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Innovation in HIT --- Health Information Technology California’s Untapped Health Care Asset

Innovation in HIT --- Health Information Technology California’s Untapped Health Care Asset. Jack Lewin MD CEO, California Medical Association CCST Meeting-----UC Irvine October 2005. Ironies. Health Information Technology---Its Time Has Come:. Practice Management

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Innovation in HIT --- Health Information Technology California’s Untapped Health Care Asset

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  1. Innovation in HIT --- Health Information Technology California’s Untapped Health Care Asset Jack Lewin MD CEO, California Medical Association CCST Meeting-----UC Irvine October 2005

  2. Ironies

  3. Health Information Technology---Its Time Has Come: Practice Management Patient and Personal Records Quality of Care

  4. Some Physicians Are More Able to Participate in the Quality Agenda Than Others

  5. Distribution of Physicians by Practice ArrangementUS Market, 1984-2001 Percent 43% 40% Employees* Self-Employed Group 37% 28% 23% Self-Employed Solo * Employees include group, hospital, medical school, government, health plan and ambulatory physician employees. Sources: AMA Physician Masterfile, 2003, AMA Physician Socioeconomic Statistics, 2003; Aventis Pharmaceuticals, 2003

  6. Are Consumers Really Interested in Quality of Care?

  7. YES** But, What is Quality?

  8. Consumerism: Short-term Health Trend, or the Future?

  9. Consumer-Driven Healthcare Trends Changes in the health insurance market Changes in who pays for healthcare Likely market influence of HDHPs/HSAs Future physician demographics and solo practice Influence of purchasing collaboratives Consumerism and quality

  10. How Real is the Quality Problem?

  11. Distribution of Fee-for-Service Medicare Spending Among Beneficiaries, 1997 Percent Fee-for-Service Beneficiaries Total Fee-for Service Spending Source: Congressional Budget Office

  12. Percent of Americans Saying “I Have A Chronic Condition” Source: Chronic Illness and Caregiving Survey, Harris 2000

  13. Alcohol dependence 11% 23% Hip fracture Peptic ulcer 33% Diabetes 45% Low back pain 69% Prenatal care 73% Breast cancer 76% Cataracts 79% RAND Study: Quality of Health Care Often Not Optimal • Doctors provide appropriate health care only about half the time Percentage of time E. McGlynn, S. Asch, J. Adams, et al., The Quality of Health Care Delivered to Adults in the United States, N Engl J Med, 2003

  14. Intermountain Health Care QI effort on CVD Results: 90% prescription rates 27% decrease in unadjusted absolute death rates Measurement-Based QI Can Make a Difference Proportions of patients receiving the appropriate discharge prescriptions Lapp & acute;, J. M. et. al. Ann Intern Med 2004;141:446-453

  15. How Will Costs of Care Interact with Quality?

  16. The Future: Increasing Value Competition at the level of the individual patient care and disease Plans and doctors distinguished by quality outcomes Potential of Risk-Adjusted Premiums Real consumer choice information “Transparency” The Need for HIT Systems!!!

  17. How has practice changed?

  18. Health Information Technology, Quality, and Reimbursement Are Interactive Issues EHRs PMRs New practice management systems, CPOE, e-Rx etc. Democratized interoperability and connectivity The Physicians’ Foundations!

  19. Actually, It’s the Pipeline, Stupid!

  20. Integrated Delivery Networks, Community Hospitals and Medical Centers The Patient Safety Institute (PSI) Improve patient safety, by making the following available: Patient-Specific Clinical Data Rx Ambulatory Data Acute Care Data At Point Of Care Pharmacies Physicians Treating Patients at Any Location Clinics & Physician Organizations Reference Laboratories • Physician-Specific Preferred • Wired and Wireless Devices • Palm Pilot • Windows CE / Pocket PC • RIIM • Browser Acute Care Data AMR, Rx, Lab HIS Systems CDR LIS Ambulatory Data

  21. Patient Physician PSI – The Network Clinic A Hospital 1 Hospital 2 PSI Hub Clinic B

  22. Patient Physician PSI – Response to Physician Clinic A 3 3 Hospital 1 Hospital 2 PSI Hub Clinic B

  23. The Current State of Physicians, Hospitals, and Health Care • Lack of Technically Trained Staff • Lack of Good Info on Best Systems • Angry About Disappointing Investments • Costs Out of Reach • Practice Workflows Antiquated • Dead Ends • Isolation vs. Interoperability

  24. Who Gets The ROI for H.I.T Investment in Health Care?

  25. The Holy Grail

  26. Opportunities for California CMS/CBO estimates $81 B national savings if HIT solutions were realized- --$8B here Twice that would be saved ($16 B in CA) in related care improvements The Medi-Cal program could be a major beneficiary Approaching the ‘Tipping Point”

  27. This is California’s Legacy

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