leveraging technology at the point of care
DESCRIPTION
Grand Rounds presentation at the University of Kansas School of Medicine, March 12, 2013TRANSCRIPT
Widescreen Test Pattern (16:9)
Aspect Ratio
Test
(Should appear circular)
16x9
4x3
Leveraging Healthcare Technology
Maximizing Efficiency At The Point-of-Care
David Voran, MD
Medical Director, Innovation Clinic
Heartland [email protected]
Good fund of knowledge but…
Minimal “System” awareness
Needed help being a part of the team
Lacked skills to elicit patient engagement and participation
Remedial training needed to use computers in front of patients
Negative impact on productivity and career satisfaction
It Doesn’t Just Happen
Younger providers have
more difficulties applying
technology than older
providers
Seminal Moments
D Kay Clawson, MD
“By the time you graduate from residency a large part of what you learned during medical school will be obsolete.”
Gordon E. Moore
the number of transistors on a chip will double approximately every two years
Robert Metcalf
Power of a network is proportional to the square of the number of nodes
Recent influencers
Law of accelerating returns
Illustrated by Moore’s and Metcalf’s laws
PC’s will match the power of the human brain around 2020
Approaching singularity
Culminate in the merger of biology and technology
Transcend limitations of our biological bodies and brains
No distinction between human and machine or between physical and virtual reality
Recent influencers
Professor of Theoretical Physics at the City University of New York
Healthcare diagnostic instruments and
information moving out of the hospital to
clinics, homes and individuals
Significant future care will be virtual,
multimedia and come to the patient
Medicine will become personal rather
than population based
We will control our genetics
A Long Time Ago … at KUMed
Accountable Care OrganizationThe world changes … again
Heading into a new worldAre we adequately prepared?
Agenda
The next healthcare inflection point has started
Effective use of technology will be a differentiator
Suggest ways to take advantage of the next curve
Impending Inflection Point Where we change the vector
External Forces = Barriers
Workforce shortages
Provider discontent
Unsustainable practices
Competitive nature of our society
Conflicting rules and regulations
Economic vicissitudes
Rate of change overwhelms adaptation resources
Vendor “lock”
Security woes
Foggy long term vision
Growing Needs, Declining Resources
0
20
40
60
80
100
2010 2020 2030 2040 2050
Medicare
Enrollment (Millions)
Where are we? … Really
Of 13 countries in recent study …
13th for low-birth weight %
13th for neonatal & infant mortality
11th for postnatal mortality
13th for years of potential life lost
11th for life expectancy @ 1 yrs (females), 12th (males)
10th for life expectancy @ 15 yrs (females ),12th (males)
10th for life expectancy @ 40 yrs (females), 9th (males)
7th for life expectancy @ 65 yrs (females), 7th (males)
3rd for life expectancy @ 80 yrs (females), 3rd (males)
10th for age adjusted mortality
225,000 iatrogenic deaths per year – 3rd leading cause of death
Barbara Starflield, MD, MPH. JAMA July 26, 2000
We are the outlier in just about any measure
“Unlike those of almost any other area we
can think of, the dynamics of the medical marketplace seem to be such that the
advance of technology has made medical care more expensive, not less.”
Steven Brill
Bitter Pill: Why Medical Bills Are Killing Us
Dennis Schmuland, Chief Health Strategy Officer, U.S. Health, February 7, 2013 MSDN Blog
Independent investments
content,
communication,
collaboration and
social platforms
Couple with business applications
Choices
If [medicine] doesn’t act on its own to reduce the cost of
health care for the nation [medicine] will lose control
Choices are to lower the disease burden or be forced to
treat disease with fewer and fewer resources
Those that can adapt, provide improved health and
lower disease cost are going to thrive
Effective use of technology…Depends heavily on willingness to change non-technology practices
Garbage In = Garbage Out
Culture of data entry only
No one measured on accuracy or completeness of data
Mindlessly enter data without “updating” key elements
Every chart replete with similar examples
Who’s Responsible?
Every one points to someone else …
… no one wants to pay anybody to be responsible
Focus on Data = Heavy IT Burden
and …
little use to us
Consequences
Reconciled Unreconciled
Tech works best when …
Paper based policy and procedures are changed
Workflow is modified
Rethink who does what, where and when
Connections made to the world
Remember Metcalf’s law
Goal of an EMR should be to know everything about the next NEW patient
Making headway (Easy to Hard)Putting pieces together from the easy to the hard
Hardware is low hanging fruitCan do more in less time with more and larger screens
Exploit new user interfaces
Touch and getting rid of chairs ≈ 30 min/day
Pa
tien
t Pa
rticip
atio
n
Embrace Self Tracking Apps
Value add opportunity
Chronic disease management
Real-time remote monitoring
Preventing visits and admissions
Optimizing health
Encourage competition, participation
Using technology paysTech / Workflow Savings/BenefitsPatient Portal & Direct messaging 4-8 hours of phone time per nurse/week
>75% reduction in phone volumes/week per physician
30% reduction in electronic messages
Nurse and physician using same work
flow tools
Less work for each person
Simplifies training
Reduces redundant data entry
Improves completeness of information collection
Increases patient involvement
Increases transparency
Large screens Exam room –
Improved access to information
Increased patient involvement
Reduction in visit times?
Nurses
Improved information display
50% reduction in window manipulation
Reduced prior auth time and frustration
Changing workflows is harder … but pays more
Technology extends contact
Chen LM, Farwell WR, Jha AK. Primary care visit duration and quality: does good care take longer? Arch Intern Med. 2009;169(20):1866-1872.
Patient Use :: Physician Use
IOM Workshop Advice
Teach patients how to obtain and use their personal health information
Teach consumers how to navigate the health system effectively
Present patients with options and listen to their concerns and feedback
Establish a connection and relationship with patients & their care givers
Avoid jargon when presenting information to patients and caregivers
Find new ways to listen to patients and families
http://www.medpagetoday.com/PublicHealthPolicy/MedicalEducation/37539?utm_source=twitterfeed&utm_medium=twitter
Critical for Meaningful Use
From digitalization of data to
active use by patients
Patient engagement begins
in the exam room
Physicians must demonstrate
this engagement
http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives
Technology extends reach
Eliminates 90 miles of driving
Increases low cost
“touches”
Facilitates communication
Inexpensive robots are harder to drive so a good deal of
practice is required. Even so bandwidth requirements limit use
to facilities with decent Wi-Fi access points.
Redesigning Exam Rooms
Facilitate point-of-care information sharing and education
Encourage patient participation at many levels
Computer in exam as much for the patient as it is for the physician
Set’s stage of MU 3 patient engagement mandate
Bricks and Mortar may be the hardest part of technology
High Tech Exam Room Suites
Solutions and Suggestions
Trying to connect the dots
Opportunities and Needs
Cleaning up the data requires culture change
Education plays a major role
It’s going to fall to the physicians in the long run
Maximizing current technologies
Encourage innovation while in training
Make time for and allow experimentation
Incorporating these skills into training
Cleaning up the Data
Career opportunities for those who are retiring or starting out
Eliminating redundant and conflicting data
Inculcating a culture of accuracy & verification
Reconciliation should be part of everyone’s job
Discovering a work flow based on patient validation and attestation
Systems approach
Learning as an integrated team
Patients, Techs, Nurses, Physicians solving problems together
A minute saved for one may lead to hours of work by others
Understand cycle time (be a patient)
Teach and understand financial implications of actions
Average cost of dictation $20K/yr (don’t allow or do it)
Always work from the patient’s perspective
Maximizing tech investment
Almost every device can be used for a synchronous visit
But very few are leveraging this – reimbursement barrier
ACO environments eliminate this barrier
Continually think of ways to eliminate logistical barrier Rounds could be conducted virtually
Several times a day if not hourly
Think low cost neighborhood clinics scattered throughout the city for primary and virtual specialty care
Recommendations
EMR clean up as part of the medical school curriculum
May go a long way to staunch the growth of corrupted data
Help incorporate chronic disease management into each visit
Group visits with physicians and care coordinators
Practical EMR training at the point of care
Piano bar, not recital
Doesn’t come naturally and must be learned
Develop a joint effort with the other residency programs to assure that every graduate is “certified” in at least 3 EMRs
KC Opportunities
Numerous residencies
History of cooperation
Good variety of EMR vendors
Provides diversity experience for residents
Different models of care
FFS, ACO and Employer based
Google Fiber … a natural multiplier
Cooperative rotation would provide graduates with tools needed to be productive in almost any career
…. some answers, Maybe
Questions?