What Problems are We Trying to Solve?

1. Electronic Prescribing and Health Information Technology:The Environmental LandscapeThe Role of ConsumersSOS Rx Coalition MeetingNational Consumers LeagueWashington, D.C.Janet M. MarchibrodaChief Executive Officer, eHealth Initiative Executive Director, Foundation for eHealth InitiativeExecutive Director, Connecting for HealthJune 30, 2004

2. What Problems are We Trying to Solve? • Looming Healthcare Crisis • Quality and Safety Challenges • Big Gap Between “What we Know” and “What We Do” • Public Health Threats Continue

3. 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

4. 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

5. 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. • It Makes it Easier to Navigate the Healthcare System

6. 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

7. 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 for tracking chronic conditions • 83% want to receive their lab tests on-line

8. 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

9. 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 doctor – 75% • Store immunization records – 69% • Transfer information to specialist – 65% • Look-up test results – 63% • Track medication use – 62%

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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).

20. 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

21. 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 a revolving loan fund for IT acquisition • Requires technical standards by January 1, 2006

22. 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 standards • Clear barriers • Provide needed incentives

23. 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

24. President Bush’s 10-Year Plan for EHR • April 26, 2004 President George W. Bush Announces 10-Year 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.

25. 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

26. 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

27. 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 evidence-based 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

28. 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

29. 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

30. 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

31. 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……

32. 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

33. 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

34. Momentum Building in Administration • CMS releases “Chronic Care Improvement Program Notice and Application” • 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. Our Approach

41. 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 and Clinical Process Change • Application of Clinical Knowledge • Organization and Governance • Legal Issues • Engaging Patients and Consumers

42. Operating Model AGGREGATE AND DEVELOP KNOWLEDGE IN KEY ISSUE AREAS VET WITH AND DISSEMINATE TO STAKEHOLDERS PRIMARY DISSEMINATION VEHICLES CLINICIANS ONLINE RESOURCE CENTER FINANCING (Incentives, Funding) 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 PAYERS EMPLOYERS, PURCHASERS CLINICAL KNOWLEDGE CHRONIC CARE PUBLICATIONS PATIENTS, CONSUMERS MEMBER ORGANIZATIONS TECHNICAL (STDS, SECURITY, ARCHITECTURE) POLICY-MAKERS

43. 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 - $6.9 million in funding and augmenting with other funding sources • 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

44. Connecting Communities for Better Health • 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 with help on financial, technical, organizational, clinical issues related to health information exchange

45. Connecting Communities for Better Health • Through meetings such as Community Learning Forum and Resource Exhibition, and other communications vehicles, extend our reach further • 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 • Building national awareness regarding why this is important and the steps that need to be taken to get there

46. 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

47. Organization Types Involvement

48. Functions Provided

49. 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

50. Connecting Communities Learning Network • Key partnering organizations • Center for Information Technology Leadership – Partners Healthcare System – John Glaser, PhD; Blackford Middleton, MD • Regenstrief Institute – J. Marc Overhage, MD, PhD • Others in the process of being finalized