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Healthcare InformationHealthcare InformationTechnologyTechnologySome Thoughts OnSome Thoughts OnFuture TrendsFuture Trends

Kim D. Slocum,Kim D. Slocum,FHIMSSFHIMSS

Director, StrategicDirector, StrategicPlanning & BusinessPlanning & Business

Development,Development,AstraZeneca LPAstraZeneca LP

March 4, 2004March 4, 2004

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Its About TheIts About The InformationInformation,,

Not TheNot The TechnologyTechnology

The enhanced use of healthcare informationThe enhanced use of healthcare information

technology is a means to an endtechnology is a means to an enda critical tool to:a critical tool to: Collect data and provide decision support tools,Collect data and provide decision support tools,

especially at the point of careespecially at the point of care

Share data between healthcare providers, payers, policyShare data between healthcare providers, payers, policymakers, and consumersmakers, and consumers

The end is more effective and more efficientThe end is more effective and more efficienthealthcare purchased on the basis ofhealthcare purchased on the basis of valuevalue andandoutcomesoutcomes rather than justrather than just unit costunit cost

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22%26%

23%

14%17%

13%14% 15% 14%

Did notfill a pr ription Had a specific medical

problem but did not visit a

doctor

Did notreceive a medical

treatment orfollow-up

recommended by a doctor

ncreased a lotncreased a littleStayed t e same

Cost Shifting Is A Blunt Instrument

Approach To Fixing HealthcareIn the past 12 months, was there a time when, because of cost, you

(Copays)

SOURCE:

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Each year, more than 57,000 people die because they do notEach year, more than 57,000 people die because they do notreceive the care that the medical profession and healthreceive the care that the medical profession and health

care community agrees they needthis is not a measurecare community agrees they needthis is not a measureof medical errors or an analysis of patient access to healthof medical errors or an analysis of patient access to healthcare...care...

despite recordperdespite recordper--capita spendingcapita spendingon health care,on health care, the quality of U.S.the quality of U.S.

medical practice badly trails the statemedical practice badly trails the stateof medical knowledgeof medical knowledge..

30 September 2003

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How Do We Bridge The Gap And DeliverHow Do We Bridge The Gap And DeliverThe Promise?The Promise?

Agreement On Healthcare Goals

What results/outcomes are valued?

Metrics/Measurement Systems

How do we collect andshare data between

stakeholders?

Compensation PlansHow do we align incentives to

secure delivery of theoutcomes we value?

Without electronic medical records, healthcare is doomed to

incremental improvements at best.Dr. George Halvorson CEO, KaiserFoundation Medical Group

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A GrowingConsensus On The RoleA GrowingConsensus On The RoleHITCan PlayHITCan Play

RAND Corporation launches study toRAND Corporation launches study to

measure efficiency/quality/safety gains tomeasure efficiency/quality/safety gains tobe had from advanced HIT usagebe had from advanced HIT usage

GAO report for Senator KennedyGAO report for Senator Kennedy

Center for Information TechnologyCenter for Information TechnologyLeadership studyLeadership study projectsprojects $87 billion$87 billion ininpotential system savings from ubiquitouspotential system savings from ubiquitousHITHIT

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Initial focusInitial focusimproving care for diabetic patients (will beimproving care for diabetic patients (will beexpanded to other conditions in future)expanded to other conditions in future)

Based on actuarial estimates of longBased on actuarial estimates of long--term costs for patient careterm costs for patient care(achievable savings of(achievable savings of $350$350 per patient per year)per patient per year)

Piloted in Louisville, Cincinnati, Boston (national rolloutPiloted in Louisville, Cincinnati, Boston (national rolloutanticipated in 2004)anticipated in 2004)

Initial approachInitial approachphysician/patient optphysician/patient opt--in with only upsidein with only upside

incentivesincentives $100 per physician per patient per year$100 per physician per patient per yeardiabetic care benchmarksdiabetic care benchmarks

$50 per patient per year$50 per patient per year

$55per physician per year$55per physician per yearinstalling clinical HIT reporting toolsinstalling clinical HIT reporting tools

Pay For PerformancePay For Performance

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60%Variation In Medicare Resource Use60%Variation In Medicare Resource UseIntensity For Equivalent PopulationsIntensity For Equivalent Populations

SOURCE: Wennberg et. al. Annals Of Internal Medicine 2/18/03

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TheCritical Importance Of HITTheCritical Importance Of HIT

As healthcare starts to shift from anAs healthcare starts to shift from an inputinput driven todriven toanan outputoutput driven model, outcomes assessmentdriven model, outcomes assessmenttools become critical to drive meaningful changestools become critical to drive meaningful changesin provider compensation systemsin provider compensation systems

Ifempowered consumers dont haveIfempowered consumers dont havequality/value information readily available, it isquality/value information readily available, it islikely that they will buy healthcare services solelylikely that they will buy healthcare services solelyon a price basison a price basis

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So Why Arent We There Yet?So Why Arent We There Yet?

Lack of standardsLack of standards

What data must be collected and how?What data must be collected and how? How does one system talk to another?How does one system talk to another?

High perceived cost of clinical systemsHigh perceived cost of clinical systems Especially acute forsmall practice settingEspecially acute forsmall practice setting

physiciansphysicians

Incentives like HITIncentives like HIT--enabled pay forenabled pay forperformance are not yet broadperformance are not yet broad--basedbased

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Emerging Federal Approach ToEmerging Federal Approach ToNurturing HITNurturing HIT

Focus on improving patient safety andFocus on improving patient safety and

biopreparednessbiopreparedness Legislative and executiveLegislative and executive--branch efforts underwaybranch efforts underway

Federal Health Architecture (FHA)Federal Health Architecture (FHA)

Consolidated Health Initiative (CHI)Consolidated Health Initiative (CHI)

National Health Information Infrastructure (NHII)National Health Information Infrastructure (NHII)

EHR functional model (in conjunction with private sector)EHR functional model (in conjunction with private sector)

ee--Prescribing and other HITPrescribing and other HIT--related provisions of 2003related provisions of 2003Medicare ActMedicare Act

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Remote Patient MonitoringRemote Patient MonitoringTechnologies Are Beginning To MatureTechnologies Are Beginning To Mature

Health Hero Network To Support

Remote Glucose Monitoring

Radio Shack Introduces NewProduct Line To Support

Consumer Health

Yahoo, Medem , WebMD Enter Diabetes

Monitoring Market

Health Hero Network Announces

Connectivity With Weight Scales,

Blood Pressure CuffsHigh Tech Underwear Could

Help Heart Patients

Diagnosis And Medicine In A Pill

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So What?So What?

New technologies will allow HIT to goNew technologies will allow HIT to goplaces it has seldom/never been beforeplaces it has seldom/never been before

Exam roomsExam rooms

Patients homesPatients homes

More information means we have aMore information means we have amovie instead of a photograph onmovie instead of a photograph onhow patients are doing, therebyhow patients are doing, thereby

improving quality of care by detectingimproving quality of care by detectingchanges in health statuschanges in health status earlyearly

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Attacking The SmallAttacking The SmallPractice SettingPractice Setting Traditional client/server applications are out ofTraditional client/server applications are out of

reach for roughly half of all US physiciansreach for roughly half of all US physicians

High costsHigh costs

Cash flow supported capital expenditure modelCash flow supported capital expenditure model

New offering from AAFPNew offering from AAFPpartnership withpartnership withseveral leading HIT vendors to reduceseveral leading HIT vendors to reduceinstallation costsinstallation costs

New Medicare Act contains grant monies,New Medicare Act contains grant monies,

safe harbors established for somesafe harbors established for somehealthcare entities to assist doctors withhealthcare entities to assist doctors withtechnology acquisition coststechnology acquisition costs

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The Genetic Revolution BeginsThe Genetic Revolution Begins

June 25, 2003

Roche Holding AG is launching the first gene test able to predict how a person

will react to a large range of commonly prescribed medicines, one of the biggestforays yet into tailoring drugs to a patient's genetic makeup.

The test is part of an emerging approach to treatment that health experts

expect could lead to big changes in the way drugs are developed, marketed and

prescribed. For all of the advances in medicine, doctors today determine the

best medicine and dose for an ailing patient largely by trial and error. The

fast-growing field of "personalized" medicine hopes to remove such risks and

alter the pharmaceutical industry's more one-size-fits-all approach in making

and selling drugs.

Leading the News: Roche Test Promises to Tailor Drugsto Patients --- Precise Genetic Approach Could MeanMajor Changes In Development, Treatment

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Converging Data Streams ShouldConverging Data Streams ShouldDriveClinical AutomationDriveClinical Automation

ComputerizedPatient Record

ConsumerDecision Support

ClinicalDecision Support

SOURCE: Health Futures, Inc.

Molecular(Genetic characterof self-pathogens)

Organ Systems(Anatomic detail)

Interventions(Orders, meds,procedures)

Tissues(Metabolism,pathology)

Cellular(Types, counts,receptors)

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Carbon And SiliconFutureConvergence

Well WellPre-Disposed

Symptomatic/AcuteTreatment

L/T FollowupCompliance

Carbon (Biology-Driven)

Silicon (Technology-Driven)

--Predictive testsbased on genetics

-- Patient histories--On-Line Assessments

-- Remote Monitoring

--MD/Pt. On-LineInteractions

--Implantable

smart devices

--Tailored treatmentplans

--Rx with lower sideeffects/ better efficacy--New therapy modalities

(e.g. gene therapy)

-- Portable data

following at risk

Patients for life

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Where HIT Needs To Be

I/P LabSystem

RadiologySystem

Hosp. BillingSystem

Pt. Registration

System

HospitalInterface

I/P PharmacySystem

O/P PharmacySystems

Home HealthSystem

O/P LabSystem

Elec. Med.Record

Office Billing

System

MD OfficeInterface

Pt. ReportedData

(On-Line Dx)(QOL Data)(Compliance)

MasterInterfaceEngine

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How YouCan HelpHow YouCan Help

Support for existing efforts (FHA, NHII, EHRSupport for existing efforts (FHA, NHII, EHRfunctional standard, Medicare HIT provisionsfunctional standard, Medicare HIT provisionsand quality demonstration programs)and quality demonstration programs)

Action on challenge of patient identifiersAction on challenge of patient identifiers

(voluntary patient identifier) that will help(voluntary patient identifier) that will helpdata sharing between stakeholdersdata sharing between stakeholders

More creative incentives, especially forMore creative incentives, especially forphysiciansphysicians

Potential consideration of bigger, broaderPotential consideration of bigger, broadersafe harbors for HIT investment to spursafe harbors for HIT investment to spurprivate sector help in wiring Americanprivate sector help in wiring Americanmedicinemedicine

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BalancingCost and ValueBalancingCost and Value

Hosp.

MD Other Rx

How much am I paying?

Focus on: component

costs

Lever:

forced

ratesetting

Hosp.MD Other Rx

What am I buying?

Focus on: overall value

Levers:

Creating/sharing info.

RESULT:Uncoordinated careAdversarial relationships

RESULT:Coordinated careCollaborative relationships

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Thank You