Minnesota e-Health Summit, June 16, 2011 Beacon Overview - Lacey Hart, MBA, PMP®

Extend advanced health IT & exchange infrastructure

Leverage data to inform specific delivery system & payment strategies

Demonstrate a vision of the future where: Hospitals, clinicians,

& patients are meaningful users of health IT

Communities achieve measurable & sustainable improvements in health care quality, safety, efficiency, and population health

2

17 Beacon Communities• Louisiana Public Health

Institute, New Orleans, LA• Southeast Minnesota, MN• Rhode Island Quality Institute,

Providence, RI• Rocky Mountain Health

Maintenance Organization, Grand Junction, CO

• Southern Piedmont Community Care Plan, Inc., Concord, NC

• The Regents of the University of California at San Diego, San Diego, CA

• University of Hawaii at Hilo, Hilo, HI

• Western New York Clinical Information Exchange, Inc., Buffalo, NY

• Community Services Council of Tulsa, Tulsa, OK• Delta Health Alliance, Inc., Stoneville, MS• Eastern Maine Healthcare Systems, Brewer, ME• Geisinger Clinic, Danville, PA• HealthInsight, Salt Lake City, UT• Indiana Health Information Exchange, INC.,

Indianapolis, IN• Inland Northwest Health Services, Spokane, WA

3

ROADMAP“New Model of Care”Improved Patient Care QualityImproved Care EfficiencyPopulation Health ManagementEffective Payment DeliverySustainable Regional ‘Practice’

Population Health DataBest-Practices Discovery Improve Clinical Quality• Asthma Management• Diabetes ManagementReimbursement Modeling

Mobilize & Align RegionCommunity EngagementTechnology InfrastructureData ExchangeAdopt National Standards

4/2010-3/2011 4/2011-3/2012 4/2012-3/2013

KEY PARTNERS: County Public Health

Mayo Clinic RochesterMayo Health System

Olmsted Medical CenterPublic School SystemsWinona Health System

SOUTHEAST MINNESOTA BEACON

4

Southeast MN BEACON GOALS Laying the groundwork for better use of

health information to improve health Demonstrate secure, confidential health

information exchange between parties authorized by the patient

Reduce inappropriate healthcare utilization and cost

Improve the ability of individuals to follow through on disease treatment plans

5

“Ultimate Aim”

Establish SE MN as “the premier population-based laboratory for healthcare delivery, best-practices discovery, reimbursement modeling, clinical quality optimization, and translational research in the country.”

6

Subject Matter Expert WGs

Office of the National Coordinator of Healthcare IT (ONC)

Federal Steering Committee (FSC) - TBN

Eval

uatio

n

Operations

Mayo & Mayo Health System Leadership

Olmsted Medical Leadership

Winona HealthLeadership

SE MN Beacon Governance

MetricsInfrastructureQuality

AcademyCommunity & PH

Engagement

Cross Beacon / ONC Projects

PracticeImplementation

Dept. of Health & Human Services (DHHS)

National Beacon Communities

Comparative Effectiveness

SE MN Beacon Organization

Project Driven teams

MN Congressional

Offices

REOT

CPCCPQOC

SE MN Schools

SE MN Healthcare

SE MN Public Health

Others

Prog

ram

Man

agem

ent

Com

mun

icat

ions

Stak

ehol

ders

Project Initiation Process

Planning Process

Approval to Execute

Public HealthLeadership

ProjectExecution LPH /

SchoolsHIE

ConnectivityData

RepositoryMini-

deliberativeAsthma Phase 1

Broad-band

Diabetes Phase 1

Immun. Pilot

Community Interest Groups

7

Healthcare Transformation

Enable Knowledge discovery in world of data

Patient Outcomes

IT

Satisfy conversations

New models

88

BEACON HIE Requirements

• HIE Document Exchange– Patient cross-correlations between providers and

county healthcare case clients.– Pulling CCD, AAP, Care Plan documents to

render appropriate patient care.– Pulling / Pushing Assessments back to clinicians

• Establish suite of solutions for various provider capacities (from significant to minimal capacity)

9

Drivers for CDR• Driving factors for the repository:

– Beacon Reporting requirements– Population Management– Infrastructures/environment &

project beyond the grant • Provider EMR Systems ->

Provider PM Systems • Population management in

support of meaningful use 10

Healthcare Transformation

Enable Knowledge discovery in world of data

Patient Outcomes

IT

Satisfy conversations

New models

11

Ensuring the values and preferences of informed patients

are brought into our program through meaningful conversation.

Guiding Values

12

Creating Conversation to Overcome Lack of Adherence

Create a two-way conversation that enables patients to participate in making decisions to the extent they prefer.

Medication Choice conversation for a typical patient with Type II Diabetes Courtesy of the Knowledge and Encounter Research Unit at Mayo Clinic in Rochester, Minnesota - Dr. Victor Montori

13

Healthcare Transformation

Enable Knowledge discovery in world of data

Patient Outcomes

IT

Satisfy conversations

New models

14

Asthma Care Coordination

Includes processes of care coordination with providers, public health and schools.

15

Telemedicine Models

16

http://semnbeacon.com/

17

Building a CommunityDan Jensen, MPH

Community Engagement VisionNew Model of Care

• Accountable Care Organization / High Quality Care– Consistent with our efforts for improving care; Beacon facilitate

improved clinical work flows – Opportunity for Providers to have national visibility as a practice

providing “high value” primary care– Sustain practice improvements as part of Beacon implementation

• MN Community Measures / Meaningful Use– Resources from REACH and SE MN community support our practice

efforts for adoption of technology in a “meaningful manner”– Beacon resources for us to advance our cause and undertake clinical

research efforts 19

Why is SE MN Beacon important to Public Health?

$ 1.7 million investment in user owned and designed community software operating in all 11 SE MN local public health departments

Lays the groundwork for better data to support local public health community health needs assessment

Increases LPH and practice infrastructure for more effective secure data exchange i.e. communicable diseases

Addresses three local public health responsibilities of Community Health Boards

Assure an adequate local public health infrastructure Promote Healthy Communities and Healthy Behaviors Assure the quality and accessibility of health services

20

Why is SE MN Beacon important to Patients (Asthma/Diabetes)

Laying the groundwork for better use of health information to improve health

Demonstrate secure, confidential health information exchange between parties authorized by the patient

Reduce inappropriate healthcare utilization and cost

Improve the ability of individuals to follow through on disease treatment plans

Consists of Eleven Counties in SE MN

Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower,

Olmsted, Rice, Steele, Wabasha, Winona

AsthmaConsists of 47 school districts

in the eleven counties in SE MN.

DiabetesConsists of Home health

facilities and nursing homes for example

Communities of Practice (Example from SE MN Beacon)

Austin Medical CenterMayo Health System

Mayo ClinicOlmsted Medical CenterWinona Health Services

22

Community Engagement Challenges in 2011

• Positively engaging the community to support record based research and practice improvement

• Scaling interventions in the region

23

PRO Initiative: Vision, Structure & ProgressDr. Jeff Sloan

25

PatientClinical profile

Patient-reported QOL-related assessmentintake

Prophylactic interventions for PRO QOL-related domains

Real-time Monitoring of PRO QOL-related domains

Treatment

Triggered supportive care or treatment modification

Improved quality of lifeImproved survivalReduced emergent care

The Vision: QOL PROs as an integrated vital sign

26

Biomarker Assay (BMA) Positive versus Negative23 trials (3,704 patients)

Median Survival (Months)

Median (95% CI)

Log-rankP-value

BMA+ 16.8 (16.1, 17.4)0.0001

BMA- 9.2 (8.1, 10.6)

Survival Time (Years)

BMA+

BMA-

27

BMA- = a score of 5 or lessin patient-reported QOL on a 0-10 scale

Directions: Please circle the number (0-10) best reflecting your response to the following that describes your feelings during the past week, including today. How would you describe: 1. your overall Quality of Life? 0 1 2 3 4 5 6 7 8 9 10 As bad as As good as it can be it can be

This is a reliable and valid measure for cancer patient populations

(Sloan, MCP, 2002; Huschka, Cancer, 2005; Locke, JPSM,2007)cut-off validation:

Butt, JPSM,2008; Sloan, Value in Health, 2007; Temel, J Thorac Oncol, 2006

28

What areas below concern you?

Money•Cost of medicine or supplies•Health insurance•Other concerns

Family•Relationship with spouse or partner•Caring for your family•Living situation

Medicine•Taking medicine•Managing side effects

Monitoring your health condition

Following a healthy lifestyle•Healthy meals•Regular exercise•Sleep (not too much or too little)

Emotional Health •Feeling sad•Feeling anxious•Other concerns about emotions

Physical Health•Pain•Fatigue•Other health concerns

Work•Schedule•Environment•Managing your health condition at work

Getting health care•Getting appointments•Visits to emergency room •Visits to urgent care clinic

Something else?

29

Clinical Pathway for Overall QOL Deficit Management  

• Specific QOL domain deficits

EVALUATION

30

PROs in Clinic can be used to:

• Find PRO-related problems

• Uncover otherwise unknown problems

• Modify treatment

31

Case Study #1

• 8 year cancer survivor annual clinic visit• Rated QOL as a 2 out of 10• Initiated conversation• Insomnia• “stupid thoughts”• Suicidal ideation

32

Case Study #1

• Psych referral

• Anti-depressant

• 1 month later QOL was 7

33

Beacon PRO Foci

• Enhanced monitoring can improve outcomes:

• Insulin Control (10%)• Education (50%)• Lifestyle (25%)• Family (35%)• Complications (up to 75%)• Estimates based on DCCT and EDIC trials

NEJM, 329,1993 and NEJM 353, 2005 . 34

35

Asthma InterventionDr. Erin Knoebel

Asthma Project Team• Accurso, Kathy, Rochester Public

School• Ahern, Lois, Public Health• Aleman, Marty, Public Health• Baumbach, Shaylene, Public Health• Beebe, Calvin E., Mayo Clinic• Bock-Goodner, Cynthia, Mayo Clinic• Donnal, T. M.D., Winona Health• Frazier, Christa, Winona Health• Gunderson, Margene, Public Health• Hart, Lacey, Mayo Clinic• Horton, Ian, Mayo Clinic• Jensen, Dan, Public Health

• Juhn, Young J., M.D., Mayo Clinic• Knoebel, Erin E., M.D., Mayo Clinic• Lowe, David. M.D.; Olmsted Medical • Martin, Erin L., Mayo Clinic• McWilliams, Deb, M.D., Mayo Clinic• O’Brien, Michael, Mayo Clinic• Naessens, James, Sc.D., Mayo Clinic • Ravikumar, Prajna, Mayo Clinic• Targonski, Paul, M.D., Ph.D., Mayo

Clinic• Wellik, Mary, Public Health• Williams, Linda M.D., Olmsted Medical• Yawn, Barbara, M.D., Olmsted Medical

37

School-aged Children: Asthma Prevalence

Asthma is estimated - to occur in 7% of school-age children nationally 1

- to occur in 12% of school aged children in Rochester, MN 2

1. CDC. Surveillance for Asthma --- United States, 1960--1995. MMWR 1998;47[No. SS-1]:1—28

2. Yawn BP, Wollan P, Kurland MJ, Scanlon P. A longitudinal study of the prevalence of asthma in a community population of school age children. J Pediatrics 2002;140(5):576-581.

38

School-aged Children: Asthma Impact

• Poorly controlled asthma can affect – a child’s ability to exercise, – self-esteem, – school performance, – school attendance.

• Asthma action plans can decrease preventable illness.

National Heart, Lung, and Blood Institute. 2007. National Asthma Education and Prevention Expert Panel report 3: guidelines for the diagnosis and management of asthma. Bethesda (MD): National Institutes of Health. Available from URL: www.nhlbi.nih.gov/guidelines/asthma/epr3/index.htm

39

Collaborative ExperienceCommunity Collaborative Asthma Project

in Olmsted County (2007 – present)• Mayo Clinic• Olmsted Medical Center• Olmsted County Public Health• Rochester Public Schools (ISD#535)• Rochester Private Schools

40

Beacon Proposal

Extend the asthma action plan model to the 11-county region, augmented with standards-based HIE.

Sharing action plans for children with asthma can:

1.Reduce healthcare utilization 2. Improve school attendance 3.Reduce time parent misses work

41

Care Coordination

Includes processes of care coordination between health professionals, public health and schools.

42

Asthma Measures

Future/Advanced Measures

Preventative Care Utilization Appropriate Med Usage Inpatient/ED Utilization Acute attacks in school School Absenteeism

Baseline Measures

% patients age 5-18% w/documented Action Plan

% w/Influenza Vaccine % w/pneumonia Vaccine

% of total ED Visits

COST – QUALITY – POPULATION HEALTH43

AAP Expansion ProjectLeverage lessons learned and tools developed in Olmsted County Asthma Action Plan Task Force providing patient-centered care to ensure anyone who cares for a child with asthma has access to and understands that child’s AAP:

• Develop a consent process • Approved by schools and state• Templates are available• Process flow sheets created

SE MN Beacon will expand to ALL school districts: • School System AAP FAQs • Consent Form to Share

Asthma Action Plan Template• Consent Form Process

Flowsheet Template

School Personnel Education :• Access and understanding of

AAPs for ALL personnel• When to Consider

communication with the Provider & Parent

44

Technology Pilots• Technology specifications created by the Asthma Action

Plan Task Force Data Base pilot program – Resources to scale the infrastructure into the Beacon region

• Will pilot first in targeted schools and use lessons learned to generalize the technology approach

• Widespread implementation of a technology solution will take time – Strong emphasis on protecting the confidentiality and best interests

of patients– Multiple EHRs

45

Qualitative Study / Focus Groups

Identify perceived needs and potential barriers related to

the wide spread use of asthma action plans for

school children.

Groups of interest: • Parents of school aged children w/

asthma • School nurses & others that care for

children with asthma in schools• School aged adolescents with asthma • Physicians / nurses who provide health

care for children with asthma

46

Focus Group Analysis:Overarching Themes

• Communication– Stakeholders

• Pairings – parent/school, school/health professional, school/health professional

– Channels• Fax, flyers, walkie talkies, computer interface, paper copies, telephone

– Frequency and timeliness• Asthma severity and control

– Continuum• Individual

• Self-reliance– Support for students’ independence– Awareness of potential triggers

47

• Policies and Protocol– Confidentiality– Initiating processes – i.e. updating AAPs– Education of staff

• “What are we allowed to do”– Assurance of medication in secondary

settings (i.e. field trips, sporting events)– Alignment with state laws, school policies and

“unwritten rules” of communication

Focus Group Analysis:Overarching Themes

48

Survey Results:Nurses and Physicians

• AAPs are an important tool for schools and families• It is important to evaluate whether AAPs make a difference in the care of

asthma in schools• It would be helpful to the care of patients with asthma to have

communications with schools (missed PE, sent home, child’s technique and understanding of disease)

• 90% agree with the concept that consistency in adhering to guidelines is needed

• Time to create the AAP is a constraint for physicians and nurse practitioners (80% no more than 3 minutes of time – preference to review, not create)

• Would like to know more about how the AAP is used at school and the training within the schools of those with access to the AAP

49

Focus Groups-School Sites(School Nurse, Health office, Teachers & Coaches)

• Knowing what to do with Student is Important– Asthma Action Plans are

useful to Health Office staff– Coaches rely on 1st Aid

Training to know what to do• Issues

– Inhalers are kept in Health Office

– Communication of Changes in med order or plan

• Suggestions– Access to electronic

information would help

50

Parent Input• Supportive of Improved

Communication with Schools

• Want Paperwork Process simplified

• Asthma Action Plans are useful tools

• Not concerned about confidentiality & communication between provider & school as long as parent in the loop

51

SE Minnesota Beacon

Using our experience with uni-directional sharing of AAP with schools and the community’s expertise in community based participatory work, we will design and develop a program to provide the child with asthma a “cocoon of care” at school, in organized activities and home, based on the healthcare home’s generated asthma action plan.

52

Winona Deep Dive – Telemedicine ModelJohn Goodman

Utilize the unique market position and resources of Winona Health along with its Winona Community

Partners to expand Beacon Medical Applications.

Winona Deep Dive (WDD)

5454

Leverage the application and meaningful use of EMR and

related HIE strategies developed within Beacon using community based telemedicine applications.

WDD Project Summary Objective

5555

Telemedicine Summary

Integrated View of Healthcare Provider

56

Proprietary and Confidential

One Standard Internal Operating SystemeClinic/eOffice/eAdmin/ePortals/EMR interface

Remote internal

operations

Other Remote HealthcareProviders

ResidentialConnections

Remote Standard

PCs

Mobile Devices

Complex/SimpleShared Remote ePortals

56

Major Telemedicine Issues Integrated View of Healthcare Provider

57

Proprietary and Confidential

One Standard Internal Operating SystemeClinic/eOffice/eAdmin/ePortals/EMR interface

Remote internal

operations

Other Remote HealthcareProviders

Remote Standard

PCs

Mobile Devices

Complex/SimpleShared Remote ePortals

ROI Justification • Reimbursement/cost control• Adoption/Utilization• Cost to implement & support

ResidentialConnections

57

Potential Adoption BarriersIntegrated View of Healthcare Provider

58

Proprietary and Confidential

One Standard Internal Operating SystemeClinic/eOffice/eAdmin/ePortals/EMR interface

Remote internal

operations

Remote HealthcareProviders

A-VuManagedPlatform

Remote Standard

PCs

Mobile Devices

Complex/SimpleRemote Shared ePortals

ResidentialConnections

Adoption/Utilization driven by:- Ease of Use and Reliability.- Security/Privacy concerns related to HIPAA

compliance.- Lack of EMR connectivity.- Measurable improvements in quality of care.- Face-to-face preference.- Time/cost to license/credential/privilege at multiple locations.

58

Proposed Beacon Solutions

• Cost reduction by leveraging commercial and consumer technologies on Broadband Networks.

• A remotely managed system to significantly improve ease of use.

• Expanded applications and locations via Broadband.• A multimode system that supports both data collection

and live teleconferencing.• EMR connection expanded by Beacon HIE.• Developing one internal medical operating structure for all

telemedicine applications.

59

Proprietary and Confidential59

One Standard Internal Operating SystemeClinic/eOffice/eAdmin/ePortals/EMR interface

Beacon Alpha Summary

Integrated View of Healthcare Provider

60

Proprietary and Confidential

Remote internal

operations

Remote HealthcareProviders

A-VuManagedPlatform

Remote Standard

PCs

Mobile Devices

Complex/SimpleRemote Shared ePortals

BeaconProgram

Development

ResidentialConnections

60

Defined Alpha Requirements

61

Proprietary and Confidential

• Multi-point conferencing.• Multiple image display.• Remote control of PTZ Camera.• Simplified custom UI.• Remotely programmed. • Pre-programmed eSessions.• Automatic eSession

documentation.• Real time data display.• Co-located with access to EMR• EMR upload control.• HIPAA security/privacy compliant• Fixed location

eOffice (Doctor/nurse/other) Shared ePortal (Patient)

• Multi-point conferencing.• Multiple image display.• Two simultaneous sent images.

• Patient PTZ camera.• Other assessment.

• Medical Devices (Blood Pressure, Spirometer, SPO2, Glucose, Weight, Thermometer, Otoscope, Stethoscope.)

• Simplified custom UI.• Remotely programmed. • HIPAA security/privacy compliant• Fixed or mobile configuration

61

WCTN Alpha Partners

62Community Partners

A-Vu Media - Broadband

Project Management

Hiawatha Headend Facility- Central Vidyo Servers

Home &Community Options

- Services to the disabled - Remote residential

management

Other Community- Winona County Services

- Winona Housing & Redevelopment

Hiawatha Broadband- High Capacity fiber Network

- VPN connections

Video

InternetPhone

Networks

Winona Health- Hospital and Clinics

- Assisted living - Nursing Home

- Home Care

Older AdultResidential ServicesSt. Anne of Winona - Assisted Living- Nursing Home

Primary Partnerswireless

Education- Winona Public Schools (K-12)

- Bluffview

# of NetworkConnections

4-20

1-8

2-42-7

2-5

OccupationalMedicine- RTP

- Other

1-3

62

Beacon Enabled HCO ServiceIntegrated View of Home Care Services

63

Proprietary and Confidential

FamilyCaregiver

PrivateResidences

Multi-unitResidences

Mobile Devices

Complex/Simple

GroupHomes

Home Care Service Provider• Care coordination

• Healthcare• Community• Family

• Active Monitoring/PERS• Intervention/Escalation

HealthCare Provider/sTelemedicine Equipped or Traditional

CommunityResources

BeaconProgram

Development

OtherBroadband

Connections

63

Future Expansion• Winona Community Telemedicine Network.

– Additional locations with Alpha participants.– Additional Participants: (Schools, public

housing, nursing homes, county jail) • Other SEMN Locations

– Schools – final locations TBD– Older Adult facilities – final locations TBD– Other disabled service providers – TBD

6464

Planned Impact• Telemedicine implemented at <50% cost of legacy

systems.• Telemedicine endorsed and actively used by 50% of WH

physicians.• Increase EMR assessment data by 300% for Diabetes and

Juvenile Asthma Patients.• Reduce lost work days due to healthcare issues.• HCO Home Care Impact for diabetes and other chronic

conditions:– Reduce medication errors.– Reduce on-site nurse visits and ER visits.

• Document a Sustainable Telemedicine Model.

6565

Questions?

Enable Knowledge discovery in world of data

Patient Outcomes

IT

Satisfy conversations

New models

66

http://semnbeacon.com/

67