IBM Healthcare and Life Sciences
Patient Centered Collaborative Care: New Healthcare
Delivery Models Enabled by Information Technology
Dr. Joseph M. Jasinski
Distinguished Engineer and Program Director
Healthcare and Life Sciences
IBM Research
IBM Healthcare and Life Sciences
Today’s Discussion
• What does Accessibility mean in the Context of Healthcare?
• A New Healthcare Delivery Model
• Technologies to Enable Improved Healthcare Delivery
2
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Healthcare Environment – More Spending Does Not Guarantee Better
Health as Measured by Longevity
• World spends about
$4.5Trillion, U.S. spends
about $2Trillion
• US ranked 37th by WHO
in Healthcare
effectiveness (btw Costa
Rica and Slovenia)
• In the U.S 42% of spend
is Centers for Medicare
and Medicade Services,
much of the rest is large
employers
• Large Corporations
spend significant
amounts on healthcare
through self insurance
• 47 million Americans
have no health insurance
• Approximately 100K
deaths in US every year
from preventable medical
Source: error.
IBM Global Business Services and IBM Institute for
Business Value
3
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
A proactive, value-based health system should help move people from
right to left – and keep them there. IT is a natural way to improve
efficiency, safety and reduce costs
Health Status
Health care spending
20% of people
generate
80% of costs
A value-based health care system
Source: IBM Global Business Services and IBM Institute for Business Value
4
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
What Does Accessibility Mean in the Context of Healthcare?
• Accessibility Challenges
- Availability: Shortage of Primary Care Physicians; Needs of Rural/Developing
-
5
Economies
Cost: Universal Access to Health Insurance; Chronic Disease; Genetic
Predisposition
Physical Access: Elderly, Home Bound, Limited Mobility
Cognitive Access: Literacy, Language, Cognitive Impairment
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Today’s Discussion
• What does Accessibility mean in the Context of Healthcare?
• A New Healthcare Delivery Model
• Technologies to Enable Improved Healthcare Delivery
6
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Why is the healthcare system broken?
“ We don't have a health care delivery system in this
country. We have an expensive plethora of
uncoordinated, unlinked, economically segregated,
operationally limited micro systems, each performing
in ways that too often create suboptimal performance
both for the overall health care infrastructure and for
individual patients." George Halvorson
We believe….
 Collaboration across the full care team is missing
 Taking a longitudinal view of the whole person’s health from wellness and prevention to at
risk to chronic care to end of life is missing
 Technology is insufficient and not helping the care team do their jobs, thus not being
adopted
 Accountability and incentives are not in place to encourage delivery of quality cost effective
care
 Care is not centered on patient needs
7
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
What do we want our healthcare to be?
Healthcare
Team
Physicians
Healthcare
Team
Care Givers
Medicaid
Staff
Employers
Medicaid
Client
Patients
I want my healthcare to be
To value me for what I do
To give me a better life
balance
Founded on a strong patient
clinician relationship
Focused on the total health
of the individual
Actively engaged in helping
people be healthy and well
Able to help individuals
make healthy choices, more
and more often
To reduce practice overhead
To free me from
administrative hassles
To improve my access to
information about my
patients
To let me do what I do best,
practice medicine
Allowing me to access
important health records no
matter what place of care
created them
To be driven by evidence
based medicine and robust
information about all relevant
aspects of an individuals live
Coordinated with others
responsible for providing
patient care and support
Affordable to employers and
individuals now, as well as in
the future
Affordable so I can offer
coverage to my employees
Easy to understand, with
less hassle
Cost effective
To be in control, and result in
the best outcome
Information to be in one place,
like banking online
Accessible 24x7, for advice,
planning, scheduling, request
prescription refills and …
To be affordable
Provide me alerts, i.e., screen
events
Higher quality
Provide me information I need
about me and my kids when I
need it
Give me access to someone
who knows me, and can
answer my questions…and
coach me through my
decisions
8
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
The political pressure for healthcare reform has never been greater
•“…the cost of our health care has weighed down our economy and the
President
Obama health care
conscience of our nation long enough. So let -there
beBarack
no doubt:
reform cannot wait, it must not wait, and it will not wait another year.”
Coverage
for All
Tools to
Payment
Reform
Align incentives
Pay for Value
Rebuild
and Restructure
Strengthen
Primary
Care
Health
Information
Technology
Health Care
Source: Obama, Barack. “Remarks of President Barack Obama -- Address to Joint Session of Congress” http://www.whitehouse.gov/the_press_office/Remarks-of-PresidentBarack-Obama-Address-to-Joint-Session-of-Congress/
9
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Patient-Centered Medical Home (PCMH) is an approach to deliver comprehensive care,
coordinated by a physician-led care team (not your house with a lot of technology)
Personal Relationship with a
Physician and Care Team
+
Proactive Focus on Health,
Care Intervention and Chronic
Disease Management
• Brief history of the evolution of the PCMH:
- 1967: American Academy of Pediatrics defined medical
home concepts related to children with special needs
- 2000-present: AAFP and ACP developed and extended
the concept to include care for all patients with chronic
illness and patient centeredness
- 2006-07: AAFP, AAP, ACP and AOA develop a common
definition of “patient-centered medical home” and link
PCMH to reform of payment for physicians
+
Technology, Services &
Applications to Support the
New Collaborative Care Model
Principles of PCMH
• Patient Centric/Personal Physician
• Physician directed medical “team”
• Whole person orientation
• Care is coordinated and/or integrated
• Emphasis on quality and safety
• Enhanced access
• Appropriate reimbursement
“The Patient-Centered Medical Home (PCMH) provides
care that is “accessible, continuous, comprehensive
and coordinated and delivered in the context of family
and community.”1
Source: 1) www.medicalhomeinfo.org/join%20statementpdf
10
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Medical Home in the Current National Debate on HC Reform
•Current House Legislation
•Medical Home Pilot Program -- An expansion of
the medical home demo in Medicare. Establishes a
medical home pilot program to asses the feasibility of
reimbursing for qualified patient-centered medical
homes. There are two models in the program: 1) the
independent patient-centered medical home structured
around a provider, targeted at the top half of high need
Medicare beneficiaries with multiple chronic diseases,
or 2) the community based medical home, targeted at
a broader population of Medicare beneficiaries with
chronic diseases and allows state-based or nonprofits
to provide care management. Provides
approximately $1.6 billion from the Trust Fund for
the 5 year pilot programs
•Medicaid medical home pilot program -- A 5year medical home pilot program for high-need
Medicaid beneficiaries. The federal government would
match costs of community care workers at 90% for the
first 2 years and 75% for the next 3, up to a total of
$1.235 billion.
11
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Today’s Discussion
• What does Accessibility mean in the Context of Healthcare?
• A New Healthcare Delivery Model
• Technologies to Enable Improved Healthcare Delivery
12
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Working Definitions for Today’s Discussion
• Electronic Medical Record – EMR.
•
•
13
An electronic collection of patient documents
specific to one physician, clinic, hospital. (Also Electronic Patient Record – EPR)
- Institution or physician centric
- Episodic
- Many versions and types exist
Electronic Health Record – EHR. An electronic collection of all healthcare
documents for an individual
- Patient Centric
- Longitudinal
- ‘Gold Standard’ – physician and institution maintained
- Very few exist in reality
Personal Health Record – PHR. An electronic collection of all healthcare
documents that an individual chooses to maintain
- Patient Centric
- Longitudinal
- Patient Controlled and Editable
- Emerging area for healthcare in some countries
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
http://www.accenture.com/NR/rdonlyres/15D767DA-7F3F-4AE6-ABDD-8260DA7BFFC5/0/eHRbrochureJune06.pdf
14
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Denmark
15
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Sundhed.dk
Services for Citizens
• General information
• Information from hospitals all
•
•
•
•
•
•
•
•
around Denmark
Yellow-pages for the entire Danish
health sector
Waiting-list information
Information about medicine
E-booking calendar
Secure communication (“e-mail”)
Personal Medicine Profile
Citizens event log
Registration as Donor
16
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Mobile Health – Robust Monitoring for Outpatient Population
• Initial application for pharmaceutical industry drug trials
-
Real-time feedback improves patient safety
Enables monitoring and dosage adjustments based on results
Accuracy & compliance documented
Sensor equipped
Bubble Pack
Compliance
monitoring
Real-time
Feedback
Health
Monitoring
Data
Server
Bluetooth Enabled
17
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
PlugFest November 2008
PAN Interface
Device Manager
XHR Interface
Sender Receiver
Wired Glucose Meter
PHM Report
•Glucose
(canned)
Telehealth
Service
Wired Glucose Meter
PHR
(canned)
PHM Report
•Weight
Wired AHD
Telehealth
Service
Wired Weighing Scale
EHR
Wired Independent Living
Activity Hub
18
IBM Research |
Continua Health Alliance
© 2008 IBM Corporation
18
IBM Healthcare and Life Sciences
Online Analytics using a stream optimized system
CENTURY’S FOCUS
PROACTIVE
OUTBREAK DETECTION
REALTIME HEALTH CENSUS
VERY LARGE NUMBER OF STREAMS
Biometric Sensor Data
Census, CDC
HIGH SPEED STREAMS
MONITORING SERVICES
SLOW SPEED STREAMS
TRENDING ANALYSIS
+
Contextual Data Sources
CLINICAL DECISION
Clinical, Insurance
WELLNESS SERVICES
THIRD PARTY CONSULTING
SELF MANAGEMENT
Wellness, Citizen
IBM System-S
19
IBM Research |
© 2008 IBM Corporation
IBM Healthcare and Life Sciences
Medical Information Hub
http://www.youtube.com/watch?v=VAwYdmUd59A
20
IBM Research |
Source: Andre Elisseeff Zurich Rsch and Nhumi Corp
© 2008 IBM Corporation
IBM Research
Real time speech to speech language translation
IBM Research |
© 2008 IBM Corporation