1 Philip Lisgor, MD ROYL, LLC(copyright) Project Description is a web app, integrated and comprehensive,

1www.TheROYL.com Philip Lisgor, MD ROYL, LLC(copyright)

Project Description

www.TheROYL.com is a web app, integrated and comprehensive, to help patients and their families/loved ones deal with Rest of Your Life planning including advanced care planning, home modifications, home health monitoring devices and earlier use of home hospice as indicated. ROYL covers medical, legal, financial and insurance issues, nursing, clergy, social services, retirement living and health aging and death management. ROYL raises patient expectations and empowers patients by simple education including the ROYL Family Conference. ROYL meets MU 2-3 needs under HITECH regarding advanced care planning and ROYL also provides a Patient Health Portal to increase patient involvement, engagement and understanding. ROYL is geared to improving health, improving health care and reducing costs of care. ROYL provides the meaningful content to bring to life the recent advances in the EHR and interoperability.

ROYL is the right thing to do ROYL is my way to do something better than I did while in practice and to help

patients, families and their loved ones to have higher standards of what to expect

http://www.TheROYL.com/




Developers Col Philip Lisagor, MD, FACS, US Army (Ret)

◦ Retired: Cardiothoracic surgeon; Assistant Dean U. NV SOM; Chief of QM, US Army MEDCOM; Chief of Surgery Reno VAMC; STS Ally Fellow, Kennedy School of Govt-Harvard *** user EMR/EHR in DOD and VA since 1995

◦ personal commitment to help patients, families and loved ones get better care than I was able to provide

Larry Weiss, PhD◦ Former head of Sanford Center for Aging, UNR

Rory Berk, MS, Medical Ethics, UNSOM


www.TheROYL.com Philip Lisgor, MD ROYL, LLC(copyright)



ROYL Products for Users Personalized file

◦ legal documents◦ information sheets◦ contacts

Personalized process Action Check Lists to accompany documents and information sheets



Current Utilization and Relationships Allscripts Wal-Mart/ Dossia.org currently starting with NV Rural Hospital

Partners, NV Health Care Assoc. (50 snfs), HHS social workers, Project ECHO (telemedicine)

CMS Grant partners included: NV Medicaid, NV HHS, NV HIE, NV HealthInsight, NV State Medical Assoc., NV Hospital Assoc., Reno News and Review, Circle of Life Hospice

Careconscious.com is leader in caregiver support

Columbia-Analytics is leader in chart review



Magnitude of Problem 10,000 Americans hit 65 per day every day

for next 20 years = 78 million Americans 1/4 American families currently involved in

care giving, will grow to to possibly 3/4 families

Only 1/16 Americans have ACP available when needed, benchmark should be 80% +

Last six months of care cost upwards of $70 billion with ? ROI, ? Patient/family satisfaction and decreased survival benefit. May go to $100 billion/year with boomers



Cultural Change 10 days in hospital for my birth (1946)

replaced by 10 hours in alternative birth center for my children (1979 & 1981). Driven by quality of care issues and economics situation

current drivers for change of ROYL◦ graying boomers◦ declining economic capacity for increased waste◦ better care, survival benefits for the sickest in

RCTs◦ ACA and ACOs◦ HITECH legislation and HHS MU 2 & 3

Advanced Care Planning Patient Engagement through Patient Health Portals



Big Data-Little Data Interoperability NwHIE Data Sharing

◦ demographic◦ billing◦ clinical

images lab notes

Gertrude Stein “A difference to be a difference must make a difference.”



Reduced Costs of Health Care currently no evidence based medicine that

EHR will reduce the cost of health care◦ some studies show more tests ordered◦ billing creep facilitated by EMR/EHR

The lowest hanging and largest piece of fruit on the health care tree remains care in the last year of life.


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ROYL Visionfulfill public’s desire to remain at home and to preserve financial integrity of the family

ROYL is antidote to fear of death panels and fear of unnecessary medical treatments!

fulfill CMS/HHS goals of

reduced hospital admissions and readmissions

improved quality of care - process

improved quality of health - outcomes

reduced costs of health care - $$$


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ROYL Missionreduce quality gap in Advanced Care Planning (ACP)increase policies/strategies to keep people at home

adaptive architecture/home modification

home health monitoring devices (wi-fi cloud connected scale for CHF, glucometer for DM, inspirometer for COPD and mini-pyxis for medicine compliance

earlier home hospice as needed

increase hospice penetration and duration


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ROYL Methodology

ROYL develops tablet app with increased ease of use, built in knowledge and logic

ROYL tablet supports new workforce to interact with patients, families and loved ones (patient and family centered care)

ROYL champions in organizations

risk managers, benefit managers, financial planners, insurance agents, lawyers, doctors, nurses, social workers, care coordinators, ROYL Health Specialists within participating organizations, discharge planners

ROYL sees ACP as index case to follow up with adaptive architecture, home health monitoring and earlier home hospice


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ROYL Innovations move from End of Life to Rest of Your Life

planning◦ culture change to ongoing planning

3 D’s: decade, diagnosis, divorce move from MDs to more peer based workers

possible with comprehensive and integrated app provide logic and information

empathy more possible with less professionals not CPT code based involve all stakeholders

lawyers, financial planners, insurance agents,risk managers, social workers, care coordinators, etc


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ROYL Metrics ROYL Metrics: # of patients with advanced

care plans (directives, proxy agents), # of CHF discharges with scales, # of DM patients with glucometers, # of COPD patients with inspirometers, # of CHF,DM and COPD patients with mini-pyxis phar dispensers, # of patients with home safety/utilization inspections, # of patients with hospice care and duration of this

Columbia-Analytics leader in redacted chart review can find problem hospitals for ACOs and ROYL is solution


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www.TheROYL.com

[email protected]


Documents

1 Philip Lisgor, MD ROYL, LLC(copyright) Project Description is a web app, integrated and comprehensive,