Maximizing the Value of e-Health for Individuals and Communities

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Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Maximizing the Value of e-Health for Individuals and Communities:
The Public Health/Clinical Partnership
Seth Foldy, MD MPH FAAFP
Senior Advisor
Public Health Surveillance and Informatics Program Office
(proposed)
Minnesota e-Health Summit, June 14, 2012
Office of Surveillance, Epidemiology, and Laboratory Services
Public Health Surveillance and Informatics Program Office
What is Value?
Value = Quality x Quantity
Cost
Quality:
Quantity:
Cost:
Effectiveness / (Safety Risk)
Units / Time
Total Cost of Operation
1
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 What is Value?
BETTER
Value = Quality x Productivity
FASTER
Cost
CHEAPER
Quality:
Quantity:
Cost:
Effectiveness / (Safety risk)
Units/Time
Total Cost of Operation
Increasing value means better outcomes or better safety
or faster production or cheaper cost
(holding all others equal)
HEALTH
INFORMATION
SYSTEMS
oriented toward
prevention
Health care
that maximizes health
CARE
MANAGEMENT
so practice workflows
support prevention and
PATIENT EMPOWERMENT
to prevent disease
and disability
PAYMENT
that rewards disease
prevention and effective
chronic disease
management
2
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Population
Healthcare
Public Health
Environment
ACTION (Policy, Services,
Enforcement, Education)
Births and associated data
Congenital disorders
Immunizations
Communicable diseases
Healthcare acquired infections
Reportable test results
Outbreaks
Poisoning
Injuries
Adverse events
Cancer & chronic disease registries
Visits and hospitalizations
Death reports
Healthcare
Public Health
Births and associated data
Congenital disorders
Immunizations
Communicable diseases
Healthcare acquired infections
Reportable test results
Outbreaks
Poisoning
Injuries
Adverse events
Cancer & chronic disease registries
Visits and hospitalizations
Death reports
Surveys
Complaints
Reports
Direct care
Enrollment
Sensors
Licenses
Inspections
Knowledge created
• Immunization history
& guidance
• Dx & Rx guidance
• Infection control
• Case management
• Drugs/vaccines
• Preventive services
guidance
• Product warnings &
recalls
• Specialized lab tests
• Community health
assessments
• Health planning
• Effectiveness
research
• Outbreak/disaster
alerts & guidance
3
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Who is that Public Health agency?







Often a state or local (or tribal or territorial) authority
Shrinking budgets and workforce
IT management/informatics workforce issues
Legacy systems vs. new ONC standards
Ruled by state & local laws/regulations
Even so, capacity is growing fast
Shared national tools support local capacity
County
Health
Department
4
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Potential Value Created for INDIVIDUALS

Quality:
 Better, more precise diagnosis, treatment, prophylaxis
 Better delivery of clinical preventive services (currently ~ 50%)
 Better case management (including environmental & social)

Safety
 Better infection control & fewer healthcare aquired infections
 Environmental and product safety (e.g., drugs, food, air)
 Privacy benefits (and risks) for patients and clinicians

Productivity
 Faster ascertainment of needed preventive services
 Faster, less redundant public health reporting

Cost
 Fewer redundant and unneeded tests/treatments
Potential Value Created for COMMUNITY

Quality
 Assessment of community health trends for planning, CQI
 Better control of infections, disease and injury risk factors

Safety





Preparation & alerts for outbreaks/disasters
Infection control
Safety collaboratives (e.g., healthcare acquired infections)
Protective laws and policies
Productivity
 Faster, easier assessment of community health trends
 Faster management of public health events

Cost
 Lower cost reporting
 Lower cost of community health assessment
 Lower opportunity costs from disease & injury
5
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Electronic Health Records &
Health Information Exchange

Great promise






Data capture and access
Structured data: searchable, sortable, comparable, reusable
Automation, computation, decision and safety support
Information exchange and interoperable systems
Encryptable information (higher security than paper)
Real risks
 Costs of conversion and maintenance
• Will public health keep pace with healthcare?
 Usability and safety
 Privacy and security concerns
• Will public health information access be threatened?
 Disruption of workflow & relationships
Getting There: First Things First

Focus
 EHR Incentive Program “Meaningful Use”
 Capacity (of EHR, HIE and public health)
 Closing the Loop (two-way communication)

Public health goals:




Maintain public health information access
Improve public health reporting
Develop capacity to query EHRs
Improve communication between public health, providers, and
patients
 Improve prevention and public health performance
6
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Healthcare
Meaningful Use STAGE 1
Electronic Information Exchange
Public Health
Births and fetal deaths
Congenital disorders
Immunizations
Communicable diseases
HAI reports
Reportable test results
Outbreaks
Poisoning
Injuries
Adverse events
Cancer & chronic disease registries
Visits and hospitalizations
(Syndromic surveillance)
Death reports
Healthcare
Proposed Meaningful Use STAGE 2
Electronic Information Exchange
Public Health
Births and fetal deaths
Congenital disorders
Immunizations
Communicable diseases
HAI reports
Reportable test results
Outbreaks
Poisoning
Injuries
Adverse events
Cancer & chronic disease registries
Visits and hospitalizations
(Syndromic surveillance)
Death reports
HL7 2.5.1
7
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Healthcare
Possible Meaningful Use STAGE 3
Electronic Information Exchange
Immunizations &
decision support
Births and fetal deaths?
Congenital disorders?
Immunizations
Communicable diseases?
HAI reports?
Reportable test results
Outbreaks
Poisoning
Injuries
Adverse events?
Cancer & chronic disease registries
Visits and hospitalizations
(Syndromic surveillance)
Death reports
Public Health
Items in green
are being
considered by
S&I Framework
PH Reporting
Initiative
Maintain Public Health Information Access

Navigate new privacy & security controls
 Maintain public health access through changing policy (e.g., optin consent) & technology

Manage transition to electronic reporting
 Migration to new standards
 Problem-solving: Technical assistance [email protected]
Provider
Vendors
Public Health
8
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 The Early Days…
Today!
9
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Improve Public Health Reporting


Move programs from manual to electronic
Reduce complexity of reporting
 Standards and Interoperability Framework Public Health
Reporting Initiative
http://wiki.siframework.org/Public+Health+Reporting+Initiative


Reduce variability and improve data quality
Explore public health use of quality reporting
Develop Capacity to Query EHRs

Participate in Query Health initiative
 http://wiki.siframework.org/Query+Health


Explore capability of EHR query to augment or
replace surveys & community health assessment
Explore capability of EHR query to augment or
replace public health reporting
 Legal framework not yet developed.
10
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Improve communication between public health,
providers and patients

Close the loop
 Stage 3: immunization history and guidance to EHR

Preventive clinical decision support
 “Situational” decision support for outbreaks and emergencies

Better capture prevention-relevant data
 Including patient-submitted data—e.g., family health, occupation


Collaboration on registries and case management
Public health-patient collaboration through personal
health records?
Feedback to Providers
Quality
Measurement
Syndromic
Surveillance
(Flu, GI)





Legend
10 Utilization Measures
10 Quality Measures
Recommendations
Syndromic data (GI disease
and Flu)
 CPT codes
 Insurance payment
information
Courtesy of Jesse Singer: The Primary Care Information Project: A Data Driven Model for Improving Health in NYC. NY City Department of
Health and Mental Hygiene.
2
2
11
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Improve Prevention Performance




Leverage electronic communication and
collaboration for better prevention
Improve public health effectiveness and productivity
through reuse of structured data
Identify and disseminate best and promising
practices
Evaluation and continuous improvement
Better
data
Better
information
management
Reduce
disease
and injury
Better
intervention
Delivery of Clinical Preventive Services
Across 56 Practices
46.3
A1c Screening*
62.4
65.5
Body Mass Index recorded*
78.3
45.9
Blood Pressure Control*
55.0
45.6
Aspirin Therapy*
53.2
77.4
Smoking Status recorded*
83.9
27.8
Breast Cancer Screening*
32.3
20.5
24.0
Influenza Vaccination*
76.6
77.9
Cholesterol Control
Smoking Cessation Intervention
31.3
31.0
A1c Control
31.3
30.4
0.0
10.0
20.0
30.0
*p<.05
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Pre EHR Upgrade
% eligble patients recieving CPS
Post EHR Upgrade
Courtesy of Jesse Singer: The Primary Care Information Project: A Data Driven Model for Improving Health in NYC. NY City Department of
Health and Mental Hygiene.
24
12
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 Five eHealth information streams that
will change population health
Mandated
PH
Reporting
Quality
Reporting
Personal
Health
Records
Queries
Registries
“Meaningful Use” is just the beginning….
Big Data,
High Capacity
Computing
Cloud
Technology
Electronic
Health
Records
Bioinformatics
Genomics
Personal
Health
Records,
Social Media
Mobile & GPS
Technology
13
Maximizing the Value of e‐Health for Individuals and Communities
Minnesota e‐Health Summit June 14, 2012 What Would Minnesota Do?






To maintain & improve public health professionals’
access to information?
To facilitate Meaningful Use exchange with public
health?
To assure public health informatics capacity?
To facilitate communication and collaboration
between providers and public health?
To create/evaluate projects leveraging informatics to
improve health outcomes?
To learn from and teach other jurisdictions?
Public Health Surveillance and Informatics Program Office (Proposed)
http://www.cdc.gov/osels/phsipo/index.html
www.cdc.gov/ehrmeaningfuluse
Drop a line: [email protected]
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: www.atsdr.cdc.gov
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