Overview of Strategic Actions to Drive HIT Adoption

Transcription

1 Overview of Strategic Actions to Drive HIT Adoption Kelly Cronin Senior Advisor Office of the National Coordinator for Health Information Technology March 2005

2 Overview Background Critical barriers and challenges Strategic Framework for Action Realizing the Vision 2

3 Health Care Costs and IT-enabled Productivity Gains Annual Expenditure (billions) $5,000 $4,000 $3,000 $2,000 $1,000 $0 National Health Expenditure trend 1.5% Annual Improvement (like retail) 4% Annual Improvement (like telecom) Short-term Health information Technology benefits preventable inpatient deaths per day >5,000 preventable ambulatory errors per day Up to $360 billion avoidable costs per year Source: 3

4 Health Information Technology Diffusion Percent Adoption Complex Networked Technology Ambulatory Electronic Health Record Inpatient Electronic Health Record Source: RAND Corporation 4

5 The Vision Medical information follows the consumer so they are at the center of their care Consumers choose physicians and hospitals based on clinical performance results Clinicians have complete patient history, computerized ordering and electronic reminders Quality initiatives measure performance and drive quality-based competition Public health and bioterrorism surveillance are seamlessly integrated into care Clinical research is accelerated and post-marketing surveillance of medical products expanded 5

6 April 27, 2004 Executive Order (13335) The National Coordinator will: Direct HHS health IT programs; Coordinate HHS health IT programs with those of other relevant Executive Branch agencies; Coordinate outreach and consultation by Executive Branch agencies with public and private parties; Develop, maintain, and implement a strategic plan for widespread health information technology adoption; and Work with OMB to plan and manage health information technology spending. 6

7 Market Failure Barriers and Challenges Payers (including Medicare) don t reward efficiency or quality Negative business case for typical health IT adopter Significant EHR adoption gap based on organization size Market failure from negative network externalities First mover disadvantage for health IT buyers Short-term losses from adoption of standards High failure risk for business reengineering Failure rate for EHR implementation exceeds 30% Variable availability of expertise Limited capacity for interoperability Standards are not rigorous and lag behind commercialization No viable health information exchange infrastructure 7

8 July 22, 2004 Strategic Framework Goal 1: Inform Clinical Practice Incentivize Electronic Health Record (EHR) adoption Reduce risk of EHR investment Promote EHR diffusion in rural and underserved areas Goal 2: Interconnect Clinicians Foster regional collaborations Develop a national health information network Coordinate federal health information systems Goal 3: Personalize Care Encourage use of Personal Health Records (PHR) Enhance informed consumer choice Promote use of tele-health systems Goal 4: Improve Population Health Unify public health surveillance architectures Streamline quality and health status monitoring Accelerate research and dissemination of evidence into practice 8

9 Federal Policy Solutions: Three Building Block Strategies Regional Health Information Organizations State or local entities to oversee and support regional health information exchange Multi-stakeholder governance with public health and quality improvement role Support of local EHR implementation in addition to technical assessment for NHIN deployment National Health Information Network A nation-wide utility that allows secure and seamless health information exchange Certification of EHR compliance with minimal standards set by the private sector Used by federal agencies to support data collection and health information exchange Electronic Health Record Adoption Strategy Reduce loss and risk for physicians investing in EHRs Implementation support for primary care physicians that leverage specialist and hospital adoption Incentives through Medicare, consolidate purchasing power, and clarify hospitalphysician affiliations 9

10 Electronic Health Record Adoption Strategy Pay-for-use directly linked to forthcoming payfor-performance Roles: Reduce loss to physicians when investing in EHRs and reduce implementation risk Support targeted at primary care physicians to leverage specialist and hospital adoption New Initiatives and Policy changes: Broadening of Stark exception for hospital investment in physician EHR Coordinate incentives on a regional level in implementation of MMA 649 pay-for-performance demonstration program 10

11 Electronic Health Record Adoption Strategy National Group for the Advancement of HIT July Statement outlined the need for public and private sector purchasers and payers, in cooperation with ONCHIT, to design a framework to advance adoption New proposal drafted to provide guidelines for coordination of incentives on a regional level Regional Initiatives, designed to incentivize adoption of HIT to improve quality performance should set a target for a combined incentive ($10,000 per participating Clinician) Target a minimum participation among payers and purchasers that represents a combined 50% market share Reach at least 30% of a clinician s patient panel through some combination of the participating payers and purchasers 11

12 Reduce Risk of EHR Investment Clinicians who purchase EHRs will want assurances that these systems will have the capabilities to meet the EHR benefits promised. A private sector Certification Commission for HIT ( has been formed HHS will link all federal financing of EHRs to certification CCHIT has 4 work groups: functionality, interoperability, security, process 12

13 Regional Health Information Organizations (RHIOs) State or local entities to oversee and support regional health information exchange Multi-stakeholder governance with public health and quality improvement role What will a RHIO do? Oversee business policies for data sharing Support physician office implementation of EHRs Every American should be covered by a RHIO that will support information exchange on their behalf 13

14 National Health Information Network A nation-wide utility that allows secure and seamless health information exchange Capitalized by public and private investment and operated by private organizations What will NHIN do? Connect clinicians to allowable data about their patients Allow federal agencies to collect and share data for public health surveillance, research, and payment administration Policy options: Federal recognition of Product Certification Commission Determine role of government in oversight of NHIN 14

15 Health Care Industry Response More than 400 articles and stories written about Administration s plan since April, 2004 More than 2,000 people attended Secretarial HIT Summit to vet Strategic Framework More than 200 organizations, working groups and conferences have endorsed Strategic Framework Thousands of private sector inquiries about new National Coordinator office Widespread vendor and association reports of increased EHR inquiries and sales More than 600 participants involved in briefing about interoperability plan last month 15

16 Commercial Industry Response HIT Leadership Panel, consisting of 9 CEOs of Fortune 100 firms Observations: Widespread adoption of health information technology should be a top priority for the U.S. health care system The federal government should use its leverage as a health care purchaser and payer to drive HIT adoption Private industry and health care organizations should take actions to drive adoption with the federal government Policy discussion planned with Business Round Table and the National Business Group on Health 16

17 Realizing the Vision 17

18 Three Phases of Implementation Robust performance competition -Consumer choice -Surveillance -Quality/health status monitoring Enhanced clinician operating capacity -EHR adoption -Rural diffusion -Accelerate research -PHRs Functional market institutions -Reduce EHR risk -Foster Regional Health Information Organizations -Build a National Health Information network -Develop national quality measures

19 Office of the National Coordinator for HIT Sign up for the ONCHIT listserv via the website 19