L2 Using Information Technology

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L2 Using Information Technology

  1. 1. 21st Century Care Innovation Project Using InformationPrimary Care with KP Primary Care Transforming Technology to Redesign HealthConnect Institute for Healthcare Improvement’s 8th Annual International Summit on Redesigning the Clinical Office Practice Nashville, TN, March 25-27, 2007 Charles Kilo, MD, MPH CEO, GreenField Health, Portland, OR Chuck.Kilo@GreenFieldHealth.com Reginald Wallen, MD Physician Director, MidAtlantic Permanente Medical Group Reginald.Wallen@kp.org
  2. 2. Objectives By the end of this session, participants will be able to: • Describe the components of a practice IT system • List considerations for workflow redesign during IT selection and implementation • Discuss critical aspects of using an IT system to improve quality of care • Challenge each other to think flexibly about their practice and their patient’s future
  3. 3. Its not about the IT… • We will discuss aspects of the technology, but we will focus on what IT enables us to do for our patients • Care and caring are at the center – the future is about caring for the patient, not about the visit • EHR implementation is a Trojan horse – it provides the opportunity to question and redesign processes, workflow, roles and how you interact with patients Leverage the opportunity Don’t pave the cowpaths • Implementation is an ongoing journey, not a one time event
  4. 4. Chronic Care Model: What are the challenges? Community Health System Resources and Health Care Organization Policies Clinical Self- Delivery Decision Information Management System Support Systems Support Design Informed, Productive Prepared, Activated Proactive Interactions Practice Team Patient Improved Outcomes
  5. 5. Basic Elements of IT for Primary Care Foundations • Practice management software for billing and scheduling • EHR with integrated scanning, faxing, e-prescribing (integrated with PM) • Decision-support (patient & practice) • Disease Registry • Clinic / Medical Group intranet Systems for connecting with patients • Patient facing shared record/personal health record • Secure messaging • Patient e-newsletter System-basics • High-speed internet connection • Connectivity to other critical IT (e.g., hospital, lab, radiology) • VPN for secure use from home • System Software and Security – OS, antivirus, anti-spam, back-up
  6. 6. Organizing Principles • Your primary focus in the design your practice system will determine what your system will look like when you’re done, including your IT. • Options include, for example: Improving physician efficiency/productivity Improving clinical quality Integration with colleagues Market differentiation Patient at the center
  7. 7. Organizing Principles – GreenField Health Use our team and our system design to deliver on the promises of: • Relationships • Service • Clinical Reliability Continually work to integrate care across boundaries
  8. 8. The GreenField Model TM Relationship Reliability Service Management Systems The Operating System © 2007, Charles Kilo, GreenField Health
  9. 9. The GreenField Model TM Customized Experience Relationship Reliability Service Management Systems © 2007, Charles Kilo, GreenField Health
  10. 10. GreenField Health’s IT System 1. GE Centricity EHR Relationship 2. GE Centricity PM Service 3. Kryptiq’s Care Manager disease registries Clinical Reliability 4. Kryptiq’s DocuTrak scanning 5. Kryptiq secure messaging and local RHIO 6. Kryptiq web portal with patient access to records 7. Kryptiq E-prescribing Integration using 8. Hospital interface for lab, x-ray, hospital documents ample supply of duct 9. Brentwood ECG – integrated tape and bailing wire 10. Midmark Spirometer – integrated 11. Clinical Content – encounter forms 12. GreenField intranet and web site 13. Electronic patient newsletter 14. Networking hardware & software 15. Knowledge sources – Epocrates, UpToDate, PubMed, Google 16. Remote access to hospital IS and our own IS 17. Network faxing 18. Network with backup, antiviral, antispam, and security software 19. Telecommunications – phone system, cell phones © 2007, Charles Kilo, GreenField Health
  11. 11. Basic Elements of Medical Practice IT Foundations Billing / Scheduling software EHR Decision-support (patient & practice) Relationship Disease Registry Clinic / Medical Group intranet Connecting with Patients Service Web portal/personal health record Patient e-newsletter Secure messaging The Network Clinical Reliability VPN for secure use from remote locations Connectivity to other IT (hospital, lab, radiology) Connectivity network between practices (virtual integration) Internet connection Security including antivirus, anti-spam, back-up Telecommunication systems © 2007, Charles Kilo, GreenField Health
  12. 12. Basic Elements of Medical Practice IT Foundations Billing / Scheduling software EHR Decision-support (patient & practice) Relationship Disease Registry Clinic / Medical Group intranet Connecting with Patients Service Web portal/personal health record Patient e-newsletter Secure messaging The Network Clinical Reliability VPN for secure use from remote locations Connectivity to other IT (hospital, lab, radiology) Connectivity network between practices (virtual integration) Internet connection Security including antivirus, anti-spam, back-up Telecommunication systems © 2007, Charles Kilo, GreenField Health
  13. 13. Basic Elements of Medical Practice IT Foundations Billing / Scheduling software EHR Decision-support (patient & practice) Relationship Disease Registry Clinic / Medical Group intranet Connecting with Patients Service Web portal/personal health record Patient e-newsletter Secure messaging The Network Clinical Reliability VPN for secure use from remote locations Connectivity to other IT (hospital, lab, radiology) Connectivity network between practices (virtual integration) Internet connection Security including antivirus, anti-spam, back-up Telecommunication systems © 2007, Charles Kilo, GreenField Health
  14. 14. Hardware and the Network: The Basics Application software Diagnostic Equipment (ECG, EHR, PMS, Outlook®, MS Spirometer) Office ® Messaging Decision support Internal Servers External Application software Network Images Local area network Fax and email (LAN) within User Devices Wide area network Wired PCs (WAN) between Wireless PCs Interfaces between systems Scanners
  15. 15. What are the key adoption challenges? 1. Cost 2. Intimidation 3. Lack of management capability 4. Lack of IT experience 5. Lack of desire, will, compelling need
  16. 16. Environmental challenges Where do I start? Where do I get advice? Are others going to pay me to have an HER, or will others pay for my EHR? What is the role of health systems and their ability to provide IT to independent medical practices? What’s the role of QIOs?
  17. 17. 21st Century Care Innovation Project Transforming Primary Care with KP HealthConnect Introduction to KP HealthConnect
  18. 18. What is Kaiser Permanente HealthConnect? • More than just an electronic medical record • The development and deployment of a highly- sophisticated information management and delivery system • A program-wide system that will integrate the clinical record with appointments, registration and billing • A complete health care business system that will enhance the quality of patient care and support the KP Promise
  19. 19. KP HealthConnect Supports: Quality Our Personal & Affordable Patients Can Trust Convenient Service Health Care High Quality Personal Affordable • We have clinical information • We have and use up-to-date • We reduce the cost of care available 24/7. clinical, social and patient and improve visit experiences. • Our clinical outcomes are preference information. • We decrease the cost of paper unsurpassed. • We provide patients information medical records. • Our clinicians know in real- for shared decision making. • We maximize appropriate time the recommended best • We enhance personalized care. revenue capture. practices. • Our pricing matches our risk. • We are the national leaders in Convenient • We administer benefits and patient safety. new products both correctly • We enhance our research to • Our patients access information and efficiently. support evidence-based care. via telephone, Web and email. • We continually improve • We actively support our patients’ operations. participation in their own care. • We minimize wait times and out- of-pocket costs with efficient access to care. • We achieve superior integration and continuity of care.
  20. 20. Program Scope Web Access Portal Ancillaries Care Delivery Core Health Plan Finance Scope of KP HealthConnect Suite Outpatient Inpatient Outpatient Membership/ General Pharmacy Admission, Discharge Scheduling and Transfer Benefits Ledger Referral & Utilization Management Health Information Management Lab Registration Claims Capital Clinicals Processing Planning Clinicals Pharmacy Radiology/ Financial Benefits Imaging Emergency Reporting Accumulation Department Billing Others Operating Room (immunizations, Health Information Pricing EKG, dictation) Management Billing System Data Warehouse / EDR Enterprise Data Repository
  21. 21. Members Can Actively Participate in Care Care Delivery Core www.kp.org Access medical record Member Web Portal Scope of KP HealthConnect Suite Outpatient Inpatient Make/change appointments Scheduling Scheduling Send messages to doctor Admission, Discharge And Transfer Registration Clinicals Check lab results Pharmacy Access health Information Clinicals Emergency Department Review eligibility & benefits Operating Room Billing Billing Account summary
  22. 22. Member’s View Through members.kp.org
  23. 23. Member’s View Through members.kp.org
  24. 24. Progress to Date Nearly 5 million members have a partial or complete KP HealthConnect ambulatory record All members will have one by mid-2008 Access to KP HealthConnect through kp.org is live in 7 of our 8 regions More than 1.7 million members are currently registered on kp.org Two KP hospitals are now live with KP HealthConnect A total of 36 hospitals will be live by the end of 2009 (including hospitals currently under construction) By the end of 2006, the KP HealthConnect practice management deployments will be complete
  25. 25. Percentage of KP Population Coverage by Year/Suite 100% 2007 2008 2007 90% 2009 2006 80% 2007 70% 2006 60% 2008 50% 2005 40% 2006 2005 30% 20% 2005 2007 10% 2004 2004 2006 0% Practice Management Outpatient Clinicals and Inpatient Clinicals KP HealthConnect Online Billing & Registration Decision Support Population coverage based on actual & planned finish dates
  26. 26. “Blue Sky” In 2015, the care delivery model is a consumer-centric paradigm where the consumer presumes choice. Members will characterize KP as providing customized and fully integrated/leveraged services with secure and seamless transitions from person to person with care that can occur in their homes for an affordable cost.
  27. 27. Our Blue Sky Vision
  28. 28. Members are Utilizing KP.org Features As of July 2006 Number of kp.org registered users: 1,706,009 Lab tests released online: 4,529,426 Test viewed online: 1,437,699 Member messages sent: 624,461 Average messages sent per member: 2.0 Visits to past office visits: 85,846 Visits to Your future appointments: 279,857
  29. 29. Online Access Is Improving Member Experience Preliminary research in the Northwest region shows that member usage of online features is resulting in statistically significant: Reductions in primary care visits Reductions in telephone calls High member satisfaction with online alternatives
  30. 30. 21st Century Care Innovation Project Creating a Patient-Centered Focus, where the care team and work flow are organized to meet the needs of the population Empowering Members to be the “real” primary care provider with the care system providing people and tools to support the member Supporting Panel Ownership by the primary care provider which enables caring for a person as a total being; earlier intervention in disease progression; and greater oversight of members with chronic disease Offering Alternatives to 1:1 Face- to-face Office Visits which can build capacity and give members choice
  31. 31. Telephone visits are enabled and enhanced by KP HealthConnect While telephone visits could have been (and were on a small scale) provided previously, Whittier has found that KP HealthConnect enables greater ease, efficiency, and scale. With KP HealthConnect… All the relevant patient information are easily accessed by the provider during a telephone visit. “Real-time” processing (notes, lab-orders, Rx orders) is possible during a telephone visit. Work is completed during the telephone visit with few or no hand-offs required. Case: Telephone Visits @ Whittier
  32. 32. Providers report that telephone visits are a better way to manage patient demand Case: Telephone Visits @ Whittier Whittier Family Medicine Provider Survey, 4/2006 (10 Providers, 1: strongly disagree; 5: strongly agree) 5 4.7 4.6 4.6 4 3 2 1.5 1 0 Model makes Better way to manage Model gives me I want to go back to my day easier patient demand for more control over old system care my day Whittier Family Medicine providers report that the phone visits gives them more control and is a better way to manage patient demand. The Medical Assistants for the physicians doing a higher quantity of phone visits can use that time to assist in Population Care Management duties and outreach for clinical strategic goals (PAP, Mammo, & Pneumonia vaccine reminders)
  33. 33. Members are very satisfied with the telephone visits. Members Satisfaction with Telephone Visits Members who had a telephone visits are highly satisfied. 8% 87% ranked their satisfaction with the 5% telephone visits a “5” on a scale of 1-5 (low/high). 87% 80% of members surveyed would be willing 5 = Highly Satisfied 4 = Satisfied to “pay” something for a telephone visit. 3 = Neutral Whittier is learning that members need to be made aware of their options. Members' Willingness to Pay for Telephone Visits Whittier is working on “educating” Percent Responding members of their options and recently 25% 20% had a test where all calls coming in for 15% a physician was triaged first by an RN. 10% Almost 40% of all calls resulted in a 5% telephone encounter. 0% $0 $5 $10 >$15 $ - Uncertain how much Dollar Amount Note: KP is pursuing detailed surveys with Whittier members in July/August 2006 to get in-depth understanding of member reaction to telephone visits. Case: Telephone Visits @ Whittier
  34. 34. Whittier is not doing the same work differently but different work. Old Model New Model (in testing) 1. Most patient-provider interaction 1. Patient has option to speak to occurs face-to-face in the office. provider over the phone or email if appropriate. 2. Medical Assistants spend the 2. Medical Assistants are able to use majority of time processing their time to help proactively care for patients, even those coming in patients with chronic conditions, e.g. for “inappropriate” office visits. lab reminders, outreach, etc. 3. RNs triage and book follow-ups 3. RNs triage and offer members on for nearly all patients requesting alternative care options and handle appointment with physician. appropriate calls themselves. We believe we are building capacity in our care team.
  35. 35. Access: Increasing capacity to touch more of patients on our panel Camp Springs Touches (Visits & Telephone) / Physician FTE 1050 791 ~ 42 touches/ 850 day/physician 650 292 ~14 touches/ 450 day/physician 250 Nov-06 Jan-06 Jun-06 Jul-06 Feb-06 Mar-06 May-06 Dec-05 Apr-06 Aug-06 Sep-06 Oct-06 Dec-06 From 2006 utilization for Camp Springs membership, •Office Visit rate = 0.16 •Telephone rate = 0.27 Source: Clarity Warehouse. Report run by: National Analytical support. Note: Telephone includes TAVs and telephone encounters.
  36. 36. Access: Increasing capacity to touch more of patients on our panel Comparison of 21st CCI teams Percent of Panel Touched - Office or Phone Encounter 2006 100% Team 1 Camp Springs Team 2 80% 73% Team 3 76% 69% Team 5 62% Team 4 56% 60% 51% 40% 20% 0% Camp Springs IM - % of paneled members with •76% of CS IM members engaged by PCP encounter by month office visits and phone encounter during 2006. 25% 20% 15% 10% 5% 0% Jan-06 Feb- Mar- Apr-06 May- Jun-06 Jul-06 Aug- Sep- Oct-06 Nov-06 Dec- 06 06 06 06 06 06 Source: Clarity Warehouse. Report run by: National Analytical support. Note: Telephone includes TAVs and telephone encounters.
  37. 37. More Touches -- Less Visits Average daily ‘Touches’ Average Daily ‘Touches’ with before panel management panel management 80 80 70 70 US mail contacts 60 RN and HCT contacts 60 No. of Daily Contacts No. of Daily Contacts Email contacts 50 50 Phone contacts 40 40 Annual health goals 30 30 quot;Fast Trackquot;'s 20 20 Group visits 10 10 Office visits 0 Office visits 1 0 1 CEC Presentation 5/2/2005 Gerard F Livaudais MD, MPH Kaiser Permanente Hawaii Region
  38. 38. “Many Hands Make Light Work.”
  39. 39. What can we do? Demo Site: http://devinternal.or.kp.org/im/demo/login.cfm
  40. 40. GreenField Health Primary care practice Research and development on delivery system design Leadership in local and national performance improvement initiatives (e.g., ACP, AAFP, IHI, AAMC, etc.) Services: 1. GreenField Health – 6 physicians 2. Practice management services 3. Teaching and consulting in practice performance improvement
  41. 41. Physician Workspace User Devices: Wired PCs Telephones Users
  42. 42. Staff Workspace User Devices: Digital Wired PCs + Vitals Printers Telephones Users
  43. 43. Devices for Clinical Users Pen Tablet Convertible •Battery •Battery •Screen •Screen •Stylus for point and click •Stylus for point and click •Wireless Antennae •Wireless Antennae •Physical keyboard like •Virtual Keyboard Docking Stations notebook •Voice files •Power •Voice files •Handwriting recognition •Battery recharges •Handwriting recognition •All Applications on the network •All Applications on the •Node on the network •All network devices (printers, network •Nothing without a computer (either fax) •All network devices above) (printers, fax) Options that connect to Docking Station: LCD Screen (no touch) Physical Keyboard Physical Keyboard w/Touch Pad (plus mouse)
  44. 44. Beyond the Visit at GreenField Health: Distribution of Patient Encounters Number of Encounters by Type per Patient per Year E-mail Phone Care 4.8 4.9 Office Visit 1.7
  45. 45. E-visits The Myths are Not True • Patients are very respectful of clinician time • Managing challenging patients • Patient are connecting to us as the trusted source, not besieging us with garbage from the internet • A great opportunity for managing challenging patients • Doctors will not participate Visit Prep • Eliminates the need for some visits • Makes visits shorter and more satisfying • Eases documentation
  46. 46. Secure Messaging and E Visits Issues of Reimbursement • Easiest in integrated models • Spreading adoption by insurers • In addition to direct payment, consider: Impact on overall productivity Stickiness – patient allegiance to your practice The energy of innovation It’s the right thing to do
  47. 47. Knowledge Management • Access to the right information at the right time to support the continuous healing relationship • Understanding the needs of our patients if they are in the office or at home – population management • Decision support to make the right thing the easiest thing to do
  48. 48. “We Know You” • Numerous options exist within the EHR to allow providers to better “know” their patients. Snapshot Demographics Problem Lists Social Documentation Health Maintenance Alerts Flowsheets Questionnaire
  49. 49. Prescribing
  50. 50. Refills
  51. 51. Knowledge Management
  52. 52. Summary • Redesigning our practices around our patients’ needs is our goal • IT enables changes that we have always wanted to make • The EHR is a Trojan horse - Use the great magnifier at the moment of flexibility to improve all of your processes, clarify roles and responsibilities and be more patient centered
  53. 53. Thank You! GreenField Kaiser Health Permanente Questions?

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