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The Role of Health IT in Health Care Transformation. Judy Murphy RN, FAAN. The Role of Health IT in Health Care Transformation. Judy Murphy, RN, FACMI, FHIMSS, FAAN Deputy National Coordinator for Programs & Policy Office of the National Coordinator for Health IT - PowerPoint PPT Presentation
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Judy MurphyRN, FAAN
The Role of Health IT in Health Care Transformation
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The Role of Health ITin Health Care Transformation
Judy Murphy, RN, FACMI, FHIMSS, FAANDeputy National Coordinator for Programs & PolicyOffice of the National Coordinator for Health ITDepartment of Health & Human ServicesWashington DC
10-12-2012, 9 - 10amTransforming Health Care: Driving Policy
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What I Will Cover . . .
• Today’s Health IT landscape
• Quality and the new IOM Report
• Consumer eHealth
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• President Bush’s goal in 2004
• Executive order established the Office of the National Coordinator for Health Information Technology (ONCHIT) as part of the Dept of Health & Human Services (HHS)– Dr. David Brailer appointed the first National Coordinator
“… an Electronic Health Record for every American by the year 2014. By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”
- State of the Union address, Jan. 20, 2004
A Bit of History …
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“To lower health care cost, cut medical errors, and improve care, we’ll computerize the nation’s health records in five years, saving billions of dollars in health care costs and countless lives.”
- First Weekly AddressJan. 24, 2009
• February 17, 2009 – the American Reinvestment and Recovery Act (ARRA – Stimulus Bill) is signed into law– HITECH component of ARRA provides an incentive program to
stimulate the adoption and use of HIT, especially EHR’s– Dr. David Bluementhal appointed the new National Coordinator
The Time is Now …
• President Obama’s goal in 2009
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• HR 1 -- 111th Congress• $787 Billion• Highly partisan vote• Healthcare gets $147.7 Billion
• $87B for Medicaid• $25B for support for extending COBRA• $10B for NIH• HITECH Component:
• $22.5B for EHR Incentives through CMS• $2B for HIT Support Programs through
ONC
HITECH = Health Information Technology
for Economic and Clinical Health
American Recovery & ReinvestmentAct of 2009 (ARRA / Stimulus Bill)
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IOMFuture of Nursing Report
Oct 2010
The focus on HIT continues …
PCAST ReportDec 2010
(President’s Council ofAdvisors on Science
& Technology)
PPACA Mar 2010(Patient Protection & Affordable Care Act)
“There is no aspect of our profession that will be untouched by the informatics revolution in progress.” - Angela McBride, Distinguished Professor and University Dean Emeritus Indiana University School of Nursing
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A Remarkable Journey
Meaningful Use
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Progress of Eligible Professionals Toward EHR Incentive Payments
Source: CMS EHR Incentive Program Data as of 8/31/2012
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Progress of Eligible HospitalsToward EHR Incentive Payments
Source: CMS EHR Incentive Program Data as of 8/31/2012
Note: Totals reflect the number of unique hospitals
that have received payments from Medicare or
Medicaid.
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Source: CMS EHR Incentive Program Data
Meaningful Use – All Paymentsas of August 31, 2012 ($ in Millions)
Jan-11 Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11 Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12 Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12 Aug-12
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$22 $16 $26 $31
$109 $80
$116
$276 $237
$387
$608
$836
$563
$619 $659
$620 $586
$428 $396
$505
Cumulative Total$7,120
Payments to All Eligible Professionals and Hospitals Under the Medicare or Medicaid EHR Incentive Programs
Amou
nt P
aid
per M
onth
(Mill
ions
)
Cum
ulati
ve A
mou
nt P
aid
(Mill
ions
)
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EHR Adoption by Ambulatory Providersas of 8-31-12
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HIT as the means, not the end
Dr. David Blumenthal, previous National Coordinator of HIT, emphasizes“HIT is the means, but not the end. Getting an EHR up and running in health care is not the main objective behind the incentives provided by the federal government under ARRA. Improving health is. Promoting health care reform is.”
- At the National HIPAA Summitin Washington, D.C.
on September 16, 2009
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Our National Quality Strategy
Better Health for the
Population
Lower Cost Through
Improvement
Better Care for Individuals
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Health Information Technology
Improving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity.
Better healthcare
Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care.
Better health
Lowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries.
Reduced costs
$
Health IT:Helping to Drive the 3-Part Aim
16Stage 2 MU ACO’s
“Stage 3 MU”PCMH
3-Part Aim
Registries to manage patient
populations
Team based care, case management
Enhanced access and continuity
Privacy & security protections
Care coordination
Privacy & security protections
Patient centered care coordination
Improved population health
Registries for disease
management
Evidenced based medicine
Patient self management
Privacy & security protections
Care coordination
Structured data utilized
Data utilized to improve delivery
and outcomes
Data utilized to improve delivery
and outcomes
Patient informed
Patient engaged, community resources
Stage 1 MU
Privacy & security protections
Basic EHR functionality,
structured data
Utilize technology
Access to information
Transform health care
Meaningful Use as a Building Block
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Quality Measurement Enabled by Health IT
• Released July 2012• Contains a catalog of over 70
activities related to health IT and quality measurement
• Describes possibilities for the next generation of quality measurement
• Illustrates challenges facing advancement
http://healthit.ahrq.gov/HealthITEnabledQualityMeasurement/Snapshot.pdf
Best Care at Lower CostThe Path to Continuously LearningHealth Care in America
September 2012
iom.edu/bestcare
• Patient harm – One-fifth to one-third of hospital patients are harmed during their stay, largely preventable.
• Recommended care – Only about half of the recommended preventive, acute, and chronic care is actually received.
• Outcome shortfalls – If all states matched care quality in the highest-performing states, 75,000 fewer deaths would have occurred in 2005.
Why now?
Quality – persistent shortfalls
• Absolute expenditures – $2.6 trillion (2009), 17% GDP
• Relative expenditures – 76% increase health costs in past 10 years, overwhelming the 30% gain in personal income
• Wasted expenditures – $750 billion (2009)
• Opportunity costs – e.g. total waste could pay salaries of all first response personnel for 12 years
Why now?
Costs – unsustainable levels, waste
Why now?
Complexity – exponentially increasing
• Increasing information – Over 800,000 new journal articles per year; up 4-fold from 1970.
• New diagnostic factors in play – phenotypes, genetics, and proteomics.
• Multiple treatment factors in play – e.g. 19 medications per day for 79 year-old patient with osteoporosis, type 2 diabetes, hypertension, and chronic obstructive lung disease; over 200 other doctors are also providing treatment to the Medicare patients of an average primary care doctor.
The Result?The U.S. health care system today
The VisionContinuous Learning, Best Care, Lower Cost
Foundational elements1. The digital infrastructure – Improve the capacity to capture clinical,
delivery process, and financial data for better care, system improvement, and creating new knowledge.
2. The data utility – Streamline and revise research regulations to improve care,
promote the capture of clinical data, and generate knowledge.
Care improvement targets3. Clinical decision support4. Patient-centered care5. Community links6. Care continuity7. Optimized operations
Supportive policy environment8. Financial incentives.9. Performance transparency10. Broad leadership
10 Recommendations
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HealthIT.gov website for patients
Back in the Day…
“The obedience of a patient to the prescriptions of his physician should be prompt and implicit. [The patient] should never permit his own crude opinions as to their fitness to influence his attention to them.”
- AMA’s Code of Medical Ethics (1847)
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And Now…
“Patients share the responsibility for their own health care….”
- AMA’s Code of Medical Ethics (current)
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“Patients can help. We can be a second set of eyes on our medical records. I corrected the mistakes in my health record, but many patients don't understand how important it will be to have correct medical information, until the crisis hits. Better to clean it up now, not when there’s time pressure.” – Dave deBronkart (ePatient Dave)
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Consumer eHealth Pledge Programwww.healthit.gov/pledge
Over 400 organizations have Pledged to provide access to personal health information for 1/3 of Americans…
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Million Hearts – Provider Goals
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Million Hearts - Consumer Challenge
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Consumer Video Challenge Winner
Dr Funky's Blood Pressure Management Rx http://bloodpressure.challenge.gov/submissions/7498-dr-funky-s-blood-pressure-management-rx
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FOCUS ON INTEROPERABILITY• E-prescribing• Transition of Care summary exchange:
• Create & transmit from EHR• Receive & incorporate into EHR
• Lab tests & results from inpatient to outpatient• Public health reporting – transmission to:
• Immunization Registries• Public Health Agencies for syndromic surveillance• Public health Agencies for reportable lab results• Cancer Registries
• Patient View, Download and Transmit to 3rd Party
Stage 2 Meaningful Use Criteria
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What’s in Your Health Record - Consumer Challenge
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Consumer Video Challenge Winner
Mark’s Storyhttp://yourrecord.challenge.gov/submissions/9688-mark-s-story
www.myopennotes.org
OpenNotes: What Was Learned Tom Delbanco, MD; Jan Walker, RN, MBA; et al
Supported by: The Robert Wood Johnson Foundation
With additional funding from the Drane Family Fund and the Richard and Florence Koplow Charitable Fund
OpenNotes study results (Annals of Internal Medicine: 2 October 2012, Vol 157, No 7)Includes editorials by Michael Meltsner, an OpenNotes patient and Carol Goldzweig,
from the Veterans Health Administration http://annals.org/article.aspx?articleid=1363511
www.myopennotes.org
About the OpenNotes Study
• More than 19,000 patients
• 105 volunteer primary care physicians
• 3 diverse sites– Beth Israel Deaconess Medical Center– Geisinger Health System– Harborview Medical Center
• 12 months of sharing notes
http://www.youtube.com/watch?v=x-0KdtcBwfI
www.myopennotes.org
Patients Were Enthusiastic
• Patients used the notes• Up to 92% of patients across the 3 sites read their doctor’s note(s)
• Patients reported important benefits• Feeling more in control of their care (77-87%)• Better understanding of health and medical conditions (77-85%)• Doing better with taking their medications (60-78%)
• Patients were rarely (1-8%) confused, worried, or offended by what they read in their doctors’ notes
www.myopennotes.org
Doctors Experienced Little Disruption and Observed Benefits
• Few doctors reported impacts on their workflow• Longer visits (0-5%)• More time addressing patients’ questions outside of visits (0-8%)
• Some doctors changed how they wrote notes• 0-21% reported taking more time writing notes• 3-36% reported changing the way they wrote about mental health,
substance abuse, cancer, and obesity
• Many doctors described strengthened relationships with their patients
