Presentation on theme: "A look at Yesterday - what we’ve gotten done"— Presentation transcript:
0 Yesterday, Today, and Tomorrow Judy Murphy, RN, FACMI, FHIMSS, FAAN Deputy National Coordinator for Programs & PolicyOffice of the National Coordinator for Health ITDepartment of Health & Human ServicesWashington DC
1 A look at . . . Yesterday - what we’ve gotten done The status of the HITECH ProgramsToday - what are our key prioritiesHealth information exchangePatient engagementTomorrow – what are the biggest challenges in our futureMeaningful use of meaningful useHealth reform
3 On the eve of the Presidential Election A Bit of History …On the eve of the Presidential ElectionPresident Bush’s goal in January 2004“… an Electronic Health Record for every American by the year By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”- State of the Union address, January 20, 2004Executive order established the Office of the National Coordinator forHealth IT (ONCHIT) as part of the Dept of Health & Human ServicesDr. David Brailer appointed the first National Coordinator for Health ITFollowed by Dr. Rob KolodnerPresident Barack Obama’s goal in January 2009“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.”- Speech at George Mason University, January 12, 2009The last two Administrations wanted every American to benefit from health IT and especially from access to EHRsPresident Bush:Executive order established the Office of the National Coordinator for Health Information Technology (ONC) as part of the Dept of Health & Human Services (HHS)Dr. David Brailer appointed the first National CoordinatorPresident Obama:February 17, 2009 – the American Reinvestment and Recovery Act (ARRA – Stimulus Bill) is signed into lawHITECH component of ARRA provides an incentive program to stimulate the adoption and use of HIT, especially EHR’sDr. David Blumenthal appointed the new National CoordinatorCongress authorized HHS to establish programs to improve health care quality, safety, and efficiency through the promotion of health IT and private and secure electronic health information exchange.February 17, 2009 – HITECH Act (part of ARRA) is signed into lawDr. David Bluementhal appointed National CoordinatorHealth IT Policy and Standards Committees are formedONC grows from around 30 to over 150 employeesDr. Farzad Mostashari becomes the current National Coordinator
5 Progress of Eligible Providers toward EHR Incentive Payments as of 8-31-12 NAMCS Survey:The percentage of primary care providers who have adopted EHRs in their practice has doubled from 20 % to 40 % between to 2011Note: The 2012 data will be available in 2013Source: CMS EHR Incentive Program Data
6 EHR Adoption of Eligible Providers by state as of 8-31-12
7 Regional Extension Centers are working with 148,448 Primary Care Providers Includes 70% of all primary care providers in the rural areas and 1,185 Rural or Critical Access Hospitals2012 GAO Report: Providers 2.3 times more likely to achieve MU if working with an REC
8 Progress of Eligible Hospitals toward EHR Incentive Payments as of 8-31-12 AHA Survey – in one year, from 2010 to 2011:Hospitals increased their use of Basic EHRs from 19% to 35% (84%)Hospitals doubled their use of Comprehensive EHRs from 4% to 9% (125%)Note: The 2012 data will be available in early 2013Note: Totals reflect the number of unique hospitals that have received payments from Medicare or Medicaid.Source: CMS EHR Incentive Program Data
9 EHR Adoption of Eligible Hospitals by state as of 8-31-12
10 Meaningful Use – All Payments as of 8-31-12 ($ in Millions) Source: CMS EHR Incentive Program Data
11 HITECH Framework for MU of EHRs Taken from: Blumenthal, D. “Launching HITECH,” posted by the NEJM on
12 National Learning Consortium Health IT Resource CenterTHEN: Work within REC community to share knowledgeNOW: Work with all external communities to share knowledgeHITRC CommunityToolsResourcesCommunities of Practice (CoPs)National Learning ConsortiumHealthIT.gov
13 Workforce Training – Community College Program Enrollment & Graduation Students Enrolled or Completed: 21,321
14 Workforce Training - University-Based Program Enrollment & Graduation As of September 14, 2012Students Enrolled or Graduated: 1,627(Target: 1,685)
15 Health Information Exchange - Directed Exchange Implementation as of 6-30-12 Summary StatsNumber of GranteesStates/territories with directed exchange options broadly available36States/territories piloting directed exchange solutions10States/territories with directed exchange options unavailable
16 Directed Exchange: Estimated number enabled as of 6-30-12 Summary StatsNumberTotal number of organizations enabled for directed exchange nationally8.349Total number of clinical & administrative staff enabled for directed exchange nationally48,649
17 Query-Based Exchange: Estimated number enabled as of 6-30-12 Summary StatsNumberTotal number of organizations enabled for query-based exchange nationally3,554Total number of individuals enabled for query-based exchange nationally56,496
18 Exchange is increasing across the nation 18 states had more than 10% of their hospitals actively engaged in sharing health information electronically as ofState% of Acute Care Hospitals Actively* Participating in Directed Exchange that is supported or enabled by State HIE grantees**Delaware100%Vermont79%Michigan48%Arkansas45%New York42%Minnesota34%North DakotaColorado26%California20%Alaska18%Utah14%State% of Acute Care Hospitals Actively* Participating in Query-Based Exchange that is supported or enabled by State HIE grantees**Delaware67%New York65%Maryland54%New Jersey32%Arizona27%Colorado26%Nebraska20%Idaho17%Kentucky16%Michigan15%Tennessee12%* Active = at least one directed message sent between production end points or at least one patient recordquery during previous calendar quarter** Data self-reported by HIE grantees, Denominators calculated with 2011 Medicare Inpatient Hospital Data
19 The Beacon Community Program: Where HITECH Comes to Life 17 diverse communities, each funded over 3 yrs to:Build and strengthen health IT infrastructure and exchange capabilities - positioning each community to pursue a new level of sustainable health care quality and efficiency over the coming years.Improve cost, quality, and population health - translating investments in health IT in the short run to measureable improvements in the 3-part aim.Test innovative approaches to performance measurement, technology integration, and care delivery - accelerating evidence generation for new approaches.
20 “Beacons for Public Health” Western New York Beacon CommunityBuffalo, NYFunded by the CDC and launched in collaboration with the ONC in 2011Primary goal: Gain an understanding of the range of activities currently conducted in population and public health within the Beacon Communities, to accelerate the work of other organizations across the countryCase studies available today!Southeastern Minnesota Beacon CommunityRochester, MNRhode Island Beacon CommunityProvidence, RISoutheast Michigan Beacon CommunityDetroit, MIGreater Cincinnati Beacon CommunityCincinnati, OHFunded by the CDC, the Beacons for Public Health project is going to allow us to explore how technology is helping to support achievement of our population health goals.Several Beacon Communities are actively engaged in technology-enabled public health efforts.The successes and lessons learned from these initiatives—which the Beacon Communities for Public Health Project is documenting—will be useful for other public health departments as they support health information exchange and EHR infrastructure for providers and public health facilities in their communities.SE Minnesota, for example is partnering with public health departments in 11 counties as they consider their exchange strategy for the community.San Diego is working on a more advanced immunization registry initiative and electronic exchange with EMS in their communityNOTE: RTI/CDC are here today and have copies of these case studies!Southern Piedmont Beacon CommunityConcord, NCSan Diego Beacon CommunitySan Diego, CACrescent City Beacon CommunityNew Orleans, LA
21 IT-Care Management Partnership: Beacons and AF4Q Bangor Beacon Community Brewer, MEMaine AllianceSoutheastern Minnesota Beacon CommunityRochester, MNWisconsin AllianceWestern NY AlliancePartnership to align “regional health care improvement” programs between ONC (Beacons) and RWJ (Aligning Forces for Quality or AF4Q)On October 24th, pioneering organizations from both programs came together to understand opportunities and gaps related to IT and care managementLessons will be shared through case studies and videosFuture topics: Behavioral health and IT, and data use agreements across communitiesHumboldt County AllianceKeystone Beacon CommunityDanville, PACleveland AllianceSouthern Piedmont Beacon CommunityConcord, NC21
22 Connecting Health IT to Payment Bangor Beacon Community Brewer, MEBangor Beacon HIT infrastructure serves as the foundation for the Bangor Pioneer ACO3 Beacon Communities (CO, Tulsa and Cincinnati) are working on how Beacon HIT infrastructure can be used to support provider practices participating in CMMI’s comprehensive primary care initiative (CPC)Greater Cincinnati Beacon CommunityCincinnati, OHColorado Beacon CommunityGrand Junction, COGreat Tulsa Health Access Network Beacon CommunityTulsa, OK22
23 EHR Certification Program: Certified Health IT Product List (CHPL) 1,642 “Unique” Certified EHR Products as of 11/01/122,744 Certified EHR Products when all product versions are counted896 EHR Vendors/DevelopersOn October 4th, ONC’s Permanent Certification Program was launched; the Temporary Certification Program which was operating for 2 years was sunsetAmbulatoryInpatientTotalComplete EHR69496790Modular EHR43641685211305121642This table shows a unique count of products. Any additional versions of the same products are not included.
25 TODAY - Key Priorities: Keeping the Patient at the center of all we do Patient-Centric health care and health record byLaying the groundwork for interoperability with standards, testing & certificationFacilitating broad implementation of health information exchangePatient Engagement by enabling patientAccessActionAttitude
26 Focus on INTEROPERABILITY in the Stage 2 Meaningful Use Criteria E-prescribing (ambulatory and inpatient discharge)Transition of Care summary exchange:Create & transmit from EHRReceive & incorporate into EHRLab tests & results from inpatient to ambulatoryPublic health reporting – transmission to:Immunization RegistriesPublic Health Agencies for syndromic surveillancePublic health Agencies for reportable lab resultsCancer RegistriesPatient ability to View, Download and Transmit their health data to a 3rd PartyCreate an export summary of patient data, in order to enable data portability
27 Focus on PATIENT ENGAGEMENT in the Stage 2 Meaningful Use Criteria Reminders for preventive/follow-up care providedEducational resources identified and providedOnline access to personal health information (portal, PHR)Visit Summaries providedPatients can send secure messages to their providerPatients can View, Download and Transmit to 3rd Party
28 Back in the Day… - AMA’s Code of Medical Ethics (1847) “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)The role of the patient – and the provider – have changed considerably in the last 150 years, as demonstrated by this statement from the AMA._________________________________Notes:The image is fromA bedridden sick young woman being examined by a doctor, accompanied by her anxious parents. Engraving by F. Engleheart, 1838, after Sir D. Wilkie. Available through Creative Commons license.
29 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)This updated statement by the AMA – and the quotes from actual patients -- represent a shift toward patient engagement in healthcare and health. This change is due to multiple factors, including changes in attitude about the capabilities of patients, as well as other trends from outside of healthcare, such as the wide adoption of information technology, that are changing our society in numerous ways:Assumptions about consumer engagement in health:- Actionable information (right info, right place, right time) contributes to individuals’ ability to effectively engage in their health- Actionable information for individuals can contribute to the following health outcomes:- Increased ability to coordinate care among multiple providers- Stronger partnerships with providers in patient-centered care- Better self management- The goal is effective engagement… not necessarily more engagement; effective health engagement by individuals should be guided by scientific evidence- Provider and patient attitudes—not just technical and financial considerations—impact individuals’ ability to use information to engage effectively in their healthPowerful “megatrends” support consumer engagement in health:- Communication technology is getting cheaper and more ubiquitous (cell phones, smart phones, tablets, etc)- Online communities are growing and proliferating (Facebook, Twitter, etc)- Technology for information collection and analysis is getting cheaper and ubiquitous (sensors, more powerful computers, etc.)- Trends are toward opportunities for greater consumer engagement in most (other!) aspects of our lives- Meaningful Use and other factors are bringing health information held by providers online- Market forces (including health reform) are requiring consumers to take greater responsibility for their health and health care_________________________________Notes:This version of the AMA code was written in 1993 and remains current.The patients and quotes pictured are from actual people interviewed by ONC. Go to for more.
30 ONC’s Consumer Engagement Strategy: The Three A’s AccessAccessGive consumers electronic access to their health information.AttitudesActionActionAll are interdependentTell you what we are doing in each….Support a shift in attitudes and expectations regarding consumer (and provider) roles.Catalyze development of tools and services that help consumers (and providers) take action using their health information.DRAFT: Not for distribution
31 ACCESS: Consumer eHealth Pledge Program Over 400 organizations have Pledged to provide access to personal health information for 1/3 of Americans…31
32 Taking the Blue Button nation-wide Get more organizations to offer Blue ButtonMake “Blue Button” a household name = “electronic access to my health data”Advance technical capabilities = “set it and forget it”One of 5 game-changing projects involving the 2012 Presidential Innovation Fellows
33 ACTION: Making it easier for Patients to use Health IT Surgeon General’s Healthy Apps ChallengeMore at:PHR Model PrivacyNoticeMore at:52 % of Americans would use a smart phone or PDF to monitor their health if they were able to access their medical records and download info about their medical condition or treatments…Together with the Department of Veterans Affairs, ONC issued a challenge for developers that builds on the current Blue Button feature that allows patients to download their health information and share it with health care providers, caregivers and others they trustThe challenge requires the development of a tool that will help individuals to use their health information, combined with other types of information, such as cost data or comparative health data, to help the patient better understand their own health status and make more informed decisions regarding their health care.
34 ACTIONBlue Button Mash-Up Challenge – develop an app that mashes up PHR data with other health-related data setsLeon Rodriguez, Director-Office of Civil Rights: clarification of the patient’s right to access their own health information under HIPAA (videos, pamphlets, answers to questions, and other guidance)More at:52 % of Americans would use a smart phone or PDF to monitor their health if they were able to access their medical records and download info about their medical condition or treatments…Together with the Department of Veterans Affairs, ONC issued a challenge for developers that builds on the current Blue Button feature that allows patients to download their health information and share it with health care providers, caregivers and others they trustThe challenge requires the development of a tool that will help individuals to use their health information, combined with other types of information, such as cost data or comparative health data, to help the patient better understand their own health status and make more informed decisions regarding their health care.
35 ATTITUDE: Health IT Animation 1 and 3 minute versions of the animation are available to use for patient teachinghttps://dl.dropbox.com/u/ /HHS_Final_HD_WithSound_ APPROVED-FINAL-2500.wmv
36 Beat Down Blood Pressure Consumer Video Challenge
37 Beat Down Blood Pressure Winner A Regular Guy Beats Down Blood Pressure:Based on self-reported 3 quarters of data – will be collecting more to understand trends across communities37
38 What’s in Your Health Record Consumer Video Challenge
39 What’s in Your Health Record Winner Wright and Luft:Based on self-reported 3 quarters of data – will be collecting more to understand trends across communities39
40 Stages of Meaningful Use TOMORROW –The biggest challenges in our futureData capturing and sharingAdvanced clinical processesImproved outcomesStage 3Stage 2Stages of Meaningful UseStage 1
41 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 Summitin Washington, D.C.on September 16, 2009
42 Best Care at Lower Cost The Path to Continuously Learning Health Care in AmericaSeptember 2012iom.edu/bestcare
43 10 Recommendations Supportive policy environment 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 targetsClinical decision supportPatient-centered careCommunity linksCare continuity7. Optimized operationsSupportive policy environment8. Financial incentives.9. Performance transparency10. Broad leadership
44 Our National Quality Strategy Better Health for the PopulationLower Cost Through ImprovementBetter Care for Individuals
45 Health Information Technology Health IT:Helping to Drive the 3-Part AimImproving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient- Centeredness, Timeliness, Efficiency, and Equity.Better healthcareKeeping 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.Better healthLowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries.Reduced costs$With the foundation we have built in Stage 1 Increasingly rigorous health information exchange requirements in Stage 2Standards adoption to reduce cost and Payment reform providing the business caseWe expect exchange to take off in 2012Health Information Technology
46 Meaningful Use as a Building Block Utilize technologyAccess to informationTransform health careImproved population healthEnhanced access and continuityData utilized to improve delivery and outcomesData utilized to improve delivery and outcomesPatient self managementPatient engaged, community resourcesCare coordinationCare coordinationPatient centered care coordinationAs the ability to integrate and manage grows, so does the data reporting requirements and expanded use of the data.Patient informedEvidenced based medicineTeam based care, case managementBasic EHR functionality, structured dataStructured data utilizedRegistries for disease managementRegistries to manage patient populationsPrivacy & security protectionsPrivacy & security protectionsPrivacy & security protectionsPrivacy & security protectionsPCMH3-Part AimACO’s“Stage 3 MU”Stage 1 MUStage 2 MU
47 Meaningful Use Is Just the Beginning: Other Three Part Aim Programs A recent analysis identified that the national network of RECs are currently working on over 190 different programs to help providers meet the Three Part Aim* Based on information from 53 of 62 RECs. Some are working on several different Three-Part Aim Programs .