Yesterday, Today, and Tomorrow
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Yesterday, Today, and Tomorrow
Judy Murphy, RN, FACMI, FHIMSS, FAANDeputy National Coordinator for Programs & PolicyOffice of the National Coordinator for Health ITDepartment of Health & Human ServicesWashington DC
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A look at . . .
• Yesterday - what we’ve gotten done– The status of the HITECH Programs
• Today - what are our key priorities– Health information exchange
– Patient engagement
• Tomorrow – what are the biggest challenges in our future– Meaningful use of meaningful use
– Health reform
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We’ve come a long way …
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President Bush’s goal in January 2004 “… an Electronic Health Record for every American by the year 2012.
By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”
- State of the Union address, January 20, 2004
President Barack Obama’s goal in January 2009“To lower health care cost, cut medical errors, and improve care, we’ll
computerize the nation’s health records in five years, saving billions of dollars in health care costs and countless lives.”
- Speech at George Mason University, January 12, 2009
Executive order established the Office of the National Coordinator forHealth IT (ONCHIT) as part of the Dept of Health & Human Services
– Dr. David Brailer appointed the first National Coordinator for Health IT– Followed by Dr. Rob Kolodner
A Bit of History …On the eve of the Presidential Election
February 17, 2009 – HITECH Act (part of ARRA) is signed into law– Dr. David Bluementhal appointed National Coordinator– Health IT Policy and Standards Committees are formed– ONC grows from around 30 to over 150 employees– Dr. Farzad Mostashari becomes the current National Coordinator
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A Remarkable Journey
Meaningful Use
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Progress of Eligible Providers toward EHR Incentive Payments as of 8-31-12
Source: CMS EHR Incentive Program Data
NAMCS Survey:
•The percentage of primary care providers who have adopted EHRs in their practice has doubled from 20 % to 40 % between 2009 to 2011
Note: The 2012 data will be available in 2013
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EHR Adoption of Eligible Providers by stateas of 8-31-12
http://dashboard.healthit.gov/HITadoption/
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Regional Extension Centers are working with 148,448 Primary Care Providers
http://dashboard.healthit.gov/rec/
2012 GAO Report: Providers 2.3 times more likely to achieve MU if working with an REC
Includes 70% of all primary care providers in the rural areas and 1,185 Rural or Critical Access Hospitals
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Progress of Eligible Hospitals toward EHR Incentive Payments as of 8-31-12
Source: CMS EHR Incentive Program Data
Note: Totals reflect the
number of unique hospitals that have received payments from
Medicare or Medicaid.
AHA Survey – in one year, from 2010 to 2011:
•Hospitals increased their use of Basic EHRs from 19% to 35% (84%)
•Hospitals doubled their use of Comprehensive EHRs from 4% to 9% (125%)
Note: The 2012 data will be available in early 2013
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EHR Adoption of Eligible Hospitals by stateas of 8-31-12
http://dashboard.healthit.gov/HITadoption/
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Source: CMS EHR Incentive Program Data
Meaningful Use – All Paymentsas of 8-31-12 ($ in Millions)
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HITECH Framework for MU of EHRs
Taken from: Blumenthal, D. “Launching HITECH,” posted by the NEJM on 12-30-2009.
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CCC SHARP
REC
Beacon
HIE
Health IT Resource Center
NOW: Work with all external communities to
share knowledge
ToolsTools
ResourcesResources
Communities of Practice
(CoPs)
Communities of Practice
(CoPs)
THEN: Work within REC community to share knowledge
National Learning Consortium HealthIT.gov
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Workforce Training – CommunityCollege Program Enrollment & Graduation
Students Enrolled or Completed: 21,321Students Enrolled or Completed: 21,321
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As of September 14, 2012
Workforce Training - University-BasedProgram Enrollment & Graduation
Students Enrolled or Graduated: 1,627(Target: 1,685)
Students Enrolled or Graduated: 1,627(Target: 1,685)
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Health Information Exchange - Directed Exchange Implementation as of 6-30-12
Summary Stats Number of GranteesStates/territories with directed exchange options broadly available 36States/territories piloting directed exchange solutions 10States/territories with directed exchange options unavailable 10
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Directed Exchange: Estimatednumber enabled as of 6-30-12Summary Stats NumberTotal number of organizations enabled for directed exchange nationally 8.349Total number of clinical & administrative staff enabled for directed exchange nationally 48,649
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Summary Stats NumberTotal number of organizations enabled for query-based exchange nationally 3,554Total number of individuals enabled for query-based exchange nationally 56,496
Query-Based Exchange: Estimatednumber enabled as of 6-30-12
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Exchange is increasing across the nation
State
% of Acute Care Hospitals Actively* Participating in Query-Based Exchange
that is supported or enabled by State HIE
grantees**Delaware 67%New York 65%Maryland 54%
New Jersey 32%Arizona 27%
Colorado 26%Nebraska 20%
Idaho 17%Kentucky 16%Michigan 15%
Tennessee 12%
State
% of Acute Care Hospitals Actively* Participating in Directed Exchange that is supported or enabled by
State HIE grantees**
Delaware 100%Vermont 79%Michigan 48%Arkansas 45%New York 42%
Minnesota 34%North Dakota 34%
Colorado 26%California 20%
Alaska 18%Utah 14%
* Active = at least one directed message sent between production end points or at least one patient record query during previous calendar quarter** Data self-reported by HIE grantees, Denominators calculated with 2011 Medicare Inpatient Hospital Data
18 states had more than 10% of their hospitals actively engaged in sharing health information electronically as of 6-30-12
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Build and strengthen health IT infrastructure and exchange capabilities - positioning each community to pursue a new level of sustainable health care quality and efficiency over the coming years.
Improve cost, quality, and population health - translating investments in health IT in the short run to measureable improvements in the 3-part aim.
Test innovative approaches to performance measurement, technology integration, and care delivery - accelerating evidence generation for new approaches.
The Beacon Community Program: Where HITECH Comes to Life
17 diverse communities, each funded over 3 yrs to:
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“Beacons for Public Health”
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Southeast Michigan Beacon Community
Detroit, MI
Southeast Michigan Beacon Community
Detroit, MI
Crescent City Beacon Community
New Orleans, LA
Crescent City Beacon Community
New Orleans, LA
Southeastern Minnesota Beacon Community
Rochester, MN
Southeastern Minnesota Beacon Community
Rochester, MN
Rhode Island Beacon Community
Providence, RI
Rhode Island Beacon Community
Providence, RI
Greater Cincinnati Beacon Community
Cincinnati, OH
Greater Cincinnati Beacon Community
Cincinnati, OH
Southern Piedmont Beacon Community
Concord, NC
Southern Piedmont Beacon Community
Concord, NCSan Diego Beacon
CommunitySan Diego, CA
San Diego Beacon Community
San Diego, CA
Western New York Beacon Community
Buffalo, NY
Western New York Beacon Community
Buffalo, NY
• Funded by the CDC and launched in collaboration with the ONC in 2011
• Primary goal: Gain an understanding of the range of activities currently conducted in population and public health within the Beacon Communities, to accelerate the work of other organizations across the country
• Case studies available today!
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IT-Care Management Partnership: Beacons and AF4Q
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Keystone Beacon Community Danville, PA
Keystone Beacon Community Danville, PA
Southeastern Minnesota Beacon Community
Rochester, MN
Southeastern Minnesota Beacon Community
Rochester, MN
Southern Piedmont Beacon Community
Concord, NC
Southern Piedmont Beacon Community
Concord, NC
Bangor Beacon CommunityBrewer, ME
Bangor Beacon CommunityBrewer, ME
Humboldt County Alliance
Humboldt County Alliance
Wisconsin Alliance
Wisconsin Alliance
Cleveland Alliance
Cleveland Alliance
Maine AllianceMaine Alliance
Western NY Alliance
Western NY Alliance
• Partnership to align “regional health care improvement” programs between ONC (Beacons) and RWJ (Aligning Forces for Quality or AF4Q)
• On October 24th, pioneering organizations from both programs came together to understand opportunities and gaps related to IT and care management
• Lessons will be shared through case studies and videos
• Future topics: Behavioral health and IT, and data use agreements across communities
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Connecting Health IT to Payment
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Great Tulsa Health Access Network Beacon
CommunityTulsa, OK
Great Tulsa Health Access Network Beacon
CommunityTulsa, OK
Greater Cincinnati Beacon Community
Cincinnati, OH
Greater Cincinnati Beacon Community
Cincinnati, OHColorado Beacon
CommunityGrand Junction, CO
Colorado Beacon Community
Grand Junction, CO
Bangor Beacon CommunityBrewer, ME
Bangor Beacon CommunityBrewer, ME
• Bangor Beacon HIT infrastructure serves as the foundation for the Bangor Pioneer ACO
• 3 Beacon Communities (CO, Tulsa and Cincinnati) are working on how Beacon HIT infrastructure can be used to support provider practices participating in CMMI’s comprehensive primary care initiative (CPC)
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EHR Certification Program:Certified Health IT Product List (CHPL) • 1,642 “Unique” Certified EHR Products as of 11/01/12
• 2,744 Certified EHR Products when all product versions are counted• 896 EHR Vendors/Developers• On October 4th, ONC’s Permanent Certification Program was
launched; the Temporary Certification Program which was operating for 2 years was sunset
Ambulatory Inpatient TotalComplete EHR 694 96 790Modular EHR 436 416 852
Total 1130 512 1642This table shows a unique count of products. Any additional
versions of the same products are not included.This table shows a unique count of products. Any additional
versions of the same products are not included.
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MU Attestations by Vendor (7/28/12)
http://www.modernhealthcare.com/article/20120728/MAGAZINE/307289983
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TODAY - Key Priorities:Keeping the Patient at the center of all we do
• Patient-Centric health care and health record by– Laying the groundwork for interoperability with
standards, testing & certification– Facilitating broad implementation of health
information exchange• Patient Engagement by enabling patient
– Access– Action– Attitude
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• E-prescribing (ambulatory and inpatient discharge)
• Transition of Care summary exchange:• Create & transmit from EHR• Receive & incorporate into EHR
• Lab tests & results from inpatient to ambulatory
• Public health reporting – transmission to:• Immunization Registries• Public Health Agencies for syndromic surveillance• Public health Agencies for reportable lab results• Cancer Registries
• Patient ability to View, Download and Transmit their health data to a 3rd Party
• Create an export summary of patient data, in order to enable data portability
Focus on INTEROPERABILITY in the Stage 2 Meaningful Use Criteria
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Focus on PATIENT ENGAGEMENT in the Stage 2 Meaningful Use Criteria
• Reminders for preventive/follow-up care provided
• Educational resources identified and provided
• Online access to personal health information (portal, PHR)
• Visit Summaries provided
• Patients can send secure messages to their provider
• Patients can View, Download and Transmit to 3rd Party
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Back in the Day…
“The obedience of a patient to the prescriptions of his physician should be prompt and implicit. [The patient] should never permit his own crude opinions as to their fitness to influence his attention to them.” - AMA’s Code of Medical Ethics (1847)
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And Now…
“Patients share the responsibility for their own health care….”
- AMA’s Code of Medical Ethics (current)
“Patients can help. We can be a second set of eyes on our medical records. I corrected the mistakes in my health record, but many patients don't understand how important it will be to have correct medical information, until the crisis hits. Better to clean it up now, not when there’s time pressure.” – Dave deBronkart (ePatient Dave)
ONC’s Consumer Engagement Strategy: The Three A’s
Catalyze development of tools and services that help consumers (and providers) take action using their health information.
Support a shift in attitudes and expectations regarding consumer (and provider) roles.
Give consumers electronic access to their health information. Access
Action
Access
Attitudes Action
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ACCESS: Consumer eHealth Pledge Program
Over 400 organizations have Pledged to provide access to personal health information for 1/3 of Americans…
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Taking the Blue Button nation-wide
• Get more organizations to offer Blue Button
• Make “Blue Button” a household name = “electronic access to my health data”
• Advance technical capabilities = “set it and forget it”
• One of 5 game-changing projects involving the 2012 Presidential Innovation Fellows
www.healthit.gov/pledge
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ACTION: Making it easier for Patients to use Health IT
• Surgeon General’s Healthy Apps Challenge More at: http://sghealthyapps.challenge.gov
• PHR Model Privacy Notice More at: http://bit.ly/qfjP1a
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ACTION
• Blue Button Mash-Up Challenge – develop an app that mashes up PHR data with other health-related data sets
• Leon Rodriguez, Director-Office of Civil Rights: clarification of the patient’s right to access their own health information under HIPAA (videos, pamphlets, answers to questions, and other guidance)
More at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/righttoaccessmemo.pdf
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ATTITUDE: Health IT Animation
http://www.healthit.gov/patients-families/video/preview-health-it-you-giving-you-access-your-medical-records
•1 and 3 minute versions of the animation are available to use for patient teaching
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Beat Down Blood PressureConsumer Video Challenge
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A Regular Guy Beats Down Blood Pressure:
http://vimeo.com/42121895
A Regular Guy Beats Down Blood Pressure:
http://vimeo.com/42121895
Beat Down Blood Pressure Winner
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What’s in Your Health RecordConsumer Video Challenge
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What’s in Your Health Record Winner
Wright and Luft:
http://vimeo.com/46790323
Wright and Luft:
http://vimeo.com/46790323
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Stages of Meaningful Use
Stage 1
Stage 2
Stage 3
TOMORROW – The biggest challenges in our future
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HIT as the means, not the end
Dr. David Blumenthal, previous National Coordinator of HIT, emphasizes
“HIT is the means, but not the end. Getting an EHR up and running in health care is not the main objective behind the incentives provided by the federal government under ARRA. Improving health is. Promoting health care reform is.”
- At the National HIPAA Summitin Washington, D.C.
on September 16, 2009
Best Care at Lower CostThe Path to Continuously LearningHealth Care in America
September 2012
iom.edu/bestcare
Foundational elements1. The digital infrastructure – Improve the capacity to capture clinical,
delivery process, and financial data for better care, system improvement, and creating new knowledge.
2. The data utility – Streamline and revise research regulations to improve care, promote the capture of clinical data, and generate knowledge.
Care improvement targets3. Clinical decision support4. Patient-centered care5. Community links6. Care continuity7. Optimized operations
Supportive policy environment8. Financial incentives.9. Performance transparency10. Broad leadership
10 Recommendations
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Our National Quality Strategy
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Health Information Technology
Improving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity.
Better healthcare
Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care.
Better health
Lowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries.
Reduced costs
$
Health IT:Helping to Drive the 3-Part Aim
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Stage 2 MUACO’s
“Stage 3 MU”PCMH
3-Part Aim
Registries to manage patient
populations
Team based care, case management
Enhanced access and continuity
Privacy & security protections
Care coordination
Privacy & security protections
Patient centered care coordination
Improved population health
Registries for disease
management
Evidenced based medicine
Patient self management
Privacy & security protections
Care coordination
Structured data utilized
Data utilized to improve delivery
and outcomes
Data utilized to improve delivery
and outcomes
Patient informed
Patient engaged, community resources
Stage 1 MU
Privacy & security protections
Basic EHR functionality,
structured data
Utilize technology
Access to information
Transform health care
Meaningful Use as a Building Block
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Meaningful Use Is Just the Beginning: Other Three Part Aim Programs
• A recent analysis identified that the national network of RECs are currently working on over 190 different programs to help providers meet the Three Part Aim
* Based on information from 53 of 62 RECs. Some are working on several different Three-Part Aim Programs .
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THE FUTURE IS NOW.
THIS IS OUR TIME.
Thanks! judy.murphy@hhs.gov
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