Connecting California:
The Role of State Leadership in Advancing
Health Information Technology
CCST Board and Council Meeting
Molly Coye, MD, MPH
Chair, CalRHIO Planning Committee
CEO, Health Tech
October 19, 2005
The Vision
If I go to see my doctor, she
or he will have all the
information needed right on
the spot. I won't have to fill
in any more forms, lab tests
won't be repeated, and my
doctor will know if I've been
to see another doctor, or to
a hospital, and what
medicines I'm taking.
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The Vision
If I'm taken to the hospital in
an emergency, the nurses and
doctors in the emergency
department will be able to find
out all the information they
need to take care of me within seconds.
3
The Vision
•
I have my own personal
health record, that I keep at
home on my computer or as a
printed record. It has all the
information I need about my
medical history, current
conditions, medicines I'm
taking, the doctors that are
caring for me, and education
about my medical conditions.
4
The Vision
•
If there is a public health
emergency.…my records will
be available to treat me or my
family at any location.
The Vision: Health care that is safe, of high quality,
and efficient, in an information-rich environment that
meets the needs of consumers, patients, providers
and others in California’s communities.
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Lessons from Katrina
“There may not have been an experience that demonstrates, for me or the
country, more powerfully the need for electronic health records ... than
Katrina."
Mike Leavitt, HHS Secretary
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Lessons from Katrina
“Starting yesterday (9/14), doctors in eight shelters for evacuees could go
to the Internet to search prescription drug records on more than
800,000 people from the storm-racked region.”
Washington Post
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National HIT Picture
•
Federal advocacy for healthcare IT
•
•
Limited federal funding
•
•
Establishing standards
‘Harmonizing’ privacy and security legislation
Safe harbor for hospital funding of physician IT
Accrediting products as standard-compatible
Stimulating development of models for national
‘highway’
Linkage to Pay-for-Performance
•
•
•
•
•
$125M proposed for health care HIT in FY 2006
Re-structuring the market
•
•
•
•
•
•
Secretary Leavitt a strong proponent
Medicare pilot
MedPAC proposal for pay-for-use of IT
Interoperability standards underway
Strong White House support
Congressional stampede
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The Baseline:
Is California Ready?
Estimates, for all California consumers and patients:
10 %:
online appointment scheduling
20 %:
pharmacy refills
40 %:
enroll in health plan online
5 %:
email with physician
5 %:
pay medical bills online
10 %:
customized health education
5 %:
personal health record online
Source: Structured inquiry of California health care leaders, November 2004
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Is Technology Transforming
California Healthcare ?
Estimates for Infrastructure:
10 %: physicians using ‘EMR light’
30 %: integrated clinical data within integrated delivery
networks (IDNs)
5 %: integrated data: plan - IDNs
<2 %: community health data shared
<5 %: telemedicine-enabled
10 %: EMR light
20 %: full EMR
Source: Structured inquiry of California health care leaders, November 2004
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The Opportunity: Safety,
Satisfaction and Efficiency
Increase access to information
•
Without HIE, 30% of the time, physicians could not find information
previously recorded in a paper chart
Reduce duplicate testing
•
Same drug or radiology exam ordered 11% of the time; patients agreed to
duplicate testing 50% of the time
Ensure complete information
•
Physicians unaware of 1 in 4 patient prescriptions
Eliminate uncertainty
•
On average, test results come from 5 or more locations; problems with
retrieval accounted for 1 in 7 admissions and 1 of 5 lab tests and radiology
exams
Reduce data collection/transfer costs
•
Cost of tracking down and obtaining information on the data user/originator
sides range from $12 - $28 per visit
*Electronic Medical Records – Getting it Right and Going to Scale. W. Edward Hammond, III, Ph.D.
Commonwealth Fund background paper. www.cmwf.org publication #695. January 2004.
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The Opportunity:
Cost and Savings
Potential benefits of EHR adoption:
(Assume 90% adoption over 15 years)
Annual Cost
Annual Savings
National - $7.7 billion
National - $81 billion
$6.5 billion for hospitals
$1.2 billion for physicians
California - $77 million (est.)
$77 billion improved efficiency
$5 billion reduced medical errors
California - $8.1 billion (est.)
Sources:
National estimates: Rand
California estimates: Extrapolation
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The Opportunity:
Office-Based Patient Care
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Health Technology Center
The Vision
•
Advancing the use of
new technologies to
make people healthier.
The Mission
• To create a trusted source
of expert information about
the future of healthcare
technologies.
The Means
• A nonprofit pooled research
center for delivery systems
and health plans. Funding
independent of technology
developers and vendors.
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HealthTech Partners
Stanford Hospital and Clinics
Baylor Health Care System
Group Health Cooperative
University HealthSystem
Consortium (UHC)
Bon Secours Health System
Kaiser Permanente
Carolinas HealthCare System
Mills-Peninsula Health Services
Froedtert Hospital
Catholic Healthcare West
PeaceHealth
Hospital Corporation of
America (HCA)
Centers for Medicare and Medicaid
Premier, Inc.
Greenville Medical Center
Services (CMS) Federal Liaison
Providence Health System
Health Alliance of Greater
Cincinnati
CHRISTUS Health
Sutter Health
Parkview Health
VHA Inc.
Blue Shield of California
Foundation
Partners HealthCare System
WellPoint Health Networks
Lucile Packard Medical Center
The Queen’s Medical Center
Texas Health Resources
Veterans’ Health Administration
New 2005
Overlake Hospital
SCAN Health Plan
University of Chicago Hospitals
and Health System
Palomar Pomerado Health
Memorial Hermann
Sandia National Laboratories
TEKES/SITRA
Trillium Health Centre
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Chinese Hospital & Health Plan
Catholic Health Initiatives CHI)
St. Alphonsus Regional
Medical Center
UC Davis Health System
Methodist Health System
Rockingham Memorial
Lumetra
Salem Hospital
Ascension Health
El Camino Hospital
CAPH
Banner Health System
John Muir/Mt. Diablo Health System
Stormont-Vail HealthCare
CalRHIO’s Role
• Independent umbrella organization
• Leading a collaborative effort to:
• incrementally build a statewide information exchange for
California
• implement projects that build systems for data exchange, and
demonstrate their feasibility and utility
• ensure participation by safety net providers and underserved
populations in data exchange and IT investment
• build financial and business case models for health information
exchange
• facilitate creation of common governance, process,
technology, and other elements needed for regional and
statewide data exchange organizations
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CalRHIO’s Role
•
encourage business, healthcare, and policy leaders to create
private and public policy agendas and funding for data
exchange and IT investment
•
help organizers of local and regional data exchange efforts
within California work toward common goals and share what
they develop and learn
• ensure that California’s data exchange projects are
consistent with national technology platforms and networks
• identify legislation and regulation necessary for statewide
data sharing
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Statewide Highway for Health
Information Exchange
Large RHIO A
Found 3
CalRHIO
A- 3
Payers found
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Little RHIO B
Found 1
B-1
Multi-Community
RHIO C Found 2
Looking for
Private Ryan
– in CA!
Medical Group/ MSO
None
Community A
Community B
National
Health
Information
Network
C -2
Community C
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Geographic Coverage
Northern Sierra
CalRHIO
and CAPG
cover the
entire state
Mendocino
Marin
Central Valley
Smart Health
Santa Cruz RHIO
Santa Cruz CCN
Loma Linda
Santa Barbara
Riverside
Health-e-LA
Long Beach
San Diego
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2005 Projects
• Linking hospital emergency departments across the state
• Defining the infrastructure necessary for statewide health data
exchange
• Supporting enhanced safety in medication management
• Improving the efficiency of administrative functions for plans and
providers
• Giving consumers more direct access to health information in a
Personal Health Record
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CalRHIO’s Future Role
• Core functions of CalRHIO
•
•
•
•
Convene and support communications, problem-solving
Resource center
State policy analysis and development
Representation to federal agencies
• Health care IT in 2010
• National ‘highway’ for data exchange established
• Public utility or commercial models
• State and federal privacy and security protections
• Standards support interoperability
• Two key tasks for CalRHIO
• Statewide exchange of health data
• Statewide adoption of electronic health records and supporting
applications by all health care entities
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Other States Act
• Nationwide 150+ bills in state legislatures addressing HIT
• 13 states have introduced or passed HIT legislation or have
Governor support through an Executive Order
• 40 states have one or more community-based data exchanges
or grants for regional health information organizations
• 28 states have formal efforts for secure health care data
exchange underway
•
Source: Health Information and Management Systems Society (HIMSS)
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New York
Legislature Created Major Funding
• $1 billion over 4 years to:
• Finance HIT investment in projects that will build a statewide
infrastructure to share clinical information
• $1.5 billion over 3 years through fed/state Medicaid waiver for HIT
investment
• Created HIT grant sources and other budget initiatives in 2005-6
• $3 million for physician HIT development
• $10 million for pay for performance (P4P) initiatives which will connect
to HIT development
• Focus
• Regional HIE projects
• E-prescribing
• EHRs
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Tennessee
Governor leveraging HIT to reform state’s Medicaid Program
• Gov. Phil Bredesen announced pilot to improve health care
delivery in SW Tennessee; managed by State in partnership with
Vanderbilt University Medical Center
• 1 million patients in 3 counties; 5 year demonstration pilot
• Funded by AHRQ, technology provided by Vanderbilt University
and Accenture
• Focus:
• ED linkage
• Clinical and administrative, eventually financial
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Arizona
Governor takes lead in Call to Action Summit
• Gov. Janet Napolitano led October Summit to create a successful
statewide electronic medical records system
• More than 300 representatives from the health care, technology
and government sectors attended
• Gov. acted on recommendations from a steering committee she
had formed to develop a roadmap for providing EMRs to all
Arizonans by 2010
• Funding TBD
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Kentucky
Legislation calls for statewide network
• Nation's first legislated statewide electronic health
network. (Took four years to pass law.)
• Universities of Kentucky and Louisville to create the
Kentucky Health Care Infrastructure Authority, which would
coordinate efforts such as conducting pilot projects and
managing the network.
• Gov. Ernie Fletcher (R), a physician, to appoint members to
a Kentucky e-Health Network Board, which would oversee
the development and implementation of the network.
• The board to meet monthly and include health care
providers, patient representatives and other stakeholders.
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Florida
Governor creates advisory board
• Gov. Jeb Bush, May 4, 2004, created the Health Information
Infrastructure Advisory Board.
• Established to advise the Agency for Health Care Administration
(AHCA) which administers Florida's $14 billion Medicaid
program, licenses and regulates more than 32,000 health care
facilities and 30 HMOs, and publishes health care data and
statistics
• Funding from AHRQ Grant
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Gulf States
Infrastructure expected to emerge post
Katrina
• Example: KatrinaHealth.org developed in
10 days; available from anywhere in US
• an online service for authorized health
professionals to gain electronic access to
prescription medication records for
evacuees from Hurricane Katrina
• medication and dosage information to
renew prescriptions, prescribe new
medications, and coordinate care
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Why Now?
• Federal leadership, pressure and pending legislation
• Technology makes data exchange possible, affordable
• California and other states are mobilizing
• Standards are under development
• State leadership
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Potential State Role in
California
Funding
• Waiver: Enable Medi-Cal to pay its share of investments in
community-wide IT infrastructure; provide financial incentives to
providers who use HIT; add telemedicine as covered service
• Funding:
• Explore use of proceeds from converted not-for-profits to create
investment fund/revolving loan fund to support RHIOs
• Authorize finance authority or other entity to establish revolving loan
fund
• Create budget line-item to fund CalRHIO
Mandates
• Mandate that every California nursing home resident have an
EHR with retrievable medication data by July 1, 2006
• Mandate that every Californian have a PHR by 2007
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Potential State Role
California
Legislation
• Researching need: removal of legal barriers to acquisition and
effective use of HIT
• Example: privacy and security of personal health information
• Researching need: legislation to create certification process for
RHIOs
• trusted intermediaries charged with facilitating HIE and promoting
public health
• promote consumer trust
• limit liabilities resulting from good-faith participation in HIE
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Are we prepared for the
“Big One”?
How can we help?
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