Patient Safety & Health IT: A Meaningful Moment

Patient Safety & Health IT: A Meaningful Moment

David R. Hunt, MD, FACSOffice of Provider Adoption SupportOffice of the National Coordinator for Health IT

“It soon became clear, however, that tacit assumptions -- the substance of dogma-- served as a barrier to effective communication.”

Barbara McClintock (1902 – 1992)

Nobel Laureate, Medicine (1983)Nobel Banquet, December 10, 1983

mo·ment (mōיmənt)• n. [ME. < L. momentum, movement,

impulse, brief space of time, importance < movimentum < movere, to MOVE]

1. an indefinitely brief period of time

2. a definite point in time

3. a brief time of being important

4. importance; consequence

5. Mech. the tendency to cause motion about a point or axis

Archimedes of Syracuse (287 - 212 BC)

100

10

5. Mech. the tendency to cause motion about a point or axis

Take Home Messages

• Meaningful change must be led by clinicians

• Meaningful success is wholly dependent on partnership

• Transition requires a system, resources, and courage

(1) ensures that each patient's health information is secure …

(2) improves health care quality, reduces medical errors, reduces health disparities…

(3) reduces health care costs …

(4) provides appropriate information…

(5) ensures the inclusion of meaningful public input…

(6) improves the coordination of care…

(7) improves public health activities…

(8) facilitates health and clinical research and health care quality ;…”

Section 3001: The National Coordinator shall develop infrastructure that …

improve, ensure, reduce, protect, facilitate, promote, improve…(9) promotes early detection, prevention, and management of chronic diseases;

(10) promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved outcomes in health care services; and

(11) improves efforts to reduce health disparities.

Cont’d…

HITECH Act• Define Meaningful Use

• Support Attainment of Meaningful Use

• Establish Public Trust

• Foster Health IT Innovation

Source: CDC/NCHS National Ambulatory Medical Care Surveyhttp://www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.htm

EHR Use in U.S. Office-based Physicians

dashed = 2009 Preliminary est.

66%

50%

54%

44%

41%

39%

0% 10% 20% 30% 40% 50% 60% 70%

Capacity to select contract, install, implement

Transition productivity loss

Concerns about system obsolescence

Finding an EHR to meet needs

Uncertainty of return on investment (ROI)

Amount of capital needed

Major Barriers to Adoption of Electronic Health Records

DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care — A National Survey of Physicians N Engl J Med July 2008;359:50-60.

Maslow's Hierarchy of Needs

Maslow, Abraham (1954). Motivation and Personality.New York:. Harper. p. 236

Health IT Hierarchy of Implementation

Principles, Policies, Procedures, Protections, Enforcement

Functional, Reliable, Interoperable

Business case, ROI, Financial and Non-financial incentives

Adoption & Implementation

HIE, Public

Health, Efficiency, Research

Incentives & Penalties

Usable

Privacy

Engagement

Public Good

“…health care reform must focus on improvinghealth and health care value for patients…

…Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care.”

March 14, 2007—Vol 297, No. 10, pg. 1103

“…health care reform must focus on improvinghealth and health care value for patients…

…Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care.”

March 14, 2007—Vol 297, No. 10, pg. 1103

•Improved individual and population health outcomes

•Increased transparency and efficiency

•Improved ability to study and improve care delivery

Nutrition

QualityBasic Science

Research

Public Heath

Education

•Improved individual and population health outcomes

•Increased transparency and efficiency

•Improved ability to study and improve care delivery

Meaningful Use of EHRs

Payment ReformComparative Effectiveness

Research

Prevention & Chronic Disease

Management

Individual Responsibility

Clinical Research

MedicalEducation

HealthLiteracy

•Improved individual and population health outcomes

•Increased transparency and efficiency

•Improved ability to study and improve care delivery

Meaningful Use of EHRs

Medicare & Medicaid

Incentives and penalties

•Improved individual and population health outcomes

•Increased transparency and efficiency

•Improved ability to study and improve care delivery

Medicare & Medicaid Incentives

and penalties

Adoption of EHRs

Meaningful Use of EHRs

Exchange of healthinformation

Regional extension centers

Workforce training

Medicare & Medicaid Incentives and penalties

State grants for health Information exchange

Standards & certificationframework

Privacy & Securityframework

Adoption of EHRs

Meaningful Use of EHRs

Exchange of healthinformation

•Improved individual and population health outcomes•Increased transparency and efficiency•Improved ability to study and improve care delivery

Research to enhance HIT

HITECH Act

Blumenthal D. Launching HITECH. N Engl J Med. 2010 Jan 4. http://healthcarereform.nejm.org/?p=2669

P. Breughel, the Elder, “Turmbau zu Babel,” 1563Kunsthistorisches Museum, Vienna

“A man who carries a cat by the tail learns something he can learn in no other way.”

Mark Twain 1835-1910

davidr.hunt@hhs.gov202-690-0024

http://healthit.hhs.gov