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The Role of Health IT in Health Care Transformation. Judy Murphy RN, FAAN. The Role of Health IT in Health Care Transformation. Judy Murphy, RN, FACMI, FHIMSS, FAAN Deputy National Coordinator for Programs & Policy Office of the National Coordinator for Health IT

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the role of health it in health care transformation1

The Role of Health ITin Health Care Transformation

Judy Murphy, RN, FACMI, FHIMSS, FAANDeputy National Coordinator for Programs & Policy

Office of the National Coordinator for Health IT

Department of Health & Human Services

Washington DC

Transforming Health Care: Driving Policy

10-12-2012, 9 - 10am

what i will cover
What I Will Cover . . .

Today’s Health IT landscape

Quality and the new IOM Report

Consumer eHealth

President Bush’s goal in 2004

A Bit of History …

  • “… an Electronic Health Record for every American by the year 2014. By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”
  • State of the Union address,
  • Jan. 20, 2004
  • Executive order established the Office of the National Coordinator for Health Information Technology (ONCHIT) as part of the Dept of Health & Human Services (HHS)
    • Dr. David Brailer appointed the first National Coordinator
“To lower health care cost, cut medical errors, and improve care, we’ll computerize the nation’s health records in five years, saving billions of dollars in health care costs and countless lives.”

- First Weekly Address

Jan. 24, 2009

The Time is Now …

  • President Obama’s goal in 2009
  • February 17, 2009 – the American Reinvestment and Recovery Act (ARRA – Stimulus Bill) is signed into law
    • HITECH component of ARRA provides an incentive program to stimulate the adoption and use of HIT, especially EHR’s
    • Dr. David Bluementhal appointed the new National Coordinator
american recovery reinvestment act of 2009 arra stimulus bill

HR 1 -- 111th Congress

$787 Billion

Highly partisan vote

Healthcare gets $147.7 Billion

$87B for Medicaid

$25B for support for extending COBRA

$10B for NIH

HITECH Component:

$22.5B for EHR Incentives through CMS

$2B for HIT Support Programs through ONC

HITECH = Health Information Technology

for Economic and Clinical Health

American Recovery & ReinvestmentAct of 2009 (ARRA / Stimulus Bill)

The focus on HIT continues …

PCAST Report

Dec 2010

(President’s Council of

Advisors on Science

& Technology)


Future of Nursing Report

Oct 2010

PPACA Mar 2010

(Patient Protection & Affordable Care Act)

“There is no aspect of our profession that will be

untouched by the informatics revolution in progress.”

- Angela McBride, Distinguished Professor and University Dean

Emeritus Indiana University School of Nursing

a remarkable journey
A Remarkable Journey

Meaningful Use


Progress of Eligible Professionals Toward EHR Incentive Payments

Source: CMS EHR Incentive Program Data as of 8/31/2012


Progress of Eligible Hospitals

Toward EHR Incentive Payments

Note: Totals reflect the number of unique hospitals that have received payments from Medicare or Medicaid.

Source: CMS EHR Incentive Program Data as of 8/31/2012


Meaningful Use – All Payments

as of August 31, 2012 ($ in Millions)

Source: CMS EHR Incentive Program Data

hit as the means not the end
HIT as the means, not the end
  • Dr. David Blumenthal, previous National Coordinator of HIT, emphasizes
  • “HIT is the means, but not the end. Getting an EHR up and running in health care is not the main objective behind the incentives provided by the federal government under ARRA. Improving health is. Promoting health care reform is.”
  • At the National HIPAA Summit
  • in Washington, D.C.
  • on September 16, 2009

Health IT:

Helping to Drive the 3-Part Aim

Better healthcare

  • Improving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity.

Better health

Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care.

Reduced costs

  • Lowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries.


Health Information Technology


Meaningful Use as a Building Block

Transform health care

Improved population health

Enhanced access and continuity

Access to information

Data utilized to improve delivery and outcomes

Data utilized to improve delivery and outcomes

Patient self management

Patient engaged, community resources

Utilize technology

Care coordination

Care coordination

Patient centered care coordination

Patient informed

Evidenced based medicine

Team based care, case management

Basic EHR functionality, structured data

Structured data utilized

Registries for disease management

Registries to manage patient populations

Privacy & security protections

Privacy & security protections

Privacy & security protections

Privacy & security protections


3-Part Aim


“Stage 3 MU”

Stage 1 MU

Stage 2 MU

quality measurement enabled by health it
Quality Measurement Enabled by Health IT
  • Released July 2012
  • Contains a catalog of over 70 activities related to health IT and quality measurement
  • Describes possibilities for the next generation of quality measurement
  • Illustrates challenges facing advancement

best care at lower cost

Best Care at Lower Cost

The Path to Continuously Learning

Health Care in America

September 2012


Why now?

  • Quality – persistent shortfalls
  • Patient harm – One-fifth to one-third of hospital patients are harmed during their stay, largely preventable.
  • Recommended care – Only about half of the recommended preventive, acute, and chronic care is actually received.
  • Outcome shortfalls –If all states matched care quality in the highest-performing states, 75,000 fewer deaths would have occurred in 2005.

Why now?

  • Costs – unsustainable levels, waste
  • Absolute expenditures – $2.6 trillion (2009), 17% GDP
  • Relative expenditures – 76% increase health costs in past 10 years, overwhelming the 30% gain in personal income
  • Wasted expenditures– $750 billion (2009)
  • Opportunity costs – e.g. total waste could pay salaries of all first response personnel for 12 years

Why now?

  • Complexity – exponentially increasing
  • Increasing information – Over 800,000 new journal articles per year; up 4-fold from 1970.
  • New diagnostic factors in play – phenotypes, genetics, and proteomics.
  • Multiple treatment factors in play –e.g. 19 medications per day for 79 year-old patient with osteoporosis, type 2 diabetes, hypertension, and chronic obstructive lung disease; over 200 other doctors are also providing treatment to the Medicare patients of an average primary care doctor.
the result
The Result?

The U.S. health care system today

the vision
The Vision

Continuous Learning, Best Care, Lower Cost

10 recommendations

Foundational elements

    • 1. The digital infrastructure –Improve the capacity to capture clinical, delivery process, and financial data for better care, system improvement, and creating new knowledge.
  • 2. The data utility – Streamline and revise research regulations to improve care,
  • promote the capture of clinical data, and generate knowledge.
    • Care improvement targets
    • Clinical decision support
    • Patient-centered care
    • Community links
    • Care continuity
    • 7. Optimized operations
    • Supportive policy environment
    • 8. Financial incentives.
    • 9. Performance transparency
    • 10. Broad leadership
10 Recommendations
back in the day
Back in the Day…

“The obedience of a patient to the prescriptions of his physician should be prompt and implicit. [The patient] should never permit his own crude opinions as to their fitness to influence his attention to them.”

- AMA’s Code of Medical Ethics (1847)

and now
And Now…

“Patients share the responsibility for their own health care….”

- AMA’s Code of Medical Ethics (current)

“Patients can help. We can be a second set of eyes on our medical records. I corrected the mistakes in my health record, but many patients don't understand how important it will be to have correct medical information, until the crisis hits. Better to clean it up now, not when there’s time pressure.”

– Dave deBronkart (ePatient Dave)

consumer ehealth pledge program www healthit gov pledge
Consumer eHealth Pledge

Over 400organizations have Pledged to provide access to personal health information for 1/3 of Americans…

consumer involvement is critical
Consumer Involvement is critical


consumer video challenge winner
Consumer Video Challenge Winner

Dr Funky's Blood Pressure Management Rx




Transition of Care summary exchange:

Create & transmit from EHR

Receive & incorporate into EHR

Lab tests & results from inpatient to outpatient

Public health reporting – transmission to:

Immunization Registries

Public Health Agencies for syndromic surveillance

Public health Agencies for reportable lab results

Cancer Registries

Patient View, Download and Transmit to 3rd Party

Stage 2 Meaningful Use Criteria

consumer video challenge winner1
Consumer Video Challenge Winner

Mark’s Story

opennotes what was learned tom delbanco md jan walker rn mba et al

OpenNotes: What Was LearnedTom Delbanco, MD; Jan Walker, RN, MBA; et al

Supported by: The Robert Wood Johnson Foundation

With additional funding from the Drane Family Fund and the Richard and Florence Koplow Charitable Fund

OpenNotes study results (Annals of Internal Medicine: 2 October 2012, Vol 157, No 7)

Includes editorials by Michael Meltsner, an OpenNotes patient and Carol Goldzweig,

from the Veterans Health Administration

about the opennotes study
About the OpenNotes Study

More than 19,000 patients

105 volunteer primary care physicians

3 diverse sites

  • Beth Israel Deaconess Medical Center
  • Geisinger Health System
  • Harborview Medical Center

12 months of sharing notes

patients were enthusiastic
Patients Were Enthusiastic

Patients used the notes

  • Up to 92% of patients across the 3 sites read their doctor’s note(s)

Patients reported important benefits

  • Feeling more in control of their care (77-87%)
  • Better understanding of health and medical conditions (77-85%)
  • Doing better with taking their medications (60-78%)

Patients were rarely (1-8%) confused, worried, or offended by what they read in their doctors’ notes

doctors experienced little disruption and observed benefits
Doctors Experienced Little Disruption and Observed Benefits

Few doctors reported impacts on their workflow

  • Longer visits (0-5%)
  • More time addressing patients’ questions outside of visits (0-8%)

Some doctors changed how they wrote notes

    • 0-21% reported taking more time writing notes
  • 3-36% reported changing the way they wrote about mental health, substance abuse, cancer, and obesity

Many doctors described strengthened relationships with their patients