More Related Content Similar to Frisse - One Step at a Time (20) More from Brian Ahier (19) Frisse - One Step at a Time1. One Step at a Time
Mark Frisse, MD
HIMSS NW Technology & Education Symposium
14 October, 2013
© 2013, Mark Frisse
2. the
Program
KN: Frisse
Big Data/Analytics
Biz Case
ICD-10
Skill Sets
Population Mgmt
OR / WA HIE
ACO Value
KN: Global to Local
Clin Analytics
State, Fed, Local
EHR Replacements
Analytics/ Pop Hlth
OHSU
Security
KN: Risk-Based Pop Mgmt
3. Analytics
KN: Frisse
Big Data/Analytics
Biz Case
ICD-10
Skill Sets
Population Mgmt
OR / WA HIE
ACO Value
KN: Global to Local
Clin Analytics
State, Fed, Local
EHR Replacements
Analytics/ Pop Hlth
OHSU
Security
KN: Risk-Based Pop Mgmt
5. Systems
KN: Frisse
Big Data/Analytics
Biz Case
ICD-10
Skill Sets
Population Mgmt
OR / WA HIE
ACO Value
KN: Global to Local
Clin Analytics
State, Fed, Local
EHR Replacements
Analytics/ Pop Hlth
OHSU
Security
KN: Risk-Based Pop Mgmt
6. Analytics, sustainability, & systems
KN: Frisse
Big Data/Analytics
Biz Case
ICD-10
Skill Sets
Population Mgmt
OR / WA HIE
ACO Value
KN: Global to Local
Clin Analytics
State, Fed, Local
EHR Replacements
Analytics/ Pop Hlth
OHSU
Security
KN: Risk-Based Pop Mgmt
7. Keynote: Four parts…
The
Turbulence
•
Forces driving change
The
Confusion
•
Uncertainties & immature markets
Some vital
•
An
•
Elements
Components for forging solutions
emergence
Reaching our goals – one step at a time
© 2013, Mark Frisse
9. Turbulence: decades in the making
Sick
Inadequately
prepared
Cost
Complexity
Opacity
Expectation
Entitlement
Moral Hazard
10. HITECH: a stimulus effort
source: http://dashboard.healthit.gov/onc/
© 2013, Mark Frisse
12. And we have given ourselves limited time
Source: Halamka JD. The Future of Standards.
© 2013, Mark Frisse
13. So we face local & national challenges
© 2013, Mark Frisse
14. Even some supporters of the Affordable Care Act worry that the flaws in the system, if
not quickly fixed, could threaten the fiscal health of the insurance initiative, which
depends on throngs of customers to spread the risk and keep prices low.
© 2013, Mark Frisse
15. The relationship of policy and technology
1997 (Paul Starr)
When [Clinton health care] reform collapsed,
so did the momentum to build an information
infrastructure for a new system.
Today (2013)
Is it possible that inadequate execution of HIT
systems will place needed health care reforms
at risk?
Starr, P., Smart technology, stunted policy: developing health information networks.
Health Affairs (Millwood), 1997. 16(3): 91-105.
© 2013, Mark Frisse
16. We are in the Northwest
© 2013, Mark Frisse
19. Remarkable adoption of office-based EHRs
Office-based provider adoption: basic EHRs
http://dashboard.healthit.gov/HITAdoption/
© 2013, Mark Frisse
20. Remarkable adoption of hospital systems
Urban: 47.7%
Rural: 33.5%
http://dashboard.healthit.gov/HITAdoption/
© 2013, Mark Frisse
21. MU: Penalty adjustments to PFS
Meaningful Use: Penalty adjustments to Medicare Physician Fee Schedule (PFS)
© 2013, Mark Frisse
Image source: Acumen Physician Solutions. http://www.acumenmd.com/avoiding-the-approaching-meaningful-use-penalty/
22. Mixed results for HITECH state HIE
Tripathi to HIT Policy Committee: State HIE
program Status
© 2013, Mark Frisse
23. Some Pioneer ACOs are opting out
7 – Medicare Shared Savings
2 – Opting out entirely
source: Advisory Board, September 2013. The population Health Leaders Reading List
© 2013, Mark Frisse
24. Inconsistent privacy policy implementation
If the interpretation of any privacy policy is excessively risk-averse, authorized health information
may not be transmitted
Institution
Policies
Contracts
State Law
{A}
Federal Law
{B}
CONSENT:
- Context
- Information
- Roles
- Relationships
- Terms
USE:
- Context
- Information
- Roles
- Relationships
- Terms
© 2013, Mark Frisse
25. Concerns rise from all quarters (as expected)
• Interoperability
• Sustainability
• ICD-10
• Certification
• Quality metric
simplification
• HIPAA
• Oversight & fraud
• Government shut-down
© 2013, Mark Frisse
27. Ambulatory care is more fragmented
C
D
B
?
A
Medicare beneficiaries see at least five different physicians
and many more pharmacists, therapists, and other clinicians.
source: Pham, H.H., et al., Care patterns in Medicare and their implications for pay for performance. N Engl J Med, 2007. 356(11): p. 1130-9.
© 2013, Mark Frisse
28. How fragmented is ambulatory care?
Slide: David Kibbe. http://www.directtrust.org/
© 2013, Mark Frisse
30. some vital Elements
a part of aspect of something –
especially one that is essential or
characteristic
© 2013, Mark Frisse
31. Change begins with us
•
•
•
•
•
•
•
•
Patients & families
Providers
Plans
States
Federal Government
Vendors (broadly defined)
Integration & analytics groups
Quality bodies
© 2013, Mark Frisse
32. Widespread agreement on many remedies
Lewin JC, Atkins G, McNeely L. The Elusive Path to Health Care Sustainability. JAMA. 2013;():-. doi:10.1001/jama.2013.280147.
© 2013, Mark Frisse
33. HIE can create a single record
Data are made available to those who require access
C
D
B
A
© 2013, Mark Frisse
36. A single record; a single plan
a single, personalized plan of care for the individual
measurable
outcomes
© 2013, Mark Frisse
37. Our search for effective analytics
source: https://www.explorys.com/docs/data-sheets/explorys-overview.pdf NOT a product endorsement
© 2013, Mark Frisse
38. Summary: Elements
We have components and new markets for
HIE (e.g., ACOs, CINS, bundles)
Planning paradigms can advance
incrementally
© 2013, Mark Frisse
40. Task: A new model for regional HIE?
Frisse’s Hunch:
• A number of “hub & spoke” HIE efforts
formed as a result of partnerships,
ACO or CIN relationships
• Some MDs will belong to multiple clouds
• Some MDs communicate only via Direct
Direct
or other
HIE services
© 2013, Mark Frisse
41. Task: “Push” only to respond to “pull”
PRACTICES
DESIGNS
NEEDS
Value-based payment
Aligned incentives
Efficient administration
Aligned CMS and health plans
Connectivity
Systems thinking
Engineered approaches
Analytics & decision support
Patient / consumer engagement
Iterative cycles of systems-based interventions
© 2013, Mark Frisse
42. Task: Solid foundations (Version 1.0)
• A systems view
• Governance
• Authentication & authorization
• Directories
• Record linkages
• Simple messaging
• Engineered privacy
• Effective & efficient audit logs
© 2013, Mark Frisse
43. Task: Improve provider quality of life
• A realistic near-term vision
• Quick wins
• First, do one or two things well
• Minimize administrative burdens
• No inaccurate / unnecessary
documentation
• Automate simple quality reporting
• Make fraud almost impossible
© 2013, Mark Frisse
44. Task: Design for population management
•
•
•
•
•
•
•
Early, demonstrable benefits
Governance & data use
Low-cost, secure connectivity
Meaningful metrics
Effective analytics
Consumer engagement
Incentives & behavioral economics
© 2013, Mark Frisse
45. Summary: Emergence
Progress through renewed emphasis on our
critical goals combined with a componentbased, systems approach incrementally
executed with tangible early results
© 2013, Mark Frisse
46. Summarizing…
Turbulence
• Demographics make this inevitable
Confusion
• Uncertainty is a by-product of change
Elements
• We have some components. Must focus on gaps
Emergence
• We are proceeding …….. one step at a time
© 2013, Mark Frisse