Building the HIT Infrastructure For Patient Centered Medical Home and ACOs: The EHR is Necessary But Not Sufficient

Date: 05.15.2013 | Zach Urbina">Zach Urbina

Charles DeShazer, VP Medical Informatics, Quality, and transformation, Dean Health System

The current changes in healthcare are compared to a “tsunami,” says DeShazer.  He also communicates how medicine and related technology are evolving.

“He who is first to battle is at ease. He who is late to battle is at labor,” says DeShazer, quoting Chinese author Sun Tzu in an analogy for the current changes in electronic health records.  DeShazer relates the massive changes in healthcare with respect to IT infrastructure and the needs associated with those changes, shifting from event-based care to population-based care.

DeShazer analogizes the idea of ACOs as building a “medical neighborhood” for the “medical home.”  He also details the shift of cost risk from payers to providers.

Next up is a presentation on the uneven distribution of cost versus population distribution.  DeShazer demonstrates ways to utilize data to drive targeted strategies.  He also presents the idea of providing outreach for high-risk patients, because small percentages of total population continue to drive costs higher.  DeShazer reports that 1% of population drives 14% of all costs.

The positive impact of healthy behavior is presented (i.e. eating well, not smoking, staying active). Also highlighted by DeShazer is the need of care coordination, especially with the 1% driving costs higher.  DeShazer reports on the need for proactive interventions, utilizing new technologies like digital information exchange, predictive analytics, performance feedback for doctors, and workflow redesign.

DeShazer continues by examining medical care evolution.  He reports on the changing fields of genomics and the need for doctors to consider the growing number of factors requiring consideration before reaching a clinical decision.

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The implications of government interventions are next presented.  DeShazer underscores the urgency of government-backed Meaningful Use and electronic health records.  He also champions the need for more granularity of diagnostic information and the clinical value of data collection.

The vision of healthcare information technology from a government perspective is considered.  This includes more digital data capture, accelerated adoption of EHR, empowering individuals to manage their care, and process improvements based on connectivity.

DeShazer notes that the crucial success factors needed to usher in the new vision of HIT include data collection, robust analytic capabilities, master data management, leveraging analytics to set up clinical decisions, and establishing accountability & feedback mechanisms.

According to DeShazer, the key infrastructure to support Patient Centered Medical Home (PCHM) include care coordination, chronic condition management, population health management, patient engagement, evidenced-based medical practice, and real-time connectivity.

DeShazer then examines the various stages of ACO maturity and lists the details associated with each stage.  He continues by discussing the quantitative measurement of all the data in the world and how it is growing at a rapid rate.  DeShazer illuminates the need for robust data analytics, delivered real-time using advanced software and hardware.

Deshazer share his experience with Meaningful Use at Dean Health System and how he and his colleagues leverage Meaningful Use as a springboard toward much more clinically specific data usage.  Key tactics and strategies include Big Data analytics, work flow optimization, and doctors managing by exception.

The speaker then concludes his prepared remarks.

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