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Tom Lloyd: Each team will have approximately
five minutes to share their work. What are the big ideas floating around
out there?
Presenter: Roxane Townsend
Our ultimate goal is to be enabled by health information exchange (HIE).
We need shared guiding principles and to agree on shared goals and roles.
We need a fair and rational statewide healthcare financial model. Transparency
of activities and roles is important.
Our differences and issues included two key ones. These are priorities
due to requirements, and how external pressures and conflicts impact
our priorities. There’s a real conflict of demands based on where
you are geographically, the size of your area, or whether the area is
affected directly or indirectly by storms.
One of our issues was the magnitude of the devastation challenges.
And we need agreement on what redesigned healthcare really is.
Presenter: Ob Soonthornsima
We started by trying to identify a few principles. A priority is to
truly make the patient the center of our focus. Around that would be
appropriate security, providers, privacy, and care. To be effective
is to make sure the workflow is what it should be. We don’t want
the health record to be outside of the physician. It should be integrated
with the workflow. At the end of the day, we really want to get around
to improving the quality.
We do have some gaps and challenges. First of all, we think there is
a tremendous amount of change management that has to take place. Consumer
education and awareness is huge. Providers also need to go through this
change management process. We also talked about governance of projects
and to clearly identify who the stakeholders are. There needs to be
standards across the system, and one that will get to a vendor neutral
solution where no one vendor dominates.
The issue is that we have disparate groups across the state. We want
to make sure whatever common solution we put out there addresses
those different groups.
We need to make sure they match and work out the areas where they don’t.
Presenter: Peter Greaves
We heard common themes about time and resource constraints. We need
to identify the risks and mitigating circumstances. There was concern
that we have not clearly articulated the plan. There was a concern over
the short-term scope as well as what it is for the long-term. We also
agreed that we really need to leverage resources.
Differences and issues included discussion around standards and whether
the timeline was achievable. The real issue is policy. There were also
differences about the type and level of benefits.
Gaps included two key ones: technical and governance. Definitions
was another gap, as well as what data should be provided. What is the
minimum?
There is also a very real gap around patient ID and resources
on the ground. Policy, interfaces, and credentialing were other gaps
we identified.
We drew a model. We have a concern that the gaps need to go beyond
the state level. If we look at implementation on the national, state,
regional, and by entity across technical, policy, legal, and governance
issues, we need to make sure they all interface appropriately.
Regarding your alignment Hypertile, are you saying that it needs to
be done or that it should be around the scope?
We’re saying there is alignment that these are important, but
not in the current solution.
The underlying supposition is whatever is built should address strategic
issues as well.
Was there discussion about risks of building the proposal?
There was a broader discussion but not on that specifically. There
is concern about moving ahead on the assumption.
Do you view the Louisiana group as the prototype for statewide infrastructure
or as a model of how to work on things together?
If it works for everyone involved, we would like to see it pushed out
to the state. If it works as a prototype, it would work for the state.
Mark Frisse: From a Tennessee point of
view, there are three camps of thought. One is to extend the desktop
as it is now, the second aligns a plan with a specific vendor, and the
third is that if we build something and ask the right questions, the
money will be well spent. You have multiple agendas in every state.
You just have to stake out your ground and say this is worth trying
for a while.
There is a difference between conceptual framework and one of governance
and technology. Everyone needs to understand that is an ongoing process.
Presenter: Tony Keck
We all truly believe the delivery systems should be patient centric.
We shared the priority of building a system that not only improves care
delivery, but also empowers the patient and enhances their care experience.
That includes a system that takes care of overall healthcare. The information
is owned by the patient but we recognize that we’re all true believers
and not fully authorized representatives of our organizations and stakeholders.
We have payers, intermediaries, physicians, IT vendors, etc. So the
ownership of information probably differs among stakeholders. That became
one of our primary gaps.
Another gap was the perceived competitive advantage. There are misalignments
around ownership of data, incentives, and reimbursement. Other gaps
include incomplete records and lack of understanding around the value
of HIT.
We believe that health information should be exchanged between institutions
as patients desire.
Everyone should have access to the same information. It is what you
do with that information that determines how successful you will be.
What was the group’s dynamic about going back to the organization?
It’s not altruism really. Patient centric care is the definition
of why we’re doing all this, but there is no surprise that the
whole effort was kicked off by the financial side instead of the clinical
side.
One of the parts of the patient centric model is the selfish side of
pushing it from the institution side.
We see that in other areas as well, like online banking.
Tom Lloyd: So what are some of the big
Ah-ha’s? There seems to be alignment about what we want to do,
but not on how we do it. What about the new model shown? (Reference
Team A's hypertile). Do you understand it yet or does it need more work?
What about the time constraints and what leeway is there with that?
Is there a process we can go back to for relief? Is there wriggle room
in the contract? So we need to get realistic in what is going to be
delivered. What are the milestones we can show?
We’re not going to change the world by September 30,
but we do need to have an information exchange on some level by then.
That becomes the short-term scope.
Can we give the deliverables and timeline on the project?
Maybe that can happen later in the session.
Tom Lloyd: The next activity will project
out into the future. What will you have to think about to get the entity
level project underway? What is the basic data set that will be reasonable?
Those are things to think about without getting the fuller list.
We need to have those kinds of discussions today.
You’re creating something brand new and nobody in this room probably
understands everything. That’s why you’re all here this
week.
What is the going forward decision around this project or the ongoing
project? It still needs to be determined.
One of the primary purposes centers on the concept of HHS. We need
a roadmap of how to get there. In parallel, we are moving forward on
the policy agenda. So we are developing prototypes at the same time
we’re developing policy.
In Tennessee, we found that question to be divisive and the wrong question
to ask. We found that when people came together from across the state,
all felt there was wriggle room. We called it a portfolio of experiments.
We view this as a piece of the puzzle that will lead us forward in a
good way. You can talk about a small piece in a bigger puzzle, to handle
issues, without looking like you’re squeezing someone out. If
you don’t send the messages right, you’ll be distracted
by asking the wrong questions.
Over these two days, we should synthesize and create building blocks
to move forward. Is that some of the intent of this session?
There is a huge amount of consensus that has to happen. If we can come
to some agreement about shared goals that we all buy into and know what
can and can’t be done, we will have a roadmap for getting the
demonstrations done. If it works and we get buy-in, we can move the
whole state forward down the road. These two days are focused greatly
on the architecture that has to be built as a demonstration.
Tom Lloyd: We have team lists for the
next assignments. Each team has a different assignment. Okay, let’s
get to work!
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