1. Innovation in HIT --- Health Information Technology Californias Untapped Health Care Asset Jack Lewin MD CEO, California Medical Association CCST Meeting-----UC Irvine October 2005

2. Ironies

3. Health Information Technology---Its Time Has Come: Practice Management Practice Management Patient and Personal Records Patient and Personal Records Quality of Care Quality of Care

4. Some Physicians Are More Able to Participate in the Quality Agenda Than Others

5. Distribution of Physicians by Practice Arrangement US Market, 1984-2001 Employees* Self-Employed Group Self-Employed Solo Percent * Employees include group, hospital, medical school, government, health plan and ambulatory physician employees. 43% 28% 40% 37% 23% Sources: AMA Physician Masterfile, 2003, AMA Physician Socioeconomic Statistics, 2003; Aventis Pharmaceuticals, 2003

6. Are Consumers Really Interested in Quality of Care?

7. YES* * But, What is Quality?

8. Consumerism: Consumerism: Short-term Health Trend, or the Future?

9. Consumer-Driven Healthcare Trends Changes in the health insurance market Changes in the health insurance market Changes in who pays for healthcare Changes in who pays for healthcare Likely market influence of HDHPs/HSAs Likely market influence of HDHPs/HSAs Future physician demographics and solo practice Future physician demographics and solo practice Influence of purchasing collaboratives Influence of purchasing collaboratives Consumerism and quality Consumerism and quality

10. Problem? How Real is the Quality Problem?

11. Percent Fee-for-Service Beneficiaries Total Fee-for Service Spending Distribution of Fee-for-Service Medicare Spending Among Beneficiaries, 1997 Source: Congressional Budget Office

12. Percent of Americans Saying I Have A Chronic Condition Percent of Americans Saying I Have A Chronic Condition Source: Chronic Illness and Caregiving Survey, Harris 2000

13. RAND Study: Quality of Health Care Often Not Optimal Doctors provide appropriate health care only about half the time Percentage of time Alcohol dependence Hip fracture Peptic ulcer Diabetes Low back pain Prenatal care Breast cancer Cataracts 11% 23% 33% 45% 69% 73% 76% 79% E. McGlynn, S. Asch, J. Adams, et al., The Quality of Health Care Delivered to Adults in the United States, N Engl J Med, 2003

14. Lapp & acute;, J. M. et. al. Ann Intern Med 2004;141:446-453 Proportions of patients receiving the appropriate discharge prescriptions Measurement-Based QI Can Make a Difference Intermountain Health Care QI effort on CVD Results: 90% prescription rates 27% decrease in unadjusted absolute death rates

15. How Will Costs of Care Interact with Quality?

16. The Future: Increasing Value Competition at the level of the individual patient care and disease Competition at the level of the individual patient care and disease Plans and doctors distinguished by quality outcomes Plans and doctors distinguished by quality outcomes Potential of Risk-Adjusted Premiums Potential of Risk-Adjusted Premiums Real consumer choice information Real consumer choice information Transparency Transparency The Need for HIT Systems!!! The Need for HIT Systems!!!

17. How has practice changed?

18. Health Information Technology, Quality, and Reimbursement Are Interactive Issues EHRs PMRs PMRs New practice management systems, CPOE, e-Rx etc. New practice management systems, CPOE, e-Rx etc. Democratized interoperability and connectivity Democratized interoperability and connectivity The Physicians Foundations! The Physicians Foundations!

19. Its the Pipeline, Stupid! Actually, Its the Pipeline, Stupid!

20. The Patient Safety Institute (PSI) Improve patient safety, by making the following available: Patient-Specific Clinical Data AtPointOfCare Physicians Treating Patients at Any Location AMR, Rx, Lab AMR, Rx, Lab HIS Systems CDR LIS HIS Systems CDR LIS Physician-Specific Preferred Wired and Wireless Devices Palm Pilot Windows CE / Pocket PC RIIM Browser Physician-Specific Preferred Wired and Wireless Devices Palm Pilot Windows CE / Pocket PC RIIM Browser Acute Care Data Ambulatory Data Acute Care Data Clinics & Physician Organizations Integrated Delivery Networks, Community Hospitals and Medical Centers Ambulatory Data Reference Laboratories Rx Pharmacies

21. PSI – The Network Hospital 2 Hospital 1 Clinic B Clinic A PSI Hub Physician Patient

22. PSI – Response to Physician Hospital 2 Hospital 1 Clinic B Clinic A PSI Hub 3 3 Physician Patient

23. The Current State of Physicians, Hospitals, and Health Care Lack of Technically Trained Staff Lack of Technically Trained Staff Lack of Good Info on Best Systems Lack of Good Info on Best Systems Angry About Disappointing Investments Angry About Disappointing Investments Costs Out of Reach Costs Out of Reach Practice Workflows Antiquated Practice Workflows Antiquated Dead Ends Dead Ends Isolation vs. Interoperability Isolation vs. Interoperability

24. Who Gets The ROI for H.I.T Investment in Health Care?

25. The Holy Grail

26. Opportunities for California CMS/CBO estimates $81 B national savings if HIT solutions were realized- --$8B here CMS/CBO estimates $81 B national savings if HIT solutions were realized- --$8B here Twice that would be saved ($16 B in CA) in related care improvements Twice that would be saved ($16 B in CA) in related care improvements The Medi-Cal program could be a major beneficiary The Medi-Cal program could be a major beneficiary Approaching the Tipping Point Approaching the Tipping Point

27. This is Californias Legacy