Presentation made at the ITCH 2017 conference in Victoria.

1. IT for Bending the Healthcare Cost Curve:
The High Needs, High Cost Approach
Presented by: Douglas Morrison, CPA,CMA, Ph.D(c)
Co-authors: Karim Keshavjee, Aziz Guergachi, Shams Mohammed
February 17, 2017
ITCH Conference , University of Victoria, B.C.
LINK TO OPEN-ACCESS PAPER:
Keshavjee K, Morrison D, Mohammed S, Guergachi A. IT for Bending the
Healthcare Cost Curve: The High Needs, High Cost Approach. Stud Health
TechnolInform. 2017;234:178-182. PubMed PMID: 28186037.

2. Agenda
 Introduction
 The Problem
 Anderson’s 8 Attributes of Successful Healthcare Organizations caring for HCHN
Patients
 Review elements and opportunities to address HNHC patients
 Proposed InfoClin Health Informatics and IT Framework
 A Historical Functional Department DMU Model
 A Regional IT Effectiveness Framework
 Discussion and Feedback
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3. The Problem –The High Cost of Care

4.  Not all high cost, high needs patients are at End of Life
 High cost, high needs (HNHC) patients include
 People with severe disabilities
 People with complex chronic conditions
 People with severe mental disorders
 Most have some sort of socio-economic deprivation
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CONTRARY TO POPULAR OPINION…

5. Our Questions: Request for you feedback
 Are Anderson’s 8 characteristics of HNHC Patient Programs Broad Enough?
 Have we missed any key elements in the IT architectural framework?
 Is the IT architecture adequate or in need of redesign for HNHC patients?
 What more is required in our IT architectural framework ?
 How do we get to our goal of addressing the IT infrastructure needs to support HNHC patients?
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6. 1. Ability to Target HNHC Patients
 Integrated Regional mandate and funding model
 Psycho-social integrated care model
 Track and follow up with Patient and Family
 Proactive to keep patient involvement and
commitment to change
 Infrastructure, transformation, informatics and
clinical services
 Proactive and interactive technologies
2. Creative Environment for
Successful Leadership
 Pushes control down to expert-manager level
 Multi-threaded matrix provider model supported
by community based technology.
 Requires patient’s family advocate interaction
 Triad consultant model for ongoing information
management and clinical outcomes evaluation
 Local clinical informatics consultant experts
Mapping Anderson’s 8 Attributes
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7. 3. Structure Program to Improve
Team Communications
 Patient and family advocate communications
 Community care orientation with links to key
information sources to track progress
 IT to facilitate early behavioural changes in the
patient
 Drive iterative clinical processes through
collaborative push technologies via Web Services
4. Strategic Use of Data
 Proactive use of decision support data to evaluate
states of change
 Integrated and aggregated data across providers
 Context and environment specific informatics
models
 Patient and clinical outcome performance
evaluation
 Localized information and mathematical models
specific to targets and metrics
Mapping Anderson’s 8 Attributes
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8. 5. Interaction with Patients and
Family
 Web services IT infrastructure with links to key
information sources
 Plot patient progress and outcome targets
according to targets in a patient centred score
card
 Empower family to take ownership for change
through collaboration with NPs and RNs.
 NPs and RNs push the communications via Web
interactions.
6. Transitions of Care
 Patients push questions and requests via mobile
devices
 Patient census checking across providers
 Trends and way points to manage care plan across
nurse practitioners and allied health managers
 Empowering family through AI and quarterly
progress evaluation
 Easy respite and home care coordination
Mapping Anderson’s 8 Attributes
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9. 7. Periodic Updates
 Clinical value and performance evaluation on a
yearly basis
 Artificial Intelligence to compile data and provide
critical path analysis
 Education and reference library updates from
agencies providing directed content from decision
support specialists
 Corporate performance scorecards with new
measures and metrics beyond utilization
management, access and LOS.
8. Physicians Spend More Time with
Patients
 Distribute authority and responsibility via
collaborative IT
 Streamline clinical workflow across team with
yearly review of practices using decision support
consultants on a local basis
 Integrated IT architectures to track utilization,
demand, access and intensity by physician-patient
roster
 IT infrastructure supports clinical professionals
on a case by case basis - “Build up and Tear down
on a Needs basis”
Mapping Anderson’s 8 Attributes
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10. IT Framework for Regional HCHN Patient Care Keshavjee et al.

11. Understanding Inter relationships between Health Informatics,
Bureaucratic Structure and Information Technology
Redesign of the historical decision making model
to encompass a regional organization to manage
HNHC Patient Wellness
 Reference: Ancarani A., Di Mauro C., Giammanco M.D. Impact of
managerial and organizational aspects on hospital wards’ efficiency:
Evidence from a case study, European Journal of Operational
Research,194(2009) 280-293.

12. Regional IT Effectiveness Framework
Hospital
Functional Department Structure
Program Management
DMU
Functional Budget
Program Budget
Goals/Constraints
Production and Clinical CareWorkflow Collaboration
Regional Communication Bus + Data Aggregation + Integration + ITInfrastructure
Adjust General Orders &
Processes
Regional Health Governance Community Patient Management
Clinical Financial
Performance Evaluation
Patient Critical Path E.H.R.
Patient Scorecard
Utilization & Efficiency
Management
CareManagement
Collaboration
Allied Health Provider
Functional Department Structure
Program Management
DMU
Functional Budget
Program Budget
Goals/Constraints
Production and Clinical CareWorkflow Collaboration
Primary Care Team
Functional Department Structure
Program Management
DMU
Functional Budget
Program Budget
Goals/Constraints
Production and Clinical CareWorkflow Collaboration

13. Conclusion
 We have mapped Anderson et al.’s 8 attributes of organizations successful with
HNHC patients to an idealized IT infrastructure
 We have then mapped existing IT infrastructures in Canada to the idealized IT
infrastructure
 This gives regional players a roadmap to take their existing infrastructures and
migrate them to new, value added infrastructures that can support high value
activities known to improve care of HNHC patients
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