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Jörg Studzinski, Director Research and Advisory Services
email: [email protected]
Frank Fritzsche, Manager Research and Advisory Services
email: [email protected]
Jan-Eric Slot, CHCIO, CIO / CMIO Bernhoven Hospital, CHIME-HIMSS
Email: [email protected]
Continuity of Care Maturity ModelPreliminary Assessment Report
21/09/2017
AGENDA
▪ The origin: “Droom” in Oss, Veghel, Uden -> Bernhoven, Synchroon, VGZ, CZ
▪ The Continuity of Care Maturity Model
▪Methodology
▪ Results
• Stakeholder Group Achievements
• Care Setting Achievements
Patient first, Bernhoven’s Dream
3
Rationale and Droom strategy
Critical success factors & experiences
New organizationalmodel
ICT & Continuity of Care
▪ Own strength as starting point of Dream (rather change ourselves than bechanged)
▪ Quailty improvement and volume reduction▪ Organize along the functions and 4 care models
▪ Create environment that supports these changes▪ Dream = docter in the lead ▪ 4 initiatives showcases ▪ Challenges
▪ Dream needs another organizational structure (C. Christensen)▪ 4 Care models have different dynamics and management models
▪ From patients in between our 4 walls to 400,000 citizens in the region
Bernhoven creates health specific value in 4 ‘’care-models’’
32 4
1Acute zorg: Op de SEH het beste van Bernhoven laten zien▪ Intensiveren van de
samenwerking met HAP▪ Versterken inhoudelijke
expertise op de SEH ▪ Inrichten van een
mensgerichte SEH▪ Bijdragen aan regiovisie
hoog-complexe acute zorg
Interventie zorgstraten: Selectief aanbod met boven-regionale allure. ▪ Alleen voldoende volume
interventies aanbieden▪ Apart organiseren van
interventies in zorgstraten▪ Samenwerken met de regio
voor laag volume verrichtingen
▪ Personaliseren van zorgproces
Diagnose- en indicatiestelling: Breed aanbod van gepersonaliseerde en gezamenlijke besluitvorming▪ Meer mogelijk maken in en ondersteunen van de 1e lijn▪ Verhogen van de kwaliteit van (monodisciplinaire)
besluitvorming ▪ Inzetten op integrale diagnostiek
Chronische zorg: Netwerkzorg binnen en buiten ziekenhuismuren▪ Organiseren van zorg samen met 1e lijn▪ Integraal begeleiden multimorbide ouderen▪ Uitbreiden van netwerk zorg
The Vicious Circle of Efficiency To Quality as the driver
More proceduresAnd services Less time for patient
Less time for quality
Efficiencydrive
Highercost
Lesscost Less overtreatment:
diagnostics, procedures
Quality
More time for patientMore time for quality
The Dream strategy is based on the convictionthat quality is the recipe for cost reduction.
6
Our strategy is supported by growing awareness that more healthcare is not always better
Dream is from, for and by docters
7
Dream strategy & initiatives
Organisation design
Ownership
Docter in the lead on 3 levels
Dream strategy started with the docters
All initiatives owned by medical docter
Dream transformation carried by 2 Chief Medical Officers
Medical Leaders in charge of 4 Care models
Participation model: specialists employees as well as
owners
Three major activities for the healthcare professional; and their translation into 4 care models (Clayton Christensen, Harvard)
8
Diagnostics
Acute zorg
Chroniccare
Interventioncarepaths
Activity
▪ Separating acute and elective patient streams in proces
and organization creates calm, peace of mind
Rational for care modelCare model
Advice & Treat (in acute setting)
Treat
Support
Advice▪ In Diagnostics there is time to reflect (do the right thing,
decision making with the patient)
▪ After joint decision making, efficiency and outcome
oriented (doing things right)
▪ Supporting patients takes place in the Continuity of Care,
▪ (Hospital, GP and at home)
Implementation of organizational model (matrix) for Bernhoven based on the 4 care models
9
Directie
Ondersteunende staf diensten
Medisch ondersteunende diensten
D&I Interventie zorgstraten Chronische zorg
ML BL ML BL
Acute zorg
Acute en intensieve
zorg
Acuut bedden-huis
Poli omgeving
ML BLML 2 BL
Verlos-kunde/ kind
Opname/ ontslag
OK interventies
Niet-OKinterventies
Electief beddenhuis
Chronische zorg poli
Transmurale netwerkzorg
ML BL
Vakgroepen
Vakgroep
Vakgroep
Vakgroep
Vakgroep
Vakgroep
Vakgroep
VGL (per vg)
Diagn. Bedrijf
Complex Hospital IT landscape (lots of legacy)
10
HIMSS Analytics by numbers
Now: start of continuity of care
13
Regional Patient Platform: Personal Health Environment
The Continuity of Care Maturity Model
CONTINUITY OF CARE MATURITY MODELA framework detailing the progressive capabilities healthcare organizations need to possess for seamlessly coordinated patient care across a continuum of care sites and providers. The model is scalable from small populations to large.
Patient Engagement
Care Coordination possible through structural and semantic interoperability
Resolve ID issues, enableHealth Information Exchange
Seamless patient record with automated care support capabilities
CONTINUITY OF CARE MATURITY MODEL
AdministratorsCEO/COO/CFO/CSOs
Clinical/Medical LeadersCMIO/CNO/CNIOs
Technology LeadersCIOs
Forge agreements, policies, and standards that allow and enable
progress
Drive clinical activities that enable and enhance coordinated care, pop
health
Build out Information & Technology that facilitates key strategies
CONTINUITY OF CARE MATURITY MODELPillars of Focus
• Health Information Exchange
• Patient Care Coordination
• Patient Engagement
• Analytics
• Organizational Strategy
• Pan-Organizational Capabilities
• Policy Level Initiatives
• IT Systems Capabilities
• Standards / Interoperability
• Security & Privacy
Clinical
Governance
Information Technology
Methodology
METHODOLOGY
Definition of Care Community and Care Settings➢ The Care Community for this engagement are the patients and citizen of Brabant North-East region.➢ Based on the requirements and objectives of Brabant North-East region the survey was conducted for
two different Care Settings: 1. Primary Care (Zorggroep Synchroon)2. Acute Care (Ziekenhuis Bernhoven)
1
Data Collection➢ Completion of Survey (~200 compliance statements, 5-point Likert Scale)➢ 1st round of completion by appointed care setting representatives: Aug 17th – 30th 2017➢ 2nd round of completion in on-site workshop setting (face-2-face) with care setting stakeholders and
HIMSS representatives: Sep 13th 2017
2
Data Analysis and Reporting➢ The data were analyzed using the HIMSS Analytics CCMM algorithm, with each compliance statement
being weighted depending on Capability Maturity (Stage), Relevance (Essential vs. Advanced) and Response Value (5-point scale)
➢ Findings were reported in PowerPoint format, with a first draft delivered on Sep 19th 2017.➢Overall timeframe: The project was carried out between 08/16/2017 (“kick-off meeting”) and
10/13/2017 (“delivery of findings”)
3
Results
1 2 3 4 5 6 7
1 47%
0 12%
0 30%
2 47%
1 50%
1 43%
0 44%
1 44%
0 28%
4 65%
EXECUTIVE SUMMARYOverall Achievements
Color Codes
red (0 to ≤ 0.5)
yellow (0.5 to < 0.7)
green (≥ 0.7 to 1)
STAGE 6
STAGE 5
STAGE 4
STAGE 3
STAGE 2
STAGE 1
STAGE 0
STAGE 7
Patient Care Coordination
Patient Engagement & Empowerment
Analytics
Health Information Exchange
Organizational Strategy
Health Authority Capabilities
Policy Level Initiatives
ICT Systems
Standards & Interoperability
Security & Privacy
CONTINUITY OF CARE MATURITY SCORE
OVERALL % OF STAGE ACHIEVEMENT
040%
ACHIEVEMENT
BY STAGEST
AG
E
OV
ER
AL
L
GOVERNANCE
CLINICAL
INFO TECH
EXECUTIVE SUMMARYOverall Achievements
▪ The care network consisting of Ziekenhuis Bernhoven (acute care hospital) and Zorggroep Synchroon (primary care organization) fulfills 40 percent of all CCMM requirements. It currently achieves CCMM Stage 0.
▪ Overall, Ziekenhuis Bernhoven achieves 43%. With 37% Zorggroep Synchroon has a somewhat lower compliance.
▪ Ziekenhuis Bernhoven scores higher in terms of analytical capabilities and organizational strategy, while ZorggroepSynchroon is more advanced in terms of patient care coordination.
▪ Both care settings demonstrate good compliance in the area of security & privacy and health information exchange.
▪ Patient engagement and interoperability & standards show the greatest need for further development.
More details will be provided with the final report.
Stage 0 0 0 0
Total Achievement 40% 34% 45% 48%
Stage 7 8% 8% 12% 0%
Stage 6 22% 20% 28% 17%
Stage 5 19% 8% 36% 28%
Stage 4 36% 27% 32% 51%
Stage 3 39% 33% 46% 43%
Stage 2 56% 60% 44% 64%
Stage 1 65% 63% 69% 63%
Continuity of care engages multiple stakeholders across many organizations and progress can only be achieved in a team effort. High level CCMM results by stakeholder group reveal the following:
▪ Information Technology stakeholders have the most advanced achievement and fulfill 48% of all requirements.On Stage 1/2 the capabilities and achievements are similarly mature, falling to 43% in Stage 3.Between Stage 4 and Stage 7 capabilities decrease continuously.
▪ Governance stakeholders come on second rank and are compliant with 45% of CCMM statements. They nearly comply with the requirements of Stage 1 on the CCMM.
▪ Clinical stakeholder achieve 34% compliance and trail somewhat behind the other 2 stakeholder groups. Their capabilities in Stage 1 and 2 are similarly mature.
EXECUTIVE SUMMARYStakeholder Results
GOVERNANCECLINICAL INFO TECHOVERALL
Stage 0 0 0
Total Achievement 40% 37% 43%
Stage 7 8% 0% 17%
Stage 6 22% 21% 23%
Stage 5 19% 14% 23%
Stage 4 36% 39% 34%
Stage 3 39% 33% 45%
Stage 2 56% 52% 59%
Stage 1 65% 63% 68%
EXECUTIVE SUMMARYCare Setting Results
Providing Continuity of Care for around 280.000 citizens is challenging and each care setting might have made different progress. Looking at the CCMM results by care setting reveals the following:
▪ Between Stage 1 and Stage 6 Primary and Acute Care are very similar in their CCMM compliance compared against each other, while the Acute Care setting already complies with some requirements of CCMM Stage 7.
▪ Primary Care meets 37% of all requirements. Especially patient care coordination and health information exchange between different providers and health authorities is relatively advanced.
▪ Acute Care fulfills 43% of CCMM requirements and performs well regarding security & privacy as well as analytics.
PRIMARY CARE ACUTE CAREOVERALL
Stakeholder Group Achievements & Recommendations
Governance
Clinical
Information Technology
Stage 0 1
Total Achievement 41% 50%
Stage 7 National and local policies are aligned. 0% 25%
Stage 6 Policies address non-compliance. 27% 29%
Stage 5Best clinical practices are derived from care community healthcare
data and operationalized across the community.22% 50%
Stage 4Policies in place for collaboration, data security, mobile device use,and interconnectivity between healthcare providers and patients.
35% 29%
Stage 3 Data governance across organizations. 43% 48%
Stage 2Policies drive clinical coordination, semantic interoperability.
Change management is documented and standardized.38% 50%
Stage 1Policies for CofC strategy, business continuity, disaster recovery,
and security & privacy. Data governance is active.62% 77%
Stage 0 Governance is informal and undocumented.
RESULTSThe governance focus refers to organization strategy, health authority capabilities including HIE to authority and policy level initiatives. Goverance stakeholders achieve different levels of compliance given that Ziekenhuis Bernhoven and Zorggroep Synchroon are in early stage of collaboration to achieve care continuity.
CLINICALGOVERNANCE INFO TECH
PRIMARY CARE ACUTE CARE
Stage 0 0
Total Achievement 32% 35%
Stage 7Comprehensive pop-health. Completely coordinated care across
all care settings. Integrated personalized medicine.0% 17%
Stage 6Dynamic intelligent patient record tracks closed loop care delivery.
Multiple care pathways/protocols. Patient compliance tracking.18% 23%
Stage 5Community-wide patient record with integrated care plans,bio-surveillance. Patient data entry, personal targets, alerts.
6% 10%
Stage 4Shared care plans track, update, task coordination with alerts and
reminders. ePrescribing. Pandemic tracking and analytics.31% 22%
Stage 3Multiple entity clinical data integration. Regional/national PACS.
Electronic referrals, consent. Telemedicine capable.25% 41%
Stage 2Patient record available to multi-disciplinary internal and tethered
care teams. EMR exchange. Immunization and disease registries.59% 61%
Stage 1Limited shared care plans outside the organization. Leverage 3rd
party reference resources. Basic alerts.66% 60%
Stage 0 Engaged in EMR/EHR maturation.
RESULTSThe clinical focus includes coordinated care, patient engagement, analytics and HIE between provider. Clinical stakeholders of both care settings achieve similar compliance against the Continuity of Care Maturity Model and remain on Stage 0.
CLINICALGOVERNANCE INFO TECH
PRIMARY CARE ACUTE CARE
Stage 0 0
Total Achievement 44% 51%
Stage 7Near real-time care community based
health record and patient profile.0% 0%
Stage 6Organizational, pan-organizational, and community-wide CDS
and population health tracking.25% 10%
Stage 5Patient data aggregated into a single cohesive record. Mobile tech
engages patients. Community wide identity management.25% 32%
Stage 4All care team members have access to all data. Semantic data
drives actionable CDS and analytics. Comprehensive audit trail.50% 53%
Stage 3Aggregated clinical and financial data. Medical classification and
vocabulary tools are pervasive. Mobile tech supports point of care.37% 50%
Stage 2Patient-centered clinical data presentation. Pervasive electronic
automated ID management for patients, providers, and facilities.60% 68%
Stage 1 Some external data incorporated into patient record. 57% 69%
Stage 0 Data is isolated.
RESULTSThe IT focus includes ICT systems, standards & interoperability and security & privacy. Both Information Technology stakeholders remain on CCMM Stage 0. Acute Care IT already shows relatively strong compliance with Stage 1 & 2 criteria.
CLINICALGOVERNANCE INFO TECH
PRIMARY CARE ACUTE CARE
Care Setting Achievements
Primary Care
Acute Care
0 0 1 0
43% 35% 50% 51%
17% 17% 25% 0%
23% 23% 29% 10%
23% 10% 50% 32%
34% 22% 29% 53%
45% 41% 48% 50%
59% 61% 50% 68%
68% 60% 77% 69%
0 0 0 0
37% 32% 41% 44%
0% 0% 0% 0%
21% 18% 27% 25%
14% 6% 22% 25%
39% 31% 35% 50%
33% 25% 43% 37%
52% 59% 38% 60%
63% 66% 62% 57%
RESULTSStage and compliance achievements, overall and by stakeholder
Primary Care
Stage
Total Achievement
Stage 7
Stage 6
Stage 5
Stage 4
Stage 3
Stage 2
Stage 1
Acute Care
GOVER-
NANCE
CLINICAL INFO
TECH
OVERALL
ACUTE
CARE
PRIMARY
CARE
GOVER-
NANCE
CLINICAL INFO
TECH
OVERALL
Better knowledge. Better analysis. Better decisions.
THANK YOU
Jörg Studzinski
Director Research and Advisory Services
email: [email protected]
Frank Fritzsche
Manager Research and Advisory Services
email: [email protected]
