Medical Summit ~ Opening Remarks on the Future of Medicine

1. Medical Summit ~ Opening Remarks on the Future of Medicine The Honorable Aneesh P. Chopra Secretary of Technology August 2008 www.healthitcouncil.vi.virginia.gov

2. Agenda for Discussion I. Vision over the Next Five Years II. Vision over the Next Ten Years III. Vision over the Next Twenty Years

3. Setting the Stage Health IT a Driver of Virginia’s “Quality and Transparency” Agenda Health Reform Commission Disparities in Outcomes • Access to Care – Focused on the uninsured • Workforce – Focused on nurses, nursing support (direct care workers), and physicians • Aging / Long Term Care – Focused on services for the aging and disabled • Quality / Transparency / Prevention – Focused on Pay-for-Performance in Nursing Homes; price, quality, & information transparency; and infant mortality, tobacco cessation, & obesity Infant Mortality Rates Deaths Per 1,000 Southwest Virginia Drug Deaths • Suffered 264 drug related deaths in 2006 (up 22%) • More than 200 or 75% due to prescription drug abuse • Rate of drug deaths per 100k more than 5 times the state average

4. Road Map for Health IT Comprehensive Reform Agenda to Deliver on the Promise of Health IT I Organizing Procurement II Establishing a Policy Framework III Seeding Innovation #DHRM Public-Private Partnership: Fulfill EO42 through innovative partnership to provide health IT-powered services for state employees #Innovation Grants: Seed capital to advance EMR adoption across Virginia’s communities #Enterprise-Wide EMR: Establish a public-private partnership to participate in CMS Pilot for small practice EMR adoption; goal to leverage program to encourage public sector adoption #Administrative Simplification: A public-private consortium to lower administrative costs, targeting smaller providers #Accountability and Transparency: Apply for Chartered Value Exchange to improve transparency and quality information within the Commonwealth

5. The Next Five Years CMS EHR Demonstration Turbo-Charges Small Practice Purchases • Purpose: Drive adoption of EHRs in primary care • Virginia one of only 12 sites awarded • Target: Small-medium PCP practices (<20 MDs) • Goal: Attract 200 practices in VA (100 control, 100 study) • Incentives: Through additional Medicare reimbursement, participating providers will earn for: Year 1: Adoption of CCHIT-certified EHR Year 2: Reporting of quality measures Year 3-5: Clinical improvements (P4P) • Value: $58,000 per physician or $290,000 per practice over five years

6. EHR Adoption Vision: Develop Applications Center of Excellence in Rural Virginia “E-Store for EHRs” Goal: Establish a public-private partnership to support multiple EMR applications in a shared services center Problem: Deliver EMR services at low-cost in an environment that encourages rapid best practice adoption Strategy: Simplify EMR acquisition, drive public sector adoption, and promote rural economic development In October, 2006, Virginia invested $150K in the OnePartner Advanced Technology and Applications Center, expected to employ 40 jobs

7. Lower Administrative Costs Payer-Provider Collaborative to Lower Transaction Costs Universal Eligibility Portal Goal: Lower transaction costs associated with verifying a patient’s insurance eligibility by jointly procuring a common portal for Virginia providers to use when interacting with Virginia Payers Scope: Allow a provider to retrieve up-to-date eligibility information on a patient from any participating Virginia health plan from a single point of entry. Timeline: RFI responses due August 15th, 2008; selection expected October, 2008; implementation in 2009 The VHEN Charter Following an initial summit in Richmond with Virginia payers and providers discussing scope and focus for a Virginia Administrative Exchange modeled on NEHEN, the VHEN workgroup formalized a charter in October 2007. Charter members include 9 Health Plans and 7 Health Systems including MCV, UVA, Riverside, Anthem-Wellpoint, Aetna, and DMAS. Source: CORE Patient Identification Survey, 2006; funded, in part, by California HealthCare Foundation

8. The Next Ten Years Universal Broadband to Become the Foundation of Health Reform Physician Broadband Access* 2007 TN Survey Case Study Description Following merger with Centra Health, SCH saves $48K in telco bill and secures 45% rural health funding by leveraging MBC Tobacco Commission approves $750k towards broadband access for qualified rural clinics to match $2.7M FCC grant Virginia launches “Virginia Telehealth Network” to increase services that elevate care quality through broadband access Only 18% of one rural Virginia hospital’s medical staff have access to high-speed broadband service 40% 14% Rural TN Urban TN The Opportunity In 2007, Governor Kaine formalized the Broadband Roundtable to better understand emerging technologies, applications, and financial models to encourage communities to provide broadband access. *Represents T-1 Level Service or Above

9. Public-Private Partnerships Evidence-Based Medicine a Key Pillar of Innovative Programs Cardiac Care Best Practices Centra Health Health Plan IT-Related Services Virginia Department of Human Resources • DHRM has accepted an unsolicited proposal under the PPEA act to provide wrap-around services for the Employee Health Plan • Many firms haveproposed to lower costs for the Commonwealth by creating a data warehouse with business intelligence and a customer service center to help advise state employees on the intervention that will most likely resolve their problem at the lowest cost • Goal to prevent duplicative care and minimize challenges felt by employees navigating the complex healthcare system • “DHRM’s comprehensive care management vision is truly ground breaking. Once operational, it will mark COVA as a leader among state employee medical plans and private industry…” – Joe Marlowe – Aon Consulting, May 2008 • Centra awarded Health IT Innovation Grant to allow community physicians to participate in ACC’s National Cardiovascular Data Registry (NCDR) Program for Improving Continuous Cardiac Care (IC3) • Centra to provide access to the IC3 program through an existing EMR that will allow physicians to exchange real-time data and best practices in cardiac care • Centra is matching the Commonwealth’s investment of $150,000 with a $100,000 contribution for a total investment of $250,000 for this project

10. The Next Twenty Years Missing Clinical Information Affects Care

11. Physicians Increasingly Reluctant to Seek Information

12. Supporting the Diagnosis Decision A Virginia Story "One of the things I try to model for my residents is that I'm trying to learn new things even though I've been doing this for a long time."  Pediatrician Stephen Borowitz • When presented with unusual symptoms that do not match the current diagnosis doctors can turn to Isabel which is easily accessible on all clinical units at UVAHS. • Isabel can provide a list of diagnoses, some of which might be outside the normal pattern doctors can fall into. • It does not replace the decision-making of the Doctor but it does provide powerful tools to augment the memory of each doctor.

13. Hand-washing ~ Mining Data to Save Lives Identifying the Value of Hand-washing Through Data Analytics A 19th Century “Super-Cruncher” Institute for Healthcare Improvement Goal: Save 100,000 lives a year Method: Look at how people are dying in hospitals and then determine if there are any large-scale statistical evidence that could point the way towards a solution As far back as the 1840s, doctors have worked to analyze data to improve healthcare interventions. Dr. Semmelweis noticed an alarmingly high mortality rate for infants born in his division (18%) compared to only 4% in another OB group. After careful review, he instituted a mandatory hand-washing program and observed the mortality rate fall to 1.8% Unfortunately, his work was not accepted by his peers, delaying data-driven medical efforts for over a century Results: Dr. Berwick found that systematic hand-washing along with a few other changes could account for as many as 25,000 lives a year in just ICU patients. Central Line Catheters Infection Rates >125,000 Reduced infections by 90% 10% Current Practice Recommended

14. Kasparov vs. Deep Blue Are We Heading Towards Google-Powered Self-Diagnosis? Google announces Google Health to help store and organize personal information Microsoft launched HealthVault to organize information, personal records