Information Systems for Population Health Management PDF

Topic 4: Information Systems to Support Population Health Management www.udst.edu.qa Learning Objectives ▸ Explain ▸Gain ▸ Describe the systems development life ▸Gain an understanding of the health care IT the process a health care organization generally goes through in selecting a HCIS cycle and it...

Topic 4: Information Systems to Support Population Health Management www.udst.edu.qa Learning Objectives ▸ Explain ▸Gain ▸ Describe the systems development life ▸Gain an understanding of the health care IT the process a health care organization generally goes through in selecting a HCIS cycle and its four major stages ▸ Discuss the various options for acquiring a insight into the problems that may occur during the system acquisition process industry and the resources available for identifying health care IT vendors HCIS and the pros and cons of each option ▸ Discuss the purpose and content of a request for information and a request for proposal in the system acquisition process 2 Outline Systems development life cycle System acquisition process System implementation process (discussed further in chapter six) Architecture Perspectives Project steering committee responsibilities Project management tools Things that can go wrong Information Technology Architecture Architecture Example Observations about Architecture 3 Definition System Acquisition ▸ The process that occurs from the time the decision is made to select a new system (or replace an existing system) until the time a contract has been negotiated and signed ▸ The process can take anywhere from a few days to a few years, depending on the organization's size, structure, complexity, and needs. 4 Activity: ▸ You are part of the board of directors ▸ You need to move from paper based to EMR system ▸ What steps will you be taking to implementing the EMR in the organization? ▸ How are you going to implement it? ▸ In groups of 3-4, write down the cycle of implementation of new technology 5 Definition System Acquisition system acquisition methods 6 Where to start from? Systems Development Life Cycle (SDLC) ▸ https://www.youtube.com/watch?v=05Un7kPMibk Example of complete system during COVID19 8 SDLC Systems Development Life Cycle (SDLC) 1. a blueprint to aid in the planning, selection, implementation, and support of a new health care information system 2. decision to invest in a health care information system should be well aligned with the organization’s overall strategic goals (deliberation) ▹ an investment in the organization’s infrastructure, not a onetime purchase. ▹ require not only up-front costs and resources but also ongoing maintenance, support, upgrades, and eventually, replacement. 9 SDLC Systems Development Life Cycle ▸ SDLC= The process an organization generally goes through in planning, selecting, implementing, and evaluating a health care information system ▹ applies when systems are purchased from a vendor or leased through cloudbased (software and hardware services delivered over the internet) computing services. ▸ Most health care organizations follow a structured process for selecting and implementing a new computer-based system. 10 SDLC Systems Development Life Cycle 11 SDLC Systems Development Life Cycle ▸ System Acquisition Process ▹ Planning and Analysis: ▹ ▹ ▹ ▹ ▹ The primary focus is on the business problem independent of any technology. Examine current systems and problems to identify opportunities for improvement. Assess the feasibility of the new system. Evaluating systems and workflow process might reveal that a new system is not needed or is not the answer to a problem If a new system is needed, the next step is to define the functional requirements. 12 SDLC Systems Development Life Cycle ▸ Design ▹ ▹ ▹ The evaluation of alternative solutions to address the business problem Consider all the options: will the system be designed in-house? Will the organization contract with an outside developer? Will the organization purchase a system from a vendor? It is generally in this phase that all alternatives are considered, a cost-benefit analysis is done, a system is selected, and vendor negotiations are finalized 13 SDLC Systems Development Life Cycle ▸ Implementation ▹ ▹ Requires significant allocation of resources in completing tasks Conducting work-flow and process analyses, installing the new system, testing the system, training staff members, converting data, and preparing the organization and staff members for the go-live of the new system. 14 SDLC Systems Development Life Cycle ▸ Support and Evaluation ▹ ▹ ▹ ▹ Changes will definitely be made to the system after it is implemented Sufficient resources need to be allocated to maintain and support the system. Health care executives often want to know the value of the IT investment, the degree to which the new system has achieved its goals should be assessed. Eventually, the system will be replaced and the SDLC process begins again. 15 Project Steering Committee https://www.youtube.com/watch?v=Dw2NDkIKKFU 16 Project Steering Committee ▸ ▸ ▸ Primary function is to plan, organize, coordinate, and manage all aspects of the acquisition process Appoint project manager ▹ ▹ ▹ Strong communication, organizational, and leadership skills Brings passion, interest, time, strong interpersonal and communication skills, and project management skills Someone who is well-respected by the organization’s leadership team Pull together a strong team ▹ ▹ Representatives from key constituent groups in the practice At least one person knowledgeable about IT, with representatives from key clinical areas such as laboratory medicine, pharmacy, and radiology in addition to representatives from the administrative, nursing, and medical staffs. 17 Committee Responsibilities 18 Committee Responsibilities ØScreen the marketplace and review vendor profiles ▹ Review of the EHR marketplace and begin investigating vendor profiles. ▹ Market analysis reports that list and describe EHR system vendors, from research firms such as Gartner or KLAS, or through attending trade shows and conferences of professional associations. 19 Committee Responsibilities Ø Determine and prioritize system requirements 20 Committee Responsibilities Ø Develop and distribute the RFP or RFI Ø The system requirements need to be packaged into a structure that a third party can respond to. Ø The requirements are packaged into a request for proposal (RFP) 21 Committee Responsibilities Ø Explore other acquisition options 22 Committee Responsibilities Ø Evaluate vendor proposals 23 Committee Responsibilities Ø Prepare a vendor analysis: https://www.youtube.com/watch?v=W3NF9ip_kxQ 24 Committee Responsibilities Ø Conduct a cost-benefit analysis 25 Committee Responsibilities Ø Prepare a summary report and recommendations ▹System goals and criteria ▹Process used ▹Results of each activity and conclusions ▹Cost-benefit analysis ▹Final recommendation and ranking of vendors ▹It is generally advisable to have two or three vendors in the final ranking, in the event that problems arise with the first choice during contract negotiations, the final step in the system acquisition process. 26 Committee Responsibilities Ø Conduct contract negotiations 27 Project Management Tools 28 What Can Go Wrong? 29 What Can Go Wrong? Ø Failing to involve the leadership team and users extensively during the selection process Ø High tech: https://www.youtube.com/watch?v=BHw6ww16zfk 30 What Can Go Wrong? Ø Turning negotiations into a blood sport Ø Negotiate a fair deal with the vendor and not leave the vendor’s people feeling as though they have just been “beaten” in a contest Ø It is important to form a healthy, respectful long-term relationship with the vendor 31 Summary System acquisition process Project steering committee responsibilities Project repository Information Technology Architecture Architecture v. platform v. infrastructure Things that can go wrong Best of breed v. monolithic v. visual integration 32 Videos Resources Working with Industry Partners | Selecting An EHR Vendor: Introduction https://www.youtube.com/watch?v=Dw2NDkIKKFU 2 1 System development life cycle https://www.youtube.com/watch?v=05Un7kPMibk 4 3 HMS Testimonial - Vendor Selection https://www.youtube.com/watch?v=W3NF9ip_kxQ 5 EHR Systems: The Benefits of Using a Cloud-Based EHR https://www.youtube.com/watch?v=BHw6ww16zfk 33 03/17/2024 HCMT 2001 Hospital Functions and Management Topic 1: Introduction to Healthcare management www.udst.edu.qa What is healthcare informatics? 1 03/17/2024 What is healthcare informatics? Interdisciplinary, scientific field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision making, motivated by efforts to improve human health (American Medical Informatics Association) Informatics is more about information than technology (with the technology acting as a tool) Friedman has defined a “fundamental theorem” of informatics, which states that informatics is more about using technology to help people do cognitive tasks better than about building systems to mimic or replace human expertise Source: Hersh W, Advice to a Young Person Considering a Career in HI. July 3, 2014. Blog(Informatics Professor). Recommendation Of The International Medical Informatics Association (IMIA) 4 2 03/17/2024 What is Health Informatics? “ Patient/Person/Human Centered Digital Health 5 What is Health Informatics? Hersh W, A stimulus to define informatics and health information technology. BMC Medical Informatics & Decision Making, 2009. 9: 24. http://www.biomedcentral.com/1472-6947/9/24/. 6 3 03/17/2024 What are the competencies required? Hersh W, A stimulus to define informatics and health information technology. BMC Medical Informatics & Decision Making, 2009. 9: 24. http://www.biomedcentral.com/1472-6947/9/24/. 7 What is Health Informatics? Hersh W, A stimulus to define informatics and health information technology. BMC Medical Informatics & Decision Making 2009. 9: 24. http://www.biomedcentral.com/1472-6947/9/24/. 8 4 03/17/2024 Qatar’s E-Health Program Mission & Goals “Ministry of Public Health.” Ministry of Public Health , www.moph.gov.qa/english/strategies/Supporting-Strategies-andFrameworks/NationalEHealthAndDataManagementStrategy/Pages/default.aspx. 9 Learning objectives Define what healthcare informatics is Discuss some of the most significant influences shaping the current and future health information technology landscapes in the United States Understand the roles national private sector and government initiatives have played in the advancement of health information technology in the United States Describe major events since the 1990’s that have influenced the adoption of health information technologies and systems 5 03/17/2024 Learning Objectives ▸ ▸ ▸ Increasing use of Health information technology (HIT) across all aspects of US health care delivery system since the 1990s resulted in Electronic health records (EHR), telehealth, social media, mobile applications Today, health care providers and organizations depend on reliable Health information technology (HIT) to aid in ▹ managing population health effectively, ▹ while reducing cost and ▹ improving quality patient care. Health information technology (HIT) development was affected by advance in information technology, as well as government and private sector actions. This chapter will provide a chronological overview of the significant government and private sector actions that affected the adoption of Health information technology (HIT). 11 History of Healthcare informatics 6 03/17/2024 Outline 1990’s: The Call for Health information technology (HIT) Institute of Medicine (IOM) Health Insurance Portability and Accountability Act (HIPAA) 2000 – 2010: The Arrival of HIT Health Information Technology for Economic and Clinical Health (HITECH) Act 2010 – Present: Health Care Reform and the Growth of HIT Affordable Care Act (ACA) Medicare Access and CHIP Reauthorization Act (MACRA) Value-based & alternative payment programs 13 Institute of Medicine (IOM) 1990’s: The Call for Health information technology (HIT) 1991: Published a report on the problems with paper-based medical records and called for computer-based patient records (CPR). Computer-based patient records (CPR) defined by Institute of Medicine (IOM) as “an electronic patient record that resides in a system specifically designed to support users by providing accessibility to complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids”. 14 7 03/17/2024 1990’s: Computer-based patient records (CPR) offered more than electronic The Call for records, version of paper Health it assisted clinicians in caring for the patient by providing him or her with reminders, alerts, clinical decision, support capabilities and information access to the latest research findings. technology they were adopted by 10% of hospitals and less than 15% of physical practices in 2001. IOM goal was not met. (HIT) Institute of Medicine (IOM) 15 The Health Insurance Portability and Accountability Act (HIPAA) 1996: Signed by President Bill Clinton Designed primarily to make health insurance more affordable and accessible Simplifies administrative processes Protects security and confidentiality of personal health information Brought national attention to the use of health information in electronic form. 16 8 03/17/2024 2000–2010: The Arrival of Health information technology (HIT) Institute of Medicine (IOM) Patient Safety report: 17 Institute of Medicine (IOM) published a report that estimated 44,000-98,000 patients die each year due to medical errors. This report focused on errors that occur in hospitals. A subsequent report by the Institute of Medicine (IOM) in 2004 called for organizations to adopt information technology capable of collecting and sharing essential health information on patients and their care. The report examined the incidence of serious safety issues in facilities other than hospitals. 2003: Medicare Modernization Act 2004: Office of the National Coordinator for Health Information Technology (ONC) 2009: Health Information Technology for Economic and Clinical Health (HITECH) Act 9 03/17/2024 2000–2010: The Arrival of Health information technology (HIT) Transparency and Patient Safety: 2000 2007 2003 The federal government promoted health care transparency and furthering the adoption of health information technology (HIT). The Medicare Modernization Act was passed in 2003, it expanded the program to include prescribing drugs and mandate the use of electronic prescribing. In 2004 President Bush called for the widespread adoption of electronic health records (EHR). In 2006 he issued an executive order to make price information publicly available, 2010 Providers started recognizing the importance of adopting improved health information technology (HIT) to collect and transmit the data needed under the different changes in reimbursement practices 19 2000–2010: The Arrival of Health information technology (HIT) Office of the National Coordinator for Health Information Technology (ONC): 2004 In 2004 president bush established the Office of the National Coordinator for Health Information Technology (ONC) and charged it with providing “leadership for the development and nationwide implementation of an interoperable health information technology 2009 In 2009 the role of the ONC was strengthened when the Health Information Technology for Economic and Clinical Health (HITECH) Act mandated it to provide leadership and oversight of the national efforts to support the adoption of Electronic health records (EHRs) and health information exchange (HIE). 2010 By the end of the decade only 25% of physician practices and 12% of hospitals implemented basic EHR systems. The low adoption of EHR is due to the cost of HIT and the misalignment of incentives (patients, payers and purchasers benefited while physicians bear the cost) 20 10 03/17/2024 2010–Present: Health Care Reform & HIT Growth Health Information Technology for Economic and Clinical Health (HITECH) and Meaningful Use: o Eligible professionals and hospitals that adopt, implement or upgrade to a certified EHR received incentive payment. o “Demonstrating meaningful use” of electronic health records (EHR) granted additional payment. o Three stages of meaningful use criteria were developed over a five-year period Stage 1: focused on data capturing or sharing Stage 2: intended to advance clinical processes Stage3: aim to show improved outcome 21 2010–Present: Health Care Reform & Health information technology (HIT) Growth Health Information Technology for Economic and Clinical Health (HITECH) and Meaningful Use (cont.): 2010 Each eligible professional who adopted and achieved meaningful electronic health record (EHR) use in 2011 or 2012 was able to earn up to $44,000 over a five-year period. The amount decreased over the period, creating incentives to providers to start sooner rather than later. 2013 Eligible providers who apply for the EHR Medicare and Medicaid Incentive Programs are required to use certified EHR technology. The Office of the National Coordinator for Health Information Technology (ONC) has authorized certain organizations to perform the actual testing and certification of EHR systems. 2018 As of December 2015, more than 482,000 health care providers received a total of over $31 billion in payments for participating in the Medicare and Medicaid EHR Incentive Programs. 2022 Eligible hospitals could earn over $2 million through the Medicare EHR Incentive Program, and the Medicaid program made available up to $63,500 for each eligible professional (through 2021) and over $2 million to each eligible hospital. 22 11 03/17/2024 2010–Present: Health Care Reform & HIT Growth Other Health Information Technology for Economic and Clinical Health (HITECH) Programs o Health Information Technology for Economic and Clinical Health (HITECH) funded sixty-two regional extension centers (RECs) throughout the nation to support providers in adopting and becoming meaningful users of electronic health records (EHRs). o The education-based programs included curriculum development, community college consortia, competency examination, and university-based training programs, with the overarching goal of training an additional forty-five thousand HIT professionals. o provided state grant to help build the infrastructure for secure exchange of health information among providers and between providers and consumers. 23 2010–Present: Health Care Reform & Health information technology (HIT) Growth Affordable Care Act: 2010 in 2010 president Obama signed the Patient Protection and Affordable Care Act (PPACA) known as the Affordable Care Act (ACA) in an attempt to achieve the simultaneous triple aims to: Improve patient experience of care, Improve the health of populations, 2015 2015: Medicare Access and CHIP Reauthorization Act (MACRA) Value-based payment methods Alternative payment methods 2022 The final assessment of the success of (Affordable Care Act) ACA is still unknown, however it heavily relies on quality health information technology (HIT). reduce per capita cost of health care 24 12 03/17/2024 Interoperability Definition The ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user HIT Interoperability Efforts ▸ it remains hard to achieve. ▸ Connect: electronic health records (EHRs), health information technology (HIT), home health monitoring systems, telehealth, and large public health databases at state and national levels. ▸ US: the Office of the National Coordinator for Health Information Technology (ONC) published a ten-year plan for achieving health information technology (HIT) interoperability in the US. The goal for 2024 is nationwide interoperability. 25 Interoperability Organizations Health Level Seven International (HL7): focused on technical standards for health information exchange HL7 Fast Healthcare Interoperability Resources (FHIR): standards introduced in 2012 and are under development to improve the exchange of EHR data Sequoia Project: focused on legal and policy barriers associated with nationwide interoperability Common well Health Alliance: a consortium of health information technology (HIT) vendors and organizations who are committed to achieving interoperability. Started in 2013 with six EHR vendors, In 2015, their membership represented 70% of hospitals. 13 03/17/2024 Qatar’s E-Health Program Mission & Goals “Ministry of Public Health.” Ministry of Public Health , www.moph.gov.qa/english/strategies/Supporting-Strategies-andFrameworks/NationalEHealthAndDataManagementStrategy/Pages/default.aspx. 27 Barriers of Interoperability like a jigsaw puzzle with multiple public and private organizations working on different pieces. Concerns about the misalignment of incentives for achieving interoperability remain. Governance and alignment of agendas among disparate organizations NOT technology Health information blocking: occurs when persons or entities knowingly or unreasonably interfere with the exchange or use of electronic health information 14 03/17/2024 Videos Resources AMIA Video: The Promise of Reducing Medical Errors https://www.amia.org/why-informatics/promise-reducingmedical-errors AMIA Video: Why Informatics: https://www.amia.org/why-informatics2 1 3 2 AMIA Video: The Art and Science to Transform Care https://www.amia.org/why-informatics/art-andscience-transform-care 29 Summary 1990’s: The Call for HIT IOM HIPAA 2000 – 2010: The Arrival of HIT HITECH Act Value-based & alternative payment programs 2010 – Present: Health Care Reform and the Growth of HIT Interoperability 30 15 03/17/2024 Conclusion 16 01/08/2024 HCMT 2001 Hospital Functions and Management Topic 2: Healthcare data www.udst.edu.qa Future trends: how does 2050 looks like? https://www.youtube.com/watch?v=6_q_LHq85Cs 1 01/08/2024 Lecture 3 3 Reality Check 90% of centers in the Gulf have no systems 90% of hospitals in the Gulf have no sharing of data 95% of medical practice are reactive, and not proactive More than 95% of medical facilities do not take decisions as a team Medical History? What is that? Population health statistics? Are you joking? Lecture 3 4 2 01/08/2024 Lecture 3 5 How do you want a human doctor to give you good results with no data??? Lecture 3 6 3 01/08/2024 Lecture 3 7 We have advanced technologies for everything Except … For our health! Lecture 3 8 4 01/08/2024 Lecture 3 9 First, understand that Health data extends life Where is your visit history? Doctor notes? Shared between doctors? Stats on your health development? Charts? Population stats? Disease outbreak? Vaccination records? Allergies management? Lab results? Medications? Lecture 3 10 Step 1 Capture health data, accurately, completely Make the data accessible 5 01/08/2024 Lecture 3 11 Electronic Health Records A repository of information about a single person in a medical setting, including clinical, demographic and other data. Goals: 1. Present complete and accurate information about a client’s health to healthcare providers 2. Provide better and easier accessibility to health records 3. Empower clients to take a more active role in their health Lecture 3 12 6 01/08/2024 Lecture 3 What to include? 1. Provider Documentation: Health care provider documentation, including details of current care and response to treatment 3. Pharmacy: Pharmacy notes, prescription records, and medication administration records 2. Ancillary Services: Documentation of additional services for related care, including laboratory reports, radiology reports, and nutrition assessments 4. Reports/Correspondence: Other reports and correspondence 13 14 Lecture 3 Some System Requirements 1. Supports structured data collection using a defined medical vocabulary. 2. Accessible at any or all times by authorized individuals. 3. Contains a problem list – patient’s clinical problems and current status 4. States the logical basis for all diagnoses documenting the clinical rationale for decisions about the management of the patient’s care. 5. Can be linked with other clinical records of a patient—from various settings and time periods. 6. Can assist the process of clinical problem solving by providing clinicians with decision analysis tools, clinical reminders, prognostic risk assessment and other clinical aids. 7. Can be linked to both local and remote databases of knowledge, literature and bibliography or administrative databases and systems so that such information is readily available to assist practitioners in decision making. 8. Addresses patient data confidentiality. 9. Can help practitioners and health care institutions manage the quality and costs of care. 7 01/08/2024 Lecture 3 15 Interoperable Systems Lecture 3 16 Interoperable 1. Administrators 2. Doctors 3. Insurance 4. Policy Makers 5. MOPH 6. Researchers 7. Other health centers 8. Smart tools Decision support systems Learning tools Analytics 8 01/08/2024 Lecture 3 17 System Modules Reception Call Center Electronic Medical Record Physicians Laboratory / Radiology Pharmacy Finances Insurance Lecture 3 18 9 01/08/2024 Lecture 3 19 Lecture 3 20 10 01/08/2024 Lecture 3 21 Lecture 3 22 11 01/08/2024 Lecture 3 23 Lecture 3 24 12 01/08/2024 Lecture 3 25 Lecture 3 26 13 01/08/2024 Lecture 3 27 Lecture 3 28 14 01/08/2024 Lecture 3 29 Lecture 3 30 Goal Improve patient care 15 01/08/2024 Learning objectives Define health care data and information Understand the major purposes for maintaining patient records Discuss basic patient health record and claims content Discuss basic uses of health care data, including big and small data and analytics Identify common issues related to health care quality Outline Health Care Data and Information Defined Health Care Data and Information Sources What are health data and health information? Where does health data originate and why? How do health care organizations use data? When does health care data become health care information? What is the impact of the trend toward analytics and big data on health care data? Health Care Data Uses How does the quality of health data impact its use? Health Care Data Quality 32 16 01/08/2024 What is the difference between healthcare data and healthcare information? Difference between healthcare data and heathcare information? Often used interchangeably but there is a distinction. Health information is processed health data. Health care data: raw health care facts, stored as characters, words, symbols, measurements or statistics. When unprocessed, they are generally not very useful for decision making. processing broadly covers everything from formal analysis to explanations supplied by the individual decision maker’s brain. knowledge is defined as “a combination of rules, relationships, ideas, and experience.” 17 01/08/2024 Discovering knowledge from healthcare data 35 Difference between healthcare data and heathcare information? The majority of health care information created and used in health care information systems comes from entries in a patient’s health record and the information is readily matched to a specific patient. The Health Insurance Portability and Accountability Act (HIPAA) is the federal legislation that protects patient’s health information. Health information is information that: Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse Relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual. HIPAA refers to this type of information as Protected health information (PHI) 18 01/08/2024 What’s the difference between EMR vs. EHR? EMR vs. EHR The terms are often used interchangeably to describe a patient’s clinical record. Electronic medical records (EMRs) are digital versions of the paper charts. Contain medical and treatment history of the patients in one organization. some advantages over paper versions such as allowing clinicians to track patients over time, identify patients due for screenings and checkups, and check on patient progress on certain parameters. doesn’t travel easily out of the organization. Electronic Health Records (EHR) have: the same advantages of electronic medical record (EMR) and more. focus on the total health of the patient. designed to share information with other health care providers, such as laboratories, and specialists. include decision-support capabilities beyond those of electronic medical records (EMRs). 19 01/08/2024 39 What about personal health records? Maintained by the individual to track personal health care information. It is not the same as a health record maintained by a health care organization or provider and does not constitute a legal document of care. Differences in Scope of Care: Episode of Care: refers to the services provided to a patient with a specific condition for a specific period of time. Continuum of Care: a concept involving a system that guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity of care. Population Health: the concept behind managing population health is to improve health outcomes within defined communities 20 01/08/2024 What are the purposed of patient records? Purpose of Patient Records Patient care: The number one reason for maintaining patient records. Patient records provide the documented basis for planning patient care and treatment for a single episode of care and for care continuum. Communication: health care professionals within an organization and across different organizations use patient records to communicate with one another about patient needs. Legal documentation: patient records are legal documents because they describe and document care and treatment. The record is considered the primary evidence in the event of a law suit or other legal action involving patient care. 21 01/08/2024 Purpose of Patient Records Billing and reimbursement: patients and payers use patient records to verify billed services. Research and quality management: patient records are used in research in order to monitor the quality of care provided in large academic medical centers as well as other health care organizations. Population health: health record information is used to monitor population health, assess health status, measure utilization of services, track quality outcomes and monitor adherence to evidencebased practice guidelines. Public health: patient records are used by federal and state public health agencies to inform policies and procedures to ensure they protect citizens from unhealthy conditions.. Components Patient Records ▸ ▸ ▸ ▸ Identification screen: information originates at the time of admission. Contains the patient’s main identification data. Recorded by the physician and coded by administrative personnel. Problem list: identifies significant illnesses and operations the patient has experienced. The list is generally maintained over time. Patient Records as Legal Documents ▸ ▸ Medication record: also called a medication administration record. It lists medicines prescribed for and subsequently administered to the patient as well as medication allergies. Physician’s orders: directions, instructions or prescriptions given to other members of the health care team regarding the patient’s medication, tests, diets, procedures and treatments. ▸ History and physical: The history component consists of any major illnesses and surgeries the patient has had, significant family history, health habits, and current medication. The history is reported by the patient. The physical component is recorded by the physician upon hands-on examination. Progress notes (SOAP): made by different staff members caring for the patient. They reflect the patient’s response to treatment along with the provider observation and plans for continued treatment. Consultation: opinions about the patient’s condition made by another health care provider inside or outside a particular health organization at the request of the attending physician or primary care provider 44 22 01/08/2024 Components Patient Records ▸ ▸ ▸ ▸ Imaging and x-ray reports: the radiologist interprets the radiology images and the interpretations or findings are documented in the patient’s record. Laboratory reports: contain results of tests conducted on body fluids, cells and tissues. Lab personnel document the lab results into the patient record. Consent & authorization forms: consent forms are signed by the patient before treatment takes place are an important aspect of the use of patient records as a legal documents. Patient Records ▸ ▸ Pathology reports: documented by the pathologist, describe tissue removed during any surgical procedure and the diagnosis based on examination of that tissue. Discharge summary: summarizes the hospital stay, including the reason for admission, significant findings from tests, procedures performed, therapies provided, responses to treatments, condition at discharge, and instructions for medications, activity, diet, and follow-up care. Operative reports: documented by the surgeon, it describe any surgery performed and lists the names of surgeons and assistants. 45 AI monitoring patients What do you think? AI and monitoring of patients? https://www.youtube.com/ watch?v=qetKUFDDF4A Maybe we should do like China for patients: https://www.youtube.com/ watch?v=JMLsHI8aV0g 46 23 01/08/2024 Components of Patient Records 47 Components Claims ▸ ▸ Health care information is stored as part of the patient record, and is used by health care organizations for billing. Accounting/Billing departments are responsible for: ▹ ▹ Verify insurance coverage Bill third party payers (private insurance companies, Medicare, or Medicaid). One of two billing standards is submitted to the third party payer depending on the type of service provided to the patient. ▹ ▹ ▸ UB-04/CMS-1450 (referred to as 837I) for inpatient, hospital-based outpatient, home health care, and long-term care services. CMS-1500 (referred to as 837P) for health care provider services, such as those provided by a physician’s office Payments are processed upon receipt. 48 24 01/08/2024 EHR Information Screen 49 EHR Problem List 50 25 01/08/2024 EHR Progress Notes 51 EHR Lab Report 52 26 01/08/2024 Codes Diagnostic and Procedural ▸ ▸ Diagnostic and procedural codes are captured during the patient encounter for tracking clinical progress but also for billing, reimbursement and other administrative purposes. Two major coding systems are employed: ▹ ICD-10 (International Classification of Diseases) ▹ CPT (Current Procedural Terminology) 53 Codes Diagnostic and Procedural ▸ ICD-10 (International Classification of Diseases) ▹ ▹ ▹ ▹ Derived from the International Classification of Diseases, Tenth Revision, which was developed by the World Health Organization (WHO). The precursors to the current International Classification of Diseases (ICD) systems were developed to enable comparison of morbidity and mortality statistics across nations. Over the years this coding evolved to ICD-10-CM (Clinical Modification) which plays a major role in reimbursement to health care institutions. Accurate ICD10 coding is vital to accurate institutional reimbursement. Procedure information is similarly coded using the ICD-10-PCS (Procedural Coding System). 54 27 01/08/2024 Codes Diagnostic and Procedural ▸ ICD-10 (International Classification of Diseases) 55 Codes Diagnostic and Procedural CPT (Current Procedural Terminology) First developed and published in 1966, the stated purpose was to provide a uniform language for describing medical and surgical services. In 1983, however, the government adopted Current Procedural Terminology (CPT), in its entirety, as the major component of the Healthcare Common Procedure Coding System (HCPCS) Since then Current Procedural Terminology (CPT) has become the standard for physician’s office, outpatient, and ambulatory care coding for reimbursement purposes. There are official guidelines for accurate Current Procedural Terminology (CPT) coding, and health care facilities that do not adhere to these guidelines are liable to charges of fraudulent coding practices. 28 01/08/2024 Data Analysis Databases and Data Warehouses 57 Data Analysis Patient records are a rich source of health care data. Before health care data can be used it must be stored and retrieved. Health care data must be processed to become information. The level of required processing differs based on the application. 58 29 01/08/2024 Data Analysis Four basic elements of data analysis ▸ Source of data ▸ Data must be stored in a retrievable manner ▸ Analytical tool applied to the stored data ▹ ▹ ▹ ▸ EHR, claims data, laboratory data, etc. Database or data warehouse Mathematical statistics, probability models, predictive models, etc. Reported in a usable manner 59 Databases and Data Warehouses ▸ ▸ A database refers to any structured, accessible set of data stored electronically. A data warehouse differs from a database in its structure and function. In health care data warehouses derived from health care information are called clinical data repositories ▹ ▹ ▹ The data from a data warehouse comes from a variety of sources. The data from the sources are extracted, “cleaned,” and stored in a structure that enables the data to be accessed along multiple dimensions, such as time (e.g., day, month, year); location; or diagnosis. Data warehouses help organizations transform large quantities of data from separate transactional files or other applications into a single decision-support database. 60 30 01/08/2024 Small v. Big Data ▸ ▸ ▸ Data stores and data analytics are not new to health care, but the speed by which the data is analysed and new information is discovered increased tremendously. Small Data ▹ Comparable to a filing cabinet ▹ Static Big Data characterized by the three Vs (Volume, Variety, Velocity) ▹ Comparable to a conveyor belt ▹ Volume ▹ Variety ▹ Velocity ▹ Veracity (accuracy) Sacristan, Jose & Dilla, Tatiana. (2015). No big data without small data: Learning health care systems begin and end with the individual patient. Journal of Evaluation in Clinical Practice. 10.1111/jep.12350. 61 Small data ▹ ▹ Disease and Procedure Indexes: contained summary information about a particular disease or treatment. Prior to EHR were card catalogues or books that kept track of disease and treatment counts. Now the disease and procedure index is handled as a EHR component. The retrieval information is based on ICD and CPT codes. Health Care Statistics: Utilization and performance statistics are routinely gathered for health care executives. Two types of statistics related to patient stay are routinely captured and reported: ▹ ▹ Census statistics: reveal the number of patients present in a facility at any time. Discharge statistics: calculated from fata accumulated when patients are discharged. 62 31 01/08/2024 Big data ▹ ▹ ▹ collected from a variety of sources (EHRs, internal databases, data warehouses, as well as the availability of data from the growing volume of other health-related sources, such as diagnostic imaging equipment, aggregated pharmaceutical research, social media, and personal devices such as Fitbits and other wearable technologies) ▹ Novel analytics that are being developed to analyze this data: The focused is no longer primarily on inpatient care, which resulted in data accumulating from hospitals, physician practices, long-term care facilities, the patient, and so on. Wide range of uses across multiple industries and efforts. For example, data on online social sites provides support communities, and contains knowledge that can be mined for research and other health-related activities. ▹ Post-market surveillance of medication and device safety ▹ Comparative effectiveness research (CER) ▹ Assignment of risk, for example, readmissions ▹ ▹ ▹ ▹ Novel diagnostic and therapeutic algorithms in areas such as oncology Real-time status and process surveillance to determine, for example, abnormal test follow-up performance and patient compliance with treatment regimes Determination of structure including intent, for example, identifying treatment patterns using a range of structured and unstructured and EHR and non-EHR data Machine correction of data-quality problems 63 Big data Impact of applying analysis to big data: ▹ Big data initiatives ->$300 to $450 billion in reduced health care spending, or 12 to 17 percent of the $2.6 trillion baseline in US health care costs. 64 32 01/08/2024 Big data: Five areas of analytics that will be crucial: ▹ ▹ ▹ ▹ ▹ Population management analytics. Producing a variety of clinical indicator and quality measure dashboards and reports to help improve the health of a whole community, as well as help identify and manage at-risk populations Provider profiling/physician performance analytics. Normalizing (severity and case mix–adjusted profiling), evaluating, and reporting the performance of individual providers (PCPs and specialists) compared to established measures and goals Point of care (POC) health gap analytics. Identifying patient specific health care gaps and issuing a specific set of actionable recommendations and notifications either to physicians at the point of care or to patients via a patient portal or PHR Disease management. Defining best practice care protocols over multiple care settings, enhancing the coordination of care, and monitoring and improving adherence to best practice care protocols Cost modeling/performance risk management/comparative effectiveness. Managing aggregated costs and performance risk and integrating clinical information and clinical quality measures 65 Vioxx example An analysis of the cumulative sum of monthly hospitalizations because of myocardial infarction, among other clinical and cost data, led to the discovery of arthritis drug Vioxx’s adverse effects and its subsequent withdrawal from the market in 2004 https://www.youtube.com/watch?v=SpT7g3lk5BI 66 33 01/08/2024 Healthcare Data Quality ▸ Depends on the use of the data ▹ Traditionally: ▹ ▹ Patient Clinical/Claim Records were used primarily for ▹ Document episodic care ▹ Generally from a single organization Today: ▹ ▹ ▹ Care providers, care coordinators, analysts, and researchers are all looking to EHR/Electronic Claims Record as a continuous source of data instead of episodic. Criteria for quality has shifted the criteria against which quality is measured will change depending on the product, service, or use. 67 Healthcare Data Quality ▸ ▸ ▸ ▸ EHRs were mainly developed as patient records whose purpose was to document and communicate episodes of patient care. Today they are evaluated as a source of data for complex data analytics and clinical research. Clinicians prefer entering unstructured data to the system (write notes), while structured data is better for research purposes. The discussion on which type to adopt will likely continue. Missing EHR data are problematic and are due to one of two reasons: ▹ Data was not collected ▹ Documentation was not complete or was not done properly. Two frameworks for evaluating health care data quality. The first was developed by the American Health Information Management Association (AHIMA) and the second is the Weiskopf and Weng framework. 68 34 01/08/2024 American Health Information Management Association (AHIMA) ▸ Developed and published as set of health care data quality characteristics: ▹ Accuracy: reflected values are correct and valid ▹ Accessibility: data must be available to the decision makers needing them ▹ Comprehensiveness: all required data must be present and available to the user ▹ Consistency: data must be consistent, an example is the use of abbreviations ▹ Currency: most data becomes obsolete after a period of time ▹ Definition: a clear definition of data elements must be provided ▹ Granularity: individual data elements are atomic (cannot be divided) ▹ Precision: relates to numeric data: closeness to the actual value ▹ Relevancy: data must be relevant to the purpose for which they were collected. ▹ Timeliness: lab results for example, must be present to the physician in a timely manner 69 Weiskopf and Weng Definition ▸ Identifies five dimensions of Electronic health record (EHR) data quality: ▹ Completeness: Is the truth about a patient present? ▹ Correctness: Is an element that is in the EHR true? ▹ ▹ ▹ ▸ Concordance: Is there agreement between elements in the EHR or between the EHR and another data source? Plausibility: Does an element in the EHR make sense in light of other knowledge about what that element is measuring? Currency: Is an element in the EHR a relevant representation of the patient state at a given point in time? The authors further identified completeness, correctness and currency as “fundamental”, while concordance and plausibility and proxies. 70 35 01/08/2024 Healthcare Data Quality Strategies for Minimizing Data Quality Issues 71 Videos Resources AMIA Video: The Promise of Reducing Medical Errors https://www.amia.org/why-informatics/promise-reducingmedical-errors AMIA Video: Why Informatics: https://www.amia.org/why-informatics2 1 3 2 AMIA Video: The Art and Science to Transform Care https://www.amia.org/why-informatics/art-andscience-transform-care 72 36 01/08/2024 Conclusion Value of Health Care Data and Information Importance of Health Care Data and Information Sources Uses and Analysis of Health Care Data Assurance of Health Care Data Quality 37 3/17/2024 HCMT 2001 Hospital Functions and Management Topic 3: Health Care Information Systems (HCIS) www.udst.edu.qa Learning Objectives Identify the major types of administrative and clinical information systems used in health care Give a brief explanation of the history and evolution of health care information systems Discuss the key functions and capabilities of electronic health record systems and current adoption rates in hospitals, physician practices and other settings Describe the use and adoption of personal health records and patient portals Discuss current issues pertaining to the use of HCIS systems including interoperability, usability, and health IT safety 1 3/17/2024 Outline Administrative v. clinical information systems Brief history of health care information systems Electronic (EHR) and personal (PHR) health records EHR adoption rates Value of EHR systems Key issues related to EHR systems 3 What’s the difference between information system and information technology? 2 3/17/2024 A few definitions ▸ Information System (IS): an arrangement of data (information), processes, people, and information technology that interact to collect, process, store, and provides as output the information needed to support the organization. ▸ Information Technology (IT): a contemporary term that describes the combination of computer technology (hardware and software) with data and telecommunications technology (data, image, and voice networks). 5 Ancient Egypt Provider Organization: is the hospital, health system, physician practice, integrated delivery system, nursing home, or rural health clinic. 3 3/17/2024 2 information systems Administrative ▸ Administrative: contains administrative or financial data, usually used to support the management functions. It includes the following: ▹ Charge capture ▹ Coding and documentation review ▹ Managed care contracting ▹ Denial management of claims ▹ Payment posting ▹ Accounts receivable follow-up ▹ Patient Collections ▹ Reporting and benchmarking 7 2 information systems Clinical ▸ Clinical: contains clinical or health related information. ▹ May be departmental systems (radiology, pharmacy, etc.). ▹ May be decision support (medication administration, EHR systems, etc.). ▹ They can be limited in scope to a single area or comprehensive and cover all aspects of patient care. 8 4 3/17/2024 Characteristics Example of the two primary information systems 9 Characteristics Example of the two primary information systems 10 5 3/17/2024 History and Evolution 1970 1960 1960s:the technological advances and environmental impact changed the development and use of information systems dramatically. 1960s – 1970s: health care executives invested primarily in administrative and financial information systems that could automate the patient billing process and facilitate accurate Medicare cost reporting. Administrative applications were generally only used in large hospitals. These applications were often developed in-house, and ran on mainframe computers. Smaller hospitals could not bear the cost, which led vendors to offer shared systems between small hospitals for computer time and storage. 1970s: with the development with minicomputers, departmental systems started to be developed. 1980 1980s: the development of microcomputers or personal computers was a significant turning point in the use of health care information systems. The change in reimbursement practices also had a big impact. The development of local area network facilitated sharing information among microcomputers. 11 History and Evolution 1990 1990s: the evolution and widespread use of the internet and e-mail were the most profound technological advances of the era. The institute of medicine published its first computer based patient records (PCRs) which was the precursors of today’s EHR. 2000 2000s: the Institute of Medicine (IOM) published a report that stated that 44000 to 98000 patients die each year due to medical errors. Other reports stated that these figures are underestimated. A subsequent report called for health care providers to adopt information technology to help prevent and reduce error. 2009 2009: the US government launched an “unprecedented effort to reengineer” the way we capture, store and use health information. This effort was realized in the Health Information Technology for Economic and Clinical Health (HITECH) Act. Nearly $30 billion was set aside over a ten-year period to support the adoption and Meaningful Use of EHRs and other types of health information technology with the goal of improving health and health care. 12 6 3/17/2024 History and Evolution 13 Example of a medical technology https://www.youtube.co m/watch?v=hyK7G2X1 6Ng&t=76s https://www.youtube.co m/watch?v=sKDbp8UJmE 7 3/17/2024 Features of EHR Features and Functions Electronic Health Records Electronic health records (EHRs) allow direct input into a computerized provider order entry (CPOE) system and advise health care practitioners 16 8 3/17/2024 What is CPOE? Computerized provider order entry (CPOE) is a computer application that accepts provider orders electronically, replacing handwritten and verbal orders. CPOE provide physician with decision support capabilities that would minimize error. 17 Features and Functions Electronic Medical Record Systems in Qatar The current implementation of a single, Electronic Medical Record (EMR) system across all Hamad Medical Corporation (HMC) hospitals and Primary Health Care Corporation (PHCC) sites is the best example of the financial and organizational commitment of these entities to automate their clinical processes and digitize their health data. 18 9 3/17/2024 19 Patient Portals in Qatar ▸ A patient portal is a secure website ▸ Patients can electronically access their medical records ▸ Schedule appointments ▸ Communicate with providers ▸ Request refills on prescriptions ▸ Review test results ▸ Pay bills ▸ Some providers allow scheduling e-visits 20 10 3/17/2024 Personal Health Account (PHA), Qatar’s EHealth Program “Ministry of Public Health.” Ministry of Public Health , www.moph.gov.qa/english/strategies/SupportingStrategies-and-Frameworks/NationalEHealthAndDataManagementStrategy/Pages/default.aspx. 21 Personal Health Account (PHA), Qatar’s E-Health Program ▸ ▸ ▸ ▸ The National Health Strategy has as one of its main goals: enhancing the wellness of the people of Qatar so that a vibrant, healthy, and productive society can be established for today, and for the future. Individuals need to be engaged and empowered to manage their own health status and that of other people they may be responsible for. This is the principal purpose of the Personal Health Account (PHA), which forms the primary focus of this strategy. The PHA will not only provide the desired single point of interaction between individuals and their health data and services, it will also act as the primary guide to decisions and priorities to be made by the national E-Health Program. “Ministry of Public Health.” Ministry of Public Health , www.moph.gov.qa/english/strategies/SupportingStrategies-and-Frameworks/NationalEHealthAndDataManagementStrategy/Pages/default.aspx. 22 11 3/17/2024 Did you know that… 5% of consumers use PHRs in 2008 and the number reached 17% in 2013. PHR use will increase significantly within the next decade. Did you know that… PHRs and personal health applications can positively affect medication adherence and quality of life for patients with chronic diseases. 12 3/17/2024 Did you know that… Initially envisioned as a tool to enable individuals to keep their own health records , share their information with health care professionals and receive customized content based on needs, values, and preferences Personal Health Records(PHR) ▸ ▸ PHRs should be lifelong, comprehensive, support information exchange and portability Reduce costs by avoiding unnecessary duplicate tests and improving communications 26 13 3/17/2024 Personal Health Records(PHR) ▸ Person-generated health data (PGHD) technologies ▹ ▹ ▹ Mobile technologies and applications to capture health and wellness Step trackers, web-based food diaries, networked weight scales, blood pressure machines Consumers use social media networks to connect with others sharing similar conditions. 27 EHR Adoption Rates in US Hospitals 28 14 3/17/2024 EHR Adoption Rates in US Hospitals ▸ ▸ In 2015, nearly 84% of US non-federal acute care hospitals had adopted EHR. This accounts for a nine fold increase since 2008. EHR adoption among specialty hospital’s is lower than general medicine hospitals (55% children, 15% psychiatric hospitals), because these hospitals were not eligible for Health Information Technology for Economic and Clinical Health Act (HITECH) incentive payments. 29 EHR Adoption EHR adoption use and characteristics among office-based physician practices in the US EHR Adoption in Office-Based Physician Practices 30 15 3/17/2024 EHR Adoption EHR Adoption in Office-Based Physician Practices ▸ There is significant increase in EHR adoption in office-based physician practices. By 2014, 79% of primary care physicians, and 70% of medical and surgical specialties had adopted a certified EHR systems. ▸ 98% of physicians in community health centers had adopted EHR. Physicians in solo and small group practices were less likely to have adopted EHR systems. 31 EHR Adoption EHR Adoption in Other Settings Resnick, H. E., & Alwan, M. (2010). Use of health information technology in home health and hospice agencies: United States, 2007. Journal of the American Medical Informatics Association, 17(4), 389-395. 32 16 3/17/2024 EHR Adoption EHR Adoption in Other Settings ▸ ▸ ▸ Less is known about EHR adoption in settings other than hospitals and physician practices. The latest national estimate dates to 2007 indicates that 44% of home health and hospice agencies have adopted EHR systems. EHR adoption in long-term care facilities in New York is 56.3% of 473 nursing homes. Facilities that did not have EHR indicated that the biggest barriers are initial cost, lack of IT staff and the lack of fiscal incentives. Resnick, H. E., & Alwan, M. (2010). Use of health information technology in home health and hospice agencies: United States, 2007. Journal of the American Medical Informatics Association, 17(4), 389-395. 33 What do you think is the impact of EHR on healthcare quality? 17 3/17/2024 EHR Adoption Impact of EHR 35 EHR Adoption Impact of EHR ▸ The major benefits of using EHR fall in one of three categories: ▹ Quality, outcomes and safety ▹ ▹ ▹ Impacts on quality are: increased adherence to evidence-based care, enhanced surveillance and monitoring, and decreased medication error. 59% of studies that examined the impact of IT on patient quality and safety demonstrated positive effects, 25% had mixed-positive outcomes, 9% were neutral and 8% were negative. Hospitals adopting EHR experienced a 27% reduction in reported patient safety events, 30% decline in medication error and 25% decline in procedurerelated errors 36 18 3/17/2024 Do you think doctors want their patient to access their health record? EHR Adoption Limitations and Need for Further Research 38 19 3/17/2024 EHR Adoption Limitations and Need for Further Research ▸ ▸ ▸ Not all studies reported positive outcomes from using EHR systems. The same EHR system can be implemented in different organizations and have different results. Two children’s hospitals implemented the same EHR system in their pediatric intensive care units. One experienced a significant increase in mortality and the other did not. 39 Challenges again... 20 3/17/2024 Key Issues & Challenges HCIS 1. Interoperability 41 Key Issues & Challenges HCIS 2. Usability ▹ Clinicians often express frustration with the usability of EHR systems. 55% of physicians reported that it was difficult or very difficult to use. Common frustration include: ▹ Confusing displays ▹ Iconography that lacks consistency ▹ Intuitive meaning ▹ The feeling that systems do not support clinicians’ cognitive workflow. ▹ The effectiveness, efficiency, and satisfaction with which the intended users can achieve their tasks in the intended context of product use ▹ Poor usability does not only result in physician frustration but can lead to error and patient safety concerns Howe JL, Adams KT, Hettinger AZ, Ratwani RM. Electronic Health Record Usability Issues and Potential Contribution to Patient Harm. JAMA. 2018;319(12):1276–1278. doi:10.1001/jama.2018.1171 42 21 3/17/2024 Key Issues & Challenges HCIS 2. Usability ▸ Key recommendations for critical usability issues: ▹ Usability and human factors research ▹ Policy recommendations ▹ Industry recommendations, ▹ Clinical end user recommendations Howe JL, Adams KT, Hettinger AZ, Ratwani RM. Electronic Health Record Usability Issues and Potential Contribution to Patient Harm. JAMA. 2018;319(12):1276–1278. doi:10.1001/jama.2018.1171 43 Key Issues & Challenges HCIS 3. Health IT Safety ▹ The institute of medicine published a report suggesting that safety is a shared responsibility between vendors and health care organizations. It requires: ▹ Building systems using user-centered design principles with adequate testing and simulation ▹ Embedding safety considerations throughout the implementation process ▹ Developing and publishing best practices ▹ Having accreditation agencies (such as the Joint Commission) assume a significant role in testing as part of their accreditation criteria ▹ Focusing on shared learning and transparency ▹ Creating a nonpunitive environment for reporting (IOM, 2011) 44 22 3/17/2024 Key Issues & Challenges HCIS 3. Health IT Safety ▹ ▹ Include (1) adverse events that reached the patient, (2) near misses that did not reach the patient, or (3) unsafe conditions that increase the likelihood of a safety event Measuring, monitoring, and creating an environment that is conducive to detecting, fixing, and learning from system vulnerabilities 45 Videos Resources Electronic Health Card System, Electronic Medical Record System in Chennai, India @Bloom1: https://www.youtube.com/watch?v=zX4A8vi1bBE 1 2 EMR Movie: Electronic Medical Records Hawaii https://www.youtube.com/watch?v=3sBe3rdisRo 46 23 3/17/2024 Summary ▸ Two main health care information systems ▹ Administrative ▹ Clinical ▸ Brief history of health care information systems ▸ Electronic health records (EHR) ▸ Personal (PHR) health records ▸ Patient Portals ▸ EHR adoption rates ▹ Higher for those eligible for HITECH incentives ▸ Value of EHR systems ▹ Safety ▹ Revenue ▹ Satisfaction ▸ Key issues related to EHR systems ▹ Interoperability ▹ Usability ▹ Health IT Safety 47 24 3/17/2024 Topic 4: Information Systems to Support Population Health Management www.udst.edu.qa Learning Objectives 1. 2. 3. Understand the data and information needs of health systems in managing population health effectively under value-based payment models Discuss the application and use of data analytics to monitor, predict, and improve performance Discuss key health IT tools and strategies for population health management including EHRs, registries, risk stratification, patient engagement, and outreach, care coordination and management, analytics, health information exchange, and telemedicine and telehealth 1 3/17/2024 What is population health? Outline What is population health? Payment models ACO challenges Accountable care core processes Health IT capabilities Patient portals From the record to the plan 4 2 3/17/2024 What is Population Health? ▸ First appeared in 2003 ▹ ▸ The health outcomes of a group of individuals, including the distribution of such outcomes within the group Today ▹ Comprises the proactive application of strategies and interventions to defined groups of individuals to improve the health of individuals within the group at a lower cost ▹ Interventions are designed to maintain and improve people’s health across the full continuum of care ▹ Preventative and medical care for the “population” of patients “attributed” to the organization 5 Population Health Challenges in Qatar “Ministry of Public Health.” Ministry of Public Health - //www.moph.gov.qa/english/strategies/National-Health-Strategy-20182022/Pages/default.aspx. 6 3 3/17/2024 Priorities for Population Health in Qatar “Ministry of Public Health.” Ministry of Public Health - //www.moph.gov.qa/english/strategies/National-Health-Strategy-2018-2022/Pages/default.aspx. 7 Global Shift in Qatar’s Thinking “Ministry of Public Health.” Ministry of Public Health - //www.moph.gov.qa/english/strategies/National-Health-Strategy-2018-2022/Pages/default.aspx. 8 4 3/17/2024 Payment methods in other countries 9 Types of Payment Models ▸ Fee-for-service: emphasizes the provision of health services by individual hospitals or providers rather than care that is coordinated across providers to address the patient’s needs ▸ Value-based care: reimbursement is tied to the quality and effectiveness of the care provided. https://www.youtube.com/watch?v=5C9yruIGV4k https://www.youtube.com/watch?v=RmXpN_pH3jQ 10 5 3/17/2024 Value-based services 11 Types of value based care This approach aims to align the incentives of healthcare providers with the goals of improving patient health and delivering efficient, high-quality care. 1. Patient-centered medical home (PCMH) Agency for Healthcare Research and Quality (AHRQ) defines a medical home not simply as a place but as a model of the organization of primary care that delivers the core functions of primary health care https://www.youtube.com/watch?v=5g4uS8F-V6o 2. Accountable care organization (ACO) https://www.youtube.com/watch?v=6NAqOBS3WVE 12 6 3/17/2024 1. Patient-centered medical home (PCMH) It is care that is: 1. Comprehensive care 2. Patient-Centered 3. Coordinated care 4. Accessible services 5. Quality and Safety https://www.ahrq.gov/ncepcr/research/care-coordination/pcmh/define.html 13 1. Accountable care organization (ACO) ACO is a healthcare delivery and payment model designed to improve the coordination an quality of care for patients while controlling healthcare costs. https://www.ahrq.gov/ncepcr/research/care-coordination/pcmh/define.html 14 7 3/17/2024 Payment Models ▸ New or modified forms of payment emerged with new models of care: ▹ Bundled Payments: may take different forms, such as making a single payment for hospital and physician services instead of separate payments. https://www.youtube.com/watch?v=1sNnwvL_sO8 ▹ Pay-for-performance (P4P) programs: reward system for hospitals, physician practices, and other providers with financial and nonfinancial incentives based on performance on select measures https://www.youtube.com/watch?v=Y4X1wiST744 ▹ Shared savings programs: are intended to reward providers by paying them a bonus that is explicitly connected to the amount by which they reduce the total cost of care compared to expected levels. ▹ Capitation or global payment: places full risk with the provider organization; the provider is responsible for the costs of all care that a patient receives. ▹ Episode-of-care payment system would pay the provider organization a single payment for all of the services associated with a hospitalization or other episode of acute care, such as a heart attack, including inpatient and post-acute care 15 Qatar’s capitation ▸ Capitation or Global Payment: ▹ ▹ ▸ Involves a fixed payment per patient over a specified period. The fixed payment covers all necessary healthcare services, regardless of the specific services rendered. Episode-of-Care Payment System: ▹ ▹ Focuses on specific "episodes" or phases of care for a particular medical condition or procedure. Payment is made for the entire care episode, covering all services related to a specific medical condition or treatment. While both models aim to control costs https://dohanews.co/spending-on-overseas-healthcare-for-qatari-nationals/ https://visitworld.today/turkey/qatar-citizenship/treatment 16 8 3/17/2024 Progress to Date PCMHs: Patient-centered medical home ▸ Growing support for the PCMH has arisen across the vast majority of the US health care delivery system to include ▹ ▹ ▹ ▹ ▹ commercial insurance plans, multiple employers, state Medicaid programs, numerous federal agencies, the Department of Defense, hundreds of safety net clinics, and thousands of small and large clinical practices nationwide. The Future of Patient-Centered Medical Homes Foundation for a Better Health Care System 17 18 9 3/17/2024 Progress to Date PCMHs ▸ A growing body of scientific evidence shows that PCMHs are saving money ▹ by reducing hospital and emergency department visits, ▹ mitigating health disparities, and improving patient outcomes ▸ Examples of specific outcomes achieved by various PCMHs include the following: ▹ Lower Medicare spending ▹ More effective care management and optimized use of health care services ▹ Improved care management and preventative screenings for cardiovascular and diabetes patients ▹ Reduced socioeconomic disparities in cancer screening The Future of Patient-Centered Medical Homes Foundation for a Better Health Care System 19 Progress to Date ACOs: Accountable care organization ▸ ▸ In the value-based care world, ACOs are expected to play a leadership role in improving population health. Although there has been considerable debate among policymakers as to the success of the ACO model, some of these ACOs are already reporting positive results for improving patient outcomes and controlling costs. Accountable Care Contracts And Lives Covered Over Time IN USA 20 10 3/17/2024 ACO Challenges ▸ Working across organizational boundaries ▸ Building the requisite infrastructure for effective data sharing ▸ Truly engaging patients in the care process ▸ Alignment and consolidation of quality measures being used in public and private programs ▸ Quality metrics may not accurately measure the overall health of the patient, making it difficult to assess the true impact and efficiency of ACO arrangements 21 Reactive vs. proactive leadership 22 11 3/17/2024 Implications for Health Care Leaders ▸ Health care delivery is changing from reactive care to a model of health management. The transformation poses challenges for providers and has implications on for today’s health care leaders by ▹ ▹ Keeping patients well and managing and preventing disease ▹ Creating a care culture that is comfortable with change and ongoing automation ▹ ▹ Engaging patients in managing their care and overall health Establishing more efficient organization and utilization of care teams and venues of care Ensuring the most cost-effective care is provided and that clinical processes are streamlined and follow the best evidence 23 24 12 3/17/2024 Implications for Health Care Leaders ▸ Industry perspectives and health care delivery practices need to shift from ▹ ▹ ▹ ▹ ▹ ▹ ▹ ▹ ▹ Care providers working independently to collaborative teams of providers Treating individuals when they get sick to keeping groups of people healthy Emphasizing volumes to emphasizing outcomes Maximizing the use of resources and assets to applying appropriate levels of care at the right place Offering care at centralized facilities to providing care at sites convenient to patients Treating all patients the same to customizing health care for each patient Avoiding the sickest chronically ill patients to providing special chronic care services Being responsible for those who seek services to being responsible for the needs of the community Putting forth best efforts to becoming high-reliability organizations 25 Core Processes Accountable Care ▸ Accountable care frameworks are based on risk and reward: ▹ providers and organizations agree to share the risk for the opportunity to access reward on meeting quality and cost goals ▸ To manage population health effectively, an organization must be able to track and monitor the health of individual patients, while also stratifying its population into subgroups that require particular services at specified intervals. 26 13 3/17/2024 Core Processes Accountable Care ▸ ▸ Stratification ▹ The ability to identify a patient or cohort at risk for a negative health event or preventable health care utilization ▹ Having the ability to identify risk, alert appropriate stakeholders, and intervene in the care process at the right time Care Management ▹ Patient-centered management and coordination of care events and activities in multiple care settings by one or more providers ▹ Overall aim is to manage the most complex patients through the health care system as well as managing the overall health of a selected population ▹ Care management ensures that all patients from the lowest risk level to high-risk “super users” receive care at the right time, in the right place, and in a manner best suited for the patient. This requires proactive care, communication, education, and outreach. 27 Core Processes Accountable Care ▸ Managing contracts and financial performance: ▹ ▹ Financial teams must have a solid ▹ handle on estimating reimbursement and associated payment distributions, ▹ carrying out predictive modeling for reimbursement contracts, ▹ measuring performance against contracts and predicting profitability, as well as integrating with other key processes to share information. To effectively manage costs, health care executives will need tools and data to support different types of financial modeling ▸Measuring, predicting, and improving performance ▹ACOs typically measure quality and outcomes data against national guidelines or peer groups, ▹they might also measure costs, utilization, and patient experience on a population-wide basis and they may use these reports as the basis for quality reporting to payer ▹Under value-based payment programs, there are real ramifications for poor care and rewards for improved care ▹Providers must forecast which patients are likely to become high-risk so they can intervene before a patient’s condition worsens ▹Retrospective monitoring: what didn’t happen and why 28 14 3/17/2024 Core Processes Accountable Care ▸ Preparation and automation is key ▹ The transition to value-based payment models relies largely on health care providers investing in the IT tools and infrastructure needed to automate and support core processes 29 Health IT Capabilities ▸ It’s all about the data ▹ ▹ Focus on data that power clinical decisions ▹ Data management Create a holistic view of the patients within a health care network (include aggregation of clinical data, claims data, administrative data and self-reported patient data) Beyond the EHR ▹ Revenue cycle systems: must complement routine activities such as registering patients, scheduling appointments, administering patient billing 30 15 3/17/2024 Health IT Capabilities 31 Qatar Health IT Capabilities 32 16 3/17/2024 Health IT Capabilities ▸ Patient engagement tools ▹ Medical interventions that occur solely through office-based patient-provider interactions will no longer provide the level of monitoring and scrutiny needed to manage the health of individuals and populations ▹ Portals ▹ ▹ Securely communicate with providers, pay bills, obtain test results, view doctors’ notes, refill prescriptions, schedule appointments, etc. ▹ Many providers are ramping up their portal efforts and seeing adoption rates well above 20 percent Social media ▹ ▹ ▹ One third of consumers use online forums and social media sites Many providers are actively engaged in using social media for patient communication Automated messaging (via text, email, or phone) ▹ Beneficial in urging patient to schedule necessary appointments, fill prescriptions, and complete discharge orders. 33 Health IT Capabilities ▸ Telemedicine/telehealth: exchanging medical information via electronic communications to improve a patient’s clinical health status ▸ Today’s telehealth framework can include services such as: ▹ ▹ ▹ ▹ ▹ ▹ ▹ ▹ Telepsychiatry Remote image interpretation (teleradiology, teledermatology) e-Visits or televisits between providers and their patients Video visits for semi-urgent care Clinician-to-clinician consultations Critical care (virtual ICU, telestroke) Remote monitoring of a patient with a chronic disease Cybersurgery or telesurgery 34 17 3/17/2024 Health IT Capabilities ▸ The need for telemedicine is driven by many factors such as: ▹ ▹ ▹ ▹ Significant increase in the US population ▹ Lack of specialists and health facilities in rural areas and in many urban areas ▹ Avoidance of adverse events, injuries, and illnesses that can occur within the health care system ▸ Telemedicine Benefits Shortage of licensed health care professionals Increasing incidence of chronic diseases Need for efficient care of the elderly, homebound, and physically challenged patients ▸ ▹ Makes care more accessible to those with mobility issues ▹ ▹ Makes patient interactions more convenient ▹ Captures and monitors data from patients at home Expands geographic horizons where medical specialists are few in number Telemedicine Concerns ▹ ▹ ▹ ▹ ▹ Provider acceptance Interstate licensure Overall confidentiality and liability Data standards Lack of universal reimbursement for telemedicine services 35 Patient Portal Adoption ▸ Top tips for patient portal adoption (KLAS) ▹ ▹ ▹ ▹ ▹ ▹ Educate patients Educate patients—again and again Educate staff members as if they were patients Give patients a reason to use the portal Talk to your vendor and physicians Hold your vendor accountable 36 18 3/17/2024 Patient Portal Adoption 37 Use of Social Media ▸ 5 reasons to “like” consumers’ use of social media 1. 2. 3. Creates a sense of community 4. Provides assistance with treatment, physician, or hospital selection 5. Complements traditional approaches to measure patient satisfaction Delivers new clinical research insights Builds awareness of cause-related issues or personal health care crises 38 19 3/17/2024 From the Record to the Plan ▸ Changes in reimbursement and care models are leading to significant changes in organization, practice and the fundamental nature and design of EHR itself. ▹ ▸ These changes can be characterized as a transition from the electronic health record to the electronic health plan. All people have a foundational plan, if the person is a healthy young man the plan may be simple. ▸ ▹ Traditional EHR capabilities will remain but the emphasis will shift to technologies and applications that assist the care team. Plans are a combination of medical care strategies with goals to maintain health ▹ ▸ Every patient’s EHR should clearly display a long term care plan to maintain health integrated with short-term plans for transient conditions. On top of foundational plans there may be a transient plan ▹ People who have a common plan are members of the same population ▹ Risk is the likelihood that the plan will not be followed or result in desired outcomes ▹ Not all care is amenable to a predefined patient plan ▹ Plans should be based on the evidence of best care and health practices ▸ Care plan attributes 39 From the Record to the Plan ▸ Plan-centric EHR ▹ ▹ A library of plans that cover a wide range of situations Algorithms to form a patient’s master plan ▹ ▹ ▹ ▸ Identifies conflicts and redundancies Highlights the care steps that optimize a patient’s health for all plans Team-based ▹ ▸ Creates a single plan Includes steps to be carried out by the patient’s primary care provider, specialists, nurse practitioners, pharmacists, case managers, and the patient Business model shift ▹ A shift from applications focused on the patient’s record to applications focused on the patient’s plan for health 40 20 3/17/2024 Videos Resources 1 Deep dive into how Philips uses analytics to inform Population Health Management https://www.youtube.com/watch?v=bGtA1MctS60 41 Summary What is population health? Payment models Patient-centered medical home (PCMH) Accountable care organization (ACO) ACO challenges Health IT capabilities Analytics Business intelligence Health information exchange (HIE) Patient engagement tools (patient portals, social media, etc.) Telemedicine/telehealth Accountable care core processes Stratification Care management Managing contracts and financial performance Measuring, predicting, and improving performance Preparation and automation From the record to the plan Care plan attributes Plan-centric EHR Business model shift 42 21