Healthcare Information TechnologySome Thoughts On Future Trends

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Healthcare Information TechnologySome Thoughts
On Future Trends

• Kim D. Slocum, FHIMSS
• Director, Strategic Planning Business
  Development, AstraZeneca LP
• March 4, 2004

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Its About The Information, Not The Technology

• The enhanced use of healthcare information
  technology is a means to an enda critical tool
  to
• Collect data and provide decision support tools,
  especially at the point of care
• Share data between healthcare providers, payers,
  policy makers, and consumers
• The end is more effective and more efficient
  healthcare purchased on the basis of value and
  outcomes rather than just unit cost

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Cost Shifting Is A Blunt Instrument Approach To
Fixing Healthcare
In the past 12 months, was there a time when,
because of cost, you
(Copays)
SOURCE
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Each year, more than 57,000 people die because
they do not receive the care that the medical
profession and health care community agrees they
needthis is not a measure of medical errors or
an analysis of patient access to health care...
despite record per-capita spending on health
care, the quality of U.S. medical practice badly
trails the state of medical knowledge.
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How Do We Bridge The Gap And Deliver The Promise?
Metrics/Measurement Systems How do we collect
and share data between stakeholders?
Agreement On Healthcare Goals What
results/outcomes are valued?
Compensation Plans How do we align incentives to
secure delivery of the outcomes we value?
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A Growing Consensus On The Role HIT Can Play

• RAND Corporation launches study to measure
  efficiency/quality/safety gains to be had from
  advanced HIT usage
• GAO report for Senator Kennedy
• Center for Information Technology Leadership
  study projects 87 billion in potential system
  savings from ubiquitous HIT

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Pay For Performance

• Initial focusimproving care for diabetic
  patients (will be expanded to other conditions in
  future)
• Based on actuarial estimates of long-term costs
  for patient care (achievable savings of 350 per
  patient per year)
• Piloted in Louisville, Cincinnati, Boston
  (national rollout anticipated in 2004)
• Initial approachphysician/patient opt-in with
  only upside incentives
• 100 per physician per patient per yeardiabetic
  care benchmarks
• 50 per patient per year
• 55 per physician per yearinstalling clinical
  HIT reporting tools

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60 Variation In Medicare Resource Use Intensity
For Equivalent Populations
SOURCE Wennberg et. al. Annals Of Internal
Medicine 2/18/03
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The Critical Importance Of HIT

• As healthcare starts to shift from an input
  driven to an output driven model, outcomes
  assessment tools become critical to drive
  meaningful changes in provider compensation
  systems
• If empowered consumers dont have quality/value
  information readily available, it is likely that
  they will buy healthcare services solely on a
  price basis

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So Why Arent We There Yet?

• Lack of standards
• What data must be collected and how?
• How does one system talk to another?
• High perceived cost of clinical systems
• Especially acute for small practice setting
  physicians
• Incentives like HIT-enabled pay for performance
  are not yet broad-based

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Emerging Federal Approach To Nurturing HIT

• Focus on improving patient safety and
  biopreparedness
• Legislative and executive-branch efforts underway
• Federal Health Architecture (FHA)
• Consolidated Health Initiative (CHI)
• National Health Information Infrastructure (NHII)
• EHR functional model (in conjunction with private
  sector)
• e-Prescribing and other HIT-related provisions of
  2003 Medicare Act

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Remote Patient Monitoring Technologies Are
Beginning To Mature
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So What?

• New technologies will allow HIT to go places it
  has seldom/never been before
• Exam rooms
• Patients homes
• More information means we have a movie instead
  of a photograph on how patients are doing,
  thereby improving quality of care by detecting
  changes in health status early

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Attacking The Small Practice Setting

• Traditional client/server applications are out of
  reach for roughly half of all US physicians
• High costs
• Cash flow supported capital expenditure model
• New offering from AAFPpartnership with several
  leading HIT vendors to reduce installation costs
• New Medicare Act contains grant monies, safe
  harbors established for some healthcare entities
  to assist doctors with technology acquisition
  costs

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The Genetic Revolution Begins
Leading the News Roche Test Promises to Tailor
Drugs to Patients --- Precise Genetic Approach
Could Mean Major Changes In Development,
Treatment
June 25, 2003 Roche Holding AG is launching the
first gene test able to predict how a person will
react to a large range of commonly prescribed
medicines, one of the biggest forays yet into
tailoring drugs to a patient's genetic
makeup. The test is part of an emerging approach
to treatment that health experts expect could
lead to big changes in the way drugs are
developed, marketed and prescribed. For all of
the advances in medicine, doctors today determine
the best medicine and dose for an ailing patient
largely by trial and error. The fast-growing
field of "personalized" medicine hopes to remove
such risks and alter the pharmaceutical
industry's more one-size-fits-all approach in
making and selling drugs.
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Converging Data Streams Should Drive Clinical
Automation
SOURCE Health Futures, Inc.
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Carbon And SiliconFuture Convergence
--Predictive tests based on genetics
--Rx with lower side effects/ better
efficacy --New therapy modalities (e.g. gene
therapy)
--Tailored treatment plans
--Implantable smart devices
-- Remote Monitoring --MD/Pt. On-Line Interactions
-- Patient histories --On-Line Assessments
-- Portable data following at risk Patients for
life
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Where HIT Needs To Be
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How You Can Help

• Support for existing efforts (FHA, NHII, EHR
  functional standard, Medicare HIT provisions and
  quality demonstration programs)
• Action on challenge of patient identifiers
  (voluntary patient identifier) that will help
  data sharing between stakeholders
• More creative incentives, especially for
  physicians
• Potential consideration of bigger, broader safe
  harbors for HIT investment to spur private
  sector help in wiring American medicine

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Balancing Cost and Value
RESULT Coordinated care Collaborative
relationships
RESULT Uncoordinated care Adversarial
relationships
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Thank You