Sanjog Aul

Welcome, listeners, this is Sanjog Aul, your host. And here is the topic for this segment. Is your Health IT a catalyst for delivering Patient Centered Care? And I have with me Mark Lantzy. Mark is the Chief Information Officer with the Indiana University Health. Hello, Mark. Thank you for joining us.

Mark Lantzy

Well, thank you, Sanjog.

Sanjog Aul

It’s good to have you. While Patient Centered Care is a Holy Grail of health care and we know that Health IT can definitely make a significant contribution, how can we work towards making Health IT a catalyst? That is what we wanted to explore here today, Mark. So my first question to you is: while Health IT is attracting significant investments overall, what are the specific readiness gaps that are preventing care coordination enablement, which is critical to realizing the Patient Centered Care dream?

Mark Lantzy

Well, Sanjog, maybe it’s good to start with a little bit of context. And first, maybe mention what investment has been made in Patient Centered Care. I think the numbers that I have, if we look at February this year, I think CMS is reporting more than 485,000 providers have received payments for participating at Medicare and Medicaid Electronic Health Record Incentive Programs. And that represents more than $30 billion in payments to providers for Medicare and Medicaid EHR incentive payments.

I say that number because it’s important to have a sense for the volume of dollars that are going into the Health IT equation to support Patient Centered Care. I think it’s also important to have a little bit of a definition of it. So when we look at Patient Centered Care, we view it as being delivered by an enabled collaborative team, using evidence-based practice that produces best patient outcomes. And then it also should address the patients’ physical, emotional, social, and spiritual needs and values. And respect the patients’ right, so that they have the opportunity to participate and make responsible decisions about treatment with their provider. And then it’s also a continuum of care.

So one of the things that I think Health IT has really enabled … is the fact that our interaction with a patient is not just a transaction anymore. It’s not an admission and a discharge for an inpatient stay. But it’s building the trust of the patient in advance of that admission. Caring for that patient during their stay and then staying with that patient through the transition after discharge and taking care of all of their needs. Some of those are going to be medical. And some of those are going to be social and psychological. So that continuum is really a big part of what I view Health IT is enabling.

So with that said, what are some of the readiness gaps so to speak? When we look at the Health IT that we’ve enabled here, we’re very proud of that. And we’re very proud of the fact that our providers see a patient record regardless of where that encounter occurred. In fact, I was talking to one of our physicians just recently who saw someone who presented in an outpatient clinic. And the symptoms that they were presenting were very difficult to diagnose just in that interaction by itself. The physician was able to look into the electronic medical record system that we have which is Sonar and they were able to see that patient had numerous visits to other physicians within the system, and also had presented with similar symptoms to the emergency room. With that and with the results of some of the tests that had already been performed, the physician was able to very quickly make a diagnosis, provide a prescription to the patient, and then engage them in other aspects of their health and set up a follow-up that ended up saving dollars and also improving the outcome for that patient.

So, that’s the type of experience that we’re looking for. In terms of what are the gaps right now, we don’t have that necessarily across all systems. And I think anybody who’s experienced the health care system of their choice knows that if they’re out of their geography, if they go to a different provider than they usually go to – there’s a good chance that that provider is not going to have access to that record that the patient may expect, if they were going to their own provider. So the degree to which we enable that cross-provider interoperability and the degree to which we’re able to follow that patient, regardless of the point of care, is in my view one of the most significant gaps. Lot of progress being made, but not far enough there.

I would say that another gap is our understanding of the people and the process associated with this and to be very specific, as organizations have looked at, the disclosure requirements and the penalties that are associated with the HIPAA Privacy and Security rules. Now consider the tolerance for risk associated what we would view as the treatment and operation components of HIPAA Privacy and Security. There is a mindset that is starting to look at interoperability as increasing risk and … might be impeding interoperability across organizations.

Sanjog Aul

Mark, so what are the challenges in deploying the software applications required for care coordination and PCC which is Patient Centered Care? And is it the lack of clarity of requirements or technology that can do the job? For those who have been able to make some strides in this same area or perhaps even nailed it, what new, more and different have they done?

Mark Lantzy

Well, Sanjog, looking at the critical success factors in an environment, let’s all agree that the environment that we work with is very complex. Complex from a data perspective and complex from an emotional perspective because it is the patient whose outcome we’re trying to drive and I think everybody has a vested interest in doing that. So taking a step back, is it the requirements? I don’t think it’s requirements. To look at the equation, you have to look at the people who are involved in the processes that are being used and the technology.

So the typical view of the system and the old waterfall approach of … being able to develop to the requirements really just does not work in this environment. And our experience has been, you have to have base technology; that is, you can deliver functionality that is appropriate for the people in the process and enables the process itself. And then have an agile and iterative development approach that allows you to build the functionality very quickly. And so when we look at something such as physician notes, I think that everybody has an appreciation for the fact that a provider does not want to sit at a screen and be typing a note while they’re interacting with the patient. Because they want to be engaged with that patient.

So according to the degree to which we can take that note process and we can automate it, we can make it easier to create through dictation or other tools. And the more that we make it a point-and-click interface and iteratively work through that, so that we can get to the point that physician and computer interaction is as easy as possible and as fast as possible, is a good example of how you enable a system to really support what we’re trying to accomplish within the caregiving environment. So again, not requirements, but really having that good iterative process on that technology base. I think on top of that and one of the things that we’ve all seen in this industry is that you need a team of individuals who have good technical knowledge, have the ability to be creative, have the ability to do critical thinking and have developed an expertise in this environment so that they can engage with the physician users in a manner that is understandable, realistic and then results in genuine functional change that makes the process more efficient.

So one of the things that we’ve really focused on is having those very special subject matter experts with the technical expertise and then working to enable new functionality very quickly with our physician partners.

Sanjog Aul

Now let’s talk about the interoperability with the partners, where the needs are there and demands are there from each partner including us in the ecosystem. And then there may be difference in priorities, but is there a common vision or incentives which would actually bring all of them together and solve those interoperability issues?

Mark Lantzy

Yeah. First and foremost, I think the common vision question is very easy to answer, Sanjog. And everybody that I talk to has the patient as the priority, I don’t think there’s any question about that.

And one of the things that I always worry about is the technology being the focus instead of the patient. But that’s really not a challenge. Everybody involved has the patient’s interest and has the patient outcomes in mind when they go into problem-solving and also take a look at interoperability. So we see it every day in terms of our system-wide rollout and, just to give you a little bit of a sense of the numbers, we’ve invested more than $50 million over the past few years to roll out to a system that now supports more than 10,000 users, and that’s delivered a set of interoperability capabilities within our system that allows us to produce the kind of results that I talked about earlier in that one physician and patient interaction.

It’s rewarding to hear those stories and as I mentioned earlier, it is equally frustrating to find out where we don’t have some of those interoperability capabilities because all partners are demanding it, all clinicians, all caregivers that I talked to are demanding it. And we’ve got to start to take a look at interoperability with an enablement lens and not let some of the concerns around the privacy and security rules jeopardize those initiatives.

One of the things that I think I’m very encouraged by is the fact that CMS is engaging in a very interactive manner. And how Privacy and Security rules apply. And they are publishing guidance in terms of the treatment and operations use cases for data between partners. And I think that gives us an opportunity from a process perspective to be better. And now if we layer onto that, many of the technology solutions that we’ve been working through with interoperability, whether that’s through health information exchanges, whether that’s through some of the vendor initiatives, we’ve got the technology underpinnings to be successful.

Sanjog Aul

Let’s take a quick break, listeners, we will be right back. And let’s discuss the pitfalls and gotchas that we need to watch out for as we go about addressing the application and interoperability issues. Please stay tuned, listeners, we will be right back after these messages.

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Welcome back. Mark, once again, what are the pitfalls and gotchas that you think we should be watching out for as we go about addressing the application and interoperability issues?

Mark Lantzy

I don’t know about gotchas or pitfalls, Sanjog. We talked a little bit about some of the process impediments that have a way of getting in the way of the technology solutions that we’re coming up with. One of the things that I will say is that as encouraged as I have been around the interoperability that we’ve been able to establish, I think there’s also some opportunity in all of this and that is looking at the population health management perspective. And what I mean by that is that we mentioned earlier some of those social aspects. And the importance of that in Patient Centered Care.

We look very seriously at social determinants because we know that social determinants do lead to higher instances of chronic disease and other public health concerns. And one of the things that as an industry that we’re trying to figure out and work through is how do we take some of the good data that we’re starting to develop around public health and incorporate that into interoperability.

So it’s one thing to have a patient’s record available to a physician, it’s another thing to have some data about that individual that might not necessarily be about the individual but might more be driven around some public health information or population health information about that individual. What are they at risk for, given some of the demographic and some of the social environment considerations?

And how do we layer that into our EMR’s…so that physicians have access to that, and could they use that to improve the treatment and improve the outcomes for those patients? So more than a pitfall and gotcha, I think it’s really an opportunity for us from an interoperability perspective. Because that information can come from a variety of sources and how we incorporate that and how we build that into our interoperability use cases, I think will be an opportunity to look forward to over the next few years.

Sanjog Aul

So when we look at health care, there’s a lot of acquisitions and consolidations happening and for the right reasons, I’m sure. What can we do to retain the required technology-enabled capability, as well as the interoperability, throughout these acquisitions and consolidations? And I suppose your organization has tried, or maybe you know of others, what works and what doesn’t?

Mark Lantzy

Well, one of the things that we know works, is where we have an opportunity to take an EMR and extend it system-wide and we’ve seen the benefits of that. Now that said, we also know the frustrations when everybody is not on the same EMR systems and the challenges with getting those integrated. When I look at the technology-enabled capability, the important thing that we need is the standards that allow systems to interoperate.

And all of us need to work with our vendors to make sure that they continue to support open standards, to enable that interoperability. And then we have to continue to work with our health information exchange partners. Within central Indiana we have an Indiana health information exchange and we are a very active participant in that and contributing data and using data from the exchange. That gives us a brokering capability for our medical records that allows us to engage with our partners. And we look at every opportunity to extend that. So, the combination of standards, the proliferation of sustainable health information exchanges, and then the processes that enable the best usage, I think are worthy, really great technology capabilities and opportunities lie there.

Sanjog Aul

Now with so many moving parts, we cannot be perfectionist, so what would you think would be a minimalistic blueprint that an organization should follow in order to a develop healthy foundation which will help, of course, with care coordination, which essentially is a foundation with an end goal to realize the benefits of Patient Centered Care?

Mark Lantzy

Well, let’s take a look at it in terms of building blocks. So I would look at the first building block to be the patients themselves. And one of the things that we want to see in every patient engagement is every opportunity to present the right information at the right time. So if you don’t have that right, then it’s hard to draw this blueprint and be a perfectionist. I think the next building block, and we‘re seeing a lot of this already in the industry, is with the proliferation of the wearable devices that allow patients to engage much more significantly in their day-to-day health.

And then also opportunities to engage with health information online, that allow them to be much more active participants. We are very active in this because, and just to give you a couple of examples, we are very focused on access and the ability to use access to make sure that patients are engaging proactively in their health and have the opportunity to see a clinician when they need it. We have recently done a telemedicine pilot that allows individuals to have a telemedicine or a live video engagement with a physician. And another thing that we’re doing is making sure that through our patient portal, our patients have an opportunity to schedule appointments online and then also engage in a messaging communication with their providers.

That allows them to engage little bit more when the health care encounter is needed, as opposed to the traditional only when a provider is available.

And for us that really is just the start of things, this has been mentioned, we’re also in the process of building a new regional academic health campus in Bloomington and one of the things that we envisioned for that new campus is an interactive and collaborative clinical research and educational experience for our patients.

And we do see the interaction, the engagement of the patient as being a very important part of that campus experience and we look forward to seeing a degree of innovation in that… So … another building block is making sure that the patient has the opportunity to engage.

The next one I would say is making sure that we’re taking advantage of the existing interoperability platforms. And as I mentioned before, that could be through health information exchanges and could also be through some of the vendor initiatives that we’re seeing to enable interoperability.

And then from a process perspective, we do have to get the patients comfortable with interoperability so that we’re not forcing the opt in or opt out options for a patient, when they interact with a provider or they interact with a system. It’s going to be important that they’re comfortable enough with knowing that their records are going to be shared and it’s in their best interest to have those records shared.

And then also making sure that, as I said, we layer in the population health management component.  We do feel that that’s an important part of the encounter with a patient and it drives positive outcomes. And we do see a lot of data being available and to the degree that we can organize that data and present it in a manner in which the physician can more effectively engage with the patient, that can allow an opportunity to continue improve outcomes.

Sanjog Aul

Once again, thank you, Mark, for sharing your thoughts and insights about how Health IT can be transformed to become a catalyst for delivering Patient Centered Care.

Mark Lantzy

Thank you, Sanjog, I appreciate the time.

Sanjog Aul

Thank you once again. And listeners, I invite you to find more conversations about IT driven Patient Centered Care, as part of our Health IT series at CIOTalkNetwork.com /ReThinkHIT