Yesterday, Today, and Tomorrow
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
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A look at . . .
• Yesterday - what we’ve gotten done
– The status of the HITECH Programs
• Today - what are our key priorities
– Health information exchange
– Patient engagement
• Tomorrow – what are the biggest challenges in our future
– Meaningful use of meaningful use
– Health reform
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We’ve come a long way …
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A Bit of History …
On the eve of the Presidential Election
President Bush’s goal in January 2004
“… an Electronic Health Record for every American by the year
2012. By computerizing health records, we can avoid dangerous
medical mistakes, reduce costs, and improve care.”
- State of the Union address, January 20, 2004
Executive order established the Office of the National Coordinator for
Health IT (ONCHIT) as part of the Dept of Health & Human Services
– Dr. David Brailer appointed the first National Coordinator for Health IT
– Followed by Dr. Rob Kolodner
President Barack Obama’s goal in January 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.”
- Speech at George Mason University, January 12, 2009
February 17, 2009 – HITECH Act (part of ARRA) is signed into law
–
–
–
–
Dr. David Bluementhal appointed National Coordinator
Health IT Policy and Standards Committees are formed
ONC grows from around 30 to over 150 employees
Dr. Farzad Mostashari becomes the current National Coordinator
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A Remarkable Journey
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Progress of Eligible Providers toward
EHR Incentive Payments as of 8-31-12
NAMCS Survey:
• The percentage of
primary care providers
who have adopted
EHRs in their practice
has doubled from 20
% to 40 % between
2009 to 2011
Note: The 2012 data will
be available in 2013
Source: CMS EHR
Incentive Program Data
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EHR Adoption of Eligible Providers by state
as of 8-31-12
http://dashboard.healthit.gov/HITadoption/
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Regional Extension Centers are working
with 148,448 Primary Care Providers
Includes 70% of all primary care providers in the rural
areas and 1,185 Rural or Critical Access Hospitals
2012 GAO Report: Providers 2.3 times more
likely to achieve MU if working with an REC
http://dashboard.healthit.gov/rec/
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Progress of Eligible Hospitals toward
EHR Incentive Payments as of 8-31-12
AHA Survey – in one year,
from 2010 to 2011:
• Hospitals increased their
use of Basic EHRs from
19% to 35% (84%)
• Hospitals doubled their
use of Comprehensive
EHRs from 4% to 9%
(125%)
Note: Totals
reflect the
number of unique
hospitals that
have received
payments from
Medicare or
Medicaid.
Note: The 2012 data will be
available in early 2013
Source: CMS EHR
Incentive Program Data
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EHR Adoption of Eligible Hospitals by state
as of 8-31-12
http://dashboard.healthit.gov/HITadoption/
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Meaningful Use – All Payments
as of 8-31-12 ($ 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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HITECH Framework for MU of EHRs
Taken from: Blumenthal, D.
“Launching HITECH,” posted by
the NEJM on 12-30-2009.
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Health IT Resource Center
THEN: Work within REC
community to share
knowledge
NOW: Work with all
external communities to
share knowledge
Tools
Beacon
HIE
CCC
REC
SHARP
Resources
Communities
of Practice
(CoPs)
National Learning Consortium
HealthIT.gov
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Workforce Training – Community
College Program Enrollment & Graduation
Students Enrolled or
Completed: 21,321
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Workforce Training - University-Based
Program Enrollment & Graduation
As of September 14, 2012
Students Enrolled or
Graduated: 1,627
(Target: 1,685)
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Health Information Exchange - Directed
Exchange Implementation as of 6-30-12
Summary Stats
States/territories with directed exchange options broadly available
States/territories piloting directed exchange solutions
States/territories with directed exchange options unavailable
Number of Grantees
36
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10
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Directed Exchange: Estimated
number enabled as of 6-30-12
Summary Stats
Total number of organizations enabled for directed exchange nationally
Total number of clinical & administrative staff enabled for directed exchange nationally
Number
8.349
48,649
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Query-Based Exchange: Estimated
number enabled as of 6-30-12
Summary Stats
Total number of organizations enabled for query-based exchange nationally
Total number of individuals enabled for query-based exchange nationally
Number
3,554
56,496
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Exchange is increasing across the nation
18 states had more than 10% of their hospitals actively engaged in
sharing health information electronically as of 6-30-12
State
Delaware
Vermont
Michigan
Arkansas
New York
Minnesota
North Dakota
Colorado
California
Alaska
Utah
% of Acute Care Hospitals
Actively* Participating in
Directed Exchange that is
supported or enabled by
State HIE grantees**
100%
79%
48%
45%
42%
34%
34%
26%
20%
18%
14%
State
Delaware
New York
Maryland
New Jersey
Arizona
Colorado
Nebraska
Idaho
Kentucky
Michigan
Tennessee
% of Acute Care Hospitals
Actively* Participating in
Query-Based Exchange
that is supported or
enabled by State HIE
grantees**
67%
65%
54%
32%
27%
26%
20%
17%
16%
15%
12%
* Active = at least one directed message sent between production end points or at least one patient record
query during previous calendar quarter
** Data self-reported by HIE grantees, Denominators calculated with 2011 Medicare Inpatient Hospital Data
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The Beacon Community Program:
Where HITECH Comes to Life
17 diverse communities, each funded over 3 yrs to:
Build and strengthen health IT infrastructure and exchange capabilities
-
positioning each community to pursue a new level of sustainable health care
quality and efficiency over the coming years.
Improve cost, quality, and population health - translating investments in
health IT in the short run to measureable improvements in the 3-part aim.
Test innovative approaches to performance measurement, technology
integration, and care delivery - accelerating evidence generation for new
approaches.
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“Beacons for Public Health”
• Funded by the CDC and
launched in collaboration
with the ONC in 2011
• Primary goal: Gain an
understanding of the range of
activities currently conducted in
population and public health
within the Beacon
Communities, to accelerate the
work of other organizations
across the country
Western New York
Beacon Community
Buffalo, NY
Southeastern Minnesota
Beacon Community
Rochester, MN
Rhode Island Beacon
Community
Providence, RI
Southeast Michigan
Beacon Community
Detroit, MI
Greater Cincinnati
Beacon Community
Cincinnati, OH
• Case studies available today!
Southern Piedmont
Beacon Community
Concord, NC
San Diego Beacon
Community
San Diego, CA
Crescent City Beacon Community
New Orleans, LA
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IT-Care Management Partnership:
Beacons and AF4Q
Bangor Beacon
Community
Brewer, ME
Maine Alliance
Southeastern Minnesota
Beacon Community
Rochester, MN
Humboldt
County Alliance
• Partnership to align “regional health
care improvement” programs
between ONC (Beacons) and RWJ
(Aligning Forces for Quality or
AF4Q)
• On October 24th, pioneering
organizations from both programs
came together to understand
opportunities and gaps related to IT
and care management
Wisconsin
Alliance
Western NY
Alliance
Cleveland
Alliance
Keystone Beacon
Community
Danville, PA
Southern Piedmont
Beacon Community
Concord, NC
• Lessons will be shared through case
studies and videos
• Future topics: Behavioral health and IT,
and data use agreements across
communities
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Connecting Health IT to Payment
Bangor Beacon
Community
Brewer, ME
• Bangor Beacon HIT infrastructure
serves as the foundation for the
Bangor Pioneer ACO
• 3 Beacon Communities (CO, Tulsa
and Cincinnati) are working on how
Beacon HIT infrastructure can be
used to support provider practices
participating in CMMI’s
comprehensive primary care
initiative (CPC)
Greater Cincinnati
Beacon Community
Cincinnati, OH
Colorado Beacon
Community
Grand Junction, CO
Great Tulsa Health Access
Network Beacon
Community
Tulsa, OK
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EHR Certification Program:
Certified Health IT Product List (CHPL)
• 1,642 “Unique” Certified EHR Products as of 11/01/12
Ambulatory
Complete EHR
694
Modular EHR
436
Total
1130
Inpatient
96
416
512
Total
790
852
1642
This table shows a unique count of products. Any additional
versions of the same products are not included.
• 2,744 Certified EHR Products when all product versions are
counted
• 896 EHR Vendors/Developers
• On October 4th, ONC’s Permanent Certification Program was
launched; the Temporary Certification Program which was
operating for 2 years was sunset
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MU Attestations by Vendor (7/28/12)
http://www.modernhealthcare.com/article/20120728/MAGAZINE/307289983
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TODAY - Key Priorities:
Keeping the Patient at the center of all we do
• Patient-Centric health care and health record by
– Laying the groundwork for interoperability with
standards, testing & certification
– Facilitating broad implementation of health
information exchange
• Patient Engagement by enabling patient
– Access
– Action
– Attitude
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Focus on INTEROPERABILITY in the
Stage 2 Meaningful Use Criteria
• E-prescribing (ambulatory and inpatient discharge)
• Transition of Care summary exchange:
• Create & transmit from EHR
• Receive & incorporate into EHR
• Lab tests & results from inpatient to ambulatory
• Public health reporting – transmission to:
• Immunization Registries
• Public Health Agencies for syndromic surveillance
• Public health Agencies for reportable lab results
• Cancer Registries
• Patient ability to View, Download and Transmit their
health data to a 3rd Party
• Create an export summary of patient data, in order to
enable data portability
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Focus on PATIENT ENGAGEMENT in the
Stage 2 Meaningful Use Criteria
• Reminders for preventive/follow-up care
provided
• Educational resources identified and provided
• Online access to personal health information
(portal, PHR)
• Visit Summaries provided
• Patients can send secure messages to their
provider
• Patients can View, Download and Transmit to 3rd
Party
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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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ONC’s Consumer Engagement Strategy:
The Three A’s
Access
Attitudes
Support a shift in attitudes and
expectations regarding consumer
(and provider) roles.
Give consumers electronic
access to their health
information.
Action
Action
Catalyze development of tools and
services that help consumers (and
providers) take action using their
health information.
ACCESS: Consumer eHealth Pledge Program
Over 400 organizations have Pledged to provide access to personal
health information for 1/3 of Americans…
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Taking the Blue Button nation-wide
www.healthit.gov/pledge
• Get more organizations to offer
Blue Button
• Make “Blue Button” a household
name = “electronic access to my
health data”
• Advance technical capabilities =
“set it and forget it”
• One of 5 game-changing projects
involving the 2012 Presidential
Innovation Fellows
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ACTION: Making it easier for Patients
to use Health IT
• Surgeon General’s Healthy Apps Challenge
More at: http://sghealthyapps.challenge.gov
• PHR Model Privacy
Notice
More at: http://bit.ly/qfjP1a
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ACTION
• Blue Button Mash-Up Challenge – develop an app that
mashes up PHR data with other health-related data
sets
• Leon Rodriguez, Director-Office of Civil Rights:
clarification of the patient’s right to access their own
health information under HIPAA (videos, pamphlets,
answers to questions, and other guidance)
More at:
http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/righttoa
ccessmemo.pdf
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ATTITUDE: Health IT Animation
http://www.healthit.gov/patients-families/video/preview-health-it-yougiving-you-access-your-medical-records
• 1 and 3 minute versions of the animation are available
to use for patient teaching
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Beat Down Blood Pressure
Consumer Video Challenge
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Beat Down Blood Pressure Winner
A Regular Guy Beats Down Blood Pressure:
http://vimeo.com/42121895
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What’s in Your Health Record
Consumer Video Challenge
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What’s in Your Health Record Winner
Wright and Luft:
http://vimeo.com/46790323
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TOMORROW –
The biggest challenges in our future
Improved
outcomes
Advanced
clinical
processes
Data capturing
and sharing
Stage 3
Stage 2
Stages of Meaningful Use
Stage 1
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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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Best Care at Lower Cost
The Path to Continuously Learning
Health Care in America
September 2012
iom.edu/bestcare
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
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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Meaningful Use Is Just the Beginning:
Other Three Part Aim Programs
• A recent analysis identified that the national network of RECs are
currently working on over 190 different programs to help providers
meet the Three Part Aim
* Based on information from 53 of 62 RECs. Some are working on several different Three-Part Aim Programs
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.
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THE FUTURE IS NOW.
THIS IS OUR TIME.
Thanks!
judy.murphy@hhs.gov
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