September Event

HIMSS Clinical & Business IntelligenceCommunity

#PutData2Work | #PopHealthIT | #PrecisionHIT

Mitch Kwiatkowsk

C&BI Committee Member

and guest Community host

Vice President, Enterprise Data Hub

Highmark Health

Welcome

Shelley Price, MS, FHIMSS

C&BI Community Organizer

Director, Payer & Life Sciences

HIMSS | Arlington, VA

Arthur Panov, MPH, CPHIMS

C&BI Community Co-Chair

Executive Director Healthcare Analytics

FAIR Health

Mike Berger, MSBA

C&BI Community Co-Chair

Vice President, Pop Health Informatics & Data

Science, Mount Sinai Health

Welcome

• Welcome

• HIMSS C&BI Community Updates / Announcements

• Presentation & Discussion:

“Blockchain – Hype and Reality – What’s working in

Healthcare?”

Erik Pupo, MBA, | Andrew Eilers, BSN, RN, MBA | Chief Information

Officer | Columbia University Irving Medical Center

• Wrap-Up / Next Steps

Agenda

Updates / Announcements

R E G I S T E R N O W

OCTOBER 22-23, 2018 Westin Copley Place

Boston, MA

FOR MORE INFORMATION, VISIT:

www.BigDataHITforum.com/Boston/2018

8

HIMSS Blockchain Task ForceMISSION: Evaluate the role of blockchain technology within the healthcare ecosystem and explore how

blockchain technology can advance existing health information exchange capabilities and educate the

health IT community on the clinical, business, technical, legal, and financial implications blockchain

technology may have on the healthcare landscape.

RESOURCES: Visit www.himss.org/library/blockchain-healthcare for access to resources including:

• Blog Posts, Webinar Recordings, and HIMSS’s article in the Blockchain in Healthcare Today journal

FY19 TOPIC AREAS OF FOCUS

• Blockchain Basics: Education on the nuts and bolts of the technology within the healthcare setting

• Applications & Use Cases: Highlights of active examples of technology in use and share insights

to the appropriateness of the technology depending on use case

• Practical Guidance and Resources: Tools to assist with understanding the many considerations

required when adopting blockchain technology.

Email blockchain@himss.org to learn more!

C&BI Community PresentationGuest Speaker(s)

We will take

questions at the

end of the

presentation…

…Please type your

questions into the

Q&A box.

#PutData2Work | #PopHealthIT | #PrecisionHIT

What is working and what is not?

Erik Pupo

Chief Information Officer

Columbia University Irving Medical Center

BLOCKCHAIN –HYPE AND REALITY

What is Working

11

DATA

RECONCILIATION

TRACK

AND

TRACE

DATA

LOCATION

IDENTITY

Where are problems?

Replacing Existing Systems and Data

Storing Health Data On-Chain

Interoperability Overhype

Technology Looking for a

Health Problem

More consortium and consensus

model innovation

Track and trace for patients

(readmissions, care coordination…)

Where is Blockchain Going?

13

Patient and Provider-Controlled

“Health Wallets”

Real time trust models for providers,

payers and patients in value-based

care

HOW TO START – CONCEPT TO SCALE

14

TIME

PILOT• Pilot use cases

BLO

CK

CH

AIN

CA

PA

BIL

ITIE

S

EXPAND & MANAGE• Expand to products

and services

DISCOVER• Learning what

others are doing• Understanding the

market need

ITERATIVE LOOP BY SELECTED USE CASE

SCALE• Build scale with internal

and external customers

EXPAND AND MANAGESCALEPILOT

PROOF OF CONCEPT• Start with a proof of

concept

DESIGN & PLAN• Vision• Value Drivers• Visualize

PROOF OF CONCEPTRE - IMAGINE

1

2

3

4

56

BLOCKCHAIN

VIGNETTES

15

OPTIMIZING VALUE BASED

CARE

DRIVING NEW REVENUE STREAMS

IMPROVING THE

BENEFICIARY EXPERIENCE

MANAGING IDENTITY

TRACK AND TRACE

16

TRACK

AND

TRACE

17

The Challenge - Supply Chain Management

Distributor

DispenserProducts are tagged and all movements are tracked. RFID chips, barcodes,

unique identifiers, EPCIS transmissions are all examples of how a product can

be tagged.

IoT helps connect the physical world to Blockchain. Example: Sensors detect

physical events such as confirming the arrival of the product with a non-

tampered microchip.

Transaction is registered into the block chain with

details of the product and transaction

Traceability and authentication of product

history

Smart contracts facilitates and verifies the

performance of a contract

Ownership records are maintained in the Block chain once the terms of transactions

have been met

Tagging of Product – Ensures product has not been

modified

Verifies legitimacy of events

Creates an immutable record of transaction with

detailed attributes captured

Ability to Track and Trace

Automatically enforces agreement

and compliance

Proof of Ownership

Connecting a sensor that detects temperature during to shipments. The data is collected while the shipment is in transit. Smart

contracts create an immutable ledger that verifies and proves the temperature was compliant throughout the shipment using the

connected sensor

Auto tagging, tracing and connecting of data provides compliance and verification

The Impact – Track and Trace

18

Blockchain traceability provides the opportunity to precisely target drug recalls, and eradicate harmful counterfeit drugs from the supply chain

VISION

• Real time notification of contamination within products through distributed ledger and IoT sensors.

• Identification of contamination at the lot level through serialization and robust audit trail, allowing supplier to contact consumer immediately & anonymously

• Prevention of counterfeit drugs from entering the supply chain through transparency and traceability

• Improves business, operational, and regulatory reporting resulting in cost efficiencies

BENEFITS

Access TrustAnonymity Real Time Safe-keeping

BLOCKCHAIN APPLICABILITY

Open Source

HOW IT WORKS

Unit packed

into shipper

box

Shipper labeled with Nested Serial

Numbers 2D Barcode

WAREHOUSING:

Shipper stacked on pallet

Pallet Serial Nesting Labeled

2D Barcode

CONTRACT PACKING: 1

Serial number

decommissioning

2

Serial number tracking & validationSerial number application & management

Enabling real time traceability and tracking of receipt across users

The Future – Blockchain and Clinical Trials

19

A blockchain platform for clinical trials connects patients, site investigators, and

allowing payers to view data

VISION

• Decentralized management of data across sponsors and sites in near-real time

increases trial agility, shifting away from sole management of data by one sponsor

(common at present) in potentially low-trust setting

• Audit trail of transactions creates visibility into data history and compliance-

readiness (including visibility into data edits by permissioned users)

• Secure data collection from IoHT devices and communications with patients

during and after trial

BENEFITS

BLOCKCHAI

N DIGITAL

CLINICAL

TRIAL

Clinical

Trial Sites

Trial

Sponsors

Contract Research

Organizations

Patient

Data

Access

Data from

Connected

Devices

Access TrustAnonymity Real Time Safe-keeping

BLOCKCHAIN APPLICABILITY

Open Source

HOW IT WORKS

Future: Enabling “Tracking and Tracing” across multiple user groups

20

OPTIMIZING VALUE-

BASED CARE

21

The Challenge – Complexity of Care

Patient Discharge Optimization

Care Delivery Optimization

Remote Patient Management

Inpatient

Remote

RehabilitationRico

Primary care Tom

Second OpinionJohn

Home MonitoringPaul

Inpatient careDave

Outpatient

Rehabilitation

Remote NurseNoraPatient Paul

Acute

Non-Acute

THE IMPACT – CROSS-PAYER DATA SHARING

22

Humana

Plan No.

Diagnostic Test Results Radiology Results

Demographics

AetnaDemographics

Referral Summary

Plan No.

Medication List

Cigna

Demographics Plan No.

Problem List Care Plan

NON-EXHAUSTIVE

Security

Certificate

Security

Certificate

Security

Certificate

Beneficiary Identity

Biometric

Identity

Biometric

Identity

• Communicate with providers in real-time about incentives available to them for specific patients

• Identify care gaps in real-time and resolve them quickly

• Shepherd patients more quickly and efficiently into appropriate care programs

• Includes visibility to all providers across the patient’s care continuum

• Guide physicians to improve clinical decision-making at the point of clinical care

Increasing the quality of care in real time

23

The Future – Value-Based Data Platform

Tx1Tx2

Tx3…

API

Member Payer A

API

Member Payer B

Login and get claims data

Hash of claims + member ID written to chain

Login and get claims data

Hash of claims + member ID written to chain

Retrieve index from prior Payer

BlockchainValue Based data model allows providers and payers to share a common view of quality and resource utilization data

• Clarity about the quality incentives available to them

• Prescriptions validated in real-time from the providers’ system

• Elimination of scanning and faxing documents

• Faster reimbursement for treatments • Additional revenue incentives tied to

quality of care delivered

Creating a common view of quality and resource utilization data

DRIVING NEW

REVENUE

STREAMS

25

The Challenge – Pain Points in Revenue

Cycle Management

can result in…caused by inconsistencies throughout claims lifecycle…Main Issues…

No Single

Source of Truth

RCM process is tracked

separately by each

stakeholder

Variability in

Data

Synchronization

Some parties share

records real time while

others use a batch

process

Contract

Changes

Incorrect balances

because policy changes

do not sync up with

ledgers

Claim

Adjustments

Prior claims adjustments

are difficult to track; dollars

are incorrectly backed out

Retroactive

Changes

Complexity with handling

retroactive changes due to

multiple databases

Authorization

Determining policy

coverage with multiple

stakeholders and

variances is challenging

Contracts & Benefits(pre-processing)

Claims(processing)

Collection(post-processing)

Overstatement

Patients are overcharged

because information is not

available in real time to

determine benefits and

Out of Balance

Health system

understanding of revenue

is out of balance across

providers and payers

Poor Beneficiary

Experience

Experience is negatively

impacted as patients

struggle to understand bill

Increased Admin

CostMillions in wasted spend

due to claims adjustments

and disputes

26

Many RCM processes become easier to manage when transparency and data integrity are improved

v

DATA INTEGRITY

Information securely shared across a

larger ecosystem, increases speed and

viability of encounter data sharing

v

TRACEABILITY

Claim is tagged at all movements and is tracked.

By tagging a claim there is a shared holistic view

of all claims adjudication activity

v

SECURITY

Detection and auditing of events to

ensure that all parties are aware when

decisions are made

v

IMMUTABILITY

Claims and other transactions

are registered into the

blockchain with detail for all to

see

v

v

COMPLIANCE

Smart contracts facilitate and

verify the regulatory

performance of claims and

authorization decisions

v

v

FINAL VERIFICATION

Ownership records are maintained

in the Blockchain and can be viewed

providers, payers and beneficiaries

SUBMISSION ADJUDICATION PAYMENTENCOUNTER

DECENTRALIZED TRANSACTIONLEDGER DATABASE

AUTONOMOUS VALIDATION & CONSENSUS

CRYPTOGRAPHICALLYSECURE

The Impact – Revenue Transparency

The Future - Optimizing the Revenue

Cycle

Blockchain can orchestrate key points in the revenue cycle management process for payers

Provider

Eligibility

Member

Eligibility

Granularity

Automation

Automate business

rules for eligibility

Transparency

Experience

Scale

Demographic

Validation

Simulation

Risk Management

Shared view

Receipt &

Registration Benefit

Determination Fee for Value

Capitation

Shared

Accumulators

28

IMPROVING THE

BENEFICIARY

EXPERIENCE

Patients with chronic conditions undergo complex treatments across a variety of providers. A large ecosystem of partners (including payers) must work together for the patient. In today’s process there is inherently lack of trust and visibility which adds no benefit to the beneficiary.

How can we improve? A blockchain solution guarantees immutability of patient records, enables secure access to information across the larger ecosystem and introduces the ability to partner with other providers during pre-screening, track and trace patient data and securely share or restrict patient data.

Value:

TRACEABILITY

Ability to Track & Trace patient data for full visibility

SECURITY

Verifies legitimacy of eventsand uses cryptography tocontrol permissions

COST REDUCTION

Collaborative ecosystem reduces time and cost

COMPLIANCE

Automatically enforces agreement and compliance

DISINTERMEDIATION

Decentralized data network

PRODUCT SAFETY

Easily accessible and real-time data enables faster pre-screening

Control over permissions and unique identifiers for patients

IMMUTABILTIY

Immutable record of transactions

Business-Driven Beneficiary-Centered

The Challenge – Chronic Care

Management

Copyright © 2018 Accenture. All rights reserved.

30

INSIGHTS

Patient-secured information

can be made accessible to

payers and other providers

DATA INTEGRITY

Information shared across providers

and payers securely facilitates

information sharing with beneficiaries.

Use of wellness and patient-generated

health data can be traced on a

blockchain and tied to events

TRACK & TRACE

Traceability and

authentication of care for

payers to conduct claims

adjudication

SERIALIZATION

A beneficiary’s activity can be tracked prior to

admission. This activity data can be used to

support pre-authorization and provider location

SECURITY

Patient data is securely

entered on the chain so that its

location can be shared with

other providers involved in care

planning

IMMUTABILITY

Transaction is registered into

the blockchain with details on

care delivered

COMPLIANCE

Smart contracts facilitates and

verifies the performance of a

provider

FINAL VERIFICATION

Ownership records are maintained in the

Blockchain once the terms of

transactions have been met and can be

shared with other providers involved in

care coordination

SCHEDULING ENCOUNTER FOLLOW-UP COORDINATIONDAILY ACTIVITY

The Impact – Traceability of Care

Copyright © 2018 Accenture. All rights reserved.

31

Beneficiary Potential

Each beneficiary has a

unique ID and can track

movement using a

wallet-like interface

Beneficiary, Payer,

Provider and Pharma

Potential

Tracks progress of

medication adherence and

care coordination

Provider and Payer

Potential

Doctor uses unique

beneficiary ID and data

insights to coordinate care.

Payer verifies the treatment

and measures quality.

Provider, Payer and

Pharma Potential

Sharing medication and

clinical outcome patterns

Provider and Payer

Potential

Larger ecosystem allows

providers and payers

better insights into patient

history

The Future – Beneficiary Data Transparency

MANAGING

IDENTITY

The Challenge - Self-Sovereign Beneficiary

Identity

The concept of self-

sovereign IDs is

established

Health plans can attest

to the identity of their

members using existing

channels

Patient consent is

built on a

decentralized

network with plans

trusting stated

access rights

These assumptions

establish the building

block to establish

record sharing over

standard exchange

protocols (e.g. FHIR,

X12, etc.)

Members can login

with their

Decentralized

Identity (DID)

creating a link

between plans

1

2

34

5

The Impact - Provider Credentialing

USING PROVIDER WALLETS TO CREDENTIAL ACROSS PLANS

CURRENT STATE PROBLEM

Requests for provider credentials are often duplicated across payers and practices resulting in unnecessary system costs and undue burden on credential issuers

BLOCKCHAIN SOLUTION

Storing and cryptographically signing credentials on the blockchain ensures members of the blockchain network have access and can trust the validity of provider credentials

Search Chain

Web interface finds the provider’s wallet on the blockchain or creates a new wallet if not found

Provider submits and attests to credentials web interface

ProviderRequesting

Organization

Payer asks provider to provide credentials

Add Credential to Provider Wallet

Add the new credential to the provider’s wallet and sends the provider wallet to credential verifier

Requires trusted registry of credential verifiers

Credential verifier validates credentials and cryptographically signs the credential in the provider’s wallet

Verify and Sign the Credential

Requesting Organization

The requesting organization and future organizations can read the signed credential directly from the blockchain

“Off-chain” “On-chain”

34

THE FUTURE – BENEFICIARY IDENTITY

Mobile App 3rd party app

Yosef Mihi

PERSONAL

Unique to you and only you

PORTABLE

Accessible anywhere you

happen to be

PERSISTENT

Data stays put

PRIVATE

The user is in control

Biometric enrolment & de-

duplication application

Enroll and

de-duplicate users’

biometrics, linking them to the

identity records management

systems of the ID data

provider

Allows users to

create a unique

profile and provides

capabilities through

which they can

securely manage

and share their own

data

An application

enables the 3rd party

organizations to

capture, view,

request and process

the data shared by

the user

36

POPULATION

HEALTH

INSIGHTS

BENEFICIARY

AND PROVIDER

IDENTITIES

.

CLAIMS

ADJUDICATION

CARE

MANAGEMENT

WHAT MIGHT BE NEXT?

QUESTIONS?

Erik Pupo

Chief Information Officer

Columbia University Irving Medical Center

New York, NY

• Want to get involved?

Topic or Speaker ideas

Key Note Presenter

Blogger | Tweeting

• Community Website

Visit the ‘Session Recordings’ tab at

www.himss.org/ClinBusIntelCommunity for

a copy of this or previous presentations

Wrap-Up / Next Steps

Contact

Shelley Price

#PutData2Work | #PopHealthIT | #PrecisionHIT

Earn CAHIMS & CPHIMS credit!

The HIMSS C&BI Community is pleased to offer webinar attendees

up to one continuing education (CE) hour for use in fulfilling the CE

requirements of the Certified Professional in Healthcare Information &

Management Systems (CPHIMS) and the Certified Associate in

Healthcare Information & Management Systems (CAHIMS) programs.

Visit the C&BI Community website for more information.

Wrap-Up / Next Steps

Wrap-Up / Next Steps

JOIN US!

Next meeting: Thursday, December 13, 2018

“Towards a Fast Track in Digital Health

Innovation (Part 2): Case Studies”

Speaker(s):

Eyal Zimlichman, MD, MSc, Deputy

General Director, Chief Medical

Officer, Chief Innovation Officer |

Sheba Medical Center, Tel Aviv, Israel

#PutData2Work | #PopHealthIT | #PrecisionHIT

Co-Chairs:

Mike Berger, MSBA Vice President, Pop Health Informatics & Data ScienceMount Sinai Health Systemmichael.berger@mountsinai.org

Arthur Panov, MPH, CPHIMS Executive Director Healthcare AnalyticsFAIR Healthapanov@us.ibm.com

HIMSS Community Organizer:

Shelley Price, MS, FHIMSSDirector, Payer and Life SciencesHIMSSsprice@himss.org | @SPriceHIMSS

FY19 Leadership & Contact Information

#PutData2Work | #PopHealthIT | #PrecisionHIT

Thank you!!!

#PutData2Work | #PopHealthIT | #PrecisionHIT

APPENDIX

Claudine Beron,* MA, PMP

FY18 C&BI Committee Chair

CEO

Initiate Government Solutions, LLC

Debbie Bottomley

Director Product Marketing

Verscend

Sharon Davis, * MS, CPHIMS, PMP

Clinical Programs Manager

Government Programs - Clinical Operations Solutions Team

Blue Cross Blue Shield of Texas

Carole L. Ettinger, MA, PMP, CPHIMSS, CHCIO-eligible

Senior Director, Information Services Division

Akron Children’s Hospital

Dave Fitzgerald

Architect Advisor (Office of the CTO)

Aetna

Charles Gabriel

Clinical Analytics Branch Chief, J-5

Defense Health Agency

Kevin Gormley, * PhD, ME

Principal Data Scientist

MITRE

Amin Hakim, MD

Medical Director, Clinical Analytics

PSLP

Mitch Kwiatkowski*

Vice President, Enterprise Data Hub

Highmark Health

Helen Catherine “Kate” Liebelt

Chief of Staff / Precision Medicine & Supply Chain

Management Consultant

Deloitte Consulting LLP

Madhuri Kudrimoti, MS, FHIMSS

Director - Clinical Informatics

Froedtert Health

Radha Nagarajan, PhD

Associate Professor of Biomedical Informatics

University of Kentucky

Carrie Powers

Project Manager

St. Luke's Health System

Todd Price, MBA, MSEd, PhD

Senior Decision Support Analyst

Mount Nittany Health

Anthony C Villanueva,* CPHIMS

CIO, Vice President of IT/IS

Neighborhood Health

Joe-Max Wakim, MSc, CPHIMS, CHIO

IT Director, Medical Center Processes and Systems

American University of Beirut Medical Center, Beirut,

Lebanon

Amber Zimmermann,* BSN, MBA, RN-BC

Sr Manager, Health Data Analytics

Philips Healthcare

* Indicates a returning

committee member

About Us: FY2019 C&BI Committee Members

About Us: C&BI Community

Looking to better leverage clinical & business intelligence tools, technologies,

and strategies to help you and your organization meet patient care delivery,

clinical and health outcome, and business operation goals? Our community

supports activities that promote peer-to-peer networking, problem solving,

solution sharing, and education.

HIMSS C&BI Community webinars let members dig into pertinent subjects

throughout the year. Our ongoing web-based programs cover topics such as:

Data aggregation and access through EDW and cloud solutions

Data management, validation, quality, and integration

Descriptive, retrospective, predictive, and prescriptive analytics

Governance – data and program

Population health management – including attribution and risk stratification

Precision medicine

Predictive modeling

Reporting, dashboards, and visualization techniques

Resource management

Skills sets and staffing

www.himss.org/ClinBusIntelCommunity

About Us: C&BI Community

• Open to all HIMSS members (current membership: approximately 8,300 people).

Join the C&BI Community today:

1. Login into your HIMSS account in the Member Center

2. Click the tab "My Involvement" | select "Participation" dropdown

3. Click on "Edit Participations"

4. Check the “Clinical & Business Intelligence Community” box

5. Click "Save"

• Will meet virtually 6 times/year

• Agenda for the meetings may include:

News you can use! New content and events

2-Minute Drills presented by various Community members

Topical discussion with key note presenter

The ‘2-Minute Drill’ is based loosely on the sports analogy, and in this case

is a fast-paced (short in length) presentation on a hot, emerging, or timely topic, news event (e.g. research paper, game-changing market or technology news), or recent and relevant event (e.g., federal public meeting, legislative/federal/judicial news, critical conference or educational event).

2-Minute Drills foster greater peer-to-peer networking, member engagement, problem solving, solution sharing, and education. If you are interested in presenting any drills,

please contact Shelley Price.