health information exchange

Health IT and Health System ReformThe Ohio State University Center for IT Innovations in HealthcareThe Ohio State University Center for IT Innovations in Healthcare

April 2011

Craig BrammerCraig BrammerOffice of the National Coordinator for Health Information [email protected]

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1 Uniting the Tribes of Health System Improvement1. Uniting the Tribes of Health System Improvement

2. HITECH Status Report

3. Uniting the Tribes in 17 US Markets: The Beacon Communities

4. Health IT as Infrastructure for Accountability

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The “Tribes” of Health System Improvement: A Multiplicity of Approaches Strategies and ToolsA Multiplicity of Approaches, Strategies and Tools

1. The Quality Improvement Crusaders

2. The Payment Reformers

3 The Consumer Energizers3. The Consumer Energizers

4. The Health IT Champions4. The Health IT Champions

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McKethan AN, Brammer CB. Uniting the Tribes of Health System Improvement. The American Journal of Managed Care. 2010;16:SP13-SP18.

Tribe 1: The Quality Improvement Crusadersy p

APPROACH: Scientific evaluation methods and management techniques to achieve better patient outcomestechniques to achieve better patient outcomes

Data analysis and performance measurementProvider feedback processes evidence informed guidelines- Provider feedback processes, evidence‐informed guidelines

Management techniquesL f t i ti lit i t- Lean manufacturing, continuous quality improvement

Learning and “best practices”d l h d h l- e.g., avoiding complications in the ICU, reducing hospital

readmissions, improving care transitions, reducing infection and surgical‐complication rates, etc.

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Tribe 2: The Payment Reformersy

APPROACH: Alternatives to volume‐based payments to support systematic improvements in care and opportunities for slower spending systematic improvements in care and opportunities for slower spending growth

Performance IncentivesPerformance Incentives- P4P, high‐performance networks, never events

Payments promoting provider alignment and care coordinationPayments promoting provider alignment and care coordination- ACOs, medical homes, bundled payments, readmission penalties

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Tribe 3: The Consumer Energizersg

APPROACH: Information and appropriate incentives to help consumers improve their own health, save money, and achieve better outcomesimprove their own health, save money, and achieve better outcomes

Value‐based insurance designRed ced copa s for effecti e treatments incenti es for seeking - Reduced copays for effective treatments, incentives for seeking care from high‐performance providers/networks

Consumer directed health plansConsumer directed health plans- HSAs and high deductable health plans

C i f ti t t h lth d i i kiConsumer information to support health decision making- Shared decision making/informed patient choice, “motivational

technologies” to support behavior modification

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Transparency of cost and quality information

Tribe 4: The Health IT Champions (aka, Wireheads)p

APPROACH: Electronic infrastructure to support administrative simplification, error avoidance, cost containment and improved outcomessimplification, error avoidance, cost containment and improved outcomes

Electronic health record adoption and information exchangeStandards and interoperabilit pri ac & sec rit MU incenti es- Standards and interoperability, privacy & security, MU incentives

Tools to support clinicians in delivering high value careCli i l d i i f f db k P ibi- Clinical decision support, performance feedback, ePrescribing

Tools to support consumers in receiving high value care- Personal health records, mHealth applications, eVisits

Tools to support purchasers in rewarding high value care

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- Data aggregation and performance measurement

Tribal Approaches to Health System Reformpp y

Quality improvement activities are often unsustainable due to volume based payment methodsvolume‐based payment methods

Payment reforms are ineffective if unaccompanied by changes in provider practices and consumer behaviorprovider practices and consumer behavior

Uncoordinated care subjects even highly engaged and informed patients to fragmented carep g

Higher spending on technology with uncertain benefits is worrisome

Yet…tribal approaches to health system reform are ubiquitous

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Segmentary Lineage and Health System Reformg y g y

In his 1940 book about the Nuer people in southern Sudan, British anthropologist E. E. Evans‐Pritchard coined the term “segmentarylineage” to describe how members of a society live in a web of nested identities or tribes.

At any given time, individuals are members of several groups in a hierarchy, from the local or proximal (eg my street my neighborhood) to proximal (eg, my street, my neighborhood) to larger groups (eg, my region, my country).

The most meaningful group affiliation at any The most meaningful group affiliation at any given time depends on the scale and nature of external threats or conflicts.

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The Scale and Nature of External Threats to Health Care

*Insert obligatory slides on spending trends, regional variation, per capita costs relative to other industrialized nations etccapita costs relative to other industrialized nations, etc.

*Insert obligatory slides on McGlynn study, IOM reports, AHRQ annual quality report, etc.annual quality report, etc.

*Mention growing dissatisfaction with health care, for example…

Majority of Americans Give Quality of Health Care a C, D or F. US News & World Report; April 14, 2011.

New Survey: 72 Percent in U S Think Health System Needs Major New Survey: 72 Percent in U.S. Think Health System Needs Major Overhaul. The Commonwealth Fund; April 15, 2011.

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The Scale and Nature of External Threats to Health Care

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The HITECH Framework: Meaningful Use at it Cits Core

Regional Extension Centers

Improved Individual & Population Health

Outcomes

ADOPTIONADOPTIONRegional Extension Centers

Workforce Training

Medicare & Medicaid Incentives and Penalties

Outcomes

IncreasedTransparency & Efficienc

MEANINGFUL USEMEANINGFUL USE

& Efficiency

ImprovedAbility to Study &

State HIE Program

St d d & C tifi tiy y

Improve Care DeliveryEXCHANGEEXCHANGEStandards & Certification

Privacy & Security

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Health IT Practice Research

Conceptual Approach to Meaningful Usep pp g

Advanced

Improved Outcomes

Capture /

care processes with decision supportp

share data support

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Meaningful Use Survey Findingsg y g

Percent of Non‐Federal Acute Care Hospitals Planning to apply for CMS’

EHR I ti P

Percent of Office‐Based Physician Practices Planning to apply for CMS’

EHR I ti PEHR Incentive Programs EHR Incentive Programs

80

9081%

80

90

50

60

70

50

60

70

41%

30

40

Planning inSubsequentY

30

40

Planning inSubsequentY

41%

0

10

20

US H it l

Year

Planning in2011 or 2012Application

0

10

20

Ph i i P ti

Year

Planning in2011 or 2012Application

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Source: American Hospital Association Information Technology Survey, 2010; National Center for Health Statistics, National Ambulatory Medical Center Survey, 2010.

US Hospitals Physician Practices

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ONC Programsg

$693 millionTechnical

– 62 Regional Extension CentersAssistance

$118 millionWorkforce Training

$118 million– 84 Community Colleges training new

health IT support personnel

State Health Information Exchange

$564 million– 56 grants to states and territories

InteroperabilityHITECH laws and policy developmentTechnology standards and certification

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ONC Program Results to Dateg

57,716 providers enrolled with the Technical

Regional Extension CentersAssistance

Workforce Training

3,600 graduating this spring

State Health Information Exchange

46 state plans approved

Interoperability449 certified EHR products on the market

conforming to standards

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State Health Information Exchange Programg g

Goal: Ensure that every provider has at least one option for meeting health information exchange requirements of meeting health information exchange requirements of meaningful use

Four year program, 56 states and territories were awarded

$548 Million awarded in total funding for HIE planning and implementation

St t d ONC d St t Pl b f f d l States need an ONC approved State Plan before federal funding can be used for implementation –46 have been approved

Multiple approaches are being pursued, many oriented around core services and gap‐filling

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State Health Information Exchange Challenge Grantsg g

10 Awards ($16 million) for Breakthroughs in Key Areas

– Reducing preventable hospital admissions (NC)– Improving long‐term care transitions (CO, MA, OK, MD)p g g , , ,– Consumer‐mediated exchange (IN, GA) – Meta‐data approaches to granular data sharing (IN)Di ib d f l i h l h (MA MT)– Distributed query for population health (MA, MT)

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Health Information Exchange (The Verb)g

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Health Information Exchange (The Verb)g

Security and Trust relationships

Security and Trust relationships

Document/Message Standards

Document/Message Standards

Directories and CertificatesDirectories and Certificates

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Vocabulary StandardsVocabulary Standards Delivery ProtocolsDelivery Protocols

Capabilities for Nationwide Health Information Exchangep g

– Secure transportp

–Content standards

– Computable consentComputable consent

– Patient matching

R d l t i– Record locator service

– De‐identification

– Distributed query

– Meta data

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Emerging Direct Ecosystem

» 50+ vendors have committed to roll‐out Direct‐enabled functionality, and ~20 states include Direct in their approved State HIE plans*

EHRs4MedicaAprimaAllscripts

Med3000MEDgleNextGen

HIEs & HIOsAAFPAbilityAkira Technologies

MedAlliesMedCommonsMEDfx

StatesAlabama CaliforniaFlorida

Care360CernereClinicalWorkse‐MDsEpic

OpenEMRPolarisRelayHealthSage HealthcareSiemens

ApeniMedAtlas DevelopmentAxolotlCareEvolutionCovisint

MedicityMedPlusMirthMobileMDNational Health Svcs

IllinoisIowaKentuckyMinnesotaMissouriEpic

GE HealthcareGreenway

SiemensSunquestWorldVistA

CovisintGarden State Health Systems Inc.

GSI HealthHarrisHINST

National Health SvcsNetDirectorOrion HealthProviderDirectRedwoodMedNetS E h

MissouriMontanaNew HampshireNew JerseyNorth CarolinaOhi

PHRsDossiaMicrosoft HealthVault

HINSTxIngenixInprivaIVANSKryptiq Corporation

Secure Exchange Solutions

SurescriptsTechsantTechnologiesThomson Reuters

OhioOregonRhode IslandSouth CarolinaTexas

NoMoreClipboard.comRelayHealth

yp q pLifepoint Informaticsmax.md

VerizonWellogic

VermontWest VirginiaWisconsin

* Source: http://directproject.org/content.php?key=getstarted&sub=vendorsupport (as of April 2, 2011) 25

Security & Interoperability Frameworky p y

Promote a sustainable ecosystem that drives increasing interoperability and standards adoptioninteroperability and standards adoption

Create a collaborative, coordinated, incremental standards process that is led by the industry in solving real world problems

Leverage “government as a platform” – provide tools, coordination, and harmonization that will support interested parties as they develop solutions to interoperability and parties as they develop solutions to interoperability and standards adoption.

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S&I Framework’s Transitions of Care Initiative

Challenge: Meaningful Use Stage 1 and foreseen Stage 2 requires information to be exchanged in Transition of Care requires information to be exchanged in Transition of Care.

Implementers confused on how to use the specifications to exchange req ired data required data

Exchange of clinical summaries hampered by ambiguous common definitions of what data elements must be exchanged, how they must be encoded, and how those common semantic elements map to MU specified formats. (C32/CCD and CCR)

Lack of a robust toolset to aid in development and validation of conformant templated clinical documents is a major impediment to the widespread

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adoption of standards.

Security & Interoperability Framework Stakeholdersy p y

Call for Participation: The overall success of the S&I Framework is dependent upon volunteer experts from the Framework is dependent upon volunteer experts from the healthcare industry and we welcome any interested party to get involved in S&I Framework Initiatives, participate in discussions and provide comments and feedback by joining the Wiki.

For more information on how to get started as a volunteer please visit: http://jira siframework org/wiki/display/SIF/Getting+Started+ahttp://jira.siframework.org/wiki/display/SIF/Getting+Started+as+a+Volunteer

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Beacon Communities

ONC allocated $265 million over 3 years to 17 communities, including $15M for technical assistance and evaluation to including $15M for technical assistance and evaluation, to demonstrate the feasibility and the health care delivery benefits of widespread HIT adoption and exchange of health information.

Core aims:Build and strengthen health IT infrastructure as a foundation to i li f h l h d ffi i iimprove quality of care, health outcomes, and cost efficiencies;

Demonstrate that health IT‐enabled interventions and Demonstrate that health IT enabled interventions and community collaborations achieve concrete cost/quality performance improvements;

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Test new innovations to improve health and health care

Beacon Community Programs

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Beacon Communities

•Governance•IT & measurement i f t t2010

•First wave of interventions2011

•Subsequent waves of interventions2012 &

infrastructure•Interventions logic models

2010 •Innovation networks

2011 interventions•Dissemination of lessons learned

2013

In 2011, Beacon interventions will “engage” ~5,000 providers and “touch” approximately 600K individuals around specific health improvement aims:

k l d• 9 Beacon Communities’ work includes improving care transitions (e.g., process improvements and information flow at hospital discharge).

• 10 Beacon Communities’ work focuses on the use of IT tools and process improvements (e g CDS) to improve performance of physician practicesimprovements (e.g., CDS) to improve performance of physician practices.

All Beacons submit cost/quality/health data on their performance quarterly.

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Starting in May 2011, CMS will supply provider‐level reports from Medicare.

Examples from Beacon Communitiesp

Central Indiana spreading admin/clinical measurement and P4P model from 9 to 42 countiesmodel from 9 to 42 counties

Grand Junction Colorado redesiging primary care with strong HIE Grand Junction Colorado redesiging primary care with strong HIE and measurement

Tulsa spreading Doc‐t0‐Doc electronic specialty referral system and deploying Archimedes provider and region‐level CDS/predictive modelingg

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Examples from Beacon Communitiesp

North Carolina deploying Asthmapolis to support pediatric asthma improvementimprovement

San Diego deploying mHealth linked to immunization registry to San Diego deploying mHealth linked to immunization registry to alert parents of young children about immunizations

Bangor, Maine using remote monitoring to help manage frail elderly

Geisinger, Intermountain & Mayo spreading tools and technologies beyond IDS to broader community

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Beacon Community 90‐Day Launch Plan

COCOCommunity Obj ti COCO

Core cost, quality, and population health

Program Goals

COCOObjectives

MOMO

COCO

MOMO MOMOMOMOMeasured Outcomes Well‐defined measurable improvement goals

improvement aims

Outputs OO OO OO OO OO OO Operational & process results of core activities

Defining risks and barriers and establishing plans to prevent or mitigate themDefining risks and barriers and establishing plans to prevent or mitigate them

Activities AA AA AA AA AAAA

Outputs OO OO OO OO OO OO Operational & process results of core activities

Tasks/interventions leading to outputs

Resources RR RR RR RR RR RR RR RR RR RR RR RR Resources needed to support activities and meet stated outcome goals

Sustainability plan outlining provider reimbursement, program revenue, and other strategies

Sustainability plan outlining provider reimbursement, program revenue, and other strategies

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Geisinger (“Keystone Beacon Program”)

Community Objectives COCO

Improve quality and efficiency among targeted patients with Chronic Obstructive Pulmonary Disease (COPD) and Heart Failure (HF)

Program GoalsSummary of 1 out of 10 Beacon/Geisinger Community Objectives (Logic Models)

j

MOMO

COCO

MOMOMeasured Outcomes

Reductions in hospital admissions, avoidable 30‐day hospital readmissions, and ED visits among target patients; increased access to/utilization of

primary care services among same patients

Obstructive Pulmonary Disease (COPD) and Heart Failure (HF)

Outputs OO OO OO OO

p y g p

Medication reconciliation outputs, hospital discharge counseling,

Specific plans to prevent or mitigate implementation risks and barriersSpecific plans to prevent or mitigate implementation risks and barriers

Activities AA AA AA AA

Outputs OO OO OO OO Medication reconciliation outputs, hospital discharge counseling, targeted case management contact, web‐based portals, others

Comprehensive HIT‐enabled care model includes care process redesign and teaming; integration across all systems of care, care protocols; performance

feedback to patients and clinicians, and reminder systems

Resources RR RR RR RR RR RR RR RR

S t i bilit l i t ti f t bl t d l li d S t i bilit l i t ti f t bl t d l li d

Specific funding allotments to core activities phased in over new areas and over time; dedicated administrative, IT, and clinical teams

Sustainability plan: integration of accountable care payment model aligned with health IT‐enabled performance improvement goals

Sustainability plan: integration of accountable care payment model aligned with health IT‐enabled performance improvement goals

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Lead Geisinger Clinic

Keystone Beacon Community

Service Area Central Pennsylvania

Population Total patient population in catchment area: 256,203 Total target patient population: 51,000

Total # of target providers: 16 practices, 3 hospitals

Select P f

•Improve the management and outcomes for patients with COPD and CHFE 90% f t t ti t ACEi ARB 100% ith f ll 7 d t di hPerformance

Improvement Goals

•Ex: 90% of target patients on ACEi or ARB, 100% with follow up <7 days post discharge •Increased patient engagement •Improve medication reconciliation•Reduce all cause hospitalizations, 30-day readmissions, and preventable ED visits for patients with CHF, COPD, and within 30 days of surgery •Improve influenza vaccination rates to 100% for patients with CHF and COPD•Improve influenza vaccination rates to 100% for patients with CHF and COPD

SelectInterventions

Hospital-Based Care Managers•Identify high-risk patients with CHF, COPD, and other chronic disease to facilitate smooth transfers to either home or a long-term care facility using the Provenhealth Navigator System (4 CM to start)

Care Managers in Ambulatory Physician Practices•Facilitate medication management and action plans for patients with COPD and CHF (3 CM to start)•Facilitate medication management and action plans for patients with COPD and CHF (3 CM to start)•Teach self-management action plans including nutrition and daily weights; •EHR-enabled exacerbation protocols for CHF and COPD management

Remote Care Managers•Centralized call center for 3 CM who will provide telephonic management for 4 weeks post discharge.

Patient Portals, PHRs, and Patient Engagementat e t o ta s, s, a d at e t gage e t•Patient portals, secure messaging, and self management tools interoperable with the EHRs facilitate patient engagement and patient-provider communication

Computerized Clinical Decisions Support Tools•Alerts identify candidates for influenza vaccine, trigger guideline based care, and notify providers via HIE connection of patient hospitalizations/ED visits

Other Notable Characteristics

The Beacon Community considers patient engagement, satisfaction, and perceived quality of life as important measures.The Beacon Community has active engagement of long-term care facilities.

Five Domains of the Beacon “Learning System"

Domain Focus AreaEstablishing Beacon strategic direction; aligning Beacon 1

g y

Establishing Beacon strategic direction; aligning Beacon Community performance improvement goals with policy at the local and national level. Communications and outreach.

Leadership & Stewardship

1

Achieving meaningful use goals; collaborating on the testing and 2

Learning from best practice care delivery innovations (e.g., care 3

Achieving meaningful use goals; collaborating on the testing and documentation of new technologies (e.g., clinical data repositories, master patient indices, EHR interfaces to HIEs)

HIT & Meaningful Use

g gtransitions programs, medication therapy management programs, medical homes, remote monitoring)

Clinical Transformation

Data & Performance 4 Developing robust performance measurement and feedback Data & Performance Measurement capabilities; testing new measures and measurement approaches

(e.g., patient‐reported outcomes measures)

Sustainability and 5 Strategic planning and implementation activities focused on

f i f i d Sustainability and Payment Reform payment reforms to sustain performance improvements and

support infrastructure developed under the Beacon Program

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Lead HealthBridge

Service Area Greater Cincinnati Region

Greater Cincinnati Beacon Community

Service Area Greater Cincinnati Region

Population Total target pediatric population: 18,000Total target pediatric population in year 1: 4600Total target providers in year 1: 123

Total adult patient population in catchment: 1,530,337Total target adult population: 159,000 Total target providers: 50

Select •Improve management for adult diabetesPerformance Improvement Goals

p g•Ex: LDL < 100, BP < 130/80, A1C < 7, and aspirin use

•Reduce ED visits and 30-day readmissions for diabetes by at least 15%•Improve outcomes for pediatric asthma

•80% of population achieves symptom control, 60% for Medicaid•Reduce pediatric asthma ED visits, school days missed, and hospitalizations by 60%I fl i ti t f hi h i k th ti ti t t 80%•Improve flu vaccination rates for high risk asthmatic patients to 80%

•Improve smoking cessation among diabetic patients by at least 5% from baseline, goal 10% by 2013

SelectInterventions

Patient Centered Medical Home•Model to be deployed in 20 practices, facilitate judicious and coordinated care, payment reform

Physician Data Reporting and Performance Feedback•Diabetes Quality Institute to monitor data and enact rapid cycle change for diabetes management

Care Coordinators in Ambulatory Physician Practices •Support asthma and diabetes management plans•MDI coaching for asthma•Self management coaching

Computerized Clinical Decision Support ToolsComputerized Clinical Decision Support Tools•Facilitate appropriate use of spirometry•Alerts for ED admissions and hospitalizations for asthma exacerbation•Screen for symptom control in asthma•CDS in schools for referral to PCP based on symptoms •Identify candidates for influenza vaccination (asthma, long-term care facilities)Identify candidates for influenza vaccination (asthma, long term care facilities)

Medication Therapy Management•Medications in hand at time of hospital or ED discharge

Other Notable Characteristics

GE has committed to providing $1 million of in-kind resources, including equipment, software and funding to assist with performance measurement, public reporting and payment reform.

What are we learning?g

It’s early but…

Clearly defined populations

Strong leadership & governanceStrong leadership & governance

Specific health care objectives

Performance measures and Performance measures and feedback systems

Evidence‐based interventions

Strategies to learn from interventions

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The “Era of Accountability” is about lowering the cost of improvementimprovement.

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Past and Emerging Models of Accountability in Provider PaymentsPayments

Performance‐based payments- “Peanuts for process”Peanuts for process

Bundled payments- Prospective payment system (PPS) (1980s)Prospective payment system (PPS) (1980s)- Participating Heart Bypass Center Demonstration (“CABG”)- Bundled or “episode” payments in new health law

Shared savings- Physician Group Practice Demonstration (“PGP” Demo)- Healthcare Quality Demonstration (“646” Demo)Healthcare Quality Demonstration ( 646 Demo)- Accountable Care Organizations in new health law

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ACA Provisions Catalyzing a Shift from Fragmented Care to Coordinated CareSUMMARY IMPLICATIONS

Patient-Centered Medical Homes (Section 3502)

Community-based, interdisciplinary inter-professional teams that support primary care practices

Will drive improved organization of outpatient care

Government to provide grants or enter into contracts with eligible entities

Will fund care coordination and a team-based approach

A t bl C O i ti (S ti 3022)Accountable Care Organizations (Section 3022)

Shared-savings program that encompasses primary care, specialist practice, and hospitals

Requires vertical coordination

Care processes to be redesigned for the efficient delivery of high-quality services

Most of the savings are likely to come from hospitalshigh quality services

Bundled Payments (Section 3025)

Pilot program Will provide incentives for care-delivery systems to reduce costs in order to increase margins

Applicable to eight conditions selected by the Secretary of healthApplicable to eight conditions selected by the Secretary of health and human services

An ‘episode’ of care defined as the period from 3 days before admission through 30 days after discharge

Readmissions Reduction Program (Section 3025)g ( )

Reduces payment for readmissions Will motivate hospitals to engage with care coordinators and organize delivery systems better

Applicable to three conditions selected by the Secretary of HHS; to be expanded in 2014

Secretary to determine definition of ‘readmissions’

Hospital-Acquired Conditions (Section 3008)

Payments for care for hospital-acquired conditions to be reduced starting in 2015

Will provide hospitals an incentive to standardize protocols and procedures to reduce hospital acquired conditions

Synergies with Proposed ACO Ruley g p

Meaningful use as core expectation Fifty percent of the ACO PCPs need to be meaningful users by the second year g

of the contract

Information must follow the patient ACOs creating data “lock in” by limiting or blocking information flow risk ACOs creating data lock‐in by limiting or blocking information flow risk having their agreements terminated

Quality measure alignmentLarge overlap between the clinical quality measures in the EHR Incentive Program and in the proposed ACO rule

Focus on care coordination and seamless transitionsFocus on care coordination and seamless transitionsBuilds on HIE and Beacon work

Patients as full partnersA b h di l d d id b d d

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Access to both medical records and evidence‐based data

Key Roles for HIT in the Era of Accountabilityy y

Putting accountability in accountable care organizations

Putting coordination into medical homes

Divvying up bundled payments among providersy g p p y g p

Tracking health care acquired infections in real time

Facilitating enrollment in health information e changesFacilitating enrollment in health information exchanges

Creating the efficiencies that will make expanded access affordable

Accelerating data collection and reporting for population health

Facilitating secure access to consumer health information

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HIE: Exchanging health

EHR:Electronically capturing and

CDS:Improved care decisions health

informationp g

processing information about patients and

l ti

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populations


In addition to EHR, HIE and CDS deployment…

Data AggregationCDWs, Linking payer and clinical data, Distributed data models, etc

Analytics Predictive modeling, performance measurement, assessing cost across

episodes of care, etcp ,

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Going Forward

BetterBetter Transform

g

Better Information

Better Technology

Goal V: Achieve Rapid Learning and Technological Ad t

a s oHealth Care

Federal Health IT Strategic

Goal IV: Empower Individuals with Health IT to Improve their Health and the Health Care System

AdvancementFederal Health IT Strategic Plan 2011‐2015

Goal III: Inspire Confidence and Trust in Health IT

Goal II: Improve Care, Improve Population Health, and Reduce Health Care Costs through the Use of Health IT

Goal I:Achieve Adoption and Information Exchange through Meaningful Use of Health IT

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The Good News About Technology Adoption

WILL THE STETHOSCOPE EVER COME INTO GENERAL USE IN

gy p

CLINICAL MEDICINE?A STRONGLY NEGATIVE VIEW EXPRESSED IN 1821

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health information exchange

Health & Medicine