Clinical Health Information Technology: Progress and Barriers

1. The Health Strategies Consultancy The Intersection of Business Strategy and Public Policy Clinical Health Information Technology: Progress and Barriers

2. Clinical IT Environment • Reimbursement is the key driver • Private sector models are proliferating • Proof statements are lacking • 2003 was a good year for legislation and granting at the federal level • But we lack political will and commitment • Public sector models will guide future

3. Private Sector Models Are Sprouting • Research by Health Strategies for Foundation for E-Health Initiative under HRSA grant • Goals of the Project: • Understand the range of HIT payment and financial incentive models in place • Identify advantages and disadvantages associated with various approaches • Consider models that can be applied at the provider and/or community level that promote HIT adoption and improve quality through financial incentives

4. Literature: Great Quality Case, Theoretical Business Case • Scientific/Scholarly literature • Bates, Birkmeyer, CITL, IOM, AHRQ, MedPAC • Gray literature • Balit, Hewitt, First Consulting (CHCF) • Industry press • Health Data Management, Healthcare Informatics, HIMSS • Popular press • New York Times, WSJ • Company/Product-specific literature • Company/Product websites (e.g., RelayHealth), press releases

5. Very Active Space

6. Current Environment: Program Categories 6 6

7. Active Space and Potential for Long Term Impact • Developmental, Iterative, Dynamic • Multiple programs and approaches are being implemented in public and private sector, but no single model • Different strategies, different incentives, different stakeholders • Too early for formal evaluation results • Healthcare is local: may be issue of Adaptability not Replicability • Anecdotally: positive response • Current success criteria = program participation • Long term success = decreased costs, increased quality, workforce efficiencies, better business... But it’s too early to tell

8. 2003: A Good Year (Legislative) • Research by Health Strategies under a stipend from IBM (in press for February) • MMA Activity • E-prescribing • Management Performance Demos • Commission on Systemic interoperability • Council for Technology and Innovation • Extension of the telemedicine demos • Chronic care improvement

9. 2003: A Good Year (Executive) • Major Granting Initiatives • AHRQ • AHRQ with VA, NIH • HRSA • NIH NLM • NIH, CDC, FDA • Interest at CMS in CAG, Carriers

10. Prospects for 2004 • SOTU line – will there be follow-up? • Legislative fragments • HR 3035 / S 1729 – medical errors reduction • HR 663 / S 720 – patient safety improvement • S 1374 – Better HEALTH • HR 2915 – National Health Info Infrastructure • Interest in specific technologies • Difficult budget situation • Skepticism on generalized value

11. Possible Entitlement Program Models • Encouraging adoption of technology that is not 100% clinically proven • Medicaid 90% match for IT upgrades • CAG technology decisions sometimes lack data • Medicare payment systems push hospitals and physicians in desired directions • Conditions of participation mandate quality • Inpatient PPS bundling with incentives • Higher bar can be articulated if desired • Inpatient DRG add-ons and OPPS

12. When Will We Achieve the Vision? • No meaningful central policy focus • Little dedicated budget • CIT Investment in UK • $17 Billion / 10 Years • Full EMR by 2005 • Full E-Prescribing by 2008 • Pluralistic health system skews alignment • No interest in mandates • Slowness in standards adoption

13. Our Panel • Focus on clinical applications • Likely progress in 2004 • Not dependent on legislative process • Policy focus • Helen Burstin, AHRQ • Commercial focus • Reggie Groves, Medtronic • William McIvor, Accordant