Beyond EHR - Achieving Operational Efficiency

Beyond EHR
Achieving Operational Efficiency & Optimization

Callum Bir
Deloitte Consulting SEA

Beyond EHR -

Start Time End Time Topic Speaker

8:30 9:00 Registration -

9:00 10:30 Business Case & Benefit Realization for EHR Callum Bir, Deloitte
across various stakeholders
10:30 10:45 Morning Coffee -

10:45 12:30 Going Beyond EHR – Opportunities & Operating Callum Bir, Deloitte
Models
12:30 13:30 Lunch -

13:30 14:30 Building Foundation going beyond EHR (Case- Victor Chai, MOHH
Study)
14:30 15:30 Secondary Uses of Data: Pharmaceutical Shirali Mewara, Deloitte
Perspective

(Case Study)
15:30 15:45 Afternoon Coffee -

15:45 16:00 Achieving Interoperability & Role of Standards Callum Bir, Deloitte

16:00 16:30 Singapore’s Approach to Standards Yu Chye Cheong, MOHH

(Case Study)
16:30 17:00 US’s Approach to Standards (Case Study) Thiam Hwa Lim, HL7

17:00 17:30 Panel Discussion

2 ©2011 Deloitte Touche Tohmatsu Limited

Benefits for EHR across various Stakeholders
Realizing Benefits

Callum Bir
Deloitte Consulting SEA

Healthcare Market is experiencing a rapid transition in the clinical needs and
the use of technology for innovation

Present-day scenario in Healthcare industry

Growing Aging Population Innovation through Technology

Increasing Healthcare Costs Increasing focus on primary &
preventive care
Shifting Evolving
Increasing Lifestyle diseases Trends Focus Resource Shortage & Medical
Tourism
Increasing Burden on Provider Emerging
Increasing Patient expectation
markets

Innovative Markets in the SEA region

Chronic Medication
Health Reform Clinical Medical
Disease Safety and E Health
Effectiveness Tourism
Management Management


Some of the Key Questions

Govt Health & Payers Providers
•How do we make healthcare affordable? • How we improve Quality of Care
• How do we increase capacity •How do we Improve Patient Safety
•How do we improve seamless • How do we improve operational /
coordination of care across the health clinical efficiency?
care continuum
• How do we increase compliance?
•How do we keep our population healthy?

Patients Life Sc Companies
• How do I stay healthy? • How do we accelerate drug discovery,
• How do I better manage my disease development, and launch medicines
and improve my lifestyle (Chronic) • How do we increase efficacy, and
• How do I share my decision making? safety?
• How do I “take-control” of my health • How do we accelerate innovation?
better?


A Seemingly Logical “Trendline”

Community-wide
Automation
Presumed Benefits

Enterprise/Integrated
Delivery System-wide
Automation
Extend
the Core
Hospital-wide
Enterprise
Automation
The

Departmental
Enterprise
Automation

Level of Complexity/Involvement


It is expected that HIEs help reduce costs and enhance quality by providing
physicians with needed information at the time treatment decisions are made

HIEs are also envisioned as a way for stakeholders to experiment with new economic
models

Typical HIE Benefits Potential U.S. net efficiency gain from use of HIEs:
>$55B per year or 3% of total healthcare expenditure of
Public Health
$1.7 T
 Improved population health Inpatient EHR $6B
 Improved wellness
 Improved monitoring and safety

Payers and Employers
 Reduced costs Outpatient EHR $25B
 Reduced MLR
 Lower absenteeism
 Efficiency

Providers
 Reduced errors
 Improved quality
 Efficiency Community Health
Information Exchange
Other (e.g., Life Sciences) $55B

 Faster routes-to-market
Sources: Center for Information Technology Leadership, Partners Health Care, Harvard (2004)

©2011 Deloitte Touche Tohmatsu Limited

Fast facts (?)

The eHealth Initiative’s (eHI) 2008 survey found that fully operational HIEs are producing
results. The eHI also found in its survey that the HIE results are translating into positive
returns on investment for their stakeholders.
The survey results are given below:

69% 52% 69%
of the fully operational exchange of fully operational exchange of operational exchange efforts
initiatives (29/42) experienced efforts (22/42) report positive (29/42) report a positive financial
reductions in health care costs. impacts on health care delivery. return on their investment (ROI) for
their participating stakeholders.
A majority (69%) of the fully About half (52%) of fully A majority (69%) of operational
operational exchange initiatives operational exchange efforts exchange efforts (29/42) report a
(29/42) experienced reductions in (22/42) report positive impacts on positive financial return on their
health care costs: health care delivery: investment (ROI) for their
 19 reduced staff time  16 improved access to test results participating stakeholders:
 11 decreased dollars spent on  13 improved quality of practice life  13 reported an ROI for hospitals
redundant tests  9 decreased support staff  9 reported an ROI for physicians
 5 documented a reduction in patient  8 improved compliance with chronic practices
admissions care and prevention guidelines  6 reported an ROI for health plans
 5 decreased cost of care for chronic  6 reported better care outcomes for  5 reported an ROI for independent
care patients Patients laboratories
 4 reported a decrease in prescribing
errors
 4 increased recognition of disease
outbreaks


Most direct benefits seem linked to streamlining information exchange
among HIE participants (Simulated Total)

Increased patient safety

Electronic receipt/
transmission of clinical Administrative savings
documentation ( e.g., filing / requesting
requests, retrieving patient
history, call-in of orders,
Duplicate tests
call-in of prescriptions )
reduction

Substitution to
generic drugs

Electronic adjudication of orders

Benefits for stakeholders groups

The grid illustrates anticipated benefits for a range of potential HIE services across stakeholder groups

Benefit potential
Service Clinical Clinical Care Quality Public health Data Personal
results records management reporting reporting aggregation health
Stakeholder delivery tools for research records
Physicians

Hospitals

Laboratories

Pharmacies

Payers

Employers

Researchers

Consumers

Anticipated magnitude of benefits of each service for stakeholder groups.

High Medium Low

Source: State-level HIE Value & Sustainability Interim Report, AHIMA


Reducing cost is possible while improving population-based outcomes
HIEs are important enablers of the healthcare delivery ecosystem

• Respond to transparency & PC 2.0
- Connected care
- Rx reimportation
- Medical tourism
4 • PHR (Shared Decision Making)
• Incentives
- Experience rating & differential
Consumerism premiums
Focus: Transparency, - Healthy behavior rewards
PHRs, Incentives, Value • Complimentary/Alternative Medicine

3 • New medical homes
Coordination of Care • Reimbursement realignment
• Primary care workforce
Focus: Primary Care 2.0 Model • MD led clinical care coordination
(The New “Medical Home”)

• 3 –7 NMEs per year
2 Comparative Effectiveness / • Center for comparative
Evidence-Based Medicine effectiveness
• Knowledge management
Focus: (1) Personalized Medicine; (2) Comparative Effectiveness; • Prepare for tort reform
Episode Based Payments to Acute Organizations

• Decreased errors
1 Health Care Information Technology • Decreased care gaps
• Reduced malpractice
Focus: EHR, HIEs, ICD-10 premiums
• Improved efficiency


Healthcare in the future may have very different delivery and reimbursement
models

Populations

Experimentation
Period

Healthcare Reform

Individuals

Fee-for-service, individual encounters Bundled payments, performance/
Volume-based payments outcome-based payments,
Volume risk proactive health management, patient
accountability
Performance risk

Technology will change lifestyle of
chronic care patient and enable self-care....

What Citizens want?
Interest in online tools and services and in
tools and aids to support self-managed care


Interest varies by generation and country in using a smart phone or PDA to
monitor their health if they are able to access medical records and download
information about their medical condition and treatments.


Consumers are highly interested in using a medical device that would
enable them to check their condition and send information to their doctor
electronically through a computer or cell phone via the Internet

17 Deloitte ©2011 Deloitte Touche Tohmatsu Limited

Technology-enabled
Self-Care self-care

Growth drivers

• Consumerism
• Increased Expectation from patients and more
importantly, care givers
• Ubiquitous computing

Barriers

• Lack of awareness of benefits
• Data Governance, Ownership, and regulatory
frameworks still needs to be worked out
• Lack of Sustainable business models
• Still in early stages of development


Regular follow-up, Mobile Monitoring ,
Chronic Care Lifestyle Lifestyle choices for chronic patients

Growth drivers

• Increased access to healthcare and health-
related information, particularly for hard-to-
reach populations
• Increase mobile (voice) coverage and adoption

Barriers

• Relatively untapped market
• Limitation on care delivery on phone

http://www.youtube.com/user/ProjectHealthDesign#p/u/16/VNdkgOuui00


Personal monitoring device to alert
Evidence Based Care and guide to make improvements
in health or treat a condition.

Growth drivers

• Significant innovation in Med Tech industry
• Rapidly growing Chronic Disease patients in
Asia
• Improved ability to diagnose and track diseases

Barriers

• Lack of complete end-to-end operator service
• Largely Silo approach till date

http://www.youtube.com/user/ProjectHealthDesign#p/u/12/rYkuswN8wMY


It has also well documented quality issue

 280,000 people will get the wrong advice today in a doctor’s office
 2,800 people will be harmed today by a medication error
 Over 98,000 people will die this year in hospitals from a preventable medical mistake
Estimated
Deaths Due to
Medical Errors
Leading Causes of Death1 Deaths in Hospitals
1 Heart Disease 727,000
2 Cancer 540,000
3 Strokes 160,000
4 COPD 109,000
5 Accidents/Adverse Effects 97,000 High (98,000)
6 Pneumonia 86,000
7 Diabetes 63,000
8 Motor Vehicles 43,000 Low (44,000)
9 Firearms 32,000
10 Suicide 31,000
…
To Err is Human’ - Selected Strategies to 14 AIDS 17,000
Improve Medication Safety
1
National Vital Statistics Report. Center for Disease Control and Prevention (CDC). Deaths Final Data
for 1997. Volume 47, number 19. P. 1 - 105. June 30, 1999.
 20% of labs and x-rays are done because prior results are unavailable
 1 in 7 hospitalizations occur because information about patient is not available
 On average. Americans receive the care recommended for their conditions only 54.9% of the time
 Translation of medical research into practice is slow—average of 17 years. For instance, nearly one-
third of patients with congestive heart failure are discharged from the hospital without ACE inhibitors,
even though it has been known for a decade that these drugs provide life-saving benefits


An example of a patient-specific HIE-enabled point of care Clinical Decision
Support - CINA

 Patient Specific

 Automated

 Produced for every patient, at every
visit, regardless of the Reason for Visit


Diagnoses and Meds
are prioritized to
highlight chronic Goals Not Met are
conditions highlighted for quick
reference and
visibility

Targeted reminders
for nursing staff
allow better leverage
of provider time and
more efficient
workflow
Labs, Calculations and
Diagnostic Procedures
pertinent to the
Action Items are
displayed for easy
reference


EHRs specifically designed for direct use by physicians such as computerized physician order
entry (CPOE) and physician documentation are critical to enhance patient safety and care quality

Building a Stronger Safety Net
Non-intercepted serious medication Preventable Adverse Drug Events
errors per 1,000 patient days per 1,000 patient days

86% decline 62% decline
7.6
2.9
1.1 1.1
Before CPOE After CPOE Before CPOE After CPOE

Prompting Best Clinical Practice
Percentage of Eligible Patients Percentage of Eligible Patients
Receiving Pneumococcal Vaccination Receiving Subcutaneous Heparin

36% 32%
18.9%
0.8%

No CPOE CPOE No CPOE CPOE
Reminder Reminder Reminder Reminder
Source: Clinical Advisory Board

CPOE (Continued)

Encouraging Cost-effective regimens or Less-Costly Drugs

Percentage of Oral H2-Blocker Orders Using Nizatidine

CPOE alert to preferred
H2 blocker introduced Estimated annual
Savings: $75,000
80% 68% 83% 90%

18% 12% 1.120% 1.1

Weeks 1 2 3 5 7 9 11

Reducing Time to Deliver Care
Physician Order to Receipt by Pharmacy Physician Order to Delivery to Patient
Care Areas

3.4 4.6 32%
hours hours
0.5 hour 1.4 hour

Before CPOE After CPOE Before CPOE After CPOE

Source: Clinical Advisory Board

Total EHR benefit projections are significant

COST DECREASE FACTORS

Cost Decrease - 1
Conservative Medium Aggressive Reduce Medication Error by implementing Physician Order Entry
124,564 124,564 124,564 A Total Adjusted Admissions
0.37 0.37 0.37 B Medication Error per 100 Admissions
$ 2,262 $ 2,262 $ 2,262 C Clinical Cost per Medication Error
3.08% 3.08% 3.08% D % of Medication Errors with Associated Litigation Costs
$ 50,105 $ 50,105 $ 50,105 E Litigation and Damages cost per Medication Error Resulting in Litigation
50.00% 60.00% 85.00% F Percent Decrease in Medication Error per 100 admissions

$ 876,536 $ 1,051,843 $ 1,490,111 Additional Annual Cost Savings = (AxB/100xCXF)+(AxB/100xDxExF)

Cost Decrease - 2
Conservative Medium Aggressive Reduce Duplicate Lab and Radiology Orders through on line order entry and results availability
$ 3,943 $ 3,943 $ 3,943 A Laboratory Cost per Adjusted Admission
$ 2,854 $ 2,854 $ 2,854 B Radiology Cost per Adjusted Admission
124,564 124,564 124,564 C Total Adjusted Admissions
10.00% 15.00% 20.00% D % Reduction in Lab Expense by Decreasing Duplicate Lab Orders
10.00% 15.00% 20.00% E % Reduction in Radiology Expense by Decreasing Duplicate Radiology Orders

$84,666,151 $126,999,226 $169,332,302 Additional Annual Cost Savings Benefit = (AxCxD)+(BxCxE)

Cost Decrease - 3
Conservative Medium Aggressive Reduce Transcription Costs by Automating Transcription through direct entry into the CIS
$1,318,712.00 $1,318,712.00 $1,318,712.00 A Current Transcription Costs (Medical Records and departmental)
30.00% 50.00% 75.00% B % Reduction in Transcription Costs

$395,614 $659,356 $989,034 Additional Annual Cost Savings Benefit = AxB

Cost Decrease - 4
Conservative Medium Aggressive Reduce Average Expense per Adjusted Admission
124,564 124,564 124,564 A Total Adjusted Admissions
$ 17,081 $ 17,081 $ 17,081 B Average Expense per Adjusted Admission
2.00% 3.00% 4.00% C % Decrease in Average Expense per Adjusted Admission

$42,554,179 $63,831,269 $85,108,358 Additional Annual Cost Savings = AxBxC


Cost Decrease - 5
Total benefit projections are significant Record Costs by Reducing Chart Pull Staff, Eliminating Storage and Supply
Conservative Medium Aggressive
Reduce Medical
Cost.

22.40 22.40 22.40 A Total Medical Records Chart Pull FTEs
$ 31,355 $ 31,355 $ 31,355 B Average Salary per Medical Record Chart Pull FTE
26% 26% 26% C Average Benefit Load per Medical Record Chart Pull FTE

54.00 54.00 54.00 D # Medical Records per Square Foot

272,722.00 272,722.00 272,722.00 E # Medical Records
$ 51.54 $ 51.54 $ 51.54 F Annual Cost per Square Foot
$ 498,697.00 $ 498,697.00 $ 498,697.00 G Annual Cost for Medical Record Forms, Folders, and Other Miscellaneous Supplies
40.00% 60.00% 75.00% H Reduction in Chart Pulls

$1,112,980 $1,289,973 $1,422,718 Additional Annual Cost Savings = [AxHxBX(1+C)]+(E/DxF)+G

Cost Decrease - 6
Conservative Medium Aggressive Reduce Pharmacy Costs through Generic Substitutions and Changes to Dosages and Forms
$ 2,854.00 $ 2,854.00 $ 2,854.00 A Pharmacy Expense per Adjusted Admission

124,564.00 124,564.00 124,564.00 B Total Adjusted Admissions
% Reduction in Pharmacy Expense per Admission due to Generic Substitutions and changes to
6.00% 10.00% 15.00% C dosages and forms

$21,330,339 $35,550,566 $53,325,848 Additional Annual Cost Savings Benefit = AxBxC

Cost Decrease - 7
Conservative Medium Aggressive Reduce Nursing Overtime Expense by Increasing Productivity

123,250 123,250 123,250 A Annual Nurse Overtime Hours
$ 53.00 $ 53.00 $ 53.00 B Average Cost per Nurse Overtime Hour
5.00% 8.00% 10.00% C Productivity Increase

$326,613 $522,580 $653,225 Additional Annual Cost Savings Benefit =AXBXC

Cost Decrease - 8
Conservative Medium Aggressive Reduce Labor Costs Through Revenue Cycle Efficiencies.

175.90 175.90 175.90 A Total Revenue Cycle FTEs

43,710 43,710 43,710 B Average Revenue Cycle FTE Salary
28% 28% 28% C Revenue Cycle FTE Benefit Load
5.00% 10.00% 20.00% D % Decrease in Revenue Cycle FTEs

$ 490,148 $ 980,295 $ 1,960,590 Additional Annual Cost Savings Benefit = AxBx(1+C)xD

Cost Decrease - 9
Total benefit projections are significant Materials Management Cost by Reducing Form and Paper Demand
Conservative Medium Aggressive Reduction in
1,000,000.00 1,000,000.00 1,000,000.00 A Total Paper, Forms, and Other Materials Management Cost
20.00% 30.00% 40.00% B % Materials Management Cost Reduction

$200,000 $300,000 $400,000 Additional Annual Cost Savings = AxB

REVENUE INCREASE FACTORS

Revenue Increase - 1
Conservative Medium Aggressive Increase Net Revenue through Decrease in Untimely Filings

2,954,388,312 2,954,388,312 2,954,388,312 A Total Annual Inpatient Gross Revenue

992,024,075 992,024,075 992,024,075 B Total Annual Inpatient Net Revenue

6,933,919 6,933,919 6,933,919 C Annual Untimely Claims Gross Write-Offs ($)
20.00% 40.00% 60.00% D % Decrease in Untimely Claims Filings

$465,654 $931,308 $1,396,962 Additional Annual Revenue Benefit =(B/A)xCxD

Revenue Increase - 2
Conservative Medium Aggressive Increase Net Revenue through Increase in Gross Revenue Charge Capture
$ 2,954,388,312 $ 2,954,388,312 $2,954,388,312 A Total Annual Inpatient Gross Revenue
$ 992,024,075 $ 992,024,075 $ 992,024,075 B Total Annual Inpatient Net Revenue
0.40% 0.50% 0.90% C % increase in Gross Revenue Capture

$ 3,968,096 $4,960,120 $8,928,217 Additional Annual Net Revenue Benefit =AxCxB/A

One Time Revenue Increase - 3
Conservative Medium Aggressive One Time Increase in Cash Collections by Decreasing Discharged-Not-Final-Billed AR
$ 992,024,075 $ 992,024,075 $ 992,024,075 A Total Annual Inpatient Net Revenue

72 72 72 B Current Days in Net AR
2.00% 5.00% 6.00% C % Decrease in Days in Net AR

$3,919,175 $9,797,936 $11,757,524 Additional One Time Cash Benefit = A/365xBxC

Revenue increase - 4
Increase in Net Revenue by reducing denied days and rebilling due to better
Conservative Medium Aggressive coding/documentation
6,231.00 6,231.00 6,231.00 A Total Annual Denied Days
19,724,726.00 19,724,726.00 19,724,726.00 B Estimated Annual Dollars associated with denied days
15.00% 20.00% 30.00% C % Decrease in Denied Days
$2,958,709 $3,944,945 $5,917,418 Additional Annual Net Revenue = B/AxAxC

Community Wide
Analytics

30

Many Benefits:
 Improved quality of care/patient
The HIE is also a tool for community-wide analytics safety
 Cost reduction (e.g., redundant
tests)
Screening & Early Diagnosis &  Enhanced operational efficiencies
(pulling information, reporting,
Prevention Detection Staging Treatment & Palliation
etc.)
 Population Management
Adult Breast Cancer Timely Breast Participation in Cancer Deaths
 Community-wide disease
Smoking Rate Screening Rate Cancer Biopsy Clinical Trials managementIn Hospice
Adolescent Colorectal Cancer Needle Biopsy for  Disease Hospice
Inappropriate Hormonal surveillance
 Etc.
Smoking Rate Screening Rate Breast Cancer Therapy - Prostatectomy Length of Stay
Advice to Early Stage Breast Clean Margins Breast Appropriate EBRT Breast Cancer
Quit Smoking Cancer Diagnosis Conserving Surgery Prostate Cancer Survival Rate
Pharmacotherapy to Advanced Stage Breast Hist. Assessment EBRT/Hormone Therapy Colorectal Cancer
Quit Smoking Cancer Diagnosis Breast Cancer Prostate Cancer Survival Rate
Adult Obesity Advanced Stage Hist. Assessment Adjuvant Radiation Lung Cancer
Rate Colorectal Cancer Dx Colorectal Cancer Breast Consv. Surgery Survival Rate
Cancer Incidence Rate Path Compliance Adjuvant Hormone Ther Prostate Cancer
All Sites For Specimens Invasive Breast Cancer Survival Rate
Breast Cancer Pathology Reports for Adjuvant Chemotherapy Breast Cancer
Incidence Rate Breast Cancer Breast Cancer Mortality Rate
Colorectal Cancer Pathology Reports for Adjuvant Chemotherapy Colorectal Cancer
Incidence Rate Colorectal Cancer Colorectal Cancer Mortality Rate
Lung Cancer Pathology Reports for Mammography After Lung Cancer
Incidence Rate Lung Cancer Treatment Mortality Rate
Prostate Cancer Pathology Reports for Colonoscopy Prostate Cancer
Incidence Rate Prostate Cancer After Treatment Mortality Rate
Breast Cancer Staged Cancer Pain All Cancers
Before Treatment Assessment Mortality Rate

Key: Better than National rate/Target Colorectal Ca. Staged Prevalence of Pain
Equal to or slightly worse than National Before Treatment Among Cancer Patients
rate/Target
Significantly worse than National Lung Cancer Staged
rate/Target Before Treatment
Improving Prostate Cancer Staged
Steady
Declining Before Treatment ©2011 Deloitte Touche Tohmatsu Limited

3-1
Screening
3-1& Early Smoking
Adult Rate
Prevention Detection Diagnosis Treatment & Palliation
Smoking Rate Screening Rate Cancer Biopsy Clinical Trials In Hospice
Adolescent Colorectal Cancer
20.00% Needle Biopsy for 22.2% Inappropriate Hormonal Hospice
Smoking Rate Screening Rate 20.0% Breast Cancer Therapy - Prostatectomy Length of Stay
19.9%
Advice to Early Stage Clean Margins Appropriate EBRT Breast Cancer
Quit Smoking Breast Cancer Dx
15.00% Breast Consv. Surgery Prostate Cancer Survival Rate
Pharmacotherapy to Advanced Stage Hist. Assessment EBRT/Hormone Therapy Colorectal Cancer
Quit Smoking Breast Cancer Dx Breast Cancer Prostate Cancer Survival Rate
Adult Obesity 10.00%
Advanced Stage Hist. Assessment
12.0%
Adjuvant Radiation Lung Cancer
All Sites 5.00% For Specimens Invasive Breast Cancer Survival Rate
0.00%
Colorectal Cancer US Pathology Reports for
GA Exchange Healthy Chemotherapy
Adjuvant Colorectal Cancer
Incidence Rate Colorectal Cancer Colorectal Cancer
People 2010 Mortality Rate
Lung Cancer Pathology Reports for Target
Mammography After Lung Cancer
Source: Behavioral Risk Factor Breast Cancer Staged
Surveillance Survey, 2006 Cancer Pain All Cancers
Colorectal Ca. Staged Prevalence of Pain
Home Next Before Treatment Among Cancer Patients
Lung Cancer Staged
Before Treatment
More
Prostate Cancer Staged
Proprietary and confidential Before Treatment ©2011 Deloitte Touche Tohmatsu Limited

Screening
3-1Trend
3-1& Early Smoking
Adult Rate
Smoking Rate Screening Rate
26% Cancer Biopsy Clinical Trials In Hospice
Adolescent Colorectal Cancer Needle Biopsy for Inappropriate Hormonal Hospice
Smoking Rate 24%
Screening Rate Breast Cancer Therapy - Prostatectomy Length of Stay
Advice to Early Stage
22% Clean Margins Appropriate EBRT Breast Cancer
Quit Smoking Breast Cancer Dx Breast Consv. Surgery Prostate Cancer Survival Rate
Pharmacotherapy to 20%
Advanced Stage Hist. Assessment EBRT/Hormone Therapy Colorectal Cancer
18%
Rate Colorectal Cancer Dx
16% Healthy Colorectal Cancer Breast Consv. Surgery Survival Rate
US GA Exchange
Cancer Incidence Rate People 2010 Path Compliance Adjuvant Hormone Ther Prostate Cancer
All Sites 14% Target For Specimens Invasive Breast Cancer Survival Rate
Breast Cancer 12% Pathology Reports for Adjuvant Chemotherapy Breast Cancer
10%
90

91

92

93

94

95

96

97

98

99

00

01

02

03

04

05

06
19

19

19

19

19

19

19

19

19

19

20

20

20

20

20

20

20
Source: Behavioral Risk Factor Breast Cancer Staged
Surveillance Survey, 2006 Cancer Pain All Cancers
Less Colorectal Ca. Staged Prevalence of Pain
Before Treatment Among Cancer Patients
Back Home Next Lung Cancer Staged
Before Treatment
Proprietary and confidential Prostate Cancer Staged
Before Treatment ©2011 Deloitte Touche Tohmatsu Limited

3-2 Peer Comparisons
Screening
& Early
Prevention 3-2 Adolescent
Detection Smoking Rate: percent of youthsTreatment & Palliation
Diagnosis age
Adult 13-17 who currently smoke
Breast Cancer Timely Breast Participation in Cancer Deaths
25%
23.0%
20% Clean Margins Appropriate EBRT Breast Cancer
Quit Smoking Breast Cancer Dx Breast Consv. Surgery Prostate Cancer Survival Rate
Quit Smoking 15%
Breast Cancer Dx Breast17.2%
Cancer Prostate Cancer
16.0% Survival Rate
Adult Obesity Advanced Stage 14.4% Hist. Assessment Adjuvant Radiation Lung Cancer
10%
Incidence Rate 0% Colorectal Cancer Colorectal Cancer Mortality Rate
Lung Cancer
Exchange Georgia U.S. Average
Pathology Reports for
Healthy
Mammography After Lung Cancer
Incidence Rate Lung Cancer People 2010
Treatment Mortality Rate
Prostate Cancer Pathology Reports for
Target
Colonoscopy Prostate Cancer
Source: (Georgia, US) YBRSS Breast Cancer Staged
survey, 2005 Cancer Pain All Cancers
Back Home Next Before Treatment Among Cancer Patients
Lung Cancer Staged
Before Treatment
More

3.2 Trend
Screening
& Early
Prevention 3-2Detection
Adolescent Smoking Rate: percent of youths age 13- & Palliation
Diagnosis Treatment
Adult 17 who currently Timely Breast
Breast Cancer smoke Participation in Cancer Deaths
Adolescent 40%
Colorectal Cancer Needle Biopsy for Inappropriate Hormonal Hospice
35%
30% Breast Consv. Surgery Prostate Cancer Survival Rate
Quit Smoking 25%
Breast Cancer Dx Breast Cancer Prostate Cancer Survival Rate
Rate
20%
Colorectal Cancer Dx Colorectal Cancer Breast Consv. Surgery Survival Rate
Cancer Incidence Rate 15% Path Compliance Adjuvant Hormone Ther Prostate Cancer
Breast Cancer
10% Pathology Reports for Adjuvant Chemotherapy Breast Cancer
Incidence Rate U.S. Breast Cancer Georgia Cancer
Breast Mortality Rate
5%
Colorectal Cancer Exchange
Pathology Reports for Healthy people 2010
Adjuvant Chemotherapy Colorectal Cancer
Incidence Rate 0% Colorectal Cancer Colorectal Cancer Mortality Rate
91

93

95

97

99

01

03

05

07
19

19

19

19

19

20

20

20

20
Source: YBRSS survey, 2005 Breast Cancer Staged Cancer Pain All Cancers
Less Colorectal Ca. Staged Prevalence of Pain
Before Treatment

3-3 Advice to Quit
Screening
& Early
3-3 Smokers who receive advice to quit
Adolescent Colorectal Cancer
100% Needle Biopsy for Inappropriate Hormonal Hospice
100% Margins
Clean Appropriate EBRT Breast Cancer
95% Breast Consv. Surgery Prostate Cancer Survival Rate
Adult Obesity Advanced Stage
90% Hist. Assessment Adjuvant Radiation Lung Cancer
All Sites 85% For Specimens Invasive Breast Cancer Survival Rate
Incidence Rate Breast Cancer
85% Cancer
Breast Mortality Rate
Colorectal Cancer 80% Pathology Reports for Adjuvant Chemotherapy Colorectal Cancer
Incidence Rate 75% Lung Cancer Treatment Mortality Rate
Prostate Cancer
Exchange Healthy People 2010 Target
Pathology Reports for Colonoscopy Prostate Cancer
Before Treatment

3-4 Pharmacotherapy
Screening
& Early
3-4 Smokers who are recommended pharmacotherapy to
assist in quitting smoking
Smoking Rate Screening Rate
90% Breast Cancer Therapy - Prostatectomy Length of Stay
Quit Smoking
80%
Breast Cancer Dx Breast Consv. Surgery Prostate Cancer Survival Rate
88.7%
Pharmacotherapy to 70%
Advanced Stage Hist. Assessment EBRT/Hormone Therapy Colorectal Cancer
60%
Rate Colorectal Cancer Dx
50% Colorectal Cancer Breast Consv. Surgery Survival Rate
All Sites 40% For Specimens Invasive Breast Cancer Survival Rate
Colorectal Cancer
20% Pathology Reports for Adjuvant Chemotherapy Colorectal Cancer
10%
Incidence Rate 0% Lung Cancer Treatment Mortality Rate
Prostate Cancer
Exchange
Pathology Reports for Colonoscopy Prostate Cancer
Before Treatment

EHR Technical
Characteristics

38

Generic HIE reference architecture

The Generic HIE reference architecture depicts a basic architecture with its various
services and security components that make up the HIE.
Channels Business services Stakeholders
e-Prescribing and Lab
Demographics Immunizations
medications orders/Results
Web/HTTP (Portal) Hospitals

Disease Admit/Visit/
Allergies Radiology
management Discharge notes
Clinics
Interactive voice
response (IVR)

Diagnostic Imaging Scheduling
Labs

Fax
Distributed services
Enterprise master Electronic medical Patients
Consent management Alerts
patient index (EMPI) record (EMR)
Electronic Data
interchange (EDI)
Record locator
Terminology Identity management EMR Lite
service (RLS) Payers

File transfer protocol
(FTP) Data services
Centers for Medicare
Data warehouse Business intelligence Audit/Logging data and Medicaid Services
(CMS)

Web service Decision support Messaging data Medical management State
Agencies/Programs
(Medicaid, Pharmacy
Infrastructure services Benefits Management,
Eligibility, Child Welfare,
Call center Audit logging Monitoring Business rules Foster Care, etc.)

Security management Messaging Exception handling


HIE sample logical architecture


HIE Data Architecture Types

Virtual or Partitioned Centralized Model Federated/decentralized Model
No centralized data repository. Each stakeholder keeps its own data within its walls and queries
Each stakeholder sends its agreed upon data to a central data repository where data is “cleansed” assemble data on the fly. It is an easy model for stakeholders to accept…with major issues
and normalized. Yet, this central data repository is virtual or the physical central repository is related to presenting the data in a normalized, significant way and with acceptable performance
partitioned in such a way that a given stakeholder controls its own data partition and could easily
take it back if required.
Central but partitioned
data repository
1
Stakeholder A

4 Stakeholder C

Stakeholder B
Stakeholder A
Operational Database

Stakeholder C

Stakeholder B

Federated Hybrid Model
Each stakeholder sets up a mirrored database on the facility’s edges

Centralized Model
2 where data can be cleansed and normalized per the exchange’s
standards. It is this database that is used to query data from the
3 Exchange.
Each stakeholder sends its agreed upon data to a central data repository where data
is “cleansed” and normalized. Typically, analytical software sits on top of the central 4
data repository for longitudinal analysis. Hybrid Model
Each stakeholder sends an agreed upon subset of patient data to a Stakeholder A
central data repository where data is “cleansed” and normalized. Part of
Central data repository the patient data remains decentralized with record locator
service/centralized metadata indicating where these decentralized
components are.
Central subset
data repository Operational Database
Edge Database
Stakeholder A
Stakeholder C

Stakeholder A Stakeholder B
Stakeholder B
Stakeholder C

Stakeholder B
Stakeholder C

HIE Data Architecture Takeaways

Below are key points and takeaways for each architecture types

Federated Centralized Hybrid
 Participating organization  HIE entity has control of  Variable types and level
retains control of their the healthcare information of connectivity
healthcare information
 Stakeholders decide the  Stakeholders decide the
 Stakeholders retain patient data to share patient data to share
control over the patient  Data security is more  Data security is more
data complex complex than Federated
 Data security is  Not a preferred option for  A preferred option as it
considered to be less stakeholders as they don’t allows leveraging existing
complex have control of the data HIOs
 Generally uses a form of (Co-Mingling of data)  Data analytics is easier
Record Location Service  Data analytics is easier
(RLS)


Many EHRs are still in the early deployment phases (estimated allocation)

Phase 1:
2: Phase 2:
3: Phase 3:
4:
Phase 0:
1: Phase 4:
5:
STRATEGY DETAILED IMPLEMEN-
FEASIBILITY
& PLANNING DESIGN TATION OPERATIONS

No broad community support

No clear objective

No self-sustainable business model

Privacy concerns

No clear value for physicians

PROGRESSION OF PHASES


Many complex, interrelated characteristics

STRATEGY & DETAILED
FEASIBILITY PLANNING DESIGN IMPLEMENTATION OPERATIONS

How the Exchange is structured, how decisions are made, and the rules
GOVERNANCE: that guide relationships among stakeholders, between old and new
participants, the governance model it will follow

Definition of an agreed upon vision, definition of core features and
FUNCTIONAL: functions that constitute HIE, definition of strong value propositions for
each key stakeholder type…

How is the Exchange architected, how it deals with standards, the set of
TECHNOLOGY:
services it must incorporate, etc…

How will privacy/data access be defined, how will secure data exchange
PRIVACY/SECURITY: be implemented, definition of patient consent policies, etc…

Definition of a self-sustainable financial model, definition of a balance
FINANCIAL: ROI among stakeholders, definition of mechanisms to counter first
mover disadvantage, etc.…


Disruptive Innovation
in Healthcare
Callum Bir
Director,
Life Sciences & Healthcare

Disruptive Innovation


Social Networking

Facebook drives more traffic online than Google


Compare hospitals & doctors?
Percent who compare physicians and hospitals before making a selection and
most trusted sources of medical information compared to other sources


Building fan pages for specific causes,
Facebook organizations or products; sharing
recreation-oriented campaigns


Posting educational videos
YouTube and testimonials


Patients Like Me

PatientsLikeMe is a data-driven social PatientsLikeMe
Type Private
networking health site that enables its
Founded 2004
members to share condition, treatment, Headquarters Cambridge,
and symptom information in order to Massachusetts,USA
Key people Ben Heywood, Co-Founder,
monitor their health over time and learn President
from real-world outcomes. Members are James Heywood, Co-Founder,
Chairman
able to find and connect with patients like David S. Williams III, Chief
Marketing Officer, Head of
them, gain social support, and learn first- Business Development
Robert Palladino, Chief
hand about ways to cope and manage. Financial Officer
Paul Wicks, PhD., R&D
PatientsLikeMe aims to help patients Director
answer the question: "Given my status, Slogan "Patients Helping Patients Live
what is the best outcome I can hope to Better Every Day"
Website patientslikeme.com
achieve, and how do I get there?" Type of site social networking
Launched October 10, 2005
Current status Active


Doctors & Citizens access
Twitter most latest from trusted sources.
Less is more..
.


Recruiting talent,
Linked-in announcing staff news


Case Studies –
Mobility

55

Examples of how Technology is Changing how we may look at EHRs


NSW Emergency Waiting Times Mobile Site


Department of Health and Human Services Tasmania
improve the quality of patient care while also increasing organisational efficiency in
their hospitals.


Transiting from Patient Oriented Care to
Consumer Model of Care ….

Beyond EHR - Achieving Operational Efficiency

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