Healthcare Highlights: HIT Drivers and Trends

Healthcare Highlights

HIT Drivers & TrendsWilliam “ Buddy” Gillespie

Director of Healthcare Solutions

Distributed Systems Services, Inc.

Former VP-CIO & CTO WellSpan Health, Retired

June 9 -10, 2011

Agenda

• HITECH & Meaningful Use

• HIT Drivers

• Trends

• Summary

Introduction

• Since the HITECH Act was passed in

February, 2009, healthcare executives

have felt the pressure to implement the

electronic health record and achieve

Meaningful Use status resulting in the

flow of incentive dollars over the next

five years.

Healthcare-Some Assembly

Required

5

HITECH-MU Objectives

• Adoption of certified EHRs

• Meaningful use of EHRs

• Incentive payments to eligible

professionals and hospitals

MU at a High Level

• Store, display, and report on key patient data

• Support provider initiatives for safe medication management

• Assist in identification of problems

• Promote exchange of clinical information (interoperability) in a standard way that others can use

• Provide patients with clinical information electronically

• Protect security and privacy using standards

• Report on clinical quality measures

HITECH-MU Objectives

• Investment in nationwide HIT

infrastructure

• Grant money for demonstration

projects & RECs

HITECH-MU Outcomes

• High quality, safe, effective, and equitable

care for all

• Seamless patient-centric care

• Realigned incentives and measures that

foster prevention, intervention, coordination,

and effectiveness

• Regional clinical information (HIE)

interoperability on a national backbone

Meaningful Use is a Journey

3-Stages over 5-Years

Challenges• Only 20% of Physician Practices have an EHR

• Competing projects on the horizon– MU

– ICD-10

– HIPAA 5010

– ACO

• Cost of IT Infrastructure

• Lack of Best Practices Use for ITSM

• Current focus on implementing vs. sustaining technology

Physician Use of EHR

Global Perspective

Hospitals continue to move up the HIMSS Analytics

EMR Adoption Model

CMS Stage 1 MU criteria for hospitals roughly correspond to Stage 4 of the HIMSS Analytics EMR Adoption Model

HIT DRIVERS

• Homecare

– Home health care

– Telemedicine

– Remote Patient Montoring

– Fiber

HIT DRIVERS

• Mobile devices/wireless access

– iPAD

– Other slate devices

– Smart Phones

– Security

– BIOMED Devices-Integration with

Electronic Health Record

HIT DRIVERS• Clinical documentation and CPOE

– Multiple vendors with semi-mature to mature products

– Still only small percent adoption by hospital physicians

– A couple of well-publicized failures/difficult starts

– Studies of ROI and safety benefits are mixed

– Doc’s don’t want to be data entry clerks, slowed down or continually warned about the obvious

– e-prescribing gaining steam

– Part of Meaningful Use!

HIT DRIVERS• Personal Health Records

HIT DRIVERS

• Restructure of Medical Records

Department

– Health Information Management

– Reporting Relationship

– Patient Portal

HIT DRIVERS

• ETL & Analytics

– Cloud Hosting

– ONC – MU Templates

– Data Warehouse

HIT DRIVERS

• Meaningful use

– Three Stages

– Physician Adoption

– Regional Extension Centers

HIT DRIVERS• ICD-10

– 2013

– Bigger than Y2K?

HIT DRIVERS

• HIPPA 5010

– 2012

HIT DRIVERS

• Health information exchanges (HIE)

– Models

– Stakeholders

– Sustainability

– Cloud Hosting

– State (PA) Status

24

Health information exchanges will be a growing U.S. healthcare opportunity

through 2015

Source: Boston Consulting Group estimate for IBM, Aug. 2010

The federal government has distributed more than $650 million to states to develop

state-led HIEs as part of the ARRA/HITECH law.

HIT DRIVERS• Medical Home

– Smart Medical Devices

• Accountable care organizations (ACOs)– Rules Published

– Reduced Revenue

– Cost pressure from downward revenue trend• First 3-years during start up

– Collaboration• HIE Role

– Competition vs. cooperation between providers• Hospital

• Physician

– Coordinated services and Patient Experience

– Patient role/provider-patient relationship

HIT DRIVERS

• Quality measures

– Six-Sigma

– Clinical Decision Support

– Analytics

HIT DRIVERS• HITECH Privacy and Security

– Fraud/abuse litigation increase

– Breaches on the rise• OCR website list of breaches

– Breach Notification• Cost

• Insurance

– Single Sign-on – Account Provisioning

– Encryption• Portable devices

• USB devices

HIT DRIVERS• IT shift to the cloud

– Private vs. Public

– Phased Approach• Exchange

• Help Desk

• Contact Center

• Virtualization

– IaaS, PaaS, SaaS

– Bandwidth

– Privacy and Security

– Service Level Agreements

– Cost Benefit• Operating vs. Capital Investment

30

HIT DRIVERS

• Mergers & Acquisitions

– Vendors

• Technical

• ISPs

• Payers into clinical and HIE market

– Providers

• Hospitals

• Physicians

– Payers

• Payers buying HIE vendors

HIT DRIVERS

• Other

– Disease management

– Evidence-based medicine

– Personalized medicine

– Genetic testing

– Value-based Reimbursement

– Individual insurance growth

– Medicare payment cuts

– Medicaid expansion

HIMSS Survey – HIT Priorities

34Source: Gartner provide technologies hype cycle, July 2010

HIMSS Survey – IT Infrastructure

36

Electronic medical records and digital medical imaging systems will drive data growth – and storage demand

HIMSS Survey – Barriers

Summary

• PHR disconnect /multiple PHRs –

personal data spread out across all

providers who deliver via their own

PHR

– Google

– Microsoft

Summary

• HIT – Cloud relieves cost pressure to sustain

infrastructure, especially for small entities with minimal capital

– Analytics (Clinical Decision Support) can be helpful in determining where care can be most cost-effectively and quality, delivered

– IT Leadership changing• CIO

• CTO

• CMIO

Summary• Lack of messaging/information sharing

between hospitals and other care providers (both in system and outside of system)

– Electronic Health Record Vendors• EPIC

• Cerner

• AllScripts

• NextGen

• PACS– Neutral Archive

– Migration to new solutions

– Storage

– Best of Breed vs. Single Solution

– Unified Communications

Summary• Care Continuum

– coordination of care – across the entire continuum of care (hospital, PCP, home health, LTAC, private practice, specialist, etc)

– location of care - drive to provide care at lowest cost location

– ACO and Collaboration

• ACO coordination will be difficult – reluctance to share financial and patient data with

competition

– desire to keep patient in the same system/network

MU

ICD-10

HIPAA 5010

ACO

Train Wreck Pending

The Current Trends

in HIT Leadership

and Staffing

HIT Staffing Pattern

Responders Could Select up to 3 Percent Continued… Percent

Clinical Application Support 41.7 PC Server Support 10.6

Process/Workflow Design 27.4 Database Administration 10.6

Clinical Informaticist 25.4 Financial Applications Support 9.5

Network and Architecture Support 20.9 Data Security 8.3

IT Security 20.9 We Don’t Currently Have Any

Needs

8.3

Clinical Transformation 20.4 IT Planning 6.8

Systems Integration 16.1 Programming 5.0

Clinical Champions 14.6 Internet/Intranet 4.8

Systems Design and

Implementation

14.3 IT Management 3.8

User Training 14.1 Regulatory/Reimbursement and

Accreditation Issues (e.g. HIPAA

and JCAHO)

3.5

Help Desk 12.1 Don’t’ Know and other .8

The Role of the

Healthcare CIO is

Shifting from

Technical Architect to

Process Change Agent

The Healthcare CIO

Role is

Changing……from

IT Manager to

Strategic Visionary

2010 Survey

2010 Survey

The HIT “Village”

• CIO

• CMIO

• CTO

• CSO

• Chief Innovation Officer

The CMIO’s Role

• A Role in Transition

• Reporting

Relationships

• Clinical Leader for IT

• Gaining Recognition

The CMIO’s Role

“CMIOs have a unique role in

advancing clinical systems….the

CMIO must be both visionary and

tactical –keeping one foot solidly

planted in the strategic camp

while periodically getting into the

weeds to keep the project on

track.”

From Chaos to change: the evolving role of the CMIO –

Dearborn Advisors

The Rising Role of the CMIO

• Over 1/3 of US health systems have

a Chief Medical Information Officer

(source: CHIME)

• 41 % of CMIOs have staff (source:

Gartner study 2009)

• 91 % of CMIOs are licensed

physicians, 68 % are still practicing

medicine (source – CMIO Magazine

2010)

• 36 % report to CIO

The CTO’s Role

• IT Infrastructure

• Technical Background

• Keeps the lights on

Thank You