Health Information Technology - Bringing Health Information to Life - David Blumenthal

8/8/2019 Health Information Technology - Bringing Health Information to Life - David Blumenthal

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Health Information TechnologyBringing Health Information to Life

DAVIDBLUMENTHAL,MD,MPP

NationalCoordinatorofHealthInformationTechnologyUSDepartmentofHealth&HumanServices

09.22.10


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Todays Agenda

TheProblem.TheSolution.

TheRoleofHIT. TheBarriers.HITECHAct.

Professionalism2


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A Familiar Story: A Broken System

COST $Billionsinunnecessaryandwastefulspending. Overuseputspatientsatrisk,drainsresources,andmakes

healthcarelessaccessibleandlesseffective.QUALITY Despiterapidadvances,thousandsofpatientsdieeachyear

frommedicalerror

COVERAGE

46.8millionuninsured;manymoreunderinsured

Office of the National Coordinator for Health Information Technology 3


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The Role of HealthInformation Technology

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HIT: The circulatory system of medicine.

Information: lifebloodofmedicine.

Wemanageinformationas

Hippocratesdidin400B.C.

HIT:themosteffectivetechnologiesforrecording,

transmittingandprocessing

information. 5


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How I learned to practice medicine:

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How my children will practice medicine:

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More practically:

HIE:Exchanginghealth

information

EHR: Electronicallycapturingandprocessing

informationaboutpatients

CDS:Improvedcaredecisions

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Health Information Exchange

(HIE)

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EXCHANGING PATIENT DATA

VocabularyStandards DeliveryProtocols

SecurityandTrustrelationships

Document/MessageStandards

DirectoriesandCertificates

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Information Exchange is a Team

Sport Thehealthcare

communityneedstoworktogethersocially,economicallyandpoliticallytocreateHIE

Theproblemisnotsoftware,buthumanware:competition,mistrust,andthelackofabusinesscaseforHIE

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WilsonGA,McDonaldCJ,McCabeGP=Jr.Theeffectofimmediateaccesstoacomputerizedmedicalrecordonphysiciantestordering:acontrolledclinicaltrialinthe

emergencyroom.AmJPublicHealth1982;72(7):698-702.

Clinical Decision Support (CDS)

Usesalgorithms,ordersets,guidelines,andinstitutionalpolicytoencourageevidence-basedpractices

Helpsprovidersimprovedocumentation,clinicaldecisionmaking,andguidelinecompliance,whilereducingutilizationofcare.

AllowsCPOEtochangepractice: Validatesorderappropriateness Verifiessimilarorderhasnotbeenplaced Abletostratifybasedonpatientcharacteristics

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Growth in Use of Advanced Imaging under

Medicare, 19952005

NEJMVolume361:841-843

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Outpatient CT examination volumes

SOURCE:SistromCLetal.Radiology2009;251:147-155

#orderedviaCPOE

#outpatientCTexams

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ONC Review of Recent Literature

UpdatesandexpandsGoldzweigetal.(2009)reviewofhealthITstudiespublished2004-2007

Focusesonpeer-reviewedarticlesdealingwiththecostsandbenefitsofhealthITsinceearly2007

Focusesonindividualoutcomeswithinarticlesandarticlesoverallconclusions.Outcomesinclude: Qualityofcare Efficiency/costsofcare Providerand/orpatientsatisfaction.

Resultsarestillpreliminary

Buntin,Hoaglin,Burke,Blumenthal(inprocessdonotcitewithoutpermission)15


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Searchyieldsbaselineof4,193

ar;clesprintedinEnglish2,692excludedby.tle

1,264excludedby.tle

plustheabstract269focused

onadop.on

64focused

onprivacy

orsecurity

231arYclesflagged

forinclusion

43Excluded

a>erfurther

review1

34Reviews

excluded

from

analyses

174Cost

andBenefit

Ar;cles

154Ar;cles

onCosts

andBenefits

101inUSA

1=E.g.reviewersdeterminedarYcledidnotaddressarelevantaspectofhealthIToritlackedoutcomes

Systematic Review Process

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Preliminary Findings

Vastmajority(142/154non-reviewarticles,92percent)positiveormixedfinding*

Morecomprehensivestudiesthatevaluatedbothefficiencyandeffectivenessofcareareoverwhelminglymorepositive(p=.0001)thanthosethatdidnot.

StudiesevaluatingEHRsarealsomorepositivethanthosethatdidnot(e.g.anERxstand-alone)(p=.03).

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Mixedfindingswerepositiveoverall,butatleastonespecificoutcomewasnegative


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US EHR Adoption

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Current Levels of Adoption by

Ambulatory Physicians

NoFunctionalEHR80%

37%intendtoinstallanewEHRsystemorreplace

currentsystemwithinthenext3years.

Source:

2009NaYonalAmbulatoryMedicalCareSurvey(NAMCS)ElectronicMedicalRecordsSupplement.

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Hospital adoption.

Hospitals(2009):13.5percentbasic.2.7percentcomprehensive.LargepercentageswithEHRcomponents.

Source:

2009AmericanHospitalAssociaYon(AHA)ITSupplement 20


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Major Barriers to EHR Adoption

PercentofphysiciansreporYngamajorbarrier

Source:

DesRochesCMetal.ElectronichealthrecordsinambulatorycareanaYonalsurveyofphysicians.NEnglJMed.359(1):50-60,2008Jul3. 21


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The Federal Governments

Response: HITECH ACT PartofAmericanRecoveryand

ReinvestmentActof2009(ARRA).

Addressesmajorbarrierstoadoption,andmuchmore.

Technicalassistance,supportandbetterinformation.

Money/marketreform.HealthInformationExchangePrivacyandsecurity.

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HITECH FRAMEWORK: MEANINGFUL USE

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Financial provisions:

Medicare/Medicaidincentives:$9-27billionstarting2011.

RewardtheMEANINGFULUSEOFEHRs Physicians:$44,000/$63,750over5-10years.

Penaltiesstartingin2015.Hospitals:$2MbonusplusextraDRG

payments.

Supportforadoption:$2billiontoOfficeofNationalCoordinatorforHealthInformationTechnology(ONC).

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Technical Assistance with Adoption

$693million60RegionalExtensionCenters.HealthInformationTechnologyResearchCenter.

$118millionTrainingover40,000newhealthITsupport

personnel

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Technical Assistance with Health

Information Exchange $564million

PromoteHIEthroughStateleadership OtherONCProgramsandPoliciesRegulationspecifyingstandardsand

certificationcriteria

RegulationcreatingcertificationprocessDevelopmentoftechnicalbasisfora

NationwideHealthInformationNetwork

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Privacy and Security as a

Foundation.

Privacy&

Security

HealthITOutcomes

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FEDERAL GOVERNMENTS ROLE:

Privacy & Security Bannedsaleofhealth

informationwithoutconsent.

Ongoingaudittrailrequirements

Federalactivityinenforcement

Expandedpatientrightstoaccesstheirinformation Innovativeencryptiontechnologytopreventbreaches

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Pillars of Meaningful Use

Patient&Family

Engagement

CoordinatedCare

Quality,Safety&Efficiency

Privacy&Security

ImprovedPublic&

PopulaYonHealth

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Office of the National Coordinator for Health Information Technology

Healthit.hhs.gov31

Conceptual Approach to Meaningful Use

Capture/sharedata

Advancedcareprocesseswithdecisionsupport

ImprovedOutcomes

2011

2013

2015

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Eligible

Professionals

(EPs)

Eligible

Hospitals

(EHs)

Objectives and Measures 25 24Measures requiring Yes/No Reporting 7 8

Measures requiring Numerator/Denominator Reporting 18 16

Core Set Criteria 15 14

Menu Set Criteria (must choose at minimum) 5 out of 10 5 out of 10

Reporting Period Year One of Application 90 days 90 days

Subsequent Reporting Period(s) 1 Year 1 Year

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Remaining challenges

HITECHagreatstart,butmanychallengestoimplementation.

Gettingregionalcentersupandrunning. Assuringinfrastructureforexchange. Trainingnecessaryworkforce. Sustainingeconomicincentivesforadoptionand

meaningfuluse.

Roleofoverallhealthreform. Definingfuturestagesofmeaningfuluse

KeepprovidersontheescalatortomoresophisticatedandbeneficialusesofHIT.

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Professionalism and HIT

Keycomponentsofprofessionalism.Uniquecompetence,basedinscienceand

demonstratedcapability.Self-governance.Moral/ethicalcommitments.

Within10years,useofEHRswillbeacoretechnicalcompetency.34


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Professionalism will drive HIT:

PrimarycarespecialtysocietieshaveallendorseduseofHITasanelementofmaintenanceofcertification.

Ipredict:ACGME.LicensingBoards.AMA/AAMCmedicalschoolaccreditation

willfollowsuit.

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Technology AdoptionWILLTHESTETHOSCOPEEVERCOMEINTOGENERALUSEIN

CLINICALMEDICINE?ASTRONGLYNEGATIVEVIEWEXPRESSEDIN1821

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QUESTION & ANSWER

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Health Information Technology - Bringing Health Information to Life - David Blumenthal