Most US Hospitals Had Basic EHR Capacity In 2013According to a new study, 58.9 percent of US hospitals had basic EHR capacity in 2013, but only 5.8 percent were able to meet all stage 2 meaningful use criteria.Julia Adler-Milstein, Catherine M. DesRoches, Michael F. Furukawa, Chantal, Worzala, Dustin Charles, Peter Kralovec, Samantha Stalley and Ashish K. Jha, Health Affairs, , no. (2014) [Web First, August 07, 2014]

•59 percent now have at least a basic EHR•Small and rural hospitals continue to lag behind their better resourced counterparts•Most hospitals are able to meet many of the stage 2 meaningful-use criteria, but only 5.8 percent of hospitals are able meet them all“Several criteria, including sharing care summaries with other providers and providing patients with online access to their data, will require attention from EHR vendors to ensure that the necessary functions are available and additional effort from many hospitals to make certain that these functionalities are used.”

“Policy makers may want to consider new targeted strategies to ensure that all hospitals move toward meaningful use of EHRs.”

EHRs – Table Stakes for Population Health

We Have Gone from This…

Sunquest

InternalInternal

Eclipsys(TDS 7000)

HCC TSINone

Eclipsys(TDS 4000)

HBOCTPA

HBOCStar

Cerner

MS MedsHBOC

KeaneKeane

IDXCerner

None None

Sunquest

PeopleSoftGeac

HBOC ESI

InternalInternal

Registration

Clinical

General Finance

Pathology

Medical Records

Order Entry

PharmacyRadiology

Patient AccountingMaterials/AP

Decision Support

HR/PayrollBudgeting

APPLICATION AMMC LB/MCHOCMMC SMMCCampus

GeacMatkon

MS MedsHealthvisionNone

Circa 2003

Epic

To This…

PeopleSoft

Registration

Clinical

General Finance

Pathology

Medical Records

Order Entry

PharmacyRadiology

Patient AccountingMaterials/AP

Decision Support

HR/PayrollBudgeting

APPLICATION

Kaufman Hall

Cerner

EPSI

CampusSMMC/SC LB/MCHOCMMC SMMC

Circa 2012

What’s Next in a “Post-EMR World?”

“EMR”Basic Business

Intelligence/AnalyticsIntra-organizational

IntegrationBasic Identity Management

Tables stakes – basic tools

“Population Health”

Multi-organizational Data Exchange

Multi-organizational Identity Management

Broader Business Intelligence/Analytics

Case ManagementCare Coordination

“Social – Mobile – Cloud”

The new frontier – scale, affiliation, new tools, risk management

Two Sides of Information- driven Care Delivery

Biometric Data

EMR Data

Hospital ADT Data

HRA Data

Pharmacy Data

Lab Results

Payer Claims

CaseNotes

“Big Data”(Not Just Our Data)

“Big Data”(Not Just Our Data)

1. “Population” Activities•Risk stratification•Disease management•Best practices•Correlation/causation•Predictive analytics

2. Individual Patient Activities•Low-cost interventions•Care management•Venues of care•Primary care•Specialist care

HMOPatients

(Closed System)

PPOPatients(Wild West)

Determine what works, what doesn’t;understand risk, take risk

Stratify and arm workforce;spend time on patients who need it

Primary Care

Physician

OB-GYN

Endocrinologist

Jane Smith, Patient with

Diabetes

PH Data Warehouse and Disease Registries

Pharmacy

Mammography

Lab Test Results

Primary Care Physician • OB-GYN • Endocrinologist

Vital to Put Information (Back) into the Hands of the Clinician

Physicians on the front lines of treatment

“Portal”

But Disparate EMRs Pose HIE and Multiple Portal Challenges

What’s needed is a solution that aggregates the information across our various systems (e.g. Epic, NextGen, Allscripts) and disseminates that information to our patients and providers.

Epic NextGen Allscripts

MyChart NextMDFollowMyHealthpenicillin

latexhayfever

Patient Portals

EMRs

Universal Patient Portal

PH Data Warehouse and Disease Registries

penicillin latex hayfever

No Option but to Share Patient Data

“We envision a future where information follows patients, unconstrained by competitive rivalry, by geographic boundaries, by cultural disinclinations to collaborate,” he said. “We want teams to emerge in local communities that make exchange possible. And we will be using the meaningful use framework and all other levers at our disposal to make that possible.”

David Blumenthal, MDNational coordinator for health information technology at the federal Office of the National Coordinator for Health Information Technology (ONC)

CHIME Meeting, Phoenix, AZ, October 6, 2010

Care EverywhereCare Everywhere team monitoring things from the Command Center

First patient to be linked using Care Everywhere

HIE June 2013

HIE Sep 2014

Current myChart Stats

Representative Population Health IT Requirements

Process Requirements IT Functions

1. Identify Populations

• Data acquisition and aggregation • Predictive modeling• Algorithmic population segmentation• Patient-provider attribution

• Data aggregation platform: EMR, CDR, CDW; HIE data warehouse1

• Claims data source• Algorithms and analytics for

inclusion/exclusion criteria by population• Processes, algorithms for attribution

2. Map and Track Care

• Identify chronic disease populations• Map against care guidelines• Map against care measures over time

• Disease registries

3. Deliver Care

• Clinical data view, e-prescribing, clinical documentation

• Decision support for interventions• Patient outreach for interventions

• EMR or physician portal• Disease registry: patient-centered view• Virtual care, home monitoring

4. Coordinate Cross-Continuum Care

• Care manager: patient data access; clinical documentation; communication tools

• Care plan mapped against patient data• Remote data acquisition: vital signs; lab values • Real-time video interaction at remote locations

• Care management systems• Encounter notification system• Home monitoring data capture• Telemedicine capabilities

5. Engage Patients• Patient contact info: email; mobile phone

numbers• Multiple communication modalities

• Patient portal• Text-based communication systems• Call center

6. Administer, Monitor and Report

• Performance data vs. goals; reporting at clinician, practice, organization-wide levels

• Data aggregation and analysis platform• Dashboards, other display tools

Provider-led Care Management

“[Provider] institutions‘ understandingof the requirements is as preliminaryas vendors' offerings.”

Top Actions for Healthcare Delivery Organization CIOs, 2013: Support Provider-Led Care ManagementWes Rishel, Gartner publication G00248027, February 2013

©2014 The Advisory Board Company • advisory.com • 29382A

18

Insurer, Seven Competing Systems Offer Market-Wide Solution

Source: “Anthem, Seven California Health Systems Team Up To Form HMO,“ California Healthline, September 17, 2014; Commins J, “Anthem Blue Cross, 7 CA Health Systems Create New Challenger, Business Model,” HealthLeaders Media, September 18, 2014; Health Care Advisory Board interviews and analysis.

Vivity Betting on Coordination over Consolidation

Anthem Blue Cross

Cedars- Sinai Medical Center

Good Samaritan Hospital

PIH Health

MemorialCare Health System

UCLA Health

Torrance Memorial Health

Huntington Memorial Hospital

• 7 health systems

• 14 hospitals

• 6,000 physicians

“What we are recognizing is that the most effective delivery model is an integrated delivery model. We can reduce waste, improve quality of care, provide people access to the top facilities in the nation, frankly, and do that in an integrated way.”

Pam KehalyAnthem Blue Cross

Health PlansWeb Based

AdministrativeData Inputs

Population HealthDATA

WAREHOUSE

Medicare Intermediary

Specialists &Ancillary Providers

Hospitals Primary CarePhysicians

Hospital Outreach& PhysicianOffice Labs

EMRs

National &Regional Labs

NationalPharmacyDatabases

A Population Health Über Warehouse in Our Future?

Where we are today

Competing on Data

“Fragmented industry structures complicate the value creation… The average [healthcare] company…is relatively small and can access only limited amounts of data. Larger players, however, usually swim in bigger pools of data, which they can more readily use to create value.”

“The US health care sector…is dotted by many small companies and individual physicians’ practices. Large hospital chains, national insurers, and drug manufacturers, by contrast, stand to gain substantially through the pooling and more effective analysis of data.”

Are you ready for the era of ‘big data’?M C K I N S E Y G L O B A L I N S T I T U T EOctober 2011

In conclusion…

“Much work remains to be done before a practical 

computer‐automated hospital information system is 

developed. In particular, a full understanding is needed 

of the present system, of the hospital environment, and 

of the reactions physicians, nurses, and hospital 

personnel have to new procedures.”

“How fast this work proceeds at Memorial Hospital 

depends on a number of factors including our success in 

obtaining outside funding. However, we are optimistic 

in our belief that a practical system can be developed 

using the concepts described in our model and that the 

system will improve the quality of medical care without 

increasing the cost to the patient.”

Charles J. Roach, Myrvin H. Ellestad, M.D., and Raymond B. Lake, 

Medical Data Processing and Computer Automated Hospitals, 

Datamation, June 1962, pp. 25‐28 

NOTE: Highlighting added. 

Nine Sectors of HIT Investment Evolving Business Requirements

Healthcare Growth Partners, 2013 Year-end Review