Transcript Siemens Corporate Design PowerPoint-Templates

John Glaser, PhD, CEO, Health Services, Siemens Healthcare
Health Information Technology and Informatics:
A Significant Evolution
Restricted © Siemens AG 2014 All rights reserved.
Answers for life.
Disclosure
• Speaker discloses that he has financial interests in and
receives compensation from Siemens Healthcare.
Page 2
Learning Objectives
• At the conclusion of this activity, the learner should be better able to:
Page 3
1.
Understand the shift from a transaction-oriented to an intelligencebased electronic healthcare record
2.
Understand the HIT system capabilities required to support
accountable care processes
3.
Understand the influence of the next IT revolution
The Challenge: Recent Slowdown but Healthcare
Costs Are Projected to Grow in 2014 and Beyond
 Acceleration in health spending growth
expected to be 6.1% in 2014 with annual
growth of 6.2% in 2015 and beyond
 Improving economy, ACA coverage expansion,
and demographics contribute to increasing
growth rate
 Total healthcare spending will reach $2.9
trillion in 2013
 By 2022, numbers of uninsured people will
drop by 30 million
 Will increase cumulative health spending by
approx. $621 billion
 Demographic trends contribute to increasing
costs. Americans ages 65 or older will
comprise 19.3% of population by 2030, up
from 13% in 2010
Source Centers for Medicare and Medicaid Services (CMS): http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/downloads/highlights.pdf
Administration on Aging (AoA): http://www.aoa.gov/Aging_Statistics/Profile/2011/4.aspx
^
The Majority of an Average Provider’s Revenue Will
likely Be Risk-Based in 10 Years
Source: The Advisory Board Company, Jan. 2014
Page 5
A Significant Shift in the Healthcare Business Model
Is Underway
Individual care providers
Collaborative teams of providers
Treating individuals when they get sick
Keeping groups of people healthy
Emphasizing volumes
Emphasizing outcomes
Maximizing the use of resources & assets
Applying appropriate levels of care at the
right place
Offering care at centralized facilities
Offering care at sites convenient to
patients
Treating all patients the same
Customizing healthcare for each patients
Avoiding the sickest chronic patients
Creating venues to provide special
chronic care services
Being responsible for those who seek our
services
Being responsible for the needs of the
community
Best efforts
High reliability organizations
Page 6
Payment Changes Will Lead to Different Care
Emphases and Organizational Models
Page 7
Providers will need to Manage and Improve Multiple
Disease-Invariant Care Processes
1 out of 5 elderly patients are
readmitted within 30 days
Every year, the average
elderly patient sees
7 doctors
across 4 practices
Less than 50% of
elderly patients are
up to date on clinical
preventive services
Elderly patients with
co-morbidities require
up to
19 medication
doses daily
Preventive
Self Management
MDs
Allied
Health
Less than half of non-
Specialties
Average surgery patient is
seen by
surgical patients
Primary
27 different health
care providers
primary care provider after
discharge
Care
Outpatient Care
Source: Best Care at Lower Cost, September 2012 Institute of
Medicine; Smith, M Study Chair
Page 8
RNs
Hospital
follow-up with their
Follow-up
It Is Not Possible to Address these Challenges
without a Foundation of Sophisticated IT
Today’s providers are taking on risk arrangements
and need to proactively manage the care and
wellness of their patient population by:
• Managing care over a continuum
• Managing the health of populations and individuals
• Supporting care teams with evidence-based
processes and advanced analytics
• Engaging patients (and their families) to take
the necessary steps to improve their health
• Improving the efficiency and effectiveness of core
operations
And providers must accomplish all of this
across an ecosystem with multiple IT systems.
Page 9
Core Technology Components Will Be Required
 An electronic health record that spans the continuum of care
 A revenue cycle and contracts management application that spans the
continuum of care
 Sophisticated business intelligence and analytics
 Systems that enable interoperability between closely affiliated
providers
 Technologies that support the engagement of patients
 Services that enable maximum leverage of healthcare IT investment
Page 10
Material Changes in Business Models, Technologies and/or
Environment Lead to Significant Changes in and Industry’s
Core IT Platforms
Retail
World Wide Web
Web-based product
review, comparison
and ordering
Banking
Deregulation
Funds Management
Content Distribution
World Wide Web
Music ecosystems;
Free news; Craigslist
Health insurance
ACA; CDHP
Exchanges; Provider
comparisons
Page 11
Three Categories of Fundamental Change in
Information Technology Will Be Experienced
Move from
Transactionbased to
Intelligencebased EHR
Page 12
Ability to
Manage
Accountable
Care
Processes
Learn to
Leverage
“Fifth IT
Revolution”
For many Years, the Core Focus of the Electronic
Health Record Has Been the Transaction
 Transactions include:
 Writing a prescription
 Retrieving results
 Documenting a visit
 This focus addressed the core
challenges:
 The serial treatment of patients
(outpatient)
 The coordination of diagnostic
and treatment activities (inpatient
care)
Page 13
For many Years, the Core Focus of the Electronic
Health Record Has Been the Transaction
 The care setting emphasized:
 Transaction speed and
efficiency
 Ease of use
 Good coverage of care
diversity
 The benefits were the reduction
in transaction problems:
 Legibility
 Medication errors
 Documentation completeness
Page 14
The Challenge: Quality Remains Uneven
“
Last September, in its report on “Best Care at Lower Costs: The Path to
Continuously Learning Health Care in America,” the IOM noted that
patients get effective care only about half the time, that gaps in
coordination remain widespread, that serious preventable medical errors
are common, and that perhaps more than 30 percent of healthcare
costs could be avoided as a result of improving quality and efficiency.
U.S. Senate Committee on Finance Testimony, June 26, 2013
Improving Health Care Quality: The Path Forward, McClellan, Mark B
Page 15
”
Our Understanding of the Complexities of
Disease is Accelerating – There Is too much to Know
Page 16
Care Process Problems Will Become Intolerable
For Every:
There Appear to Be:
1,000 patients coming in for
outpatient care
14 patients with life threatening or serious ADEs
1,000 women with a marginally
abnormal mammogram
360 who will not receive appropriate
follow-up care
1,000 referrals
250 referring physicianswho have not received
follow-up information four weeks later
1,000 patients who qualified for
secondary prevention of high cholesterol
380 will not have a LDL-C, within three years,
on record
Extrapolated from various studies conducted by Partners Healthcare.
Page 17
Machine Reconciliation of Data Inconsistencies
Page 18
The Emphasis Will Shift from Transaction Support to
Include Intelligence Support – Core Objectives
 Guide clinical diagnostic and
therapeutic decisions
 Ensure sequence of care
activities
conform to the evidence and
performance contract
requirements
 Monitor the execution of core
clinical processes
 Capture, report and integrate into
EHRs quality and performance
measures
 Support the interactions of the
care team
Page 19
Three Categories of Fundamental Change in
Information Technology Will Be Experienced
Move from
Transactionbased to
Intelligencebased EHR
Page 20
Ability to
Manage
Accountable
Care
Processes
Learn to
Leverage
“Fifth IT
Revolution”
Accountable Care Management Processes
The key is managing the care plan of the individual and stepping back and looking at the population
in aggregate.
Populations will include those that are a readmission risk, are undergoing a procedure bundle or have
a chronic disease
Page 21
Determine Variation from Plan:
Readmissions Dashboard
Page 22
Concurrent Quality Intelligence: Cohort Monitoring
Page 23
Creating Approaches to Moving Population
Management Applications to the Next Generation

A shift from a generation characterized by:
 Management of only the sickest/high risk patients
 Static risk categorization
 Single disease/condition focus based on simple data values and events
 “List” generation with significant manual work
 Retrospective

To a generation characterized by:
 Management of all patients
 Risk categorization that follows a patient’s evolving risk
 Multi-disease/condition focus using evidence-based care plans
 Significant process automation and leverage of the care team including
the patient
 Concurrent
Page 24
Three Categories of Fundamental Change in
Information Technology Will Be Experienced
Move from
Transactionbased to
Intelligencebased EHR
Page 25
Ability to
Manage
Accountable
Care
Processes
Learn to
Leverage
“Fifth IT
Revolution”
The “Quantified Self”
Page 26
Characteristics of this Era
The era is characterized by:
 Networked, powerful processors almost everywhere and on almost anything
 Diverse array of sensitive and specific “sensors”
 Massive amounts of data and novel methods for analyzing it
 Software delivered as a service
 A wide variety of collaboration, community and knowledge resources
This era will enable us to:
 Use large data volumes to perform “real world” analysis and experiments
 Orchestrate complex processes
 Deliver new services, e.g., location aware and location invariant services
 Extend and enrich fundamental human activities such as being a member of a
community and searching for information
Page 27
Comparison of Relative Risk of Medications
Using EHR Data
Source: Brownstein J, Murphy
S, Goldfine A, Grant R, Sordo
M, Gainer V, Colecchi J,
Dubey A, Nathan, D, Glaser J,
Kohane I. Rapid identification
of myocardial infarction risk
associated with diabetic
medications using electronic
medical records. Diabetes
Care 2010;33(3):526-31.
Page 28
Tailoring Cancer Therapy
Computational Models
Shape and
Appearance
Multi-parametric MRI
Molecular Level
Spectroscopy, CEUS
Tissue Biomechanics
(Elastography, Fibrosis)
Histopathology
Circulating
Tumor Cells
H&E stained,
Phase
Cell/Tissue
AMACR, CK903
Contrast
Self-Organization
SNP, mRNA, Proteomics…
Page 29
Modeling and Estimation
Cell Level
Imaging and Sensing
Tissue Level
PET/CT
Apoptosis
Molecular Networks
Individualized Treatment
Decision Making, Therapy Selection and Optimization
Observations
Organ Level
Patient
Biologically Guided
Radiotherapy
Ablative Therapy
Chemo Therapy
Immuno and Gene Therapy
Who Is this Person and
What Are They Trying to Do?
Page 30
The EHR Must Be Designed for the Future;
Not the Past
 Support collaboration
 Inter-disciplinary and
multi-disciplinary teams
 Shared worklists
 Enable personalized care
 Treatment decision support
 Predictive models
 Intelligent order sets and
documentation templates
 Enables reliable processes
 Workflow engine
 Health information exchange
Page 31
 Manage populations
 Disease registries
 Referral management
 Provides introspection
 Guideline adherence
assessment
 Quality measures capture
and real time display
 Financial optimization analyses
Questions
Page 32