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John D. Halamka, MD Chief Information Officer Harvard Medical School

Working Session 4: Quality and Efficiency Expanding the Use of Healthcare IT: The United States Initiative and the Development of Healthcare IT in Japan. John D. Halamka, MD Chief Information Officer Harvard Medical School Beth Israel Deaconess Medical Center February 26, 2011. Agenda.

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John D. Halamka, MD Chief Information Officer Harvard Medical School

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  1. Working Session 4: Quality and Efficiency Expanding the Use of Healthcare IT:The United States Initiative and theDevelopment of Healthcare IT in Japan John D. Halamka, MD Chief Information Officer Harvard Medical School Beth Israel Deaconess Medical Center February 26, 2011

  2. Agenda • Need for a National Healthcare IT Program • History of Healthcare IT in the US • Major US Healthcare IT Initiative • Current State of Healthcare IT in Japan • Lessons for development of Healthcare IT Japan 2

  3. Need for a National Healthcare IT Program in US • Improve quality of care • High error rates • High variability in care quality • Poor outcomes • Improve efficiency of care • Low value: quality/cost • Costs rising much faster than inflation 3

  4. QUALITY: SAFE CARE Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 5 EXHIBIT 16 Medical, Medication and Lab Errors Among Sicker Adults in US Percent reporting medical mistake, medication error, or lab error in past 2 years 2005 2007 United States International Comparison AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 2005 and 2007 Commonwealth Fund International Health Policy Survey.

  5. EFFICIENCY Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 8 Duplicate Medical Tests Among Sicker Adults in US Percent reporting doctor ordered test that had already been done in past 2 years 2005 2007 United States International Comparison AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 2005 and 2007 Commonwealth Fund International Health Policy Survey.

  6. EFFICIENCY Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 61 International Comparison of Spending on Health1980–2005 Average spending on healthper capita ($ US PPP*) Total expenditures on healthas percent of GDP * PPP=Purchasing Power Parity. Data: OECD Health Data 2007, Version 10/2007. 61

  7. History of Healthcare IT in the US • From 2001 – 2008 Bush Administration established • American Health Information Community • Overall governance healthcare IT governance body • Certification Commission for Health Information Technology • Test and certify the functionality of electronic health records • Healthcare Information Technology Standards Panel • Harmonize standards for exchange of data among payers, providers, patients, government • Funded at $50 million per year • Did not provide incentives to accelerate adoption 7

  8. EFFICIENCY Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 11 Physicians’ Use of Electronic Medical Records in US Percent of primary care physicians using electronic medical records 2001 2006 United States International Comparison AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 2001 and 2006 Commonwealth Fund International Health Policy Survey of Physicians.

  9. New National Healthcare IT Initiative in USObama Administration 2009 – 2011 • National policy • Health Information Technology Policy Committee • National standards with certification • Health Information Technology Standards Committee • Regional extension centers and Health Information Exchanges • $2 billion • Incentives to adopt and achieve “Meaningful Use” of Electronic Health Records -- $21 billion • Privacy and security protections 19

  10. National Healthcare IT Funding

  11. Funding Targeted to Achieve Five Objectives in US$ 23 Billion Total • Improve quality, safety, efficiency, and reducing health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • Ensure privacy and security for personal health information

  12. Current State of Healthcare IT in Japan • Information silos in hospitals • Little adoption of electronic health records • Privacy concerns and other policies which restrict data sharing • Lack of incentives to coordinate care • Highly variable software functionality and workflow automation 12

  13. Goals for a Healthcare IT Initiative in Japan • Care coordination for an aging population • Cost control • Safety improvements • Quality measurement • Privacy protections 25 25

  14. Working Session 4: Quality and Efficiency Expanding the Use of Healthcare IT:The United States Initiative and the Development of Healthcare IT in Japan John D. Halamka, MD February 26, 2011 • jhalamka@caregroup.harvard.edu • http://geekdoctor.blogspot.com

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