HIMSS Analytics Continuity of Care Maturity Model Going Beyond EMRAM

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Copyright © HIMSS Analytics

HIMSS Analytics

Continuity of Care Maturity Model – Going Beyond EMRAM

Model Information

http://himssanalytics.org/CCMM

Jan-Eric Slot CIO Bernhoven Ziekenhuis [email protected] Jörg Studzinski Senior Consultant HIMSS Analytics [email protected]

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Agenda

• Introduction to HIMSS and HIMSS Analytics

• Defining Continuity of Care

• The Industry Challenge…and Our Approach to a Solution

• Introducing the Continuity of Care Maturity Model

– Acknowledging Multiple Stakeholders

• Survey Methodology

• Example Achievements

• Discussion

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HIMSS WORLDWIDE AT A GLANCE

Mission: Transform health through information technology

• Not-for-profit organization founded in 1961, headquartered in Chicago

• Providing global leadership for the use of information technology (IT) to optimize

health and care outcomes

• Represents 54,000 individual and 600 corporate members, plus 250 not-for-profit

partner organizations with a presence in 200+ countries all over the world

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HIMSS BRANCHES – FOR A HOLISTIC VIEW

Events

HIMSS organizes events around the world on the most pressing issues facing health and healthcare.

Media

HIMSS provides and shares information on highly relevant aspects in the healthcare environment.

Market Intelligence (Analytics)

HIMSS supports improved decision making for healthcare organizations, technology solutions providers

and others by delivering quality data and analytical expertise.

Government Relations

HIMSS educates policy leaders on how to harness the power of IT to enhance patient care, foster

innovation, and transform a region’s or country’s health system.

Professional Development

HIMSS equips stakeholders to advance their careers with resources, education, mentoring,

networking and certifications.

Optimizing health and

care outcomes through IT

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ABOUT HIMSS ANALYTICS

• Wholly-owned, not-for-profit subsidiary of the Healthcare

Information and Management Systems Society (HIMSS)

• Collects and analyzes healthcare information related to IT

adoption and environments in numerous countries

• Delivers thought leadership, services, and analytical expertise

to the Healthcare IT Community



Providers



Government



Consultancies

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What is “Continuity of Care”?

Citizens’ perspective…

Non-disruption of care provided to a patient

throughout his/her care journey, across care settings

and care givers

Provider perspective…

Alignment of healthcare resources, across care

settings, coordinated in a way that delivers the best

healthcare services and value possible for a defined

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Traditional Care Setting Orientation

General Practitioners

Private Practices

Community Care

Acute Care Facility

Specialty Hospital

Outpatient Surgery Center

Dental Care Center

Same Day Surgery

Emergency Department

Emergency Care Center

Pharmacy Care Center

Patient Home

Group Living Care

Isolated Decisions

• Errors

• Incorrect diagnosis

Increased Costs

• Inefficient system usage

• Redundant services

Uncoordinated Care

• Isolated care episodes

• Lost efficiencies

• Lost opportunity

Systemic Inefficiencies

• Lacks health info. sharing

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Coordinated Care Orientation

Health Information Exchange

• Health information sharing

• Consolidated EMR

• Semantic interoperability

Coordinated Patient Care

• Coordinated treatment

• Reduced Errors

• Care team alerts

Advanced Analytics

• Population health

• Patient specific CDS

Patient Engagement

• Personalized alerts, goals

• EMR access, input

• Mobile access

General Practitioners

Private Practices

Community Care

Acute Care Facility

Specialty Hospital

Outpatient Surgery Center

Dental Care Center

Same Day Surgery

Emergency Department

Emergency Care Center

Pharmacy Care Center

Patient Home

Group Living Care

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Patient Scenarios

Roberto

Head injury

No radiology image sharing No EMR sharing

Outcome

• Medication conflict results in

Emergency visit, additional x-rays and MRI, and admission

• Redundant tetanus shot given

• No follow-up

Adela

Heart Surgery

Sent home with no way to monitor

Outcome

• Did not properly take

medications

• Weight gain

• Emergency Department

visit and readmission to hospital

Patrick

Multiple health complications Seeing multiple specialists

Outcome

• Lack of shared EMR and HIE

results in care and medication conflicts

• Contradicting directives

• Confused patient

• Inefficient care

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Coordinated Care Orientation

• Reduced Errors

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• Reduced Errors

• Mobile access

Adela

Heart Surgery

Sent home with mHealth weight scale

Care coordinator explains best practice follow-up treatment

Outcome

• Weight tracked by technology,

alerts sent if issues arise

• Care coordinator verifies adherence

to medications and therapy regime

Continuity of Care Value Propositions

• Reduced chance of re-admission, medical issues

• Alerts for patient and core care team when problems arise

• Patient engagement facilitated

• Consistent coordinated care and care across all care settings

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Coordinated Care Orientation

• Reduced Errors

• Mobile access

• Reduce redundant healthcare services (x-rays, MRI, tetanus shot)

• No adverse medication reaction

• Ongoing up to date EMR for future care

Outcome

• EMR + medication reconciliation (eMAR)

prevents adverse drug event

• Tetanus shot noted in EMR history

Outcome

• Stitches removed in primary care setting

• Wound checked for infection, healing

Roberto

Head injury

No radiology image sharing No EMR sharing

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• Reduced Errors

• Mobile access

• All providers and care teams have access to all medical info

• Patient engagement facilitated

• Efficient care from core care team facilitated by coordinated care

• Pop health analytics identifies best care practices, which are

able to be managed and merged

Coordinated Care Orientation

Patrick

Multiple health complications Seeing multiple specialists

Outcome

• While still seeing multiple providers,

all informed of all activities

• Best care practice protocol put in place

• Alerts for patient and core care team when

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Continuity of Care Maturity Model –

Purpose

• Provide orientation:

o

Information/Knowledge: What characterizes continuity of care?

o

Benchmarking: What is our status? How are my peers doing?

o

Action/Strategies: What gaps need to be closed, when?

• Global applicability, local adjustments possible

• Complement existing EMR Adoption Models

• EMRAM

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Model Audiences



Regional & National Health Authorities/ Ministries of Health



Hospital Trusts / Integrated Delivery Networks (IDN)



Health Management Organizations (HMOs) / Accountable Care

Organizations (ACOs)



(Private) care chains

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CCMM Pillars of Focus

Health

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Analy

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Str

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Pa

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Capabilities

Po

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Initia

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IT

Syste

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Capabilities

St

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Security

&

Priv

acy

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Multiple Model Stakeholders

Administrators

CEO/COO/CFO/CSOs

Clinical/Medical

Leaders

CMIO/CNO/CNIOs

Technology Leaders

CIOs

Forge agreements, policies,

and standards that allow and

enable progress

Drive clinical activities that

enable and enhance

coordinated care, pop health

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Governance Focus

National and local policies are aligned.

CCMM Governance Focus

Policies address non-compliance.

Policies in place for collaboration, data security, mobile device use, and interconnectivity between healthcare providers and patients Best clinical practices are derived from care community healthcare data and operationalized across the community

Policies drive clinical coordination, semantic interoperability. Change management is documented and standardized

Policies for CofC strategy, business continuity, disaster recovery, And security & privacy. Data governance is active

Governance is informal and undocumented Data governance across organizations

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Clinical Focus

Comprehensive pop-health. Completely coordinated care across all care settings. Integrated personalized medicine

CCMM Clinical Focus

Dynamic intelligent patient record tracks closed loop care delivery. Multiple care pathways/protocols. Patient compliance tracking

Shared care plans track, update, task coordination with alerts and reminders. ePrescribing. Pandemic tracking and analytics.

Community-wide patient record with integrated care plans, bio-surveillance. Patient data entry, personal targets, alerts.

Multiple entity clinical data integration. Regional/national PACS. Electronic referrals, consent. Telemedicine capable.

Patient record available to multi-disciplinary internal and tethered care teams. EMR exchange. Immunization and disease registries. Limited shared care plans outside the organization. Leverage 3rd party reference resources. Basic alerts.

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IT Focus

Near real-time care community based health record and patient profile

CCMM IT Focus

Organizational, pan-organizational, and community-wide CDS and population health tracking

All care team members have access to all data. Semantic data drives actionable CDS and analytics. Comprehensive audit trail Patient data aggregated into a single cohesive record. Mobile tech engages patients. Community wide identity management

Aggregated clinical and financial data. Medical classification and vocabulary tools are pervasive. Mobile tech supports point of care Patient-centered clinical data presentation. Pervasive electronic automated ID management for patients, providers, and facilities Some external data incorporated into patient record.

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Methodology

• Defining the “Care Community”

– The population who’s continuity of care is being profiled

• Define up to five care settings, such as…

1. Primary Care

2. Acute Care

3. Home based Care

4. Urgent Care

5. Long Term Care

• Completing Survey

– Excel based

– Respond to ~230 compliance statements

– 10 categories such as Care Coord., Pt Engagement, Analytics, HIE, Org. Strategy,

Security & Privacy, etc…

– Five pre-defined responses

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Scoring Tutorial

• 8 Stage model, like the EMRAM model

– Lowest is Stage 0, highest Stage 7

• Overall and stage level progress reported as a percentage

– Conveys overall progress against all requirements

– Color scale represents % progress against each stage

– Shows areas of strength and opportunity

• Passing a stage requires

or > compliance

– On that stage and all previous stages

– Your “Stage” standing is the highest stage passed

– Accommodates different approaches in priorities, resources types, and

execution of healthcare advancements

• Scoring is hierarchical

Total 37% Stage 7 9% Stage 6 27% Stage 5 35% Stage 4 47% Stage 3 37% Stage 2 55% Stage 1 59% Stage 0 83% 1 2 3 4 5 _{1 2 3}

Overall Results

Stakeholder Results

Care Setting Results

70%

Stage Progress (example data)

Primary Care Acute Care Post-Acute Care Home Based Care Long Term Care

Total 17% Total 31% Total 10% Total 15% Total 8% Stage 7 10% Stage 7 10% Stage 7 0% Stage 7 20% Stage 7 20% Stage 6 15% Stage 6 24% Stage 6 7% Stage 6 7% Stage 6 7% Stage 5 7% Stage 5 16% Stage 5 7% Stage 5 9% Stage 5 0% Stage 4 14% Stage 4 46% Stage 4 0% Stage 4 14% Stage 4 7% Stage 3 34% Stage 3 50% Stage 3 24% Stage 3 24% Stage 3 6% Stage 2 28% Stage 2 63% Stage 2 9% Stage 2 41% Stage 2 31% Stage 1 44% Stage 1 86% Stage 1 47% Stage 1 33% Stage 1 14%

Stage 0 60% Stage 0 40% Stage 0 60% Stage 0 50% Stage 0 40%

Governance Clinical Info Tech

Total 16% Total 38% Total 33% Stage 7 12% Stage 7 Stage 7 0% Stage 6 12% Stage 6 40% Stage 6 13% Stage 5 8% Stage 5 19% Stage 5 39% Stage 4 16% Stage 4 43% Stage 4 35% Stage 3 28% Stage 3 41% Stage 3 42% Stage 2 34% Stage 2 43% Stage 2 40% Stage 1 45% Stage 1 54% Stage 1 70%

Stage 0 50% Stage 0 50% Stage 0 75%

Total 37% Stage 7 9% Stage 6 27% Stage 5 35% Stage 4 47% Stage 3 37% Stage 2 55% Stage 1 59% Stage 0 83%

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Information Tech Stakeholder Achievements

Info Tech

Primary Care Acute Care Post Acute Care Home Based Care Long Term Care

Total 38% Total 55% Total 23% Total 22% Total 23%

Stage 7 0% Stage 7 0% Stage 7 0% Stage 7 0% Stage 7 0%

Stage 3 30% Stage 3 90% Stage 3 50% Stage 3 20% Stage 3 20%

Stage 1 67% Stage 1 75% Stage 1 83% Stage 1 67% Stage 1 58%

Stage 0 75% Stage 0 100% Stage 0 75% Stage 0 75% Stage 0 50%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stage 7 Primary Care Acute Care Post Acute Care Home Based Care Long Term Care

Info Tech Stakeholders

Total 33% Stage 7 0% Stage 6 13% Stage 5 39% Stage 4 35% Stage 3 42% Stage 2 40% Stage 1 70% Stage 0 75%

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IT Stakeholder Recommendations

Information Technology stakeholders support clinical stakeholder initiatives and implement

governance stakeholder policies and strategy. There is a delicate balance between

maintaining and optimizing operational systems while extending and modernizing

capabilities and technology.

Stage 1 Recommendations

1) Implement master patient, physician, and facility identification strategy in support of the sharing of

data across the continuum of health

2) Integrate external reference data into analytics environment (registries, immunization, census,

population health, etc…)

Stage 2 Recommendations

1) With collaboration from governance and clinical stakeholders begin to build a patient-centered clinical

data repository with data from most parts of the organization including associated, affiliated, and

tethered providers in support of building analytics capabilities and patient engagement (i.e.: patients

log into one interface and sees consolidated clinical information)

Stage 3 Recommendations

1) Pervasively implement medical classification and vocabulary tools in support of discrete standardized

data

(e.g. CPT, ICD, SNOMED, LOINC, others…; national standard compliance if applicable)

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Overall Governance Clinical Info Tech

Total 40% Total 31% Total 48% Total 55%

Stage 7 7% Stage 7 10% Stage 7 Stage 7 0%

Stage 6 30% Stage 6 24% Stage 6 56% Stage 6 25%

Stage 3 56% Stage 3 50% Stage 3 55% Stage 3 90%

Stage 0 56% Stage 0 40% Stage 0 50% Stage 0 100%

Acute Care Setting Achievements

Recommendations

 Work with Info Tech Stakeholders to document and implement an overarching information and

communications technology strategy

 Develop master patient, provider and facility indexes that are common

 Develop an overarching care coordination strategy, focusing on higher volume care settings and

eventually extending into all care settings

 Develop care plans that can be shared and leveraged across all care settings as appropriate

 Build a patient-centered data repository supporting analytics, patient engagement, and coordinated care

 Aggregate clinical and financial patient data into repository, including some externally sourced data

 Further expand multi-level clinical decision support systems (CDSS) including into other care settings

(e.g.: across acute care facility service lines, in all facilities)

 Provide actionable clinical decision support and advanced analytics (batch and on-demand), including