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Information Technology: Putting the Patient at the Center of the Information Flow

Information Technology: Putting the Patient at the Center of the Information Flow. 25th Annual Rosalynn Carter Symposium on Mental Health Policy November 6, 2009 Robert M. Kolodner, MD. The Ultimate Reason for Health IT. Perspective for you to consider:.

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Information Technology: Putting the Patient at the Center of the Information Flow

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  1. Information Technology: Putting the Patient at the Center of the Information Flow 25th Annual Rosalynn Carter Symposium on Mental Health Policy November 6, 2009 Robert M. Kolodner, MD

  2. The Ultimate Reason for Health IT Perspective for you to consider: What quality and value of health care services do you demand? What quality of health do you want and deserve? Carter Symposium -- Kolodner 2 November 6, 2009

  3. Topics For My Brief Remarks • Current Health Care Challenges • Future of Health and Care • Health Information Technology (IT) • And then there was $$$$ • Potential New Health IT Direction • Caveats Regarding Change Carter Symposium -- Kolodner 3 November 6, 2009

  4. Section 1 Current Health Care Challenges And Health IT Carter Symposium -- Kolodner 4 November 6, 2009

  5. Why is Health IT a Central Strategy for Health Care? Current Lack of Information: • Higher Costs • Leads to 1 in 7 hospital admissions* • When care providers do not have access to previous medical records • 12% of physician orders are not executed as written* • 20% of laboratory tests unnecessary* • Requested because previous studies are not accessible • Avoidable Errors • Drug errors • Complicate 1 in 6.5 hospitalizations • Occur in 1/20 outpatient Rxs * Revolutionizing Health Care Through Information Technology President’s IT Advisory Committee (PITAC), 2004 Carter Symposium -- Kolodner 5 November 6, 2009

  6. Problems with Both Safety and Quality To Err is Human: 98,000 patients die from avoidable errors The Quality Chasm: Every Patient “Crossing the Quality Chasm” 2001: IOM Americans receive on average 55% of the evidence-based care** ** N Engl J Med 2003;348:2635-45. Carter Symposium -- Kolodner 6 November 6, 2009

  7. Quality/Reliability Challenges Remain in Health Care • Immunization: 55 – 94% • B-Blocker after an MI: 70 – 98% • Airline Baggage Handling: > 99.99% • Airline Safety: > 99.9999% 10-1 10-2 10-3 10-4 10-5 10-6 Frequency of Failures Occurring From Dr. Jonathan B. Perlin. Used with permission. Carter Symposium -- Kolodner 7 November 6, 2009

  8. New Freedom Commission on Mental Health Final Report: Achieving the Promise: Transforming Mental Health Care in America Carter Symposium -- Kolodner 8 November 6, 2009

  9. Privacy and Security: Concerns • Control of information and flow • Breaches of security and violations of privacy • Technology leading policy • Identity Theft/ De-identification • Secondary uses of data • Ability to aggregate data • Lack of understanding about how info is currently used • Genomic data and family history affect family members • Consequences(loss of insurance, work, or other forms of discrimination) Carter Symposium -- Kolodner 9 November 6, 2009

  10. Katrina: Impact Of Privacy on People with MH & SA Disorders www.katrinahealth.org/patients.html Carter Symposium -- Kolodner 10 November 6, 2009

  11. Community Health:Hurricane Katrina Relief • 50,000 New Orleans VA Patients did not lose their medical records, even when they lost their City • Their VA Electronic Health Records followed them around the U.S.! Carter Symposium -- Kolodner 11 November 6, 2009

  12. Section 2 The Future of Health and Care

  13. Transforming Health Care:Moving from Treating to Preventing to Predicting BIRTH Injury and Acute Illness Family History Genetics Environmental Exposures Death Chronic Illness Lifestyle Intervene Predict & Avoid Manage & Prevent 1. Adapted from Perlin, Dr. Jonathan B, Healthcare 1015 & beyond: Some Thoughts on Planning Ahead, p. 95 Carter Symposium -- Kolodner 13 November 6, 2009

  14. Perspective of People on Their Future HealthCare • Stay Healthy • Prevention • Increased Self-Care • Personal Health support • Convenient Care • Minimize time and travel • Tele-care • Tele-monitoring • High Quality, Coordinated Care • Enable care across providers & sites • Allow access to a lifetime of information – wherever and whenever They choose Better Health Carter Symposium -- Kolodner 14 November 6, 2009

  15. Future Health Care Direction and ^ Person-Centered Patient-Centered Patient-Focused Person-Focused Patient-Centric Consumer-?? Carter Symposium -- Kolodner 15 November 6, 2009

  16. Section 3 Health Information Technology (IT) Carter Symposium -- Kolodner 16 November 6, 2009

  17. Health IT – Role in Health Care Transformation Individual and Population Health & Well-being Population Health (Public Health, R&D, Quality Improvement, Emergency Preparedness) Health Care Transformation (Higher Quality, More Efficient, Patient-Focused) Health IT solutions must support the needs of BOTH “perspectives” and ^ Carter Symposium -- Kolodner 17 November 6, 2009

  18. Key Health IT Components to Enable Transformation A Robust, Interoperable, Health IT Environment: • Electronic Health Records (EHR / EMR) • Personal Health Records (PHR) • Population Health Information (Public Health, Biosurveillance, Quality Improvement, Research, Emergency Preparedness) • Standards (Data, Technical and Security) • Interoperable Health Information Exchange Network (Nationwide Health Information Network - NHIN) Carter Symposium -- Kolodner 18 November 6, 2009

  19. Health ITUser populations Individuals Population Health Care Providers Carter Symposium -- Kolodner 19 November 6, 2009

  20. Person-centered Individuals Population Health Care Providers Carter Symposium -- Kolodner 20 November 6, 2009

  21. However This is NOT about technology… It is about RESULTS: • Improved Health Care Quality • Containing Health Care Costs • Improved Health Care Outcomes • Improved Health Carter Symposium -- Kolodner 21 November 6, 2009

  22. Section 4 And then there was $$$$ Carter Symposium -- Kolodner 22 November 6, 2009

  23. The American Recovery and Reinvestment Act of 2009

  24. American Recovery and Reinvestment Act (ARRA) Health Information Technology for Economic and Clinical Health Act [HITECH Act] in H.R.1http://www.whitehouse.gov/the_press_office/ARRA_public_review/ Carter Symposium -- Kolodner 24 November 6, 2009

  25. American Recovery and Reinvestment Act (ARRA) Carter Symposium -- Kolodner 25 November 6, 2009

  26. American Recovery and Reinvestment Act (ARRA) Estimated $17,200,000,000 net over 10 years starting in 2011 Carter Symposium -- Kolodner 26 November 6, 2009

  27. Key Acronyms and Phrases for U.S. Health IT HIT Policy Committee CCHIT HITSP HIT Standards Committee Meaningful Use NHIN Breach notification ONC Carter Symposium -- Kolodner 27 November 6, 2009

  28. Section 5 Potential New Health IT Directionand Impact Carter Symposium -- Kolodner 28 November 6, 2009

  29. Disruptive Changes Are the “Norm” Carter Symposium -- Kolodner 29 November 6, 2009

  30. Clay Christensen’s Statement “Head on competition drives prices up. Disruption drives cost and prices down.” HIT Platform Meeting – BostonSept 30, 2009 Carter Symposium -- Kolodner 30 November 6, 2009

  31. Disruptive Innovations in (Health) IT GENERAL TRENDS: • Users have more capabilities at lower cost • Users can create their own individual “environment” • Simple-to-use • Configuration settings • Downloads • Rearrangements of application locations • Users are creating more of their own content and posting it on the web for all to see • Web 2.0 • Web 3.0 • Health 2.0 Carter Symposium -- Kolodner 31 November 6, 2009

  32. Disruptive Innovations in (Health) IT New Business Models: • More “Open Source” solutions available • Changing business models – “user-centered” • Business opportunities through support services rather than “vendor lock” • Enables users to share solutions more widely and accelerate innovation HOWEVER • “Open Source” ≠ Free Carter Symposium -- Kolodner 32 November 6, 2009

  33. Transforming Health The “locus of control" is changing. Carter Symposium -- Kolodner 33 November 6, 2009

  34. Section 6 A Few Caveats Regardingthe Pattern of Change Carter Symposium -- Kolodner 34 November 6, 2009

  35. How Transformational Change Occurs EHR Adoption Transformational Change in Health Care Delivery & Health Health IT Tipping Point TIME Carter Symposium -- Kolodner 35 November 6, 2009

  36. Opportunities Created by the World Wide Web Carter Symposium -- Kolodner 36 November 6, 2009

  37. A Repeating, Predictable Cycle… Cited in Paykel, ES and Coppen A, Eds. Psychopharmacology of affective disorders. Oxford University Press. 1979, page 160. Carter Symposium -- Kolodner 37 November 6, 2009

  38. Carter Symposium -- Kolodner 38 November 6, 2009

  39. In Summary Carter Symposium -- Kolodner 39 November 6, 2009

  40. Health IT “Success”: A Vision for 300 Million You have • Safe, high quality, efficient, convenient carewherever you are • Health IT is woven into the fabric of health care delivery nationwide • Your health information available to you or whomever YOU choose – anytime, anywhere • The information to make informed choices to improve your health and well-being • Timely, personalized, context-sensitive health information serves as a valuable and useful resource • Trust that your privacy is protected • And that your health information can be aggregated with that of others – without compromising your privacy Carter Symposium -- Kolodner 40 November 6, 2009

  41. The Ultimate Reason for Health IT Health IT is a key enabler for us ALL to get: The quality and value of health care serviceswe demand The quality of healthwe want and deserve Carter Symposium -- Kolodner 41 November 6, 2009

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