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Harness Your Clinical and Financial Data with an Enterprise Health Information Exchange


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The importance of Enterprise Health Information Exchange (EHIE) as a key way to empower your physicians and patients and demonstrate meaningful use of electronic health records:

- Present the business case for EHIE as an important architecture that matters to progressive health systems
- Take a look at some of the market-leading EHIE architectures and products
- Provide real exam...ples of organizations that are using EHIE to improve their operations

Published in: Health & Medicine
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Harness Your Clinical and Financial Data with an Enterprise Health Information Exchange

  1. 1. Harness Your Clinical and Financial Data with an Enterprise Health Information Exchange August 26, 2010
  2. 2. Table of Contents <ul><li>Consumerism in Healthcare </li></ul><ul><li>Physician Practice Alignment in Healthcare </li></ul><ul><li>Government, Payors, Analytics and Healthcare Reform </li></ul><ul><li>Enterprise Health Information Exchange Approach </li></ul><ul><li>Coordinated/Connected Care Examples </li></ul><ul><li>Questions </li></ul>
  3. 3. About Perficient Perficient is a leading information technology consulting firm serving clients throughout North America. We help clients implement business-driven technology solutions that integrate business processes, improve worker productivity, increase customer loyalty and create a more agile enterprise to better respond to new business opportunities. Follow Perficient’s Healthcare IT team at:
  4. 4. Fast Facts <ul><li>Founded in 1997 </li></ul><ul><li>Public, NASDAQ: PRFT </li></ul><ul><li>16 locations throughout the U.S. & Canada: </li></ul><ul><ul><li>Chicago, Cincinnati, Cleveland, Columbus, Dallas, Denver, Detroit, Fairfax, Houston, Indianapolis, Minneapolis, New Orleans, Philadelphia, San Jose, St. Louis and Toronto </li></ul></ul><ul><li>1,100+ employees </li></ul><ul><li>Dedicated solution practices </li></ul><ul><li>Served 400+ clients in past 12 months </li></ul><ul><li>Alliance partnerships with major technology vendors </li></ul><ul><li>Multiple vendor/industry technology and growth awards </li></ul><ul><li>Key Differentiators: </li></ul><ul><ul><li>Focused expertise, lower cost, faster time-to-value </li></ul></ul><ul><ul><li>IT Solutions with Business Focus </li></ul></ul><ul><ul><li>Mature, proven Project Methodology </li></ul></ul><ul><ul><li>Global Development Centers in China & Europe </li></ul></ul><ul><ul><li>Healthcare Thought Leadership </li></ul></ul>
  5. 5. Our Solutions
  6. 6. Provider Landscape…. Quality Reporting Clinical Processes Orders, Medications, Results, Alerts Scheduling, Pre-Reg Billing, Collections, Denial Management Charge Capture Eligibility and Medical Necessity Checking Point of Service Collections Pay for Performance Reporting RAC Audits Coding Patient Transfers Discharge Registration Check In EDI Standards ICD 10 5010 Physician Alignment ARRA Decision Support Consumerism
  7. 7. Consumerism in Healthcare
  8. 8. Healthcare Consumer Interesting Facts <ul><li>Only 20% are content to let their doctor make the decision </li></ul><ul><li>93% of consumers are insecure about their ability to handle future health care costs </li></ul><ul><li>90% would willingly travel outside their community – including 39% to foreign countries - for comparable and less expensive treatment programs </li></ul><ul><li>Nearly half of Medicare enrollees are self-directed activists in their care, and many use websites for information about price and quality </li></ul><ul><li>78% want to customize their healthcare coverage and experience to include the features they value, with the cost changed accordingly </li></ul><ul><li>84% prefer generic drugs to name brands </li></ul><ul><li>34% would use a retail/walk-in clinic; 16% already have </li></ul>Source: Deloitte LLP - United States
  9. 9. Consumer Trends – Retail Clinics <ul><li>Growth of Retail Clinics: </li></ul><ul><ul><li>More than 1 in 3 consumers surveyed are receptive to the idea of using retail clinics </li></ul></ul><ul><ul><li>1 in 6 already have </li></ul></ul><ul><ul><li>Interest in retail clinics is especially high among Baby Boomers, with nearly 38% saying they would use a retail clinic </li></ul></ul><ul><li>More than 800 clinics operate across the country at chain stores.  With waiting times less than 30 minutes, most people go for convenience but this is also a more affordable option for the uninsured. </li></ul><ul><ul><li>Convenient Care Association (CCA) is forecasting that retail clinic totals will reach 5,000 by the end of the decade </li></ul></ul><ul><li>Patient satisfaction is high for these centers: </li></ul><ul><ul><li>92% satisfaction with convenience </li></ul></ul><ul><ul><li>89% satisfaction with quality of care </li></ul></ul>Source: Deloitte LLP - United States
  10. 10. Consumer Trends – On-Line Access Source: Deloitte LLP - United States Economist Magazine Consumer Trends – On-Line Access Source: Deloitte LLP - United States Economist Magazine Online Access Generation Study: Gen X, Baby Boomers, and women are the most likely to use health-related sites
  11. 11. Consumer Trends – Prevention & Wellness Source: Deloitte LLP - United States Consumer Trends – Prevention & Wellness Source: Deloitte LLP - United States
  12. 12. Preventative Care Preventative Care
  13. 13. Consumer Trends -- Quality Source: HealthView Plus 2006
  14. 14. Physician Practice Alignment in Healthcare
  15. 15. Physician Numbers <ul><li>By 2025, the Association of American Medical Colleges projects a shortage of 124,000 physicians, 46,000 of them in primary care. </li></ul><ul><li>In some cases, midlevel providers, such as nurse practitioners and physician assistants, are helping to alleviate the burden on overworked primary care doctors. </li></ul><ul><li>The American Medical Association reports that the total number of physicians employed in community hospitals increased 24 percent between 2003 and 2007, while the number of physicians nationally increased only 8 percent. </li></ul>
  16. 16. Physician Numbers (Cont.) <ul><li>A recent survey by the Society for Healthcare Strategy and Market Development indicated that health care leaders across the nation believe the percentage of physicians on hospitals' active staffs who are employed will increase from 10 percent today to 25 percent by 2013. </li></ul>
  17. 17. Physician Practice Challenges <ul><li>50% of physician practices are small community based that have less than three physicians </li></ul><ul><li>Increased pressure around reimbursements </li></ul><ul><li>Increasing cost of running their practices </li></ul><ul><li>Increased regulatory rules and compliance requirements from CMS and the Payor organizations (i.e. P4P) </li></ul><ul><li>The recently based ARRA Stimulus Bill around adoption of EMRs and the associated behavioral changes </li></ul><ul><li>Challenges in creating the right incentive models </li></ul>How do you Align and Connect to your Physician Practices?
  18. 18. Physician Alignment Matters <ul><li>The average annual revenue generated per medical Specialty: </li></ul><ul><li>Orthopedic Surgery $3.0M </li></ul><ul><li>Cardiology (noninvasive) $2.6M </li></ul><ul><li>Cardiology (invasive) $2.5M </li></ul><ul><li>General Surgery $2.4M </li></ul><ul><li>Neurosurgery $2.4M </li></ul><ul><li>Internal Medicine $2.1M </li></ul><ul><li>Family Practice $2.0M </li></ul><ul><li>Hematology/Oncology $1.8M </li></ul><ul><li>Pulmonology $1.8M </li></ul><ul><li>Gastroenterology $1.3M </li></ul>Source: Meritt, Hawkins & Assoc. and Healthcare Financial Mgt. Assoc.(HFMA)
  19. 19. Physicians in Crisis <ul><li>WHAT DOCTORS ARE SEEKING: </li></ul><ul><li>An American Hospital Assn. report found increased requests for jobs as well as money. During 2009, 56% of hospital CEOs said their facility got more physician requests for aid. Of those CEOs: </li></ul><ul><ul><li>83% reported more physicians wanting increased pay for on-call or other services provided to the hospital. </li></ul></ul><ul><ul><li>69% reported more physicians seeking hospital employment. </li></ul></ul><ul><ul><li>56% reported an overall increase in doctors asking for financial aid. </li></ul></ul><ul><ul><li>31% reported more doctors looking to sell their practices to hospitals. </li></ul></ul><ul><ul><li>23% reported more doctors seeking to partner on buying equipment. </li></ul></ul>
  20. 20. <ul><li>Government, Payors, Analytics and </li></ul><ul><li>Healthcare Reform </li></ul>
  21. 21. American Recovery and Reinvestment Act <ul><li>Signed in February </li></ul><ul><li>Large component dedicated to Healthcare </li></ul><ul><li>Title XIII. Health Information Technology for Economic and Clinical Health Act -> HITECH Act </li></ul><ul><ul><li>Outlines roles, powers, etc </li></ul></ul><ul><ul><li>Updated security and privacy provisions </li></ul></ul><ul><li>Title IV. Medicare and Medicaid Health Information Technology </li></ul><ul><ul><li>Outlines incentives for Electronic Health Record adoption </li></ul></ul>
  22. 22. ARRA “Meaningful Use” EHR Criteria – Standard Reporting
  23. 23. ARRA “Meaningful Use” EHR Criteria – Standard Reporting (Cont.)
  24. 24. ARRA “Meaningful Use” Criteria -- Analytics
  25. 25. 127 Measures (43 Nurses) This CANNOT be conquered one Core Measure or quality metric at a time. An active vendor partnership is needed, with a solution that enables agility, adaptability, adoption and clinical excellence. Unscalable personnel costs in suboptimal processes … … and lost pay for performance money … Quality Measures Reporting 2003 2006-07 2008 2009 2010 2011 10 Measures 21 Measures 27 Measures (10 Nurses) 30 Measures 72 Measures
  26. 26. Non-reimbursement for Preventable Conditions: The “Never Events” <ul><li>Pressure ulcers </li></ul><ul><li>Surgical site infections </li></ul><ul><li>Vascular catheter-associated infections </li></ul><ul><li>Air emboli </li></ul><ul><li>Blood incompatibility </li></ul><ul><li>Catheter-associated urinary tract infections </li></ul><ul><li>Hospital acquired injuries </li></ul><ul><li>Preventable events – Object left during surgery </li></ul>Once again, this CANNOT be conquered one Core Measure or quality metric at a time. An active vendor partnership is needed, with a solution that enables agility, adaptability, adoption and clinical excellence. 8 Now, 21 by 2009 $36 B in Costs in 2008 $70 B in Costs in 2009 WHY? Again, unscalable personnel costs in suboptimal processes … … and lost reimbursement … National Private Payers
  27. 27. Healthcare Reform <ul><li>Health Systems need to be focused on reimbursement mitigation strategies </li></ul><ul><li>The advent of Accountable Care Organizations (ACOs) should to be evaluated and considered by many healthcare organizations </li></ul><ul><li>We appear to be moving towards a capitation reimbursement model for care delivery </li></ul><ul><li>Health Systems that are able to harness and partner with all the disparate care delivery entities are going to be able to drive a sustainable business model </li></ul><ul><li>CMS and Health Insurance Payors are driving reimbursement models that put Health Systems at risk for the cost of the continued delivery of care that is not coordinated or aligned </li></ul>
  28. 28. Enterprise Health Information Exchange Approach
  29. 29. Healthcare Organizations are Experiencing the Most Challenging Environment in Decades… <ul><li>Manage regulatory changes and maintain compliance </li></ul><ul><li>Improve citizen care without increasing costs </li></ul><ul><li>Prevent internal & external security breaches </li></ul><ul><li>Manage data growth – analytics, clinical information </li></ul><ul><li>Facilitate availability & reliability of services </li></ul><ul><li>Support move to personalized healthcare </li></ul><ul><li>Drive engaged physician and patient relationships </li></ul><ul><li>Improve clinician satisfaction </li></ul><ul><li>Create TRUE clinical and financial data transparency </li></ul>
  30. 30. Solution On-Ramps Drive Progressive Transformation Delivering ROI and Increasing Reuse With Each Project Time Flexibility Start with disparate systems with complex integration <ul><li>Why a Framework for healthcare? </li></ul><ul><li>Roadmap and reference architectures based on best practices </li></ul><ul><li>Incremental development </li></ul><ul><li>Easier integration with disparate applications </li></ul><ul><li>Share critical clinical and operational information </li></ul><ul><li>Service reuse across the organization </li></ul><ul><li>Reduced maintenance and operational risk </li></ul>Achieve a simplified SOA-enabled infrastructure 3 Pick an on-ramp project and start rationalizing 1 Build on the value of previous projects and reuse assets 2 Applications have to be “ripped and replaced” Integration is done with “hardwiring” Without SOA New services can be built flexibly by reusing assets Integration is done “loosely” with modular “services”
  31. 31. ESB for Healthcare Healthcare Integration and Interoperability <ul><li>Solution </li></ul><ul><li>High performance integration and exchange of clinical, business, and administrative information across the healthcare organization. </li></ul><ul><li>Compliant with HL7 V2, V3 Clinical Document Architecture, Continuity of Care Record. </li></ul><ul><li>Routing and transformation services. </li></ul>Governance Health Integration Framework Business Partners Healthcare Provider Solutions
  32. 32. Health Analytics Enterprise Health Analytics <ul><li>Solution </li></ul><ul><li>Enterprise data warehouse, tools and capabilities to aggregate and analyze data across the healthcare organization to improve clinical and business outcomes and results. </li></ul><ul><li>Reporting and Dashboards for Meaningful Use, patient safety, quality, research and business operations. </li></ul>Governance Health Integration Framework Business Partners Healthcare Provider Solutions
  33. 33. Portals Provider and Citizen Portals <ul><li>Solution </li></ul><ul><li>Single secure web portal for Providers or citizens, providing access to clinical, financial and administrative information from disparate legacy applications. </li></ul><ul><li>Real-time integration using SOA: </li></ul><ul><ul><li>Multi-vendor </li></ul></ul><ul><ul><li>Multi-system </li></ul></ul><ul><li>Unified communications for physicians, staff and patients. </li></ul>Governance Health Integration Framework Business Partners Healthcare Provider Solutions
  34. 34. Health Information Exchange Health Information Exchange <ul><li>Solution </li></ul><ul><li>Secure exchange of healthcare information across local, regional, state-wide and/or national healthcare communities. </li></ul><ul><li>Based on Integrating the Healthcare Enterprise (IHE) profiles </li></ul><ul><li>Document registry and repository services </li></ul><ul><li>Record locator services </li></ul><ul><li>Fine grained access and consent management </li></ul><ul><li>Collaborative messaging services </li></ul><ul><li>Real-time monitoring and feed of topical information for bio-surveillance or public health </li></ul>Governance Health Integration Framework Business Partners Healthcare Provider Solutions
  35. 35. An Enterprise HIE Reference Architecture Epic Cerner Lawson Siemens Agfa Eclipsys
  36. 36. <ul><li>Coordinated/Connected Care Examples </li></ul>
  37. 37. Performance Excellence Healthcare System Business Rules Clinical Best Practices Key Performance Indicators Chief Medical Officer Chief Nursing Officer Department Directors Nurse Unit/Shift Managers Attending Physicians Alerts Risk Assessments Daily Dashboards Weekly/Monthly Reports Patients Health Status Post Discharge Monitoring Therapy Adherence Alerts/Reminders Certification Accreditation Regulatory Compliance Outcomes-based Reimbursement Quality/Safety Process Improvement Quality Reporting KPI Monitoring Process Monitoring Meaningful Use Enterprise Applications, Electronic Health Record, Revenue Cycle Solutions, Diagnostic, Testing
  38. 38. Coordinated Care Platform <ul><li>Increased use of information technology to capture clinical data, and more importantly, connect the participants in the care process, creates significant opportunities for organizations to materially improve Health outcomes </li></ul>Patients/Consumers Healthcare Systems Physicians, Clinicians, Medical Homes Building on Foundational HIT systems and infrastructure Create a data-driven, intelligent, collaboration Platform Connect Health Systems with their Consumers and Physicians to achieve outcomes Enterprise Applications, Electronic Health Record, Revenue Cycle Solutions, Diagnostic, Testing
  39. 39. Care Coordination Platform Example Retail Pharmacies PBMs Medical Home PCPs Care Management Team Patients/Consumers Prescription Pickups Rx Refills Record Medication Usage Home Device Integration Alerts/eReminders/Calls Update CareTracker Health Information Exchange Maintain Chronic Disease Patient Registry Assign/Create Clinical Protocol for Chronic Patients Monitor Patient Status Medication Adherence Protocol Adherence Manage Events (Rx, Appts, Alerts, Secure Messaging) Health Care System Personal Health Records Clinical Protocols Clinical Best Practices EHR
  40. 40. Questions?
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