Transforming Healthcare Quality and Management Through Informatics

1
Transforming Healthcare Quality and Management
Through Informatics

• Robert L Jesse, MD, PhD
• Principal Deputy Under Secretary for Health
• Veterans Health Administration

2
The Future of Healthcare in VHA

• Redefining healthcare networks
• From bricks-and-mortar to people
• Every patient will be a unique node on the
  network
• Transition from episodic to longitudinal care
• Span from prevention to end-of-life
• Optimize patient centered care
• Decentralization and distribution
• Transition the EMR to a Health Management
  Platform (HMP)
• Principled but rapid development processes

3
FROM CHART TO HEALTH MANAGEMENT PLATFORM
A Promising Future
A Successful Past

• Patient Facing
• Provider Facing
• System Facing
• Knowledge driven
• Agile

4
Transforming Healthcare

• Transactional Quality and Management
• a healthcare redesign process through which
  clinical practices are both enhanced and ensured
  by real-time insights into their systems.
• Quality is integrated into the workflow
• Data is aggregated through the workflow process
• Quality and safety are driven by efficiency

5
Healthcare Informatics RedesignFundamentals

• Guiding Principle 1
• If data is important enough that it is needed to
  manage the patient and/or the system, then it
  must be acquired as an integral part of the work
  process and not through retrospective data
  collection.

6
Healthcare Informatics RedesignFundamentals

• We must know what were doing, not just what
  weve done.
• Systems control and quality management must be
  integrated into care delivery and not be managed
  as secondary processes.
• Caveats
• Knowing what or which data are needed is
  critical
• New technologies will be required
• Usability, human factors, dashboards
• Context of data becomes vital

7
Healthcare Informatics RedesignFundamentals

• Guiding Principle 2
• Solutions must make the work easier, and not
  impose undue burden or require re-work.
• There should be NoPainfor the gain
• Technology must facilitate the workflow but not
  drive it.
• Technology must never encumber the work.

8
Healthcare Informatics RedesignFundamentals

• Guiding Principle 3
• Real-time visibility into the system must be
  available, and it must be transparent across the
  enterprise
• Manage all patient-health system interactions
• location and times - waits and delays
• Manage patient-staff relationships
• Include patient-staff transitions (handoffs)
• Manage all tests and procedures in real-time
• From scheduling to completion
• Concurrent documentation

9
Patient VisibilityKey Component for the
Intelligent HMP

• Provide the right information ? to the right
  people ?at the right time ? in the right place ?
  in a comprehendible form
• Automated Bed Boards (EDIS and inpatient BMS)
• Intelligent scheduling linked to activities
• Form Factors
• Mobile Computers
• Context driven views
• Comprehensive management of patient flow from
  point of entry through to discharge
• Automation of all processes that impact patient
  flow

10
Healthcare Informatics RedesignFundamentals

• Guiding Principle 4
• In order to deliver evidence-based care we must
  have evidence-based management.
• Clinical processes support
• Administrative processes support
• IT support
• Materials management
• Point of service logistical support
• Systems engineering capability

11
Healthcare Informatics RedesignThe Fundamentals

• Guiding Principle 5
• In order to ensure that we effectively manage the
  delivery of evidence-based care we must manage
  complexity
• Data Information Knowledge Wisdom

This requires a highly effective Electronic
Health Platform
12
Healthcare Informatics RedesignFundamentals

• Guiding Principle 6
• Informatics platforms must be context sensitive,
  and they must be configurable and adaptable to
  meet the needs of the user.
• Team facing
• Multiple user types
• System facing
• Patient facing
• Support multiple devices for I/O
• Infinite configurability to enable all new models
  of healthcare delivery (agility)

13
Summary

• Data must be acquired as an integral part of the
  workflow process.
• Adoption is dependant on workload burden.
• Real-time visibility into- and transparency
  across the enterprise are required.
• Evidence-based management is needed to ensure
  evidence-based care.
• Knowledge and complexity management are crucial
  to moving forward.
• Flexibility and adaptability to multiple users
  needs

14
EHR Modernization

• Health Care Delivery Teams need
• Role and context-specific interfaces to clinical
  systems
• Greater support for workflow and cognitive tasks
• More powerful and integrated clinical decision
  support

A provider facing Health Management Platform
15
EHR Modernization

• Successful patient care depends on participation
  by activated patients. This requires
• Personal Health Records
• Patient-oriented health libraries
• Modern communication platforms (social media)
• Self-management tools and resources
• Patient-centric I/O capabilities

A patient facing Health Management Platform
16
EHR Modernization

• Successful heath care delivery depends on a
  functional healthcare system.
• The system of records reflects the performance of
  the health care delivery process
• Registries and cohort management tools inform
  both quality and performance management.
• Intra- and inter-system performance comparisons
  provide transparency into a systems health.

A system facing Health Management Platform
17
EHR Modernization

• Provider Facing
• Patient Facing
• System Facing
• Integrated Transactional - Agile

HMP Health Management Platform
18
The Future of Healthcare in VHA

• Redefining healthcare networks
• From bricks-and-mortar to people
• Every patient will be a unique node on the
  network
• Transition from episodic to longitudinal care
• Span from prevention to end-of-life
• Optimize patient centered care
• Decentralization and distribution
• ownership
• Transition the EMR to a Health Management
  Platform (HMP) to enable the above
• Principled and agile development
• Role and context based

19
Questions

• robert.jesse_at_va.gov