E-Health Networks The New Shape of Public Health
NGA State Alliance for e-Health2nd Annual State Learning Forum
Stephen GoldsmithDaniel Paul Professor of GovernmentDirector, Innovations in American Government ProgramHarvard University John F. Kennedy School of Government
Developed in conjunction with Deloitte Center of Health Solutions and Deloitte Research
2 Governing by Network .
Traditional Bureaucracy Is Inadequate
Agency 1
Division Division
Unit Unit
Agency 2
Division Division
Unit Unit
Agency 3
Division Division
Unit Unit
Department Department Department Department Department Department
Bureau Bureau Bureau Bureau Bureau Bureau
Citizen
3 Governing by Network .
The New Shape of Government
CCID Organizatio
n
Local Government
HospitalsFederal Agency
International NGOs
NGOsState
Government
Health Provider
4 Governing by Network .
Models of Government
Hierarchicalgovernment
Public-Private Partnerships
Networkedgovernment
Joined upgovernment
High
Low
HighLow
Level of public/private collaboration
Network mgt. Capabilities
5 Governing by Network .
Types of Networks
DEGREE OF GOVERNMENT INVOLVEMENTMore Less
IntergovernmentalSupply chain Ad hoc
Civic switchboard
Information dissemination
Service contract
Channel partnership
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Networked Organization Models that HIT Can Learn From
Anthrax Crisis Response
SARS Hurricane Katrina
Response
7 Governing by Network .
Governing by Network has Many Advantages…
Networked government
benefits
Improved Speed and
flexibilitySpecialization
Increased reach Innovation
8 Governing by Network .
What a Health Network Might Look Like
9 Governing by Network .
State HIE Network Model
10 Governing by Network .
Health Information Exchanges
FederalNHIN
National Health Information
Network
State HIE
RHIO RHIO
NetworkHealth Networks
NetworkHealth Networks
The “big picture” of the health information network
11 Governing by Network .
States must lead the change.
…in collaboration with health consortiums, citizens,
payers, providers, and others.
States Can Play Many Roles in an
HIE NetworkConvenerEducator
AdministratorPolicy Maker
Initiator/ CatalystOperator
Coordinator
The Many Roles of Government
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ObesityMental
Health
Child Welfare
Infant Mortality
Information Sharing and Incentives
Information Sharing Needs
Schools
Relation to Other Sectors
Your Role
Role of the
Private Sector
Managing the
Network
Issues and Delivery Networks
= Sector 1= Sector 2
Possible Organizations
Public Hospital andCommunity
Health
Local Non Profits
National Foundations
State Health Policy and Finance
13 Governing by Network .
1. Define of Public Value Carefully Better Health, Not Better Transactions
2. Design Network Correctly—Understand All Assets
3. Quality Decision Making
4. Congruence of Goals
5. Build Skills and Capacity
6. Network Leadership
Key Principles to Create Networked Model
14 Governing by Network .
After:DC Health Care Networks, From One to Many
Before:DC General Hospital
1. New Role for Government: Focus on Public Value
15 Governing by Network .
Public Value Definition
• The point of all activity is for each party to create value
Government role: to transform existing social conditions in collectively desired directions
•Demonstrations of value creation lie in evidence showing changes in conditions
• Problem: Not everyone sees value in the same way
16 Governing by Network .
Different Ideas of Value
•Satisfy patient demands
•Produce Better Health
•Reduce Costs
•Make a Profit
•Meet Social Needs
•Achieve a Just Society
17 Governing by Network .
Four Programmatic Areas Behind The Curve to Reduce Cost and Improve Care
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Examples of How Electronic Systems Drive Better Outcomes
Care ManagementImprove care while managing costs, maximizing the health care investment. Care management, disease management, and utilization review. Electronic Health Records/Health Information ExchangeImprove quality of care and enhance service to individuals. Patient Data Hub, allowing for the integration of disparate healthcare data sources and follow-on analysis to produce actionable information at the point of care.
Emergency Department Diversion Prevent overcrowding, promote wellness, and make better use of scarce resources. Proactive medical management.
Through data analysis of historical medical claims, access analysis, and education techniques.Lower ED usage.
Long-Term Care / Renal Care AuditsDetect and correct errors and prevent future overpayments. Make better use of data to improve care to individuals.
Nursing Home DiversionManage ongoing healthcare costs and provide care where it’s needed.
19 Governing by Network .
Pennsylvania NEDSS system The development of PA-NEDSS has allowed the Pennsylvania
Department of Health to cut the reporting cycle patient cases from3 weeks to fewer than 24 hours.
2. Design Network: Map Parties, Understand Tools
2. Design Network: Map Parties, Understand Tools
20 Governing by Network .
PA-NEDSS – An HIE Making a Difference
Investigators
Laboratories CDC
Local & StateHealth
Departments
DOH Central Office
Physicians
Hospitals
EDR App
Integrated Data
Collection, Management
, Analysis, Transmissio
n, and Disseminatio
n
Epi-X
Rapid reporting and discussion of
health events, 24/7
access to key officials and
expert assistance
Health Alert
Network
Health Information Technology
More Timely
Intervention
MoreComplete
Patient View
Privacy Centric & Secure
Bio-terrorism RapidDetection Rapid
Response Enabler
Point ofCare Data
Entry
Real-timeData
Collection
400+
700+
170+
20
Master Patient Index
Patient Search & Match
De-duplication
Linked Disease Reports
HL7 based HIE
Patient Centric System
Working Example : Extending Existing Public Health Systems to Serve as HIE channels; All Actors Work Toward Same Goal
Copyright © 2005 Deloitte Development LLC. All rights reserved. 21
Decide Who Should Do the Integrating
Government1
Prime Contractor2
Third Party 3
Government
Contractor
Subcontractor
Subcontractor
Subcontractor Subcontractor
Subcontractor
Subcontractor
Subcontractor
Contractor
Contractor
Contractor
Third PartyPrivate
Provider
Contractor
Subcontractor
Contractor Contractor
Contractor
SubcontractorSubcontractor
Subcontractor
Subcontractor
SubcontractorSubcontractorSubcontractor
Subcontractor
Government GovernmentGovernment Government Government
Subcontractor
Subcontractor
Subcontractor Subcontractor
Subcontractor
Subcontractor
GovernmentGovernmentGovernmentGovernmentGovernment
PrimeContractor
22 Governing by Network .
Education and
RhetoricMoney
RegulationsCapacity to
Convene
Information Sharing and Incentives
Information Sharing Needs
Role of Other
Government Agencies
Relation to Other Sectors
Your Role
Role of the
Private Sector
Managing the
Network
DoUse multiple levers to build and activate networks
= Sector 1= Sector 2
Don’t Manage each network the same way
Sector Scale
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• Driving network governance vision down the organization
• Training and recruiting for the new skill sets (and cultural change) needed
• Treating partners as real partners
• Developing and enforcing shared outcome goals
• Horizontal management in a vertical government
• Government as 800 pound gorilla
3. Quality Decision Making: Numerous Challenges
24 Governing by Network .
4. Aligning Values and IncentivesCongruence of Goals: Develop the Network Design
• What
– Goal of network?
• How
– Levers used to initiate and sustain network?
– Type of network?
– Identify each parties goals
• Who
– Partners in the network?
– Who integrates network?
4. Aligned Values and IncentivesCongruence of Goals: Develop the Network Design
Copyright © 2005 Deloitte Development LLC. All rights reserved. 25
Share - Don’t offload risk
Guidelines for Sharing Risk
• Which network partners are best at managing which risks?
• Who is bringing the bulk of innovation to the table?
• How much control does the public sector have over the network and/or over the particular risk involved?
• Are the contract costs of the risk shifting worth it?
• Are the risks actually regulatory in nature?
Copyright © 2005 Deloitte Development LLC. All rights reserved. 26
Assuring the Performance of Networked Arrangements
Public Health “Networks”
Which have Worked?
What Could Work Better?
Future “Networks”
Define Best Practices
Monitor Performance
Chara
cteri
stic
s of
“Netw
ork
s”
Copyright © 2005 Deloitte Development LLC. All rights reserved. 27
A Life Cycle Approach to Performance
Achieving results
from networks
Structure Incentives/Share Risk
Measure Network Performance
Set Goals/Align
Values
ManageChange
28 Governing by Network .
Federal and State agencies working together can:
• Provide backbone services for other participants to build their networks
• Provide process, monetary, policy, interoperable standards, and other support for these participants to get on the network
• Extend existing health and human services networks and infrastructure
• Coordinate across networks and improve data sharing and decrease redundancies
5. Build Capacity: New Networks and Extend Existing Ones
HIE networks that will enable a unique unprecedented combination of public (federal and state), non-profit, commercial, and citizen networks to come
together and get connected as part of one large integrated network to provide quality outcome based healthcare transformation
5. Build Capacity:New Networks and Extend Existing Ones
29 Governing by Network .
Open Source Innovation: Tapping into the “Wisdom of the Crowds”
• A large group of people is better at solving complex problems than an expert, no matter how brilliant
• What are the implications for government?
30 Governing by Network .
Keys to Unlock the Kingdom
Unlocking information unleashes the power of networks to fulfill public services and discharge government duties. Governments can use IT tools to facilitate this result in five ways:
• Coordinating activities
• Synchronizing responses
• Enabling a single client view
• Sharing knowledge
• Measure performance
31 Governing by Network .
Do Invest resources to ensure cultural alignment is achieved within your organization.
Don’t Expect changes to happen overnight.
6. Networked Leadership:Encourage Behaviors that Promote the Networked Approach
©2005 Deloitte. All rights reserved
10 Apr 2023
Attributes of Highly Effective Network/Relationship Managers
AttributesAttributes
Successful network managers have the ability to:
Work across sector boundaries
Work across sector boundaries
Identify the Network ParticipantsBest Placed to Meet Goals
Identify the Network ParticipantsBest Placed to Meet Goals
Recruit managers who can excel in this new environment
Recruit managers who can excel in this new environment
Thrive in Highly Fluid Environment with High levels of Discretion
Thrive in Highly Fluid Environment with High levels of Discretion
Develop and Manage Relationships & Strategy
Develop and Manage Relationships & Strategy
Understand What Each Partner/ Stakeholder Needs in order to
Perform Role in Network
Understand What Each Partner/ Stakeholder Needs in order to
Perform Role in Network
Embrace mission change from doer to enabler, from rowing to steering
Embrace mission change from doer to enabler, from rowing to steering
©2005 Deloitte. All rights reserved
10 Apr 2023
1. Define of Public Value Carefully Better Health, Not Better Transactions
2. Design Network Correctly—Understand All Assets
3. Quality Decision Making
4. Congruence of Goals
5. Build Skills and Capacity
6. Network Leadership
Key Principles to Create Networked Model
Copyright © 2005 Deloitte Development LLC. All rights reserved. 34
A Change of Thinking Needed…
“People are very open minded about new things. As long as they are exactly like the old ones.”
- Charles Kettering