1. Health IT Seminar Review
CLIFF KAUFMAN

2. Focus on NC
 NC Strategy for HIT
Steve Cline, DDS, MPH
HIT Coordinator, NC DHHS
 Using Telehealth Technology for Rehabilitation
Helen Hoenig MD, MPH
Durham VA Med Ctr Duke University
 CCNC Informatics Center
Annette DuBard, MD, MPH
North Carolina Community Care Networks, Inc.
 NCB Prepared
Steve Potenziani, PhD
Executive Director, NCB-Prepared Collaborative

3. NC Strategy for HIT
GOALS PROBLEMS
 Improved healthcare quality  Paper is inefficient
 Better health outcomes  Duplicate tests
 Individuals  Medical errors
 Populations
 Lack of information
 Control costs
 Too much information
 Better engage health care
 Consumer engagement
consumers
 Quality-Quality-Quality

4. The 12-Step Approach
1. Admit we have a problem
2. Must get clinical information into an electronic sharable format.
3. Incentivize targeted providers to adopt EHRs and meaningful use
4. Create a new standard for EHR vendors
5. Build a mechanism for sharing health information electronically
6. Make sure healthcare providers know how to use the new systems
7. Make sure the network has the capacity for all these new users
8. Make good use of the data (Data Analytics)
9. Make good use of the technology to improve health
10. Children as a priority
11. Learn from the leaders
12. Sustainability

5. Keys to Success
 EHR Adoption
 Consumer Engagement
 Change Leadership
 Strengthen the “Trust Fabric” of health info exchange
 GOOD USE OF THE DATA!
And the Winner Is . . .
• Whoever can figure out how to take the tsunami of new health
data that is heading our way and turn it into actionable health
information.
• Whoever can help us move from surveillance and reaction to
event prediction and prevention.

6. Telehealth Technology for Rehabilitation
Public Health Problem
 It is difficult for persons with physical disability, particularly in remote areas, to
access health care.
 High cost and burden of travel.
 Limited rehab specialists in remote areas.
 Clinicians have limited insight into how individual is functioning in home
environment.
What is Telehealth?
 Telehealth is comprised of diverse technologies that allow health care to be
provided in situations where distance separates those receiving services from
those providing services.
 Telehealth changes the location for providing health care services from the
doctor’s office or hospital to the local clinic or the patient’s own home.

7. Telehealth Encounters by VA Providers

8. Telehealth – Rehab Clinical Trials
 Telerehabilitation for exercise & functional training:
 4 RCTs with Televideo alone or with other Teletechnology.
 4 different populations (geriatric gait disorder, post-stroke, ICU
survivor, post-op orthopedic surgery).
 Non-inferiority in clinical outcomes compared to Standard PT.
 Better functional outcomes , performance-based & self
report, compared to Usual Care (no PT).
 Equipment reliability and visual clarity a challenge in all studies

9. Teletechnology QI Study
 3 types physical function tested
 Fine motor coordination: finger taps (front view)
 Gross motor coordination: gait (lateral view)
 Spatial relationship: cane height (front & lateral views)
 Reliability & validity determined
 3 common Internet speeds (64, 384, 768 kps)
 In person (community standard) and slow motion videotape (gold standard)
 Internet bandwidth had a strong effect on validity and reliability for the fine
motor and gross motor tasks.
 Fine motor coordination - Reliability & Validity comparable to Standard Care
@768 kps
 Gross motor coordination (gait ) – Validity not comparable to Standard Care
 Still spatial relationships - Reliability & Validity comparable to Standard Care
at all of the bandwidths

10. Teletechnology Infrastructure
Security
 HIPPA
 Full face image and/or Voice = PHI
 Can’t post cell phone video to U-tube for review
 Skype isn’t HIPPA compliant
Costs
 Equipment
 Internet access
 Who pays?

11. CCNC Informatics Center
Information Support for Patient-Centered Care
 Develop a better healthcare system for NC starting with public payers
 Strong primary care is foundational to a high performing healthcare system
 Additional resources needed to help primary care manage populations
 Must build better local healthcare systems ( public-private partnership).
Community Care is a clinical partnership, not a regulatory management agency.
 Physician leadership is critical. Providers who are expected to improve care
must have ownership of the improvement process
 Achieve savings through better quality and efficiency of care
 Timely data is essential to success

12. CCNC Informatics Center Data Flow

13. HC Data for Population Mgmt and QI
1. Identification of High-Risk/ High-Opportunity Patients for
Targeted Services (Examples: Identification of individuals with
above-expected preventable utilization, Hypertension Self-
Management Support)
2. Cost/utilization performance measurement coupled with
actionable information (Examples: Pharmacy Initiatives, In-
patient and ED Reporting)
3. Quality Measurement and Feedback coupled with actionable
information (Examples: Practice Views with
County, Network, and State Benchmarks; i.e., % eye exams for
diabetes patients)

14. ID of Patients for Case Mgmt
Historically, case management efforts have
= Historical or predicted costs for an individual been targeted at the highest utilizers
$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K
CRG#1 $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K
Expected potentially preventable costs
CRG#2
$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K
Priority patients for care management
CRG#3 $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K

15. NCB Prepared
A Public/Private Consortium (UNC, NCSU, SAS, DHS) focused on
bio-surveillance – accurately detect and rapidly analyze biological
hazards to ensure public health and safety.
• Improve early recognition of
outbreaks augmenting bio-
surveillance
• Improve situational awareness
• Faster and more accurate information
for decision makers
• Integration with emergency
management and law enforcement

16. Analytics – Reactive vs. Proactive

17. Data Value
PROCESS
Get Data
Use Analytics
Provide Information
CLIENT OPPORTUNITIES (?) Food Pharma
Finance Pub Health
EMS News

18. Focus on NC – Recurring Themes
 Government (US & NC) Funding
 Fundamental Change tied to Technology
 Big Data used predictively not reflexively
 Improve patient care
 Security
 Cost Models
 Opportunities!