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CONTINUITY OF CARE MATURITY MODEL James E., Gaston, MBA FHIMSS Sr. Director maturity Models, HIMSS Analytics [email protected]
CONTINUITY OF CARE MATURITY MODEL
James E., Gaston, MBA FHIMSS
Sr. Director maturity Models, HIMSS Analytics
Healthcare Care
“Health [space] care” must be the focal point of our efforts to improve the lives and health of our
citizens, not the business of “healthcare.”
What is “Continuity of Care”?
Citizens’ perspective…
Non-disruption of care provided to a patient throughout his/her care journey, across care settings
and care givers
Industry perspective…
Alignment of healthcare resources, across care settings, orchestrated in a way that delivers the best healthcare services and value possible for a defined
population
Continuity of Care Maturation Model
Model Overview • Improve care coordination over diverse care settings
• Engages 3 key stakeholder groups
• Leverages an 8 stage maturity model, like EMR Adoption
– 4 key focus areas theme for each stage, across entire model
• Aspirational model drives value based care approach
• Simple assessment survey
• Action oriented, strategically focused deliverables
Affiliated Ambulatory Private Practice
Healthcare Center Regional Primary Care
Acute Care Facility Specialty Hospital
Outpatient Surgery Center Dental Care Center Same Day Surgery
Emergency Department Emergency Care Center Pharmacy Care Center
Patient Home Group Living Care
What is a Care Setting
Care Setting Orientation Traditional Silo’ed • Isolated Decisions
– Errors
– Increased Diagnosis
• Uncoordinated Care
– Isolated care episodes
– Lost efficiencies
– Lost opportunity
• Increased Costs
– Inefficient system usage
– Redundant services
• Systemic Inefficiencies
– Lacks health info. sharing
– Incomplete health picture
Coordinated • Health Information
Exchange – Health information sharing
– Consolidated EMR
– Semantic interoperability
• Coordinated Patient Care – Coordinated treatment
– Reduced Errors
– Care team alerts
• Advanced Analytics – Population health
– Patient specific CDS
• Patient Engagement – Personalized alerts, goals
– EMR access, input
– Mobile access
Health Information Exchange Instead of this…
Move to this…
Coordinated Patient Care Instead of this…
Move to this…
Analytics Driving Healthcare
Patient Engagement
Patient Engagement – Personalized alerts, goals
– EMR access, input
– Mobile access
Continuity of Care Maturity
Copyright © HIMSS Analytics
Multiple Model Stakeholders Administrators
CEO/COO/CFO/CSOs
Clinical/Medical Leaders CMIO/CNO/CNIOs
Technology Leaders CIOs
Forge agreements, policies, and standards that allow and enable progress
Drive clinical activities that enable and enhance coordinated care, pop health
Build out Information & Technology that facilitates key strategies
Continuity of Care Maturity Model Survey Approach & Achievement
• Compliance statements for each stage in each key focus category
– Lowest is Stage 0, highest Stage 7
– Compliance measured using a Likert Scale
• Overall and stage level achievement presented as a percentage
– Color and % conveys overall progress against compliance
– Identifies areas of strength as well as opportunity
• Achieving a stage requires 70% or > stage compliance
– On that stage and all previous stages
– Your “Stage” standing is the highest stage achieved
– Accommodates different approaches in priorities,
resources types, and execution
Stage Achievement 2
Overall Compliance 32%
Stage 7 0%
Stage 6 4%
Stage 5 15%
Stage 4 28%
Stage 3 25%
Stage 2 75%
Stage 1 77%
Continuity of Care Maturity Model
Example organization… • Achieved Stage 2 compliance
• 32% Overall compliance
• Has made progress through Stage 6
Continuity of Care Maturity Model Engagement Process
• Define Scope & Contract
– Understand overall needs
– Breadth and depth of engagement
– Prepare and sign contract for engagement
• Identify Population and Care Settings
– What “care community” of patients are we profiling
– What care settings are we looking at
Ambulatory, Acute, Urgent, Long Term Care, Home
• Survey
– On-site survey
– Discussion with leadership teams for each care setting
– Survey questions completed
• Findings Review & Presentation
– Review findings results
Findings Presented Executive Summary • Summary achievement standings • Description of achievement • Overall recommendations
By Stakeholder Group • Individual achievement standings • Individual recommendations
Across Care Settings • Individual achievement standings • Individual recommendations
Example Recommendations – IT Stakeholders Stage 1 Recommendations
1) Move to consolidate patient data with external care providers and settings in order to create a collective patient centered view, minimizing silo’s of patient data. This allows a centralized approach to managing data as whole and is ideal for advancing data governance efforts.
2) Consider creative or diplomatic ways to include external reference data such as census, population data, or other types of data that enhance population health management abilities and insights. This may require coordinating activities with governance leaders to craft and implement policies or request exemptions, or working with clinical leaders who have strategic responsibilities that align with population health.
Stage 2 Recommendations
1) Pervasive and automated user identity management is suggested to lay the foundation for future electronic secure and attributed communications and activities.
2) Work with governance leaders to define and implement standardized templates, procedures, and messaging protocols for clinical and financial data exchange across collaborating health care providers
Advanced Stage Recommendations
1) Leverage semantic (discrete) patient data in support of multiple coordinated care initiatives, such as the oncology special treatment program being developed, providing actionable clinical decision support and advanced analytics, including drug interaction, age and sex appropriate findings, and diagnosis recommendations. Use semantic data in support of population health management including tracking vaccination programs, flu outbreak activity, and other epidemic/pandemic activities
2) Consider providing a comprehensive audit trail of whom accessed what information for both internal auditing and patient benefit. Extending this capability to allow automated alerts to be sent if data is over-accessed or inappropriately accessed should be considered.
Continuity of Care Assessment
Value Proposition
• Prescriptive direction across 4 key focus areas
– Care Coordination
– Health Information Exchange
– Analytics
– Patient Engagement
• Actionable stakeholder group directives & alignment
• Actionable care setting profiles and directives
• Scalable across populations and care settings
“Health [space] care” must be the focal point of our efforts to improve the lives and health of our
citizens, not the business of “healthcare.”
Thank you!
James E. Gaston, MBA FHIMSS
Sr. Director Maturity Models, HIMSS Analytics
