Introduction

Better Health

Jacob Reider

@jacobr

Doug Fridsma?

Self Identity?

EHR Vendor

Office of the National Coordinator for Health Information Technology

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Healthy People

Health and Human Services Operating Divisions: Administration for Children and Families (ACF) Administration on Children, Youth and Families (ACYF) Administration on Aging (AoA) Agency for Healthcare Research and Quality (AHRQ) Agency for Toxic Substances and Disease Registry (ATSDR) Centers for Disease Control and Prevention (CDC)

Centers for Medicare and Medicaid Services Food and Drug Administration (FDA) Health Resources and Services Administration (HRSA) Indian Health Service (IHS) National Institutes of Health (NIH) National Cancer Institute (NCI) Office of the Inspector General (OIG) Substance Abuse and Mental Health Services Administration (SAMHSA)

Staff Divisions: Assistant Secretary for Administration (ASA) Assistant Secretary for Financial Resources (ASFR) Assistant Secretary for Legislation (ASL) Assistant Secretary for Public Affairs (ASPA) Assistant Secretary for Planning and Evaluation (ASPE) Assistant Secretary for Preparedness and Response (ASPR) Center for Faith-Based and Neighborhood Partnerships (CFBNP) Departmental Appeals Board (DAB) Intergovernmental External Affairs (IEA) Office for Civil Rights (OCR) Office on Disability (OD) Office of the General Counsel (OGC) Office of Global Affairs (OGA) Office of the Inspector General (OIG) Office of Medicare Hearings and Appeals (OMHA)

National Coordinator for Health Information Technology (ONC) Assistant Secretary for Health, Office of the Assistant Secretary for Health (ASH) Surgeon General

Meaningful Use

the short version

HITECH ACT

• $28B • Hospitals and “Eligible Providers” • “Meaningful Use” of certified Electronic Health

Records

HITECH ACT

2008 2014

10%

100%

Hospitals

Practices

3 Stages

1. ADOPT ✔

2. EXCHANGE

3. IMPROVE

Meaningful Use

3 Stages

1. ADOPT ✔

2. EXCHANGE ✔

3. IMPROVE

Portal

Portal

3 Stages

1. ADOPT ✔ 2011-14

2. EXCHANGE ✔ 2014-17

3. IMPROVE

Measurement

Office of the National Coordinator for Health Information Technology

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Clinical Quality Measures – on paper

Office of the National Coordinator for Health Information Technology

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Quality Measures

Office of the National Coordinator for Health Information Technology

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Research • What’s happening?

Guidelines • What

SHOULD Happen

Quality Measures

• Did it happen?

CDS • It will

happen

Clinical Decision Support

Osheroff ’s 5 Rights

the Right Information… Evidence-based, useful for guiding action and answering questions

…to the Right Stakeholder… Both clinicians and patients

…in the Right Format… Alerts, Order Sets, answers, etc.

…through the Right Channel… Internet, mobile devices, clinical information systems

…at the Right Point in the Workflow to influence key decisions/actions Osheroff, Teich, Levick et. al. Improving outcomes with CDS: an implementer's guide, 2nd edition. HIMSS. 2012.

Office of the National Coordinator for Health Information Technology

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✔

3-Part Aim

Reduced cost

$ $ $ $$$

Better health Better care

3-Part Aim

Reduced cost

$ $ $ $$$

Better health Better care

Technology

Quality Measure

Expectation

EHR Capability

Quality (measurement) Chasm 2.0

Quality Measure

Expectation

EHR Capability

Quality (measurement) Chasm 2.0

Coupled, “Hard-Coded” CDS

What We Don’t Want

IT Maturity

Who loves computers?

Safety

Diagnosing Organizational Culture

• All tribes have a dominant cultural stage.

• The stage is evident from language, behavior, and relationship structures within the organization.

• Higher cultural stages outperform lower cultural stages.

• Organizations can move up one stage at a time.

• “Stage Inflation” - What is the actual stage, not what do you want it to be (people often inflate their organization’s stage by one).

5 Stages of Culture % of Tribes at each Stage

Low Performing High Performing

The History of the CIO

“You IT people don’t get it” “Why the ^%$# didn’t I get invited to that &^%$ meeting?” “This &^%$ system isn’t going to work – I told you so…”

Transforming

• What is best for YOU

• What are my strengths and how do we work best together?

What Stage is your Organization?

• What is the language and behavioral patterns?

• What are the typical relationship structures?

• People trained in Tribal Leadership can detect the Stage within a few minutes of walking into a work group

Tip Take the Culture Meter Survey on triballeadership.net

Natural Group

Thriving Organization ?

How do you create a Stage Four or Five culture so you can leverage the full power of your tribe to have a

thriving and high performing organization?

How to Leverage the Tribal Culture?

Access to Greatness

Enlightened

• What is best for the patients and providers and what role should I play?

• How do we discover what is best for all participants and non-participants in health? How can we inspire best efforts?

The History of the CIO

What if?

What if there is no “medical record?" What if there is no “progress note?" What is there is no “document?" What if there is no “visit" What if there is no “doctor?" What if there is no “diagnosis" What if there is no such thing as “non-compliant?" What if the primary user is the individual? What if we stopped saying “user?" What if we stopped saying “patient?"

1816

"What a ridiculous idea,” "We doctors are called upon for our brilliant medical minds. To say we should carry some frivolous tool around with us is absolutely ridiculous and below us."

Measurement

Office of the National Coordinator for Health Information Technology

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Worry Score

What’s next?

• Today

– Note Bloat

• Tomorrow

– Observations

What’s next?

• Today

– Encounters

• Tomorrow

– Relationships

What’s next?

• Today

– Computers

• Tomorrow

– Devices

“Those who say it can’t be done should get out of the way of those doing it” Chinese Proverb