Transcript Title of Presentation Arial 50pt Bold

The Role of Process Improvement,
and Information Technology in
Achieving our Nation’s 21st Century
Healthcare Goals
C. Martin Harris, M.D.
Chief Information Officer, Cleveland Clinic
Executive Director, eCleveland Clinic
Focusing on Healthcare’s
21st Century Challenges
Quality
Cost
Care Coordination / Prevention
Focusing on Healthcare’s
21st Century Challenges
Quality
Cost
Care Coordination / Prevention
Value Equation
Value =
Quality
Cost
CABG Mortality
National Benchmark Data
10
8
6
%
STS
4
2
0
STS
1.0%
1.0%
Primary
Reoperation
Quality of Diabetes Care:
Patients Treated by Physicians using EHR vs. Paper Medical
Records
% of Patients Receiving Care
A significantly higher
proportion of patients being
treated by physicians with
EHRs received care that
aligns with accepted
treatment standards*
95%
93%
86%
78%
83%
63%
51%
31%
15%
7%
Composite:
All Four Recommended
Care Processes
Measurement of
Glycated Hemoglobin
Kidney
Management
EHR Practices
Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality
of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved
from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article
Pneumococcal
Vaccination
Eye
Examination
Paper-Based Practices
* Even after adjusting for patient demographic characteristics and
insurance type, differences remain significant; p<0.001
Health Outcomes for Diabetes Patients:
Patients Treated by Physicians using EHR vs. Paper Medical
Records
% of Patients Receiving Care
A significantly higher
proportion of patients being
treated by physicians with
EHRs obtained
better outcomes*
87%
82%
71%
66%
56%
52%
48%
44%
39%
34%
33%
16%
Composite:
At Least Four of Five
Outcomes Standards
LDL Cholesterol
< 100mg/dl or Use
of Statin Drug
NonSmoker
Glycated
Hemoglobin <8%
EHR Practices
Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality
of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved
from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article
BP
<140/80mm
Hg
BMI
<30
Paper-Based Practices
* Even after adjusting for patient demographic characteristics and
insurance type, differences remain significant; p<0.005
eHealth Services
Providers
MyPractice:
Electronic Medical
Record System
MyPractice
●
Hospital
Patients
MyPractice:
●
Community
MyChart:
MyConsult:
Your Personal Health
Connection
Your First Choice for
a Second Opinion
Dr.Connect:
VirtualVisit:
MyMonitoring:
Improved
Communication;
Improved Care
Patient/Physician
Interaction Globally
Ongoing Condition
Reporting from Home
H
Ashtabula County
Medical Center
FHC
Cleveland
Clinic
Toronto
H
Euclid Hospital
FHC
Willoughby Hills
Family Health Center
HC
FHC
R.E. Jacobs
FHC
Health Center
Elyria Family
Health Center
Cleveland
Clinic
H
H
FHC
Lutheran Hospital
South Pointe
Hospital
Beachwood Family
Health and Surgery Center
FHC
H
Westlake Family
FHC
Health Center Lakewood
Family Health
Lorain Family Health
Center
And Surgery Center
H
FHC
Fairview Hospital
Lou Ruvo Center
for Brain Health
Las Vegas, Nevada
Hillcrest Hospital
H
Lakewood Hospital
FHC
H
S.T.J.
Health Center
FHC
Marymount Hospital
FHC
Twinsburg Family
Health Center
Solon Family
Health Center
FHC
H
Independence Family
Health Center
Medina
Hospital
FHC
FHC
Strongsville Family Health
and Surgery Center
Brunswick Family
Health Center
FHC
Wooster Family
Health Center
H
FHC
Chagrin Falls Family
Health Center
Cleveland
Clinic
Florida
MyPractice Electronic Medical Record
Nurses
Physicians
Schedulers
Residents
Front Desk
Patients
Researchers
MyPractice Electronic Medical Record
Cleveland Clinic User and Encounter Statistics
Through September, 2011
Physicians:
Residents / Fellows:
Pharmacists:
Other End Users:
Patients in the EMR:
Encounters:
Prescriptions:
Orders:
Total Results:
7,043
2,553
393
38,776
6,351,317
35,591,311
70,720,222
218,125,905
703,501,604
MyPractice Electronic Medical Record
Ambulatory Functionality
• Messaging
• Schedule
• Results
• Documentation
• Physician Order Entry
• Best Practice Alerts
MyPractice Electronic Medical Record
Inpatient Functionality
• Inpatient Census
• All Results
• Medication Administration Record
• Vital Signs and I&O
• Documentation
• Computerized Physician Order Entry
(CPOE)
eHealth Services
Providers
Patients
MyChart:
MyConsult:
Electronic Medical
Record System
MyPractice
●
Community
Your Personal Health
Connection
Your First Choice for
a Second Opinion
eResearch:
Dr.Connect:
VirtualVisit:
MyMonitoring:
Research
Standardization: Real
Data; Real Results
Improved
Communication;
Improved Care
Patient/Physician
Interaction Globally
Ongoing Condition
Reporting from Home
MyPractice:
MyChart
Patient Services
•
•
•
•
•
View medical information
View health reminders
View schedule
Prescription renewal request
Online appointment scheduling
MyChart
iPhone App:
• Test Results
• Messages
MyChart
• Appointments
Future / Past
• Preventive Care
• Health SummaryMeds, Allergies,
Problems,
Immunizations
2
3
... ..... H ...
.... .....
...
....
.
.
County
. . . . . FHC Ashtabula
. . . . . .Cleveland. . Medical Center .
.
. . Clinic . .
....
. H . . Toronto. . . FHC . . .
..
...
...
....
Euclid
Hospital
Willoughby
Hills . .
.
.
.
.
.
.
MyChart Patients: 371,903
.........
. . Family Health Center .
..
. . . . HC . . . . . . . . . . . .
....
....
....
.....
.....
. . . . S.T.J. . . . . H . . . . .
...
. . . . Cleveland Health
.....
Center . .
. FHC
......
.........
...
..
.
. . . H . . . . . . . . Clinic . . . . . . . . .Hillcrest
. . . .Hospital
......
.R.E. Jacobs . FHC . . . . . . . .
.....
......
. . . . . . . FHC . . .
H
.
. . . . . Lakewood Hospital . .
.....
.......
...
.Health
. . .Center
. . Elyria Family.
. . . . . . . . . Lutheran Hospital . . . . H . . . . . .Beachwood Family .
. . . . . .Health Center FHC . . .
..
. . South Pointe . . Health and Surgery Center
. . . . . . . . . . .Westlake
. Family
. . . FHC . . . . . . . .
. . Hospital . . . . . . . . . . . . . .
. . . . . FHC . . Health Center . Lakewood. . . . . . . . H . . . . . . . . . . . . . .
...
.....
...
. Health . . . . . . .
. . . . . . . . . . . . FHC
. . Lorain
. . . Family Health
. . . . . . . . . Family
.
.
.
.
...
Marymount Hospital . . . FHC . . . .
Center
.... ...
............. ....
. .Twinsburg Family.
. . And Surgery Center . . H . . . . . .
. . . . . . . H Solon Family . Health Center .
.....
......
. . . . . . FHC . . . . . . .
. Health Center . . . . . . . . .
. . . . FHC . . Fairview Hospital . Independence Family . . . . Medina. . . . . . . . . . . . . .
.....
. . . . . . . . . . . . Health Center . . . . . Hospital . . . . . . . . . H . .
. . . Lou Ruvo Center. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..
. . . for Brain Health . . FHC . . . . . . . . . . . . . .
. . . . . FHC . . . . Cleveland .
. . Las Vegas, Nevada .
. . . . . . . . . . . FHC . . . . .
. . . . . Clinic . .
. . . . . . . . Strongsville Family Health. . FHC . . . . .
....
Family . . Florida . .
. . . . . . . . . . and Surgery Center . .
. . . Wooster Family . . Chagrin
. HealthFalls
..
Center . . .
. . . . . . . . . . . . . . . . . Brunswick Family . Health Center . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . Health Center . . . . . . . . . . . . . . . . . . . . . . . . . .
................................................. ...
Challenges: Beyond Technology
• Near Real-Time Management
Information
Challenges: Beyond Technology
Near Real-Time Management Information
•
Within the surgical services resource area, surgical supplies
are categorized into several functional categories
Supply Category
Surgeon 1
Surgeon 2
Surgeon 3
Surgeon 4
Surgeon 5
Implants
$3,818
$3,048
$3,844
$4,065
$4,002
OR Time
364
377
432
360
357
Misc. Supplies
258
225
948
158
200
Blades & Knives
79
123
79
95
138
Sutures
21
27
29
21
27
Others
580
740
647
602
650
$5,120
$4,540
$5,979
$5,301
$5,374
Total
Challenges: Beyond Technology
•
•
Average cost per Encounter
Cost variation for one type of blade reflects frequency of use
Blade Type
Surgeon 1
Surgeon 2
BLADE,STRYKER 277-96-250
RECIPROCATING
1.85
BLADE,STRYKER 277-96-275
RECIPROCATING
1.85
BLADE,STRYKER 277-96-300
RECIPROCATING
BLADE, STRYKER 2108-156
9.80
Surgeon 3
Surgeon 4
9.42
12.02
34.53
Surgeon 5
5.16
39.02
BLADE, STRYKER, 2108-182
37.11
33.78
0.99
46.77
BLADE,5627-10-500, DEPUY
45.94
7.89
BLADE,5627-11-500, PFC SIGMA
61.59
13.81
9.88
SAWBLADE, STABLECUT, 506076
BLADE SAGITTAL, 2108107004
0.50
BLADE,STRYKER,2108-189
34.05
Total
78.88
123.25
39.61
37.11
30.13
78.63
94.51
137.53
Challenges: Beyond Technology
• Near Real-Time Management
Information
• Context-Based Training
Challenges: Beyond Technology
Challenges: Beyond Technology
• Near Real-Time Management
Information
• Context-Based Training
• Shared Goals and Incentives
Cleveland Clinic Community Physician
Partnership, Medical Mutual Explore Innovative
Relationship to Enhance Coordination and Quality
of Care
First of its kind in Ohio, program will reward superior quality and
efficient care, promote move toward performance-based payment
11/9/10
Cleveland Clinic Community Physician Partnership (CPP) and Medical
Mutual of Ohio have signed an agreement to form an innovative
relationship to enhance coordination and quality of care across northeast
Ohio.
“This proposed affiliation with the Cleveland Clinic Community Physician
Partnership will enhance provider collaboration and build a delivery
model that puts the patient at the center of the care continuum,” said
Delos M. Cosgrove, MD, CEO and President of Cleveland Clinic. “This type
of coordination encourages communication between patient, provider and
insurer with the goal of ultimately improving outcomes and building
accountability for a higher level of care for our patients.”
Focusing on Healthcare’s
21st Century Challenges
Quality
Cost
Care Coordination / Prevention
Focusing on Healthcare’s
21st Century Challenges
Quality
Cost
Care Coordination / Prevention
Nearly Half of Americans Have
One or More Chronic Diseases
45%
133 Million
Americans
Wu S, Green A. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000
U.S. Patients with One or More Chronic Conditions
Account for Three in Four Healthcare Dollars Spent
U.S. Healthcare
Spending (2006) =
$2.1 trillion
25%
75%
Chronic Disease
Healthcare Costs =
~$1.58 trillion
Centers for Disease Control and Prevention. Chronic Disease Overview page.
http://www.cdc.gov/nccdphp/overview.htm. April 6, 2007
Online Care Coordination
and Diabetic Management
Diabetics, particularly those with multiple coconditions, spend 2.3 times more on healthcare
than non-diabetics
Hospitalizations
Vision / Coronary
Complications
Cost (Financial and Human)
(Increase Likelihood)
Reduced Health
Maintenance
Compliance
Problem-Related
Hypertension / Heart
Interventions
Preventive Activities
Patient Responsibility
(Episodic Physician Supervision)
Patient-Driven
Scheduling
Time
eHealth Services
Providers
MyPractice:
Electronic Medical
Record System
MyPractice
●
Hospital
Patients
MyPractice:
●
Community
MyChart:
MyConsult:
Your Personal Health
Connection
Your First Choice for
a Second Opinion
Dr.Connect:
VirtualVisit:
MyMonitoring:
Improved
Communication;
Improved Care
Patient/Physician
Interaction Globally
Ongoing Condition
Reporting from Home
MyMonitoring
MyMonitoring
MyMonitoring
Health Information
Exchange
Public / Private
MyPractice: Physician Results View
Patient Flowsheet Data
MyMonitoring
Health Information
Exchange
Public / Private
MyChart
Dear Patient,
You are managing your blood sugars well.
Keep up the good work. Continue watching what
you eat and doing your moderate, daily exercise.
Please schedule your next office appointment for
120 days from now.
Message me if you have additional questions.
Cost Reduction
Medicare spending per patient
during last two years of life
UCLA Medical Johns Hopkins
Center
Hospital
Massachusetts Cleveland Clinic Mayo Clinic
General Hospital
Foundation
(St. Mary’s
Hospital)
Total Medicare spending
$93,842
$85,729
$78,666
$55,333
$53,432
Inpatient site of care
$63,900
$63,079
$43,058
$34,437
$34,372
Outpatient site of care
$14,125
$13,404
$11,509
$8,906
$7,557
Skilled nursing/long-term care facility
$6,891
$3,287
$15,149
$5,101
$7,114
Other sectors of care
$8,926
$5,959
$8,951
$6,889
$4,389
Executive Summary, April 2008
Cost Reduction
Service Line Cost Management
Cost Management Initiative
•
Standardize materials and services to improve consistency
(predictable outcomes) and reduce unnecessary costs
Sustainable Way of Working
1. Create a standard approach to Service Line Cost Management
- Definitions
- Roles and Responsibilities
- Data Analysis & Interpretation
- Improvement Implementation
2. Educate & develop the ongoing organizational capability within
Cleveland Clinic Health System - sustain an environment that
continually scrutinizes costs
Cost Reduction
Liver Transplant Cost Management Team
• Driven by multi-disciplinary team
-
Liver Transplant Surgeons
Infectious Disease
OR Nurse Managers
Transplant Coordinators
Pharmacy
Continuous Improvement
Supply Chain
Finance
• Analyze cost across continuum of care
-
Reviewed costs from all resource areas
• Focus on factors the team can control
-
The Institute has identified opportunities to reduce costs in the
OR
Cost Reduction
Liver Transplant Cost Management Team
• Excluding acquisition costs, direct cost per
encounter decreased from $47,834 to $43,588
Direct Cost per Encounter by Resource Area
$14,000
2010
$12,000
2011
Cost Reduction: $4,245
$10,000
9%
$8,000
$6,000
$4,000
$2,000
$0
Path/Lab
Pharmacy
Surg Svcs
Nursing
Resp/Pulm
Imaging
Others
Cost Reduction
Knee Replacement (DRG 470)
Technical Direct Cost per Encounter
$6,000
2010
2011
Cost Reduction: $507
$5,000
6%
$4,000
$3,000
$2,000
$1,000
$0
Surgical
Services
Nursing
Rehab
Anesthesia
Pharmacy
Path/Lab
Resp/Pulm
Others
YTD June 2010 & YTD June 2011 (Adjusted for LOS outliers)
Online Care Coordination
and Diabetic Management
Diabetics, particularly those with multiple coconditions, spend 2.3 times more on healthcare
than non-diabetics
Hospitalizations
Vision / Coronary
Complications
Cost (Financial and Human)
(Increase Likelihood)
$
Reduced Health
Maintenance
Compliance
Problem-Related
Hypertension / Heart
Interventions
Ongoing
Education
Preventive Activities
Patient Responsibility
Online,
Physician-Supervised
GlucoseTracking
(Episodic Physician Supervision)
Online Care
Coordination
Patient-Driven
Scheduling
Online Scheduling
Time
Health
Maintenance
Compliance
Focusing on Healthcare’s
21st Century Challenges
Quality
Cost
Care Coordination / Prevention
Focusing on Healthcare’s
21st Century Challenges
Quality
Cost
Care Coordination / Prevention
eHealth Services
Providers
MyPractice:
Electronic Medical
Record System
MyPractice
●
Hospital
Public / Private
Sector Connectivity
Patients
MyPractice
●
Community
MyChart:
MyConsult:
Your Personal Health
Connection
Your First Choice for
a Second Opinion
Dr.Connect:
VirtualVisit:
MyMonitoring:
Improved
Communication;
Improved Care
Patient/Physician
Interaction Globally
Ongoing Condition
Reporting from Home
Cleveland Clinic Pilots Microsoft HealthVault
CLEVELAND, Nov. 10, 2008 / PRNewswire via COMTEX / — Cleveland Clinic,
a World-class academic medical institution and leader in health information
technology, today announced collaboration with Microsoft Corp., a worldwide
leader in software, to pilot the patient-controlled data exchange between
Microsoft® HealthVaultTM, a Web-based personal health platform; a suite of
widely-used digital medical devices; and e Cleveland Clinic MyChart®,
Cleveland Clinic’s electronic personal health record (PHR) system.
Today, more than 150,000 Cleveland Clinic patients use eCleveland Clinic
MyChart®. The short-term pilot, begun on Monday, Nov. 3, is the first pilot in
the country to follow multiple diseases in the clinical delivery setting using
multiple at-home devices such as glucometers, heart rate monitors, weight
scales and blood pressure monitors.
True Value of Health Data Exchange to Cleveland Clinic Patients
All data available to
Cleveland Clinic treating
physicians
MyPractice
Electronic Medical Record System
Patient transfers data to
Cleveland Clinic MyPractice
State
NHIN
HIE
Patient transfers data from all physicians, hospitals, retail
pharmacies, commercial laboratories and digital devices.
Home Devices
Physicians
Hospitals
Retail Pharmacies Com. Laboratories
Mr. Jones fills out online
medical questionnaires and
sends required scans and
test results to Cleveland
Clinic.
After being diagnosed with a heart
condition requiring surgery by his doctor
at home in Arizona, Mr. Jones goes
online to request a MyConsult remote
second opinion from a cardiology
specialist at The Cleveland Clinic
In three days Mr. Jones
receives his second
opinion verifying that he
needs surgery, but
Cleveland Clinic
specialist recommends
valve repair instead of
replacement.
In three
days Mr. aJones
Because Cleveland Clinic
is considered
national
his second
center of excellence forreceives
heart surgery,
Mr. Jones
opinion
that he
schedules his surgery and
fliesverifying
to Cleveland.
needs surgery, but
Cleveland
Clinic
Before he leaves, he signs
up for the
Microsoft
specialist
recommends
HealthVault personal health information
valve
repairall
instead
management service, and
imports
the of
replacement.
information related to the
care he has received in
Arizona—this includes his laboratory tests,
hospitalizations and medication history.
What Cleveland Clinic knows about
Mr. Jones prior to his arrival.
Mr. Jones chooses to share his health history
with his Cleveland Clinic specialist and, by
simply selecting “send to Cleveland Clinic,”
ensures that everything his surgical care team
needs to know about him is in his eCleveland
Clinic MyPractice electronic medical record
before he ever leaves Arizona.
All of Mr. Jones’ care is documented in the
eCleveland Clinic MyPractice electronic
medical record system.
Mr. Jones travels to Cleveland Clinic, for
mitral valve repair surgery, confident that
his care team on both sides of the United
States is virtually working together to
deliver the best care possible.
Before he is discharged, Mr.
All of
Jones
Mr. Jones’
signs up
care
foris documented in the
MyChart so that he can securely
eCleveland
connect
Clinicto
MyPractice
his
electronic
own personal health information
medicaland
record
receive
system.
messages from his care team anywhere there is an
Internet connection.
And because his physician at home signed up for
Cleveland Clinic’s DrConnect service, every
aspect of Mr. Jones’ treatment progress is
securely available to his primary care doctor.
Then he travels to Florida
to spend a month with his
sister while he recuperates.
While he is in Florida, Mr. Jones uses Microsoft HealthVault to utilize
Cleveland Clinic’s MyMonitoring services. Through a secure
Internet connection, he downloads daily information from his digital
scale and blood pressure monitoring device into HealthVault, which
then sends it to Cleveland Clinic’s electronic medical record system
and MyChart so that he and his physicians can work together to
keep him on the right track..
Then he travels to Florida
to spend a month with his
sister while he recuperates.
While he is in Florida, Mr. Jones uses Microsoft HealthVault to utilize
Cleveland Clinic’s MyMonitoring services. Through a secure
Internet connection, he downloads daily information from his digital
scale and blood pressure monitoring device into HealthVault, which
then sends it to Cleveland Clinic’s electronic medical record system
and MyChart
so that
he and his
can home
work together
to
Now fully
recovered,
Mr.physicians
Jones returns
to
keep himArizona
on the right
track..
where
he receives his ongoing follow-up care
from his own physician while staying connected to
his Cleveland Clinic care team through MyChart,
MyMonitoring, and DrConnect for his local
physician. He also knows that all the other Cleveland
Clinic eHealth services are still available to him
should the need ever again arise.
And because Microsoft HealthVault is interfaced with the
Cleveland Clinic MyPractice electronic medical record
system, he can assemble and store a comprehensive
history of all the treatment he received from any
healthcare provider which will be available to him and
the providers he chooses in the future.
MyPractice
MyConsult
DrConnect
MyChart
Now fully recovered, Mr. Jones returns home to
Arizona where he receives his ongoing follow-up care
from his own physician while staying connected to
his Cleveland Clinic care team through MyChart,
MyMonitoring, and DrConnect for his local
physician. He also knows that all the other Cleveland
MonitoringClinic eHealth services are still available to him
should the need ever again arise.
Confident,
Empowered
Patient
Security,
Access and
And because Google Health and Microsoft HealthVault are
interfaced with the Cleveland Clinic
MyPractice electronic
Control
medical record system, he can assemble and store a
comprehensive history of all the treatment he received from
any healthcare provider which will be available to him and
the providers he chooses in the future.
MyPractice
MyConsult
DrConnect
VirtualVisit
MyChart
Monitoring
Online Care Coordination
and Diabetic Management
Diabetics, particularly those with multiple coconditions, spend 2.3 times more on healthcare
than non-diabetics
Hospitalizations
Vision / Coronary
Complications
Cost (Financial and Human)
(Increase Likelihood)
$
Reduced Health
Maintenance
Compliance
Problem-Related
Hypertension / Heart
Interventions
Ongoing
Education
Preventive Activities
Patient Responsibility
Online,
Physician-Supervised
GlucoseTracking
(Episodic Physician Supervision)
Health
Maintenance
Compliance
Online Care
Coordination
Patient-Driven
Scheduling
Online Scheduling
Ongoing
Education
Health
Maintenance
Time
Coaching
$
Focusing on Healthcare’s
21st Century Challenges
Quality
Value-Based
U.S. Healthcare
Cost
System
Care Coordination / Prevention