Transcript Janet Marchibrodas` presentation handouts

Electronic Prescribing and
Health Information Technology:
The Environmental Landscape
The Role of Consumers
SOS Rx Coalition Meeting
National Consumers League
Washington, D.C.
Janet M. Marchibroda
Chief Executive Officer, eHealth Initiative
Executive Director, Foundation for eHealth Initiative
Executive Director, Connecting for Health
June 30, 2004
What Problems are We Trying to Solve?

Looming Healthcare Crisis
 Changing
demographics: Americans age 65+ will increase
from 12% of population in 1997 to 20% of population in
2003
 Rising
healthcare costs: Premiums increased 12.7% at the
beginning of 2002 and are likely to be higher this year
 Physicians
leaving practice; shortfall of 400,000 nurses
nationwide
 Number
of uninsured approx. 15.8% or 44 million of U.S.
2
What Problems are We Trying to Solve?
 Quality
and Safety Challenges
 Between
44,000 and 98,000 Americans die in hospitals
each year as a result of medical errors…the cost is
approximately $37.6 billlion annually
 Estimated
770,000 people are injured each year due to
adverse drug events. Inadequate availability of patient
information is directly associated with 18%
 Adverse
drug events in 5% to 18% of ambulatory patients
 In
a 2001 Robert Wood Johnson survey, 95% of doctors,
89% of nurses and 82% of health care executives say they
have witnessed serious medical errors
3
What Problems are We Trying to Solve?
 Big
Gap Between “What we Know” and “What We
Do”
 American
adults, on average, receive only 54.9% of the
healthcare recommended for their conditions
 Nearly
one-third of patients with congestive heart failure
are discharged from the hospital without being given ACE
inhibitors, even though it’s been known for a decade that
these drugs provide life-saving benefits
 Takes
about 17 years for new knowledge in clinical trials
to be incorporated into every data medical practice
4
What Problems are We Trying to Solve?
 Public
Health Threats Continue
 Traditionally,
public health surveillance has been
conducted manually, by phone fax and mail
 The
SARS outbreak highlights gaps and weaknesses in
ability to perform disease surveillance and protect the
public from natural diseases as well as potential bioterror
threats
5
Patient Perspectives
 Our
healthcare system is fragmented….care is
delivered by a variety of independent physicians,
hospitals and other providers
 We
interact with many plans and providers over a
lifetime making continuity of our personal health
information a challenge
 Clinicians
sometimes provide care without knowing
what has been done previously and by
whom…which can lead to treatments that may be
redundant, ineffective or even dangerous
6
Patient Perspectives
 Vital
data sit in paper-based records that can neither
be accessed easily nor combined into an integrated
form to present a clear and complete picture of our
care
 Our
paper hospital records are unavailable when
needed about one-third of the time
 Physicians
spend an estimated 20-30% of their time
searching for and organizing information
7
Why Information Technology Matters
 It
Improves Quality and Saves Lives
 Center
for Information Technology Leadership recent
study indicates prevention of more than 2 million
adverse drug events and 190,000 hospitalizations per
year could be realized from adoption of CPOE in the
ambulatory care environment.
 Computerized
physician order entry reduced error rates
by 55%--from 10.7 to 4.9 per 1,000 patient days and
reduced serious medication errors by 88% at Brigham
&Womens Hospital
8
Why Information Technology Matters
 It
Makes it Easier to Navigate the Healthcare
System
Scheduling appointments, handling quick questions and
refilling prescriptions online saves time and headaches
Having access to one’s comprehensive health
information (lab results, pharmacy, etc.) helps patients
and their clinicians keep better track of care
Accessing educational information about conditions
prior to coming in for visits enables more quality time
between the patient and the clinician
9
Why Information Technology Matters
 It
Saves Money
 CITL study
indicates $44 billion in savings per year could
be realized from adoption of CPOE in the ambulatory
care environment.
 CITL also
released research findings that indicate that
standardized healthcare information exchange among
healthcare IT systems would deliver national savings
of $86.8 billion annually after full implementation
and would result in significant direct financial
benefits for providers and other stakeholders
10
Why Information Technology Matters
 It
Saves Money
 A recent
cost benefit analysis of electronic medical
record systems showed that their use by primary care
providers could result in $86,000 in savings over five
years. Benefits include reduced drug spending,
reductions in radiology, and decreased billing errors.
 Kaiser
Permanente study found that when physicians
used a computerized system, the average time spent in
the unit dropped by 4.9 days to 2.7, slashing costs by
25%
11
Increasing Demand from Consumers

A Harris consumer interactive poll found that:
 80%
want personalized medical information on-line
from their physicians
 69%
want on-line charts fir tracking chronic
conditions
 83%
want to receive their lab tests on-line
12
Increasing Demand from Consumers

Clinicians receiving computerized patient symptom
assessments prior to a patient visit addressed 51% of
their patients symptoms, compared with only 19% of
those not receiving assessments

63% of consumers in a February 2004 survey agreed it
would be “very valuable” to have their complete medical
history stored in one computer file that can be accessed
anywhere in the hospital
13
Increasing Demand from Consumers
Foundation for Accountability Survey for Connecting for
Health

In response to question: “if you could keep your medical
records online, what would you do?”
 Email
 Store
doctor – 75%
immunization records – 69%
 Transfer
information to specialist – 65%
 Look-up
test results – 63%
 Track
medication use – 62%
14
Despite Evidence Adoption Rates Low

More than 90 percent of the estimated 30 billion health transactions
each year are conducted by phone, fax or mail

Healthcare lags behind all industries when it comes to spending on IT.
While 11.10%, 8.10% and 6.5% of revenues were invested in IT in the
financial services, insurance and consumer services industries,
respectively in 2002, only 2.2% of healthcare industry revenues were
spent on IT

Only a third of hospitals nationwide have computerized physician
order entry (CPOE) systems completely or partially available. Of
those, only 4.9% require their use.

Fewer than 5% of U.S. physicians prescribe medications electronically
15
Barriers to Adoption of Information Technology

Leadership - Within the public and private sectors…at the
national level, at the community level, within provider
institutions and clinician practices

Funding and a Business Model - Misalignment of incentives
among those who pay for IT and those who benefit from it. The
need for upfront funding and a sustainable business model to
support investment

Standards – The lack of interoperability and standards to support
mobilization of information and connectivity across systems

Organizational and Work-Flow Change – Migrating to an
electronic system is difficult
16
eHealth Initiative Purpose

eHealth Initiative was formed to clear barriers to the
adoption of information technology and a health
information infrastructure to drive improvements in
quality, safety and efficiency for patients…focusing on:
 Leadership
 Financing
and Business Model
 Standards
 Organizational
and Work-Flow Change
17
eHealth Initiative Mission and Vision
Our Mission: Drive improvement in the quality,
safety, and efficiency of healthcare through
information and information technology
Our Vision: Consumers, providers and those
responsible for population health will have ready
access to timely, relevant, reliable and secure
health care information and services through an
interconnected, electronic health information
infrastructure to promote better health and
healthcar
18
eHealth Initiative’s Members

Health care information technology suppliers

Health systems and hospitals

Health plans

Employers and purchasers

Non-profit organizations and professional societies

Pharmaceutical and medical device manufacturers

Practicing clinician organizations

Public health organizations

Research and academic institutions
19
A Number of Policy Changes are Emerging

There is Rapidly Increasing Momentum for the Use of
IT in Healthcare to Address These Challenges
 Congress
 Administration
 Private
Sector
20
IT Provisions in Medicare Modernization Act

Electronic Prescription Program

Establishes a real-time electronic prescribing program for all
physicians, pharmacies, and pharmacists who serve Medicare
beneficiaries with Part D benefits

Requires following electronic information: drug being
prescribed, patient’s medication history, drug interactions,
dosage checking, and therapeutic alternatives

Requires DHHS to develop, adopt, recognize or modify initial
uniform standards for e-prescribing

Establishes a safe harbor from penalties under the Medicare
anti-kickback statute

Provides that these standards will pre-empt state law or
regulation that are contrary to or restrict the ability to carry out
the electronic prescribing program
21
IT Provisions in Medicare Modernization Act

Grants to Physicians

Authorizes Secretary to make grants to physicians
to defray costs of purchasing, leasing, installing
software and hardware; making upgrades to enable
eRx; and providing education and training

Requires 50% matching rate

Authorizes appropriation of $50 million for grants
in FY 2007 and such sums as necessary for fiscal
years 2008 and 2009
22
IT Provisions in Medicare Modernization Act
 Payment



Demonstrations
Pay for performance demonstration program with
physicians to meet needs of beneficiaries through
adoption and use of IT and evidence based
outcomes measures
Four demonstration sites – carried over three years
HHS Secretary shall pay a per beneficiary amount
to each participating physician who meets or
exceeds specific performance standards regarding
clinical quality and outcomes
23
IT Provisions in Medicare Modernization Act

Chronic Care Improvement

Provides for phased-in development, testing, implementation
and evaluation by randomized control trials of chronic care
improvement programs by HHS Secretary

HHS Secretary will enter into an agreement with chronic care
improvement organizations within 12 months

Required elements of a chronic care improvement plan includes
the use of monitoring technologies that enable patient guidance
through the use of decision support tools and the development of
a clinical information database to track and monitor each
participant across settings and evaluate outcomes
24
Other Legislation Related to IT

National Health Information Infrastructure Act
 Sponsor:
Rep. Nancy Johnson (R-CT)
 Within
six months, NHII Officer (in cooperation with key
stakeholders named in the Act) to develop an NHII
strategic plan including public sector and private sector
activities.
 Within
one year, NHII strategic plan submitted to
Congress (also includes information on progress on
interface recommendations, standards recommendations
and required assessments).
25
Other Legislation Related to IT

Health Information for Quality Improvement Act (S. 2003)

Sponsor: Sen. Hillary Clinton (D-NY)

Within six months, Office of NHII within Office of DHHS
Secretary

Within two years, Secretary shall adopt a set of voluntary national
data and communication standards to promote interoperability

Within 12 months, Secretary shall submit to Congress
comprehensive NHII strategic plan

Grants to hospitals and other healthcare providers

DHHS, DoD and VA through e-gov initiative shall develop,
implement and evaluate procedures to enable patients to access and
append personal health data through personal health records
26
Other Legislation Related to IT

Health Care Quality Modernization, Cost Reduction and
Quality Improvement Act
 Sponsor
– Senator Edward M. Kennedy
 Introduced
May 13, 2004
 Provides
grants or cooperative agreements for clinical
informatics systems – requires matching funds
 Establishes
 Requires
a revolving loan fund for IT acquisition
technical standards by January 1, 2006
27
Other Legislation Related to IT

Health Care Quality Modernization, Cost Reduction and Quality
Improvement Act

Mandates increase in federal health program reimbursement to
any provider that operates a qualified clinical informatics system,
consistent with the standards and to those that carry out quality
improvement activities. Increases begin in 2005 and are equal to
1% of reimbursement involved and proceed until 2009, when the
increases are equal to .2% of reimbursements involved.

Mandates decrease in federal health program reimbursement to
any provider UNLESS they operate a qualified clinical
informatics system, consistent with the promulgated technical
standards and to those that carry out quality improvement
activities. Decreases begin in 2010 and are equal to .2%
reimbursement involved and proceed until 2014, when the
increases are equal to 1% of reimbursements involved.
28
Other Legislation Related to IT

Senate HELP Committee Chair Gregg announced plans on
April 27, 2004 to introduce bipartisan legislation to carry out
Bush’s call for electronic health records for all patients
within a decade
 Federal
leadership
 Information
 Clear
standards
barriers
 Provide
needed incentives
29
Recognized Importance at Presidential Level
“By computerizing health records, we can avoid
dangerous medical mistakes, reduce costs and
improve care”
President George W. Bush - State of the Union Address,
January 20, 2004
30
President Bush’s 10-Year Plan for EHR

April 26, 2004 President George W. Bush Announces 10Year Plan to Assure that Most Americans Have Electronic
Health Records:
 Within
the next ten years, electronic health records will
ensure that complete health information is available for
most Americans at the time and place of care, no matter
where it originates. Participation by patients will be
voluntary.
 These
electronic health records will be designed to share
information privately and securely among and between
healthcare providers when authorized by the patient.
31
President Bush’s 10-Year HIT Plan

Creation of new, sub-Cabinet level post reporting to DHHS
Secretary – National Health Information Technology Coordinator

The federal government to complete the identification and adoption
of standards that will allow medical information to be stored and
shared electronically while assuring privacy and security

Doubling funding to $100 million for demonstration projects that
will help test the effectiveness of HIT and establish best practices
for more widespread adoption in the healthcare industry

Creating federal incentives and opportunities which encourage
healthcare providers to use electronic medical records
32
President Bush’s April 27 Executive Order

Establishment within Office of the DHHS Secretary the position of
National Health Information Technology Coordinator – within 90 days

Within 90 Days:

DHHS Secretary will provide options to provide incentives to
promote adoption of interoperable HIT

Director OPM will provide options to provide incentives to
promote adoption of interoperable HIT

Secretary of VA and DoD will jointly report on approaches to to
work more actively with private sector to make systems available as
affordable option for providers in rural and medically underserved
communities
33
President Bush’s April 27 Executive Order

Policy consistent with vision of nation-wide interoperable HIT
infrastructure that:

Ensures appropriate information to guide medical decisions at time
and place of care

Improves quality, reduces errors and advances delivery of evidencebased care and reduces healthcare costs

Promotes a more effective marketplace, greater competition and
increased choice

Improves coordination of care through secure and authorized
exchange of healthcare information

Ensures patients’ individually identifiable health information is
secure and protected
34
President Bush’s April 27 Executive Order

Responsibilities of National HIT Coordinator

Develop, maintain, and direct implementation of strategic plan in
both public and private sectors

Advance the development, adoption and implementation of
standards through collaboration of public and private sector
interests

Ensure key technical, scientific, economic issues affecting adoption
are addressed

Evaluate benefits on evidence and costs and to whom they accrue

Address privacy and security issues and recommend methods to
ensure appropriate authorization, authentication and encryption for
transmission over Internet

Not assume or rely upon additional Federal resources or spending
to accomplish adoption
35
Secretary Thompson May 6 Announcements

Summit of 100 leaders in healthcare

Announced David Brailer, MD, PhD as National Health
Information Technology Coordinator

HHS and other federal agencies will adopt 15 additional standards
agreed to by Consolidated Health Informatics Initiative

SNOMED now available for free use from National Library of
Medicine web site

HL7 announced a favorable vote on a functional model and
standards for an electronic health record
36
Emerging Focus Areas

Incentives to encourage adoption

Electronic prescribing as a key building block

Stark exception

Certification of standards

Supporting clinicians with implementation

Health information exchange networks privately operated for secure
data exchange and transport

State, regional or local health information exchange authorities to
assure compliance with laws
37
A Bi-Partisan Issue…

Democratic Presidential candidate John Kerry has several
provisions related to information technology in his
agenda...

Patrick Kennedy (D-RI) and Newt Gingrich joined together
for May 3 NYT Op-Ed Piece and conference in RI

Considerable support by Sen. Clinton, Sen. Dodd, Sen.
Kennedy and Rep. Kennedy

A Bi-Partisan Issue……
38
Momentum Building in Administration

AHRQ $50 million HIT Program…planning and implementation
grants with emphasis on multi-stakeholder involvement and matched
funding…large rural component…also $10 million focused on
evaluating value…

Additional $50 million for demonstration projects proposed for FY 05
in DHHS Secretary’s budget

AHRQ’s State and Regional HIT Demonstrations Program seeks to
identify and support statewide data sharing and interoperability
activities aimed at improving quality, safety, efficiency and
effectiveness of healthcare

DoD and Department of Veterans Affairs playing a critical leadership
role in demonstrating feasibility and value of HIT
39
Momentum Building in Administration

CMS launching four demonstration programs “DOQ-IT”
to test incentives for quality outcomes and use of IT

CMS published Phase II of regulations to implement the
Stark Law – creates new exceptions including
“provision of community-wide health information
services”.

President’s Information Technology Advisory
Committee launches Health Subcommittee and issues
report
40
Momentum Building in Administration

CMS releases “Chronic Care Improvement Program Notice and
Application”

Ten geographic areas in which in the aggregate at least 10% of
the Medicare FFS population resides

Medicare beneficiaries eligible are those that are entitled to
benefits under Part A, are enrolled under Part B, but not enrolled
in a plan under Part C and those that have congestive heart
failure and/or complex diabetes or chronic obstructive
pulmonary disease

Enormous opportunity to merge HIT goals
41
Momentum Building in Administration

CDC PHIN Program promotes integration and use of standards
and leveraging data that already resides in the system – e.g.
Biosense - $130 million in proposed FY 05 budget

NCVHS – several work groups focusing on these
issues…Subcommittee on Standards and Security, Subcommittee on
Privacy and Security, Work Group on the NHII

Considerable work within the DoD and the VA

Council for the Application of Health Information Technology
(CAHIT) – DHHS interagency IT coordinating body launched by
Secretary Thompson
42
Momentum Building in Private Sector

HL7 developed functional model for electronic health
record… ballot has passed

IOM issued report on patient safety data standards in Fall of
2003

A number of payment pilots and other incentive programs
emerging from employer and plan communities, including
Bridges to Excellence

Leapfrog Group announces Fourth Leap – comprehensive
scoring survey to help patients rank hospital quality
43
eHealth Initiative Focus for 2004: Overview

In our early years, we focused on raising general awareness
of the need for IT and tackling one of the key barriers to
adoption— data standards

In 2004, we will:
 Expand
our work on two other areas that will help to
achieve our mission: “making the business case and
securing financing” and “developing the field” in key
challenge areas…
 Continue
to focus on data standards
44
eHealth Initiative Focus for 2004

Align incentives and promote public and private sector investment in
improving America’s healthcare through IT and an electronic health
information infrastructure

Drive investment in research related to the value of IT in
addressing quality, safety and efficiency challenges

Fund strategic demonstration projects through Connecting
Communities for Better Health that evaluate and demonstrate
impact of IT and further development of strategies and tools for
accelerating IT adoption and electronic connectivity

Develop and promote policy options to align incentives and enable
public and private sector investment in IT and health information
infrastructure

Dramatically increase national awareness of the role of IT in
addressing healthcare challenges through the Investing in America’s
Health campaign
45
eHealth Initiative Focus for 2004

Develop the field to enable more widespread and effective
implementation of IT and an electronic health information
infrastructure

Engage national experts to aggregate and develop knowledge,
resources and tools for key challenge areas related to IT and a
health information infrastructure

Provide resources and tools to help communities and stakeholders
implement IT and a health information infrastructure through the
Connecting Communities for Better Health Learning Network and
Resource Center and several meetings including Community
Learning Forum in June

Expand information sharing beyond the U.S. by facilitating a global
dialogue on the challenges and strategies for implementing an
electronic health information infrastructure through the Leadership
in Global Health Technology Initiative
46
eHealth Initiative Focus for 2004

Continue to drive adoption of standards to promote an interoperable,
interconnected healthcare system through work with key partners

Leverage the work of the Connecting for Health, a public-private
sector collaboration funded the Markle and Robert Wood Johnson
Foundations, that is developing an incremental roadmap for U.S.
electronic health information infrastructure, and addressing key
issue areas such as data standards; organization and sustainability;
linking patient data; and the personal health record

Through the EHR Collaborative, a coalition made up of AHIMA,
AMA, AMIA, CHIME, eHI, HIMSS and NAHIT, facilitate
collaboration among HIT organizations to achieve common goals
related to the adoption of standards
47
Our Approach
Review,
Evaluate &
Develop
Models
Engage
Those Who
Can Effect
Change
Educate and
Advocate
For
Change
Provide
Resources
and Tools
48
Areas of Interest
Areas Critical to IT and Health Information Infrastructure
 Upfront
Funding and Sustainable Incentive Models
 Technical
(Architecture, Standards, Security)
 Protecting
Patient Privacy
 Clinician Adoption
 Application
of Clinical Knowledge
 Organization
 Legal
and Clinical Process Change
and Governance
Issues
 Engaging
Patients and Consumers
49
Operating Model
AGGREGATE AND
DEVELOP
KNOWLEDGE IN
KEY ISSUE AREAS
VET WITH AND
DISSEMINATE
TO STAKEHOLDERS
PRIMARY
DISSEMINATION
VEHICLES
FINANCING
(Incentives, Funding)
CLINICIANS
ONLINE RESOURCE CENTER
LEGAL
(Data Use, Stark Issues)
HOSPITALS AND
OTHER PROVIDERS
VIDEO, WEB, PHONE
CONFERENCES
CLINICIAN ADOPTION AND
PROCESS CHANGE
HEALTHCARE IT
PHARMA AND DEVICE MFR
FACE TO FACE
CONFERENCES
PRIVACY
PUBLIC HEALTH
TARGETED BRIEFINGS
CLINICAL KNOWLEDGE
CHRONIC CARE
PAYERS
EMPLOYERS, PURCHASERS
PUBLICATIONS
TECHNICAL (STDS,
SECURITY, ARCHITECTURE)
PATIENTS, CONSUMERS
MEMBER ORGANIZATIONS
POLICY-MAKERS
50
Connecting Communities for Better Health

Goal is to catalyze activities on a national, regional, and
local basis that will lay the foundation for electronic
connectivity and a health information infrastructure

Funded under Foundation for eHealth Initiative
cooperative agreement with HRSA - $3.9 million in year
one, $2.9 million in year two…augmenting funding
through other contributions and grants
51
Connecting Communities for Better Health

Provide seed funding to multi-stakeholder collaboratives within
communities that are using electronic health information exchange
and other IT tools to drive improvements in healthcare, with the goal
of evaluating and widely disseminating lessons learned

Gaining critical input from experts, “on-the-ground implementers”,
and key stakeholders on key areas related to health information
exchange: technical, organizational, financial and clinical

Through Community Learning Network and Online Resource Center,
provide communities and other healthcare stakeholders interested in
health information exchange with guidance on how to plan and
implement IT and health information exchange programs designed to
mobilize healthcare information across organizations to drive
improvements in health and healthcare
52
Connecting Communities for Better Health

Through Community Learning Forum and Resource
Exhibition, and a wide range of video, audio and other
meetings and conferences, provide those interested in
health information exchange with guidance on how to
plan and implement IT and health information exchange
programs that will mobilize healthcare information
across organizations to drive improvements in health
and healthcare

Creating and widely publicizing a pool of “electronic
health information exchange-ready” communities to
facilitate interest and public and private sector
investment in such initiatives
53
Connecting Communities for Better Health

Building national awareness among policy-makers,
healthcare leaders, and other drivers of change,
regarding the feasibility and value of health information
exchange, the key barriers that need to be overcome, and
the strategies and policies that need to be deployed to
overcome those barriers and support wider diffusion

Collaborating and aligning with related activities both
within the public and private sectors
54
Those Engaged in Health Information Exchange*

California

Indiana

Massachusetts

North Carolina

Rhode Island

Utah

Washington
*Sample
55
Those Exploring Health Information Exchange*

Delaware

Florida

Maryland/Washington, D.C.

New York

Ohio

Tennessee
*Sample
56
Response to Request for Capabilities


What We Asked For in our 2003 Request for Capabilities
Statements:

Multi-stakeholder initiatives involving at least three
stakeholder groups

Matched funding

Use of standards and a clinical component
What We Received:

134 responses representing 42 states and the District of
Columbia proposing collaborative health information
exchange projects across the country
57
pa
at
ie
n
t
Pr
tie
im
nt
ar
y
Sp
Ca
ec
re
ia
lity
Ca
La
re
bo
ra
to
rie
s
R
Lo
ad
ca
i
l H olog
ea
y
St
lth
at
e
D
He
ep
t
al
th
D
ep
t
In
du
st
C
ry
on
su
m
er
Pa
y
Fe
Em ers
de
pl
ra
oy
lG
er
ov
s
C
er
om
nm
m
P
en
un
ha
ity
rm t
H
ac
ea
ie
lth
s
Ce
nt
er
R
s
eg
u
la
Sc
to
ho
rs
ol
C
lin
ics
O
ut
In
p
Percentage of Respondents
Organization Types Involvement
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
58
C
59
at
a
ro
llm
en
O
ffi
t
ce
EM
C
R
on
s
su
lta
tio
ns
R
em
in
R
de
es
rs
ul
tD
el
ive
ry
R
ep
os
ito
ry
En
g
en
t
e
rti
n
D
re
po
ge
m
nc
Al
er
ts
R
ai
l
EL
ille
tie
nt
y
an
Pa
lit
M
an
r
er
rd
e
O
th
O
em
rv
e
tie
nt
tie
nt
Su
Q
ua
as
e
Pa
Pa
Functions Provided
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
60
C
x
pa
tie
nt
ED
ra
to
ry
In
pa
tie
nt
bo
y
il R
ol
og
et
a
O
ut
La
R
ad
i
lg
y
og
y
lity
th
o
io
l
Pa
ar
d
ed
er
m
s
ib
i
la
i
rib
sc
O
th
El
ig
R
C
ns
G
I
ar
y
tio
lm
on
Tr
an
Pu
cip
Pr
es
Data Types (%)
Data Types Involved
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Communities to be Funded

To be announced on July 21, 2004 as part of DHHS Event

Strategically focused on critical areas that need to be addressed to
implement health information exchange

Replicable and sustainable technical architecture models

Alignment of incentive models

Use of replicable data exchange standards

Addressing ways to accurately link patient data

Multi-jurisdictional models

Electronic prescribing issues
61
Connecting Communities Learning Network

Key partnering organizations
for Information Technology Leadership –
Partners Healthcare System – John Glaser, PhD;
Blackford Middleton, MD
 Center
 Regenstrief
 Others
Institute – J. Marc Overhage, MD, PhD
in the process of being finalized
62
Connecting Communities Learning Forum

June 24 – 25, 2004, Washington, D.C.

Practical, hands-on, interactive meeting designed to help
communities implement IT and health information exchange

Very few general sessions, mostly break-outs led by the best in
the field in each targeted area

Tackled key issues related to health information exchange:
technical, clinical, financial, organizational, legal

Laid the groundwork for “a community of communities” to learn
from experts and each other…..
63
Electronic Prescribing Initiative - Goals

Rapidly expand the adoption of electronic prescribing to drive
quality, safety and efficiency improvements

Develop and promote design and implementation guidelines and
principles that:


Facilitate rapid development of usable, implementable, high
value prescribing tools

Support workflow of clinicians

Support safety and optimal care
Develop and promote adoption of incentives to accelerate adoption
64
Electronic Prescribing Initiative

More than 70 of the nation’s leading experts on electronic
prescribing from every stakeholder group involved in or impacted
by the prescribing chain – Co-Chair Jonathan Teich, MD, PhD

Got consensus amongst a diverse group regarding key principles

Three Groups….

Steering Group

Incentives Working Group

Design and Implementation Working Group
65
Electronic Prescribing Initiative

Connectivity providers

Hospitals and other healthcare organizations

Health plans, employers and third party payers

Healthcare IT suppliers

Patient and consumer groups

Pharmacies

Pharmaceutical manufacturers

Patient and consumer groups

Pharmacy benefit managers

Practicing clinicians
66
Electronic Prescribing Initiative – Take-aways

Ambulatory errors are common and preventable

Electronic prescribing can address quality, safety and efficiency
challenges

Making the transition is difficult

The design and implementation recommendations presented
today can help…immensely

Everyone must play a part…incentives are critical to assist with
transition

The timing could not be more important, given the upcoming
implementation of the Medicare Modernization Act
67
Electronic Prescribing Initiative Recommendations

Levels of electronic prescribing and benefits that accrue at each
level

Current barriers to physician adoption

Recommendations

Usability for prescriber

Clinical decision support

Communication

Standards and Vocabularies

Implementation
68
Connecting for Health
Connecting for Health was created in September 2002 to
catalyze the creation of an information technology
infrastructure in healthcare. It has the following strategic
objectives:
1. Put the need for interoperability and information mobility at the
forefront of the public policy agenda related to IT
2. Secure a patient role in the IT agenda by defining and
establishing a role for them to access and control their own
health information
3. Engage a broad level of public and private sector collaboration
and leadership behind this agenda

Funded and led by Markle Foundation with support from
the Robert Wood Johnson Foundation
69
Connecting for Health Assumptions

A health information network is worthwhile, provides
value and is the basis for future high quality care
delivery

It can only be accomplished by “dynamic connectivity”
that allows information to move when its needed to the
place that its needed at the time it is needed in a private
and secure manner

Achieving this goal will require public and private
sector collaboration
70
Connecting for Health Phase I Accomplishments

Built consensus on an initial set of data standards that are
“adoption-ready”

High-level overview of value proposition for
interoperability and a migration framework to get there

Identified and communicated examples of privacy and
security-related “noteworthy practices” to support
organizations across the health care system with
examples of what others have done.
71
Connecting for Health Phase I Accomplishments

Defined the high-level characteristics of personal health
record and studied consumer attitudes and concerns

Launched a public-private sector national demonstration
project to highlight both the feasibility and value of an
electronic, standards-based data interchange—the
Healthcare Collaborative Network

A “call to action” from the Connecting for Health
Steering Group regarding key steps related to moving
towards an interoperable health care system
72
Connecting for Health Phase I Accomplishments

Leadership and commitment demonstrated by Steering
Group members and Connecting for Health
organizations to drive implementation of data standards
and an interoperable health care system
73
Connecting for Health Deliverables

Incremental “Roadmap” or “shared path” for achieving electronic
connectivity– near-term actions the public and private sectors can
get behind – first draft to be released in July 2004

Working Group Recommendations – to be released July – Sept 04

Technical Architecture, Incremental Applications, and Data
Standards including Security Standards

Accurately Linking Patient Information

Organizational and Sustainability Models for CommunityBased Health Information Exchange

Policies for Electronic Information Sharing between Clinicians
and Patients
74
The Role of the Consumer

Our vision is about putting the patient in the center and
mobilizing information in a patient-centric way to
support the health and healthcare of patients

Currently there is a gap between consumer perception of
reality in the healthcare system and reality itself

A thoughtful, carefully executed awareness campaign
targeted to consumers is needed to increase understanding
of the role of HIT in healthcare (why do we care?) and to
stimulate demand for actions that will improve quality,
improve safety and increase efficiency
75
The Role of the Consumer

The consumer’s role is critical and the role of consumer organizations
is critical to moving us towards a safer, higher quality healthcare
system

How you can help

Convert the language we ordinarily use to describe why this is
important, to language that is easy to understand by
consumers…leverage the work of Connecting for Health…report to
be released in July 2004

Develop and implement a communications strategy that will help
“take these messages to America”

Leverage the insights and expertise of all of the stakeholders in the
system…the voice of clinicians is especially important
76
What Does All of this Mean?
“Never doubt that a group of thoughtful,
committed people can change the world.
Indeed it’s the only thing that ever has.”
Margaret Mead
77
Closing

We are finally building momentum…the “stars and
planets are aligning” which is due to leadership in
public and private sectors

The focus has shifted from “whether we should” to
“how will we do this?”

This work will create lasting and significant changes in
the U.S. healthcare system…how clinicians
practice…how hospitals operate….how healthcare gets
paid for…how patients manage their health and
navigate our healthcare system
78