Bringing Health Information to

Life: the HITECH Agenda

February 4, 2010

DAVID BLUMENTHAL, MD, MPP

National Coordinator of Health Information Technology
US Department of Health & Human Services
Today’s Agenda

y The Role of Health Information Technology

y The Current State.
y Obstacles.
y The Federal Response.
y The Role of Professionalism.
y Your Role.
 The Role of Health
Information Technology
HIT: The circulatory system of
medicine.
y Information: medicine’s lifeblood.

y We store and manage information

as Hippocrates did in 400 B.C.
y HIT: the most effective way to
nourish 21st century practice.
How I learned to practice medicine:
How my daughter will practice medicine:
 She will benefit from:

y EHR: y HIE: y CDS:

Electronically Exchanging Improved
capturing and health care
processing information decisions &
information coordination
about patients
 The road there is challenging…
Current Levels of Adoption by Ambulatory Physicians
Fully
Functional
EHR
No Functional
EHR 4%
83%
Basic EHR
13%

• 17% purchased
system but have
not implemented it
yet

•26% intend to
purchase within 2
years

Source:
DesRoches CM et al. Electronic health records in ambulatory care—a national survey of physicians. N Engl J Med. 359(1):50-60, 2008 Jul 3.
 Hospital adoption lags as well.
Hospitals (2008):
y 10 percent basic.
y 1.5 percent comprehensive.
y Large percentages with pieces of EHR.

Source:
DesRoches CM et al. Electronic health records in ambulatory care—a national survey of physicians. N Engl J Med. 359(1):50-60, 2008 Jul 3.
Barriers to Health Information
Technology Adoption and Effective Use

y Market Failures

y Technology and Logistics

y Absent Platform for Exchange – public good

y Privacy and Security Concerns

 Major Barriers to EHR Adoption
Percent of physicians reporting a “major barrier”

100%
Have an EHR Do not have functional EHR

75% 67%
51% 54%
50% 44% 45%
39% 41%
36% 37%
29%
24% 24%
25%

0%
Lack of Uncertainty Finding a System Capacity to Loss of
capital of ROI system that becoming implement productivity
meets your obsolete
needs

Source:
DesRoches CM et al. Electronic health records in ambulatory care—a national survey of physicians. N Engl J Med. 359(1):50-60, 2008 Jul 3.
The Federal Government’s
Response: HITECH ACT
y Part of American Recovery and
Reinvestment Act of 2009 (ARRA)
y Establishes the revolutionary goal of
Meaningful Use.
y Systematically addresses major barriers to
adoption and Meaningful Use.
y Money/market reform.
y Technical assistance, support and better
information.
y Health information exchange
y Privacy and security.
Conceptual Considerations
y Change management, not technology installation.
y Hearts and minds of nation’s providers.
y The escalator concept.
y Payoff is in effective use – MEANINGFUL USE.
y Must support practice redesign, changes in practitioner
decision-making and workflow.
y The goal is health and health system improvement.
y Strategy must be multifactorial and properly timed and
address these known barriers.
y Must be flexible and constantly reassessed.
 y Patient/Family Engagement
y Care coordination
y CPOE & e-prescribing
y Quality, safety & efficiency of care
y Reduce disparities
y Public health
y Privacy & Security

15
Office of the National Coordinator for Health Information Technology
 Meaningful Use in Practice
Stage 1 - 2011
yelectronically capturing health
information in a coded format
yusing that information to
track key clinical conditions
ycommunicating that
information for care
coordination purposes
yinitiating the reporting of
clinical quality measures and
public health information.
Stage 2 - 2013
ydisease management
yclinical decision support
ymedication management
ysupport for patient access to
their health information
yquality measurement and
research
ybi-directional communication
with public health agencies.
Stage 3 -2015
yimprovements in quality,
safety and efficiency
ydecision support for national
high priority conditions
yaccess to self management
tools
yaccess to comprehensive
patient data, and improving
population health outcomes.
First Payment CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 and
Year later**

2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3

2012 Stage 1 Stage 1 Stage 2 Stage 3
2013 Stage 1 Stage 2 Stage 3
2014 Stage 1 Stage 3
2015 and Stage 3
later*

*Avoids payment adjustments only for EPs in Medicare EHR Incentive Program
**Stage 3 criteria of meaningful use or a subsequent update to criteria if one is
established
 Meaningful Use Objectives for Eligible Health
Professionals and Eligible Hospitals - 2011

EXAMPLES
• Use CPOE
• Implement drug-drug, drug-
allergy, drug-formulary checks
• Maintain an up-to-date problem ƒ
list
• Maintain active medication list
• Maintain medication allergy list
• Record demographics
• Record and chart changes in vital
signs
• Incorporate clinical lab-test
results into EHR as structured
data
Generate lists of patients by
specific conditions to use for
quality improvement, reduction
of disparities, and outreach
ƒ Report ambulatory quality
measures to CMS
19
Core Quality Measures for Eligible
Professionals - 2011
• Preventive care and screening: Inquiry regarding tobacco
use

• Blood pressure management

• Drugs to be avoided by the elderly:

• Patients who receive at least one drug to be avoided
• Patients who receive at least two different drugs to be avoided

20
Specialty Quality Measures for
Professionals
Will need to select one of the following specialties
Cardiology Obstetrics and Gynecology
Pulmonology Neurology
Endocrinology Psychiatry
Oncology Ophthalmology
Proceduralist/Surgery Podiatry
Primary Care Radiology
Pediatrics Gastroenterology
Nephrology

21
 Obstacle: Market Failure
HITECH Response: Financial Provisions
y Medicare/Medicaid incentives: $14-27 billion from 2011
on.
y Strategy rewarding adoption, not
y Reward the “MEANINGFUL USE” OF EHRs
y Physicians: $44,000/$63,750 over 5-10 years.
y Penalties starting in 2015.
y Hospitals: $2M bonus plus extra DRG payments.
y Support for adoption:
y $2 billion to Office of National Coordinator for Health
Information Technology (ONC).
HITECH Response to Gaps in Technical
Assistance, Technology, Human Resources
y $693 million
y 70 Regional Extension Centers.
y Health Information Technology Research
Center.
y $564 million
y Promote HIE through State leadership.
y $118 million
y Training over 40,000 new personnel
The Federal Government has Adopted
a Solutions-Based Strategy
Obstacle Intervention Funds Allocated
Financial Medicare and Medicaid Incentive
Resources Program for “Meaningful Use.” $27 B*

Technical
Assistance
Regional Extension Centers $643 M

Human
Resources
Workforce Training Programs $118 M

Information National Health Information Network &

Sharing Standards and Certification $64.3 M

Exchange Health Information Exchange $564 M

Strategic Health Information Technology
Technology Advanced Research Projects $60 M

Breakthrough
Examples
Beacon Communities Program $235 M
Privacy and Security as a Foundation.

Health IT
Outcomes

Privacy &
Security
 HITECH Response to Gaps in Privacy
and Security
y Banned sale of health information

y Ongoing audit trail requirements

y Federal activity in enforcement

y Expanded patient rights to access their

information

y Innovative encryption technology to

prevent breaches

26
HITECH FRAMEWORK: MEANINGFUL USE AT CORE

Regional Extension Centers

ADOPTION
Workforce Training Improved Individual &
Population Health
Outcomes

Increased
Transparency &
Medicare and Medicaid Incentives and Penalties
MEANINGFUL USE Efficiency

Improved
Ability to Study &
State Grants for Health Information Exchange
Improve Care Delivery

Standards and Certification Framework

EXCHANGE

Privacy and Security Framework

Health IT Practice Research

 Remaining challenges
y HITECH a great start, but many challenges to
implementation.
y Getting definition of meaningful use right:
y Stretch, but don’t break.
y Getting regional centers up and running.
y Assuring infrastructure for exchange.
y Training necessary workforce.
y Promote innovation in health information technology.
Technology Adoption
WILL THE STETHOSCOPE EVER COME INTO GENERAL USE
IN
CLINICAL MEDICINE?
A STRONGLY NEGATIVE VIEW EXPRESSED IN 1821

Office of the National Coordinator for Health Information Technology

Professionalism and HIT.
y Key components of professionalism.
y Unique competence, based in science and
demonstrated capability.
y Self-governance.
y Moral/ethical commitments.
y Within 10 years, use of EHRs will be a core
technical competency.
Professionalism will drive HIT
y Primary care specialty societies have all endorsed
use of HIT as an element of maintenance of
certification.
y I predict:
y ACGME.
y Licensing Boards.
y AMA/AAMC medical school accreditation will
follow suit.
Your Role

Contribute to this inevitable revolution

in modern medicine.

y The American public expect nothing less.

 QUESTION & ANSWER

33
Office of the National Coordinator for Health Information Technology