eHI Blueprint for Change HealthTechNet November 16, 2007 Page 1 Transforming Care Delivery at the Point of Care: Barriers and Solutions Christine Bechtel Vice President, Public Policy and Government Relations eHealth Initiative

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 2 Who we are… Our Mission: Driving improvements in the quality, safety, and efficiency of healthcare through information and information technology eHI Members include: clinicians, consumer groups, employers and healthcare purchasers, health plans, health information technology (HIT) suppliers, hospitals and other providers, laboratories, pharmaceutical and medical device manufacturers, pharmacies, public health agencies, quality improvement organizations, standards groups, and state, regional and community-based organizations

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 3 What we do…  Develop, disseminate and advocate for multi-stakeholder consensus  Monitor, analyze and influence the policy environment  Develop and disseminate tools and resources  Provide hands on technical assistance  Launch learning laboratories

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 4 HIT Adoption  Adoption rates relatively low  Overall 5%-39% with full or partial EHR, depending on study 5% functional EHR** 14% minimally functional EHR** –Hospitals: 24% with CPOE  Adoption of HIT that includes all critical functions is highly variable. **Source: Preliminary data from MGH Institute for Health Policy, GWU and RTI, Nov. 2007

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 5 Minimally Functional EHR: Defined  Clinical notes  Computerized orders for –Prescriptions –Labs –Radiology  Viewing Results for –Imaging –Labs Source: Preliminary data from MGH Institute for Health Policy, GWU and RTI, Nov. 2007

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 6 Functional EHR: Defined  Clinical notes  Computerized orders for –Prescriptions –Labs –Radiology  Viewing Results for –Imaging –Labs  Patient demographic data  Patient problem lists  Patient Rx lists  Notes include medical history, follow up  Orders sent electronically for Rx, labs and radiology  Elec. Images returned  Alerts for interactions, etc  Out of range lab levels highlighted  Reminders for guideline based interventions Source: Preliminary data from MGH Institute for Health Policy, GWU and RTI, Nov. 2007

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 7 EHR Adoption Rates Source: Preliminary data from MGH Institute for Health Policy, GWU and RTI, Nov. 2007

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 8 Barriers to EHR Adoption and Use  Lack of a sustainable business model –Unclear ROI, lack of capital  Concerns about the privacy and security aspects of this –Patients and Providers  Concerns about liability –What do I do with all this data?  Lack of demand –From patients, providers and payors

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 9 Barriers to EHR Adoption and Use  System selection  Workflow change, loss of productivity  Physician resistance

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 10 Physician Views of Barriers

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 11 Driving Transformation  Under current conditions, widespread adoption in physician practices by 2024 (Ford et al, JAMIA, January 06) –Small practices largest challenge; deliver 60% of care  Changing the trajectory requires: –Aligning incentives to support a business case –Engaging Consumers –Creating interoperable standards –Supporting development of HIE –Privacy and Security Policies –Supporting physician adoption, esp. among small practices

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 12 Federal Activities Offer Building Blocks  Office of the National Coordinator  Standards Harmonization (HITSP)  Standards Certification (CCHIT)  Development and Testing of NHIN Prototypes (NHIN Prototypes) – New Awards Just Announced  Addressing Privacy and Security: The Health Information Privacy and Security Collaboration (HISPC)  AHIC Now Transitioning to the Private Sector  Secretary’s Value-Driven Healthcare Initiative  CMS Demonstrations  Funding by Other Agencies: AHRQ, HRSA, etc

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 13 National Private Sector Activities Serve as Building Blocks  Purchasers and Health Plans Beginning to Consolidate Expectations (in sync with Four Cornerstones); AQA, QASC, Employer Toolkit released in Feb 2007  Incentives Initiatives Getting Traction: Bridges to Excellence (18 markets) and IHA – focus on quality improvement, performance measurement and use of health IT  Consumer Facing Applications Rolling Out: Microsoft, Dossia, Google, RevolutionHealth, AHIP and BCBSA, rolling out as we speak, as market leaders such as WebMD continue to increase penetration

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 14 State-Level Policy Activity  In 2007 so far, 208 bills have been introduced across 50 states that refer to the adoption or implementation of health IT, nineteen of which have been signed into law in sixteen different states.  To date, 20 executive orders have been issued by governors in 15 states, which are designed to drive improvements in health and healthcare through the use of IT--eight executive orders in 2007 alone

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 15 Highlights From Our Survey of State, Regional and Local Efforts  2006 survey indicated 165 state and regional initiatives operating in 49 states, D.C. and Puerto Rico.  Most difficult challenge: sustainable business model  Payment system has great impact but there are near-term opportunities for sustainability  Criteria for success: building social capital, good business acumen and execution

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 16 Regional Approaches to Improving Health Care “In the absence of substantial national health care reform, regional quality improvement efforts appear to offer the best hope for transforming American healthcare.” Dr. Ed Wagner, MacColl Institute

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 17 With all of this activity, what do we do? Where do we begin?

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 18 eHealth Initiative Blueprint?  A plan for action at the national, state and local levels that represents consensus among multiple stakeholders in healthcare on –shared vision, set of principles, strategies and specific actions (including timelines) –for improving health and healthcare through information and information technology.

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 19 eHI Blueprint  A guide to enhancing healthcare improvement strategies through use of health IT and health information exchange.  Key elements: –Role of Health IT in addressing healthcare challenges –Shared Vision –Consensus principles, strategies and actions in 5 areas –Overview of current initiatives –Key resources

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 20 Our Shared Vision  High-performing healthcare system where: –All those engaged in the care of the patient are linked together in secure and interoperable environments, –The decentralized flow of clinical health information directly enables the most comprehensive, patient- centered, safe, efficient, effective, timely and equitable delivery of care [1] Where and when it is needed most – at the point of care. [1][1] Institute of Medicine, 2001.

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 21 Our Shared Vision  Financial and other incentives are aligned to directly support and accelerate all of the key elements of transformation – –engaging consumers –transforming care delivery –improving population health  in a secure, private, and trusted environment

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 22 Process  More than 100 stakeholders participated directly in development – hands-on approach  More than 200 organizations participated in a broad variety of ways  Senior Staff and Outside Experts  36 committee meetings between April – September

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 23 Transforming Care Delivery at the Point of Care

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 24 Transforming Care Delivery Shared Vision  Patient care is high quality, patient-centered, for a lifetime, and reflects a coordinated and collaborative approach.  Complete, timely and relevant patient-focused information and clinical decision support tools are available at the point of care –as part of the provider’s workflow  High quality and efficient patient care is supported by interoperable health IT and secure data exchange across all relevant stakeholders.

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 25 Overarching Strategies  Move Providers to Adopt Health IT Systems: –Getting Providers to Make the Decision  Supporting Adoption and Effective Use: –Providers Have Made the Decision to Adopt HIT, What Do They Do Now?  Transforming Care Delivery Through HIT and HIE: –Providers have implemented the system, how do they transform care?

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 26 Caveats  HIT not the goal; improved quality is  HIT as essential enabling infrastructure  Driving quality vs. HIT adoption –First two broad categories focus on infrastructure development –Third broad category focuses on transformation

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 27 Strategies for Transformation 1.Research what motivates providers to purchase health information technology,  as well as best practices for how health information exchange networks can play a role in HIT adoption. 2.Educate and motivate providers to adopt health information technology and use it effectively. 3.Educate providers about currently available incentives and financing options. 4.Monitor and report on adoption rates.

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 28 Strategies 5. Improve and expand incentives and financing options. 6. Provide education, tools and support, tailored to provider size and specialty, to help providers select and implement health information technology and use it effectively. 7.Ensure interoperability between and across all relevant stakeholders through common standards.

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 29 Strategies 8. Enable providers to collect electronic data at all points of care as part of the normal workflow, and to use health information for multiple purposes, including quality improvement, care management, billing, decision support, performance measurement, research, and initiatives to reduce health disparities and improve the health of the general population. 9. Establish and use quality measures and decision support tools. 10. Use and exchange digital health information to transform care at the point of care, in a team environment and across settings.

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 30 Example Actions

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 31 Key Take-Aways  Driving healthcare change will require aligning efforts around: –Engaging consumers –Transforming care delivery –Improving population health –Aligning incentives  With the foundational underpinnings of health IT, –while assuring privacy and security

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 32 Key Take-Aways  Will require finding common ground and building social capital across all the stakeholders in the healthcare system  Requires focus at multiple levels: national, state and local  It’s in the intersections that we will accelerate progress

eHI Blueprint for Change HealthTechNet November 16, 2007 Page 33 Questions and Feedback  Search the Blueprint Online: –  Christine Bechtel, Vice President of Public Policy and Government Relations –