Working Session 4: Quality and Efficiency
Expanding the Use of Healthcare IT:The United States Initiative and the
Development of Healthcare IT in Japan
John D. Halamka, MDChief Information OfficerHarvard Medical School
Beth Israel Deaconess Medical Center February 26, 2011
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Agenda
• Need for a National Healthcare IT Program
• History of Healthcare IT in the US
• Major US Healthcare IT Initiative
• Current State of Healthcare IT in Japan
• Lessons for development of Healthcare IT Japan
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Need for a National Healthcare IT Program in US
• Improve quality of care
– High error rates– High variability in care quality
– Poor outcomes
• Improve efficiency of care– Low value: quality/cost
– Costs rising much faster than inflation
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Medical, Medication and Lab Errors Among Sicker Adults in US
International Comparison
AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom.Data: 2005 and 2007 Commonwealth Fund International Health Policy Survey.
EXHIBIT 16
2005 2007
United States
QUALITY: SAFE CARE
Percent reporting medical mistake, medication error, or lab error in past 2 years
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 5
Duplicate Medical Tests Among Sicker Adults in US
International Comparison
AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom.Data: 2005 and 2007 Commonwealth Fund International Health Policy Survey.
EFFICIENCY
2005 2007
United States
Percent reporting doctor ordered test that had already been done in past 2 years
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 8
International Comparison of Spending on Health1980–2005
* PPP=Purchasing Power Parity.Data: OECD Health Data 2007, Version 10/2007.
Average spending on healthper capita ($ US PPP*)
Total expenditures on healthas percent of GDP
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EFFICIENCY
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 61
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History of Healthcare IT in the US
• From 2001 – 2008 Bush Administration established • American Health Information Community
– Overall governance healthcare IT governance body
• Certification Commission for Health Information Technology– Test and certify the functionality of electronic health records
• Healthcare Information Technology Standards Panel– Harmonize standards for exchange of data among payers, providers, patients,
government
• Funded at $50 million per year
• Did not provide incentives to accelerate adoption
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Physicians’ Use of Electronic Medical Records in US
International Comparison
AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom.Data: 2001 and 2006 Commonwealth Fund International Health Policy Survey of Physicians.
EFFICIENCY
Percent of primary care physicians using electronic medical records
2001 2006
United States
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 11
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New National Healthcare IT Initiative in USObama Administration 2009 – 2011
• National policy
– Health Information Technology Policy Committee
• National standards with certification– Health Information Technology Standards Committee
• Regional extension centers and Health Information Exchanges – $2 billion
• Incentives to adopt and achieve “Meaningful Use” of Electronic Health Records
-- $21 billion
• Privacy and security protections
National Healthcare IT Funding
Regional Extension Centers: $643 million Health Information Exchange: $564 million Pilot Programs: $235 million Training: $118 million Health Information Network: $64.3 million Informatics Research : $60 million
Funding Targeted to Achieve Five Objectives in US$ 23 Billion Total
• Improve quality, safety, efficiency, and reducing health disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population and public health
• Ensure privacy and security for personal health information
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Current State of Healthcare IT in Japan
• Information silos in hospitals
• Little adoption of electronic health records
• Privacy concerns and other policies which restrict data sharing
• Lack of incentives to coordinate care
• Highly variable software functionality and workflow automation
12
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Goals for a Healthcare IT Initiative in Japan
• Care coordination for an aging population
• Cost control
• Safety improvements
• Quality measurement
• Privacy protections
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Working Session 4: Quality and Efficiency
Expanding the Use of Healthcare IT:The United States Initiative and the
Development of Healthcare IT in Japan
John D. Halamka, MD February 26, 2011
http://geekdoctor.blogspot.com
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