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Patient Safety & Health IT: A Meaningful Moment. David R. Hunt, MD, FACS Office of Provider Adoption Support Office of the National Coordinator for Health IT. Barbara McClintock (1902 – 1992). - PowerPoint PPT Presentation
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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
