The Role of Health IT in
Health Care Transformation
Judy Murphy
RN, FAAN
The Role of Health IT
in Health Care Transformation
Judy Murphy, RN, FACMI, FHIMSS, FAAN
Deputy National Coordinator for Programs & Policy
Office of the National Coordinator for Health IT
Department of Health & Human Services
Washington DC
Transforming Health Care: Driving Policy
10-12-2012, 9 - 10am
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What I Will Cover . . .
• Today’s Health IT landscape
• Quality and the new IOM Report
• Consumer eHealth
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A Bit of History …
• President Bush’s goal in 2004
“… an Electronic Health Record for
every American by the year 2014. By
computerizing health records, we can
avoid dangerous medical mistakes,
reduce costs, and improve care.”
- State of the Union address,
Jan. 20, 2004
• Executive order established the Office of the National
Coordinator for Health Information Technology (ONCHIT)
as part of the Dept of Health & Human Services (HHS)
– Dr. David Brailer appointed the first National Coordinator
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The Time is Now …
• President Obama’s goal in 2009
“To lower health care cost, cut medical
errors, and improve care, we’ll
computerize the nation’s health records
in five years, saving billions of dollars in
health care costs and countless lives.”
- First Weekly Address
Jan. 24, 2009
• February 17, 2009 – the American Reinvestment and
Recovery Act (ARRA – Stimulus Bill) is signed into law
– HITECH component of ARRA provides an incentive program to
stimulate the adoption and use of HIT, especially EHR’s
– Dr. David Bluementhal appointed the new National Coordinator
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American Recovery & Reinvestment
Act of 2009 (ARRA / Stimulus Bill)
•
•
•
•
HR 1 -- 111th Congress
$787 Billion
Highly partisan vote
Healthcare gets $147.7 Billion
•
•
•
•
$87B for Medicaid
$25B for support for extending COBRA
$10B for NIH
HITECH Component:
• $22.5B for EHR Incentives through CMS
• $2B for HIT Support Programs through ONC
HITECH = Health Information Technology
for Economic and Clinical Health
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The focus on HIT continues …
PPACA Mar 2010
(Patient Protection &
Affordable Care Act)
IOM
Future of Nursing Report
Oct 2010
PCAST Report
Dec 2010
(President’s Council of
Advisors on Science
& Technology)
“There is no aspect of our profession that will be
untouched by the informatics revolution in
progress.”
- Angela McBride, Distinguished Professor and University Dean
Emeritus Indiana University School of Nursing
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A Remarkable Journey
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Progress of Eligible Professionals
Toward EHR Incentive Payments
Source: CMS EHR
Incentive Program Data
as of 8/31/2012
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Progress of Eligible Hospitals
Toward EHR Incentive Payments
Note: Totals reflect the
number of unique hospitals
that have received
payments from Medicare or
Medicaid.
Source: CMS EHR
Incentive Program Data
as of 8/31/2012
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Meaningful Use – All Payments
as of August 31, 2012 ($ in Millions)
Payments to All Eligible Professionals and Hospitals Under the Medicare or Medicaid EHR Incentive Programs
$900
$8,000
$836
Cumulative Total
$7,120
$800
Source: CMS EHR
Incentive Program Data
$659
$619
$608
$600
$563
$6,000
$620
$586
$5,000
$505
$500
$428
$387
$400
$4,000
$396
$3,000
$276
$300
$237
$2,000
$200
$116
$109
$80
$100
$22
$0
Cumulative Amount Paid (Millions)
Amount Paid per Month (Millions)
$700
$7,000
$16
$26
$1,000
$31
$0
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EHR Adoption by Ambulatory Providers
as of 8-31-12
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HIT as the means, not the end
Dr. David Blumenthal, previous National
Coordinator of HIT, emphasizes
“HIT is the means, but not the end. Getting
an EHR up and running in health care is not
the main objective behind the incentives
provided by the federal government under
ARRA. Improving health is. Promoting
health care reform is.”
- At the National HIPAA Summit
in Washington, D.C.
on September 16, 2009
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Our National Quality Strategy
Better Health
for the
Population
Better Care
for
Individuals
Lower Cost
Through
Improvement
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Health IT:
Helping to Drive the 3-Part Aim
Better healthcare
Improving patients’ experience of care within the Institute of
Medicine’s 6 domains of quality: Safety, Effectiveness, PatientCenteredness, Timeliness, Efficiency, and Equity.
Better health
Keeping patients well so they can do what they want to do.
Increasing the overall health of populations: address behavioral
risk factors; focus on preventive care.
Reduced costs
Lowering the total cost of care while improving quality, resulting
in reduced monthly expenditures for Medicare, Medicaid, and
CHIP beneficiaries.
$
Health Information Technology
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Meaningful Use as a Building Block
Transform
health care
Improved
population health
Access to
information
Enhanced access
and continuity
Data utilized to
improve delivery
and outcomes
Data utilized to
improve delivery
and outcomes
Patient self
management
Patient engaged,
community
resources
Care coordination
Care coordination
Patient centered
care coordination
Patient informed
Evidenced based
medicine
Team based care,
case management
Basic EHR
functionality,
structured data
Structured data
utilized
Registries for
disease
management
Registries to
manage patient
populations
Privacy & security
protections
Privacy & security
protections
Privacy & security
protections
Privacy & security
protections
Stage 2 MU
PCMH
3-Part Aim
ACO’s
“Stage 3 MU”
Utilize technology
Stage 1 MU
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Quality Measurement Enabled by Health IT
• Released July 2012
• Contains a catalog of over 70
activities related to health IT and
quality measurement
• Describes possibilities for the next
generation of quality measurement
• Illustrates challenges facing
advancement
http://healthit.ahrq.gov/HealthITEnabledQualityMeasurement/Snapshot.pdf
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Best Care at Lower Cost
The Path to Continuously Learning
Health Care in America
September 2012
iom.edu/bestcare
Why now?
Quality – persistent shortfalls
• Patient harm – One-fifth to one-third of hospital patients are
harmed during their stay, largely preventable.
• Recommended care – Only about half of the recommended
preventive, acute, and chronic care is actually received.
• Outcome shortfalls – If all states matched care quality in the
highest-performing states, 75,000 fewer deaths would have
occurred in 2005.
Why now?
Costs – unsustainable levels, waste
• Absolute expenditures – $2.6 trillion (2009), 17% GDP
• Relative expenditures – 76% increase health costs in past 10
years, overwhelming the 30% gain in personal income
• Wasted expenditures – $750 billion (2009)
• Opportunity costs – e.g. total waste could pay salaries of all
first response personnel for 12 years
Why now?
Complexity – exponentially increasing
• Increasing information – Over 800,000 new journal articles
per year; up 4-fold from 1970.
• New diagnostic factors in play – phenotypes, genetics, and
proteomics.
• Multiple treatment factors in play – e.g. 19 medications per
day for 79 year-old patient with osteoporosis, type 2 diabetes,
hypertension, and chronic obstructive lung disease; over 200 other
doctors are also providing treatment to the Medicare patients of
an average primary care doctor.
The Result?
The U.S. health care system today
The Vision
Continuous Learning, Best Care, Lower Cost
10 Recommendations
Foundational elements
1. The digital infrastructure – Improve the capacity to capture clinical, delivery
process, and financial data for better care, system improvement, and creating new
knowledge.
2. The data utility – Streamline and revise research regulations to improve care,
promote the capture of clinical data, and generate knowledge.
Care improvement targets
3.
4.
5.
6.
7.
Clinical decision support
Patient-centered care
Community links
Care continuity
Optimized operations
Supportive policy environment
8. Financial incentives.
9. Performance transparency
10. Broad leadership
HealthIT.gov website for patients
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Back in the Day…
“The
obedience of a
patient to the
prescriptions of his
physician should be
prompt and implicit.
[The patient] should
never permit his own
crude opinions as to
their fitness to
influence his
attention to them.”
- AMA’s Code of
Medical Ethics (1847)
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And Now…
“Patients share the
responsibility for their own
health care….”
- AMA’s Code of Medical Ethics
(current)
“Patients can help. We can be a
second set of eyes on our medical
records. I corrected the mistakes
in my health record, but many
patients don't understand how
important it will be to have
correct medical information, until
the crisis hits. Better to clean it up
now, not when there’s time
pressure.”
– Dave deBronkart (ePatient Dave)
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Consumer eHealth Pledge Program
www.healthit.gov/pledge
Over 400 organizations have Pledged to provide access to personal
health information for 1/3 of Americans…
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Consumer Involvement is critical
LINK: http://youtu.be/QCc6QgYUFEM
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Million Hearts – Provider Goals
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Million Hearts - Consumer Challenge
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Consumer Video Challenge Winner
Dr Funky's Blood Pressure Management Rx
http://bloodpressure.challenge.gov/submissions/7498-dr-funky-s-bloodpressure-management-rx
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Stage 2 Meaningful Use Criteria
FOCUS ON INTEROPERABILITY
• E-prescribing
• Transition of Care summary exchange:
• Create & transmit from EHR
• Receive & incorporate into EHR
• Lab tests & results from inpatient to outpatient
• Public health reporting – transmission to:
• Immunization Registries
• Public Health Agencies for syndromic surveillance
• Public health Agencies for reportable lab results
• Cancer Registries
• Patient View, Download and Transmit to 3rd Party
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What’s in Your Health Record - Consumer Challenge
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Consumer Video Challenge Winner
Mark’s Story
http://yourrecord.challenge.gov/submissions/9688-mark-s-story
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OpenNotes: What Was Learned
Tom Delbanco, MD; Jan Walker, RN, MBA; et al
Supported by: The Robert Wood Johnson Foundation
With additional funding from the Drane Family Fund and the Richard and
Florence Koplow Charitable Fund
OpenNotes study results (Annals of Internal Medicine: 2 October 2012, Vol 157, No 7)
Includes editorials by Michael Meltsner, an OpenNotes patient and Carol Goldzweig,
from the Veterans Health Administration
http://annals.org/article.aspx?articleid=1363511
www.myopennotes.org
About the OpenNotes Study
http://www.youtube.com/watch?v=x-0KdtcBwfI
• More than 19,000 patients
• 105 volunteer primary care physicians
• 3 diverse sites
– Beth Israel Deaconess Medical Center
– Geisinger Health System
– Harborview Medical Center
• 12 months of sharing notes
www.myopennotes.org
Patients Were Enthusiastic
• Patients used the notes
• Up to 92% of patients across the 3 sites read their doctor’s
note(s)
• Patients reported important benefits
• Feeling more in control of their care (77-87%)
• Better understanding of health and medical conditions (77-85%)
• Doing better with taking their medications (60-78%)
• Patients were rarely (1-8%) confused, worried, or
offended by what they read in their doctors’ notes
www.myopennotes.org
Doctors Experienced Little
Disruption and Observed Benefits
• Few doctors reported impacts on their workflow
• Longer visits (0-5%)
• More time addressing patients’ questions outside of visits (0-8%)
• Some doctors changed how they wrote notes
• 0-21% reported taking more time writing notes
• 3-36% reported changing the way they wrote about mental health,
substance abuse, cancer, and obesity
• Many doctors described strengthened relationships
with their patients
www.myopennotes.org
Thank you!
For more information, contact:
judy.murphy@hhs.gov
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