Integrating the Patient into the Care Delivery Team Moving from passive recipient to being co-responsible for their health Orion Health David Hancock – Solution Director, UK, Europe and Middle East
Integrating the Patient into the Care Delivery Team Moving from passive recipient to being co-responsible for their health
Orion Health
David Hancock – Solution Director, UK, Europe and Middle East
The Need to be More Patient-Centric
Integrating the Patient into the Care Delivery Team
Page 3 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
Driving change in Healthcare Delivery in Turkey
Non Communicable
Disease
Patient Experience
Hospital Investment
• c70% of all mortality is caused by NCDs1
• Type 2 diabetes has doubled in little more than a decade2
• Obesity levels are increasing3
1. MoH and Baskent Univ 2004 2. TURDEP (Turkish Diabetes Epidemiology Studies 1997-98 and 2010) 3. Various (including the above)
• More than 95,000 new hospital beds are required by 2023
• Massive MoH Investment Programme including large PPP initiative
• High Expectations of Service
• Massive Internet Penetration
• False Boundaries in Healthcare (as in rest of world)
Page 4 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
Supporting information following the patient - Typical Diabetic Patient’s Journey
Diabetes
Patient
HbA1c Check-Up and
Take Blood Sample
Create Plan for
Managing Lipids, BP.
Prescribe Drugs
Appointment, suspect
kidney failure Consultation
Review
Eye Check
Review &
Treatment
Review &
Treatment
Prescribe Drugs
GFR, Serum
Albumen,
HbA1c etc Review &
Treatment
Review &
Treatment
Ulcer Evaluation
Hypoglycemic
Event ( In Coma) Review
Lab Tester ER Doctor
Hosp 1
GP Primary
Care Nurse
Primary Care Org
1
Endocrinologist
Hosp 2 Hosp 2
Home
Health
Nurse
Community
Health 1
Psycho
logist
Provider 5
Nephrol
-ogist
Hosp 4
Opthalmol
-ogist
Hosp 3
Podiatrist
Hosp 3
Lab
Tester
Hosp 4
Review Consultation,
Prescribe Drugs Evaluation,
Revasculation and
Wound Mgt Review. Presentation of
Ulcer
Treatment in Hospital
CBT for Depression
CBT for Depression
CBT for Depression
Page 5 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
Managing Long Term Conditions – Supporting Behavioral Change
Minimal Extensive Degree to which behaviour change is required
Mo
tiva
tion
to a
dh
ere
to b
est-k
no
wn
the
rap
y
WEAK Consequences are Delayed
STRONG Consequences are Immediate
Obesity
Type II Diabetes
Congestive Heart
Failure
COPD
Schizophrenia
Addictions
Coronary Artery
Disease
Cystic Fibrosis
Parkinson’s
Chronic Hepatitis
B
Hyperlipidemia
Hypertension
Diseases with Immediate Consequences
Diseases with Delayed Consequences
Be
ha
vio
ur D
ep
en
de
nt D
isea
ses
Tec
hn
olo
gy D
ep
en
de
nt D
isea
ses
Depression
Chronic Back Pain
Epilepsy
Multiple Sclerosis
Allergies
Psoriasis Crohn’s Disease
Sickle Cell Anemia
Type I Diabetes
Taken from The Innovators Prescription, Clayton M Christensen
40 percent of deaths are caused (in US) by modifiable behaviors, such as poor
nutrition, physical inactivity, and tobacco.
A Path to Healthcare Co-Responsibility between Patient and Care Delivery Team
HIMSS Continuity of Care Model
Page 7 • Copyright © 2012 Orion Health™ group of companies • All rights reserved
Page 8 • Copyright © 2012 Orion Health™ group of companies • All rights reserved
The Path to Healthcare Co-Responsibility
HIMSS Maturity Level Healthcare Capability Patient Centricity
7 Knowledge-Driven Engagement, Multi-vendor, Interconnected Healthcare Delivery Model
Multiple Care pathways using personalised clinical evidence (past patient performance, genomics etc.) Patient making informed decisions
Patient as Colleague
6 Closed Loop Care Coordination Multiple pathways mgmt with consistent, contextual use of best clinical evidence, integration to home devices and healthcare apps
Patient as Helper
5 Community Wide Patient Record, Patient Engagement Focus
Multiple condition pathway coordination, with patient as an actor – often in administrative processes
Patient as Consumer
4 Care Coordination w/ Actionable Data, Semantic Interoperable Care Record
Basic task coordination, rule-based alerts, single best view of patient record, structured
Patient Centric Care Pathway
3 Normalized Patient Record, Shared Care Plan, Structural Interoperability
Single best view of patient record, structured data
Structured Patient Centric Record
2 Patient Centred Clinical Data, System-to-System
XDS-style, federated exchange: document centric
Patient Folder
1 Basic Peer-to-Peer Data Exchange Basic interoperability between systems None
0 Limited/no e-Communication
Sustainable Foundations
Planning and Implementing for Success
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Building a Business Case through a Platform
Don’t create more islands of information
Find Economies of Scale in utilising your investment
Focus on Admininstrative areas as well as Clinical
Drive Innovation in Applications
Page 11 • Copyright © 2012 Orion Health™ group of companies • All rights reserved
Clinical
Applications
Patient
Portal
Extensions
Clinician View
Appoint
ments
Messages Chart Health
Library
CDR
Authentication
Healthcare
Platform
Healthcare
Service Bus
SQL Server/
Oracle
SDK • Filter
• Comm
Points Data Connectors
HL7 v2, v3
IHE, NCPDP
X12, XML
HIPAA, SMTP
Web Services
Etc.
Devices Web Services
Identity and Relationships Auditing Security, Privacy
and Consent
RESTful APIs RESTful APIs
External
System
Technical interfaces and external systems
Key
Web Apps Web Apps Mobile
Clinicians
(Circle of Care)
Patients and
Caregivers
Shared
Files
Circle of
Care
Allergies
Problems
Diagnoses
Procedures
Immunizations
Encounters
Maternity
Medications
Lab, Rad
Documents
Patient View
Page 12 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
NSW Health, electronic Blue Book, Australia
• Solution:
– A platform for new applications and services
– Electronic Blue Book for mothers and new-borns through a secure web portal + native iPhone and Android applications
• Implementation by an independent third party developer:
– Orion Health’s role was to provide the secure web portal views to the well-child record, designed to be managed and updated by the parents of new born children through to the age of five.
– The customer involved an independent organization with extensive iOS and Android development experience.
Page 13 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
Summary
• We need to deliver Patient-Centric care Records that span the patient journey
• Vast majority of care is actually self care, we have to support change in Patient Behaviour and Patient Co-Responsibility
• The HIMSS Continuity of Care Model provides a framework to move towards Patient Co-Responsibility
– Patient as Consumer Patient as Colleague
• Successful Projects focus on overall business case
• Support Best of Breed devices and Apps on a standards based infrastructure
Page 14 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
Q U E S T I O N S A N S W E R S