Yesterday, Today and Tomorrow: April 26, 2013, 1:15-2pm

1. Yesterday, Today and Tomorrow: April 26, 2013, 1:15-2pm Judy Murphy, RN, FACMI, FHIMSS, FAANDeputy National Coordinator for Programs & Policy Office of the National Coordinator for Health IT Department of Health & Human Services Washington DC

2. A look at . . . Yesterday - what we’ve gotten done The status of the EHR Incentive Program 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

3. A Remarkable Journey … Meaningful Use

4. Meaningful Use – Eligible Professionals Registered and Paid 521,600 Total Eligible Professionals Total Professionals Registered: 350,844 (67%) Total Professionals Paid: 186,582 (36%) 2013 Goal 2012 Goal Source: CMS EHR Incentive Program Data as of 12/31/2012

5. Ambulatory EHR use has doubled in the last5 years – 72% of doctors now use an EHR Source: CDC NAMCS Physician Survey

6. http://dashboard.healthit.gov/

7. http://dashboard.healthit.gov/HITAdoption

8. Meaningful Use – Eligible Hospitals Registered and Paid 5,011 Total Eligible Hospitals Total Hospitals Registered: 4,224 (84%) Total Hospitals Paid: 3,525 (70%) 2013 Goal 2012 Goal Source: CMS EHR Incentive Program Data as of 12/31/2012

9. Hospital EHR use has tripled since 2010 –45% of hospitals now use EHR SOURCE: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement, 2012

10. EHR Adoption of Eligible Hospitals by state SOURCE: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement, 2012

11. Percent of hospitals with capabilities tomeet select MU Core objectives: 2008-2012 SOURCE: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement, 2012

12. Total EHR Incentive Payments to All Eligible Providers and Hospitals Source: CMS EHR Incentive Program Data as of 12/31/2012

13. 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

14. E-prescribing has seen a hockey stick growth Percent of physicians e-prescribing using an EHR in December 2008 and June 2012 Source: Hufstader M, Swain M, Furukawa MF. State Variation in E-Prescribing Trends in the United States. ONC Data Brief, no. 4. Washington, DC: Office of the National Coordinator for Health Information Technology, November 2012.

15. Exchange is growing • Three EHR vendors (Cerner, eCW and EPIC) are each exchanging millions of patient records a month • New England Healthcare Exchange Network has 200,000 directed exchanges a month • HealthBridge in Ohio has 3.2 million directed exchanges a month • Lots of IDNs and hospitals are spearheading exchange • Rapid growth in exchange supported by the State HIE program

16. 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 Focus on INTEROPERABILITY in the Stage 2 Meaningful Use Criteria

19. Four additional Interoperability Modules 4 other modules that cover the Meaningful Use Stage 2 interoperability data exchange criteria have been released: 1.       Transitions of care between care providers and care venues 2.       Lab interoperability between hospitals and ambulatory providers 3.       View, download, and transmit of information between patients and providers 4.       Transmission of information to public health agencies

21. Questions to ask your EHR vendor • These should be clearly posted on vendor website • Will you be exchanging provider • and patient trust bundles through DirectTrust or other mechanisms?

22. Patient EngagementBack 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)

23. And Now… • Patient as Partner • Engaged patients demonstrate better health outcomes • Patients increasingly expect engagement via IT, as in many other aspects of their lives • Meaningful Use criteria 66% of Americans say they would consider switching to a physician who offers access to medical records through a secure Internet connection – according to a 2011 Deloitte Survey

24. The Blockbuster Drug of the Century(Aug 28, 2012)

25. Top Trend (Feb 22, 2013)

26. The Three A’s Approach toConsumer Engagement Increase consumer Access to their health information Enable consumers to take Action with their information Shift Attitudes to support patient-provider partnership

27. Focus on Consumer ACCESS 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

28. ACCESS: Consumer eHealth Pledge Program Over 400organizations have Pledged to provide access to personal health information for 1/3 of Americans…

29. ACTION: Making it easier for Patients to use Health IT • Blue Button Mash-Up Challenge – develop an app that mashes up PHR data with other health-related data • Design Challenge - rethink how the medical record is presented; make health information patient-centered & improve the patient experience • 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) • See: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/ • righttoaccessmemo.pdf

30. http://challenge.gov/

31. Mobile Apps • Designs • Videos http://challenge.gov/ONC

33. ATTITUDE: Health IT Animation http://www.healthit.gov/patients-families/video/preview-health-it-you-giving-you-access-your-medical-records • 1 and 3 minute versions of the animation are available to use for patient teaching

34. What’s in Your Health Record Consumer Video Challenge

35. What’s in Your Health Record Winner Wright and Luft: http://vimeo.com/46790323

36. Stages of Meaningful Use TOMORROW – The biggest challenges in our future Stage 3 Stage 2 Stage 1

37. Meaningful Use as a Building Block Transform health care Improved population health Enhanced access and continuity Access to information Data utilized to improve delivery and outcomes Data utilized to improve delivery and outcomes Patient self management Patient engaged, community resources Utilize technology 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 PCMH 3-Part Aim ACO’s “Stage 3 MU” Stage 1 MU Stage 2 MU

38. New payment approaches are creating a strong business case for exchange Source: Muhlestein, February 19th post on the Health Affairs Blog http://healthaffairs.org/blog/2013/02/19/continued-growth-of-public-and-private-accountable-care-organizations/

39. The Vision Continuous Learning, Best Care, Lower Cost September 2012

40. Thank you!For more information, contact:judy.murphy@hhs.gov