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Health Information Technology Citizen’s Health Care Working Group

Health Information Technology Citizen’s Health Care Working Group. Presented by Scott D. Williams, M.D., M.P.H. Vice-President, HealthInsight July 22, 2005. Overview. HealthInsight Medicare Quality Improvement Organization (QIO) with CMS contract for Utah and Nevada DOQ-IT Project Pilot

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Health Information Technology Citizen’s Health Care Working Group

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  1. Health Information TechnologyCitizen’s Health Care Working Group Presented by Scott D. Williams, M.D., M.P.H. Vice-President, HealthInsight July 22, 2005

  2. Overview • HealthInsight • Medicare Quality Improvement Organization (QIO) with CMS contract for Utah and Nevada • DOQ-IT Project Pilot • Promoting the use of Electronic Medical Records in small and medium primary care physician offices • Utah Health Information Network (UHIN) • 12 years of successful administrative health data exchange • Claims, remittance, eligibility • Credentialing, coordination of benefits, EFT • Regional Health Information Organization development grantee (AHRQ) • Labs, pharmacy, clinical notes and reports

  3. Technology Architecture Hardware/ Software Connections Support Governance Community interests Privacy, security Resource allocation Issues in Health IT • Value • Who benefits & who pays? • Efficiency • Outcomes • Standards • Self-regulated • Externally- regulated • Market driven

  4. Health IT: Applications • Electronic Medical Record (EMR) • Paperless office • Personal Health Record • Health Information Exchange (HIE) • Regional Health Information Org. (RHIO) • Allows interoperability between stakeholders • Clinical Decision Support Systems (CDSS) • Case and cohort management • Computerized Physician Order Entry (CPOE) • Prompts, recalls, trends, protocols, drug interactions, generics, performance measures

  5. Value: Administrative Health Data • UHIN (17 million claims/year) • Efficiency of Claims Processing by 1 adjudicator • Paper 100-150/ day • Scanned 300/ day • EDI 700-800/ day • Autoprocessing 60% of claims require no human involvement • Payer value- just for intake of claim • Paper = $6-10/ claim • EDI < $1/ claim • Provider value • Faster payments • Fewer rejected claims • Less staff time

  6. Lessons Learned: UHIN • Champion- credible, neutral, trusted • Value accrues to all participants • Drives priorities • Drives business model • Community ownership & governance • Consensus decision making • Standards driven • Use of data subject to governance process

  7. Value: EMRs EMR Adoption Physician Offices 17% Hospital ER 31% Hospital Outpatient 29% CDC March 2005 HIMSS, September 2004

  8. Initial Capital Cost (345/423, ms = 1.85) Time Cost (323/423, ms = 2.74) Confidentiality and Security Concerns (181/423, ms = 2.93) Maintenance cost (300/423, ms = 3.00) Interfere with doctor-patient communication Concerns about learning new technology Lack of technical support Lack of control over decision Lack of perceived benefits Value: EMR Adoption Barriers among Physicians ms = mean score Massachusetts Medical Society Survey Spring 2003

  9. Value: EMR Business Case for the Physician • Process efficiency (requires workflow redesign) • Transcription • Forms • Telephone calls • Information collection from patients • Lower overhead • Fewer FTEs • Less space needed for charts • Increased reimbursement • Better coding & recovery • More patients seen (if workflow changes) • Pay for Performance

  10. Value: EMR Business Case for the Physician Wang, S.J. et al. 2003

  11. Value: EMR Business Case for the Physician Wenner Georgia HIMSS Dec 2002

  12. Value: EMR Business Case for the Physician Wenner Georgia HIMSS Dec 2002

  13. Value: HIE • Automation of clinical processes • More timely, complete, accurate patient information at point of service • Efficiency of connectivity • Facilitate clinical decision support systems across communities

  14. Value: HIE • Missing Patient Data • 13.6% of primary care physician visits • 52% of missing data resides outside of system • 44% of data somewhat likely to adversely affect patients • 60% of data likely to delay care or result in additional services • More likely among recent immigrants, new patients, those with complex medical problems • Less likely where physician has full EMR and also in rural areas Smith et al. JAMA. February 2005

  15. RHIOs: “Wiring” Healthcare Efficiently Future system will consolidate information and provide a foundation for unifying efforts Hospitals Public health Hospitals Public health Primary care physician Laboratory Primary care physician Laboratory Health Information Exchange Pharmacy Pharmacy Specialty physician Specialty physician Payors Payors Ambulatory center (e.g. imaging centers) Ambulatory center (e.g. imaging centers) Current system fragments patient information and creates redundant, inefficient efforts Source: Indiana Health Information Exchange

  16. Value: HIE • Based on published data and expert opinion • Interoperability • Level 2 = Fax • Level 3 = Machine-organizable data • Level 4 = Machine-interpretable data • Net Value after full implementation • Level 2 = $21.6 billion /year • Level 3 = $23.9 billion/ year • Level 4 = $77.8 billion/ year • Costs: Benefit Calculation for Level 4 • Years 1-10 = $276 billion: $613 billion = $338 billion • Year 11 + = $16.5 billion: $94.3 billion = $77.8 billion Walker et al. Health Affairs. January 2005

  17. Value: Level 4 HIE • Contributions to the $94.3 billion benefit: Service categories • Contributions to the $16.5 billion cost Walker et al. Health Affairs. January 2005

  18. Value: Level 4 HIE • Where does $77.8 billion net value accrue (HIE Only)? Walker et al. Health Affairs. January 2005

  19. Value: Level 4 HIE • 50-200 Bed Hospital • $2.7 million in IT investment • $250,000/year in maintenance • $1.3 million/year in transaction savings • $570,000 from other providers • $200,000 from other laboratories • $170,000 from radiology centers • $250,000 from payers • $70,000 from pharmacies Walker et al. Health Affairs. January 2005

  20. HIE: UHIN Approach • Identify value-based priority use cases with interested stakeholders • Obtain broader stakeholder support • Develop and adopt technical model • Develop and adopt financing model • Convene standards development process • Adopt standards • Pilot, refine, implement

  21. Value: CDSS “...risk-adjusted cost varied almost 3-fold...” Duke Clinical Research Institute 2002 Practice Variation “...cost of poor quality was...nearly 30% of the expense base...core medical processes that comprise the majority of what we do” Mayo Clinic “...72% drop in mean respiratory costs...” APAM 2000 30% “...27% difference in cost of treating otitis media...” Ozcan 1998 “...20 to 30% of the acute and chronic care that is provided today is not clinically necessary...” Becher, Chause 2001 70% “...The cost of poor quality in health care is as much as 60% of costs...” Brent James, M.D., IHC. Project Hope, Wennberg et.al., 2003/HealthAlliant “...30% of direct health care outlays are the result of poor-quality care...” MBGH, Juran, et al 2002 Annual U.S. health care expenditures: $1.7 trillion x 30% = ~ $500 billion

  22. CPOE 25% improvement in ordering of corollary medications by faculty and residents (p<0.0001) Overhage, 1997 55% decrease in non-intercepted serious medication errors (p=0.01) Bates, 1999 81% decrease in medication errors (p<0.0001) Bates, 1999 Improvement in 5 prescribing practices (p<0.001) Teich, 2000 CDSS 6 of 14 studies showed improvement in patient outcomes. Hunt 1998 43 of 65 studies showed improvement in physician performance. Hunt 1998 17% improvement in antibiotic regimen suggested by computer consultant versus physicians (p<0.001) Evans 1994 70% decrease in adverse drug events caused by anti-infectives (p=0.02) Evans 1998 Value: CDSS Source: Center for Information Technology Leadership, 2003

  23. Value: CDSS 100% Medical Knowledge Treatment 50% of Cost 20% of Return Diagnostic Redundancy Patient Data Errors EMR HIE CDSS Source: SBCCDE, CITL, Gordian Project analysis

  24. Value: Outpatient CPOE • Savings from nationwide adoption • Adverse Drug Reactions = $2 billion • Eliminate 2 million adverse drug reactions • Eliminate 190,000 hospitalizations • Medication management = $27 billion • Radiology management = $10.4 billion • Laboratory management = $4.7 billion • Total = $44 billion Source: Center for Information Technology Leadership, 2003

  25. Value: Who benefits? Who Pays? Private Payers Medicare Medicaid Self-insured Self-pay Physicians Ambulatory Computer-based Physician Order Entry Source: Center for Information Technology Leadership, 2003

  26. Health IT: Federal Government Roles • Facilitate the implementation of a national strategy • Support innovation experiments • Confirm business value and align incentives • Coordinate the implementation strategies of federal health care agencies • Assure the rapid development of data and technical standards with broad input • Assure that privacy and security regulations don’t encumber interstate health data exchange • Incentivize health IT savings to be redirected into effective health care interventions

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