Marsha K. Millonig, BSPharm, MBA President & CEO Catalyst Enterprises, LLC

1. Advancements in Pharmacy Technology NABP/AACP District III Meeting Marsha K. Millonig, BSPharm, MBA President & CEO Catalyst Enterprises, LLC

2. Today’s Objectives • Describe the HIT landscape in the United States, how national HIT priorities are set and the most promising opportunities for pharmacists to “connect” to them. • Define common HIT terms. • Provide an overview of federal programs created through the Recovery Act (stimulus bill/HITECH provisions) to accelerate the adoption and “meaningful use” of health information technology. • Understand opportunities for pharmacists to improve medication use when enabled by HIT interoperability and patient-specific electronic medical record (EMR) access. • Discuss current and future pharmacy processes that may be supported by HIEs and related opportunities for the profession to advance care through HIE. • Describe new and emerging technologies that will affect the practice of community pharmacy and their impact on the delivery of patient services. • Review return on investment and implementation costs trends for new and emerging technology

3. “You think you understand the situation but what you don’t understand is that the situation just changed.”-----Putnam Investment advertisement

4. In our professional careers… • …we have witnessed the transition from the industrial age to the information age.

5. From typewriters to computers

6. Moore’s Law…Gordon Moore 1965 • Since the invention of the integrated circuit in 1958, the number of transistors that can be placed inexpensively on an integrated circuit has increased exponentially, doubling approximately every two years. • Almost every measure of the capabilities of digital electronic devices is strongly linked to Moore's law: processing speed, memory capacity, even the number and size of pixels in digital cameras.

7. Moore’s law in real life…

8. “If we had similar progress in the automotive technology, today you could buy a Lexus for $2. It would travel at the speed of sound, and go about 600 miles on a thimble of gas.” • John Naisbett

9. It can be exhausting!

10. Why is Health IT a Central Strategy for Health Care? • Current Lack of Information: • Leads to 1 in 7 hospital admissions* • When care providers do not have access to previous medical records • 12% of physician orders are not executed as written* • 20% of laboratory tests unnecessary* • Requested because previous studies are not accessible • Drug errors • Complicate 1 in 6.5 hospitalizations • Occur in 1/20 outpatient Rxs • * President’s IT Advisory Committee (PITAC)

11. HIT Evolution • 1989: Medicare Catastrophic Coverage Act—majority of pharmacies computerized in anticipation • 1996: HIPAA administrative simplification and standardized code sets, identifiers, EDI • 2001: SureScripts and RxHub formed to tackle e-prescribing

12. HIT Evolution • 2003 Medicare Modernization Act and Medicare Part D with e-prescribing initiative and MTM • 2003: IOM endorses National Health Information Infrastructure • 2004: President Bush creates National Coordinator for HIT • How many have there been and who are they? • First draft national strategic framework for HIT • CCHIT created • "We will make wider use of electronic records and other health information technology to help control costs and reduce dangerous medical errors."-- President Bush, January 31, 2006

14. HIT Evolution • 2005: SureScripts becomes agent for CCHIT certification of medication mgmt interoperability requirements • 2006: CCHIT only official entity recognized by HHS to certify HIT products and systems • 2007: E-prescribing becomes legal in all 50 states

15. HIT Evolution • 2008: SureScripts and RxHub merge • 2008: CMS issues e-prescribing regulations for MPD • 2008: Common language for HIT terms: EMR, EHR, PHR, RHIO, HIO, NHIN • 2008: ONC issues 2008-2012 strategic plan

16. The Health IT Infrastructure • ONCHIT • David Blumenthal • http://www.hhs.gov/healthit/ • "We will make wider use of electronic records and other health information technology to help control costs and reduce dangerous medical errors."-- President Bush, January 31, 2006

17. Common Language and Terms

18. Terms • EHR • EMR • PHR • HI exchange • Health information organization • Regional health information organization • NHIN

19. The ONC-Coordinated Federal Health IT Strategic Plan: 2008 - 2012 • Released June 2008 • Second plan • Lays out the health IT agenda: the Collaboration • 5-year plan: 2008 - 2012 • Two goals, eight objectives, 43 strategies • Measure for each objective • Milestone for each strategy • Details current activities of Federal agencies

20. HIT Interoperability is common theme National standards are needed to enable information flow Principle difference EMR and EHR is interoperable exchange Control of information distinguishes EHR from PHR HIE is process; HIO is oversight, RHIO is type of HIO

21. Privacy and Security Collaborative Governance Interoperability Adoption Summary of Health IT Strategic Goals and Objectives: 2008-2012 Objective 1.3: Promote nationwide deployment of electronic health records (EHRs) and personal health records (PHRs) and other consumer health IT tools. Objective 1.2: Enable the movement of electronic health information to support patients’ health and care needs. Objective 1.1: Facilitate electronic exchange, access, and use of electronic health information, while protecting the privacy and security of patients’ health information. Objective 1.4: Establish mechanisms for multi-stakeholder priority-setting and decision-making. Goal 1. Patient-focused Health Care Objective 2.2: Enable exchange of health information to support population-oriented uses. Objective 2.1: Advance privacy and security policies, principles, procedures, and protections for information access in population health. Objective 2.4: Establish coordinated organizational processes supporting information use for population health. Objective 2.3: Promote nationwide adoption of technologies to improve population and individual health. Goal 2. Population Health