Patient Centered Care requires accurate, actionable and customizable information accessible to all involved in individual’s care as well as effective integrated healthcare and wellness ecosystem. This is only possible through robust and cohesive software applications as well as related interoperability among partners. With acquisitions and consolidations PLUS disparate business priorities and technology stack, how do we create a common ground and build a foundation for Care Coordination required by Patient Centered Care?

Contributor

• • Mark Lantzy, CIO, Indiana University Health

Transcript

Sanjog Aul [00:00:00]:
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 Indiana University Health. Hello, Mark. Thank you for joining us.

Mark Lantzy [00:00:17]:
Thank you, Sanjog.

Sanjog Aul [00:00:19]:
Glad to have you and while patient centered care is a holy grail of healthcare and we know that health IT can definitely make a significant contribution, how can we work towards making health IT a catalyst? That’s 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 [00:00:51]:
Sanjog, maybe it’s good to start with a little bit of  context to stand first and maybe mention what that investment has been in patient centered care. I think the numbers that I have, if we look at February this year, I think PMS is reporting more than 485,000 providers have received payments for participating in Medicare and Medicaid Electronic Health Record Incentive Program and that represents more than $30 billion in payments to providers for Medicare and Medicaid EHR incentive payment. I say that number because it’s important to have a sense for the volume of dollars that are going into the help it equation to support patient centered care. I think it’s also important to have a little bit of a definition of it. When we look at patient centered care, we view it as being delivered by an enabled collaborative team using evidence based practice that produces dissertation outcomes and then it also should address a patient’s physical, emotional, social and spiritual needs and values and respect for patients.

Mark Lantzy [00:02:01]:
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 in this space 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. So 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, with that said, what are some of the readiness staff, 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 records regardless of where that encounter occurred. In fact, I was talking to one of our physicians just recently who saw someone who presented in a outpatient clinic and the symptoms that they were presenting were very difficult to diagnose just in that interaction by ourselves, the physician was able to look into the electronic medical record system that we have, which is  Cerner, and they were able to see that patient had numerous visits to other physicians with any symptoms and also had presented with similar symptoms to the emergency room.

Mark Lantzy [00:03:35]:
With that and with the result 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 on 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 is we don’t have that necessarily across all systems and I think anybody who’s experienced the healthcare system of their choice know that if they’re out of their geographies, if they go to a different provider than they usually go to, there’s a good chance that provider is not going to have access to that record that the patient may affect 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. A 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 it and to be very specific, as organizations have looked at the disclosure requirements and the penalties that are associated with the HIPPA privacy and security rules, now the tolerance for  risk associated with what we would view as the treatment and operations component of HIPPA security and privacy, there is a mindset that is starting to look at interoperability as increasing risk and something that organization might be impeding interoperability across organization.

Mark Lantzy [00:05:26]:
So hopefully that responds to the question. Happy to expand on that at all.

Sanjog Aul [00:05:30]:
Mark, what are the challenges in deploying the software applications required for care coordination and PCC, which is patient centered care? Is it the lack of clarity of requirements or technology that can do the job for those who have been able to make strides in this area or perhaps even nailed it? What new, more or different have they done.

Mark Lantzy [00:05:52]:
When I look at the critical success factors in an environment and 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 who’s outbound, more time to drive and I think everybody has a vested interest in doing that. So taking a step back, is it requirement? I don’t think it’s requirement. We look at the equation. You have to look at the people involved, processes that are being used and the technologies. The view of the physical view of the system and the old waterfall approach of having the right of requirement and then being developed to the requirement 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

Mark Lantzy [00:06:59]:
and 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 to the degree to which we can take that note project 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 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 in the script giving environment. So again, not requirement, 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 ethical knowledge, have the ability to be creative, have the ability to do critical thinking and have developed an expert sheet in this environment so that they can engage with the physician users in a manner that is understandable, realistic, and then result in genuine functional change that makes the process more efficiently more efficient and one of the things that we really focus on is having those very special subject matter experts, that deep technical expertise and then working to enable new functionality very quickly with our physician partners.

Sanjog Aul [00:08:45]:
Now let’s talk about the interoperability of basically we talk about interoperability with the partners where the needs are there and demands are there from each partner. Including us in the ecosystem but and there may be difference in priorities, but is there a common vision or incentives which would actually bring all of them together and solve this interoperability issue?

Mark Lantzy [00:09:07]:
First and foremost I think the common vision question is very easy to answer, Sanjog and everybody that I talk to has a patient as a priority. I don’t think there’s any question about that and one of the things that I always worry about is and technology being the focus instead of the patient but that’s really not a challenge. Everybody involved has the patient interest and has 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 rollouts

Mark Lantzy [00:09:45]:
and just to give you a little bit of a sense of these numbers, we’ve invested more than $50 million over the past few years to roll out new age system that now support more than 10,000 users and stats delivered a set of interoperability capability within our system that allows us to produce the kind of results that I talked about earlier of in that one physician and patient interaction and rewarding to hear those stories and as I mentioned earlier, it is equally frustrating to find out that, we don’t have some of those interoperability capabilities because partners are demanding it, clinicians, all caregivers  that I talk to are demanding it and we’ve got to start to take a look at interoperability with an enable ment 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 the PMS 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 sees an opportunity from a process perspective to these dados and now if we lay along to that many of the technology solutions that we’ve been working through with interoperability, whether that’s through information exchanges, whether that’s through some of the vendor initiatives, we’ve got the technology underpinning for these installable.

Sanjog Aul [00:11:20]:
Let’s take a quick break listeners. We’ll 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’ll be right back after these messages.

Sanjog Aul [00:12:22]:
Welcome, so 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 interoperability issues?

Mark Lantzy [00:12:33]:
I don’t know about gotchas or pitfalls, Sanjog. We talked a little bit about some of the process and pattern and set 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’ve 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 we mentioned earlier some of those, the social aspect and the importance of that and 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, 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.

Mark Lantzy [00:14:03]:
What are they at risk for given some of the demographics and some of the social environment considerations and how do we layer that into our EMRs so that physicians have access to that and could they use that to improve the treatment and improve the outcome of those patients? So more than a pitfall and a 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 fill that into our interoperability use cases I think will be an opportunity to look forward to over the next few years.

Sanjog Aul [00:14:43]:
So when we look at in healthcare, 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 if, suppose your organization has tried or maybe others, what works and what doesn’t.

Mark Lantzy [00:15:07]:
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 benefit to that. Now that said, we also know the frustrations when everybody is not on the same EMR systems and the challenges with giving 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 we need to follow the seeds to work with our vendors and make sure that they continue to support open standards, 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 allow us to engage with our partners and we look at every opportunity to extend that. There’s a combination of standards, the proliferation of sustainable health information exchanges and then the processes that enable the best usage, I think are where the really great technology, capability and opportunity lie.

Sanjog Aul [00:16:34]:
Now, with so many moving parts, we cannot be perfectionists. So what would you think would be a minimalistic blueprint an organization should follow in order to develop Health IT foundation, which will help of course, Care Coordination, which essentially is a foundation with an end goal to realize the benefits of patient centered care.

Mark Lantzy [00:16:55]:
Take a look at it in terms of building blocks. So I would look at the first building blocks to be the patient 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 and show if you don’t have that, then it’s hard to draw such blueprints and be a perfectionist. I think the next building blocks, and we’re seeing a lot of it already in the industry 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’re very active in this because, and just to give you a couple of examples, we’re very focused on ACTA and the ability to use ACTA and 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 engagements with a physician and another thing that we’re doing is making sure that through our patient portals our patients have an opportunity to schedule appointments online and then also engage in a messaging communication with their provider that allows them to engage a little bit more when the healthcare encounter is needed as opposed to the traditional only one provider is available and for us that really is just a start of things,

Mark Lantzy [00:18:45]:
is has been mentioned, we’re also in the process of building a new regional academic health campus in Bloomingtons and one of the things that we envision 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 has been a very important part of that Stanford experience and I look forward to seeing a degree of innovation in that build. So that’s another building block is making sure that the patient has the opportunity and engage. The next one I would say is making sure that we are taking advantage of the existing interoperability platform that as I mentioned before, that can see 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 patient comfortable with interoperability so that we’re not overthinks the OPS in or OPS out option for a patient when they interact with a provider or they interact with the system that’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 components. We do feel that’s an important part of the encounter with a patient and it drives positive outcomes

Mark Lantzy [00:20:21]:
and we do see a lot of data being available and to the degree that we stand organize that data and present it in a manner in which the physician can more effectively engage with the patient, then we’ll have an opportunity to continue to improve out some.

Sanjog Aul [00:20:37]:
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 [00:20:47]:
Thank you Sanjog. I appreciate the time.

Sanjog Aul [00:20:49]:
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.

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