Transforming Care Delivery at the Point of Care: Barriers and Solutions

eHI Blueprint for ChangeHealthTechNet

November 16, 2007Page 1

Transforming Care Delivery at the Point of Care:

Barriers and Solutions

Christine BechtelVice President, Public Policy and Government Relations

eHealth Initiative



Who we are…

Our Mission:

Driving improvements in the quality, safety,

and efficiency of healthcare

through information and information

technology

eHI Members include:

clinicians, consumer groups, employers and healthcare

purchasers, health plans, health information technology (HIT) suppliers, hospitals and other

providers, laboratories, pharmaceutical and medical device manufacturers, pharmacies, public

health agencies, quality improvement organizations, standards groups, and state,

regional and community-based organizations



What we do…

Develop, disseminate and advocate for multi-stakeholder consensus

Monitor, analyze and influence the policy environment

Develop and disseminate tools and resources

Provide hands on technical assistance Launch learning laboratories



HIT Adoption

Adoption rates relatively low Overall 5%-39% with full or partial EHR,

depending on study• 5% functional EHR**• 14% minimally functional EHR**

– Hospitals: 24% with CPOE

Adoption of HIT that includes all critical functions is highly variable.

**Source: Preliminary data from MGH Institute for Health Policy, GWU and RTI, Nov. 2007



Minimally Functional EHR: Defined

Clinical notes Computerized orders for

– Prescriptions– Labs– Radiology

Viewing Results for – Imaging– Labs

Source: Preliminary data from MGH Institute for Health Policy, GWU and RTI, Nov. 2007



Functional EHR: Defined

Clinical notes Computerized orders for

– Prescriptions– Labs– Radiology

Viewing Results for – Imaging– Labs

Patient demographic data Patient problem lists Patient Rx lists Notes include medical

history, follow up Orders sent electronically

for Rx, labs and radiology Elec. Images returned Alerts for interactions, etc Out of range lab levels

highlighted Reminders for guideline

based interventionsSource: Preliminary data from MGH Institute for Health Policy, GWU and RTI, Nov. 2007



EHR Adoption Rates

Source: Preliminary data from MGH Institute for Health Policy, GWU and RTI, Nov. 2007



Barriers to EHR Adoption and Use

Lack of a sustainable business model– Unclear ROI, lack of capital

Concerns about the privacy and security aspects of this– Patients and Providers

Concerns about liability– What do I do with all this data?

Lack of demand – From patients, providers and payors



Barriers to EHR Adoption and Use

System selection Workflow change, loss of productivity Physician resistance



Physician Views of Barriers



Driving Transformation

Under current conditions, widespread adoption in physician practices by 2024 (Ford et al, JAMIA, January 06)

– Small practices largest challenge; deliver 60% of care Changing the trajectory requires:

– Aligning incentives to support a business case– Engaging Consumers – Creating interoperable standards – Supporting development of HIE– Privacy and Security Policies– Supporting physician adoption, esp. among small

practices



Federal Activities Offer Building Blocks

Office of the National Coordinator Standards Harmonization (HITSP) Standards Certification (CCHIT) Development and Testing of NHIN Prototypes (NHIN

Prototypes) – New Awards Just Announced Addressing Privacy and Security: The Health

Information Privacy and Security Collaboration (HISPC)

AHIC Now Transitioning to the Private Sector Secretary’s Value-Driven Healthcare Initiative CMS Demonstrations Funding by Other Agencies: AHRQ, HRSA, etc



National Private Sector ActivitiesServe as Building Blocks

Purchasers and Health Plans Beginning to Consolidate Expectations (in sync with Four Cornerstones); AQA, QASC, Employer Toolkit released in Feb 2007

Incentives Initiatives Getting Traction: Bridges to Excellence (18 markets) and IHA – focus on quality improvement, performance measurement and use of health IT

Consumer Facing Applications Rolling Out: Microsoft, Dossia, Google, RevolutionHealth, AHIP and BCBSA, rolling out as we speak, as market leaders such as WebMD continue to increase penetration



State-Level Policy Activity

In 2007 so far, 208 bills have been introduced across 50 states that refer to the adoption or implementation of health IT, nineteen of which have been signed into law in sixteen different states.

To date, 20 executive orders have been issued by governors in 15 states, which are designed to drive improvements in health and healthcare through the use of IT--eight executive orders in 2007 alone



Highlights From Our Survey of State, Regional and Local Efforts

2006 survey indicated 165 state and regional initiatives operating in 49 states, D.C. and Puerto Rico.

Most difficult challenge: sustainable business model

Payment system has great impact but there are near-term opportunities for sustainability

Criteria for success: building social capital, good business acumen and execution



Regional Approaches to Improving Health Care

“In the absence of substantial national health care reform, regional quality improvement efforts appear to offer the best hope for transforming American healthcare.”

Dr. Ed Wagner, MacColl Institute



With all of this activity, what do we do?

Where do we begin?



eHealth Initiative Blueprint?

A plan for action at the national, state and local levels that represents consensus among multiple stakeholders in healthcare on – shared vision, set of principles, strategies and

specific actions (including timelines) – for improving health and healthcare through

information and information technology.



eHI Blueprint

A guide to enhancing healthcare improvement strategies through use of health IT and health information exchange.

Key elements:– Role of Health IT in addressing healthcare challenges – Shared Vision– Consensus principles, strategies and actions in 5 areas– Overview of current initiatives– Key resources



Our Shared Vision High-performing healthcare system where:

– All those engaged in the care of the patient are linked together in secure and interoperable environments,

– The decentralized flow of clinical health information directly enables the most comprehensive, patient-centered, safe, efficient, effective, timely and equitable delivery of care [1]

• Where and when it is needed most – at the point of care.

[1] Institute of Medicine, 2001.



Our Shared Vision

Financial and other incentives are aligned to directly support and accelerate all of the key elements of transformation – – engaging consumers– transforming care delivery – improving population health

in a secure, private, and trusted environment



Process

More than 100 stakeholders participated directly in development – hands-on approach

More than 200 organizations participated in a broad variety of ways

Senior Staff and Outside Experts 36 committee meetings between April –

September



Transforming Care Delivery at the Point of Care



Transforming Care Delivery Shared Vision

Patient care is high quality, patient-centered, for a lifetime, and reflects a coordinated and collaborative approach.

Complete, timely and relevant patient-focused information and clinical decision support tools are available at the point of care– as part of the provider’s workflow

High quality and efficient patient care is supported by interoperable health IT and secure data exchange across all relevant stakeholders.



Overarching Strategies

Move Providers to Adopt Health IT Systems: – Getting Providers to Make the Decision

Supporting Adoption and Effective Use: – Providers Have Made the Decision to Adopt HIT, What Do They

Do Now?

Transforming Care Delivery Through HIT and HIE: – Providers have implemented the system, how do they transform

care?



Caveats

HIT not the goal; improved quality is HIT as essential enabling infrastructure Driving quality vs. HIT adoption

– First two broad categories focus on infrastructure development

– Third broad category focuses on transformation



Strategies for Transformation

1. Research what motivates providers to purchase health information technology,

as well as best practices for how health information exchange networks can play a role in HIT adoption.

2. Educate and motivate providers to adopt health information technology and use it effectively.

3. Educate providers about currently available incentives and financing options.

4. Monitor and report on adoption rates.



Strategies

5. Improve and expand incentives and financing options.

6. Provide education, tools and support, tailored to provider size and specialty, to help providers select and implement health information technology and use it effectively.

7. Ensure interoperability between and across all relevant stakeholders through common standards.



Strategies

8. Enable providers to collect electronic data at all points of care as part of the normal workflow, and to use health information for multiple purposes, including quality improvement, care management, billing, decision support, performance measurement, research, and initiatives to reduce health disparities and improve the health of the general population.

9. Establish and use quality measures and decision support tools.

10. Use and exchange digital health information to transform care at the point of care, in a team environment and across settings.



Example Actions



Key Take-Aways

Driving healthcare change will require aligning efforts around:– Engaging consumers– Transforming care delivery– Improving population health– Aligning incentives

With the foundational underpinnings of health IT, – while assuring privacy and security



Key Take-Aways

Will require finding common ground and building social capital across all the stakeholders in the healthcare system

Requires focus at multiple levels: national, state and local

It’s in the intersections that we will accelerate progress



Questions and Feedback

Search the Blueprint Online:– www.ehealthinitiative.org/blueprint

Christine Bechtel, Vice President of Public Policy and Government Relations– [email protected] – 202-624-3270

Documents

Transforming Care Delivery at the Point of Care: Barriers and Solutions