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 SystemIntegrated System with e-HR Health Info Exchange EHR Specialist EHR PCMH Sure Scripts Pharmacy Communication Barrier 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