicare of unplanned rehospitalizations in 2004 was $17.4 billionN Engl J Med 2009;360:1418-28.
Section 3025 – Hospital ReadmissionsBeginning October 1, 2012, DRG payments to hospitals who have“excess” readmissions for certain conditions will be reduced.The floor adjustment factor will be 99% for fiscal year 2013, 98% for2014, and 97% for fiscal year 2015 and thereafter.First three conditions to track AMI, heart failure and pneumonia.October 1, 2014, the list expands COPD (chronic obstructive pulmonary disease), CABG (coronary artery bypass graft), PTCA (percutaneous transluminal coronary angioplasty), and other vascular conditions.3. The Patient Protection and Affordable Care Act (HR 3590 enrolled: Sec 3025)
Coordination andCollaborative Workflows The Evidence
Controlling Costs Starts with BetterManagement of Chronic Diseases• Medicare beneficiaries with multiple chronic illnesses see an average of 13 different physicians• Fill 50 different prescriptions a year• Account for 76% of all hospital admissions• Account for 88% of all prescriptions filled• Account for 72% of physician visits• And are 100 times more likely to have a preventable hospitalization than someone with no chronic conditions We must improve management of Chronic Diseases through Better Care Coordination Testimony of Gerard F. Anderson, Ph.D., Johns Hopkins Bloomberg School of Public Health, Health Policy and Management, before the Senate Special Committee on Aging, “The Future of Medicare: Recognizing the Need for Chronic Care Coordination, Serial No. 110-7, pp. 19-20 (May 9, 2007).
How Physicians Currently Use MobileDevice(s) “Super-Mobile” Physicians drive higher utilization, demand tablet access to sensitive patient data11 QuantiaMD* Research Report, “Tablets Set to Change Medical Practice”, June 15, 2011. See www.quantiamd.com/q- qcp/QuantiaMD_Research_TabletsSetToChangeMedicalPractice.pdf
Patients Report Experiencing Poor CoordinationPercent U.S. adults reported in past two years: Your specialist did not receive basic medical 13 information from your primary care doctor Your primary care doctor did not receive a 15 report back from a specialist Test results/medical records were not 19 available at the time of appointment Doctors failed to provide important medical information to other doctors or 21 nurses you think should have it No one contacted you about test results, or 25 you had to call repeatedly to get results Any of the above 47 0 20 40 60Source: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2008.
Commonwealth Survey of PCPs How does the US compare with other in communicationsPercent reporting that they receive information back for “almost all” referrals(80% or more) to Other Doctors/Specialists: 100 82 76 75 75 68 62 61 50 37 25 0 AUS CAN GER NETH NZ UK USSource: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
Evidence for Care Coordination2007 prospective cohort study of 756 patients with “life- limiting illnesses ” in California • In the “patient-centered” group (358): – 38% fewer admissions – 36% fewer inpatient days – 30% fewer ED visits • 26% lower cost Sweeney L, Halpert A, Waranoff J. Patient-Centered Management of Complex Patients Can Reduce Costs Without Shortening Life. Am J Manag Care. 2007;13:84-92.
ED Visits by Source of Care and Income http://www.aafp.org/afp/2009/0115/p94.html
Evidence for Care CoordinationGeisinger Health System in Pennsylvania • 36 primary care practices with NCQA Level 3PCMH certification vs. control practices • Positive results: – 40% reduction in 30-day readmissions – 20% reduction in (total) admissions – 7% lower costsArvantes, J. Geisinger Health System Reports That PCMH Model Improves Quality, Lowers Costs. AAFPNews Now. May 26, 2010.
New West Physicians (Denver, CO)76 Providers (41 FP, 17 IM, 8 Hospitalist, 10 mid levels)Level 1 PCMH NCQA (pending)• Extended Hour and After hrs Access (24x7)• EMR is all offices connected to hospital, labs, path• EPrescribing and electronic prescription delivery• Quality improvement CDM programs• $4.4M cumulative HIT investment ($11M incr. rev „07-‟09)• Centralized coordinated Post discharge and follow up with 24 hrs (including we deliver your meds)• Daily team meetings: 30 minute review of the dayRESULT: 1% 30 day readmit rate (usual 6-18%+) American Hosp Association Jan 2011 ACO Case Study: New Physicians West
Collaborative WorkflowsExample Use Cases
To Support Care Coordination for BetterOutcomes, Mobilized Data is Critical Gather & Store Data EMPOWER citizens Share the Data Mobilize Data
End-To-End Story Care Coordination Across the Continuum Mobile Data is Critical Health Clinical Decision Support Emergency Checkup Personal Health RecordSelf Check& Control Data Data Exchange Patient-Centric Care Exchange Clinic Electronic Health Record Data Repository Home Community Hospital Visiting Remote Care Diagnostic Academic Hospital Pharmacy Long term Research Care
Right Form Factor/Capabilities for the JobIn Hand Usage USER EXPERIENCE Table Top Usage Frequent/ Short Sessions Fewer/Longer Sessions Content Significant data creation,Portable Disinfectable, sealed, entry, medium collaboration rugged, Barcode, data collection/ manageability, RFID, Handwriting viewing, media image editing Medium forms, data collection/ viewing, mediaSIZE Simple forms, data Notebooks collection/viewing, MCA+ Netbooks Ultrabooks small media TabletsPocketable Smartphones and Handhelds Some Convergence Multi-Function FUNCTIONALITY Basic/Medium Internet Immersive/Visual Internet +MCAs have a variety of processors from Atom to Core i5 & i7 vPro
What Real time Collaboration Might looklike
Possible Collaborative Workflows• EMS: Treat in place: EMT/ doc / homecare nurse/ community care worker• ED Discharge to home : doc/ homecare nurse/ community care worker• ED Admit: ED nurse / floor nurse / transportation• Consults Acute inpatient: doc/doc/therapists/ pharmacist/ etc)• Consults Chronic Disease outpatient: doc/ doc/ therapists/ homecare nurse / community care worker/ etc• Homecare: doc/ homecare nurse/ community care worker
Healthcare Security & Privacy Across Desktop Virtualization Options Application Virtual Virtual OS Image Terminal Virtualiz- Hosted Container Streaming Services ation Desktop Client Client PHI at Rest Server Server Server or Server or Server Risk Isolation Virtual Virtual App Client / Client / Client / Strategy Containers Isolation Server Server Server Able to Work Offline Yes Yes No No No Manage and Patch Centralized Centralized Centralized Centralized Centralized User Session Data Sync Data Sync Session on Session on Session on Availability with Server with Server Server Server Server 2nd Generation Intel® Core™ vPro™ Processor Family Based PCs Support ALL Desktop Virtualization Models24
The Case For MMR (Multimedia Redirect) (2) VDI Cloud Svc Queries (1) User Requests Device Media, GFx, Network Capabilities Virtual Desktop 2 (3) If High End Client Enterprise VDI and Cloud Low BW connection, then render/decode locally on client Local AppRedirected (4) If Low End Client &Media (MMR) High BW connection then render/decode in DC Low Server and stream bitmap Client Side Server Side Utilization (1%) Central Data
Streaming and Virtual Hosted Desktop Study:Phase 2IT@Intel White Paper, Intel Information Technology Computing Models, April 201026
Secure Mobile Computing (MPOC) and Care Collaboration27
Mobility Drives Higher Needfor Protection Frequent 2M laptops/year are reported as stolen and 97% are never found23 78% of US organizations have some type of encryption strategy in 2009, Costly up from 66 percent in 200726 The average cost of a lost laptop is $49,24624 >59% of respondents say it is very important Often from the inside to encrypt employee’s 70% of all reported security mobile devices26 breaches were due to insiders2523 Source: Processor, May19,2006. http://www.processor.com/editorial/article.asp?article=articles/P2820/30p20/30p20.asp&guid=024E96876DB944D89AA42906DB9FFE84;24 Source: Ponemon Institute , April 2009 , http://communities.intel.com/docs/DOC-3076 ; 25 Source: CNET News.com, from Ponemon Institute Survey (163 F1000 companies) ,January2005, http://forums.cnet.com/5208-6132_102-0.html?threadID=56566 ; 26 Source: Symantec Global Internet Security Threat Report Trends for 2008,Volume XIV, Symantec, April 2009http://eval.symantec.com/mktginfo/enterprise/white_papers/b-whitepaper_internet_security_threat_report_xiv_04-2009.en-us.pdf
BIG QUESTION: PHI (CHI) on the Client?As data is more portable it is more susceptible to being lost or stolen. NO PHI on Client/ Thin only PHI on Client/ Rich compute Improved Security Flexible compute models Central Manageability Online/Offline data access Fast Provisioning Remote access Network Security and Reliability Cost of Downtime / Data Loss Bandwidth Requirements Security Regulatory requirements Placing PHI on Client requires Balancing Multiple Tensions
Data Breaches In Georgia30 http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html
Protecting Mobile PHI Intel Hardware Enabled Security Technologies• SSD (Solid State Drive) with AES: high performance, low power, robust, encrypted solid state drives• AES-NI (Advanced Encryption Standard – New Instructions): high performance encryption of PHI at rest, in use, in transit IPT (Identity Protection Health Technology): strong 2-factor authentication Info Exchange• Anti-Theft: mitigating loss or theft of client with PHI• vPro AMT (Active Management Technology): improving manageability and compliance• VT/TXT (Virtualization and Trusted Execution Technologies): protecting server confidentiality and SSL/TLS integrity in a virtualized / cloud environment or IPSec EHR Client EHR Server SSD AES- IPT Anti- vPro SSL/TLS AES- IPT VT / (AES) NI Client Theft AMT or IPSec NI Server TXT 31
Intel® Anti-Theft Technology Protection: Tamper-resistant security feature in laptop hardware that detects potential theft and disables itself. Non-Destructive: When returned, the laptop can be easily reactivated without harming laptop or data. Owner Recovery Message: Disabled laptop can display unique recovery message and contact information to return laptop to its owner Track, Manage & Recover laptops Enhanced Data Encryption solutions for Business32
SUMMARYMobile computing is more than simple data look up. Different devices for different tasks Data consumption/ creation at the point of care are a good startCollaborative workflows are where you want to goSecurity when going mobile is paramount. Encryption and two factor authentication are good startsBalanced compute models that take advantage of central server manageability and security with client side execution, lowers IT costs, and can improve the end-user experience GATHER SHARE MOBILZE EMPOWER33