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Using Technology to Bridge the Chasm of Quality in Healthcare. By Stephen H. Carson, MD Associate Clinical Professor, UCSD Chief Med Officer, SDCMS Foundation. Facts Driving SDCMS Foundation Concerns. Medical bills = #1 cause of personal bankruptcy in the U.S

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using technology to bridge the chasm of quality in healthcare
Using Technology to Bridge the Chasm of Quality in Healthcare

By Stephen H. Carson, MD

Associate Clinical Professor, UCSD

Chief Med Officer, SDCMS Foundation

facts driving sdcms foundation concerns
Facts Driving SDCMS Foundation Concerns
  • Medical bills = #1 cause of personal bankruptcy in the U.S
  • U.S. has 45 million uninsured and 40 million underinsured
  • U.S. spends 1.5-3X more per capita as countries with universal healthcare and yet the outcomes are no better
  • Healthplans collectively profited $4 billion last year
  • Patient are shouldering more of the costs of healthcare with deductibles and copays increasing & benefits decreasing
  • Plans are dropping out of non-profitable markets.
  • Corporate corruption / Obscene executive salaries
  • Medical errors have not decreased despite cost increase
  • VA-like bidding would yield Medicare savings of $1 billion/yr
  • On average, 30% of premiums are not spent on patient care
summary of foundation priorities
  • Improve access to quality medical care
  • Increase the quality of health care
  • Improve the health of San Diego County residents
  • Improve patient safety and reduce medical errors
  • Improve the coordination and timeliness of care
  • Improve access to all information necessary to make the best decisions for patients at the point of care
  • Improve health literacy
  • Help ALL physicians in the county achieve these goals
physician goals for technology
Physician Goals for Technology
  • Improve quality, service, and safety of medical care
  • Increase the efficiency of workflow
  • Secure single “sign on” tool to import ALL data to the point of care in an “easy to read” integrated format
  • Clinical guidelines and decision support
  • Continuing education
  • Patient risk assessment
  • Community continuity of care records & registries
  • Automated patient reminders
  • Eligibility/Benefits/Claims verification
  • e-Rx: eliminate handwriting error & adverse reactions
  • Maintain privacy and confidentiality
barriers to md adoption of technology
Barriers to MD Adoption of Technology
  • Cost: Most of the Savings Accrue to the Healthplans
  • History of false starts
  • Time: Physicians are swamped with regulations (HIPAA)
  • Lack of standards and interoperability (HL-7)
  • Privacy and Security: Fear of profiling
  • Stakeholder commitment: Silo mentality & Competition
  • Healthcare industry in general is slow to change

Physicians are technophiles and recognize the value of Technology in Patient Safety and Quality Improvement


The Problem Today

Physicians can require up to 20 separate log on procedures, passwords & agreements to gather data from each patient contact point

Lab, X-Ray, Pharmacy


MD Office

Health Plan


Contact Points



hipaa health insurance portability and accountability act
Administrative Simplification

Common interchange structure

Standard employer/provider identifier

Electronic signature with specific transactions

Data transmission for benefits/claims

Information Privacy

Rights of individuals to records

Authorized uses and disclosures of information

Requires identity authentication of requestor/provider of health records

HIPAAHealth Insurance Portability and Accountability Act



Hospitals, X-ray, Labs

Lab, X-ray, discharge summaries, consultant and other reports

Medical Groups

Data only

labs, X-ray, meds, diagnosis, allergies, immunizations, consultant reports, discharge summaries and more




San Diego Medical Information Network Exchange

eRx option

*Patient information retrieval and more extensive storage

*Electronic Rx

Public Health Dept.

Informed San Diego #211

Network of Care

Public Health Nurses

Bio-terrorism/ Health Alerts

Disease Surveillance

CCR option

*Data retrieval

*Electronic Rx

*Centralized record

Pharmacy Benefit Managers and Pharmacies

Health Plan Formularies

Patient Medication Lists

Drug alerts

Allergy alerts

Sure Scripts and Rx Hub

*Patient Education



*Events Calendar

*Physician Resources

Decision Support

*Care planning

*Clinical advice

*Local guidelines

EMR option

*Electronic Rx

*Full EMR




Help Desk

San Diego Medical Information

Network Exchange (SDMINE)

SDCMS Foundation

CAL Institute for Technology and Telecom

Hosted by


Directory(Phone, Address, Email, Mapquest)


Electronic Prescribing - DoctorFirst

  • Healthplan

Check, Credit Card and Debit verification

Electronic Medical Record - Chart Connect

  • Physicians
  • Hospitals
  • Labs / Xray
  • Pharmacy
  • Home Health
  • Nursing Care


Practice Management - Elligence

  • PSS

Automatic Appointment


  • MedPlus
    • Secure Exchange of Medical Information
    • eRx and Continuity of Care Record
    • Eligibility and Benefit Verification



Patient Education

  • In Multiple Languages


*Pharmacy Links/Formulary Information


Clinical Decision Support - Enigma

SD Dept. of Public Health

  • SDIR (immunizations)
  • eMan
  • NetworkofCare

Medical Group


1MedLink – Single Sign On/Password Management




SureScripts = single portal to all SD Pharmacies Increases the efficiency, quality and safety of prescribing
  • Based in Alexandria,VA
  • Formed in August 2001
  • Formed by:
    • NACDS
    • NCPA
  • Strategic industry alliance to:
    • Promote true electronic connectivity between physicians and pharmacies
    • Enable widespread prescribing connectivity (local and national)
    • Reduce medical errors


Physician Practices

current system plagued by serious quality and patient safety problems
Patient safety

*1.5% to 4.0% of Rx’s have errors with potential for serious patient risk

Quality of care

*1.1 billion scripts never filled

* Patient satisfaction issues

Potential Savings: $ 2 billion / yr

Impact on productivity

*Physician time:1 hour per day

*Pharmacy: 4 hours per day

Illegible handwriting

Phone tag and fax tag

Patient waiting in the pharmacy


Current System Plagued by Serious Quality and Patient Safety Problems




Welcome Dr. Rice

Rice, Joe MD


Welcome Dr. Rice

Rice, Joe M.D.


Welcome Dr. Rice

Joe Rice M.D.

predictors of health
Predictors of Health
  • Racial +/- Ethnic Group
  • Income
  • Education Level
  • Literacy
  • Income
  • Employment status
  • Age
  • Geographic Location of Home
consequences of poor health literacy
Consequences of Poor Health Literacy
  • Lack of compliance with medical regimen including missed appointments
  • Medication errors and medication noncompliance
  • Late diagnosis
  • Limited preventive care
  • Malpractice suits

Physicians agree that one of their most important tasks is PATIENT EDUCATION


more than half of our patients are unable to understand