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![The relationship of policy and technology
1997 (Paul Starr)
When [Clinton health care] reform collapsed,
so did the momentum to build an information
infrastructure for a new system.
Today (2013)
Is it possible that inadequate execution of HIT
systems will place needed health care reforms
at risk?
Starr, P., Smart technology, stunted policy: developing health information networks.
Health Affairs (Millwood), 1997. 16(3): 91-105.
© 2013, Mark Frisse](https://image.slidesharecdn.com/himssnwfrisseonestepatatime-131014153557-phpapp02/85/Frisse-One-Step-at-a-Time-15-320.jpg)
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Frisse - One Step at a Time
Mark Frisse gave a keynote address covering four main topics: the turbulence in healthcare due to various forces driving change; the current confusion from uncertainties in the evolving healthcare system; some vital elements that could help forge solutions; and the need for an emergent, incremental approach to progress. He argued that meaningful change requires renewed focus on critical goals through a systematic, component-based approach with tangible early results.
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Frisse - One Step at a Time
- 1. One Step ata Time Mark Frisse, MD HIMSS NW Technology & Education Symposium 14 October, 2013 © 2013, Mark Frisse
- 2. the Program KN: Frisse Big Data/Analytics BizCase ICD-10 Skill Sets Population Mgmt OR / WA HIE ACO Value KN: Global to Local Clin Analytics State, Fed, Local EHR Replacements Analytics/ Pop Hlth OHSU Security KN: Risk-Based Pop Mgmt
- 3. Analytics KN: Frisse Big Data/Analytics BizCase ICD-10 Skill Sets Population Mgmt OR / WA HIE ACO Value KN: Global to Local Clin Analytics State, Fed, Local EHR Replacements Analytics/ Pop Hlth OHSU Security KN: Risk-Based Pop Mgmt
- 4. Sustainability KN: Frisse Big Data/Analytics BizCase ICD-10 Skill Sets Population Mgmt OR / WA HIE ACO Value KN: Global to Local Clin Analytics State, Fed, Local EHR Replacements Analytics/ Pop Hlth OHSU Security KN: Risk-Based Pop Mgmt
- 5. Systems KN: Frisse Big Data/Analytics BizCase ICD-10 Skill Sets Population Mgmt OR / WA HIE ACO Value KN: Global to Local Clin Analytics State, Fed, Local EHR Replacements Analytics/ Pop Hlth OHSU Security KN: Risk-Based Pop Mgmt
- 6. Analytics, sustainability, &systems KN: Frisse Big Data/Analytics Biz Case ICD-10 Skill Sets Population Mgmt OR / WA HIE ACO Value KN: Global to Local Clin Analytics State, Fed, Local EHR Replacements Analytics/ Pop Hlth OHSU Security KN: Risk-Based Pop Mgmt
- 7. Keynote: Four parts… The Turbulence • Forcesdriving change The Confusion • Uncertainties & immature markets Some vital • An • Elements Components for forging solutions emergence Reaching our goals – one step at a time © 2013, Mark Frisse
- 8. the Turbulence characterized by conflict,disorder, or confusion; not controlled or calm; unsteady movement © 2013, Mark Frisse
- 9. Turbulence: decades inthe making Sick Inadequately prepared Cost Complexity Opacity Expectation Entitlement Moral Hazard
- 10. HITECH: a stimuluseffort source: http://dashboard.healthit.gov/onc/ © 2013, Mark Frisse
- 11. The initiatives beforeus EHR HIE Care Transitions Meaningful Use Finances Workforce
- 12. And we havegiven ourselves limited time Source: Halamka JD. The Future of Standards. © 2013, Mark Frisse
- 13. So we facelocal & national challenges © 2013, Mark Frisse
- 14. Even some supportersof the Affordable Care Act worry that the flaws in the system, if not quickly fixed, could threaten the fiscal health of the insurance initiative, which depends on throngs of customers to spread the risk and keep prices low. © 2013, Mark Frisse
- 15. The relationship ofpolicy and technology 1997 (Paul Starr) When [Clinton health care] reform collapsed, so did the momentum to build an information infrastructure for a new system. Today (2013) Is it possible that inadequate execution of HIT systems will place needed health care reforms at risk? Starr, P., Smart technology, stunted policy: developing health information networks. Health Affairs (Millwood), 1997. 16(3): 91-105. © 2013, Mark Frisse
- 16. We are inthe Northwest © 2013, Mark Frisse
- 17. Summary: Turbulence Titanic demographicand economic circumstances urge action….but how fast can culture change? © 2013, Mark Frisse
- 18. the Confusion lack of understanding;uncertainty; the state of being bewildered Con-fusion: melting down and recreating © 2013, Mark Frisse
- 19. Remarkable adoption ofoffice-based EHRs Office-based provider adoption: basic EHRs http://dashboard.healthit.gov/HITAdoption/ © 2013, Mark Frisse
- 20. Remarkable adoption ofhospital systems Urban: 47.7% Rural: 33.5% http://dashboard.healthit.gov/HITAdoption/ © 2013, Mark Frisse
- 21. MU: Penalty adjustmentsto PFS Meaningful Use: Penalty adjustments to Medicare Physician Fee Schedule (PFS) © 2013, Mark Frisse Image source: Acumen Physician Solutions. http://www.acumenmd.com/avoiding-the-approaching-meaningful-use-penalty/
- 22. Mixed results forHITECH state HIE Tripathi to HIT Policy Committee: State HIE program Status © 2013, Mark Frisse
- 23. Some Pioneer ACOsare opting out 7 – Medicare Shared Savings 2 – Opting out entirely source: Advisory Board, September 2013. The population Health Leaders Reading List © 2013, Mark Frisse
- 24. Inconsistent privacy policyimplementation If the interpretation of any privacy policy is excessively risk-averse, authorized health information may not be transmitted Institution Policies Contracts State Law {A} Federal Law {B} CONSENT: - Context - Information - Roles - Relationships - Terms USE: - Context - Information - Roles - Relationships - Terms © 2013, Mark Frisse
- 25. Concerns rise fromall quarters (as expected) • Interoperability • Sustainability • ICD-10 • Certification • Quality metric simplification • HIPAA • Oversight & fraud • Government shut-down © 2013, Mark Frisse
- 26. The “hospital” mentalityis pervasive A B C © 2013, Mark Frisse D
- 27. Ambulatory care ismore fragmented C D B ? A Medicare beneficiaries see at least five different physicians and many more pharmacists, therapists, and other clinicians. source: Pham, H.H., et al., Care patterns in Medicare and their implications for pay for performance. N Engl J Med, 2007. 356(11): p. 1130-9. © 2013, Mark Frisse
- 28. How fragmented isambulatory care? Slide: David Kibbe. http://www.directtrust.org/ © 2013, Mark Frisse
- 29. Summary: Confusion What worksin some places does not easily work everywhere Progress is unevenly distributed © 2013, Mark Frisse
- 30. some vital Elements apart of aspect of something – especially one that is essential or characteristic © 2013, Mark Frisse
- 31. Change begins withus • • • • • • • • Patients & families Providers Plans States Federal Government Vendors (broadly defined) Integration & analytics groups Quality bodies © 2013, Mark Frisse
- 32. Widespread agreement onmany remedies Lewin JC, Atkins G, McNeely L. The Elusive Path to Health Care Sustainability. JAMA. 2013;():-. doi:10.1001/jama.2013.280147. © 2013, Mark Frisse
- 33. HIE can createa single record Data are made available to those who require access C D B A © 2013, Mark Frisse
- 34. Sophisticated planning systemsexist © 2013, Mark Frisse © Mia Levy, 2013
- 35. Collaborative planning systems Analysis Plan Activation Task Management Task Performance ©2013, Mark Frisse © Mia Levy, 2013
- 36. A single record;a single plan a single, personalized plan of care for the individual measurable outcomes © 2013, Mark Frisse
- 37. Our search foreffective analytics source: https://www.explorys.com/docs/data-sheets/explorys-overview.pdf NOT a product endorsement © 2013, Mark Frisse
- 38. Summary: Elements We havecomponents and new markets for HIE (e.g., ACOs, CINS, bundles) Planning paradigms can advance incrementally © 2013, Mark Frisse
- 39. an Emergence the processof coming into being, or becoming important or prominent © 2013, Mark Frisse
- 40. Task: A newmodel for regional HIE? Frisse’s Hunch: • A number of “hub & spoke” HIE efforts formed as a result of partnerships, ACO or CIN relationships • Some MDs will belong to multiple clouds • Some MDs communicate only via Direct Direct or other HIE services © 2013, Mark Frisse
- 41. Task: “Push” onlyto respond to “pull” PRACTICES DESIGNS NEEDS Value-based payment Aligned incentives Efficient administration Aligned CMS and health plans Connectivity Systems thinking Engineered approaches Analytics & decision support Patient / consumer engagement Iterative cycles of systems-based interventions © 2013, Mark Frisse
- 42. Task: Solid foundations(Version 1.0) • A systems view • Governance • Authentication & authorization • Directories • Record linkages • Simple messaging • Engineered privacy • Effective & efficient audit logs © 2013, Mark Frisse
- 43. Task: Improve providerquality of life • A realistic near-term vision • Quick wins • First, do one or two things well • Minimize administrative burdens • No inaccurate / unnecessary documentation • Automate simple quality reporting • Make fraud almost impossible © 2013, Mark Frisse
- 44. Task: Design forpopulation management • • • • • • • Early, demonstrable benefits Governance & data use Low-cost, secure connectivity Meaningful metrics Effective analytics Consumer engagement Incentives & behavioral economics © 2013, Mark Frisse
- 45. Summary: Emergence Progress throughrenewed emphasis on our critical goals combined with a componentbased, systems approach incrementally executed with tangible early results © 2013, Mark Frisse
- 46. Summarizing… Turbulence • Demographics makethis inevitable Confusion • Uncertainty is a by-product of change Elements • We have some components. Must focus on gaps Emergence • We are proceeding …….. one step at a time © 2013, Mark Frisse
- 47. Frisse ME. HealthAffairs 28.2 (2009): w379-w384. © 2013, Mark Frisse