2. Meaningful Connections: Patient Centered Medical Home and Health IT David Nace, MD, VP, Chief Medical Officer, McKesson and Company; Chair, Center for eHealth Information Adoption and Exchange (CeHIA) Ted Epperly, MD, Program Director & CEO, Family Medicine Residency of Idaho, President, AAFP (Moderator)

3. Health care Industry – Environmental Factors –82% of Americans feel fundamental change is needed. –Evidence is produced at an astonishing rate, but not effectively put into practice. –“System” of care is fragmented, uncoordinated and inefficient. –Primary care continues to be marginalized and threatened.

4. Current Administration Coverage for All Payment Reform Align incentives Pay for Value Strengthen Primary Care Health Information Technology Tools to Rebuild and Restructure Health Care

5. Stimulus Plan Overview Health care provisions in the stimulus bill ￭ Additional funding for state Medicaid programs ￭ Prevents additional state restrictions on Medicaid coverage Medicaid $90 B Health Insurance $25 B ￭ Extension of COBRA as gap coverage for early retirees Health IT $21 B ￭ Funding for health connectivity initiatives ￭ Incentives for physicians and hospitals to adopt EHRs ONCHIT $2 B ￭ New entities to establish standards, HIT policy and certify ￭ New (and more restrictive) privacy provisions NIH $10 B ￭ Additional funding for scientific research grants Other HHS $10 B ￭ Comparative effectiveness, wellness and prevention initiatives ￭ Grants, loans and training programs “HITECH” Act

6. Meaningful Use: Meaningful Connections Identifies health IT as a “critical platform” of the PCMH. (Re) Conceptualizes health IT as an e-platform and set of tools. Health IT functional priorities to support a PCMH. Critical capabilities to engage consumers with health IT. Explores the current use of health IT by primary care physicians.

7. Health IT Capabilities and Functionalities to Support a PCMH “One Size (Does Not) Fit All” Exchange Ability to collect, store, exchange and manage relevant PHI. Ensure that relevant health information is accessible at the point of care (anytime, anywhere). Enable Enable decision support for evidence-based treatments and tests. Participate Facilitate consumer access, education, empowerment, and participation tools for decision-making related to their health and medical condition. Measure Ability to measure and report on processes of care. Collaborate Ability for team members to communicate among themselves. Team member access to information during the process of care and care delivery.

8. Health IT Capabilities and Functionalities to Support “Meaningful Connections” What do we mean by “Meaningful Use” –Demonstrable management and e-exchange of health information that results in improved quality of care. Value of the “Connected Medical Home” –Supports participatory medicine, reduces costs, improves outcomes and closes the “collaboration gap.” Relevant health data must be accessible to patients, clinicians, and caregivers. Data portability and interoperability are essential. Engaging the patient as an active participant is critical.

9. Importance of a Consumer Focus Closing the Collaboration Gap- -Creating Real Time Collaboration Patients forget 40-80% of information upon leaving the clinician’s office. 75% of patients want on- line services now, but less than 5% have this capability. 55% of patients want to connect with clinicians via email.

10. The Connected Medical Home Importance of a Consumer Focus Improved patient/clinician communications Access to personal health information Education, self- care, empowerment, decision support Prescription refills, lab results, etc. Scheduling appointments

11. “Boots-on-the-Ground” Case Examples What We Learned Current status –Clinician to clinician communication is more established than clinician to patient communication. –There is a wide spectrum of health IT adoption. Compelling quotes –“HIT is the tool, not the answer.” –“Using HIT without rethinking patient flow and physician workflow is a waste.” HIT adoption is leading to: –Better care coordination (team work) –Better quality reporting with measureable results Implementation is expensive but can result in: –Fewer patient calls –Increased satisfaction of patients and physicians –Increased adoption of best practices and preventive care –Higher quality and improved outcomes

12. The PCPCC Center for eHealth Information Adoption and Exchange (CeHIA) - An Open Invitation Mission: “To evaluate the use and application of health information technology to support and enable its development and broad adoption to support the patient centered medical home.” Release and distribute “Meaningful Connections” report Bring clarity and specificity to the term “Meaningful Use” Launch a participatory engagement strategy Develop and sustain a PCMH Health IT Resource Center 2009

13. PCPCC CeHIA Leadership and Call Schedule David Nace, MD, VP, Chief Medical Officer, McKesson and Company (Co-Chair) Janet Marchibroda, MBA, Chief Healthcare Officer, IBM (Co-Chair) James Crawford, MD, PhD, SVP, Laboratory Services, North Shore- Long Island Jewish Health System (Co-Chair) Chris Nohrden, MPH, Executive Director Calls Bi-Weekly - Thursday, 1 PM EST - 2nd and 4th Thursday of the Month Schedule: 5/14, 5/28, 6/11, 6/25, 7/9, 7/23, (No August Calls), 9/10, 9/24, 10/8, 10/22, 11/12, 12/10 Call in number (712)432-3900, Code 471334#