Healthcare IT Megatrends and the Evolution of High-Value Healthcare Christopher A. Longhurst, MD, MS ( @calonghurst) CIO and Clinical Professor of Medicine and Pediatrics UC San Diego Health (@ucsdhealth)
The Rapidly Evolving Landscape Healthcare Trends Health IT Implications • Precision medicine • Analytics / data • Consumers take charge • Patient engagement • Healthcare everywhere • Monitoring, telehealth • More with less: from • Interoperability and volume to value communication • Consolidation of • Consolidation of EMR healthcare systems instances 2
New England Journal of Medicine , Nov 2011
Health Affairs , July 2014
Figure 1 – The Green Button in Action
J. Comp. Eff. Res. , May 2015
Informatics Consults (Stanford and University of California) More information at http://greenbutton.stanford.edu 8
Combining healthcare data from across the six UC medical schools and systems Clinical Data Warehouse A UC Healthcare Big Data Analytics Platform
Bringing UC’s clinical data together creates an asset with few (if any) peers UC Big Health Data Governance UC Big Health Data Platform Platforms Use Cases Outputs/Visualizations Phenotypic (Epic) Operational Research ‐ Readmissions ‐ UCRex Financial / Claims Information ‐ Sepsis ‐ PCORNET Reports Discovery Image Repository ‐ Quality ‐ NCATS ACT Bio‐banking ‐ Patient Sat. ‐ OMOP Scorecards/ Alerts/Decision ‐ Efficiency ‐ Cohort Discovery ‘Omics Dashboards Support ‐ Pop Health ‐ Patient Data Sets Public Data Sources ‐ etc. ‐ etc. High Frequency Data Statistical Predictive Analysis Analytics Technology Foundation Natural Metadata Master Terminology KB/Ontology Analytic Big Data Geospatial BI Language Mgmt Data Mgmt Mgmt Mgmt Tools Technologies Processing Technologies Processing 10
The Rapidly Evolving Landscape Healthcare Trends Health IT Implications • Precision medicine • Analytics / data • Consumers take charge • Patient engagement • Healthcare everywhere • Monitoring, telehealth • More with less: from • Interoperability and volume to value communication • Consolidation of • Consolidation of EMR healthcare systems instances 11
Health Record Data Banks? 12
Who is using your EMR…?
Patient Portal at UC San Diego Health 14
Direct and Open Scheduling @ UCSD Health
OpenNotes in Australia?
EHR-Integrated Home Monitoring (JAMIA , 2016) 17
Pre-Visit Questions / Patient-Reported Outcomes Before Optimization After Optimization
Clinical Trials Recruiting
Jacobs Medical Center, Nov 2016 Bedside tablets control lighting, blinds, temperature, entertainment system, and “smart” portal with care team photos, medical record access, education videos
Larry Weed (1924 – 2017) Grand Rounds, 1971 HIMSS Symposium, 2013 “Patients are the largest untapped resource in medical care today.” - Larry Weed, MD, 1969 21
The Rapidly Evolving Landscape Healthcare Trends Health IT Implications • Precision medicine • Analytics / data • Consumers take charge • Patient engagement • Healthcare everywhere • Monitoring, telehealth • More with less: from • Interoperability and volume to value communication • Consolidation of • Consolidation of EMR healthcare systems instances 22
Is EMR Interoperability Solved in the USA? Breadth of the Epic EHR System At UC San Diego Health, Nationwide 35,483,991 patient records we’ve exchanged were exchanged using Epic > 1 Million Patient Records in 2016 CareEverywhere in April 2017 alone with organizations spanning 50 States, including “1 9 0 m illion, or som e 830 Hospitals 5 4 % of patients in the U.S. are 1,050 Emergency Departments and now served by Epic products 22,830 Clinics .” - Judy Faul kner , Epic
San Diego Outbreak of Hepatitis A (October 2010) 24
JAMIA , 2017 25
The Rapidly Evolving Landscape Healthcare Trends Health IT Implications • Precision medicine • Analytics / data • Consumers take charge • Patient engagement • Healthcare everywhere • Monitoring, telehealth • More with less: from • Interoperability and volume to value communication • Consolidation of • Consolidation of EMR healthcare systems instances 26
UC Health CIOs Tom Andriola UC Office of the President John Cook UC Davis Health Mike Pfeffer, MD UCLA Health Joe Bengfort UCSF Chuck Podesta UC Irvine Health Chris Longhurst, MD UC San Diego Health
Cloud EMR?
UCI/SD Collaboration Guiding Principles • Clinical and business transformation with be sponsored by clinical and business leaders with full transparency from IS leadership. • Identify and support opportunities for strategic business alignment and leveraging scale for value (e.g. tele-radiology, telehealth, revenue cycle, call center, pharmacy, population health, clinical research, materials management). • UCI will accept standard UCSD build for similar departments unless both sites agree that build should be changed for patient safety, revenue capture, or other best practice. All other requests will be subject to combined governance review. • Perfect is the enemy of good – decisions need to be timely. • Identify, acknowledge, and minimize risk.
UC San Diego Health and UC Irvine Health Today FY18/FY19 FY20+ Expansion Of Shared Services Shared Epic Support Model Sharing Roles
How do we ensure our healthcare system learns from every patient, at every visit, every time?
Thank you! Chris Longhurst, MD, MS cio@ucsd.edu @calongurst (copies of all papers available by request)
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