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  • 1. Practical Solutions C. Peter Waegemann EHR Visionary and Advocate•  One of 20 outstanding people who make healthcare better (HealthLeaders Magazine)•  Former chair of 12 standards organizations•  Father of ISO TC 215•  “The Ralph Nader of healthcare who tells the truth” (TEPR attendees)•  Author of the book, Knowledge Capital in the Digital Society•  International speaker and consultant•  mHealth expert and HIT strategist
  • 2. Joined Medical CEO Records Institute Chair, Centre for Focus on CEOFirst Chair Advancement of mHealth mHealth Electronic Health Initiative of TEPR FocusConference Records UK/Europe on Chaired 12 ISO TC 215Patient Card Standards Two term Chair SNOMED Digital International SocietyAdvocate Committees of ANSI HISBPersonal Health Record: On card, on portable device, on mobile phone: Participatory Health 1985 1990 1995 2000 2005 2010 “Knowledge “Handbook of Over 100 articles and Record Storage “Handbook of Capital in Information book chapter on EHRs/ the Digital and Space and Image EMRs, mHealth and Society” Management” published 1983 Management Participatory Health published for the 1990s”
  • 3. }  Vision of CPR/EHRs was never implemented: Vision failed over 30 years. Not one fully interoperable and functional EHR has been completely implemented}  Documentation and functionality problems have never been resolved}  Financial incentives are used to entice providers to implement often inadequate and little-liked systems}  Patient involvement is no more than lip service}  Healthcare is stuck in the 20th century and has to reinvent itself to be part of the Digital Society of the 21st Century Let me explain…
  • 4. Implementation: Even a little computerizationWhat is Success? helps, however outdated and inadequate EHR/EM R Syste•  69% use a PC for interacting with ms patients•  55 % print out online Don’t hav material for patients e to be !•  ? Use email with patients Cutting-Source: HealthEd Ed ge Academy To be effeAll hospitals have an c ti v eHIS computer system
  • 5. EHR/EMR Systems Don’t have to be ! Of modern technology! Cutting-Edge a little! To be somewhat effectiveBut a little effectiveness is notsufficient as we are facing a crisis
  • 6. } Unbearable costs} Inadequate quality of care}  Inefficiencies}  Unhappy physicians}  Unhappy support staff}  Outdated HIT}  Patronizing care processes
  • 7. The Disconnect with the emerging Digital Society is another. In a Digital Society}  “Consumers do (some of) the work”}  New (often automated) communication}  Virtual communities}  Transparency
  • 8. No Doctor Can Memorize All Necessary Information In stage 1, all memory and informationHuman processing (thinking) was taking place in theIntelligence brainDevelopment In stage 2, books and documents supplemented the brain. Active interaction between information stored in the brain, information stored in books and information added on notes occurred. Books supported the brain. In stage 3, most of the information is stored in WIC. The brain’s central function is to navigate the wealth of information, to create context of much of the data and to discern between various information according to one’s belief system. From my book Knowledge Capital in the Digital Society
  • 9. Changes to our understanding of intelligence Concept NewBrain’s new role understanding educational New in dominating over paradigm intelligencethe information memorizing field systems Transparency and WIC Literacy knowledge equality Departure from linear (book) WIC-based Emotional information fact checking motivators will Apps will capture be monitored guide people From Knowledge and guided Capital in the Digital Society
  • 10. Care Referrals management Support for Eligibility care plan Cloud Medication Guidelines management and Protocols Mobile devices Orders Indexing makes digital Cost information accessible management Decision support for Internet provides computer Follow-up Diagnoses connectivity communication Patient Rules, processing and communication languages Patient enters make up operating systems and software data instructionsAccess all Electrical algorithm processing units combined in patient integrated circuits make up the computer dataNot just computers, not just the Internet, not mHealth, but the six elements thatmake up the World Information Community (WIC) in the Digital Society aretogether changing our life and our healthcare
  • 11. }  HIT has been pretty much stuck on old technologies and approaches. While other industries have reinvented themselves, healthcare has stayed with outdated approaches.}  All previous attempts at interoperability have failed. They will fail in the future until we consider new concepts.}  We need to move from EHR/EMR/MU strategies to 21stcentury strategies.}  New strategies will require a combination of national efforts and individual provider efforts.
  • 12. What Providers should Key demand from IT functionalities •  Care and decision support •  Easier documentation users get from •  Easy ordering of tests/ medications/therapies/etc. IT •  Transparency and direct integration of back office•  Renewals •  Simple connectivity to•  Scanning pharmacies and other care•  e-prescribing associates•  Medical tracking •  Easier and secure•  Easier use communication with patients•  Lower cost •  Higher efficiency and lower•  Billing system integration cost •  Systems doctors loveSource: MRI and Capterra InfoNewt
  • 13. }  e-Prescribing (eRx) }  Summary lists  Drug interaction  Allergies checking  Medications  Formulary management  Problems  Refills/repeats }  Clinical and}  Physician order entry administrative  Diagnostic tests and procedures workflow tasking}  Results management }  Charge capture/billing  Abnormal results  Medical necessity warning  Automated coding  Trending/graphing  E&M coding
  • 14. 21.  Present alerts for disease management,1.  Manage Patient Demographics preventive services and wellness2.  Manage Medication List 22.  Notifications and reminders for disease3.  Manage allergy and adverse reaction management, preventive services, and4.  Manage patient history wellness5.  Summarize a record (Capture and 23.  Clinical task assignment and routing Create a CCR) 24.  Inter-provider communication6.  Manage Clinical Documents and notes 25.  Pharmacy communication7.  Capture External Documents 26.  Provider demographics (Document imaging) 27.  Scheduling8.  Capture of External Images (Radiology) 28.  Report Generation9.  Generate and record patient-specific 29.  Health Record Output instructions 30.  Encounter Management10.  Order medication 31.  Rules-driven financial and administrative11.  Order diagnostic tests coding assistance12.  Manage order sets 32.  Eligibility verification and determination of13.  Manage results coverage14.  Manage consents and authorizations 33.  Manage practitioner/patient relationship15.  Manage patient advance directives 34.  Clinical decision support system guidelines16.  Support standard care plans 35.  Entity Authorization17.  Capture variances from standard care plans, guidelines, protocols 36.  Enforcement of confidentiality18.  Support for drug interaction 37.  Data retention, availability, destruction19.  Support for medication or 38.  Audit trail immunization administration and 39.  Extraction of data supply20.  Support for non-medication ordering 40.  Current users (referrals, care management)
  • 15. What Needs to be DoneBetter Quality E-care providing Better adherence Less time spent on documentation Better of Care better quality of care to guidelines and protocols – time for communication reduces errors care processes Reduction or Reduction of wastefulCost Savings elimination of services through duplicate services communication Efficiencies Reduction or Real-time Reduction or Efficiencies through modern Internet-based elimination of documentation financial elimination of technologies bottleneck transactions duplicate services Major New communication Customized Patient educational pattern between communication Involvement campaign to providers and patients of patients with educate patients payers Customized Care team communication Real-timeCommunication communication with care communication associates with payers HIT Apps link Browser Apps New data to link to support care capturing Developments formularies Internet process methods
  • 16. Mobile apps link to formularies}  Widely achieved but needs refinement}  Lesson: Successes bypassed traditional paths}  First mHealth applications •  Drug databases •  Currently most used apps •  Reference programs •  Many medical books transferred into apps •  Educational apps •  Lots of apps for students and CE apps
  • 17. At the point-of-care: Browser link to Internet}  Understanding the vision}  Widely achieved but needs refinement}  Needs easier navigation}  Gap between computer-savvy docs and old- fashioned approaches
  • 18. Apps to support care processes}  Despite the mHealth hype, few implementations}  Vision}  Integration into HIS systems is a problem
  • 19. New data capturing methods}  Documentation cost and problems}  Future of transcription?}  Goal: Documentation that is less costly and easier}  Waiting for “the big solution”
  • 20. Internal care team communication}  Ending “lone opinions” and information silos}  The false promise of Telemedicine}  Establishing the care team
  • 21. 1.  Identification: Photo identification, online ID, etc.2.  Patient-Provider3.  Provider-Patient4.  Provider-Provider5.  Provider-Payer6.  Payer-Patient7.  Public Health-Provider and External care Provider-Public Health team8.  Patient-Public Health communication }  How to bring modern communication into your organization Provider Patient Other Providers Other Care Members Payer Pharmacy Public Health Others
  • 22. }  Complaints from Vendors and Providers and Patients}  Time to adjust HIPAA to realities of the digital society
  • 23. Real-time communication with payers•  Real-time financial transactions •  Virtual eligibility determination •  Virtual charge capture •  Virtual adjudication
  • 24. Customized connectivity with By texting and care partners email Needed The one-click connection with care partners such as•  Pharmacies•  Hospitals•  Lab•  Therapists•  Other Providers
  • 25. Cost Containment, Efficiencies, evenQuality of Care depend on One Element: Patients}  Patients must be allowed and encouraged to be fully informed about their health. They must be given full transparency in the care process, both in medical and financial data.
  • 26. Major educational campaign to educate patients}  Why can’t we spend $100 million on educating patients about participation in their healthcare? ◦  Information in every waiting room and exam room ◦  A national advertising campaign ◦  Providers must do their part
  • 27. New communication pattern between providers and patients•  Digital communication of the 21st century •  Text messages •  Automated confirmations and reminders •  Email •  Integrated apps Move from periodic visits to continuous and managed e-visits
  • 28. Customized communication of patients with payers}  Cost options should always be available for both providers and patients}  Transparency: Make patients aware of how much a procedure costs so they can make informed decisions, budget, and speak up when the money is wasted
  • 29. Efficiencies through modern Internet-based technologies}  Let the patient do the work: Documentation, Appointment Scheduling, etc.}  Reduce duplication}  Efficiency
  • 30. Reduction or elimination of documentation bottleneck}  National efforts to develop a solution}  Pressure on leading companies
  • 31. Real-time financial transactions}  Cut the Gordian Knot}  National effort to include all stakeholders
  • 32. Reduction or elimination of duplicate services}  Across providers and within provider organizations}  Emergency Departments
  • 33. }  Analyze what went wrong}  National efforts to manage health costs}  National efforts toward a new direction in HIT}  What providers should do}  What payers should do}  Patients
  • 34. }  Analyze how to improve and/or integrate MU}  Consensus development on new strategy}  Consensus development on reworking HIPAA}  National discussion on standards developments}  Analysis of future role of ONC
  • 35. }  Paradigm shift towards patients ◦  Create patient network community ◦  New communication methods}  Create internal care team policies and systems}  Improve EMR System
  • 37. }  Policy for apps}  Browser strategy and help}  Data capture: Transcription, alternatives}  Patient outreach ◦  Collect mobile phone numbers ◦  Create new communication agreements ◦  Automated text and email systems ◦  Communication policies ◦  Patient educational material}  Care team policies and systems}  Customized communication with pharmacies, hospitals, labs, etc.}  Appointment system}  Business intelligence
  • 38. }  Need for national attention to the lack of HIT openness}  Inefficiencies, old modules, technologies of the 1990s}  Individual organizations breaking away are generally not successful}  How to overcome industry interests and vested group thinking
  • 39. }  Obamacare and change to ICD 10 offer great opportunities}  Need for a national framework for a payment system that each competing company can adjust to its marketing and business strategy}  Transparency to providers and patients}  Real-time eligibility determination, charge capture, and adjudication}  New communication in informing the patient the costs of care
  • 40. }  Most of the current EMR/HIT systems are outdated, inadequate and do not fit into the digital society}  We are heading toward a major seismic shift in healthcare}  National re-thinking and redesign is needed ◦  Mandating interoperability ◦  Opening the HIS industry to competition ◦  National campaign to involve patients ◦  Efforts to redefine HIPAA for the digital society ◦  Mandating transparency}  Providers should start now implementing digital society healthcare features
  • 41. peter@waegemann.netwww.waegemann.net Available as eBook or paperback from Amazon.comQuestions?