Information Technology:
Putting the Patient at the
Center of the Information
Flow
25th Annual Rosalynn Carter Symposium on Mental
Health Policy
November 6, 2009
Robert M. Kolodner, MD
The Ultimate Reason for
Health IT
Perspective for you
to consider:
What quality and value of health care services
do you demand?
What quality of health do you want and deserve?
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Topics For My Brief Remarks
I.
Current Health Care Challenges
II. Future of Health and Care
III. Health Information Technology (IT)
IV. And then there was $$$$
V. Potential New Health IT Direction
VI. Caveats Regarding Change
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Section 1
Current Health Care Challenges
And Health IT
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Why is Health IT a Central
Strategy for Health Care?
Current Lack of Information:
• Higher Costs
–
Leads to 1 in 7 hospital admissions*
• When care providers do not have
access to previous medical records
–
–
12% of physician orders are not executed as written*
20% of laboratory tests unnecessary*
• Requested because previous studies
are not accessible
• Avoidable Errors
–
Drug errors
• Complicate 1 in 6.5 hospitalizations
• Occur in 1/20 outpatient Rxs
* Revolutionizing Health Care Through Information Technology
President’s IT Advisory Committee (PITAC), 2004
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Problems with Both Safety
and Quality
To Err is Human:
98,000 patients die
from avoidable errors
The Quality Chasm:
Every Patient
“Crossing the Quality Chasm” 2001: IOM
Americans receive
on average 55% of
the evidence-based
care**
** N Engl J Med 2003;348:2635-45.
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Quality/Reliability Challenges
Remain in Health Care
•
•
•
•
Immunization: 55 – 94%
B-Blocker after an MI: 70 – 98%
Airline Baggage Handling: > 99.99%
Airline Safety: > 99.9999%
10-1
10-2
10-3
10-4
10-5
10-6
Frequency of Failures Occurring
From Dr. Jonathan B. Perlin. Used with permission.
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New Freedom Commission
on Mental Health
Final Report: Achieving the Promise: Transforming Mental Health Care in America
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Privacy and Security:
Concerns
•
•
•
•
Control of information and flow
Breaches of security and violations of privacy
Technology leading policy
Identity Theft/ De-identification
• Secondary uses of data
• Ability to aggregate data
• Lack of understanding about
how info is currently used
• Genomic data and family history
affect family members
• Consequences (loss of insurance, work, or other forms of discrimination)
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Katrina: Impact Of Privacy on
People with MH & SA Disorders
www.katrinahealth.org/patients.html
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Community Health:
Hurricane Katrina Relief
• 50,000 New Orleans VA Patients did not lose their medical records,
even when they lost their City
- Their VA Electronic Health Records followed them around the U.S.!
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Section 2
The Future of
Health and Care
Transforming Health Care:
Moving from
Treating to Preventing to Predicting
1. Adapted from Perlin, Dr. Jonathan B, Healthcare 1015 & beyond: Some Thoughts on Planning Ahead, p. 95
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Perspective of People on Their
Future Health Care
• Stay Healthy
• Prevention
• Increased Self-Care
• Personal Health support
• Convenient Care
• Minimize time and travel
• Tele-care
• Tele-monitoring
• High Quality, Coordinated Care
• Enable care across providers & sites
• Allow access to a lifetime of information –
wherever and whenever They choose
Better Health
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Future Health
^
Care Direction
Person-Centered
Patient-Centric
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Consumer-??
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Section 3
Health
Information Technology (IT)
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Health IT – Role in Health Care
Transformation ^
Health Care Transformation
Population Health
(Higher Quality, More Efficient, PatientFocused)
(Public Health, R&D, Quality Improvement,
Emergency Preparedness)
Health IT solutions must support the needs of
BOTH
“perspectives”
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Key Health IT Components to
Enable Transformation
A Robust, Interoperable, Health IT Environment:
• Electronic Health Records (EHR / EMR)
• Personal Health Records (PHR)
• Population Health Information
(Public Health, Biosurveillance, Quality Improvement,
Research, Emergency Preparedness)
• Standards (Data, Technical and Security)
• Interoperable Health Information Exchange Network
(Nationwide Health Information Network - NHIN)
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Health IT
User populations
Individuals
Care Providers Population
Health
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Person-centered
Individuals
Care Providers Population
Health
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However
This is NOT about technology…
It is about RESULTS:
• Improved Health Care Quality
• Containing Health Care Costs
• Improved Health Care Outcomes
• Improved Health
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Section 4
And then there was $$$$
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The
American Recovery and
Reinvestment Act
of 2009
American Recovery and
Reinvestment Act (ARRA)
Health Information Technology
for Economic and Clinical Health Act
[HITECH Act] in H.R.1
http://www.whitehouse.gov/the_press_office/ARRA_public_review/
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American Recovery and
Reinvestment Act (ARRA)
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American Recovery and
Reinvestment Act (ARRA)
Estimated $17,200,000,000 net
over 10 years starting in 2011
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Key Acronyms and Phrases
for U.S. Health IT
Meaningful Use
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Section 5
Potential New Health IT Direction
and Impact
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Disruptive Changes Are the
“Norm”
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Clay Christensen’s Statement
“Head on competition drives prices
up. Disruption drives cost and prices
down.”
HIT Platform Meeting – Boston
Sept 30, 2009
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Disruptive Innovations in
(Health) IT
GENERAL TRENDS:
• Users have more capabilities at lower cost
• Users can create their own individual “environment”
• Simple-to-use
• Configuration settings
• Downloads
• Rearrangements of application locations
• Users are creating more of their own content and posting it on
the web for all to see
• Web 2.0
• Web 3.0
• Health 2.0
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Disruptive Innovations in
(Health) IT
New Business Models:
• More “Open Source” solutions available
• Changing business models – “user-centered”
• Business opportunities through support services rather than
“vendor lock”
• Enables users to share solutions more widely and accelerate
innovation
HOWEVER
• “Open Source” ≠ Free
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Transforming Health
The “locus of control" is changing.
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Section 6
A Few Caveats Regarding
the Pattern of Change
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How Transformational
Change Occurs
EHR Adoption
Transformational Change in
Health Care Delivery & Health
Health IT
Tipping
Point
TIME
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Opportunities Created by the World
Wide Web
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A Repeating, Predictable
Cycle…
Cited in Paykel, ES and Coppen A, Eds. Psychopharmacology of affective disorders. Oxford University Press. 1979, page 160.
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In Summary
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Health IT “Success”: A Vision for 300 Million
You have
• Safe, high quality, efficient, convenient care
wherever you are
• Health IT is woven into the fabric of health care delivery nationwide
• Your health information available to you or whomever YOU choose –
anytime, anywhere
• The information to make informed choices
to improve your health and well-being
• Timely, personalized, context-sensitive health information serves as a
valuable and useful resource
• Trust that your privacy is protected
• And that your health information can be aggregated with that of others –
without compromising your privacy
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November 6, 2009
The Ultimate Reason for
Health IT
Health IT is a
key enabler for us
ALL to get:
The quality and value of health care services
we demand
The quality of health we want and deserve
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November 6, 2009