Sachin H. Jain, MD, MBA Office of the National Coordinator for Health IT United States Department of Health and Human Services The Nation’s Health IT Agenda: Building a Foundation for Health Reform

Critical reminders that expanded coverage is an important start…but not enough…. Insured patients still get the wrong medication and suffer adverse drug events Insured patients still suffer when their health information is spread out across multiple sites Insured patients still experience disparities in their care

The world is not where we want it to be…

Current Levels of Adoption by Ambulatory Physicians No Functional EHR 80% 37% intend to install a new EHR system or replace current system within the next 3 years. Source: 2009 National Ambulatory Medical Care Survey (NAMCS) Electronic Medical Records Supplement.

Hospital adoption is no different… Hospitals (2009): –13.5 percent basic. –2.7 percent comprehensive. –Large percentages with pieces of EHR. Source: 2009 American Hospital Association (AHA) IT Supplement

Major Barriers to EHR Adoption Percent of physicians reporting a “major barrier” Source: DesRoches CM et al. Electronic health records in ambulatory care—a national survey of physicians. N Engl J Med. 359(1):50-60, 2008 Jul 3.

Common Sentiments About Government Among Investors, Innovators, Entrepreneurs… Government stifles innovation Government should not be involved in setting technology policy Government funding typically skews incentives

With HITECH, the Obama Administration and the Congress got it right… What we are not doing… Specifying technology Dictating vendors Imposing burdensome regulations What we are doing… Providing $30 billion in new capital for health IT investments Specifying standards for certification Defining rules of play through “meaningful use”

Incentive program basics… $2 M+ for hospitals (based on discharges) Up to $44,000 for Medicare physicians Up to $63,750 for Medicaid physicians Penalties kick in after 2015 Meaningful Use defined in three stages Must achieve all three stages of meaningful use to obtain full incentive payments

How to Think About “Meaningful Use”… What providers must achieve in order to quality for incentive payments A carrot and a stick An assurance that we are rewarding changes in clinical behavior, not purchasing “Stretch not break”

The Five Pillars of Meaningful Use Improve quality, safety, efficiency and reduce health disparities Engage patients & families in their health care Improve care coordination Improve population and public health Ensure adequate privacy & security protections for personal health information

Office of the National Coordinator for Health Information Technology Healthit.hhs.gov 14 Conceptual Approach to Meaningful Use Capture / share data Advanced care processes with decision support Improved Outcomes

The HITECH Act Addresses Barriers to IT Implementation ObstacleInterventionFunds Financial Resources CMS Incentive Program Up $2 million per hospital and up to $63,750 per physician Technical Assistance Regional Extension Centers $643 Million Human Resources Workforce Training Programs $118 Million Exchange Health Information Exchange and NHIN $620 Million Technology SHARP Grants $60 million Breakthrough Examples Beacon Communities $235 Million

Two Types of Opportunities Exist… HITECH Implementation EMR Implementation ($30B) Regional Extension Centers ($640 M) Health Information Exchange ($543M) Beacon Communities ($225 M) Workforce Grants ($115M) SHARP Grants ($60M) Post-HITECH World New stores of health information New models of health care delivery New methods of exchanging and using health information

Regional extension centers Workforce training Medicare & Medicaid Incentives and penalties State grants for health Information exchange Standards & certification framework Privacy & Security framework Adoption of EHRs Meaningful Use of EHRs Exchange of health information Improved individual and population health outcomes Increased transparency and efficiency Improved ability to study and improve care delivery Research to enhance HIT Blumenthal D. Launching HITECH. N Engl J Med Jan 4. HITECH Act Programs Now Launched

What is the vision we are driving towards? Health IT enables proactive care delivery for individuals and populations Health IT enables better decisions at the point of care that is responsive to patient’s medical history Health care delivery is more integrated across all points of service Patients are more engaged in their health care delivery

Some additional levers of support it Health Plans Health Systems “Top Doctors” US News and World Report Medical Schools Federation of State Medical Boards American Board of Medical Specialties Medical Liability Carriers

HITECH a great start, but many challenges to implementation. –Getting definition of future stages of meaningful use right: Stretch, but don’t break. –Getting regional centers up and running –Assuring infrastructure for exchange –Training necessary workforce –Sustaining economic incentives for adoption and Meaningful Use Role of overall health reform. HITECH Act – Remaining Challenges

HITECH a great start, but many risks as well –Major privacy and security breach –Implementation risk –Managing expectations of both providers and patients HITECH Act – Risks

Technology Adoption WILL THE STETHOSCOPE EVER COME INTO GENERAL USE IN CLINICAL MEDICINE? A STRONGLY NEGATIVE VIEW EXPRESSED IN 1821 Office of the National Coordinator for Health Information Technology

QUESTION & ANSWER Office of the National Coordinator for Health Information Technology 23

We need your participation in reforming health care delivery