This document discusses the importance of self-advocacy and patient empowerment. It notes that the physician-patient relationship is no longer controlled solely by physicians, and patients are now expected to take a more active role in their own care. It also discusses changes in healthcare reimbursement models and the importance of monitoring outcomes and processes. Overall it advocates for teaching patients self-advocacy skills which help empower them and improve their health for a lifetime.

1. Advocating helps today
Teaching self-advocacy helps for a
lifetime

2.  No longer a physician controlled relationship
 Patients expected to comply or they will
receive less attention
 Changes in reimbursement to reflect FFS, and
changes in therapeutic outcome and process
 Risk adjustment for payment strategies
 Penalties for non-participating physicians

3. Jeffrey Harris
Untangled Healthcare
Untangled Healthcare
Assisting communities to monitor and
improve healthcare
www.untangledhealthcare.com
www.untangled health.com
All presentations on Slide share
Jeffharris@untangled healthcare.com
"Go to the people, live with them,
learn from them....
Start with what they know, build with
what they have...."
Lao Tzu

4.  Process and Outcome Measures
 Fee for Service
 Improvement from Baseline
 Accountable Care Organizations Carrot and
Stick

5. 28% of 500 persons with no previous healthcare visit in prior year to death

6. Monitor
Discover
Bio-Psycho-Social History
Goals, Wants, Needs
Activate
Insurance Exchange
Primary Care
Medical Home
Patient Contract
Evaluate
Patient Compliance
Disease Self Mastery
Learning Barriers
Assist
Identify and link
community
resources:
Transportation, Meals
on Wheels, Patient
Peers
Educate
Primary and Secondary Prevention
Self Monitoring
Resource Utilization
Urgent Care Guidelines
Communication Skills
Functional
Status
Physical
Social
Cognitive
Compliance
Comorbidity
Assist with
reporting
outcomes to
PCP

7. NHIN (National Health Information Network)
The components of HIT: NHIN, e-HR, e-Rx, e-labs, Secure messaging, online appoints,
Patient right to electronic file within 24 hours (not e-fax) Computerized order entry
Timeline-2010-2017
Health
Information
Exchanges
State Level
Community
HIE
Business
Domain HIE
Provider
Groups
Health Plans
The Patient’s Universe and Patients Rights to
Share
Prescription and
Diagnostic
Testing
Standards
Personal Health
Records
Hospital Systems and Ambulatory
Centers and Practices
Electronic Medical Record
Old Technology
Electronic Health Record
New Technology
HITECH Act Enforcement Final Rule
The Health Information Technology for Economic and Clinical Health (HITECH) Act,
enacted as part of the American Recovery and Reinvestment Act of 2009, was signed
into law on February 17, 2009, to promote the adoption and meaningful use of health
information technology.

8. Manual transcription errors of critical
information used to influence critical
treatment decisions continues to be the
largest source of “therapeutic
misadventure”

12. Identity
Verification
•Provider Info, e-HR info, PHR Info,
Demographics
•Involves requirement to produce audit
similar to credit report, who, what,
when, where
Access
Restriction and
Management
By Data Class
•HIV/SIDS, Mental Health,
Substance abuse, Sickle Cell,
Genetic Information, STD,
Developmental Diabetes
•The ability to control who can see,
edit, save: Includes time
limitations, embargoed records
Content
Preferences
•Service reminders, Labs, Advanced
Directives, Living Will, DNR,
Healthcare Proxy, Lab and test results,
Language needs, Clergy Preference

Components
of Access
Management
•Level or Status (Opt In, Opt Out)
•Involves requirement to produce
audit similar to credit report, who,
what, when, where
Consent
Information
•Requester type and location,
purpose and use, sensitive flags
such as Labs, Meds, Diagnosis,
Notes
•The ability to control who can
see, edit, save: Includes time
limitations, embargoed records
Content
Preferences
•Service reminders, Labs, Advanced
Directives, Living Will, DNR,
Healthcare Proxy, Lab and test
results, Language needs, Clergy
Preference

13. Local hospital affiliate
Local Pharmacy
Single Practice
EMR Silo
Non Integrated System Integrated System with e-HR
Health Info Exchange
EHR
Specialist EHR
PCMH
Sure
Scripts
Pharmacy
CommunicationBarrier
PHR
Hospital
System
EHR
Various Labs
LIMS
f
Imaging
PACS

21.  Located physician with knowledge of health
data interchange and motivation to heal
 Located surgeons who would treat me as equal
 Located tools online that worked and were
interoperable
 Created my own accounts {HealthVault,
Connected to
 Connected to CVS, SPINN secure
Communication and LabCorp

24. Decision Support

27. Who ordered
drug
Where did record come
from
Is this patient staying with
medical home or Dr. Shopping

33. In conclusion, patients hospitalized with CHF have a high risk for
readmission after discharge. Patients with a history of
hospitalization as a result of CHF, longer hospital stay, and a history
of hypertension are at increased risk for readmission, and our data
suggest that socioeconomic factors, including poor follow-up visits,
poor professional support, and no occupation, are also potentially
important predictors. Therefore a systematic CHF patient
management system that coordinates care in the hospital, outpatient,
and home settings is clearly needed to reduce the morbidity and
mortality of patients with CHF and thus lower the over-all costs for
the treatment of these patients.

34. Apparently
Healthy
•Educate on reform
•Educate on Medical Home
Episodic
Care
•Participate in care coordination
•Educate on provider selection and best
practices
Chronic
Care
•Participate in interdisciplinary coordination
•Monitor patient for self mastery

35. 2010-2011
Attestation to
implement
2012-2013
Proof of adoption
and population
management
2014-2020
Submission to
ACOs, penalties
for not complying

36.  HITECH Act
Bush administration effort to create a
standardized electronic health record
 Physician Protection and Patient Safety Act:
Charles Randle
 Accordable Care Act Present Administrate ion
Effort to alter reimbursement for first contact,
comprehensive and continuous care (Primary
Care Medical Home and Insurance Reform

37. DIABETIC GANGRENE
PRIOR TO AMPUTATION
DIABETIC WITH HEALTHY FEET
GOOD SELF MANAGEMENT
 My feet forever please