david blumenthal 09-22-10
DESCRIPTION
ONC PresentationTRANSCRIPT
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Health Information Technology Bringing Health Information to Life
DAVID BLUMENTHAL, MD, MPP National Coordinator of Health Information Technology
US Department of Health & Human Services
09.22.10
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Today’s Agenda
• The Problem. • The Solution. • The Role of HIT. • The Barriers. • HITECH Act. • Professionalism
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A Familiar Story: A Broken System COST • $Billions in unnecessary and wasteful spending. • Overuse puts patients at risk, drains resources, and makes
healthcare less accessible and less effective. QUALITY • Despite rapid advances, thousands of patients die each year
from medical error
COVERAGE • 46.8 million uninsured; many more underinsured
Office of the National Coordinator for Health Information Technology 3
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The Role of Health Information Technology
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HIT: The circulatory system of medicine.
Information: lifeblood of medicine.
We manage information as Hippocrates did in 400 B.C.
HIT: the most effective technologies for recording, transmitting and processing information.
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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: Exchanging health information
EHR: Electronically capturing and processing information about patients
CDS: Improved care decisions
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Health Information Exchange (HIE)
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EXCHANGING PATIENT DATA
Vocabulary Standards Delivery Protocols
Security and Trust relationships
Document/Message Standards
Directories and Certificates
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Information Exchange is a Team Sport
• The health care community needs to work together socially, economically and politically to create HIE
• The problem is not software, but humanware: competition, mistrust, and the lack of a business case for HIE
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Wilson GA, McDonald CJ, McCabe GP= Jr. The effect of immediate access to a computerized medical record on physician test ordering: a controlled clinical trial in the emergency room. Am J Public Health 1982;72(7):698-‐702.
Clinical Decision Support (CDS) • Uses algorithms, order sets, guidelines, and institutional
policy to encourage evidence-‐based practices
• Helps providers improve documentation, clinical decision making, and guideline compliance, while reducing utilization of care.
• Allows CPOE to change practice: – Validates order appropriateness – Verifies similar order has not been placed – Able to stratify based on patient characteristics
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Growth in Use of Advanced Imaging under Medicare, 1995–2005
NEJM Volume 361:841-‐843
Office of the National Coordinator for Health Information Technology 13
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Outpatient CT examination volumes
SOURCE: Sistrom C L et al. Radiology 2009;251:147-‐155
# ordered via CPOE
# outpatient CT exams
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ONC Review of Recent Literature • Updates and expands Goldzweig et al. (2009) review of health IT
studies published 2004 -‐2007
• Focuses on peer-‐reviewed articles dealing with the costs and benefits of health IT since early 2007
• Focuses on individual outcomes within articles and articles’ overall conclusions. Outcomes include: – Quality of care – Efficiency/costs of care – Provider and/or patient satisfaction.
• Results are still preliminary
Buntin, Hoaglin, Burke, Blumenthal (in process – do not cite without permission) 15
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Search yields baseline of 4,193 ar;cles printed in English
2,692 excluded by .tle
1,264 excluded by .tle plus the abstract 269 focused
on adop.on
64 focused on privacy or security
231 arYcles flagged for inclusion
43 Excluded a>er further review1
34 Reviews excluded from
analyses
174 Cost and Benefit Ar;cles
154 Ar;cles on Costs
and Benefits
101 in USA
1 = E.g. reviewers determined arYcle did not address a relevant aspect of health IT or it lacked outcomes
Systematic Review Process
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Preliminary Findings • Vast majority (142/154 non-‐review articles, 92 percent)
positive or mixed finding*
• More comprehensive studies that evaluated both efficiency and effectiveness of care are overwhelmingly more positive (p = .0001) than those that did not.
• Studies evaluating EHRs are also more positive than those that did not (e.g. an ERx stand-‐alone) (p = .03).
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“Mixed” findings were positive overall, but at least one specific outcome was negative
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US EHR Adoption
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Current Levels of Adoption by Ambulatory Physicians
No Functional EHR 80%
• 37% intend to install a new EHR system or replace current system within the next 3 years.
Source: 2009 NaYonal Ambulatory Medical Care Survey (NAMCS) Electronic Medical Records Supplement.
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Hospital adoption. • Hospitals (2009):
– 13.5 percent basic. – 2.7 percent comprehensive. – Large percentages with EHR components.
Source: 2009 American Hospital AssociaYon (AHA) IT Supplement 20
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Major Barriers to EHR Adoption Percent of physicians reporYng a “major barrier”
Source: DesRoches CM et al. Electronic health records in ambulatory care—a naYonal survey of physicians. N Engl J Med. 359(1):50-‐60, 2008 Jul 3. 21
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The Federal Government’s Response: HITECH ACT
• Part of American Recovery and Reinvestment Act of 2009 (ARRA).
• Addresses major barriers to adoption, and much more. – Technical assistance, support and better information.
– Money/market reform. – Health Information Exchange – Privacy and security.
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HITECH FRAMEWORK: MEANINGFUL USE
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Financial provisions: • Medicare/Medicaid incentives: $9-‐27 billion starting 2011. – Reward the “MEANINGFUL USE” OF EHRs – Physicians: $44,000/$63,750 over 5-‐10 years.
• Penalties starting in 2015. – Hospitals: $2M bonus plus extra DRG payments.
• Support for adoption: – $2 billion to Office of National Coordinator for Health Information Technology (ONC).
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Technical Assistance with Adoption • $693 million
– 60 Regional Extension Centers. – Health Information Technology Research Center.
• $118 million – Training over 40,000 new health IT support personnel
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Technical Assistance with Health Information Exchange • $564 million
– Promote HIE through State leadership • Other ONC Programs and Policies
– Regulation specifying standards and certification criteria
– Regulation creating certification process – Development of technical basis for a Nationwide Health Information Network
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Privacy and Security as a Foundation.
Privacy & Security
Health IT Outcomes
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FEDERAL GOVERNMENT’S ROLE: Privacy & Security
• Banned sale of health information without consent.
• Ongoing audit trail requirements
• Federal activity in enforcement
• Expanded patient rights to access their information
• Innovative encryption technology to prevent breaches
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Pillars of Meaningful Use
Patient & Family
Engagement
Coordinated Care
Quality, Safety & Efficiency
Privacy & Security
Improved Public &
PopulaYon Health
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Office of the National Coordinator for Health Information Technology Healthit.hhs.gov 31
Conceptual Approach to Meaningful Use
Capture / share data
Advanced care processes with decision support
Improved Outcomes
2011
2013
2015
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Eligible Professionals
(EPs)
Eligible Hospitals
(EHs)
Objectives and Measures 25 24
Measures 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 • HITECH a great start, but many challenges to
implementation. – Getting regional centers up and running. – Assuring infrastructure for exchange. – Training necessary workforce. – Sustaining economic incentives for adoption and
meaningful use. • Role of overall health reform.
– Defining future stages of meaningful use • Keep providers on the escalator to more sophisticated and beneficial uses of HIT.
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Professionalism and HIT
• Key components of professionalism. – Unique competence, based in science and demonstrated capability.
– Self-‐governance. – Moral/ethical commitments.
• Within 10 years, use of EHRs will be a core technical competency.
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Professionalism will drive HIT:
• Primary care specialty societies have all endorsed use of HIT as an element of maintenance of certification.
• I predict: – ACGME. – Licensing Boards. – AMA/AAMC medical school accreditation will follow suit.
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Technology Adoption WILL THE STETHOSCOPE EVER COME INTO GENERAL USE IN
CLINICAL MEDICINE? A STRONGLY NEGATIVE VIEW EXPRESSED IN 1821
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QUESTION & ANSWER
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