Physician-Centric eHealth Finding/Creating/Delivering Value for MDs

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Physician-Centric eHealth
Finding/Creating/Delivering Value for MDs

• Peter Basch, MD
• Medical Director, e-Health Initiatives
• MedStar Health
• November 16, 2001

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The centric thing

• Patient-centric
• Your lifetime medical record
• Healthcare
• Physician-centric
• The toolsets that we must buy and use to have a
  quality and efficient clinical encounter that
  results in a satisfactory medical-legal document

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Provider as customer

• Patient-centric
• Physician-centric
• The toolsets that we must buy and use to have a
  quality and efficient clinical encounter that
  results in a satisfactory medical-legal document
• Physicians (under current system) are both the
  primary purchasers of ehealth applications, and
  the rate-limiters for adoption and use of
  applications purchased by healthplans and
  employers

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We need a hug

• Patient-centric
• Physician-centric
• The toolsets that we must buy and use to have a
  quality and efficient clinical encounter that
  results in a satisfactory medical-legal document
• Physicians (under current system) are both the
  primary purchasers of ehealth applications, and
  the rate-limiters for adoption and use of
  applications purchased by healthplans and
  employers
• Physician need to be enticed to stay in the
  system

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Not now, Im having a bad decade

• lt50 of MDs satisfied with practice
• 48 of MDs in mid-50s leaving medicine
• 38 early retirement
• 10 going over to the dark side
• Med school applications ? 18
• 2.1 applicants for every first-year spot

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A word about clinical messaging

• Many types of messages
• Brainstorming transformation in eHealth as
  compared to technologic changes in banking
• My favorite email from a patient

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What if Healinx decided to do an ad with
Mastercard.
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Email your doctor a medical question?
25.00
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Patient e-mail
Dr. Basch - I cant get thru your fuc_at_! phone
system. I am completely out of my BP pills and
need to get a refill before I have a stroke.
Please call them in to 202-555-5555 and I will
see you next month for my physical (if I live
that long).
Priceless
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Office of eHealth Initiatives

• MedStar Health
• 7 hospital CDO in the Baltimore-Washington region
• 2B in revenue, 22,000 employees, 4500 physicians
• OeHI
• Research, evaluate, syndicate eHealth
  applications that provide value for physicians in
  their office settings, and in the interface
  between office-hospital
• Physician Advisory Board and staff
• Advises CIO, CMO

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Handouts

• No, youre in the right room...
• Handout somewhat follows the talk as of page 5
• MedStar OeHI info sheet
• Medical Leadership in the World of e-Healthcare
  - Healthleaders 6/01
• A Rationale and Strategy for Incenting Clinical
  Information Technology -
  e-Healthcare Connections 8/01
• Towards an Improved Physician-I.T. Vendor
  Relationship - eHI 10/01

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Building Physician-Centric eHealth

• Early bloopers
• Landscape, value proposition
• Build fundamentals
• Input, throughput, output
• Workflow, mindflow, careflow
• Drivers - positive and negative
• Putting it together

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Early bloopers

• Physician as technophobe
• Forrester Report 3/01 - Why Physicians Hate the
  Net

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Forrester II
xxxxx
Net
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Landscape

• ?Reimbursements, ?costs, ?process friction
• Information technology represents a
  nonreimbursable cost
• Patient volume is not needed, wanted

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The value proposition

• ?Reimbursements, ?costs, ?process friction
• Information technology represents a
  nonreimbursable cost
• Volume is not needed, wanted
• Toolsets must primarily
• ?Productivity
• ?Efficiency

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The value proposition

• ?Reimbursements, ?costs, ?process friction
• Information technology represents a
  nonreimbursable cost
• Volume is not needed, wanted
• Toolsets must primarily
• ?Productivity
• ?Efficiency
• Quality and safety will follow

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Build fundamentals - I

• Must solve a problem (ours)

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Build fundamentals - I

• Must solve a problem (ours)
• Must work and work very well
• Better
• Cheaper
• Faster
• Intuitive

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Build fundamentals - I

• Must solve a problem (ours)
• Must work and work very well
• Better
• Cheaper
• Faster
• Intuitive
• Must not add unnecessary workflows

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Build fundamentals - I

• Must solve a problem (ours)
• Must work and work very well
• Better
• Cheaper
• Faster
• Intuitive
• Must not add unnecessary workflows
• Must not add new liabilities

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Build fundamentals - II

• Practicing physicians must be deeply involved in
• Process design
• Look and feel
• Usability testing
• Modeling of process change

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Build fundamentals - III

• There is no single killer app
• There are many achievable killer applets
• Specialty specific
• Setting specific
• Function specific

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Input, Throughput, Output

• Input
• What patients think they want
• (And what they would get under a FFS
  market-driven model)

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Input, Throughput, Output

• Input
• Throughput
• The key to enhanced productivity
• Most difficult/expensive to set up right
• Requires major infrastructure development

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Input, Throughput, Output

• Input
• Throughput
• Output
• e-outbox
• near point-of-care solutions
• can work with low e-readiness
• can work with no provider involvement
• perhaps the best first incremental step
• what patients really want

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Re-tooling apps for ?value,?cost
Cost
Value
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The flows

• Workflow

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The flows

• Workflow - healthcare _at_ speed of thought

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The flows

• Workflow - healthcare _at_ speed of thought
• Mindflow

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The flows

• Workflow - healthcare _at_ speed of thought
• Mindflow - appears like MDs think

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The flows

• Workflow - healthcare _at_ speed of thought
• Mindflow - appears like MDs think
• Careflow

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The flows

• Workflow - healthcare _at_ speed of thought
• Mindflow - appears like MDs think
• Careflow - healthcare _at_ gt speed of thought
• protocols
• error correction
• guidelines
• best practices

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Drivers - positive

• Positive
• eHealthcare one less thing
• Subliminal resolution of managed care/regulatory
  issues/frictions
• Raising the enjoyment of practice flag
• Tail wags the dog

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Drivers - positive and negative

• Positive
• eHealthcare one less thing
• Subliminal resolution of managed care/regulatory
  issues/frictions
• Raising the enjoyment of practice flag
• Tail wags the dog
• Negative
• Documentation
• Coding

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Putting it together - my shopping list

• Problem-focused, problem solving
  specialty/setting specific applets
• better, faster, cheaper, intuitive
• no added workflows, liabilities
• Reasonably priced
• Designed tested by practicing MDs
• Aware of workflow, mindflow, careflow
• Can work in low e-readiness, but mindful of
  coming integration
• Provider view frictionless medicine