Health IT: Meaningful Transitions David R. Hunt, MD, FACS Chief Medical Officer and Acting Director, OHITA Office of the National Coordinator for HIT

tran·si´tion n. [L. transitio a pasing over] 1.a passing from one condition, form, stage, activity, place, etc. to another 2.the period when this occurs 3.a word, phrase, sentence or group of sentences that relates a preceding topic with a succeeding one.

Medicine used to be simple, ineffective and relatively safe. Now it is complex, effective and potentially dangerous. The role and education of doctors in the delivery of healthcare. Hollister Lecture delivered at the Institute of Health Services Research, Northwestern University, Illinois, USA. October Lancet 1999;353:1178–81. Sir Cyril Chantler

4 Take Home Messages Meaningful change must be led by clinicians Meaningful success is wholly dependent on partnership Transition requires a system, resources, and courage

5 Time Energy B A + AB Energy of Activation for a Reaction (E a ) E a without catalyst E a with catalyst Energy Released by Reaction

6 Time Energy + Energy of Activation for a Reaction (E a ) Without Recovery Act With Recovery Act Efficiency and Quality Care Paye r

7 Small Practices (<5 docs) 42% 21% 37% Medium Practices (> 6-10 docs) Large Practices (> 11 docs) EHR Adoption by Practice Size DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care — A National Survey of Physicians N Engl J Med July 2008;359: % Physicians* Percentage of physicians With notes, Rx orders, & ability to order and obtain lab results

8 Change is Underway: Drivers of Health IT Adoption Industry Leadership Rising Health Care Costs Political Leadership Declining Efficiency Drivers of Health Information Technology Clinical Leadership

9 This Act may be cited as the “ American Recovery and Reinvestment Act of 2009 ”.

(1) ensures that each patient's health information is secure … (2) improves health care quality, reduces medical errors, reduces health disparities… (3) reduces health care costs … (4) provides appropriate information… (5) ensures the inclusion of meaningful public input… (6) improves the coordination of care… (7) improves public health activities… (8) facilitates health and clinical research and health care quality ;…” Section 3001: The National Coordinator shall develop infrastructure that …

improve, ensure, reduce, protect, facilitate, promote, improve… (9) promotes early detection, prevention, and management of chronic diseases; (10) promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved outcomes in health care services; and (11) improves efforts to reduce health disparities. Cont’d…

12 Capacity to select contract, install, implement Transition productivity loss Concerns about system obsolescence Finding an EHR to meet needs Uncertainty of return on investment (ROI) Amount of capital needed Major Barriers to Adoption of Electronic Health Records DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care — A National Survey of Physicians N Engl J Med July 2008;359:50-60.

“And I realize today that if your vision is your vision, that and a quarter gets you a cup of coffee. But if you can make your vision your customer's vision, then you have a business.” Washington Post January 9, 2002 Michael Saylor, CEO Microstrategy

14 Maslow's Hierarchy of Needs Maslow, Abraham (1954). Motivation and Personality.New York:. Harper. p. 236

15 Health IT Hierarchy of Implementation

16 Capacity to select contract, install, implement Transition productivity loss Concerns about system obsolescence Finding an EHR to meet needs Uncertainty of return on investment (ROI) Amount of capital needed Major Barriers to Adoption of Electronic Health Records DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care — A National Survey of Physicians N Engl J Med July 2008;359:50-60.

“…reckoning that all such matters should be kept secret…” Privacy Hippocrates

18 Principles, Policies, Procedures, Protections Privacy

Iago: Who steals my purse steals trash; ’t is something, nothing; ’T was mine, ’t is his, and has been slave to thousands; But he that filches from me my good name… …And makes me poor indeed. Othello. Act iii. Sc. 3

20 54% Finding an EHR to meet needs 44% Concerns of obsolescence 39% Capacity to implement SEC HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION ASSISTANCE. (a)Health Information Technology Extension Program- To assist health care providers to adopt, implement, and effectively use certified EHR technology that allows for the electronic exchange and use of health information… (c) Health Information Technology Regional Extension Centers- (1) IN GENERAL- The Secretary shall provide assistance for the creation and support of regional centers (in this subsection referred to as `regional centers') to provide technical assistance and disseminate best practices and other information learned from the 41% Transition productivity loss

21 54% Finding an EHR to meet needs 44% Concerns of obsolescence 39% Capacity to implement SEC INFORMATION TECHNOLOGY PROFESSIONALS IN HEALTH CARE. (a) In General- The Secretary, … shall provide assistance to institutions of higher education (or consortia thereof) to establish or expand medical health informatics education programs, including certification, undergraduate, and masters degree programs, for both health care and information technology students to ensure the rapid and effective utilization and development of health information technologies (in the United States health care infrastructure). 41% Transition productivity loss

22 “No one would remember the Good Samaritan if he only had good intentions. He had money as well.” Margaret Thatcher

23 66% Amount of capital needed 50% Uncertainty of ROI SEC INCENTIVES FOR ELIGIBLE PROFESSIONALS. (a) INCENTIVE PAYMENTS.—Section 1848 of the Social Security Act (42 U.S.C. 1395w–4) is amended … (o) INCENTIVES FOR ADOPTION AND MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY.— (i)… with respect to covered professional services furnished by an eligible professional during a payment year (as defined in subparagraph (E)), if the eligible professional is a meaningful EHR user

24 (a) (2) (A) (i) MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY- The eligible professional demonstrates to the satisfaction of the Secretary, in accordance with subparagraph (C)(i), that during such period the professional is using certified EHR technology in a meaningful manner, which shall include the use of electronic prescribing as determined to be appropriate by the Secretary SEC INCENTIVES FOR ELIGIBLE PROFESSIONALS 66% Amount of capital needed 50% Uncertainty of ROI

25 (a) (2) (A) (ii) INFORMATION EXCHANGE- The eligible professional demonstrates to the satisfaction of the Secretary, … the electronic exchange of health information to improve the quality of health care, such as promoting care coordination. 66% Amount of capital needed 50% Uncertainty of ROI Value, Education, Outreach SEC INCENTIVES FOR ELIGIBLE PROFESSIONALS Health Informati on Exchang e

26 (a) (2) (A) (iii) REPORTING ON MEASURES USING EHR- … in a form and manner specified by the Secretary, on such clinical quality measures and such other measures as selected by the Secretary … 66% Amount of capital needed 50% Uncertainty of ROI Value, Education, Outreach SEC INCENTIVES FOR ELIGIBLE PROFESSIONALS Health Informati on Exchang e

27 P. Breughel, the Elder, “Turmbau zu Babel,” 1563 Kunsthistorisches Museum, Vienna Tower of Babel

May you find what you are looking for May you come to the attention of those in authority May you live in interesting times _________ Proverb, Parable, Allegory, or News?