SLIDE 1
Jay Srini jsrinij@gmail.com 412 760 9593
SLIDE 2 2014 NRTRC TELEMEDICINE CONFERENCE
”FACE TIME ME BEFORE YOU TAKE THOSE TWO ASPIRINS!!
“Jay Srini MS MSBA FIMSS” “March 24 2014”
DISCLOS OSURES
Practice Ga Gap: p: Lack o
n how t to pr provide spe pecialty care services t to und under-served po popu pulations i in n the r region. Desired ed O Outcome me: :
- Providers will be able to apply knowledge acquired from the conference to better provide care
using telemedicine to patients across the region.
- Providers will be able to solve problems within their practice using telemedicine.
- Providers will be able to identify the services available for their patients via telemedicine within
their region.
- Providers will be able to recognize the changes in telemedicine and how best to continue
improving their practices during change. Di Disclosure o
relationships i in n the pa past 12 mont nths: I I have no no relevant financial relation
with c com
mercial interests t that ma may y have a direct bearing on
matter
is C CME activ ivit ity.
SLIDE 3 CONSESUS ON THE EASY STUFF
The he term rm t telemedicine lit iterally means “ “healing at a a dis distance” through t the L Latin “medic dicus” and Gre Greek “ “tele.”. ”. Ac Acco cording ng to t
Americ ican Telemedi dicine A Assoc
ion, “ “telemedic icine is is the use of
medic dical in infor
exchange f from
sit ite to
via ia electronic ic communications t to i improve a a patient’s c clinical h health status.” ” This is in includes “ “the use o
ations and i informat ation t technology gy to provide a access t to health assessment, dia diagnosis, in interventio ions, c con
ion, s supervisio ion a and information a across d distan ance. Telehea healt lth servic ices allow c con
rs t to
ducatio ion a and support f for
self-management throu
the I Internet, v via ia t their ir h hom
rs or
ireless de devic ices.
Lets agree to the t term c connected h health h to combine face t to face , , virtual , , community based care t to p provide an ecosystem of care a and e education
which h uses multiple modalities
SLIDE 4
THE DESTINATION
SLIDE 5
SEVERAL INITIATIVES HAVE BEEN LAUNCHED
ME MEDICAL H HOME ME SHARED S D SAVINGS NGS BUNDL NDLED P D PAYMENT PAY Fo For P PERFO FORMANCE ACAs s … … BU BUT
SLIDE 6 SUPPLY /DEMAND ASYMMETRY
Growth in
in chronic ic illness wil ill l continue to spir iral al u upwar ard, 40 percent in increas ase in heart diseas ase an and a a 50 percen ent increa ease in cancer er and diabetes projec ected d for 2023. Baby by boomers are e just begi eginning g to en enter their h high gh-maintenan ance hea ealth care e yea ears of sixty-five ve-plus ( non debat atab able) VS phys ysicians an and nurse ses- (Cli linicians) are both in sh short sup
workforce s stat atistics d dat ata) a) Scope o
practic ice r regulat ations are restrictiv ive f for non physic ician an clin inicians
SLIDE 7
SO HOW DO WE GET THERE
MAJOR I IMPEDIMEN ENT: SHOR ORTAGE E OF CLINI NICAL EX EXPERTISE and C COS OST HAMPERING NG SCALABILITY OF PILOT S SOLUTIONS ONS.
SLIDE 8 CONCERNS
The f first st g grou
"The Al Alarmed," is s made up 1 16% of
They b believe heal ealth c chan ange e is an an urgent prob
- blem but have no c
- clear i
idea of
how t w to f
x it. ( (Aging B Baby b boom
s) The se secon
0%) is s "The C Con
They b believe it is s you
neighbors problem n no t
They a are in control! l! ( (mille llenn nnial, l, c current ntly ly healthier b baby boome mers) The t third g grou
"The C Cautious" s" ( (23%), a are peop
- ple on
- n the fence. (Enli
lightene ned b baby b boome mers, qu quantified s self folks, s, ) ). The f fourth g h group, "T "The he D Disengaged" " (10 10%), d doe
sn't k know anything a and nd does no not w want nt t to kno now ( ( con
by life issu ssues or s or lack t thereof) The f fifth th g group, "T "The D Doubtf tful" ( " (12%), do
believe there i is s away t to
solve i
sky i is s falling and nd the cup i up is half lf f full ull)
SLIDE 9
THE E CASE F E FOR R SHARED RED D DEC ECISION N MA MAKING NG SHARED ED D DEC ECISION MA N MAKING NG A AND ND HEA EALTH L LITER ERACY FRA RAMEW MEWORK RKS FOR R SHARED RED DEC ECISION N MA MAKING NG TEC ECHNO NOLOGIES ES A AND ND SOLUTIONS NS U USING NG C CONNEC NNECTED ED H HEA EALTH THE E FUTURE : RE : IMPO MPOSSIBLE B E BEC ECOMES MES EVI EVITABLE E
AGENDA
SLIDE 10 ONE SIZE FITS ALL – NOT A REALITY IN MEDICINE
http:/ ://www ww.m .managedcarem emag. g.com/ m/archives es/1304/1304.s .shareddecision.h .html
Patients: The recent advancements in technology have ushered in an era of patient empowerment. Previously, patients were largely reliant on doctors for any knowledge or information regarding their health; now, patients have the tools to track and monitor their health at home or on-the-go, allowing them to be active members of their own health team.
http://www.linkedin.com/today/post/article/20140218152316-12941029-5-technological- breakthroughs-changing-the-future-of-doctor-patient-relationships
SLIDE 11 Only 10–15 percent of an individual’s health status is attributable to the health care services he or she receives. The rest is driven by behavior, genetics, and social determinants including living conditions, access to food, and education status.
That means t that the t tril illi lions of dollar ars the U United S States spends on health care service ces con
- ntribute to
- on
- nly on
- ne-tenth o
- f the natio
ion’s health. An in individual al’s behavior is is by f far the sin ingle most im important contributor t to his is or her overal all h
It is also a a substan antial al d driv iver of heal alth care costs.
SLIDE 12 SHARED DECISION MAKING NOT A NEW PHENOMENON:
In n a 200 2001 r 1 rep eport, Cr Cross ssin ing t the Qualit ity Ch Chasm sm, the he In Institute
Medicine re recommended re redesigning he health c care re pr processes ac according t to 10 rules, man many o
whic ich e emph phasize sh shar ared de decis ision mak making. One ne rule le, f , for instance, u , underli rlines t the i impor
pat patient as as the so source o
envisioning a a heal alth c car are sy system t that at e encourag ages sh shar ared de d decis ision mak making an and d accommo mmodat dates p s patie ients' s' p preferences. s.
SLIDE 13 IN FACT WE HAVE RECONGNISED IT FOR MORE THAN 3 DECADES
One ne of t the f e first i instances w wher ere t the e ter erm ‘ m ‘shared d dec ecision ma maki king’ w was u used ed w was in a repo eport en entitled t the e ‘Pres esident's C Comm mmission for The S e Study o
Problems in Medicin ine an and B Bio iomedical al Research.[1] T This is work b buil ilt o
increasing in interest in in pa patient-centredness and nd a an n inc ncreasing e emphasis o
n recogni nising p pati tient aut utono nomy i in n hea ealth care i e inter eractions s since t the e 1970s. Charle les des escribed a set of pr principles f for s shared d dec ecision ma maki king, s stating “t “that a at l lea east two pa participa pants, t the e clinician a and pa patient be i e involved; that b both pa parties share e information; that b both pa parties t take s steps eps t to build a a consensus about the pr e pref efer erred tr treatment; and nd th that a an n agreement i is r reached o
n the tr treatment t to imp mpleme ement.
”Thes ese e princ nciples r rely o y on n an n eventua ual a arrival a at a t an n agreement b but ut th this fina nal p princ nciple i is no not t ful ully accepted b by others in the f e fiel
. The vie iew that at it it is is ac acceptable to ag agree to d dis isagree is is al also regarded a as a an n acceptable o
utcome of shared d decision making.
^ Charles C, Gafni A, Whelan T (March 1997). "Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango)". Soc Sci Med 44 44 (5): 681–92. doi:10.1016/S0277-9536(96)00221-3. PMID 9032835.
SLIDE 14
WHERE ARE WE NOW
SLIDE 15 NOT FAR ENOUGH IN OUR JOURNEY
The care patients receive doesn't always align with their
- preferences. For example, in a study of more than 1000 office
visits in which more than 3500 medical decisions were made, less than 10% of decisions met the minimum standards for informed decision making.
Bradd addock CH CH III, E Edw dwar ards K KA, Hasenberg rg NM, M, Laid aidley TL, L Levin inson W
d decis isio ion m makin ing i in outpat atie ient p practic ice: t time t to get b back to basics
JAMA 1999 1999;282 82:23 2313-23 2320 20
Similarly, a study showed that only 41% of Medicare patients believed that their treatment reflected their preference for palliative care over more aggressive interventions.
Covinsky KE, F Fuller J JD, , Ya Yaffe K, e et al. Com
and d decision-making in ser eriously i ill p ll pat atients: f findings o
e SUPPORT p project: t : the S Study t to Understand P Prognoses a and Preferences f for O Outcome mes a and R Risks o
. J Am Geriat atr Soc 2000;48:Suppl:S187-S193
SLIDE 16 SHARED DECISION MAKING AND EFFECTIVENESS
A 2011 Cochrane Collaborative review of 86 studies showed that as compared with patients who received usual care, those who used decision aids had increased knowledge, more accurate risk perceptions, reduced internal conflict about decisions, and a greater likelihood of receiving care aligned with their
- values. Moreover, fewer patients were undecided or
passive in the decision-making process — changes that are essential for patients' adherence to therapies.
SLIDE 17 SHARED DECISION AND OPTIMAL CHOICES
Co Consi sist stently, as as man many y as as 20% o
f patients w who ho par articipate in in shar shared d decis ision ma making g cho hoose se less ss in invasive su surgi gical
and nd m more e co cons nser ervative t trea eatmen ent t than d do
ents who d do no not us use e deci ecision a aids
St Stac acey D, , Bennett C CL, L, Barr rry MJ MJ, , et al. . Deci cision a aids for r people f faci cing h health t tre reatment o
r sc screening d decisi sions.
Coc
Database se Sy Syst Rev 2 2011;1 1;10:C 0:CD00 00143 431- CD0014 01431
Medli line ne
SLIDE 18 WHY PAYERS SEE ALIGNMENT
In 2008, the Lewin Group estima mated d that imp mplem emen enting shared ed decision mak akin ing for ju just 11 procedures w would ld yie yield more t than an $9 bill illion in in savin ings n nat atio ional ally over 10 years. In n ad addit ition, a a 2012 study by G y Group He Heal alth in in Was ashin ington Stat ate showed that at p providin ing decision aid aids to pat atie ients elig igible for hip an and knee replac acements s substan antiall lly y reduced both surgery r y rates and costs — with up to 38% fewer surge geries a and s savings of 12 to 2 21% o
mo months.4 Th The e myriad ben enefits of this approach argu gue for mo more rapid d imple lementat atio ion of Sectio ion 3506 of the ACA.
SLIDE 19
HEALTH AFFAIRS STUDY
SLIDE 20 HEALTH AFFAIRS:
Source: Veroff D, Marr A, and Wennberg DE. Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions. Health Aff 2013;32(2):285–293. NOTES: Medical costs were capped at $200,000 per year. Advanced imaging includes magnetic resonance imaging, X-ray computed tomography, and positron emission tomography. Standard imaging includes standard X-rays and ultrasound. **p < 0:05
***p < 0:01
****p < 0:001
SLIDE 21 WHERE DOES ACA FIT IN
Sec Section 3506 o
- f the Affordable Care Act di
directly rel elates to Sh Shared Dec Decision Mak
ifical ally y it would ld offer funding resources t to an indep depen endant
anization to develop standards for S Shared Decis ision M Makin ing, a and tools to as assis ist in the im implementat ation o
Shar ared Decision Mak Making. Additio ional l funding i in the form o
grants ma may be e available to providers who a are e wil illi ling an and ab able le to show effective im implementat ation of t these tools in in the practice setting. Fin inal ally, there is is au authorizat ation from t the C Center of Me Medicai aid an and Me Medicar are to begi gin t testing g the i e imp mpact of Shared ed Decision M Making M g Mode dels across met etrics that at tak ake in into ac account both c cost, q qual ality an and sat atisfac action.
SLIDE 22
WHAT DO PATIENTS/CONSUMERS WANT
HOW IMPORTANT IS IT FOR YOUR PHYSICIAN PROVIDE YOU OPTIONS FOR SDS
SLIDE 23
THE E CASE F E FOR R SHARED RED D DEC ECISION N MA MAKING NG SHARED ED D DEC ECISION MA N MAKING NG A AND ND HEA EALTH L LITER ERACY FRA RAMEW MEWORK RKS FOR R SHARED RED DEC ECISION N MA MAKING NG TEC ECHNO NOLOGIES ES A AND ND SOLUTIONS NS U USING NG C CONNEC NNECTED ED H HEA EALTH THE E FUTURE : RE : IMPO MPOSSIBLE B E BEC ECOMES MES EVI EVITABLE E
AGENDA
SLIDE 24 THE FORGOTTEN ASSET
We We have p e positioned p patien ents a as passive r e reci ecipien ents o
care, e, no not f ful ully r recog ecogni nizing t that t they h have t e trem emen endous i ins nsights, exper ertise a e and nd e exper erien ence ce t that ca can n hel elp us us bui build co cost- effic icient, high high-quality, saf safe syst systems o s of f car are,” ,” Bev J Johnson
esident a and nd C CEO EO of the e Ins nstitute f e for Patien ent- and F Famil mily-Cen enter ered ed C Care.
SLIDE 25 AMA ON HEALTH LITERACY
Acco ccording to the A e Amer erica can Med Medica cal A Association
low h hea ealth liter eracy h has bee been n associ ciated ed w with p poorer er h health, h higher er medical al e expenses, m , medicat ation non-adher eren ence a and nd increas ased h hospital alizat ation. . In the r e rep eport, “ “Hea ealth L Liter eracy, A A Pr Pres escr cription t to End End Conf nfusion,” t the e Ins nstitute o e of Med Medicine s e states es, “ “ef efforts t to improve q e qua uality, red educe co uce costs, a and nd r red educe uce disparities es ca cann nnot s succeed ucceed without s simultaneo eous i improvem emen ents i in n hea ealth liter eracy.”
SLIDE 26 OPPORTUNITY COST OF LACK OF HEALTH LITERACY The e Nat atio ional nal Ins Instit itutes f for Heal ealth (N (NIH IH) ) id ident entif ifies ies t the e lac ack o
ealth lit iter eracy as as a a “majo ajor s sour urce o e of econo nomic inef ineffic icien iency in in the e US US heal ealthcar are s e system em,” and and attribut butes
$1 $106 06 b bil illion t to $238 $238 b bil illion e eac ach y year t to its s si side e effects. s.
SLIDE 27
WHY DO IT??
http://bhmpc.com/2013/05/shared- decision-making-trend-ticking-upwards/
SLIDE 28 JUST DO IT!!
Doct ctors ar are o
ly p par art o
e cure Posted: February 19, 2014 - 12:00 pm ET Tags: Physicians, Public Health Regarding “More p patients c con
lling h high bloo
pressure, b but s still b l belo low U. U.S. g goals ls”:
You can have the best doctors in the world, but if you don't follow their advice, they won't be able to do much to help you. Stop overeating, be more active, make the right lifestyle changes and take your medicine as long as told to do so. Work with a good dietitian and eat the proper foods. Get your cholesterol down and find ways to relax.
More p patients con
lling h high bloo
pressure, but s still b l belo low U. U.S. g goal
- als. By Steven Ross Johnson. 1:45 pm, Feb.
14 | http://www.modernhealthcare.com/article/20140214/BLOG/302149996
SLIDE 29 NLM ON HEALTH LITERACY
Accordin ding to the N Nat ational L Lib ibrary o
dicine, po poor healt lth l h litera racy b y begets p poor h r healt lth o
: People le who stru ruggle le w with h healt lth l h litera racy a y are l less l likely t ly to get flu sh shots an and d unde derstan and me medi dical in
They are m more re l likely t ly to make m medication e error
. In genera ral, l, the hey a are re a als lso le less li likely t to
and re receive pr preventative c car are an and d mo more l lik ikely t to become hospit pital aliz ized a and have n negat ativ ive d disease ase o
mes.
SLIDE 30 HELP FOR THE ELDERLY
People 65 and older make nearly twice as many physician visits per year compared to adults 45 to 65, but two-thirds of older people are unable to understand the information given to them about their prescription medications, according to the National Institutes of Health.
http://www.washingtonpost.com/sf/brand-connect/wp/2014/02/14/low-health-literacy-compromises-health-increases-costs/
SLIDE 31
SHARED DECISION MAKING AND HEALTH LITERACY GO HAND IN HAND
Min MinuteClinic ic, the medical al clin inic in in CVS/pharmacy, w was as the nat ation’s f first retail il clinic p provide der to imp mplem emen ent t the e “Ask Me 3” health literacy program m design gned d by y the Nat ational P Pat atie ient Saf afety Foundat ation. The e progr gram m aims t to e enhance e commu mmunications bet etwee een patien ents and phar armac acis ists by y encourag aging p pat atients to as ask an and understand the an answers t to three questions: What is is my m y main ain p problem? W What at do I need to do? Why is it im important f for me t to do this?
SLIDE 32
TO “MAKE NO DECISION ABOUT ME, WITHOUT ME, A REALITY” – NOT EASY
SLIDE 33
THE E CASE F E FOR R SHARED RED D DEC ECISION N MA MAKING NG SHARED ED D DEC ECISION MA N MAKING NG A AND ND HEA EALTH L LITER ERACY FRA RAMEW MEWORK RKS FOR R SHARED RED DEC ECISION N MA MAKING NG TEC ECHNO NOLOGIES ES A AND ND SOLUTIONS NS U USING NG C CONNEC NNECTED ED H HEA EALTH THE E FUTURE : RE : IMPO MPOSSIBLE B E BEC ECOMES MES EVI EVITABLE E
AGENDA
SLIDE 34 THE IOM REPORT
- BEST CARE AT LOWER COST, PATH TO CONTINOUSLY LEARNING
HEALTHCARE IN AMERICA PATIENT NT CENT NTREDNE NESS PROVIDE CARE T THAT T IS S RESP SPECTF TFUL AND R D RESP SPONSI SIVE T TO IND NDIVIDUAL PREFERENCES NE NEEDS AND ND VALUES PATI TIENT T VALUES S GUIDE DE ALL DE DECISI SIONS
- CARE CHOICES ARE INFLUENCED BY AN EVIDENCED BASED
CONVERSATION BETWEEN PATIENTS CLINICIANS
- HEALTHCARE PROVIDERS EMPOWER PATIENTS TO BECOME ACTIVE
PARTICIPANTS IN BOTH THEIR CARE AND BROADER HEALTH OF THEIR COMMUNITY.
SLIDE 35
WHAT DO PATIENTS SAY
SLIDE 36
SLIDE 37
SLIDE 38
NATIONAL EHEALTH COLLABORATIVE
SLIDE 39
SLIDE 40
SLIDE 41 FRAMEWORKS AND
The Interna nationa nal Patient nt D Decision
Stand ndards Collaboration
evidence-based guideli lines for certificatio ion indic icating t that : decision aids should ld i inclu lude questions to help p patients clari rify fy their r va values and und understand how those e values es a affect thei eir d decisions; inf nformation a about ut treatment o
ptions, pr presented i in n a balanc nced m manne nner and nd i in n plai ain lan angu guag age; e; an and u up-to-date data f from m pub published s studies o
n the likelihood of ac achieving t g the e treat eatmen ent go goal al wi with t the e pr proposed i intervention a and nd on n the na nature and frequency of
compl plications.
2013 November Su Supplement in in BMC M Medic ical Informatics an and Decisio ion Making ng. The International Patient Decision Aid Standards (IPDAS) Collaboration’s Quality Dimensions: Theoretical Rationales, Current Evidence, and Emerging Issues.
SLIDE 42 QUALITY DIMENSION OF IPDAS
Resu sults This dimension requires patient decision aids to be based on research evidence about the relevant options and the nature and likelihood of their effect on outcomes that matter to patients. The synthesis of evidence should be comprehensive and up-to-date, and the evidence itself subject to critical appraisal. Ethical (informed patient choice), quality-of-care (patient-centered care), and scientific (evidence-based medicine) arguments justify this requirement. Empirical evidence suggests that over two thirds of available decision aids are based on high-quality evidence syntheses. Emerging issues identified include the duties of developers regarding the conduct of systematic reviews, the impact of comparative effectiveness research, their link with guidelines based on the same evidence, and how to present the developers’ confidence in the estimates to the end-users. Systematic application of the GRADE system, common in contemporary practice guideline development, could enhance satisfaction of this dimension. Conclu lusions ns While theoretical and practical issues remained to be addressed, high-quality patient decision aids should adhere to this dimension requiring they be based on comprehensive and up-to-date summaries of critically appraised evidence.
http: p://w /www.biomed medcen entr tral.com/1 m/1472-6947/13/S2/S5 S5 Basing inf nformation o
n comprehensive, c criti tically y appraised, and nd up up-to-date te synthe heses of t
he s sci cientifi fic e evidence: a quality dimension
he Internatio ional P Pat atie ient Decision Aid Aid St Stan andar ards
SLIDE 43
ACROSS OUR BORDERS… LET KNOWLEDGE FLOW
SLIDE 44
GRADE- QUALITY OF EVIDENCE
SLIDE 45
THE E CASE F E FOR R SHARED RED D DEC ECISION N MA MAKING NG SHARED ED D DEC ECISION MA N MAKING NG A AND ND HEA EALTH L LITER ERACY FRA RAMEW MEWORK RKS FOR R SHARED RED DEC ECISION N MA MAKING NG TEC ECHNO NOLOGIES ES A AND ND SOLUTIONS NS U USING NG C CONNEC NNECTED ED H HEA EALTH THE E FUTURE : RE : IMPO MPOSSIBLE B E BEC ECOMES MES EVI EVITABLE E
AGENDA
SLIDE 46 TECHNOLOGY CAN REDUCE FRICTION AND COST
duced d costs for phys ysician ans and patients
- Improved efficiency for phys
ysician ans an and pat atie ients
Grea eater Ac Access ss to phys ysician ans an and other provider ders- even enings gs and d we weekends
duced t d time a me away from m work for patien ents
mproved ed patien ent sat atis isfaction an and p phys ysicia ian s sat atisfaction.
Grea eater choice o
- f physicians/providers
- Access to phys
ysician ans while traveling f for work o
pleas asure
to brin ing others to the vis isit it - out ut-of
e childr dren, f for exam ample
SLIDE 47 IN THE WORDS OF : MARK BERTOLINI (AETNA)
Emp mployees es are payi ying 4 41 percent of
healthcare d dol
,” “If If the t trend l line c con
in another three to
years employees will be payi ying mor more than h
And when we reach t that po point, y you’ u’ll have a very different c cus ustomer sitting a across f from you u talking about ut their c costs, and nd how come it c costs s so muc uch.” “T “The e chronically ill 5 5 pe percent of the po popul pulation that c cons nsumes more than 4 n 40 pe percent of healthcare c cos
. Patient engagement c can reduce readmission
chron
reduce those costs, b but ut onl nly i if you u can n make the pa patient i int nterested i in e n eng ngaging with you u befor
too l
“If y you u take s someone t through a dialogue about ut metabolic syndrome, about ut diet, the l lack of exercise, th the i impact of f meta tabolic s syndrome, th the f fact th ct that 60 60 perce cent over r th the next 20 20 years w will g get et diabet etes es, , you lose them, m,” he said. “ . “It’s ’s like C Charlie B Brown’s ’s m mother er – ‘Wa Wa wa wa wa wa wa wa wa wa.’ So how do you u make it work? You u put put i it in n the pa palm of their hand nd.”
SLIDE 48
JAMA ARTICLE ON DERMATOLOGY
SLIDE 49 BEATING THE BLUES: BY PASSING THE BLUES
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/O/PDF%20OnlineCouchMentalHealthWeb.pdf
SLIDE 50
SOCIAL MEDIA AND SHARED DECISION MAKING
SLIDE 51 Mark Merolli , Kathleen Gray , Fernando Martin-Sanchez Health ou
and r related e effects of
soc
media i in c chron
disease m management: A A literature r review a and analysis of
affordance ces Journal of Biomedical Informatics, Volume 46, Issue 6, 2013, 957 - 969 http://dx.doi.org/10.1016/j.jbi.2013.04.010
SOCIAL MEDIA AND SHARED DECISION MAKING
SLIDE 52
SMART PATIENTS
SLIDE 53
WEARABLE MONITORING
SLIDE 54 UBIQUITOUS CONTINOUS COMPREHENSIVE CARE
In Integrated c care: : You, u, y your ur doctor or other health care pr providers conne nnected th through e electr ctronic h c health th re reco cords Access to
ywhere: E Ema mail y you
doc
- ctor
- r, or
- r have access to
- you
- ur care
provider via mob mobile or
In Increased access to
access increases screening rate tes, decreases h heart disease/attacks, and nd h helps c cont ntrol chronic c cond nditions Day-to to-day h health: h: Being able to l
life y you
want to, w
means ns pl playing w with your ur kids o
mount untains, walking around the block or running g a a mar marat athon Spiri ritual & Emotional Health: h: Feeling s sup upported in y n your ur l life, being a able to look b back a at each d day and nd kno now y you a u accompl plished t the things you’ u’d hope ped t to d do
SLIDE 55 CONNECTED CARE IS HERE TO STAY AND EXPAND ACROSS ALL CARE SETTINGS
David Grabowski and James O’Malley provide the first indications in a controlled study of eleven nursing homes that switching from on-call to telemedicine physician coverage during
- ff hours could reduce hospitalizations and therefore generate cost savings
SLIDE 56
BLOCKBUSTER DRUG OF THE CENTURY: PATIENT ENGAGEMENT
Shared decision making is critical for quality health outcomes ….but Patient engagement is crucial to enable SDM ….however This Cannot happen without optimal health literacy Technology can enable each step of the process but a comprehensive care system is needed to meet individual consumer needs.
SLIDE 57 CHALLENGES:
, , “A De Demonstration of Shared De Decision M Making in n Primary Ca Care Highlights Barriers t to Adopt ption and nd Potential R Reme medies” Health h Affa fairs(Fri riedberg rg 2 2013)” “physic
sicia ians a s are a already ady o
d and have insuffic icie ient t train ainin ing to mak make sh shar ared de d decision mak making w work” “informat atio ion s syst stems c ms cannot p prompt pt o
patie ients t s through t the decisio sion-mak makin ing p process” ss”; a and “addi adding an any new w pr process t to a a ph physi sician ans o
ice w workflow wil w will b be a a cha hall llenge”
SLIDE 58
PAYMENT REFORM A MUST
SLIDE 59 RECOMMENDATIONS
CMS MS could rap apidly certify t these tools ls an and r require th the use use of proven n decision n ai aids use i e in the e Medi dicare e and d Medi dicaid d programs ms for 2 20 ((x ((x) ma main procedures wher ere e e effec ectiven enes ess is evaluated d …… develop
- p a penalty for thos
- se who
- choos
- ose not
- t to use them
The e documen mented ed use o
atie ient decision aid aids c could b be u used as as a a qualit ality metric ic in in p pat atie ient-cen enter ered ed medi edical h homes mes, a accountable e care organizations, an and sys ystems car aring for pat atie ients elig igible for both Me Medicare an and Me Medic icai aid. (Value b e based ed incen entives – cost efficiencies an and im improved qual ality) Eligib ibility criteria a for incentives to adopt electronic heal alth r record technolo logy y might b be expanded ded to include t de the e use of shared ed decision making a g and patien ent decisi sion n aids. s.
SLIDE 60 FROM THE CHAIRS OF CONNECTED CARE ALLIANCE
Time is
is rig ight t to ad address these is issues, an and the foll llowing f fac acts ar are indis isputable:
more widely r recognized a as a job creator a and nd an n eng ngine f for e econo nomic growth.
- The evidence base for connected care has grown. Studies are published regularly that
demonstrate e imp mproveme ments i in qu quality, , access a and cost – inclu luding one recently ly t that highli lighted how w Par artners H Heal ealthcar are S System em in Bo Boston r red educed r read eadmissions of 1,200 h hear eart fai ailure e patients by y 50 percent t throu
a home
monitor
prog
.
- Connected care aligns with broader efforts to strengthen the nation’s healthcare system. Notably,
an n emph phasis o
n accoun untable care is put putting pr pressure on n pr providers to be in n better cont ntact
utside of the office o
nd conne nnected c care offers a low-cost way f for pr providers to follow up up with t their pa patients.
- States and comm
- mmercial i
insurers a are increasingly r reimbursing for
con
care. . In In 2013 alon
, legislation w was int ntroduced i in n 25 states to advance some t type pe of telehealth po policy, a and nd 20 states es n now requ quire c e commercial insurer ers t to c cover telehealth services es.
expansion
- n of
- f coverage con
- ntinues, m
mor
will be enrolled in p private health i insurance plans or
Medicaid than ever b befor
but mi might not b be able to
a phys
Con
care c can help c consumers f find a doctor r that s suits t their r health n h needs. By y For
mer S
(D-S.D. D.), Trent Lott (R-Miss.) and nd J John B n Breaux ux ( (D-La.) Read mor more: : http://thehill.com/op
nion/ n/op
98269-conne nnected-he healthcare-is
is-ou
if-wa washin ington-acts#ixzz2u
2uIoXx88K 88K
SLIDE 61
BI PARTISAN ISSUE
Former Senate Majority Leader William Frist asserts, consumers newly empowered by actionable knowledge “will channel our chaotic, fragmented, and wasteful health care sector toward a more seamless, transparent, accountable, and efficient system.” Health Affairs and the Bipartisan Policy Center (BPC) cosponsored a forum on connected health that was chaired by Senator Frist, a senior fellow at BPC.
SLIDE 62
TECHNOLOGY SHOULD BE HI-TOUCH NOT JUST HI-TECH
http://www.dailymail.co.uk/health/article- 2142982/BabyBloom-The-hi-tech-incubator- allows-mother-bond-baby-bed--comes-built- video-camera.html
SLIDE 63
AUDACITY OF HOPE
SLIDE 64
3D PRINTING OF FINGERS
http://www.dailymail.co.uk/news/article- 2562310/Boy-9-born-without-fingers-gets- robotic-hand-thanks-internet-plans-librarys- 3D-printer.html
SLIDE 65
THE IMPOSSIBLE BECOMES THE INEVITABLE
http://gizmodo.com/wheelchair-bound-woman-walks-again-with-a-3d- printed-ex-1528719886
