The Role of Health IT in Health Care Transformation

1. The Role of Health IT in Health Care Transformation • Judy Murphy • RN, FAAN

2. The Role of Health ITin Health Care Transformation 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 Transforming Health Care: Driving Policy 10-12-2012, 9 - 10am

3. What I Will Cover . . . Today’s Health IT landscape Quality and the new IOM Report Consumer eHealth

4. President Bush’s goal in 2004 A Bit of History … • “… an Electronic Health Record for every American by the year 2014. By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” • State of the Union address, • Jan. 20, 2004 • Executive order established the Office of the National Coordinator for Health Information Technology (ONCHIT) as part of the Dept of Health & Human Services (HHS) • Dr. David Brailer appointed the first National Coordinator

5. “To lower health care cost, cut medical errors, and improve care, we’ll computerize the nation’s health records in five years, saving billions of dollars in health care costs and countless lives.” - First Weekly Address Jan. 24, 2009 The Time is Now … • President Obama’s goal in 2009 • February 17, 2009 – the American Reinvestment and Recovery Act (ARRA – Stimulus Bill) is signed into law • HITECH component of ARRA provides an incentive program to stimulate the adoption and use of HIT, especially EHR’s • Dr. David Bluementhal appointed the new National Coordinator

6. HR 1 -- 111th Congress $787 Billion Highly partisan vote Healthcare gets $147.7 Billion $87B for Medicaid $25B for support for extending COBRA $10B for NIH HITECH Component: $22.5B for EHR Incentives through CMS $2B for HIT Support Programs through ONC HITECH = Health Information Technology for Economic and Clinical Health American Recovery & ReinvestmentAct of 2009 (ARRA / Stimulus Bill)

7. The focus on HIT continues … PCAST Report Dec 2010 (President’s Council of Advisors on Science & Technology) IOM Future of Nursing Report Oct 2010 PPACA Mar 2010 (Patient Protection & Affordable Care Act) “There is no aspect of our profession that will be untouched by the informatics revolution in progress.” - Angela McBride, Distinguished Professor and University Dean Emeritus Indiana University School of Nursing

8. A Remarkable Journey Meaningful Use

9. Progress of Eligible Professionals Toward EHR Incentive Payments Source: CMS EHR Incentive Program Data as of 8/31/2012

10. Progress of Eligible Hospitals Toward EHR Incentive Payments Note: Totals reflect the number of unique hospitals that have received payments from Medicare or Medicaid. Source: CMS EHR Incentive Program Data as of 8/31/2012

11. Meaningful Use – All Payments as of August 31, 2012 ($ in Millions) Source: CMS EHR Incentive Program Data

12. EHR Adoption by Ambulatory Providersas of 8-31-12

13. HIT as the means, not the end • Dr. David Blumenthal, previous National Coordinator of HIT, emphasizes • “HIT is the means, but not the end. Getting an EHR up and running in health care is not the main objective behind the incentives provided by the federal government under ARRA. Improving health is. Promoting health care reform is.” • At the National HIPAA Summit • in Washington, D.C. • on September 16, 2009

14. Our National Quality Strategy

15. Health IT: Helping to Drive the 3-Part Aim Better healthcare • Improving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity. Better health Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care. Reduced costs • Lowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries. $ Health Information Technology

16. 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

17. Quality Measurement Enabled by Health IT • Released July 2012 • Contains a catalog of over 70 activities related to health IT and quality measurement • Describes possibilities for the next generation of quality measurement • Illustrates challenges facing advancement http://healthit.ahrq.gov/HealthITEnabledQualityMeasurement/Snapshot.pdf

18. Best Care at Lower Cost The Path to Continuously Learning Health Care in America September 2012 iom.edu/bestcare

19. Why now? • Quality – persistent shortfalls • Patient harm – One-fifth to one-third of hospital patients are harmed during their stay, largely preventable. • Recommended care – Only about half of the recommended preventive, acute, and chronic care is actually received. • Outcome shortfalls –If all states matched care quality in the highest-performing states, 75,000 fewer deaths would have occurred in 2005.

20. Why now? • Costs – unsustainable levels, waste • Absolute expenditures – $2.6 trillion (2009), 17% GDP • Relative expenditures – 76% increase health costs in past 10 years, overwhelming the 30% gain in personal income • Wasted expenditures– $750 billion (2009) • Opportunity costs – e.g. total waste could pay salaries of all first response personnel for 12 years

21. Why now? • Complexity – exponentially increasing • Increasing information – Over 800,000 new journal articles per year; up 4-fold from 1970. • New diagnostic factors in play – phenotypes, genetics, and proteomics. • Multiple treatment factors in play –e.g. 19 medications per day for 79 year-old patient with osteoporosis, type 2 diabetes, hypertension, and chronic obstructive lung disease; over 200 other doctors are also providing treatment to the Medicare patients of an average primary care doctor.

22. The Result? The U.S. health care system today

23. The Vision Continuous Learning, Best Care, Lower Cost

24. Foundational elements • 1. The digital infrastructure –Improve the capacity to capture clinical, delivery process, and financial data for better care, system improvement, and creating new knowledge. • 2. The data utility – Streamline and revise research regulations to improve care, • promote the capture of clinical data, and generate knowledge. • Care improvement targets • Clinical decision support • Patient-centered care • Community links • Care continuity • 7. Optimized operations • Supportive policy environment • 8. Financial incentives. • 9. Performance transparency • 10. Broad leadership 10 Recommendations

25. HealthIT.gov website for patients

26. Back 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)

27. And Now… “Patients share the responsibility for their own health care….” - AMA’s Code of Medical Ethics (current) “Patients can help. We can be a second set of eyes on our medical records. I corrected the mistakes in my health record, but many patients don't understand how important it will be to have correct medical information, until the crisis hits. Better to clean it up now, not when there’s time pressure.” – Dave deBronkart (ePatient Dave)

28. Consumer eHealth Pledge Programwww.healthit.gov/pledge Over 400organizations have Pledged to provide access to personal health information for 1/3 of Americans…

29. Consumer Involvement is critical LINK: http://youtu.be/QCc6QgYUFEM

30. Million Hearts – Provider Goals

31. Million Hearts - Consumer Challenge

32. Consumer Video Challenge Winner Dr Funky's Blood Pressure Management Rx http://bloodpressure.challenge.gov/submissions/7498-dr-funky-s-blood-pressure-management-rx

33. FOCUS ON INTEROPERABILITY E-prescribing Transition of Care summary exchange: Create & transmit from EHR Receive & incorporate into EHR Lab tests & results from inpatient to outpatient Public health reporting – transmission to: Immunization Registries Public Health Agencies for syndromic surveillance Public health Agencies for reportable lab results Cancer Registries Patient View, Download and Transmit to 3rd Party Stage 2 Meaningful Use Criteria

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

35. Consumer Video Challenge Winner Mark’s Story http://yourrecord.challenge.gov/submissions/9688-mark-s-story

36. OpenNotes: What Was LearnedTom Delbanco, MD; Jan Walker, RN, MBA; et al Supported by: The Robert Wood Johnson Foundation With additional funding from the Drane Family Fund and the Richard and Florence Koplow Charitable Fund OpenNotes study results (Annals of Internal Medicine: 2 October 2012, Vol 157, No 7) Includes editorials by Michael Meltsner, an OpenNotes patient and Carol Goldzweig, from the Veterans Health Administration http://annals.org/article.aspx?articleid=1363511

37. About the OpenNotes Study http://www.youtube.com/watch?v=x-0KdtcBwfI More than 19,000 patients 105 volunteer primary care physicians 3 diverse sites • Beth Israel Deaconess Medical Center • Geisinger Health System • Harborview Medical Center 12 months of sharing notes

38. Patients Were Enthusiastic Patients used the notes • Up to 92% of patients across the 3 sites read their doctor’s note(s) Patients reported important benefits • Feeling more in control of their care (77-87%) • Better understanding of health and medical conditions (77-85%) • Doing better with taking their medications (60-78%) Patients were rarely (1-8%) confused, worried, or offended by what they read in their doctors’ notes

39. Doctors Experienced Little Disruption and Observed Benefits Few doctors reported impacts on their workflow • Longer visits (0-5%) • More time addressing patients’ questions outside of visits (0-8%) Some doctors changed how they wrote notes • 0-21% reported taking more time writing notes • 3-36% reported changing the way they wrote about mental health, substance abuse, cancer, and obesity Many doctors described strengthened relationships with their patients

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