Transcript Connecting Payers, Providers, and Patients

Connecting Payers, Providers, and Patients
A Journey of Innovation
John D. Halamka MD
May 28, 2012
The Need for Innovation
• Universal adoption of usable electronic
health records
• Frictionless Healthcare Information
Exchange
• Turning data into information, knowledge
and wisdom
• Engaging patients and families in ways that
add value
• Protecting privacy
Universal adoption of usable electronic
health records
•
•
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Getting the data in
The ideal form factor
Integration with workflow
Leveraging the power of the care team
Agile continuous improvement of the
products
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Patient Profile Screen
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Problems
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Medications
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Medication History and Reconciliation
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Reports
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Care Plans
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Frictionless Healthcare Information Exchange
• The “View” Approach
• The “Push” Approach
• The “Pull” Approach
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The Massachusetts Statewide
Health Information Exchange
MassHealth
DPH
BIDMC
Partners
EOHHS
Berkshire Health
System
NEHEN
NwHIN
Statewide HISP
Provider/Entity
Directory
Secure Certificate
Management
Direct Gateway
Services
Web
Portal
Audit
log
Atrius
SafeHealth
MD
Fallon Clinic
MD
MD
MD
UMass
Memorial
MD
MD
MD
MD
Basic Commonwealth HIE Services
HIE Services
Repository of physician names, entities,
affiliations, and security credentials
Provider directory
“Lookup” services
Repository of security certificates for
authorized users of HIE services
Certificate repository
DIRECT gateway
Adaptor that transforms messages from
one standard to another without
decrypting the message
“Message-handling” services
Secure, encrypted mailbox for users
without standards-compliant EHR
Web portal mailbox
Users have 2 ways to connect
HIE Services
User types
2 methods of accessing
HIE services
Physician practice
Provider directory
EHR connects directly
Hospital
Certificate repository
Long-term care
Other providers
Public health
Health plans
Labs and imaging
centers
DIRECT gateway
Browser access to webmail inbox
Web portal mailbox
Accelerating Use of HIE
Value of statewide HIE network and services will increase exponentially with the
number of users
Removing adoption barriers is key to increasing number of users
–
Up-front cost and difficulty of system integration is significant barrier to
adoption to most users, especially small practices and safety-net
providers
Can address this barrier through a variety of means
•Align all funding streams to maximize opportunities for synergy
•Leverage existing assets
•Build services where the users are
•Lower the cost and ease the difficulty of using the statewide HISP
Roadmap for Statewide HIE Program
Phase 1
Information Highway
•Create infrastructure to enable secure transmission (“directed
exchange”) of clinical information
•Will support exchange among clinicians, public health, and
stand-alone registries
•Focus on breadth over depth
Phase 2
Analytics and Population Health
•Create infrastructure to facilitate data aggregation/analysis
Facilitate
normalization and
aggregation
•Will support Medicaid CDR and quality measure infrastructure
•Will support vocabulary translation services (lab, RX)
Phase 3
Search and Retrieve
Enable queries for
•Create infrastructure for cross-institutional queries for and
records
retrieval of patient records
Increasing cost and complexity
The Reality of Vendor Products
• EHR vendor roundtable held on December 16, 2011
– Over 20 vendors participated in 4-hour session
– Mix of ambulatory, hospital, and HIE vendors
• Goal was to understand vendors current and near-future
interoperability capabilities and get feedback on MA approach
• Findings
– There is wide variation in vendor interoperability capabilities
– Few if any vendors have production Direct-enabled systems in place
today
– There are no standardized approaches to integration with centralized
provider directories or PKI infrastructure
– All of the vendors supported a centrally coordinated approach to interface
development and deployment
Turning data into information, knowledge and
wisdom
• Centralized or distributed databases?
• Prospective or retrospective reporting?
• Structured or non-structured data capture?
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A Centralized Database
BIDPO
QDC
Distributed Databases
Distributed Databases
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Prospective Reporting
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Retrospective Reporting
Structured Data Capture
•VITAL SIGNS:
Blood pressure 110/70. Height 5 feet 3-1/2 inches,
weight 122 pounds, and BMI is 21.5.
•CURRENT MEDICATIONS:
1. Docusate sodium 100 mg b.i.d.
2. Ferrous sulfate 325 mg b.i.d.
3. Magnesium oxide 400 mg b.i.d.
4. Aspirin 81 mg daily.
5. Plavix 75 mg daily.
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Unstructured Data Capture
• MEDICATIONS:
1. He currently takes 3% hypertonic saline nebs
twice daily.
2. Pulmozyme 2.5 mg nebs twice daily.
3. He takes Bactrim 5 mL twice daily every Friday,
Saturday, Sunday for PCP prophylaxis.
4. He takes Zithromax 2.5 mL once daily every
Friday, Saturday, Sunday for neutrophil
modulation.
5. He takes Zyvox 600 mg one tablet twice daily
but is stopping on 9/12.
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The Role of Natural Language
Processing and other evolving tools
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Engaging Patients and Families
• Tethered and non-tethered personal health
records
• Home care devices
• Creating value - Open Notes, Passport to
Trust
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Protecting Privacy
• The challenge of BYOD
• Protecting data at the server and the client
• Respecting patient privacy preferences
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The Anonymizer
Name: Rob Smith
DOB: 6/7/1972
Anonymizer
Rob
cd5dced41028cb7ea51d52a888089d73
00c9782a552a2d09b1b85e0d0db52ef3
7f2b6e48ea7d042bbe85e46ef2107da4
Variants
0d06b31faa7c44682d770706640465d2
B5e341a4b0cdf0e8de7b6f957818d746
bd0ec72f2424729efa7baac9a636970a
Smith
6/7/1972
Robert
7/6/1972
1972
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Patient Identifiers Are First Anonymized
Re-Constructed
Identities
Observations
Mark Randy Smith
DOB: 06/07/74
123 Main Street
713 731 5577
Record #A-701
FEATURES:
Mark Randy Smith, M.
Randal Smith
123 Main Street
713 731 5577
DOB 06/07/74
Sensors
Lab
Results
M. Randal Smith
DOB: 06/07/74
713 731 5577
Record #B-9103
Outcomes
31
Patient Identifiers Are First
Anonymized
Re-Constructed
Identities
Observations
Cd5dced41028cb …
00c9782a552a2 …
7f2b6e48ea7d0 …
…
Record #A-701
FEATURES:
Mark Randy Smith, M.
Randal Smith
123 Main Street
713 731 5577
DOB 06/07/74
Sensors
Lab
Results
0d06b31faa7c…
B5e341a4b0c…
00c9782a552…
…
Record #B-9103
Outcomes
32
Identity Resolution Occurring
Post Anonymization
Re-Constructed
Identities
Observations
Sensors
Cd5dced41028cb …
00c9782a552a2 …
7f2b6e48ea7d0 …
…
Record #A-701
FEATURES:
Mark Randy Smith, M.
Randal Smith
123 Main Street
713 731 5577
DOB 06/07/74
Lab
Results
0d06b31faa7c…
B5e341a4b0c…
00c9782a552…
…
Record #B-9103
Outcomes
33
Patient Linkage Data is Not
Stored in Clear Text
Re-Constructed
Identities
Observations
Sensors
Cd5dced41028cb …
00c9782a552a2 …
7f2b6e48ea7d0 …
…
Record #A-701
Lab
Results
0d06b31faa7c…
B5e341a4b0c…
00c9782a552…
…
FEATURES:
Mark Randy Smith, M.
Randal Smith
123 Main Street
713 731 5577
DOB 06/07/74
Record #B-9103
Outcomes
34
Patient Linkage Data is Stored
Anonymized
Re-Constructed
Identities
Observations
Cd5dced41028cb …
00c9782a552a2 …
7f2b6e48ea7d0 …
…
Record #A-701
FEATURES:
Cd5dced41028cb7ea51…
00c9782a552a2d09b1b…
7f2b6e48ea7d042bbe8…
…
Sensors
Lab
Results
0d06b31faa7c…
B5e341a4b0c…
00c9782a552…
…
Record #B-9103
Outcomes
35
Maximizing Discovery Minimizing Disclosure!
Observations
Mark Randy Smith
DOB: 06/07/74
123 Main Street
713 731 5577
Record #A-701
Sensors
Policy Controls
Discovery
Lab
Results
M. Randal Smith
DOB: 06/07/74
713 731 5577
Record #B-9103
Record #A-701
Matches
Record #B-9103
Policy Controls
Outcomes
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The Challenges We Face
• V = Volatility. The nature and dynamics of change,
and the nature and speed of change forces and
change catalysts.
• U = Uncertainty. The lack of predictability, the
prospects for surprise, and the sense of awareness
and understanding of issues and events.
• C = Complexity. The multiplex of forces, the
confounding of issues and the chaos and confusion
that surround an organization.
• A = Ambiguity. The haziness of reality, the potential
for misreads, and the mixed meanings of conditions;
cause-and-effect confusion.
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Questions?
http://geekdoctor.blogspot.com
[email protected]