Market Trends and Practical Examples

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Agenda

• Market Trends in Interoperability

• Integrating Clinic and Hospital EMRs

• HL7 FHIR

Today’s Speakers

• Brian Fugere, GM, Global Marketing, Value-Based Care Solutions, GE Healthcare

• Geoffrey Lay, Sr. Product Management Leader, GE Healthcare

• Tim Fitzgerald, Director of IT, The Oregon Clinic

• Keith Boone, Interoperability Guru, GE Healthcare

Survey Conducted With eHealth Initiative in Fall 2016

Healthcare Delivery

74%

Health Information Exchange

(HIE)18%

Payer8%

Perspectives on Interoperability and Value-Based Care

• 95% agree that strong interoperability capabilities are a key IT requirement for a successful transition to value-based care

• 85% agree that current interoperability solutions in the market are not meeting their needs as they transition to value-based care

eHealth Initiative Survey Fall 2016

Rate Your Current Interoperability Solutions Ability to Drive Value-Based Care Outcomes

20.8%

63.9%

15.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Table stakes – we have the basics,

interoperability is not driving outcomes

Some value add –interoperability is

driving some benefits

Significant value add – interoperability is driving significant

benefitseHealth Initiative Survey Fall 2016

Overwhelming Agreement That Strong Interoperability is Key to Successful Transition to Value-Based Care

79%48%

1%18% 19%

15%

37%

31%

57% 49%

3%5%

25%

10% 18%

1% 4%

25%

10% 8%1% 3% 17% 4% 6%1% 3% 1% 1%

0%10%20%30%40%50%60%70%80%90%

100%

Stronginteroperability

capabilities are akey IT requirement

for a successfultransition to VBC.

Currentinteroperabilitysolutions in themarket are not

meeting our needsas we transition to

VBC.

Since 2008,technology has

helped decreasehealthcare costs

Since 2008,technology hashelped increase

healthcare quality

Technology hashelped promoteteam-based care

concepts

Agree Completely Agree Somewhat Neither Agree nor Disagree

eHealth Initiative Survey Fall 2016

Interoperability Budget Changes Over Next 2-3 Years

Decrease significantly,

2.9%Decrease a little, 5.7%

No change, 17.1%

Increase a little, 40.0%

Increase significantly,

28.6%

eHealth Initiative Survey Fall 2016

47% 42%16% 13%

43% 48%

55%38%

10% 10%28%

49%

0%10%20%30%40%50%60%70%80%90%

100%

…readily available via an always-on connection

…readily available AND also easy to locate

…readily available, easy to locate AND also

integrated into clinicians workflow

…readily available, easy to locate, integrated into clinician's workflow AND

also drives significant practice outcomes

Significant value add - I would pay premium fee for this capacitySome Value add - I would pay a nominal fee for this capacityTable stakes - Iam not willing to pay for this

Willingness to Pay…

eHealth Initiative Survey Fall 2016

Need for Standardization

• Lack of standardization among vendors.• Need for standardized vocabulary and well-defined

operational definitions of data fields.

Integration with EMR

• Information coming from another provider needs to be integrated in our EMR.

• There should be a query and retrieve function.

Strong Business Case

• There needs to be increased willingness to share patient data among providers.

• Currently difficult to directly show improved outcomes as a result of investment.

Data Ownership • Payers still own data, so it is difficult to retrieve.

Comments from Respondents “Inability to convert all the data from over

300 systems into one data warehouse in a

usable fashion”

“Inability to convert all the data from over

300 systems into one data warehouse in a

usable fashion”

“Access to data from disparate

platforms due to cost, politics, and

restrictions on proprietary code”

“Access to data from disparate

platforms due to cost, politics, and

restrictions on proprietary code”

“Integration with outside data,

integration into workflow”

“Integration with outside data,

integration into workflow”

“Depends on how you define interoperability.”

“Depends on how you define interoperability.”

eHealth Initiative Survey Fall 2016

Overall Trends• Strong agreement that interoperability is needed for value-based

care

• Majority of respondents did not feel interoperability was decreasing healthcare costs in their organizations, and many expect their budgets for IT to increase in the coming years

eHealth Initiative Survey Fall 2016

Overall Trends• Connectivity across provider organizations is most important to

organizations. Exchanging data for regulatory reporting and industry wide data for research purposes is not as important connectivity area for payer, provider and HIE organizations.

• Majority felt federal policies and regulations are not currently sufficient to help the nation achieve interoperability by 2020, however majority believe more federal incentives are needed.

eHealth Initiative Survey Fall 2016

Give Clinicians an Hour Back Each Day: Interoperability with Epic® Care Everywhere

• Geoffrey Lay, Sr. Product Management Leader, Interoperability, GE Healthcare

• Tim Fitzgerald, Director of IT, The Oregon Clinic

ROI DisclaimerHYPOTHETICAL EXAMPLE. Information presented in this example is hypothetical and for illustrative purposes only. Any analysis or information derived from this example is for general information purposes only and is being furnished free of charge without representation or warranty of any kind whatsoever. This example contains certain assumptions that may not be valid for your specific facts and circumstances. This example and any analysis are provided for your use only and may not be transferred to any third party.

YOU MUST INDEPENDENTLY VERIFY THIS INFORMATION AND SEEK EXPERT ADVICE. You should not rely on any analysis, calculation, output or information provided by this example. Any reliance shall be at your sole risk, and we shall have no liability to you or any third party for any reason. Nothing in this example and no analysis derived therefrom should be construed as constituting tax, accounting, legal or financial advice. You should consult your own professional advisors for such advice. Nothing herein constitutes a proposal or commitment for any particular transaction. Any such transaction would be subject to execution of documentation in form and substance satisfactory to GE.

HEALTH CARE PROFESSIONALS ARE RESPONSIBLE FOR MAKING INDEPENDENT CLINICAL DECISIONS AND APPROPRIATELY BILLING, CODING AND DOCUMENTATION THEIR SERVICES. This example is not intended to interfere with a health care professional’s independent clinical decision making. Other important considerations should be taken into account when making purchasing decisions, including clinical value. The health care provider has the responsibility, when billing to government and other payers (including patients), to submit claims or invoices for payment only for procedures which are appropriate and medically necessary and in accordance with applicable laws. Consult with your reimbursement manager or a healthcare consultant, as well as experienced legal counsel, prior to any expansion of service.

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Give Clinicians an Hour Back Each Day:Interoperability with Epic Care Everywhere

Objective

• Increase clinical efficiency and enhance care quality by improving connectivity between ambulatory practice and referring hospitals.

Agenda• Challenges associated with care

coordination• Benefits of clinical integration• Anticipated outcomes• Next steps

Background/Overview

• Multi-specialty ambulatory clinic, 230 providers• Physician-owned, autonomous• Provide specialty care for two large hospital systems who use Epic

Care Everywhere• Ongoing dialogue with hospital leadership about care

coordination/improving communication• Ongoing internal dialogue about efficiency, clerical burden, and time

spent with patients• Dr. Craig Fausel

Challenges Associated With Care Coordination

Via Fax,phone

CHALLENGE: Current Referral Process Costs Providers and Staff Time and Lacks Agility

e-Referral Schedule Visit(s)

Request Records

Attach Records Into Chart

Create Chart

Med Asst. Chart Review

MD Chart Review

Review Chart

Visits Occur Chart Notes Sent

DocumentVisits

Hospital System

Via PDF/Fax

Key challenges1. Staff invest significant time retrieving and

attaching data to chart2. Physicians lose time reviewing attached

data that isn’t integrated into chart3. Important data can be overlooked4. Missing data is not easy to obtain in real

time

Via PDF/Fax

Ambulatory Practice

Benefits of Clinical Integration

INNOVATION: Interface with Hospital System Increases Clinical Efficiency and Enhances Care Quality

e-Referral Schedule Visit(s)

Request Records

Integrate data Into Chart

Create Chart

Med Asst. Chart Review

MD Chart Review

Review Chart

Visits Occur Chart Notes Sent

DocumentVisits

Hospital System

Via CCDA

Key benefits1. Referral data integrated into chart2. Physicians spend less time searching for

data3. Administrative staff spend less time.

preparing charts4. Missing clinical data easy to obtain in real

time before patient leavesVia CCDA

Ambulatory PracticeVia CCDA

Anticipated Outcomes

Ambulatory Practices Gain Efficiency

The Oregon Clinic expects providers to gain 60 min/day per provider in chart efficiency.

“Normally changing healthcare is hard, but in this case we think it will be really easy.”

- Tim Fitzgerald, Director of IT, The Oregon Clinic

Health System Sees Clinical Benefits From the Integration

“Working in the ED on Saturday night, I was able to access labs recently done at The Oregon Clinic for a patient I was seeing. Having the recent labs for comparison was so helpful in the clinical care of this patient. Access from the Epic side was seamless and looks just like other local (Epic) facilities in Care Everywhere. Thanks so much for your hard work on this important tool that will no doubt help countless patients our organizations care for together.”

- Dr. Andy Zechnich, CMIO, Providence Health System

The Workflow

24

Start a Chart Update and Open the Reconcile Form

Type of document(CCD or Progress

Note)

Source of Document Date of Service

Filters and Actions

Summary of Results Returned

Reconcile this CCDA

Select the Latest CCDA and Reconcile

Review/Compare

Select and Reconcile Medications

Select Medication to Import

Select and Reconcile Medications

Select Problems to Import

Select and Reconcile Problems

Compare known allergies

Select and Reconcile Allergies

Reconciled Medications in Centricity™ Practice Solution

Reconciled Problems in EMR

Current Status

Current Status at The Oregon Clinic

• Rolling out to HIM department and each specialty with very positive feedback from clinicians. Expected completion Q/2017.

• The connectivity has created hope for clinicians. It’s clear that there is an urgent, significant need out there.

• Two additional Health Systems in progress.

Any descriptions of future functionality reflect current product direction, are for informational purposes only and do not constitute a commitment to provide specific functionality. Timing and availability are subject to change and applicable regulatory approvals.

Carequality and GE Healthcare

Carequality and GE Healthcare

• Building out our cloud based endpoint now• Establishing our pilot sites• Participation on Carequality production calls• Goal: General Availability in Q3 of 2017

Any descriptions of future functionality reflect current product direction, are for informational purposes only and do not constitute a commitment to provide specific functionality. Timing and availability are subject to change and applicable regulatory approvals.

The Commitment to Interoperability

The GE Commitment Continues• Added three development teams globally• Trained more than 100 engineers in FHIR• Onboarded numerous partners in our API program• Demonstrated two FHIR prototypes at Centricity Live• Continued our commitment to FHIR development• Brought new product to Connectathons in HL7 and IHE• Piloted use of IHE profiles with an ambulatory clinic and three hospitals• Spinning up our Carequality Implementer program• Piloted FHIR development with customers and partners

Looking Forward in 2017• Introducing use of HL7 FHIR APIs in for release in mid 2017:

– Centricity Practice Solution 12.3– Centricity EMR 9.12

• 33 FHIR Resources supported for Clinical & Practice Management use.• FHIR infrastructure also appearing in our Project Northstar program.• Future plans include:

– Cloud support of FHIR APIs– Connecting payers and providers with FHIR APIs

• More Interoperability to show at Centricity LIVE, Boston, May 17-20, 2017

Any descriptions of future functionality reflect current product direction, are for informational purposes only and do not constitute a commitment to provide specific functionality. Timing and availability are subject to change and applicable regulatory approvals.

The Magic of FHIR• We’ve enabled John Halamka’s “Magic Button” using HL7 FHIR®

• Entering pilot stage at Fenway Health and Beth-Israel Deaconess Medical Center

Any descriptions of future functionality reflect current product direction, are for informational purposes only and do not constitute a commitment to provide specific functionality. Timing and availability are subject to change and applicable regulatory approvals.

New Standards? No ProblemsAlliance of Chicago demonstrating use of Centricity Practice Solution 12.2 with• our new API Server • our new CDA GeneratorBuilt with 10 years of Connectathon experience to produce a new standards based document

Demonstrating Interoperability Across the Spectrum

Summary

GE Healthcare's commitment• It’s all about the customer and outcomes

– Enhance Care Quality, Improved Provider Efficiency, Strengthen Financial Performance

• It’s all about standards– Carequality, FHIR

• Five use cases in the Interoperability Showcase– Come see us!

Providers Will Not Succeed in the World of Value-Based Care

Without Interoperating With Their Environment.

Let’s Join Together to Help Them!

Thank you for joining us.

Questions?