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Toward an Electronic Health Infrastructure for the Nation December, 2009 Ned Ellington, PhD Health IT Research Center Office of the National Coordinator for Health Information Technology (ONC). Still in the Cutting Room…. Agenda. The Challenge Health IT and the Winds of Change

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slide1

Toward an Electronic Health Infrastructure for the Nation

December, 2009

Ned Ellington, PhD

Health IT Research Center

Office of the National Coordinator for Health Information Technology (ONC)

agenda
Agenda
  • The Challenge
  • Health IT and the Winds of Change
  • Where We are Right Now
  • A Nationwide Health IT Agenda under the “HITECH” Act
health expenditure as a share of gdp oecd countries

Germany

Switzerland

France

Portugal

New Zealand

Italy

Hungary^

Belgium

Austria

Greece

Canada

Iceland

Netherlands^

Sweden

Norway

Denmark

Luxembourg^

Spain

Japan^

Turkey

Czech Republic

Mexico

Poland

Korea

Ireland

Finland

Slovak Republic

Health Expenditure as a Share of GDP – OECD Countries#

% GDP

16

15.3

14

12

11.5

11.1

10.7

10.3

10.2

10.2

10.1

9.8

9.5

9.5

10

9.2

9.1

9.1

9.1

9.0

8.9

8.3

8.3

8.2

8.1

8.0

7.6

7.5

7.5

8

7.2

7.1

6.4

6.2

6.0

6

4

2

0

United States

United Kingdom

Australia*

# - Source: Organisation for Economic Co-operation and Development (OECD) Health Data 2007, July 2007 (30 countries)

^ - 2004/2005

* - 2004

challenges in u s health care
Challenges in U.S. Health Care
  • Cost (16% of GDP and growing)
  • Lags behind in many health indicators (32nd in infant mortality)
  • Safety (~100,000 deaths per year due to preventable medical errors)
  • Quality and efficiency
    • Enormous variation in cost and outcome
    • Care delivered does not follow best practices
    • More care (at more cost) does not equate to healthier people
slide6

Why is Health IT a Central Strategy for Health Care?

  • Lack of Information:
  • 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.
  • Medication errors
    • Complicate 1 in 6.5 hospitalizations
    • Occur in 1/20 outpatient Rxs
agenda1
Agenda
  • The Challenge
  • Health IT and the Winds of Change
  • Where We are Right Now
  • A Nationwide Health IT Agenda under the “HITECH” Act
slide8

Office of the National Coordinator (ONC)

  • Executive Order, April 2004:
  • Then President Bush created the National Coordinator position
    • To advance the vision of developing a nationwide interoperable health information technology infrastructure
    • To achieve the goal of widespread adoption of interoperable electronic health records (EHR) by 2014: “majority of Americans”
  • Key Role for the Office of the National Coordinator (ONC):
  • Provide leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve
    • The quality and efficiency of health care and
    • The ability of consumers to manage their health
  • This established a National Health IT Agenda
dr david blumenthal new national coordinator for health it
Dr. David Blumenthal –New National Coordinator for Health IT

“To increase the effective use of electronic health systems, private and public agencies and groups must accomplish, at a minimum, the following tasks:

  • Get doctors, hospitals, and other health care providers to acquire and use electronic health records.
  • Get those electronic health records to "talk to one another" by becoming interoperable.
  • Get providers to use EHRs to improve quality and efficiency in the provision of health care services.”

\

agenda2
Agenda
  • The Challenge
  • Health IT and the Winds of Change
  • Where We are Right Now
  • A Nationwide Health IT Agenda under the “HITECH” Act
ehr adoption where are we in office practices
EHR Adoption: Where are we in office practices?

25

20

15

10

5

0

Level of EHR Function: 2008-2009

Basic System

17%

Percentage

Fully Functional

4%

12

adoption in hospitals jha et al nejm 2009
Adoption in Hospitals: Jha et al. NEJM 2009

By panel definition:

1.5% have comprehensive system

10.9% have basic system

Installed across major clinical units

13

Matheson Lecture

a slightly different way to look at the hospital data
A slightly different way to look at the hospital data

Percent of hospitals fully implementing:

Laboratory and radiology reports: 77%-78%

Drug allergy/interaction alerts: 45%-46%

Medication lists: 45%

14

slide15

State and Local Gov

Health Bank orPHR Support Organization

Community Health Centers

SSA

DoD

IHS

CDC

VA

Community #1

Labs

IntegratedDelivery System

Pharmacies

Progress: The Nationwide Health Information Network

Mobilizing Health Information Nationwide

Community #2

The Internet

Standards, Specifications and Agreementsfor Secure Connections

Matheson Lecture

15

agenda3
Agenda
  • The Challenge
  • Health IT and the Winds of Change
  • Where We are Right Now
  • A Nationwide Health IT Agenda under the “HITECH” Act
1 national coordination
1. National Coordination
  • ONC becomes a permanent organization
  • Two Federal Advisory Committees
    • Policy
    • Standards
  • Strategic Plan to be Revised
  • Standards and Certification Criteria to be Formally Adopted
  • Governance of Nationwide Health Information Network
2 payment incentives and meaningful use
2. Payment Incentives and Meaningful Use
  • A hospital or eligible provider must be a meaningful user to receive payment incentives (up to $44,000 per provider)
  • Changes the focus from technology potential to clinician behavior
  • By law, a “meaningful user” must:
    • Use a certified EHR
    • Exchange health information
    • Report quality measures
meaningful use is being defined
Meaningful Use is Being Defined

Meaningful Use Recommendations: August 14, 2009 http://healthIt.hhs.gov/meaningfuluse

Policy priorities for MU

Improve quality, safety, efficiency and reduce disparities

Engage patients and families

Improve care coordination

Improve population and public health

Ensure adequate privacy and security

19

meaningful use will follow an ascension path
Meaningful Use Will Follow an “Ascension Path” *

2009

2011

2013

2015

HITECH Policies

2011 Meaningful Use Criteria (Capture/share data)

2013 Meaningful Use Criteria

(Advanced care processes with decision support)

2015 Meaningful Use Criteria (Improved Outcomes)

*Report of sub-committee of Health IT Policy Committee

3 grant programs in hitech
3. Grant Programs in HITECH

Mandatory programs of:

Implementation assistance (Extension Program)

Grants to states to promote health IT, emphasizing health information exchange

Education: building health IT workforce

Optional programs of:

Grants to states and tribes for loan programs

Demonstration program integrating Health IT in health professionals education – Beacon Program

Program of “Enterprise Integration Centers” shall be established through the National Institute of Standards and Technology.

21

4 key privacy provisions
4. Key Privacy Provisions

Appoint a Chief Privacy Officer

Breach notifications – for protected health information

Prohibition on the sale of EHR data or protected health information without authorization

Patient’s right of access to information in electronic form

22

agenda4
Agenda
  • The Challenge
  • Health IT and the Winds of Change
  • Where We are Right Now
  • A Nationwide Health IT Agenda under the “HITECH” Act
  • Closing observation
slide24

Comments

Suggestions

Ideas

ned.ellington@hhs.gov

the two element view based on implementation
The “Two Element” View: Based on Implementation

Element 1: Adopted Health IT Systems

Element 2: A Trusted Pathway to Exchange Information

Matheson Lecture

combining the elements enables meaningful use
Combining the Elements Enables Meaningful Use
  • Statutory Components of MU
  • Adoption of certified EHRs
  • Health information exchange
  • Quality reporting

Matheson Lecture

building element 1

Practices Hospitals

Progress 2009

Building Element 1

Adopted Health IT Systems

Primary Initiatives:

  • Payment Incentives
  • Regional Extension Centers Grants
  • Health IT Workforce Grants
  • Certification

Matheson Lecture

element 1 progress
Element 1: Progress

Adopted Health IT Systems

  • Incentives
  • Regional Extension Centers Grants
  • Health IT Workforce Grants
  • Certification

Regulation defining MU being drafted

Funding Opportunity Issued August 20

“Interim final rule” to be issued by December 31

Funding Opportunity Issued “Soon”

Matheson Lecture

building element 2
Building Element 2

A Trusted Pathway to Exchange Information

Primary Initiatives:

  • Standards
  • Grants to States
  • Nationwide Health Information Network
  • Privacy and Security

Matheson Lecture

element 2 progress
Element 2: Progress

Element 2: A Trusted Pathway to Exchange Information

  • Standards
  • Grants to States
  • Nationwide Health Information Network
  • Privacy and Security

First set adopted by December 31, 2009

Funding Oppy Issued August 20

CPO, new regulations, State activities

In very limited production

Matheson Lecture

standards
Standards
  • Health IT Standards Committee makes recommendations for standards
  • Focus on meaningful use
  • Recommendations released August 20, 2009 as advice
    • Content and vocabulary (clinical operations WG)
    • Quality measures (clinical quality WG)
    • Privacy and security standards (P&S WG)
  • “Interim Final Rule” to be issued before end of 2009

Matheson Lecture

agenda5
Agenda
  • The Challenge
  • Health IT and the Winds of Change
  • Where We are Right Now
  • A Nationwide Health IT Agenda under the “HITECH” Act
    • Plan
    • Progress
  • Closing observation

Matheson Lecture

the two element view based on implementation1
The “Two Element” View: Based on Implementation

Element 1: Adopted Health IT Systems

Element 2: A Trusted Pathway to Exchange Information

Matheson Lecture

combining the elements enables meaningful use1
Combining the Elements Enables Meaningful Use
  • Statutory Components of MU
  • Adoption of certified EHRs
  • Health information exchange
  • Quality reporting

Matheson Lecture

the two elements won t take us all the way
The Two Elements Won’t Take Us All the Way

Public Health Worker

Cancer Researcher

Family Member

Patient

Oncologist/Pathologist

Primary Care Practitioner

Matheson Lecture

need an element 3

3

Need an Element 3!

Public Health Worker

Cancer Researcher

Family Member

Patient

Oncologist/Pathologist

Primary Care Practitioner

Matheson Lecture

element 3 enables a learning system

3

Element 3 Enables a “Learning System”

Smart

Applications

“Gridware”

“Learningware”

Matheson Lecture

agenda and recap
Agenda and Recap
  • The Challenge (Foundation of health reform)
  • Health IT and the Winds of Change (We have our marching orders)
  • Where We are Right Now (Not too far)
  • A Nationwide Health IT Agenda under the “HITECH” Act (To build Elements 1 and 2)
    • Plan
    • Progress
  • Closing observation (Also need Element 3)

Matheson Lecture

slide39

Thanks and Write to Me:

charles.friedman@hhs.gov

healthit.hhs.gov

Matheson Lecture