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0 Yesterday, Today, and Tomorrow Judy Murphy, RN, FACMI, FHIMSS, FAAN Deputy National Coordinator for Programs & Policy Office of the National Coordinator.

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Presentation on theme: "0 Yesterday, Today, and Tomorrow Judy Murphy, RN, FACMI, FHIMSS, FAAN Deputy National Coordinator for Programs & Policy Office of the National Coordinator."— Presentation transcript:

1 0 Yesterday, Today, and Tomorrow Judy Murphy, RN, FACMI, FHIMSS, FAAN Deputy National Coordinator for Programs & Policy Office of the National Coordinator for Health IT Department of Health & Human Services Washington DC

2 1 A look at... Yesterday - what we’ve gotten done – The status of the HITECH Programs Today - what are our key priorities – Health information exchange – Patient engagement Tomorrow – what are the biggest challenges in our future – Meaningful use of meaningful use – Health reform

3 2 We’ve come a long way …

4 3 President 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, 2004 President 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, 2009 Executive order established the Office of the National Coordinator for Health IT (ONCHIT) as part of the Dept of Health & Human Services –Dr. David Brailer appointed the first National Coordinator for Health IT –Followed by Dr. Rob Kolodner A Bit of History … On the eve of the Presidential Election February 17, 2009 – HITECH Act (part of ARRA) is signed into law –Dr. David Bluementhal appointed National Coordinator –Health IT Policy and Standards Committees are formed –ONC grows from around 30 to over 150 employees –Dr. Farzad Mostashari becomes the current National Coordinator

5 4 A Remarkable Journey Meaningful Use

6 5 Progress of Eligible Providers toward EHR Incentive Payments as of Source: CMS EHR Incentive Program Data NAMCS Survey: The percentage of primary care providers who have adopted EHRs in their practice has doubled from 20 % to 40 % between 2009 to 2011 Note: The 2012 data will be available in 2013

7 6 EHR Adoption of Eligible Providers by state as of

8 7 Regional Extension Centers are working with 148,448 Primary Care Providers GAO Report: Providers 2.3 times more likely to achieve MU if working with an REC Includes 70% of all primary care providers in the rural areas and 1,185 Rural or Critical Access Hospitals

9 8 Progress of Eligible Hospitals toward EHR Incentive Payments as of Source: CMS EHR Incentive Program Data Note: Totals reflect the number of unique hospitals that have received payments from Medicare or Medicaid. 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 2013

10 9 EHR Adoption of Eligible Hospitals by state as of

11 10 Source: CMS EHR Incentive Program Data Meaningful Use – All Payments as of ($ in Millions)

12 11 HITECH Framework for MU of EHRs Taken from: Blumenthal, D. “Launching HITECH,” posted by the NEJM on

13 12 Health IT Resource Center NOW: Work with all external communities to share knowledge Tools Resources Communities of Practice (CoPs) THEN: Work within REC community to share knowledge National Learning Consortium HealthIT.gov

14 13 Workforce Training – Community College Program Enrollment & Graduation Students Enrolled or Completed: 21,321

15 14 As of September 14, 2012 Workforce Training - University-Based Program Enrollment & Graduation Students Enrolled or Graduated: 1,627 (Target: 1,685) Students Enrolled or Graduated: 1,627 (Target: 1,685)

16 15 Health Information Exchange - Directed Exchange Implementation as of Summary StatsNumber of Grantees States/territories with directed exchange options broadly available36 States/territories piloting directed exchange solutions10 States/territories with directed exchange options unavailable10

17 16 Directed Exchange: Estimated number enabled as of Summary StatsNumber Total number of organizations enabled for directed exchange nationally8.349 Total number of clinical & administrative staff enabled for directed exchange nationally48,649

18 17 Summary StatsNumber Total number of organizations enabled for query-based exchange nationally3,554 Total number of individuals enabled for query-based exchange nationally56,496 Query-Based Exchange: Estimated number enabled as of

19 18 Exchange is increasing across the nation 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% State % 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 Dakota34% Colorado26% California20% Alaska18% Utah14% * Active = at least one directed message sent between production end points or at least one patient record query during previous calendar quarter ** Data self-reported by HIE grantees, Denominators calculated with 2011 Medicare Inpatient Hospital Data 18 states had more than 10% of their hospitals actively engaged in sharing health information electronically as of

20 19 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. The Beacon Community Program: Where HITECH Comes to Life 17 diverse communities, each funded over 3 yrs to:

21 20 “Beacons for Public Health” 20 Southeast Michigan Beacon Community Detroit, MI Southeast Michigan Beacon Community Detroit, MI Crescent City Beacon Community New Orleans, LA Crescent City Beacon Community New Orleans, LA Southeastern Minnesota Beacon Community Rochester, MN Southeastern Minnesota Beacon Community Rochester, MN Rhode Island Beacon Community Providence, RI Rhode Island Beacon Community Providence, RI Greater Cincinnati Beacon Community Cincinnati, OH Greater Cincinnati Beacon Community Cincinnati, OH Southern Piedmont Beacon Community Concord, NC Southern Piedmont Beacon Community Concord, NC San Diego Beacon Community San Diego, CA San Diego Beacon Community San Diego, CA Western New York Beacon Community Buffalo, NY Western New York Beacon Community Buffalo, NY Funded by the CDC and launched in collaboration with the ONC in 2011 Primary 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 country Case studies available today!

22 21 IT-Care Management Partnership: Beacons and AF4Q 21 Keystone Beacon Community Danville, PA Keystone Beacon Community Danville, PA Southeastern Minnesota Beacon Community Rochester, MN Southeastern Minnesota Beacon Community Rochester, MN Southern Piedmont Beacon Community Concord, NC Southern Piedmont Beacon Community Concord, NC Bangor Beacon Community Brewer, ME Humboldt County Alliance Wisconsin Alliance Cleveland Alliance Maine Alliance Western NY Alliance Partnership to align “regional health care improvement” programs between ONC (Beacons) and RWJ (Aligning Forces for Quality or AF4Q) On October 24 th, pioneering organizations from both programs came together to understand opportunities and gaps related to IT and care management Lessons will be shared through case studies and videos Future topics: Behavioral health and IT, and data use agreements across communities

23 22 Connecting Health IT to Payment 22 Great Tulsa Health Access Network Beacon Community Tulsa, OK Great Tulsa Health Access Network Beacon Community Tulsa, OK Greater Cincinnati Beacon Community Cincinnati, OH Greater Cincinnati Beacon Community Cincinnati, OH Colorado Beacon Community Grand Junction, CO Colorado Beacon Community Grand Junction, CO Bangor Beacon Community Brewer, ME Bangor Beacon HIT infrastructure serves as the foundation for the Bangor Pioneer ACO 3 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)

24 23 EHR Certification Program: Certified Health IT Product List (CHPL) 1,642 “Unique” Certified EHR Products as of 11/01/12 2,744 Certified EHR Products when all product versions are counted 896 EHR Vendors/Developers On October 4 th, ONC’s Permanent Certification Program was launched; the Temporary Certification Program which was operating for 2 years was sunset AmbulatoryInpatientTotal Complete EHR Modular EHR Total This table shows a unique count of products. Any additional versions of the same products are not included.

25 24 MU Attestations by Vendor (7/28/12)

26 25 TODAY - Key Priorities: Keeping the Patient at the center of all we do Patient-Centric health care and health record by – Laying the groundwork for interoperability with standards, testing & certification – Facilitating broad implementation of health information exchange Patient Engagement by enabling patient – Access – Action – Attitude

27 26 E-prescribing (ambulatory and inpatient discharge) Transition of Care summary exchange: Create & transmit from EHR Receive & incorporate into EHR Lab tests & results from inpatient to ambulatory Public health reporting – transmission to: Immunization Registries Public Health Agencies for syndromic surveillance Public health Agencies for reportable lab results Cancer Registries Patient ability to View, Download and Transmit their health data to a 3 rd Party Create an export summary of patient data, in order to enable data portability Focus on INTEROPERABILITY in the Stage 2 Meaningful Use Criteria

28 27 Focus on PATIENT ENGAGEMENT in the Stage 2 Meaningful Use Criteria Reminders for preventive/follow-up care provided Educational resources identified and provided Online access to personal health information (portal, PHR) Visit Summaries provided Patients can send secure messages to their provider Patients can View, Download and Transmit to 3 rd Party

29 28 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)

30 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)

31 ONC’s Consumer Engagement Strategy: The Three A’s Catalyze development of tools and services that help consumers (and providers) take action using their health information. Support a shift in attitudes and expectations regarding consumer (and provider) roles. Give consumers electronic access to their health information. Access Action Access AttitudesAction

32 31 ACCESS: Consumer eHealth Pledge Program Over 400 organizations have Pledged to provide access to personal health information for 1/3 of Americans…

33 32 Taking the Blue Button nation-wide Get more organizations to offer Blue Button Make “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

34 33 ACTION: Making it easier for Patients to use Health IT Surgeon General’s Healthy Apps Challenge More at: PHR Model Privacy Not ice More at:

35 34 ACTION Blue Button Mash-Up Challenge – develop an app that mashes up PHR data with other health-related data sets Leon 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: ccessmemo.pdf ccessmemo.pdf

36 35 ATTITUDE: Health IT Animation giving-you-access-your-medical-records 1 and 3 minute versions of the animation are available to use for patient teaching

37 36 Beat Down Blood Pressure Consumer Video Challenge

38 37 A Regular Guy Beats Down Blood Pressure: Beat Down Blood Pressure Winner

39 38 What’s in Your Health Record Consumer Video Challenge

40 39 What’s in Your Health Record Winner Wright and Luft:

41 40 Stages of Meaningful Use Stage 1 Stage 2 Stage 3 TOMORROW – The biggest challenges in our future

42 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 Summit in Washington, D.C. on September 16, 2009

43 Best Care at Lower Cost The Path to Continuously Learning Health Care in America September 2012 iom.edu/bestcare

44 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 3. Clinical decision support 4. Patient-centered care 5. Community links 6. Care continuity 7. Optimized operations Supportive policy environment 8. Financial incentives. 9. Performance transparency 10. Broad leadership 10 Recommendations

45 44 Our National Quality Strategy

46 45 Health Information Technology Improving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient- Centeredness, Timeliness, Efficiency, and Equity. Better healthcare 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. Better health Lowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries. Reduced costs $ Health IT: Helping to Drive the 3-Part Aim

47 46 Stage 2 MU ACO’s “Stage 3 MU” PCMH 3-Part Aim Registries to manage patient populations Team based care, case management Enhanced access and continuity Privacy & security protections Care coordination Privacy & security protections Patient centered care coordination Improved population health Registries for disease management Evidenced based medicine Patient self management Privacy & security protections Care coordination Structured data utilized Data utilized to improve delivery and outcomes Patient informed Patient engaged, community resources Stage 1 MU Privacy & security protections Basic EHR functionality, structured data Utilize technology Access to information Transform health care Meaningful Use as a Building Block

48 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.

49 48

50 49 THE FUTURE IS NOW. THIS IS OUR TIME. Thanks!


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