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 CEO
First Chair Advancement of mHealth mHealth
Electronic Health Initiative
of TEPR Focus
Conference Records UK/Europe on
Chaired 12 ISO TC 215
Patient Card Standards Two term Chair SNOMED Digital
International Society
Advocate Committees of ANSI HISB
Personal 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 computerization
What 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 helps, however outdated and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 effe
All hospitals have an c ti v e
HIS computer system

5. EHR/EMR Systems
Don’t have to be !
Of modern technology!
Cutting-Edge
a little!
To be somewhat effective
But a little effectiveness is not
sufficient 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} Outdated HIT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 information
Human
processing (thinking) was taking place in the
Intelligence
brain
Development
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
New
Brain’s new role understanding
educational New
in dominating over
paradigm intelligence
the 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 instructions
Access all
Electrical algorithm processing units combined in
patient integrated circuits make up the computer
data
Not just computers, not just the Internet, not mHealth, but the six elements that
make up the World Information Community (WIC) in the Digital Society are
together 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 love
Source: 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 wellness
2. Manage Medication List
22. Notifications and reminders for disease
3. Manage allergy and adverse reaction management, preventive services, and
4. Manage patient history wellness
5. Summarize a record (Capture and 23. Clinical task assignment and routing
Create a CCR)
24. Inter-provider communication
6. Manage Clinical Documents and
notes 25. Pharmacy communication
7. Capture External Documents 26. Provider demographics
(Document imaging) 27. Scheduling
8. Capture of External Images
(Radiology) 28. Report Generation
9. Generate and record patient-specific 29. Health Record Output
instructions 30. Encounter Management
10. Order medication
31. Rules-driven financial and administrative
11. Order diagnostic tests coding assistance
12. Manage order sets 32. Eligibility verification and determination of
13. Manage results coverage
14. Manage consents and authorizations 33. Manage practitioner/patient relationship
15. Manage patient advance directives
34. Clinical decision support system guidelines
16. Support standard care plans
35. Entity Authorization
17. Capture variances from standard care
plans, guidelines, protocols 36. Enforcement of confidentiality
18. Support for drug interaction 37. Data retention, availability, destruction
19. Support for medication or 38. Audit trail
immunization administration and 39. Extraction of data
supply
20. Support for non-medication ordering 40. Current users
(referrals, care management)

15. What Needs to be Done
Better 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 wasteful
Cost 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-time
Communication 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-Provider
3. Provider-Patient
4. Provider-Provider
5. Provider-Payer
6. Payer-Patient
7. Public Health-Provider and External care
Provider-Public Health team
8. 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, even
Quality 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

36. } The new paradigm
} The future is in digital care communities
IRTUAL HEALTH SERVICES
PROVIDER’S PATIENTS = INFORMATION COMMUNITY
DOCTORS’ SPECIALTY KNOWLEDGE = CAPITAL
PARTICIPATING PATIENTS = RESOURCES
UTOMATED APPOINTMENT SYSTEMS
HEALTHCARE CANNOT CONTINUE TO BE ONE-SIDED
TRANSPARENCY = COMMUNICATION, COMMUNICATION
CARE MANAGEMENT VS. INDIVIDUAL WHIMS
ARKETING HEALTH SERVICES

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.net
www.waegemann.net Available as eBook or
paperback from
Amazon.com
Questions?