Beyond EHR - Achieving Operational Efficiency
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Transcript of Beyond EHR - Achieving Operational Efficiency
Callum Bir
Deloitte Consulting SEA
Beyond EHR
Achieving Operational Efficiency & Optimization
©2011 Deloitte Touche Tohmatsu Limited
Beyond EHR -
2
Start Time End Time Topic Speaker
8:30 9:00 Registration -
9:00 10:30 Business Case & Benefit Realization for EHR
across various stakeholders
Callum Bir, Deloitte
10:30 10:45 Morning Coffee -
10:45 12:30 Going Beyond EHR – Opportunities & Operating
Models
Callum Bir, Deloitte
12:30 13:30 Lunch -
13:30 14:30 Building Foundation going beyond EHR (Case-
Study)
Victor Chai, MOHH
14:30 15:30 Secondary Uses of Data: Pharmaceutical
Perspective
(Case Study)
Shirali Mewara, Deloitte
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
(Case Study)
Yu Chye Cheong, MOHH
16:30 17:00 US’s Approach to Standards (Case Study) Thiam Hwa Lim, HL7
17:00 17:30 Panel Discussion
Callum Bir
Deloitte Consulting SEA
Benefits for EHR across various Stakeholders
Realizing Benefits
©2011 Deloitte Touche Tohmatsu Limited
Healthcare Market is experiencing a rapid transition in the clinical needs and
the use of technology for innovation
4
Health Reform Clinical Effectiveness
Chronic Disease
Management
Medication Safety and
Management
Growing Aging Population
Increasing Healthcare Costs
Increasing Lifestyle diseases
Innovation through Technology
Increasing focus on primary &
preventive care
Resource Shortage & Medical
Tourism
Shifting
Trends
Evolving
Focus
Emerging markets
E Health
Innovative Markets in the SEA region
Increasing Patient expectation Increasing Burden on Provider
Present-day scenario in Healthcare industry
Medical Tourism
©2011 Deloitte Touche Tohmatsu Limited
Some of the Key Questions
5
Govt Health & Payers
•How do we make healthcare affordable?
• How do we increase capacity
•How do we improve seamless
coordination of care across the health
care continuum
•How do we keep our population healthy?
Patients
• How do I stay healthy?
• How do I better manage my disease
and improve my lifestyle (Chronic)
• How do I share my decision making?
• How do I “take-control” of my health
better?
Providers
• How we improve Quality of Care
•How do we Improve Patient Safety
• How do we improve operational /
clinical efficiency?
• How do we increase compliance?
Life Sc Companies
• How do we accelerate drug discovery,
development, and launch medicines
• How do we increase efficacy, and
safety?
• How do we accelerate innovation?
©2011 Deloitte Touche Tohmatsu Limited
A Seemingly Logical “Trendline”
6
Level of Complexity/Involvement
Pre
su
med
Ben
efi
ts
The
Enterprise
Automation
Departmental
EnterpriseHospital-wide
Automation
Extend
the Core
Enterprise/Integrated
Delivery System-wide
Automation
Community-wide
Automation
©2011 Deloitte Touche Tohmatsu Limited
It is expected that HIEs help reduce costs and enhance quality by providing physicians with needed information at the time treatment decisions are made
Potential U.S. net efficiency gain from use of HIEs:
>$55B per year or 3% of total healthcare expenditure of
$1.7 T
Typical HIE Benefits
Public Health
Improved population health
Improved wellness
Improved monitoring and safety
Payers and Employers
Reduced costs
Reduced MLR
Lower absenteeism
Efficiency
Providers
Reduced errors
Improved quality
Efficiency
Other (e.g., Life Sciences)
Faster routes-to-market
Sources: Center for Information Technology Leadership, Partners Health Care, Harvard (2004)
Community Health
Information Exchange
$55B
Outpatient EHR $25B
Inpatient EHR $6B
HIEs are also envisioned as a way for stakeholders to experiment with new economic
models
©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%
of the fully operational exchange
initiatives (29/42) experienced
reductions in health care costs.
52%
of fully operational exchange
efforts (22/42) report positive
impacts on health care delivery.
69%
of operational exchange efforts
(29/42) report a positive financial
return on their investment (ROI) for
their participating stakeholders.
A majority (69%) of the fully
operational exchange initiatives
(29/42) experienced reductions in
health care costs:
19 reduced staff time
11 decreased dollars spent on
redundant tests
5 documented a reduction in patient
admissions
5 decreased cost of care for chronic
care patients
About half (52%) of fully
operational exchange efforts
(22/42) report positive impacts on
health care delivery:
16 improved access to test results
13 improved quality of practice life
9 decreased support staff
8 improved compliance with chronic
care and prevention guidelines
6 reported better care outcomes for
Patients
4 reported a decrease in prescribing
errors
4 increased recognition of disease
outbreaks
A majority (69%) of operational
exchange efforts (29/42) report a
positive financial return on their
investment (ROI) for their
participating stakeholders:
13 reported an ROI for hospitals
9 reported an ROI for physicians
practices
6 reported an ROI for health plans
5 reported an ROI for independent
laboratories
©2011 Deloitte Touche Tohmatsu Limited
Most direct benefits seem linked to streamlining information exchange
among HIE participants (Simulated Total)
Administrative savings
( e.g., filing / requesting
requests, retrieving patient
history, call-in of orders,
call-in of prescriptions )
Electronic adjudication of orders
Substitution to
generic drugs
Duplicate tests
reduction
Electronic receipt/
transmission of clinical
documentation
Increased patient safety
©2011 Deloitte Touche Tohmatsu Limited
The grid illustrates anticipated benefits for a range of potential HIE services across stakeholder groups
Benefits for stakeholders groups
Service
Stakeholder
Clinical results
delivery
Clinical records
Care management
tools
Quality reporting
Public health reporting
Data aggregation
for research
Personal health
records
Physicians
Hospitals
Laboratories
Pharmacies
Payers
Employers
Researchers
Consumers
Benefit potential
High Medium Low
Anticipated magnitude of benefits of each service for stakeholder groups.
Source: State-level HIE Value & Sustainability Interim Report, AHIMA
©2011 Deloitte Touche Tohmatsu Limited
Reducing cost is possible while improving population-based outcomes
HIEs are important enablers of the healthcare delivery ecosystem
11
Consumerism
Focus: Transparency, PHRs, Incentives, Value
Coordination of Care
Focus: Primary Care 2.0 Model (The New “Medical Home”)
Comparative Effectiveness / Evidence-Based Medicine
Focus: (1) Personalized Medicine; (2) Comparative Effectiveness; Episode Based Payments to Acute Organizations
Health Care Information Technology
Focus: EHR, HIEs, ICD-10
• Respond to transparency & PC 2.0 - Connected care
- Rx reimportation
- Medical tourism
• PHR (Shared Decision Making)
• Incentives - Experience rating & differential
premiums
- Healthy behavior rewards
• Complimentary/Alternative Medicine
• New medical homes
• Reimbursement realignment
• Primary care workforce
• MD led clinical care coordination
• 3 –7 NMEs per year
• Center for comparative
effectiveness
• Knowledge management
• Prepare for tort reform
• Decreased errors
• Decreased care gaps
• Reduced malpractice
premiums
• Improved efficiency
1
3
2
4
©2011 Deloitte Touche Tohmatsu Limited
Healthcare in the future may have very different delivery and reimbursement
models
12
Experimentation Period
Fee-for-service, individual encounters Bundled payments, performance/
Volume-based payments outcome-based payments,
Volume risk proactive health management, patient
accountability
Performance risk
Individuals
Populations
Healthcare Reform
Consumer Perspectives
13
Technology will change lifestyle of
chronic care patient and enable self-care....
©2011 Deloitte Touche Tohmatsu Limited 15
What Citizens want?
Interest in online tools and services and in
tools and aids to support self-managed care
©2011 Deloitte Touche Tohmatsu Limited
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.
©2011 Deloitte Touche Tohmatsu Limited
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 18
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
Technology-enabled self-care
©2011 Deloitte Touche Tohmatsu Limited 19
Chronic Care Lifestyle
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
Regular follow-up, Mobile Monitoring ,
Lifestyle choices for chronic patients
©2011 Deloitte Touche Tohmatsu Limited 20
Evidence Based Care
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
Personal monitoring device to alert
and guide to make improvements
in health or treat a condition.
Provider Perspectives
21
©2011 Deloitte Touche Tohmatsu Limited 22
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
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
Leading Causes of Death1
Deaths
Estimated
Deaths Due to
Medical Errors
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
…
14 AIDS 17,000
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.
To Err is Human’ - Selected Strategies to
Improve Medication Safety
©2011 Deloitte Touche Tohmatsu Limited
Patient Specific
Automated
Produced for every patient, at every
visit, regardless of the Reason for Visit
An example of a patient-specific HIE-enabled point of care Clinical Decision
Support - CINA
©2011 Deloitte Touche Tohmatsu Limited
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
Goals Not Met are highlighted for quick reference and visibility
Diagnoses and Meds are prioritized to highlight chronic conditions
©2011 Deloitte Touche Tohmatsu Limited
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
Non-intercepted serious medication
errors per 1,000 patient days
Before CPOE After CPOE
7.6
1.1
86% decline
Preventable Adverse Drug Events
per 1,000 patient days
Before CPOE After CPOE
2.9
1.1
62% decline
Percentage of Eligible Patients
Receiving Pneumococcal Vaccination
No CPOE
Reminder
CPOE
Reminder
0.8%
36%
Percentage of Eligible Patients
Receiving Subcutaneous Heparin
18.9%
32%
No CPOE
Reminder
CPOE
Reminder
Source: Clinical Advisory Board
Prompting Best Clinical Practice
Building a Stronger Safety Net
©2011 Deloitte Touche Tohmatsu Limited
Percentage of Oral H2-Blocker Orders Using Nizatidine
Weeks
1.1
CPOE alert to preferred
H2 blocker introduced
1.1
Physician Order to Receipt by Pharmacy
Before CPOE After CPOE
3.4
hours
0.5 hour
Physician Order to Delivery to Patient
Care Areas
4.6
hours 32%
Before CPOE After CPOE
Source: Clinical Advisory Board
Reducing Time to Deliver Care
Encouraging Cost-effective regimens or Less-Costly Drugs
1.4 hour
1 2 3 5 7 9 11
20% 18% 12%
80% 68% 83% 90%
Estimated annual
Savings: $75,000
CPOE (Continued)
©2011 Deloitte Touche Tohmatsu Limited
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
©2011 Deloitte Touche Tohmatsu Limited
Total benefit projections are significant Cost Decrease - 5
Conservative Medium Aggressive
Reduce Medical Record Costs by Reducing Chart Pull Staff, Eliminating Storage and Supply
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
6.00% 10.00% 15.00% C
% Reduction in Pharmacy Expense per Admission due to Generic Substitutions and changes to
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
©2011 Deloitte Touche Tohmatsu Limited
Total benefit projections are significant Cost Decrease - 9
Conservative Medium Aggressive Reduction in Materials Management Cost by Reducing Form and Paper Demand
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
Conservative Medium Aggressive
Increase in Net Revenue by reducing denied days and rebilling due to better
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
©2011 Deloitte Touche Tohmatsu Limited
Prevention
Screening & Early
Detection Treatment & Palliation
Key: Better than National rate/Target Equal to or slightly worse than National rate/Target Significantly worse than National rate/Target Improving Steady Declining
Prostate Cancer
Incidence Rate
Lung Cancer
Incidence Rate
Adult
Smoking Rate
Adolescent
Smoking Rate
Advice to
Quit Smoking
Pharmacotherapy to
Quit Smoking
Adult Obesity
Rate
Cancer Incidence Rate
All Sites
Breast Cancer
Incidence Rate
Breast Cancer
Screening Rate
Hist. Assessment
Breast Cancer
Colorectal Cancer
Screening Rate
Advanced Stage
Colorectal Cancer Dx
Early Stage Breast
Cancer Diagnosis
Advanced Stage Breast
Cancer Diagnosis
Clean Margins Breast
Conserving Surgery
Needle Biopsy for
Breast Cancer
Timely Breast
Cancer Biopsy
Pathology Reports for
Breast Cancer
Path Compliance
For Specimens
Pathology Reports for
Colorectal Cancer
Pathology Reports for
Lung Cancer
Breast Cancer Staged
Before Treatment
Lung Cancer Staged
Before Treatment
Participation in
Clinical Trials
Inappropriate Hormonal
Therapy - Prostatectomy
Appropriate EBRT
Prostate Cancer
EBRT/Hormone Therapy
Prostate Cancer
Adjuvant Radiation
Breast Consv. Surgery
Adjuvant Hormone Ther
Invasive Breast Cancer
Adjuvant Chemotherapy
Breast Cancer
Mammography After
Treatment
Cancer Pain
Assessment
Prevalence of Pain
Among Cancer Patients
Hist. Assessment
Colorectal Cancer
Adjuvant Chemotherapy
Colorectal Cancer
Cancer Deaths
In Hospice
Hospice
Length of Stay
Pathology Reports for
Prostate Cancer
Colorectal Ca. Staged
Before Treatment
Colonoscopy
After Treatment
All Cancers
Mortality Rate
Breast Cancer
Mortality Rate
Colorectal Cancer
Mortality Rate
Lung Cancer
Mortality Rate
Prostate Cancer
Mortality Rate
Prostate Cancer Staged
Before Treatment
Breast Cancer
Survival Rate
Colorectal Cancer
Survival Rate
Lung Cancer
Survival Rate
Prostate Cancer
Survival Rate
Diagnosis &
Staging
Colorectal Cancer
Incidence Rate
Many Benefits:
Improved quality of care/patient safety
Cost reduction (e.g., redundant tests)
Enhanced operational efficiencies (pulling information, reporting, etc.)
Population Management Community-wide disease
management Disease surveillance Etc.
The HIE is also a tool for community-wide analytics
©2011 Deloitte Touche Tohmatsu Limited
3-1
Prevention
Screening
& Early
Detection Diagnosis Treatment & Palliation
Prostate Cancer
Incidence Rate
Lung Cancer
Incidence Rate
Colorectal Cancer
Incidence Rate
Adult
Smoking Rate
Adolescent
Smoking Rate
Advice to
Quit Smoking
Pharmacotherapy to
Quit Smoking
Adult Obesity
Rate
Cancer Incidence Rate
All Sites
Breast Cancer
Incidence Rate
Hist. Assessment
Breast Cancer
Breast Cancer
Screening Rate
Colorectal Cancer
Screening Rate
Advanced Stage
Colorectal Cancer Dx
Early Stage
Breast Cancer Dx
Advanced Stage
Breast Cancer Dx
Clean Margins
Breast Consv. Surgery
Needle Biopsy for
Breast Cancer
Timely Breast
Cancer Biopsy
Pathology Reports for
Breast Cancer
Path Compliance
For Specimens
Pathology Reports for
Colorectal Cancer
Pathology Reports for
Lung Cancer
Breast Cancer Staged
Before Treatment
Lung Cancer Staged
Before Treatment
Participation in
Clinical Trials
Inappropriate Hormonal
Therapy - Prostatectomy
Appropriate EBRT
Prostate Cancer
EBRT/Hormone Therapy
Prostate Cancer
Adjuvant Radiation
Breast Consv. Surgery
Adjuvant Hormone Ther
Invasive Breast Cancer
Adjuvant Chemotherapy
Breast Cancer
Mammography After
Treatment
Cancer Pain
Assessment
Prevalence of Pain
Among Cancer Patients
Hist. Assessment
Colorectal Cancer
Adjuvant Chemotherapy
Colorectal Cancer
Cancer Deaths
In Hospice
Hospice
Length of Stay
Pathology Reports for
Prostate Cancer
Colorectal Ca. Staged
Before Treatment
Colonoscopy
After Treatment
All Cancers
Mortality Rate
Breast Cancer
Mortality Rate
Colorectal Cancer
Mortality Rate
Lung Cancer
Mortality Rate
Prostate Cancer
Mortality Rate
Prostate Cancer Staged
Before Treatment
Breast Cancer
Survival Rate
Colorectal Cancer
Survival Rate
Lung Cancer
Survival Rate
Prostate Cancer
Survival Rate
Home
3-1 Adult Smoking Rate
Source: Behavioral Risk Factor Surveillance Survey, 2006
20.0% 19.9%
22.2%
12.0%
0.00%
5.00%
10.00%
15.00%
20.00%
US GA Exchange Healthy
People 2010
Target
Next
More Proprietary and confidential
©2011 Deloitte Touche Tohmatsu Limited
Breast Cancer
Survival Rate
Colorectal Cancer
Survival Rate
Lung Cancer
Survival Rate
Prostate Cancer
Survival Rate
3-1Trend
Prevention
Screening
& Early
Detection Diagnosis Treatment & Palliation
Prostate Cancer
Incidence Rate
Lung Cancer
Incidence Rate
Colorectal Cancer
Incidence Rate
Adult
Smoking Rate
Adolescent
Smoking Rate
Advice to
Quit Smoking
Pharmacotherapy to
Quit Smoking
Adult Obesity
Rate
Cancer Incidence Rate
All Sites
Breast Cancer
Incidence Rate
Hist. Assessment
Breast Cancer
Breast Cancer
Screening Rate
Colorectal Cancer
Screening Rate
Advanced Stage
Colorectal Cancer Dx
Early Stage
Breast Cancer Dx
Advanced Stage
Breast Cancer Dx
Clean Margins
Breast Consv. Surgery
Needle Biopsy for
Breast Cancer
Timely Breast
Cancer Biopsy
Pathology Reports for
Breast Cancer
Path Compliance
For Specimens
Pathology Reports for
Colorectal Cancer
Pathology Reports for
Lung Cancer
Breast Cancer Staged
Before Treatment
Lung Cancer Staged
Before Treatment
Participation in
Clinical Trials
Inappropriate Hormonal
Therapy - Prostatectomy
Appropriate EBRT
Prostate Cancer
EBRT/Hormone Therapy
Prostate Cancer
Adjuvant Radiation
Breast Consv. Surgery
Adjuvant Hormone Ther
Invasive Breast Cancer
Adjuvant Chemotherapy
Breast Cancer
Mammography After
Treatment
Cancer Pain
Assessment
Prevalence of Pain
Among Cancer Patients
Hist. Assessment
Colorectal Cancer
Adjuvant Chemotherapy
Colorectal Cancer
Cancer Deaths
In Hospice
Hospice
Length of Stay
Pathology Reports for
Prostate Cancer
Colorectal Ca. Staged
Before Treatment
Colonoscopy
After Treatment
All Cancers
Mortality Rate
Breast Cancer
Mortality Rate
Colorectal Cancer
Mortality Rate
Lung Cancer
Mortality Rate
Prostate Cancer
Mortality Rate
Prostate Cancer Staged
Before Treatment
3-1 Adult Smoking Rate
Source: Behavioral Risk Factor Surveillance Survey, 2006
10%
12%
14%
16%
18%
20%
22%
24%
26%
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
US GA ExchangeHealthy
People 2010
Target
Home Back Next
Less
Proprietary and confidential
©2011 Deloitte Touche Tohmatsu Limited
Breast Cancer
Survival Rate
Colorectal Cancer
Survival Rate
Lung Cancer
Survival Rate
Prostate Cancer
Survival Rate
3-2 Peer Comparisons
Prevention
Screening
& Early
Detection Diagnosis Treatment & Palliation
Prostate Cancer
Incidence Rate
Lung Cancer
Incidence Rate
Colorectal Cancer
Incidence Rate
Adult
Smoking Rate
Adolescent
Smoking Rate
Advice to
Quit Smoking
Pharmacotherapy to
Quit Smoking
Adult Obesity
Rate
Cancer Incidence Rate
All Sites
Breast Cancer
Incidence Rate
Hist. Assessment
Breast Cancer
Breast Cancer
Screening Rate
Colorectal Cancer
Screening Rate
Advanced Stage
Colorectal Cancer Dx
Early Stage
Breast Cancer Dx
Advanced Stage
Breast Cancer Dx
Clean Margins
Breast Consv. Surgery
Needle Biopsy for
Breast Cancer
Timely Breast
Cancer Biopsy
Pathology Reports for
Breast Cancer
Path Compliance
For Specimens
Pathology Reports for
Colorectal Cancer
Pathology Reports for
Lung Cancer
Breast Cancer Staged
Before Treatment
Lung Cancer Staged
Before Treatment
Participation in
Clinical Trials
Inappropriate Hormonal
Therapy - Prostatectomy
Appropriate EBRT
Prostate Cancer
EBRT/Hormone Therapy
Prostate Cancer
Adjuvant Radiation
Breast Consv. Surgery
Adjuvant Hormone Ther
Invasive Breast Cancer
Adjuvant Chemotherapy
Breast Cancer
Mammography After
Treatment
Cancer Pain
Assessment
Prevalence of Pain
Among Cancer Patients
Hist. Assessment
Colorectal Cancer
Adjuvant Chemotherapy
Colorectal Cancer
Cancer Deaths
In Hospice
Hospice
Length of Stay
Pathology Reports for
Prostate Cancer
Colorectal Ca. Staged
Before Treatment
Colonoscopy
After Treatment
All Cancers
Mortality Rate
Breast Cancer
Mortality Rate
Colorectal Cancer
Mortality Rate
Lung Cancer
Mortality Rate
Prostate Cancer
Mortality Rate
Prostate Cancer Staged
Before Treatment
14.4%
17.2%
23.0%
16.0%
0%
5%
10%
15%
20%
25%
Exchange Georgia U.S. Average Healthy
People 2010
Target
3-2 Adolescent Smoking Rate: percent of youths age
13-17 who currently smoke
Source: (Georgia, US) YBRSS survey, 2005
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More
Proprietary and confidential
©2011 Deloitte Touche Tohmatsu Limited
Breast Cancer
Survival Rate
Colorectal Cancer
Survival Rate
Lung Cancer
Survival Rate
Prostate Cancer
Survival Rate
3.2 Trend
Prevention
Screening
& Early
Detection Diagnosis Treatment & Palliation
Prostate Cancer
Incidence Rate
Lung Cancer
Incidence Rate
Colorectal Cancer
Incidence Rate
Adult
Smoking Rate
Adolescent
Smoking Rate
Advice to
Quit Smoking
Pharmacotherapy to
Quit Smoking
Adult Obesity
Rate
Cancer Incidence Rate
All Sites
Breast Cancer
Incidence Rate
Hist. Assessment
Breast Cancer
Breast Cancer
Screening Rate
Colorectal Cancer
Screening Rate
Advanced Stage
Colorectal Cancer Dx
Early Stage
Breast Cancer Dx
Advanced Stage
Breast Cancer Dx
Clean Margins
Breast Consv. Surgery
Needle Biopsy for
Breast Cancer
Timely Breast
Cancer Biopsy
Pathology Reports for
Breast Cancer
Path Compliance
For Specimens
Pathology Reports for
Colorectal Cancer
Pathology Reports for
Lung Cancer
Breast Cancer Staged
Before Treatment
Lung Cancer Staged
Before Treatment
Participation in
Clinical Trials
Inappropriate Hormonal
Therapy - Prostatectomy
Appropriate EBRT
Prostate Cancer
EBRT/Hormone Therapy
Prostate Cancer
Adjuvant Radiation
Breast Consv. Surgery
Adjuvant Hormone Ther
Invasive Breast Cancer
Adjuvant Chemotherapy
Breast Cancer
Mammography After
Treatment
Cancer Pain
Assessment
Prevalence of Pain
Among Cancer Patients
Hist. Assessment
Colorectal Cancer
Adjuvant Chemotherapy
Colorectal Cancer
Cancer Deaths
In Hospice
Hospice
Length of Stay
Pathology Reports for
Prostate Cancer
Colorectal Ca. Staged
Before Treatment
Colonoscopy
After Treatment
All Cancers
Mortality Rate
Breast Cancer
Mortality Rate
Colorectal Cancer
Mortality Rate
Lung Cancer
Mortality Rate
Prostate Cancer
Mortality Rate
Prostate Cancer Staged
Before Treatment
0%
5%
10%
15%
20%
25%
30%
35%
40%
1991
1993
1995
1997
1999
2001
2003
2005
2007
U.S. Georgia
Exchange Healthy people 2010
3-2 Adolescent Smoking Rate: percent of youths age 13-
17 who currently smoke
Source: YBRSS survey, 2005
Back Next Home
Less
Proprietary and confidential
©2011 Deloitte Touche Tohmatsu Limited
Breast Cancer
Survival Rate
Colorectal Cancer
Survival Rate
Lung Cancer
Survival Rate
Prostate Cancer
Survival Rate
3-3 Advice to Quit
Prevention
Screening
& Early
Detection Diagnosis Treatment & Palliation
Prostate Cancer
Incidence Rate
Lung Cancer
Incidence Rate
Colorectal Cancer
Incidence Rate
Adult
Smoking Rate
Adolescent
Smoking Rate
Advice to
Quit Smoking
Pharmacotherapy to
Quit Smoking
Adult Obesity
Rate
Cancer Incidence Rate
All Sites
Breast Cancer
Incidence Rate
Hist. Assessment
Breast Cancer
Breast Cancer
Screening Rate
Colorectal Cancer
Screening Rate
Advanced Stage
Colorectal Cancer Dx
Early Stage
Breast Cancer Dx
Advanced Stage
Breast Cancer Dx
Clean Margins
Breast Consv. Surgery
Needle Biopsy for
Breast Cancer
Timely Breast
Cancer Biopsy
Pathology Reports for
Breast Cancer
Path Compliance
For Specimens
Pathology Reports for
Colorectal Cancer
Pathology Reports for
Lung Cancer
Breast Cancer Staged
Before Treatment
Lung Cancer Staged
Before Treatment
Participation in
Clinical Trials
Inappropriate Hormonal
Therapy - Prostatectomy
Appropriate EBRT
Prostate Cancer
EBRT/Hormone Therapy
Prostate Cancer
Adjuvant Radiation
Breast Consv. Surgery
Adjuvant Hormone Ther
Invasive Breast Cancer
Adjuvant Chemotherapy
Breast Cancer
Mammography After
Treatment
Cancer Pain
Assessment
Prevalence of Pain
Among Cancer Patients
Hist. Assessment
Colorectal Cancer
Adjuvant Chemotherapy
Colorectal Cancer
Cancer Deaths
In Hospice
Hospice
Length of Stay
Pathology Reports for
Prostate Cancer
Colorectal Ca. Staged
Before Treatment
Colonoscopy
After Treatment
All Cancers
Mortality Rate
Breast Cancer
Mortality Rate
Colorectal Cancer
Mortality Rate
Lung Cancer
Mortality Rate
Prostate Cancer
Mortality Rate
Prostate Cancer Staged
Before Treatment
100%
85%
75%
80%
85%
90%
95%
100%
Exchange Healthy People 2010 Target
3-3 Smokers who receive advice to quit
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Proprietary and confidential
©2011 Deloitte Touche Tohmatsu Limited
Breast Cancer
Survival Rate
Colorectal Cancer
Survival Rate
Lung Cancer
Survival Rate
Prostate Cancer
Survival Rate
3-4 Pharmacotherapy
Prevention
Screening
& Early
Detection Diagnosis Treatment & Palliation
Prostate Cancer
Incidence Rate
Lung Cancer
Incidence Rate
Colorectal Cancer
Incidence Rate
Adult
Smoking Rate
Adolescent
Smoking Rate
Adult Obesity
Rate
Cancer Incidence Rate
All Sites
Breast Cancer
Incidence Rate
Hist. Assessment
Breast Cancer
Breast Cancer
Screening Rate
Colorectal Cancer
Screening Rate
Advanced Stage
Colorectal Cancer Dx
Early Stage
Breast Cancer Dx
Advanced Stage
Breast Cancer Dx
Clean Margins
Breast Consv. Surgery
Needle Biopsy for
Breast Cancer
Timely Breast
Cancer Biopsy
Pathology Reports for
Breast Cancer
Path Compliance
For Specimens
Pathology Reports for
Colorectal Cancer
Pathology Reports for
Lung Cancer
Breast Cancer Staged
Before Treatment
Lung Cancer Staged
Before Treatment
Participation in
Clinical Trials
Inappropriate Hormonal
Therapy - Prostatectomy
Appropriate EBRT
Prostate Cancer
EBRT/Hormone Therapy
Prostate Cancer
Adjuvant Radiation
Breast Consv. Surgery
Adjuvant Hormone Ther
Invasive Breast Cancer
Adjuvant Chemotherapy
Breast Cancer
Mammography After
Treatment
Cancer Pain
Assessment
Prevalence of Pain
Among Cancer Patients
Hist. Assessment
Colorectal Cancer
Adjuvant Chemotherapy
Colorectal Cancer
Cancer Deaths
In Hospice
Hospice
Length of Stay
Pathology Reports for
Prostate Cancer
Colorectal Ca. Staged
Before Treatment
Colonoscopy
After Treatment
All Cancers
Mortality Rate
Breast Cancer
Mortality Rate
Colorectal Cancer
Mortality Rate
Lung Cancer
Mortality Rate
Prostate Cancer
Mortality Rate
Prostate Cancer Staged
Before Treatment
88.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Exchange
3-4 Smokers who are recommended pharmacotherapy to
assist in quitting smoking
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Advice to
Quit Smoking
Pharmacotherapy to
Quit Smoking
Proprietary and confidential
EHR Technical Characteristics
38
©2011 Deloitte Touche Tohmatsu Limited
The Generic HIE reference architecture depicts a basic architecture with its various
services and security components that make up the HIE.
Generic HIE reference architecture
Stakeholders Business services
Demographics e-Prescribing and
medications Immunizations
Lab
orders/Results
Infrastructure services
Security management Messaging
Audit logging Monitoring Business rules
Exception handling
Channels
Interactive voice
response (IVR)
Fax
Web service
Electronic Data
interchange (EDI)
Call center
Web/HTTP (Portal)
File transfer protocol
(FTP)
Disease
management
Admit/Visit/
Discharge notes Allergies Radiology
Diagnostic Imaging Scheduling
Data services
Decision support Messaging data
Data warehouse Business intelligence Audit/Logging data
Distributed services
Record locator
service (RLS) Terminology
Enterprise master
patient index (EMPI) Consent management Alerts
Identity management
Medical management
Clinics
Labs
Centers for Medicare
and Medicaid Services (CMS)
Patients
State
Agencies/Programs (Medicaid, Pharmacy
Benefits Management,
Eligibility, Child Welfare, Foster Care, etc.)
Hospitals
Payers EMR Lite
Electronic medical
record (EMR)
©2011 Deloitte Touche Tohmatsu Limited
HIE sample logical architecture
©2011 Deloitte Touche Tohmatsu Limited
HIE Data Architecture Types
Federated/decentralized Model No centralized data repository. Each stakeholder keeps its own data within its walls and queries
assemble data on the fly. It is an easy model for stakeholders to accept…with major issues
related to presenting the data in a normalized, significant way and with acceptable performance
Stakeholder A
Stakeholder B
Stakeholder C
Centralized Model
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
data repository for longitudinal analysis.
Stakeholder A
Stakeholder B
Stakeholder C
Operational Database
Central data repository
Virtual or Partitioned Centralized Model
Each stakeholder sends its agreed upon data to a central data repository where data is “cleansed”
and normalized. Yet, this central data repository is virtual or the physical central repository is
partitioned in such a way that a given stakeholder controls its own data partition and could easily
take it back if required.
Stakeholder C
Central but partitioned
data repository
Each stakeholder sends an agreed upon subset of patient data to a
central data repository where data is “cleansed” and normalized. Part of
the patient data remains decentralized with record locator
service/centralized metadata indicating where these decentralized
components are.
Stakeholder A
Stakeholder B
Stakeholder C
Central subset
data repository
Hybrid Model Stakeholder A
Stakeholder B
Stakeholder C
Operational Database Edge Database
Federated Hybrid Model Each stakeholder sets up a mirrored database on the facility’s edges
where data can be cleansed and normalized per the exchange’s
standards. It is this database that is used to query data from the
Exchange.
1
2 3
4
4
Stakeholder A
Stakeholder B
©2011 Deloitte Touche Tohmatsu Limited
Below are key points and takeaways for each architecture types
HIE Data Architecture Takeaways
Federated Centralized Hybrid
Participating organization
retains control of their
healthcare information
Stakeholders retain
control over the patient
data
Data security is
considered to be less
complex
Generally uses a form of
Record Location Service
(RLS)
HIE entity has control of
the healthcare information
Stakeholders decide the
patient data to share
Data security is more
complex
Not a preferred option for
stakeholders as they don’t
have control of the data
(Co-Mingling of data)
Data analytics is easier
Variable types and level
of connectivity
Stakeholders decide the
patient data to share
Data security is more
complex than Federated
A preferred option as it
allows leveraging existing
HIOs
Data analytics is easier
Current State of EHRs
43
©2011 Deloitte Touche Tohmatsu Limited
Many EHRs are still in the early deployment phases (estimated allocation)
44
Phase 4:
OPERATIONS
Phase 3: IMPLEMEN- TATION
Phase 2: DETAILED DESIGN
Phase 1: STRATEGY & PLANNING
Phase 0: FEASIBILITY
Phase 5:
OPERATIONS
Phase 4: IMPLEMEN- TATION
Phase 3: DETAILED DESIGN
Phase 2: STRATEGY & PLANNING
Phase 1: FEASIBILITY
PROGRESSION OF PHASES
No broad community support
No clear objective
No self-sustainable business model
Privacy concerns
No clear value for physicians
©2011 Deloitte Touche Tohmatsu Limited
Many complex, interrelated characteristics
45
FEASIBILITY
STRATEGY &
PLANNING
DETAILED
DESIGN
IMPLEMENTATION
OPERATIONS
GOVERNANCE:
FUNCTIONAL:
TECHNOLOGY:
PRIVACY/SECURITY:
How the Exchange is structured, how decisions are made, and the rules
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
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
services it must incorporate, etc…
How will privacy/data access be defined, how will secure data exchange
be implemented, definition of patient consent policies, etc…
FINANCIAL: Definition of a self-sustainable financial model, definition of a balance
ROI among stakeholders, definition of mechanisms to counter first
mover disadvantage, etc.…
Disruptive Innovation
in Healthcare
Callum Bir
Director,
Life Sciences & Healthcare
©2011 Deloitte Touche Tohmatsu Limited 47
Disruptive Innovation
©2011 Deloitte Touche Tohmatsu Limited
Social Networking
48
Facebook drives more traffic online than Google
©2011 Deloitte Touche Tohmatsu Limited 49
Compare hospitals & doctors?
Percent who compare physicians and hospitals before making a selection and
most trusted sources of medical information compared to other sources
©2011 Deloitte Touche Tohmatsu Limited 50
Building fan pages for specific causes,
organizations or products; sharing
recreation-oriented campaigns
©2011 Deloitte Touche Tohmatsu Limited 51
YouTube
Posting educational videos
and testimonials
©2011 Deloitte Touche Tohmatsu Limited
Patients Like Me
52
PatientsLikeMe is a data-driven social
networking health site that enables its
members to share condition, treatment,
and symptom information in order to
monitor their health over time and learn
from real-world outcomes. Members are
able to find and connect with patients like
them, gain social support, and learn first-
hand about ways to cope and manage.
PatientsLikeMe aims to help patients
answer the question: "Given my status,
what is the best outcome I can hope to
achieve, and how do I get there?"
PatientsLikeMe
Type Private
Founded 2004
Headquarters Cambridge,
Massachusetts,USA
Key people Ben Heywood, Co-Founder,
President
James Heywood, Co-Founder,
Chairman
David S. Williams III, Chief
Marketing Officer, Head of
Business Development
Robert Palladino, Chief
Financial Officer
Paul Wicks, PhD., R&D
Director
Slogan "Patients Helping Patients Live
Better Every Day"
Website patientslikeme.com
Type of site social networking
Launched October 10, 2005
Current status Active
©2011 Deloitte Touche Tohmatsu Limited 53
Doctors & Citizens access
most latest from trusted sources.
Less is more..
.
©2011 Deloitte Touche Tohmatsu Limited 54
Linked-in
Recruiting talent,
announcing staff news
Case Studies – Mobility
55
©2011 Deloitte Touche Tohmatsu Limited
Examples of how Technology is Changing how we may look at EHRs
56
©2011 Deloitte Touche Tohmatsu Limited
NSW Emergency Waiting Times Mobile Site
57
©2011 Deloitte Touche Tohmatsu Limited
Department of Health and Human Services Tasmania
improve the quality of patient care while also increasing organisational efficiency in
their hospitals.
58
Transiting from Patient Oriented Care to
Consumer Model of Care ….
©2011 Deloitte Touche Tohmatsu Limited 60