Health IT Seminar Review

1. Health IT Seminar Review Cliff Kaufman

2. Focus on NC • NC Strategy for HIT Steve Cline, DDS, MPH HIT Coordinator, NC DHHS • Using Telehealth Technology for Rehabilitation Helen Hoenig MD, MPH Durham VA Med Ctr Duke University • CCNC Informatics Center Annette DuBard, MD, MPH North Carolina Community Care Networks, Inc. • NCB Prepared Steve Potenziani, PhD Executive Director, NCB-Prepared Collaborative

3. NC Strategy for HIT GOALS PROBLEMS • Improved healthcare quality • Better health outcomes • Individuals • Populations • Control costs • Better engage health care consumers Paper is inefficient Duplicate tests Medical errors Lack of information Too much information Consumer engagement Quality-Quality-Quality

4. The 12-Step Approach • Admit we have a problem • Must get clinical information into an electronic sharable format. • Incentivize targeted providers to adopt EHRs and meaningful use • Create a new standard for EHR vendors • Build a mechanism for sharing health information electronically • Make sure healthcare providers know how to use the new systems • Make sure the network has the capacity for all these new users • Make good use of the data (Data Analytics) • Make good use of the technology to improve health • Children as a priority • Learn from the leaders • Sustainability

5. Keys to Success EHR Adoption Consumer Engagement Change Leadership Strengthen the “Trust Fabric” of health info exchange GOOD USE OF THE DATA! And the Winner Is . . . • Whoever can figure out how to take the tsunami of new health data that is heading our way and turn it into actionable health information. • Whoever can help us move from surveillance and reaction to event prediction and prevention.

6. Telehealth Technology for Rehabilitation It is difficult for persons with physical disability, particularly in remote areas, to access health care. High cost and burden of travel. Limited rehab specialists in remote areas. Clinicians have limited insight into how individual is functioning in home environment. Public Health Problem What is Telehealth? • Telehealth is comprised of diverse technologies that allow health care to be provided in situations where distance separates those receiving services from those providing services. • Telehealth changes the location for providing health care services from the doctor’s office or hospital to the local clinic or the patient’s own home.

7. Telehealth Encounters by VA Providers

8. Telehealth – Rehab Clinical Trials Telerehabilitationfor exercise & functional training: 4 RCTs with Televideo alone or with other Teletechnology. 4 different populations (geriatric gait disorder, post-stroke, ICU survivor, post-op orthopedic surgery). Non-inferiority in clinical outcomes compared to Standard PT. Better functional outcomes , performance-based & self report, compared to Usual Care (no PT). Equipment reliability and visual clarity a challenge in all studies

9. Teletechnology QI Study • 3 types physical function tested • Fine motor coordination: finger taps (front view) • Gross motor coordination: gait (lateral view) • Spatial relationship: cane height (front & lateral views) • Reliability & validity determined • 3 common Internet speeds (64, 384, 768 kps) • In person (community standard) and slow motion videotape (gold standard) • Internet bandwidth had a strong effect on validity and reliability for the fine motor and gross motor tasks. • Fine motor coordination - Reliability & Validity comparable to Standard Care @768 kps • Gross motor coordination (gait ) – Validity not comparable to Standard Care • Still spatial relationships - Reliability & Validity comparable to Standard Care at all of the bandwidths

10. Teletechnology Infrastructure Security HIPPA Full face image and/or Voice = PHI Can’t post cell phone video to U-tube for review Skype isn’t HIPPA compliant Costs Equipment Internet access Who pays?

11. CCNC Informatics Center Information Support for Patient-Centered Care • Develop a better healthcare system for NC starting with public payers • Strong primary care is foundational to a high performing healthcare system • Additional resources needed to help primary care manage populations • Must build better local healthcare systems ( public-private partnership). Community Care is a clinical partnership, not a regulatory management agency. • Physician leadership is critical. Providers who are expected to improve care must have ownership of the improvement process • Achieve savings through better quality and efficiency of care • Timely data is essential to success

12. CCNC Informatics Center Data Flow

13. HC Data for Population Mgmtand QI • Identification of High-Risk/ High-Opportunity Patients for Targeted Services (Examples: Identification of individuals with above-expected preventable utilization, Hypertension Self-Management Support) • Cost/utilization performance measurement coupled with actionable information (Examples: Pharmacy Initiatives, In-patient and ED Reporting) • Quality Measurement and Feedback coupled with actionable information (Examples: Practice Views with County, Network, and State Benchmarks; i.e., % eye exams for diabetes patients)

14. ID of Patients for Case Mgmt Historically, case management efforts have been targeted at the highest utilizers = Historical or predicted costs for an individual CRG#1 $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K CRG#2 $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K Expected potentially preventable costs CRG#3 $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K Priority patients for care management

15. NCB Prepared A Public/Private Consortium (UNC, NCSU, SAS, DHS) focused on bio-surveillance – accurately detect and rapidly analyze biological hazards to ensure public health and safety. • Improve early recognition of outbreaks augmenting bio-surveillance • Improve situational awareness • Faster and more accurate information for decision makers • Integration with emergency management and law enforcement

16. Analytics – Reactive vs. Proactive

17. Data Value PROCESS Get Data Use Analytics Provide Information CLIENT OPPORTUNITIES (?) Food Pharma Finance Pub Health EMS News

18. Focus on NC – Recurring Themes Government (US & NC) Funding Fundamental Change tied to Technology Big Data used predictively not reflexively Improve patient care Security Cost Models Opportunities!