using health information technology to improve care outcomes
DESCRIPTION
USING HEALTH INFORMATION TECHNOLOGY TO IMPROVE CARE OUTCOMES. HCN BOARD RETREAT TONY AMOFAH, MD, MBA, FACP, CMO, COMMUNITY HEALTH OF SOUTH FLORIDA, INC CMIO, HEALTH CHOICE NETWORK, INC. OUTLINE. The changing h ealth c are l andscape for CHCs Traditional patient flow - PowerPoint PPT PresentationTRANSCRIPT
USING HEALTH INFORMATION TECHNOLOGY TO IMPROVE CARE
OUTCOMES
HCN BOARD RETREATTONY AMOFAH, MD, MBA, FACP,
CMO, COMMUNITY HEALTH OF SOUTH FLORIDA, INCCMIO, HEALTH CHOICE NETWORK, INC
OUTLINE• The changing health care landscape for CHCs• Traditional patient flow• Time-tested interventions• HIT as a strategy for success– Use of available HIT in our CHCs– Positioning for success with Managed Care, ACO, HRSA
• Inertia– Overcoming inertia
• Take home messages
CHANGES IN EXPECTATIONS OF CHCs
• PAST– CHCs –”only game in town”– Sole Medicaid provider– Focus on patients seen in
our CHCs• Active – 2 visits
– Quantity• # of patients seen• Poverty level• # of A1c done
– Credit for ordering tests– Good old paper– Funding guaranteed
• PRESENT & FUTURE– Competition– Population health
• 1 visit
– Patient engagement in care– Quality + Quantity
• Outcomes
– Health information technology• Initially # with E.H.Rs• Now: E.H.Rs used meaningfully
– Transparency and Accountability
– Pay for performance
THE HEALTH CENTER STRESSORS
FINANCIAL STABILITY
CHC
RISK MANAGEMENT
MANAGED CARE
E.M.R
PROVIDER RECRUITMENT &
RETENTION
SURVIVAL
QUALITY
STAFF TURNOVER
FACILITIES & LOGISTICS
MONITORING AGENCIES
UNFUNDED SERVICES
CORPORATE COMPLIANCE
& AUDITS
GROWTH
PAYROLLANCILLARY SERVICES
PRODUCTIVITY
COMMUNITY ALLIANCES
GRANT FUNDING CODING
UDS
MU
ICD 10
HEDIS PCMH
PAY FOR PERFORMANCE
TRADITIONAL PATIENT FLOW
5
Patient arrives
• Front desk check in• ID verification• Payment collected
Nursing encounter
• Vital signs, BMI, pain scale• Reason for visit• FBS
Provider encounter
• Chronic dis mgmt• Med refills• Labs• Referrals mgmt
Patient discharged
• Apptmt
HEALTH CENTER STRATEGY:WHICH OF THESE INTERVENTIONS?
PCP visit
Specialist Visit
Emergency RoomHosp Visit
Case Management
Capitation Patient Arrangements
DRGs
PCP Gatekeeper
Risk Sharing Arrangements
Pay for PerformanceProvider Report Cards
Telephonic Case Management
Outreach Interventions
Diabetes Education Classes
CoPay Adjustments
Grocery Shopping Sessions
Self Management Support
Pre-visit Planning
Shared Medical Appointments
Health Information Technology Tools
Patient
Bundled Payments
Closed, Limited Panels
Discharge Planning
HEALTH CARE INDUSTRY TIME-TESTED INTERVENTIONS
BEST BANG FOR THE BUCK IN OUR CHCS?
SUPPORT STAFF/CARE TEAM BASED
CARE
PATIENT ENGAGEMENT
STRATEGIES
PRE-VISIT PLANNING
HEALTH INFORMATION TECHNOLOGY
AVAILABLE HIT TOOLS1. E.H.R tools– Forms/Templates – Health reminders– Flow sheets– Pharmacy Benefits Management History (PBM Hx)
2. Patient portal tools– Appointment scheduling– Medical summary– Pre-visit questionnaires
3. Informatics tools: CLEAR dashboard– Quality indicators– Provider report cards– Personalized Care Gap Report
PATIENT PORTAL TOOLSMy Medical Summary
Satisfies Meaningful Use CORE MEASURE 7: Patient Electronic Access
Required fields to display are:• Allergies,• Lab Results,• Plan of Care• Problems,• Procedures,• Social History,• Vital Signs,• Chart Summary• Chart Access
History
PATIENT PORTAL TOOLSRequesting an Appointment
Patient completes all fields in the Request Appointment screen.
Clicks Submit once complete.
Staff reviews message details.
Searches for an open time slot in POMIS.
13
Patient schedules apptmt
Prompted to complete pre-visit
forms
Patient completes pre-visit tests
Arrives for visit
Support staff visit
Provider visit
Patient discharged
Care team reviews planned care visit report and patient’s record for care gaps (Pre-orders tests)
Pre-visit care team phone call
Care team huddle;Review of personalized patient care gap report;Left at front desk for patient
Address care gapsProvide education handouts Commence self mgmt. goal setting
Patient home
Hospital & Specialist visits
Patient homeCare CoordinationPhone Tree Calls
Shared medical visits
CLEAR
CLEAR
HEALTH REMINDERS
PATIENT PORTAL
FORMS & TEMPLATES
Informatics at point of care
CLEAR
HIEPATIENT PORTAL
CLEAR
Appointment request & receipt via portal
Resolve remaining care gapsUnderscore self mgmt. goals
WHAT HAS MADE THESE POSSIBLE?
1. Economies of scale2. Collective brain power3. Collaboration– Across CHCs– With vendors and stakeholders
4. Inherent competitiveness sparked by benchmarking
THE TRADITION OF THE FEUDING GIANTS
Tobacco Cessation Counsel-ing
Childhood Immunization Compliance
HTN - Controlled Blood Pressure
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Community Health of S. Florida
Citrus Health Network
POSITIONING FOR SUCCESS
1. Answers to questions– Who are our patients?– Which are at highest risk?– What are their care gaps– What is our current performance?
2. Value in facilitating management of patients in their “white space”
3. Enhanced efficiency of patient visits
REASONS FOR “TECH INERTIA”
1. Insufficient staff2. Too many patients3. Limited patient access to the internet4. Reports inaccurate5. Wrong phone #s6. Competing priorities7. Funding
TAKE HOME MESSAGES
1. “>50% of payments in a few years will be value based”
2. Health Information Technology Tools will be increasingly critical for success– Population health analytics, care coordination
and patient engagement solutions
3. No barriers should prevent HIT utilization maximization
4. Its all about results!