Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved. The Future Direction of Health Care Information Technology John Glaser, PhD CEO,

Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.

The Future Direction of Health Care Information Technology

John Glaser, PhDCEO, Siemens Health ServicesSeptember 20, 2010

Page 2 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.

Increasing Growth in Healthcare Costs

Chronic Disease Under Control: Managed Care Plan Distribution, 2006

70 73

49

81

88

68

6056

30

0

25

50

75

100

Private Medicare Medicaid

Mean 90th %ile 10th %ile

Note: Diabetes includes ages 18–75; hypertension includes ages 18–85.Data: Healthcare Effectiveness Data and Information Set (NCQA 2007).

Percent of adults with diagnosed diabetes whose HbA1c level <9.0%

Uneven Care Quality

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 3

6057

53

68 67 66

4946

39

0

25

50

75

100

Private Medicare Medicaid

Mean 90th %ile 10th %ile

Percent of adults with hypertension whose blood pressure <140/90 mmHg

Diabetes Hypertension


Factors Contributing to Heightened Pressure on Health Care – Particularly Costs

Relentless increases in care costs to individuals and purchasers of care

Cost increases occurring against an adverse economic backdrop Federal government deficits State government revenue shortages Lingering economic recession for businesses Slow job growth, underwater mortgages and evaporated retirement plans for

consumers Suspicion that cost increases reflect monopolistic behavior rather than the true

costs of care

Lack of comparable increases in care quality and safety Problematic data on care quality

Too much care variation Data that distinguishes no one Overall poor performance on global measures of health


Techniques for Limiting Growth InHealth Spending and Likely Impact

Very Limited Impact Encourage Greater Use of

Preventive Services (Short-term)

• Limited Impact Provide Better Price and

Quality Information Require Patients To Pay

More Restrict Use of Harmful

Care Reduce Expense and Waste

of Medical Mal-Practice System

Reduce Administrative Costs of Insurance

Develop and Use Government Supported “Comparative Effectiveness Studies”

Greater Impact Restructure Payment System -- (Bundled

Payment and Value Based Pricing) Restructure Delivery System (Integrated

Care) Restrict Use of Marginally Useful Care Limit Supply of Expensive Services Incentives to Use Preventive Services

(Long-Term) Expand and Restructure Primary Care ---

Create Effective “Medical Homes” for Patients

Create a Governmental “High Cost Reinsurance System” with Effective Disease Management

Systems for Chronic Conditions Greatest Potential Impact

Gov. Regulation of Payments To Providers Establish Global Budgets

Source: Discussion at The Cash Catalyst Meeting, Stuart H. Altman, 7/15/10


Health IT as a Critical Enabler for Health Care Transformation

TIMETIME

Transformational Change in Health Care Delivery and Population Health - ACA

Technology Adoption and Use - HITECH

20042004 2012?2012?


Examples of Meaningful Use

Maintain an up-to-date problem list of current and active diagnoses

At least 80% of patients seen or admitted have at least one entry

Record smoking status for patients 13 and older At least 50% of patients seen or admitted have “smoking status” recorded

Send reminders to patients per patient preference for preventive/follow-up care (M)

Reminders sent to 20% of all patients seen that are over 65 years old

Provide patients with an electronic copy of their health information

At least 50% of patients who request an electronic copy are provided it within 3 business days

Provide summary of care record for each transition of care or referral (M)

Summary provided for at least 50% of all transitions of care or referrals

Capability to provide electronic syndromic surveillance data to public health agencies (M)

Perform at least one test of capacity to provide such data


Crosswalk of Meaningful Use, Standards and Certification Criteria

Meaningful Use

Objectives

Meaningful Use

Objectives

Certification Criteria

Certification Criteria

StandardsStandards

E-RxE-Rx Capability to E-Rx must be includedCapability to E-Rx must be included

NCPDP SCRIPT8.1/10.6 must be used

NCPDP SCRIPT8.1/10.6 must be used

Provide Patient Summary RecordProvide Patient

Summary Record

Capability to electronically transmit a patient summary record

must be included

Capability to electronically transmit a patient summary record

must be included

Continuity of Care Document (CCD) or

Continuity of Care Record (CCR) must be used plus

vocabulary standards

Continuity of Care Document (CCD) or

Continuity of Care Record (CCR) must be used plus

vocabulary standards

Electronically Submit Data to Immunization

Registries

Electronically Submit Data to Immunization

Registries

Capability to electronically transmit

immunization data must be included

Capability to electronically transmit

immunization data must be included

HL7 2.5.1 or HL7 2.3.1and

CVX Code Set

HL7 2.5.1 or HL7 2.3.1and

CVX Code Set


CMS Estimates of the Number of Providers who will be Meaningful Users in 2011

Scenario 2011 2012 2013

Eligible Professionals Low 10% 13% 15%

High 36% 40% 44%

Hospitals Low 30% 35% 46%

High 43% 58% 73%

Baselines considerations (2008):

29% of hospitals have some level of medication CPOE (AHA)

4% of eligible professionals have a full function electronic health record


32 million now covered

Closes Medicare donut hole

Expands Medicaid

New private insurance regulations

85% of insurance premiums to care

Cadillac Tax on high-cost plans

Insurance industry taxed $70 billion

Pharma to contribute $84 billion

2.3% tax on medical devices

Medicare payroll tax increase to 2.35%

3.8% Medicare tax on high incomes

Comparative Effectiveness Research

Bundled Payment Program

Accountable Care Organizations

Patient Re-Admission Penalties

Value-based payments for Hospitals



Expands Medicaid
















Expands Medicaid
















Expands Medicaid














The Health Care Reform Legislation focused on Access but has Significant Payment Reform Provisions

Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.

$940 billion over ten years


Changing Perspective

SpecialtyHospitals &

Clinics

Provider-centric Person-centric

Implications• Data/information/knowledge focus (not function/UI focus) • EHR focus shifts to coordination and collaboration • Open, standards-based data exchange• Move towards person controlled data access

RetailClinics

GeneralHospitals

Employers

NetworksThat Profit

From Health

FacilitatedPatient

Networks

IndependentPhysicians’Practices

AcademicMedicalCenters

Provider

Provider

Provider

Provider

ProviderProvider

Provider

Provider

Provider


Horizon 1 - Exchange

Horizon 2 - Orchestrate

Horizon 3 - Guide

HIT Market Evolution

2009 2013 2015 2017Low

High

Market Evolution

Exchange•Non-disruptive secure sharing of normalized patient data

•Respects privacy boundaries•Directed push dominates

Drivers•MU stages 2, 3•Physician recruitment•Federal/state grants

Orchestrate•Builds on Exchange•Actionable, supports care coordination across settings

•Driven by care guidelines, care-giver arrangements

Drivers•Payment reform, bundled payments

•ACOs, medical homes

Guide•Builds on Orchestrate•Provides care-givers with contextual knowledge at PoC

•Supports translational research

Drivers•Heightend eimbursement pressures

•Comparative effectiveness implementation

Stakeholder Value


Lower Altitude but Still High Altitude Ramifications

From now on Medicare/Medicaid payments will be materially based on effective use of EHRs Beginning with meaningful use And moving to payment reform

Meaningful use pressure will “snowball” Payment reform and increased care accountability assume meaningful use Commercial health plan incentives may be based on an assumption that

meaningful use has been achieved Maintenance of certification may have meaningful use requirements Will licensure and/or accreditation consider meaningful use status?

Industry EHR development agenda will be increasingly dominated by certification, interoperability, meaningful use and ACA requirements The Federal agenda will define the EHR


Lower Altitude but Still High Altitude Ramifications

The presence of a broadly adopted EHR will cease to be a competitive differentiator. Differentiation could occur in several areas: EHR-leveraged care improvement within the organization and with other

providers

Care analyses and secondary use of data

Superior utilization of clinical decision support

Engagement of the patient in their care

A wide variety of new “species” will enter the healthcare information technology market They will focus on secondary use of data and delivering “intelligence” to the

care process extending into the EHR


Health Plans (and others) are Making Moves


Health Plans (and others) are Making Moves


Near Term Ramifications for Information Technology

Electronic health record Core EHR capabilities, e.g., manage a problem list and eprescribing, remain very

relevant

Other functions increase in importance Ability to identify and track a patient across multiple organizations

Clinical decision support to deliver evidence-based guidelines, reminders, order sets and alerts

Disease registries to provide analyses of care processes and outcomes for a population

Care documentation

Some functions are new Technologies to support care coordination and care team collaboration, e.g., discussion rooms and event

messaging

Health Information Exchange Initial exchange efforts will be focused on a well defined set of clinical relationships

Enable exchange of “directed push” transactions

Support messaging of patient events, e.g., missed radiology procedure appointment


Near Term Ramifications for Information Technology

Data Management Business intelligence tools to support

Assessment of care quality and costs for cohorts of patients (episodes and bundles)

Analyses of practice variations

Examination of care delivery alternatives

Predictive modeling to identify high risk patients

Personal Health Records Provide patients with access to their EHR data

Support communication with care team

Enable direct entry of data

Provide access to health information and self management tools


Identifying a CMP Patient


Email and Page Alerts – Admissions and Discharges

From: Care Management Program Admit Notification [mailto:[email protected]] Sent: Thu 01/01/2008 12:00 PM To: Neagle, Mary Subject: ABC Patient MRN 123456 Has Been Admitted to the ED at approx 17:26 on 07/10/2008 (AMN)

Neagle, Mary, your patient ABC Patient MRN: 123456 Has Been Admitted to the ED at approx 12:00 on 01/01/2008 (AMN) With a Chief Complaint of: CP/ SOB

*** This alert is generated when a patient is REGISTERED in the ED *** *** Clinical information may not be immediately available ***


Inpatient Census – Real Time


We are in for a Tumultuous but Exciting Period of Time

Payment change is THE “disruptive innovation” in care delivery

The Federal agenda “defines” several aspects of the healthcare information technology industry: Conceptual models of healthcare information technology

Definition of the electronic health records

Interoperability and exchanges

Standards

Adoption and implementation support (RECs)

A wide range of new entrants with innovative ideas and diverse interests will enter the market


?Questions

Documents

Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved. The Future Direction of Health Care Information Technology John Glaser, PhD CEO,