Bridging the Chasm

1. Bridging the Chasm Nina Schwenk, MD FACP Washington DC April 20, 2009

2. Meeting Goals • Establish the value of standards and interoperability to the clinical community • Identify priorities from a clinical perspective • Have clinicians clearly articulate their requirements in non-technical terms • Identify common processes by which the specialty groups can define and communicate information requirements to the HIT community

3. Thank You

5. Health Care Information Technology Standards & Interoperability SummitNovember 18 - 20, 2008 Providers invited to summit included: • Mayo Clinic • Ochsner Health System • Palo Alto Medical Foundation • Partners Healthcare • University of Pittsburgh Medical Center • Vanderbilt Medical Center • Virginia Mason Medical Center • Cleveland Clinic • Dartmouth • Health Partners • Henry Ford Health System • Kaiser Permanente • Intermountain Healthcare • Lahey Clinic

6. Health Care Information Technology Standards & Interoperability SummitNovember 18 - 20, 2008 Vendors invited to summit included: • IBM • Intel • Lawson • McKesson • Microsoft • Oracle • Siemens • Sun Microsystems • Avaya • Cerner • Cisco • Dell • Epic • GE Health Care • Google • Hewlett Packard

7. Summit Goal Through a consensus process identify three to six health care IT-dependent solutions that will overcome critical barriers to patient-centered health care delivery through increased interoperability and application of established national and international standards. Engage participating provider and IT partner groups to work collaboratively to develop these solutions.

8. Provider Session

9. Agenda • Barriers to Patient-Centered Care Delivery • Using Health IT to Advance Health Care Reform: Moving Beyond Theory to Pragmatic Solutions • Dr. Robert Kolodner • Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery • Creating an Action Plan for Providers

10. Which of these statements best describes theU.S. health care system today? (select one) • Complete state of crisis • Overall – major problems • Some segments with major problems • Few segments with major problems • No significant problems

11. Rank these entities on the degree they would influence health reform:(Rank each item 1 to 10 with 1 being no influence, 10 being major influence) Federal government State government Health care providers Health care payers Employers/non-health organizations Consumers/individuals

12. In your opinion, how much influence do you think the following groups have had on increasing medical costs in the United States?(Rank the list in order of influence) • Doctors and hospitals • Drug companies • Medical technology companies • Insurance companies • People who don’t take care of themselves

13. Difficulty In the next 100 days, how difficult/important will it be for President Elect Obama to address the following topics:(Rank each item 1 to 10 with 1 being not difficult,10 being very difficult) • Healthcare • War • Illegal immigration • Automaker bailout • Banking bailout • Foreign Policy

14. Importance In the next 100 days, how difficult/important will it be for President Elect Obama to address the following topics:(Rank each item 1 to 10 with 1 being not important, 10 being very important) • Healthcare • War • Illegal immigration • Automaker bailout • Banking bailout • Foreign Policy

15. Importance Difficulty

16. Barriers to Patient-Centered Care Delivery • Health Care Reform Cornerstones • Creating Value • Coordinated Care • Payment Reform • Health Insurance for All

17. Barriers to Patient-Centered Care Delivery • Perspectives • Patient • Provider • Purchaser • Payer

19. Using Health IT to Advance Health Care Reform • “Moving Beyond Theory to Pragmatic Solutions” • Dr. Robert Kolodner

20. Overview of the Federal Health IT Strategic Plan • Establish a governance structure that coordinates organizational processes • Protect the privacy and security of patient health information • Enable the movement of health information by setting standards that allow interoperability • Promote adoption of technologies • Establish a nationwide health information network

21. * Information Sharing & Exchange* Standards & Interoperability

22. Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery

23. Health Care Ecosystem Today Patients Government Providers Compliance Purchasers Regulators Payers Industry

24. Lack of “interoperable”health care ecosystem

25. Business Case for “Interoperable”Health Care Ecosystem • Value • Cost • Coordinated Care • Innovation • New Business Opportunities • Effectiveness and Efficiency • Intelligence gathering • Market

26. Personal Health Record Patient Provided Information Vocabulary Universal Patient Identifier Clinical Data Architecture Standard, interoperable core medical information Affordability to purchasers and patients/efficiency Standard measures of value Safety (clinical quality) Coordination of care Device manufacturer standardization Clinical decision support tools Medication reconciliation Standardized network-to-network interoperability Infrastructure vendor collaboration EMR vendorcollaboration Health Care IT Dependent Opportunities

27. Patient Centered (Rank each item 1 to 10 with 1 being low priority, 10 being high priority) Personal Health Record Patient provided information Vocabulary Universal patient identifier Clinical data architecture Core medical information Affordability to purchasers and patients /Efficiency Standard measures of value Safety (Clinical quality) Coordination of care Device manufacturer standardization Clinical decision support tools Medication reconciliation Standardized Network-to-network interoperability Inter-organizational interoperability Infrastructure vendor collaboration EMR vendor collaboration

28. Business Value (Rank each item 1 to 10 with 1 being low priority, 10 being high priority) Personal Health Record Patient provided information Vocabulary Universal patient identifier Clinical data architecture Core medical information Affordability to purchasers and patients /Efficiency Standard measures of value Safety (Clinical quality) Coordination of care Device manufacturer standardization Clinical decision support tools Medication reconciliation Standardized Network-to-network interoperability Inter-organizational interoperability Infrastructure vendor collaboration EMR vendor collaboration

30. Provider prioritiesto support health care Value andCoordinated Care • Universal patient identifier • Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for communication among EMRs, PHRs, medical devices and more. • Vocabulary • Standardized network-to-network interoperability (i.e. NHIN) • Medication reconciliation

31. Creating an Action Plan for Providers • Establish a provider coalition that would drive a collective agenda to advance the top two priorities developed here • Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape • Advance the top two priorities developed here by integrating with the existing landscape

33. Creating an Action Plan for Providers • Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape

34. Joint Provider/IT Vendor Session

35. Agenda • Review Provider session outcomes • Engage IT Vendors in discussion regarding barriers and solutions • Determine next steps

36. Provider expectations for IT Partners Universal patient identifier • IT partners must support the use of a voluntary and/or required universal patient identifier

37. Provider expectations for IT Partners Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for exchange among EMRs and PHRs and others. • Vocabulary • Standardized network-to-network interoperability (i.e. NHIN) • Medication reconciliation IT partners must support interoperability standards

39. Joint Action Plan for Providers and IT Vendors • Establish a coalition to advance the top two priorities developed here that connects to the larger landscape

40. Coalition Output to Date • Letter of support to Congress (HIT funding) • HIT Framework for Action (principles for HIT investment) • Input to the ONC on its Strategic Plan update

41. Coalition Output to Date • Position on “Meaningful Use” provision in the Stimulus Bill • Grant proposal for stimulus funding to further coalition objectives • Invite additional members?

42. Thank You

43. Thank You