Clinical Health
Information
Technology:
Progress and
Barriers
The Health Strategies Consultancy
The Intersection of Business
Strategy and Public Policy
Clinical IT Environment
• Reimbursement is the key driver
• Private sector models are proliferating
– Proof statements are lacking
• 2003 was a good year for legislation and
granting at the federal level
– But we lack political will and commitment
• Public sector models will guide future
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Private Sector Models Are Sprouting
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Research by Health Strategies for Foundation
for E-Health Initiative under HRSA grant
Goals of the Project:
1. Understand the range of HIT payment and financial
incentive models in place
2. Identify advantages and disadvantages associated
with various approaches
3. Consider models that can be applied at the provider
and/or community level that promote HIT adoption
and improve quality through financial incentives
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Literature: Great Quality Case,
Theoretical Business Case
• Scientific/Scholarly literature
– Bates, Birkmeyer, CITL, IOM, AHRQ, MedPAC
• Gray literature
– Balit, Hewitt, First Consulting (CHCF)
• Industry press
– Health Data Management, Healthcare Informatics, HIMSS
• Popular press
– New York Times, WSJ
• Company/Product-specific literature
– Company/Product websites (e.g., RelayHealth),
press releases
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Very Active Space
Current Environment: Program Categories
Program Type
Description
Payment Differentials
Bonuses or add-on payments that reward providers and/or
delivery systems for adoption and diffusion of HIT directly or for
improved quality, where HIT is a necessary tool and resource
Cost Differentials
Differences in consumer co-payments or deductibles that vary
based on predetermined quality measures, intended to steer
consumers to providers that have adopted HIT or achieved
certain quality outcomes
Innovative
Reimbursement
Reimbursement for a new category of care or service that is
directly related to the use of HIT (e.g., email communication,
virtual provider-patient visit)
Shared Risk
Withholding a certain amount of fees or delaying rate increases
contingent on technology implementation or quality
improvements.
Combined Programs
Combination of two or more of the above often with the included
benefit of public disclosure of provider progress/ outcomes.
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Active Space and Potential for
Long Term Impact
• Developmental, Iterative, Dynamic
– Multiple programs and approaches are being implemented in
public and private sector, but no single model
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Different strategies, different incentives, different stakeholders
Too early for formal evaluation results
• Healthcare is local: may be issue of Adaptability
not Replicability
• Anecdotally: positive response
• Current success criteria = program participation
• Long term success = decreased costs, increased
quality, workforce efficiencies, better business...
But it’s too early to tell
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2003: A Good Year (Legislative)
• Research by Health Strategies under a
stipend from IBM (in press for February)
• MMA Activity
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E-prescribing
Management Performance Demos
Commission on Systemic interoperability
Council for Technology and Innovation
Extension of the telemedicine demos
Chronic care improvement
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2003: A Good Year (Executive)
• Major Granting Initiatives
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AHRQ
AHRQ with VA, NIH
HRSA
NIH NLM
NIH, CDC, FDA
• Interest at CMS in CAG, Carriers
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Prospects for 2004
• SOTU line – will there be follow-up?
• Legislative fragments
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HR 3035 / S 1729 – medical errors reduction
HR 663 / S 720 – patient safety improvement
S 1374 – Better HEALTH
HR 2915 – National Health Info Infrastructure
• Interest in specific technologies
• Difficult budget situation
• Skepticism on generalized value
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Possible Entitlement Program Models
• Encouraging adoption of technology that
is not 100% clinically proven
– Medicaid 90% match for IT upgrades
– CAG technology decisions sometimes lack data
• Medicare payment systems push hospitals
and physicians in desired directions
– Conditions of participation mandate quality
– Inpatient PPS bundling with incentives
• Higher bar can be articulated if desired
– Inpatient DRG add-ons and OPPS
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When Will We Achieve the Vision?
• No meaningful central policy focus
• Little dedicated budget
– CIT Investment in UK
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$17 Billion / 10 Years
Full EMR by 2005
Full E-Prescribing by 2008
• Pluralistic health system skews alignment
• No interest in mandates
• Slowness in standards adoption
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Our Panel
• Focus on clinical applications
– Likely progress in 2004
– Not dependent on legislative process
• Policy focus
– Helen Burstin, AHRQ
• Commercial focus
– Reggie Groves, Medtronic
– William McIvor, Accordant
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