Patient engagement? There’s an app for that!

October 20th @ 3:10 PMLocation: Avalon 10

Speakers:Peter Tippett, MD, PhD, DataMotion HealthBob Janacek, CTO, DataMotion HealthJeremy Marut, Director Enterprise Architecture, HackensackUMC

HiMSS Patient Engagement Definition

• A patient's greater engagement in healthcare contributes to improved health

outcomes.

• Information technologies can support engagement.

• Patients want to be engaged in their healthcare decision-making process……

• ….those who are engaged as decision-makers in their care tend to be

healthier and have better outcomes.

What is Patient Engagement? | HIMSS

What is required for effective patient engagement?

What is required for effective Patient Engagement?

•Access to Information!!• Chronic Conditions• Lab Results• Diagnostic Imaging Results• General Diagnosis• Prescribed Medicines• Treatment History

• In short (or long!) – a person’s longitudinal medical record

What is required for effective Patient Engagement?

•Ability to Share Information!!• Care Team• Care Settings• Family• Securely• Not paper, fax or mail…..

• In short – electronic information should be shared electronically

How to Get Access to Medical Records

Portal or mobile app? What do patients / people prefer?

Both!!

Patient Engagement Survey: Patients Want Mobile Apps!

• “Healthcare providers that do not meet consumers’ growing desire for mobile patient engagement are at risk of losing customers – and revenue.”

• “Hospitals have engaged less than 2 percent of their patients using mobile apps.”

Sources: Accenture analysis, 2013 Accenture Consumer Survey on Patient Engagement, Google Play, iTunes

Source: https://www.accenture.com/us-en/insight-accenture-consumer-survey-patient-engagement-summary

Patients Want Online Access and Communications!

Source: https://www.accenture.com/us-en/insight-accenture-consumer-survey-patient-engagement-summary

But they aren’t getting it…yet!

Killer App for

Patient Engagement?

ACME Health System • Schedule Appointments

• Receive Reminders

• Refill Prescriptions

• Communicate Securely

• Access Medical Records

Done?

Communicate in Compliance - HIPAA!

• Health Information Portability and Accountability Act

• Security Rules• Privacy Rules• Business Associate Agreements

• Non-Compliance = Audits and Fines• Breaches = Audits and Fines

HIPAA Compliance

• What’s needed for HIPAA compliant mobile communications?

End-to-end encryption Transaction logging Identity validation Risk assessment and address the risk

Access to Patient Data - EHR Interoperability!

• Access to patient data requires connections and access to EHR systems and HIEs

• Standard protocols for connecting and retrieving data, and APIs

Three Real-World Scenarios

Service Cloud

Bob Janacek, CTO, DataMotion Health

15

DocSnap - Patient-Centric Care Collaboration

$

Hospital EHR(XDR, Direct)

Payer(Direct, TLS, Fax)

Primary Care(App, Direct, Portal)

Pharmacy / Labs(Direct, Portal, TLS, Fax)

Family Care Givers(App, Email, Portal)

Social Workers(App, Email, Portal, Fax)

Skilled Nursing(App, Email, Portal, Fax)

Meals on Wheels(App, TLS, Fax)

Patient(Mobile App, Email, Portal)

HIE(Direct, XDR, Portal)

“I’ve just been diagnosed with Hep C – am I covered for that?”

• Message exchange must be HIPAA compliant

“You’re covered. I attached some information on finding treatment.”

Secure Messaging Service Provider: everything is encrypted, logged and HIPAA compliant!

“I’ve just been diagnosed with Hep C

– am I covered for that?”

“You’re covered. I attached some information on finding treatment.”

HackensackUMC Health System Mobile Application

Jeremy Marut Director Enterprise Architecture

HackensackUMC

HackensackUMC Giving Power to the Patient

Giving Power to the Patient – Pre-Visit

Giving Power to the Patient – During Visit

MyChart Bedside Clinical Documentation, Orders & Results

Giving Power to the Patient – Post-Visit (Life)

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{Token}

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Notes

NotesNotes

Participation

HackensackUMC Observed Challenges

1. Interoperability

2. Patient Identity

3. Privacy & Security

Challenge: Interoperability

Health IT Interoperability – Modernization and App Culture

Traditional HL7 StandardForce Feeding InteroperabilityWith enough money and time, anyone can feign interoperability

• EVERYONE has their own flavor of the standard

• Event driven, transactional, push-model

• Specialized and non-portable training to become proficient

• Non-extensible and highly customized to confirm to workflows driving events and customization of standard

• Many moving parts with multiple points of failure

• Result in self-perpetuating anti-interoperable systems

• No inherent security

C-CDA & Direct ExchangeSomewhat Better Interoperability

• EVERYONE still has their own flavor of the standard (two competing DIRECT standards)

• Query based model (no single standard query/push) for document exchange

• Less specialized but still specialized and non-portable training to become proficient

• Non-extensible and highly customized to confirm to workflows driving events and customization of standard

• TOO MUCH INFORMATION & Not Discrete

• Result in self-perpetuating anti-interoperable systems

• Layer of security

API Based IntegrationFHIR Standard Interoperability

• A single standard; yet extensible

• Standard web programming proficiency used universally across industries (any developer will do)

• Highly extensible; allows for rapid development and reusable code regardless of workflow (even if you customize the original standard) [conformance statement]

• Few moving parts with known designated endpoints

• Result in highly-interoperable systems

• Out of the box security compatibility (i.e. oAuth)

Challenge: Patient Identity

Who knows the Patient Best? The Patient.

Patient Controlled PrivacyMobile Enabled & Technologically Secured

Secure & PrivateWeb TLS double encryption (encrypted packet over encrypted tunnel)

API trust & access policies

App-to-App trust

DIRECT

Facial recognition & Experian enrollment

Patient explicitly gives access to participants via tokens

Data FusionPHI resulting from the analysis of shared data

Patient and participants have the data in the palm of their hands at all times: DataMotion HackensackUMC Gatekeeper

HackensackUMC Putting it all Together – “Appify”

3rd Party AppsExternal HackensackUMCApps

FHIR/RESTful API Common Services Layer (CSL)

Public API Management: oAuth, Direct, Security, Traffic

FHIR Library: Resources, Object Model, Validators (Open Source & Custom)

Orchestration: Integration, Legacy Translation (Open Source & Custom)

Internal HackensackUMCSystems

Summary - Patient Engagement Requirements

• Access to Medical Records

• Portals AND mobile apps

• Share the information securely

• Communicate with providers

• Schedule appointments / get reminders

• Take care of ‘paperwork’ online (and at home or wherever)

Audience Q&A

• Dr. Tippett, DataMotion Health

• Bob Janacek, DataMotion Health

• Jeremy Marut, HackensackUMC

Thank You for Joining Us!