HEALTH INFORMATION TECHNOLOGY: TALES FROM THE TIPPING POINT

Transcription

1 THREE TALES: THE HYPE, HELP, AND HOPE HEALTH INFORMATION TECHNOLOGY: TALES FROM THE TIPPING POINT Leslie Lenert MD, MS, FACMI Associate Chair for Ambulatory Care, Department of Medicine Professor of Medicine and Biomedical Informatics WHAT IS A TIPPING POINT? TIPPING POINT: HOW INNOVATION DISSEMINATES DIFFUSION OF EMR/EHRS WHAT IS A BASIC EMR/EHR 1

2 UTAH LEADS THE USA IN EHR ADOPTION THE HYPE Utah: Upgrading basic EHRs to fully functional EHRs THE HYPE ON GOVERNMENT EHR ADOPTION HITECH ACT: CARROT AND A STICK WORDL of Meaningful Use Final Rule EHR adoption program: To be eligible for incentives totaling (over 5 years) $44,000 for Medicare providers and $63,000 for Medicaid providers To avoid penalties starting in 2015 of 1% of Medicare billings that can increase to as much as 5% of billings at the discretion of the Secretary of HHS. Providers must practice using certified EHR technology in a meaningful manner, which shall include e-prescribing, as determined by the Secretary is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care...and submits information on such clinical quality measures and other measures as selected by the Secretary (1) MEANINGFUL USE PROGRAM REALITY IS COMPLEX 2

3 MU STAGE 1 REQUIREMENTS (WAIT THERE IS MORE): MU STAGE 1 REQUIREMENTS ACTUAL REGULATIONS 276 PAGES MU IMPLEMENTATION ASSISTANCE WORK INVOLVED IN A MU STAGE CYCLE EHR ENHANCEMENT ATTESTATION ADOPTION MEASUREMENT FULL INCENTIVE PROGRAM PROCESS PROGRESS SO FAR WITH MU EHR ENHANCEMENT EHR ENHANCEMENT EHR ENHANCEMENT ATTESTATION ADOPTION ATTESTATION ADOPTION ATTESTATION ADOPTION MEASUREMENT MEASUREMENT MEASUREMENT STAGE 1 STAGE 2 STAGE

4 A CAUTION TO OFFICE OF THE NATIONAL COORDINATOR HELP: GRAND CONVERGENCE Convergence for Systems of Care Financial incentives HITECH PPACA ACO and other bundled payment initiatives New models for medical practice Medical home ECHO Technological Teleheath maturity APP store computing Cloud computing Resurgence of AI in Medicine and NLP FINANCIAL INCENTIVES: BUNDLING WHAT IS AN ACCOUNTABLE CARE ORGANIZATION (ACO)? An ACO is an organization that can take responsibility and share financial risk for a complete episode of care NEW MEDICAL MODELS MEDICAL HOME MODEL Personal Physician Payment Reform (pay for episode of care, for coordination of care) Physician Directed Care (practice team led by physician) Enhanced Access ( , extend hours, decision aids) Quality and Safety (evidence based medicine perspective, use of IT to facilitate quality and assessment of quality) Whole Person Orientation Integration (bring together all services needed to address a medical issue) 24 4

5 PRIMARY CARE AS A SYSTEM ADVANCED IT INFRASTRUCTURE Okay. I have minute visits that I have to accomplish before I can go home tonight. The primary care physician will walk into the office and say, With my team, I am going to spend my day trying to make my panel of patients as healthy as possible. This is the panel of patients, these are the people who are overdue for mammograms, for Pap smears, for immunizations. These are the people on my panel with diabetes, whose hemoglobin A1c s are too high or who haven t had a hemoglobin A1c in the past year. We are going to contact these people. We are going to bring them in for the lab tests they need. And if they are out of control with regard to their chronic disease, they re going to meet with a nurse who has a physicianwritten protocol as to how to increase their medications to get their sugars back under control. vz1 Thomas Bodenheimerger 25 Can t do medical homes without advanced IT services. ECHO EXTENSION FOR COMMUNITY HEALTH OUTCOMES (ECHO) MODEL OUTCOMES EQUAL OR BETTER THAN SUBSPECIALIST CARE Activities Protocol based care Delivered by rural physicians who become local experts Education and support from interdisciplinary teams based in an academic medical 5

6 Slide 25 vz1 May add medication adherence component here Vivienne Zhu, 2/4/2010

7 TECHNOLOGY AVAILABLE TODAY HEALTH INFORMATION EXCHANGE IS HERE TODAY CLOUD COMPUTING EHR AND MORE INTEGRATED SYSTEMS: HEALTH BUDDY HOME MONITOR POPULAT ION MONITO RING HEALTH BUDDY PROTOCOLS 6

8 VA NATIONAL EXPERIENCE Cost: 1600/pt/year PANEL MANAGEMENT: INDIGO FROM ARCHIMEDES Panel management software--prioritization Looks across diagnosis and disease management areas Prioritizes interventions based on risk reduction or other criteria Individualized estimates of benefit Ranks patients in terms of expected benefit CONTACT RESOURCE MANAGEMENT (CRM) TOOLS IPHONE 4 REMOTE HEALTH Microsoft CRM tools adapted for tracking communications with patients with diabetes Facebook and twitter links to publish BP readings to friends and family results to providers MEDICATION ADHERENCE MedSmart Remind and dispense medications Programmable up to 6 reminder alarms per day Event Notification and reporting to multiple caregivers THE HOPE: FUTURE TECHNOLOGIES THAT WILL CHANGE MEDICINE Research Areas Effectiveness Intelligent Context-Aware Reminding Location of user & dispenser Activity of user Importance of drug about $

9 IPHONE LIKE EHRS AN INSIGHT INTO PROBLEMS WITH EHR AND HEALTH INFORMATION EXCHANGE EHR s built of apps that you chose that do what you want. app1 app2 app3 api Common data model RESULT: A CALL FOR A NEW ARCHITECTURE FOR HEALTH EXCHANGE NEW SENSORS AND TELEMEDICINE DEVICES Addresses fundamental issues for privacy, security, and scalability of EHRs and Nationwide Health Information Network CROWD SOURCING HEALTH ASTHMAPOLIS DR. WATSON DISCOSURE: I am a consultant for IBM Sprioscout 8

10 BACK TO THE FUTURE: ILIAD, INTERNIST-1 DEEP Q & A WATSON IN THE EXAM ROOM CONCLUDING REMARKS: I In a complex health system, you have an enormous number of independent actors, especially in a system like ours... Physicians and health care professionals have to be part of the process every step of the way. You need to make this a collaborative effort, not a top-down procurement project. David Blumenthal on the failure of the NHS EHR System Whatever you are doing in health IT has to work for you TIPPING POINT: WHAT S YOUR ROLE? 9