Unprecedented Patient Care Continuity
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The document discusses introducing Health Catalyst Embedded Care GapsTM to address gaps in patient care and continuity of care. Preventable illnesses and deaths continue to have major effects, and COVID-19 further delayed patient care and increased provider burnout. Embedded Care GapsTM aims to close more gaps in patient care by detecting illnesses sooner and reducing missed opportunities, while reducing administrative burden on providers through seamless integration with electronic health records during the patient visit. This allows addressing critical care needs and catching up on delayed care in a sustainable way.
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Unprecedented Patient Care Continuity
- 1. Unprecedented Patient-Visit Care Continuity: Introducing Health Catalyst Embedded Care Gaps™ November 2021
- 3. © Health Catalyst. Confidential and proprietary. Preventable Illnesses Health in the U.S. 3 - The Lancet Public Health, Oct 2020 27% of US health care spending is due to preventable illnesses Annual costs attributed to preventable illnesses estimated at over $730B Between ¼ and ½ of all deaths fall into the category of preventable deaths Source: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30204-8/fulltext, October 1, 2020
- 4. © Health Catalyst. Confidential and proprietary. The Primary Care Physician 4 Evaluating patients and making treatment decisions Responding to patient diagnostic and treatment data Tracking patient diagnostic data Screening patients for diseases Gathering patient preventive services utilization history Intervening on patient lifestyle factors Educating patients about disease-specific self-care activities Educating patients about medications Following up on referrals Responding to requests for Home Health Care orders Responding to prescription refill requests Handling forms for patients Receiving messages from patients Resolving messages from patients Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756167/, January 2018
- 5. A primary care physician would spend 21.7 hours per day to provide all recommended acute, chronic, and preventive care for a panel of 2,500 patients.1 Family doctors spend 86 minutes of “pajama time” with EHRs nightly 2 1: Link to Annals of Family Medicine | 2: Link to AMA
- 6. For each patient visit, physicians spend about 16 minutes on EHR Tasks https://www.hcinnovationgroup.com/population- health-management/news/13030978/survey-physician- sentiment-mixed-on-benefits-of-data-analytics-tools Primary care doctors spend more than 50% of workday on EHR tasks https://www.fiercehealthcare.com/practices /primary-care-doctors-spend-more-than-50- workday-ehr-tasks Overall, physicians spent 5.9 hours per weekday — 4.5 hours during clinic hours and 1.4 hours after hours — on EHR-related activities https://www.healthcaredive.com/news/another-study- highlights-ehr-burden-on-physicians/504805/ 6
- 7. © Health Catalyst. Confidential and proprietary. Poll Question 1 • Do your providers feel like they have the right information to have continuity in patient data? • Always – 8.1% • Sometimes – 86.5% • Never – 5.4% 7
- 8. © Health Catalyst. Confidential and proprietary. Only 39 percent of physicians said electronic health records (EHRs) provide all the data they need to care for their patients. Only 36 percent of physicians said they’re satisfied with the access they have to patient data within their existing workflows. 8 https://www.hcinnovationgroup.com/policy-value- based-care/article/13027025/complexity-of-quality- measures-lack-of-access-to-patient-data-significant- obstacles-on-the-path-to-valuebased-care https://newsroom.questdiagnostics.com/2018-07-17- New-Study-Reveals-Stalled-Progress-Toward-Value- Based-Care
- 9. © Health Catalyst. Confidential and proprietary. 9 Preventable illnesses continue to have a staggering effect on our population Our primary care physicians are burned out
- 10. © Health Catalyst. Confidential and proprietary. 10
- 11. © Health Catalyst. Confidential and proprietary. COVID-19: A Lingering Impact 41% of U.S. adults had delayed or avoided medical care including urgent or emergency care (12%) and routine care (32%) -cdc.gov 11 Source: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6936a4-H.pdf
- 12. © Health Catalyst. Confidential and proprietary. What Care Was Forgone Due to COVID-19? 12 Source: Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic JAMA Netw Open. 2021;4(1):e2034882. doi:10.1001/jamanetworkopen.2020.34882
- 13. © Health Catalyst. Confidential and proprietary. Why Did Patients Forego Care? 13 Source: Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic JAMA Netw Open. 2021;4(1):e2034882. doi:10.1001/jamanetworkopen.2020.34882
- 14. © Health Catalyst. Confidential and proprietary. COVID Impact to Physician Burnout 40% 61% 0% 10% 20% 30% 40% 50% 60% 70% 2018 2021 % of Physicians Experiencing Burnout 14 Source: https://physiciansfoundation.org/wp-content/uploads/2021/08/2021-Survey-Of-Americas-Physicians-Covid-19-Impact-Edition-A-Year-Later.pdf
- 15. © Health Catalyst. Confidential and proprietary. Hope after COVID The very existence of preventable disease and preventable deaths should be a rallying cry, a motivation for anyone in any health profession, and really for anyone in a position of responsibility for populations in general. 15 - The Lancet Public Health, Oct 2020 Source: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30204-8/fulltext, October 1, 2020 The COVID-19 pandemic has shown that health can come to the forefront of conversations. COVID-19 has resulted in the entire world changing its trajectory during the course of 2020, as national governments worldwide have aimed to prevent the pandemic from spreading. This has put prevention front and center. Can we not extend the lessons learned in the past year to bring about a permanent doubling down on prevention, putting it at the heart of our conversations on health, well beyond the COVID-19 pandemic? This would require us to embrace the notion that no amount of preventable illness or death is acceptable, and that the $730.4 billion could be repurposed.
- 17. © Health Catalyst. Confidential and proprietary. Feedback – Single-Blinded Interviews “The most valuable thing you can do in value-based care is get care gaps to the point of care …it’s utterly useless if you give them to them any other time.” - CIO “A 30 to 50% increase in performance would not shock me for a group that previously identified care gaps outside the EHR.” - Director of PHM Informatics “75% of work in population health requires embedding specifics like care gaps back into the EHR.” - AVP of Population Health 17
- 18. © Health Catalyst. Confidential and proprietary. Unprecedented Patient-Visit Care Continuity We need a way to: • Address gaps in patient care • Catch up on crucial care delayed during COVID19 lockdowns While we make sure that we: • Reduce provider burnout, or at minimum do not contribute to it • Reduce administrative burden on providers and office staff • Improve the patient visit experience With the goal of: • Closing more gaps in patient care • Detecting illness sooner, and slowing its progression • Reducing missed opportunities for revenue 18
- 19. © Health Catalyst. Confidential and proprietary. Unprecedented Patient-Visit Care Continuity 19 Bringing the pieces together DOS™ Data Operating System MeasureAble™ Embedded Care Gaps™
- 20. © Health Catalyst. Confidential and proprietary. 20 Distilling This John Smith Just Walked In and Needs an A1C and a Foot Exam Into This And Embedding it Into the EMR
- 21. © Health Catalyst. Confidential and proprietary. Seamless EHR Integration 21 Proactive Alerts Embedded in your Visit Workflow Documented Recommendations in the Encounter Note Patient Specific Alert Powered Directly from Health Catalyst
- 22. © Health Catalyst. Confidential and proprietary. Poll Question 2 Do your providers do pre-visit planning today? • Always – 13.8% • Sometimes – 58.6% • Never – 27.6% 22
- 24. © Health Catalyst. Confidential and proprietary. Traditional Visit Workflow 24 Patient Schedules a Visit Patient Checks In for a Visit Rooming Nurse Preps Visit for Provider Provider Sees Patients Provider Orders Diagnostic Tests Patient Goes To The Lab Provider Contacts Patient About Results
- 25. © Health Catalyst. Confidential and proprietary. Planned Visit Workflow 25 Patient Schedules a Visit Staff Plans for Visit and Orders Diagnostics Patient Checks In for a Visit Rooming Nurse Preps Visit for Provider Provider Sees Patients Patient Goes To The Lab Provider Contacts Patient About Results
- 26. © Health Catalyst. Confidential and proprietary. Manual Pre-Visit Workflow 26 Patient Schedules a Visit Staff Plans for Visit and Orders Diagnostics Patient Goes To The Lab Patient Checks In for a Visit Rooming Nurse Summarizes Visit for Provider Provider Sees Patients and Discusses Results
- 27. © Health Catalyst. Confidential and proprietary. Manual Pre-Visit Workflow 27 Patient Schedules a Visit Staff Plans for Visit and Orders Diagnostics Patient Goes To The Lab Patient Checks In for a Visit Rooming Nurse Summarizes Visit for Provider Provider Sees Patients and Discusses Results Saves Five Minutes of Provider Time for Follow Up Per Visit Adds 10 Minutes to Staff per Visit
- 28. © Health Catalyst. Confidential and proprietary. Embedded Pre-Visit Workflow 28 Patient Schedules a Visit Visit Automatically Summarized Patient Goes To The Lab Patient Checks In for a Visit Visit Automatically Summarized Provider Sees Patients and Discusses Results
- 29. © Health Catalyst. Confidential and proprietary. Embedded Pre-Visit Workflow 29 Patient Schedules a Visit Visit Automatically Summarized Patient Goes To The Lab Patient Checks In for a Visit Visit Automatically Summarized Provider Sees Patients and Discusses Results Saves Five Minutes of Provider Time Per Visit 45 Minutes Per Day or $300 In Potential Revenue
- 30. © Health Catalyst. Confidential and proprietary. 30
- 31. © Health Catalyst. Confidential and proprietary. Benefits Reduced Planning: • Automatic Decision Support • Computerized Documentation • Accurate Prep with Minimal Effort Efficient Visits: • Actionable Procedure Orders • Automated Visit Agendas • Fewer Clicks through the EMR Higher Quality Care: • Measures from the Source of Truth • No Margin of Error • More Time for your Patient 31
- 33. © Health Catalyst. Confidential and proprietary. Pilot Findings 33 Average Patient Has More Than One Measure to Address Helped Providers Close over 7,500 Gaps Providers Saved Time at Each Visit Care Gaps Averaged over $40 in Reimbursement
- 34. © Health Catalyst. Confidential and proprietary. Dramatic Score Changes 34 Embedded Care Gaps Go Live
- 35. © Health Catalyst. Confidential and proprietary. Poll Question 3 • How many ambulatory EHRs does your system have? • 1 – 52.6% • 2-3 – 26.3% • 4+ – 21.1% 35
- 37. © Health Catalyst. Confidential and proprietary. Availability Current Capabilities • Medication Refills • Care Gaps Current EHR Integrations • Epic • Cerner What’s Next? • Additional Workflow Integrations • Additional EHR Integrations 37
Editor's Notes
- October 2020 study by The Lancet Public Health Demonstrates the impact of preventable illnesses on spending and deaths in the US
- Our hero in the battle against preventable illnesses? The Primary Care Provider Study by the Veterans Health Administration involving 327 Primary Care Providers Catalogued a list of 14 discrete PCP tasks which fall on providers without assistance from staff team members Bottom Line: We are asking too much of our PCPs
- There is quite literally not enough time in the day for a primary care doctor to care for their patient panel Doctors are making up time after hours
- Physicians are spending 16 minutes per visit on EHR tasks More than half of a primary care doctor’s workday is spent in the EHR Of the almost 6 hours or EHR time spent in a workday, almost an hour and a half is spent after hours
- Almost 2/3 of physicians say that the EHR lacks data they need to care for patients A similar percentage lack access to the data they need to address patient care gaps in their workflows
- As preventable illnesses continue to weigh down our medical system, the combination of the burnout our providers are experiencing makes it feel insurmountable. But it gets worse…
- While COVID-19 had a dramatic impact on nearly every aspect of all of our lives, today we’ll discuss how it impacted patients and their preventable illnesses
- Due to COVID-19 and the associated office closures and stay at home orders, our ability to address care gaps and preventable illnesses was severely constrained as 41% of American adults delayed or skipped medical care
- According to the Journal of the American Medical Association with over 1300 respondants: Close to 2/3 of those who skipped care who reported having needed care, skipped preventative care About half skipped mental health appointments And around half reported a new severe issue, despite not seeking care
- From the same study: While a smaller percentage of those who skipped care or missed doses of prescription medication did so due to financial concerns, The top reason given was physician office closures, followed closely by fears of virus exposure All of this illustrates how our challenge of impacting the strain of preventable illnesses on our healthcare system and patient outcomes was impacted by COVID-19, but what about our primary care physicians?
- Provider burnout was a severe issue already, but COVID-19 made it much worse. In June 2021, the Physicians Foundation reported a drastic increase in provider burnout, growing from 40% to 61%. Is there a silver lining?
- How do we harness the energy around prevention that has taken over our everyday conversations around vaccination rates and masks and hand-washing? How can we double down on prevention? How can we arm our primary care providers with the insights they need to help their patients detect diseases early? To proactively address their chronic conditions? To take control of their health?
- To answer those questions, we asked people like you, and this is what we heard:
- Traditional office visit workflow Physician lacks lab results during appointment Added burden to provider and staff to contact patient about results Suboptimal experience for the patient who leaves appointment without provider advice
- Planned office visit workflow Physician is made aware of care gaps, but still lacks lab results during appointment Added burden to provider and staff to contact patient about results, with additional work required to manually plan the visit Still a suboptimal experience for the patient who leaves appointment without provider advice
- Manual Pre-visit workflow Unlike the previous scenario, the office staff coordinates with the patient ahead of time, asking the patient to visit the lab prior to the office visit. While this arms the physician with the lab results during the appointment, it adds a large burden on the office staff, negating much of the productivity gains.
- Manual Pre-visit workflow Unlike the previous scenario, the office staff coordinates with the patient ahead of time, asking the patient to visit the lab prior to the office visit. While this arms the physician with the lab results during the appointment, it adds a large burden on the office staff, negating much of the productivity gains.