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Health Data System Dilemmas The role of health IT in the transformation agenda Randy Duguay Director, Market & Business Development TELUS Health Solutions


Outline 

Top Issues in Health

Patient-centric Care & Transformative Health Services

Emerging Solutions

Healthcare in the Clouds

Health Analytics & BI

mHealth

Consumer Health

Concluding discussion 

Is Access to private/ personalized health information a threat or an opportunity?

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Top Issues in Health


Top 5 Issues in Canadian Healthcare

Canadian healthcare system is unsustainable Long wait Medication Insufficient times, errors and Chronic focus on poor Disease compliance access to prevention Management causing and care and prevalence important patient lack of quality increasing selfcontinuity management issues of care

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Need for improvement

in performance

to address cost challenge


Chronic Disease Management 

Chronic Disease is responsible for 60% of the global disease burden (Source: World Health Organisation)

In Canada, the cost of chronic illness, disability and death is $80 billion

The answer is to provide tools to: – Identify those at risk who require routine screening – Support clinical decision-making and standardized care protocols for patients – Facilitate collection and analysis of information to track trends, support evidence-based therapies, empower the patient, and improve overall outcomes

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Medication Errors and Non-Compliance   

40 percent of hand-written prescriptions have errors up to 50 percent of patients do not take their medication properly 20 percent of prescriptions are not filled

The answer – Medication Reconciliation for: – Optimizing drug selection for a particular patient – Checking prescriptions against the patient’s drug profile to identify drug interactions – Ensuring appropriate lab tests are performed to manage drug therapy – Implementing step therapy protocols, particularly for expensive specialty drugs

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Long Wait Times. Poor Access to Care. Lack of Care Continuity 

The answer is:

The magnitude of the problem annually in Canada

Connecting the disparate systems existing within acute, primary and home care to allow for the sharing of patient information at different points-of-care

Enabling the coordination of care through collaborative services such as secure emails, electronic referrals, results distribution and electronic selfscheduling

And, using remote patient monitoring technology to keep patients on track and out of the emergency room

– over 1 billion diagnostic events – 30 million doctor’s office visits

– 3.5 million surgical procedures – almost all of these are booked manually 

Canada has low scores in: – Access to doctor or nurse when sick or needing care – Highest use of emergency room in the past 2 years; generating unnecessary pressure on the acute care system; – Worst scores in delays for a specialist appointment and for elective surgery

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Prevention and Patient Self-Management 

Prevention of disease instead of remediation reduces the drain on our healthcare system resources and improves the overall health of our population. The Answer: – Online tools are widely available

– Wellness programs offered through insurer and employers – Many of these tools are available today including consumer ehealth services (like TELUS health space), personal health records, Electronic Medical Record connectivity, remote patient monitoring and more

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Performance Management Unfortunately Canada is behind in some areas:  

Pay-for-Performance – controversial subject National spending on healthcare has experienced an 8 percent annual growth on average in the last decade By 2030 healthcare spending could absorb 4/5 of Ontario’s budget

The Answer: Analytics / Business Intelligence Solutions 

Need to be able to analyze public health trends as well as hospital and physician performance and implement pay-per-for-performance strategies based on identified and agreed-to key performance indicators.

It is already working in:  The UK  The Netherlands 

The United States

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Patient-centric Care & Transformative Health Services


eHealth Vision Organizations are investing in health solutions that foster collaboration, drive prevention and empower the patient

Preventative-Health Consumer-centric Era

+

Collaborative Health Provider-centric Era

Transactional Health Facility-centric Era

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  

 

TELUS Health Space Personal health records Wellness

Regional EHR; reaching from hospitals to primary care physicians & pharmacists Home & Community care EMR, Extended health care professionals

Infrastructure-driven EHR projects In-facility clinical and administrative applications Transaction payment automation

2010

2030

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Why focus on health technology data solutions? Information is the currency of healthcare Conversion from paper to digital files

Facilitated workflows

Informationbased and process driven transactions

Information sharing, coordination

Facilitated service transitions and care collaboration

Analytics for decisionmaking and predictive modeling

The main dilemmas in health care will require addressing these areas of need to help enable care providers in providing patient-centric care Committing to and supporting healthcare innovation by:  Empowering knowledge workers

 Drive better decisions

 Engaging the consumer / patient as part of the team

 Create more capacity

 Changing how we use and share information

 Shift from remediation to prevention

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Consumer Health Solutions Will help empower the Consumer to play an active role in addressing their health and wellness and that of their loved ones. The vision To provide real-time, portable personal & family health management services that empower consumers and their care providers The goal  Work with physicians and professional care

givers to build the best self- and collaborative care solutions  Provide most Canadians a platform for easy,

private storage and exchange of their health information  Build an ecosystem of application and solution

providers to help consumers manage their own health  Connect consumers to their care givers  Develop smart self-care tools that automatically

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Emerging Solutions


Healthcare Game Changers

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1.

Healthcare in the Cloud

2.

Health Analytics

3.

mHealth

4.

Consumer health


What is Cloud Computing? Cloud is shifting the customer experience from locally stored data and locally run applications to accessing data and applications over a network “The Cloud” is the

“The Cloud” isnetwork the network that connects that connects consumers and to applications consumers and businesses businesses to and storage.applications It typically takes the form and storage. typically takes the form network, of the public ItInternet, a private of the public Internet, a or a hybrid of the private network, or atwo hybrid of the two

The goal of the cloud is to reduce costs through efficient usage of resources, while enhancing the services to end-users.

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Sharing information across the continuum-of-care An easy and affordable way to access and share patient information through the cloud

Long term stay organisation Hospital

Home

Information sharing between all of the provider community

Pay for use services, no initial investment

Result Distribution eReferral Medication Rec. RPM and Disease Mgnt

Access to portal or interface to EMR Clinic (GP or Specialist)

Pharmacy

Laboratory, imagery or other

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Home and Community Care

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SaaS model where data resides in the source system


Health Analytics

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Data Analytics and Healthcare Transformation 

Health Analytics provides high quality information, analyses, predictive modeling and methodological support to enhance health system evidence-based decision making.

Explosion of data becoming available through EHRs, EMRs, labs (hundreds of disparate systems across the care continuum)

BI solutions can extract disparate data and analyze it into meaningful information for: – Clinical analysis – Operational analysis and outcomes reporting – Financial analysis

Successful implementation requires consistent engagement of both clinicians and administrators

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Meaningful Use – Coming to Canada

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BI Will Have a Dramatic Impact on Healthcare Why?  Meaningful Use in Canada will Result in Policy Changes: – Environment is becoming increasingly outcomes focused – New funding models are emerging across the care continuum – ROI is clearly demonstrable in U.S. for health technology investments (EHRs); Canada will follow 

Setting and Measurement of KPIs: – Proactive measurement leads to better management and allows for continuous improvement

Better Patient Care: – The ability to capture and analyze relevant patient information – medications, lab results, images, orders, diagnoses, vital signs – in an EHR improves decision-making, patient safety and outcomes

Cost Savings: – Data can help reduce costly medical errors, minimize duplicate tests and reduce prescribing errors

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Case example: Medical University of South Carolina Using the aggregated and analyzed information, MUSC has been able to: 

Improve clinical decision making and patient care

Develop and evaluate protocols, treatments and drug based on medical research

Facilitate productivity improvements through user access to the data enabling reporting, analyzing, and electronically disseminating clinical information across the enterprise

Improve organizational efficiencies through the significant reduction in manual effort required to support clinical analysis and reporting

In addition, MUSC has experienced efficiencies including: 

The ability to conduct deep analysis across patient populations

Providing deeper longitudinal analysis of patient histories

Implementing best practise compliance comparisons

An increase in patient safety

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Tablet Computing & mHealth

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Smart phones and Tablet computing are here 

Over 70% of physicians own a smartphone;

More than 25 % of 900 US healthcare organizations plan to deploy the iPad and other iOS devices immediately; nearly 70 % plan to deploy within the next year; Source: HIMSS

Currently there are 17,000 mHealth applications in major app stores on the net to manage chronic conditions, weigth problems or other health and wellness issues; Source: research2guidance

1/3 of physicians said they make decisions based on incomplete information and believe the greatest benefit of mobile devices will be to help them make decisions faster as they access more accurate data in real-time; Source: HRI

40% of physicians said they could eliminate 11% to 30% of office visits through the use of mobile technologies like remote monitoring, email or text messaging with patients; Source: PWC

Are physicians and extended healthcare professionals using mobility in their day-to-day practice? Information for life Information for life

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Breaking the barriers to mHealth Adoption 

Integration to clinical information system: – In the US, 2/3 of physicians confirm that their mobile devices are not connected to their hospital or clinic information system

Perception of Security threats – 33% of Primary Care Physicians and 41% of specialists are worried about privacy and security issues relating to mobility

Reimbursement of phone consultations, email consults and telehealth

Perception of Network Coverage and Bandwidth issues

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Consumer Health

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Consumers are an integral part of the transformation Context A patient consults a specialist in a clinic and is diagnosed with a chronic disease. The patient’s primary care physician refers him a remote patient monitoring program managed by the Community Health Center

1

2

The Community Health Centre program nurse evaluates the patient condition and defines the personalized care plan within RPM service

The nurse visits the patient at his home and educates the patient on the RPM devices as well as his disease selfmanagement program.

3 The patient follows the care plan, enters the required data and learns how to manage his chronic condition.

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Consumers are an integral part of the transformation Context A patient consults a specialist in a clinic and is diagnosed with a chronic disease. The patient’s primary care physician refers him a remote patient monitoring program managed by the Community Health Center

1

2

The Community Health Centre program nurse evaluates the patient condition and defines the personalized care plan within RPM service

The nurse visits the patient at his home and educates the patient on the RPM devices as well as his disease selfmanagement program.

3 The patient follows the care plan, enters the required data and learns how to manage his chronic condition.

Information for life Information for life

28


Consumers are an integral part of the transformation Context A patient consults a specialist in a clinic and is diagnosed with a chronic disease. The patient’s primary care physician refers him a remote patient monitoring program managed by the Community Health Center

1

2

The Community Health Centre program nurse evaluates the patient condition and defines the personalized care plan within RPM service

The nurse visits the patient at his home and educates the patient on the RPM devices as well as his disease selfmanagement program.

3 The patient follows the care plan, enters the required data and learns how to manage his chronic condition.

Information for life Information for life

29


Consumers are an integral part of the transformation Context A patient consults a specialist in a clinic and is diagnosed with a chronic disease. The patient’s primary care physician refers him a remote patient monitoring program managed by the Community Health Center

4 In the meantime, the nurse tracks the alerts triggered by the patient, takes action and adjusts the care plan if necessary

5

When the patient’s condition is stabilized and he has sufficient knowledge to self-manage his condition, the program nurse discharges the patient from the RPM program.

6 The patient receives training on PHR/health space tools to help him continue to manage his condition.

Information for life Information for life

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Consumers are an integral part of the transformation Context A patient consults a specialist in a clinic and is diagnosed with a chronic disease. The patient’s primary care physician refers him a remote patient monitoring program managed by the Community Health Center

4 In the meantime, the nurse tracks the alerts triggered by the patient, takes action and adjusts the care plan if necessary

5

When the patient’s condition is stabilized and he has sufficient knowledge to self-manage his condition, the program nurse discharges the patient from the RPM program.

6 The patient receives training on PHR/health space tools to help him continue to manage his condition.

Information for life Information for life

31


Consumers are an integral part of the transformation Context A patient consults a specialist in a clinic and is diagnosed with a chronic disease. The patient’s primary care physician refers him a remote patient monitoring program managed by the Community Health Center

4 In the meantime, the nurse tracks the alerts triggered by the patient, takes action and adjusts the care plan if necessary

5

When the patient’s condition is stabilized and he has sufficient knowledge to self-manage his condition, the program nurse discharges the patient from the RPM program.

6 The patient receives training on PHR/health space tools to help him continue to manage his condition.

Information for life Information for life

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Concluding discussion Is access to private/ personalized health information a threat or an opportunity?

Randy Duguay - Health Data System Dilemmas  
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