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Collaborating safely over the Internet 2011


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This presentation talks about the 4 elements that make for smoother transitions of care with fewer hospital readmits. Several free and low cost Internet tools are highlighted. As well there is a discussion of HIPAA considerations.

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Collaborating safely over the Internet 2011

  1. 1. Collaborating (safely) over the Internet Tasha Beauchamp,MSc Webmaster, Research Scientist [email_address] 707-477-0700 NHPCO Clinical Conference - October 6, 2011 - San Diego, CA
  2. 2. Objectives <ul><li>Identify the business case for collaboration </li></ul><ul><li>Name 4 key factors for reducing readmissions </li></ul><ul><li>Explain pros/cons of collaborating via the Internet </li></ul><ul><li>Describe several tools </li></ul><ul><li>Identify necessary components for HIPAA compliance </li></ul>
  3. 3. Poll: How wired are you? <ul><li>__ Telehealth monitoring? </li></ul><ul><li>__ E-Communication with families? </li></ul><ul><li>__ E-Prescribing? </li></ul><ul><li>__ Electronic medical records? </li></ul><ul><ul><li>__ Share with other providers? </li></ul></ul><ul><ul><li>__ Allow patients/families access? </li></ul></ul><ul><li>__ Planning EMRs? </li></ul>
  4. 4. The Business Case for Collaboration
  5. 5. Where goes CMS,so goes the nation <ul><li>Targeting 30-day re-admissions </li></ul><ul><li>Value-based purchasing </li></ul><ul><ul><li>Outcomes </li></ul></ul><ul><ul><li>Process (evidence-based) </li></ul></ul><ul><ul><li>Public accountability </li></ul></ul><ul><li>Collaboration in transitions of care </li></ul>
  6. 6. 30-day re-admissions: Penalizing doctors and hospitals <ul><li>12 million Medicare beneficiaries hospitalized in 1 year </li></ul><ul><li>Nearly 1:5 (19.6%) re-admitted w/in 30 days </li></ul>NEJM (2009). Re-hospitalizations among Medicare Fee for Service Pts. v360:14, pp1418-1428
  7. 7. Value-based purchasing What gets measured gets managed <ul><li>Patient care outcomes </li></ul><ul><ul><li>Hospital Compare: CHF readmits </li></ul></ul><ul><li>Best practices (OASIS-C) </li></ul><ul><ul><li>Risk assessments </li></ul></ul><ul><ul><li>Protocols for CHF, pain, depression, pt/caregiver education </li></ul></ul><ul><li>Patient satisfaction (CAHPS) </li></ul><ul><ul><li>Home Health Compare. Hospice next? </li></ul></ul>
  8. 8. Collaboration in Transitions of Care <ul><li>Accountable Care Organizations </li></ul><ul><ul><li>Bundled payments </li></ul></ul><ul><ul><li>Shared savings </li></ul></ul><ul><li>Care Transitions QIO </li></ul><ul><ul><li>14 demonstration projects </li></ul></ul>
  9. 9. Care Transitions Intervention University of Colorado <ul><li>Teach self-management skills (Coach) </li></ul><ul><li>30-day intervention </li></ul><ul><li>1 home visit, 3 phone calls </li></ul><ul><li>Significantly less likely to be readmitted </li></ul><ul><li>$295,594 anticipated 12 mos. savings </li></ul><ul><ul><li>350 chronically ill adults with an initial hospitalization </li></ul></ul>Coleman, Eric. U of Colorado.
  10. 10. 4 Key Interventions <ul><li>Medication management </li></ul><ul><li>Follow-up appointment </li></ul><ul><li>Know the signs of a problem </li></ul><ul><li>Dynamic communication tools </li></ul>Coleman, Eric. U of Colorado.
  11. 11. What does this mean business-wise? <ul><li>Concentrate on reducing readmissions </li></ul><ul><li>Develop critical pathways based on evidence </li></ul><ul><li>Collaborate with other providers </li></ul><ul><li>Make it easy to work together </li></ul><ul><li>Include patients and families </li></ul><ul><ul><li>Medication management </li></ul></ul><ul><ul><li>Follow-up appointment </li></ul></ul><ul><ul><li>Know signs of a problem </li></ul></ul><ul><ul><li>Dynamic communication tools </li></ul></ul>
  12. 12. The pros and cons of Internet collaboration (aka “Working in the Cloud”)
  13. 13. Clinical Advantages of the Cloud <ul><li>24/7 accessibility </li></ul><ul><li>Geographically independent </li></ul><ul><li>Asynchronous (convenient) </li></ul><ul><li>Interactive (team) </li></ul><ul><li>Password-protected </li></ul><ul><li>Multiple levels of access </li></ul><ul><li>Patient/family can have access </li></ul>
  14. 14. Clinical Disadvantages of the Cloud <ul><li>Requires electricity (Katrina!) </li></ul><ul><li>Requires computer and Internet access </li></ul><ul><li>Requires computer skills </li></ul><ul><li>Requires protection against hacking (HIPAA) </li></ul><ul><li>Must remember password! </li></ul>
  15. 15. Demographics Is this realistic?
  16. 16. Who is on the Net? By Age May 2011 Pew Internet & American Life,
  17. 17. Who is on the Net? By Income May 2011 Pew Internet & American Life,
  18. 18. Who is on the Net? By Location May 2011 Pew Internet & American Life,
  19. 19. Who is on the Net? By Race May 2011 Pew Internet & American Life,
  20. 20. Caregivers and the Internet <ul><li>39% of “Netizens” go online to help someone with a major illness. </li></ul><ul><li>Most commonly Boomer children seeking info for ailing parent. </li></ul><ul><li>1:3 say Internet helped to find services </li></ul>Pew Internet & American Life, multiple reports.
  21. 21. 4 Key Interventions for Reducing Readmissions
  22. 22. 1. Medication Management (Real Time Medication Schedule)
  23. 23. 2. Follow-up appointment with MD (Appointment Calendar)
  24. 24. 3. Signs of a Problem and What to Do (Patient Education)
  25. 25. 4. Dynamic Tools (Assessments & Secure Communciations)
  26. 26. Meet Louise and Shirley
  27. 27. Medication Management & Follow-up Appointments Patient & Provider iPhone and Android apps available
  28. 28. Patient View
  29. 29. Schedule by Time: Pill box view
  30. 30. Wallet Size
  31. 31. Special Instructions
  32. 32. In Spanish
  33. 33. Can set daily reminders
  34. 34. Weekly checklist
  35. 35. Can set refill reminders
  36. 36. Patient List in Provider View
  37. 37. Standard Protocols
  38. 38. Change a medication
  39. 39. Modify Doses & Instructions
  40. 40. Print “contract” for client to sign
  41. 41. In Spanish
  42. 42. Appt Calendar (Follow-up appt!)
  43. 43. Patient Education
  44. 44. Health Record
  45. 45. MyMedSchedule/MedActionPlan Summary <ul><li>Dynamic tools </li></ul><ul><li>Med Schedules </li></ul><ul><li>Instructions </li></ul><ul><li>Reminders </li></ul><ul><li>Appointments </li></ul><ul><li>Patient Education </li></ul>
  46. 46. Knowing Signs of Problem & Dynamic Communication Tools Heart 360 Microsoft HealthVault
  47. 47. Health Literacy Emergency – Caution – Looking Good
  48. 48. Heart 360: American Heart Association
  49. 49. Heart 360 Enter Data Manually
  50. 50. Heart 360 Download from Devices
  51. 51. Heart 360 Provider View
  52. 52. Heart 360 Invite Patient
  53. 53. Heart 360 Patient Summary
  54. 54. Heart 360 Set Alerts
  55. 55. Heart 360 Secure Email
  56. 56. Heart 360 Summary <ul><li>Dynamic tools </li></ul><ul><li>Shows warning signs </li></ul><ul><li>Can communicate securely </li></ul><ul><li>Requires Microsoft HealthVault account </li></ul>
  57. 57. HIPAA & Privacy Concerns Disclaimer: I am not a lawyer!
  58. 58. HIPAA compliance for Covered Entities <ul><li>Physical security </li></ul><ul><li>Administrative security </li></ul><ul><li>Technological security </li></ul><ul><ul><ul><li>Password protection (authorized access) </li></ul></ul></ul><ul><ul><ul><li>Encryption (hacker-proofing) </li></ul></ul></ul><ul><ul><ul><li>Security audits </li></ul></ul></ul><ul><ul><ul><li>Access log for patient (if requested) </li></ul></ul></ul><ul><ul><ul><li>Breach notification </li></ul></ul></ul><ul><li>Business Associates have same restrictions </li></ul>
  59. 59. Privacy Protections MyMedSch Microsoft HV Heart 360 Me & My CGs HIPAA Compliant √ √ √ De-identifies, aggregates for research √ √ √ Displays ads Pharma ads on provider side only No, but links to partners & sends emails Yes, for own products Shares info w/advertisers De-identified, aggregated Not without permission De-identified, aggregated Patient Price Provider Price Free Free Free Probably Free $16/mo $12/pt/mo
  60. 60. Care Transitions Who is on the team? PCP Hospital Hospice Nurse Social Worker Pharmacist DME SNF Cardiologist
  61. 61. Microsoft HealthVault Personal Health Record <ul><li>Store Information </li></ul><ul><ul><li>Allergies, Conditions, List of doctors, Medications </li></ul></ul><ul><ul><li>Documents (e.g., Advance Directives) </li></ul></ul><ul><li>Download information </li></ul><ul><ul><li>Data from telehealth devices </li></ul></ul><ul><ul><li>Data from partners (MyMedSchedule, Heart 360…) </li></ul></ul><ul><li>Secure email communication </li></ul>
  62. 62. Microsoft HealthVault A Cloud Ecosystem for Sharing Microsoft HealthVault
  63. 63. Microsoft HealthVault
  64. 64. Microsoft HealthVault Storing Health Information
  65. 65. Microsoft HealthVault Uploading Documents (Advance Directive)
  66. 66. Microsoft HealthVault Entering Information Manually
  67. 67. Microsoft HealthVault Use Tools to Import Information
  68. 68. Microsoft HealthVault Click to
  69. 69. Microsoft HealthVault Business model based on tools
  70. 70. Microsoft HealthVault Ecosystem Pros and Cons <ul><li>Pros </li></ul><ul><li>HIPAA-compliant </li></ul><ul><li>HL7 compatible </li></ul><ul><li>Many choices </li></ul><ul><li>Lots of interactivity </li></ul><ul><li>Patient is in charge </li></ul><ul><li>Cons </li></ul><ul><li>Patient is in charge (requires skill/initiative) </li></ul><ul><li>Choices are overwhelming </li></ul><ul><li>Lots of time to set up & maintain </li></ul><ul><li>Business model? </li></ul>
  71. 71. A Simpler Alternative Comprehensive But not as dynamic
  72. 72. Me and My Caregivers
  73. 73. Me and My Caregivers Medication List
  74. 74. Me and My Caregivers Adding Medications
  75. 75. Me and My Caregivers Calendar Feature
  76. 76. Me and My Caregivers Add follow-up appointment
  77. 77. Me and My Caregivers Post Assessments in Daily Log
  78. 78. Me and My Caregivers Enter Doctor List and Insurance Info
  79. 79. Me and My Caregivers Care Team Blog for “Signs” and Communication
  80. 80. Me and My Caregivers Quick Orientation for Paid Caregivers
  81. 81. Me and My Caregivers Pros and Cons <ul><li>Pros </li></ul><ul><li>HIPAA-compliant </li></ul><ul><li>Very simple </li></ul><ul><li>Very practical </li></ul><ul><li>Fewer computer skills needed </li></ul><ul><li>Cons </li></ul><ul><li>Not very interactive (no dynamic tools) </li></ul><ul><li>Costs money $12/mo </li></ul><ul><li>Has ads and product sales </li></ul>
  82. 82. Comparison Chart MedAction MS HealthVault Me & My CGs Medication Schedule √ (MyMedSchedule) √ Appt Calendar √ (MyMedSchedule) √ Signs of Problem (Pt Ed) Soon (Heart 360) ≈ Entered manually in blog Dynamic Assessments - - - (Heart 360) ≈ Entered manually in log Secure Communication - - - Secure email Blog-like thread Provider Version Free Probably Free ≈ $12/pt/mo
  83. 83. Make your Company a Collaborative Partner <ul><li>Concentrate on reducing readmissions </li></ul><ul><li>Develop critical pathways based on evidence </li></ul><ul><li>Collaborate with other providers </li></ul><ul><li>Make it easy to work together </li></ul><ul><li>Include patients and families </li></ul><ul><ul><li>Medication management </li></ul></ul><ul><ul><li>Follow-up appt with MD </li></ul></ul><ul><ul><li>Know what to do if sxs get worse </li></ul></ul><ul><ul><li>Dynamic communication tools </li></ul></ul>
  84. 84. Questions? <ul><li>Tasha Beauchamp, MSc </li></ul><ul><li>707-477-0700 (Pacific) </li></ul><ul><li>[email_address] </li></ul>