Physician-Centric eHealth Finding

1. Physician-Centric eHealth Finding/Creating/Delivering Value for MDs Peter Basch, MD Medical Director, e-Health Initiatives MedStar Health November 16, 2001

2. The “centric” thing Patient-centric Your lifetime medical record Healthcare Physician-centric The toolsets that we must buy and use to have a quality and efficient clinical encounter that results in a satisfactory medical-legal document

3. Provider as customer Patient-centric Physician-centric The toolsets that we must buy and use to have a quality and efficient clinical encounter that results in a satisfactory medical-legal document Physicians (under current system) are both the primary purchasers of ehealth applications, and the rate-limiters for adoption and use of applications purchased by healthplans and employers

4. We need a hug Patient-centric Physician-centric The toolsets that we must buy and use to have a quality and efficient clinical encounter that results in a satisfactory medical-legal document Physicians (under current system) are both the primary purchasers of ehealth applications, and the rate-limiters for adoption and use of applications purchased by healthplans and employers Physician need to be enticed to stay in the system

5. “Not now, I’m having a bad decade” <50% of MDs satisfied with practice 48% of MDs in mid-50s leaving medicine 38% early retirement 10% “going over to the dark side” Med school applications ? 18% 2.1 applicants for every first-year spot

6. A word about clinical messaging Many types of messages Brainstorming transformation in eHealth as compared to technologic changes in banking My favorite email from a patient

7. What if Healinx decided to do an ad with Mastercard….

8. Email your doctor a medical question?

9. Patient e-mail

10. Office of eHealth Initiatives MedStar Health 7 hospital CDO in the Baltimore-Washington region 2B in revenue, 22,000 employees, 4500 physicians OeHI Research, evaluate, syndicate eHealth applications that provide value for physicians in their office settings, and in the interface between office-hospital Physician Advisory Board and staff Advises CIO, CMO

11. Handouts No, you’re in the right room... Handout somewhat follows the talk as of page 5 MedStar OeHI info sheet “Medical Leadership in the World of e-Healthcare” - Healthleaders 6/01 “A Rationale and Strategy for Incenting Clinical Information Technology” - e-Healthcare Connections 8/01 “Towards an Improved Physician-I.T. Vendor Relationship” - eHI 10/01

12. Building Physician-Centric eHealth Early bloopers Landscape, value proposition Build fundamentals Input, throughput, output Workflow, mindflow, & careflow Drivers - positive and negative Putting it together

13. Early bloopers Physician as technophobe Forrester Report 3/01 - “Why Physicians Hate the Net”

14. Forrester II - “Dr Strangelove -or How I Learned to Stop Worrying and Love the Net”Forrester II - “Dr Strangelove -or How I Learned to Stop Worrying and Love the Net”

15. Landscape ?Reimbursements, ?costs, ?process friction Information technology represents a nonreimbursable cost Patient volume is not needed, wanted

16. The value proposition ?Reimbursements, ?costs, ?process friction Information technology represents a nonreimbursable cost Volume is not needed, wanted Toolsets must primarily ?Productivity ?Efficiency

17. The value proposition + ?Reimbursements, ?costs, ?process friction Information technology represents a nonreimbursable cost Volume is not needed, wanted Toolsets must primarily ?Productivity ?Efficiency Quality and safety will follow

18. Build fundamentals - I Must solve a problem (ours)

19. Build fundamentals - I Must solve a problem (ours) Must work and work very well Better Cheaper Faster Intuitive

20. Build fundamentals - I Must solve a problem (ours) Must work and work very well Better Cheaper Faster Intuitive Must not add unnecessary workflows

21. Build fundamentals - I Must solve a problem (ours) Must work and work very well Better Cheaper Faster Intuitive Must not add unnecessary workflows Must not add new liabilities

22. Build fundamentals - II Practicing physicians must be deeply involved in: Process design “Look and feel” Usability testing Modeling of process change

23. Build fundamentals - III There is no single killer app There are many achievable killer applets Specialty specific Setting specific Function specific

24. Input, Throughput, Output Input What patients think they want (And what they would get under a FFS market-driven model)

25. Input, Throughput, Output Input Throughput The key to enhanced productivity Most difficult/expensive to set up right Requires major infrastructure development

26. Input, Throughput, Output Input Throughput Output “e-outbox” “near point-of-care” solutions can work with low e-readiness can work with no provider involvement perhaps the best first incremental step what patients really want

27. Re-tooling apps for ?value,?cost

28. The “flows” Workflow

29. The “flows” Workflow - healthcare @ speed of thought

30. The “flows” Workflow - healthcare @ speed of thought Mindflow

31. The “flows” Workflow - healthcare @ speed of thought Mindflow - appears like MDs think

32. The “flows” Workflow - healthcare @ speed of thought Mindflow - appears like MDs think Careflow

33. The “flows” Workflow - healthcare @ speed of thought Mindflow - appears like MDs think Careflow - healthcare @ > speed of thought protocols error correction guidelines best practices

34. Drivers - positive Positive eHealthcare = one less thing Subliminal resolution of managed care/regulatory issues/frictions Raising the “enjoyment of practice” flag Tail wags the dog

35. Drivers - positive and negative Positive eHealthcare = one less thing Subliminal resolution of managed care/regulatory issues/frictions Raising the “enjoyment of practice” flag Tail wags the dog Negative Documentation Coding

36. Putting it together - my shopping list Problem-focused, problem solving specialty/setting specific applets better, faster, cheaper, intuitive no added workflows, liabilities Reasonably priced Designed & tested by practicing MDs Aware of workflow, mindflow, careflow Can work in low e-readiness, but mindful of coming integration Provider view = frictionless medicine