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New Study Shows Patient Care Alerts Nearly Doubled in One Year

New Study Shows Patient Care Alerts Nearly Doubled in One Year

Alerts and Related Patient Record Queries Provide Critical Health Information to Healthcare Professionals to Support and Improve Patient Care Coordination

NEW YORK, NY – More healthcare professionals are receiving patient care alerts and increasingly performing related patient record queries through the Statewide Health Information Network for New York (SHIN-NY), according to a new report by the New York eHealth Collaborative (NYeC).

The preliminary report used data from HEALTHeLINK, Healthix, and Rochester RHIO—three of New York’s eight regional health information exchange networks connected by and comprising the Statewide Health Information Network for New York. The study looked at patient care alerts trends and their role in expanding the usage of an additional SHIN-NY service, patient record queries. The SHIN-NY allows participating healthcare professionals, with patient consent, to quickly access electronic health information and securely exchange data statewide.

Researchers found that subscription alert services, where participating SHIN-NY providers receive real-time notifications when a patient is admitted to or discharged from a hospital or emergency department, increased by 95 percent from 2016 to 2017. At the same time, query-based exchanges prompted by alerts, where providers request patient records for more comprehensive information at the time they are needed, increased by 102 percent.

“This study demonstrates the SHIN-NY is working, usage is growing, and every day it is helping providers manage their patients’ care. Alerts and queries are free services offered to participating providers—we need everyone to get connected,” said Valerie Grey, Executive Director of NYeC.

“We hear from our participant doctors every day and see more and more evidence as to how HEALTHeLINK and the SHIN-NY are working in support of better, more efficient patient care,” said Dan Porreca, HEALTHeLINK Executive Director. “With our ability to alert providers of their patients’ admissions and discharges to healthcare facilities, including local emergency department visits in real time and the ability to query HEALTHeLINK to understand what happened with their patient during that visit, care coordination is enhanced greatly. They can also schedule timely and needed follow-up visits to review diagnoses and new medications with their patients, ultimately reducing the chance of future readmissions.”

“Our participants have come to rely upon clinical alerts for helping to manage patients with complex issues. To better support care management workflows, Healthix provides clinical summaries or CCDs with alerts, pushing data to providers so they receive the patient’s clinical history with the alert. This enables them to make real-time clinical decisions,” said Tom Check, President and CEO of Healthix.

“Alerts directly support and impact transitions of care across our 13-county region and the whole of New York,” says Jill Eisenstein, President and­ CEO, Rochester RHIO. “They help our Rochester RHIO partners take more immediate and beneficial actions, resulting in a higher ­­degree of efficient and effective patient care.”

The report also analyzed how organizations across the care continuum utilized additional SHIN-NY services after receiving alerts. Long-term care, health homes, federally qualified health centers, and primary care clinics received the most alerts. Specialists had the highest rate of follow-up queries to search for patient records through the SHIN-NY.

The report, funded by NYeC and prepared by researchers at Indiana University Richard Fairbanks School of Public Health and Weill Cornell Medical College, compared data from the second quarters of 2016 and 2017. It is a first-of-its-kind study surrounding the quantification of the relationship of alerts and query-based exchange. The study provides a baseline measurement to conduct additional research and gain a more comprehensive view of the value and role of alerts in providing clinicians with real-time information about their patients to support care coordination.

The next phase of the study will assess potential cost savings and patient outcomes with the usage of alerts and corresponding queries.

The preliminary report is available at www.nyehealth.org/alerts-study

About Rochester RHIO

Rochester RHIO is a secure electronic health information exchange serving authorized medical providers and over one million patients in Monroe, Allegany, Chemung, Genesee, Livingston, Ontario, Orleans, Schuyler, Seneca, Steuben, Wayne, Wyoming, and Yates counties in upstate New York. The service allows a medical care team to share records across institutions and practices, making patient information available wherever and whenever needed to provide the best care. Patients benefit from fewer repeated tests, easier second opinions, a reduced risk of mistakes caused by poor handwriting or incomplete records, and more informed care during office visits and emergencies. It is a Qualified Entity of the Statewide Health Information Network for New York (SHIN-NY). Healthcare professionals and patients can learn more by visiting RochesterRHIO.org

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Distribution of Health Insurance coverage in NY State vs. USA

Distribution of Health Insurance coverage in NY State vs. USA

Distribution of Health Insurance coverage in NY State vs. USA

Health Insurance                            NY state                        USA

 Private                                             33%                               34%

Medicare                                          20%                               23%

Medicaid                                         27%                                17%

Other                                                20%                               26%

USA Medicaid spending is $575 Billion/year

Not counting admin cost, NY State Medicaid spending is $65 Billion/year only to be exceeded by CA $80 Billion. Per Medicaid person spending in NY State is $10500/year only to be exceeded by MA $11100/year, Nevada the lowest $4100/yr. while USA average is $5600/year. NY state Medicaid spending almost 2 times of the national average, hence VBP, P4P and Medicaid Redesign programs coming up.

 

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AHRQ: Cracking the Code in Healthcare:

AHRQ: Cracking the Code in Healthcare:

AHRQ: Cracking the Code in Healthcare:

What is the triple aim of the Affordable Care Act?

The three components are: (1) improve the patient experience, (2) improve population health and (3) reduce per capita cost. … In 2010, the Patient Protection and Affordable Care Act (ACA) promised quality, affordable health care for all Americans.

Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. It is an approach to health that aims to improve the health of an entire human population.

Population Health Management is the aggregation of patient data across multiple health information technology resources, the analysis of that data into a single, actionable patient record, and the actions through which care providers can improve both clinical and financial outcomes.

What is a value based care?

With fee-for-service, doctors and hospitals are paid based on the number of healthcare services they deliver, such as tests and procedures. Payment generally has little to do with whether their patients’ health improves. But what does that mean for you? A valuebased approach is designed around patients.

ValueBased Payment (VBP) is a strategy used by purchasers to promote quality and value of health care services. The goal of any VBP program is to shift from pure volume-based payment, as exemplified by fee-for-service payments to payments that are more closely related to outcomes.

The Hospital ValueBased Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries.

Healthy People 2020 aims to reach four overarching goals: Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all.

The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.

Radical Redesign in Health Care:

 Change the balance of power: Co-produce health and wellbeing in partnership with patients, families, and communities.

  1. Standardize what makes sense: Standardize what is possible to reduce unnecessary variation and increase the time available for individualized care.
  2. Customize to the individual: Contextualize care to an individual’s needs, values, and preferences, guided by an understanding of what matters to the person in addition to “What’s the matter?”
  3. Promote wellbeing: Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require health care.
  4. Create joy in work: Cultivate and mobilize the pride and joy of the health care workforce.
  5. Make it easy: Continually reduce waste and all non-value-added requirements and activities for patients, families, and clinicians.
  6. Move knowledge, not people: Exploit all helpful capacities of modern digital care and continually substitute better alternatives for visits and institutional stays. Meet people where they are, literally.
  7. Collaborate and cooperate: Recognize that the health care system is embedded in a network that extends beyond traditional walls. Eliminate siloes and tear down self-protective institutional or professional boundaries that impede flow and responsiveness.
  8. Assume abundance: Use all the assets that can help to optimize the social, economic, and physical environment, especially those brought by patients, families, and communities.
  9. Return the money: Return the money from health care savings to other public and private purposes.

Change Balance of Power:  How?

 

  1. Sift power from Doctor to Patient.
  2. Use what patient and family brings. Talk less and ask more and listen.
  3. Do not ask “What’s the matter” but ask “What matters to you”
  4. Make transparency limitless.
  5. Protect privacy but “Repeal and Replace HIPPA”!
  6. Equip homes and communities to replace institutions.
  7. Share decision making.
  8. Do not design care systems around one hard case or cases.

Examples:

  1. Dr Kavita Bhavan at Utah school of medicine: Long term IV antibiotics given in the hospital then at home by visiting nurse converted to self-administered IV antibiotics by the patients. Project saved 26000 hospital days in that population of patients saving the system $40 Million. Now being adopted at many communities.
  2. 10 year old kid made a U-Tube video how to daily self-introduce nasogastric tube. He was self-feeding x 12 hours a day to maintain nutrition in the setting of Crohn’s disease and mal absorption so that others can follow his examples.
  3. Children’s hospital in Ireland initiated a program where by each pediatric patient had his own chef where they can order what they would want to eat saving money in waste of food and improving nutrition.
  4. Rural small community hospital serving population of 3000 or so people in Wisconsin empowered the patients. Bellin Health in Green Bay, Wis., has employed a technique gained from user experience research to change the balance of power and more deeply understand how the diagnosis and treatment of gynecological cancer integrates into the everyday ebb and flow of a patient’s life over time.
  5. In Sweden a patient named Christian Farman who was an engineer with Chronic kidney failure and chronic dialysis use started self-dialysis program where by patients were in charge to hook themselves up and start dialysis, improving their experience, satisfaction and joy. Now 50% of the dialysis in Sweden is done by patients reducing cost of care by 50% and reduction in infection rate by 30%. This experiment was reproduced in Waco Texas where hospitalization rate fell by 50% and mortality by 30%
  6. In Scotland one of the elementary school of 480 students had 45% obesity rate among the students. Student and teachers started a program “Daily Mile”. Fit to play and Fit to learn. Students and teachers will run a mile daily at the start of the school. After 18 months obesity rate in student population was 0%. Program is now spreading worldwide. In Netherlands 580 schools are now have daily mile program.
  7. North Shore–LIJ Health System in New York recently partnered with Project ECHO at the University of New Mexico School of Medicine to explore how to move knowledge, not people while delivering much needed care for those with behavioral health conditions
  8. NY times 10/6/2016 issue printed letter to editor from husband of a young 23 years old Asthma patient who died after 7 days of hospitalization in one of the hospital in New York where by husband described the genuine compassionate care provided to his wife and how nursing and physician staff took upon themselves to accommodate every need of the family by sifting control to the patient and family. Along the way many rigid rules of the hospital policy and procedures were broken. Letter worth reading.

https://www.nytimes.com/2016/10/06/well/live/a-letter-to-the-doctors-and-nurses-who-cared-for-my-wife.html

Summary adopted from the lecture of Dr. Don Berwick
Former Administrator,
Centers for Medicare and Medicaid Services

Tarun Kothari MD 10/25/17

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