California Council on Science and Technology

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• California Council on Science and Technology
• Steve Ryan
• February 3, 2005

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Healthcare Issuesin the U.S. and California

• Health insurance coverage for all
• Quality and safety of health care
• Cost and affordability of health care
• Information technology in health (HIT)
• Electronic Health Record (eHR or EMR)
• Comparative performance
• Outcome measures

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Healthcare Issues(continued)

• Health workforce shortages, low professional
  morale, and mismatches of personnel to care needs
  including nursing staffing and training
• Underinvestment in disease prevention, health
  protection, and public health infrastructure
• Health illiteracy
• Coherent strategies, incentives, and systems to
  promote scientific discovery
• Pressures on Academic Health Centers
• Inadequate management of chronic diseases

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Healthcare Issues(continued)

• Disparities in care and outcomes
• Closure of trauma-emergency rooms
• Payor Issues
• No more managed care
• All insurance
• Employers have decided to exit
• Defined contribution- not benefit
• Outsourcing
• STEM CELLS
• Seismic Code Hospital Compliance

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• Healthcare 15 GDP
• Hospitals OPD ?9-14
• Prescription Drugs ?9
• MDs ?5

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(No Transcript)
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Consumer Survey by Harris

• 59 HIT will give them control in managing their
  health
• 63 HIT will prevent unnecessary visits
• 52 believe they will benefit from cost savings
• BUT
• 53 believe HIT will be more trouble than current
  system
• 77 concerned MDs will miss clues apparent in
  face to face
• 61 believe HIT will increase cost of HC
• 89 believe they will pay for increased costs

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Summary

• HIT is HOT AREA in Health Care
• President Bush David Brailer
• California leaders
• Goals
• Improve quality and safety
• Reduce cost and improve efficiency

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HIT in Health Care

• Reduction of medical errors
• MDs ready access to
• Best practice guidelines
• Evidence databases
• EMR in HC network
• Reduce costs
• Eliminate redundancy
• Speed delivery of care

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HIT Case

• More theoretical than proven
• E.g. lt10 of hospitals use CPOE
• Broad scale interventions and policy changes to
  transform practice of medicine
• Government policy makers
• Health system executives

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RAND Project

• Quantitative model
• Estimate costs and benefits
• Elimination of medical errors
• ? Acute Care
• ? Mortality
• ? Costs for HC payers and organizations

From Brook and Hillestad
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RAND Project (continued)

• Quantify HC quality and savings from HIT
• Process view in a system model
• Focus on benefits, costs, barriers, and enablers
  of FUTURE HIT

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HIT and Physicians

• 90 - Personal use of internet
• lt20 (?5) EMR

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HIT and Physicians

• Barriers to Adoption of HIT
• Start up costs 56
• Lack of uniform standards 44
• Lack of time 39
• Need HIT tools for all MDs
• Accessible
• Affordable

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Barriers to EMR Implementation

• Organizational
• Data
• Cultural
• Capital
• 50,000 per MD
• 48 hours training
• Wal Mart organized around coherent goal
• HC Complexity, fluid, patient clues to MD

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Patient Confidentiality

• Early concerns, e.g.
• Local newspaper access to medical histories
• HIPAA
• Human Interaction
• Patient and Physician (HC Provider)

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• Consumers favor IT in areas of HC but in some
  areas frequently prefer and demand high touch
  approaches

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The Actual Drivers of Transformation Today

• The transformation of healthcare in California
  has been driven by
• Health Plans
• Medical groups, IPAs
• Employers
• State government
• Hospitals
• The impact of information technology is at early
  stage
• Demonstrations by medical groups, IPAs
• Larger investments underway by delivery systems,
  health plans

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Models

• Mayo IBM
• Enabling Legislation
• Delaware
• Florida
• Wyoming

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California Status

• Trails Other States
• Pockets of EMR Implementation
• Kaiser

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California Has National Leaders in Healthcare IT

• Robert Brook and Richard Hillestad RAND
• Molly Coye HealthTech
• Jack Lewin CMA
• Leonard Schaeffer WellPoint (Anthim)
• Many others
• Other National Leaders
• David Brailer
• Harvey Fineberg
• Don Berwick
• Don Detmer

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GOAL

• Application of Information Technology to
  Healthcare
• Improve Quality of Healthcare
• Protect Patients from Medical Error
• Reduce Cost of Healthcare
• Avoid unnecessary duplication
• Integrate Healthcare System
• Payors
• Providers
• Public

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Health Information Network

• High quality care
• Safer care
• Lower cost
• Reduce
• Duplicate Diagnostic Tests
• Unnecessary Admissions

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Patient Safety Institute

• Create integrated statewide
• Clinical Information
• Sharing Networks
• Jack Lewin, M.D. CMA EVP/CEO

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System Benefits

• Patient-specific individual medicine
• Disease surveillance
• Research
• Pay for units
• Pay for performance (outcomes)

From Lewin/PSI
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FDA/Pharmaceutical Benefits

• FDA surveillance of past approval (Phase 4)
• Pharmaceutical Industry
• Costs and profits
• Safety

From Lewin/PSI
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Technology Exists For

• First systemic approach to monitoring and
  surveillance of adverse drug effects
• MDs to monitor compliance with Rx regimen
• Lowering overall cost of health care
• Faster patient recruitment for clinical trials

From Lewin/PSI
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Barriers to Statewide Networks

• No demonstrated scalable architecture supported
  by MDs Hospitals Consumers
• No national trusted third party
• No viable business model

From Lewin/PSI
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Architecture Selected Feature

• Giant Master Patient Index or Switch links and
  retrieves disparate medical information at
  originating sources
• Reliable and Fast. 99.98 availability
  patient-centric record in 4 to 5 seconds
• Non-profit PSI and its members own the license
  for the open architecture technology, not a for
  profit vendor

From Lewin/PSI
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Molly Coye, M.D.

• Health Tech - Founder CEO
• A.H.A - Board
• IOM
• To Err is Human
• Crossing the Quality Chasm
• California - Director of DHS
• New Jersey - Commissioner

From Coye/HealthTech
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Molly Coye Health Tech Convened

• Stakeholders
• Payors - Insurance
• Providers - MDs
• - Hospitals
• - Pharmaceuticals
• Government
• Technology - CISCO
• - Oracle
• - HP

From Coye/HealthTech
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The Need for State Leadership

• California lags
• Legislation Wyoming, Florida, Delaware
• Planning bodies
• Funding
• Stakeholders brought to the table
• Medicaid and indigent care
• Disease management
• Investment in IT as administrative match
• RHIO formation
• gt 400 communities in the U.S.

From Coye/HealthTech
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California Health Information Exchange Project -
Vision

• VISION
• Support the use of information technology, and
  the creation of a statewide health information
  data exchange system to
• Improve the safety and quality of healthcare in
  California
• Improve the efficiency of healthcare in
  California

From Coye/HealthTech
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Better, Cheaper Care and Projections of State
Savings

• Projected net annual benefit, at 75 adoption
  rate, for Massachusetts 2.48 billion
• Electronic communication between patients and
  their physicians
• Electronic prescribing
• Ambulatory computerized physician order entry
• Inpatient CPOE
• Regional data sharing
• Intensivist onsite 24x7 in ICUs
• Disease management
• New England Healthcare Institute Advancing
  Innovation, November 2003 www.nehi.net

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New England Healthcare Institute Estimates
Massachusetts Savings
Total Net Annual Benefit 2.5 Billion
Regional Data Sharing
E- Prescribing
Patient-Physician Email
140
24
168
E-ICU
Ambulatory CPOE
177
Disease Management
290
Millions
710
Inpatient CPOE
977
Advanced Technologies
www.nehi.net - October 2003
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The Tipping Point Are We There Yet?
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Emergence of Health Data Exchange in California
From Coye/HealthTech
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California Health Information Exchange Project -
Goals

• Cal-RHIO GOALS
• to help the organizers of regional efforts in
  California share information, materials,
  technology, and learnings
• to facilitate
• development of common governance, processes,
  technology, and other elements of regional
  healthcare information organizations (RHIOs) in
  California, and
• encourage the formation of one or more RHIOs
  within the state, with a statewide umbrella
  organization
• to help key stakeholders in the health care and
  business communities and state policy leaders
  develop private and public policy agendas that
  will support the
• rapid development and implementation of health
  care information technology within California,
  and the
• protected exchange of that information

From Coye/HealthTech
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California Health Information Exchange Project -
Commitments

• COMMITMENTS
• to promote widespread access to the benefits of
  information technology and data exchange for
  underserved populations and safety net providers
• to make the project, its website and
  publications, and proposals for organizational or
  technical developments publicly available for
  comment and contributions.

From Coye/HealthTech
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California Health Information Exchange Project
Draft Principles

• DRAFT PRINCIPLES
• Transparent
• Common approaches to technology, governance,
  financing, and other aspects of information
  technology investment and data exchange
• Across California
• Between California and national efforts
• Sound business and financing models for each
  component
• Inclusive

From Coye/HealthTech
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California Health Information Exchange Project -
Organization
STATEWIDE UMBRELLA ORGANIZATION
From Coye/HealthTech
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www.healthtech.org

• The Vision
• Advancing the use of new technology to make
  people healthier
• The Mission
• To create a trusted source of expert information
  about the future of health care technologies
• The Means
• A non-profit pooled research center for delivery
  systems and health plans.
• Funding independent of developers and vendors of
  technology

From Coye/HealthTech
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State Agenda for IT Transformation

• Federal role
• Clear the underbrush
• Standards and certification
• Fraud and abuse, Stark
• Enable RHIOs
• Build the highways
• Network certification for data exchange
• Public use data
• Public health
• Quality and safety
• Defense
• Health quality and efficiency reports
• Reimbursement

From Coye/HealthTech
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State Agenda for IT Transformation

• State agenda
• Bank accounts for all
• EHR, direct access for all Californians
• Security and confidentiality
• Access for underserved
• Neural networks across the state
• Providers, anceillary, plans, patients
• Regional data exchange networks coalesce
• Establish RHIOs to provide governance, financing
• State investment in IT and IT-enabled programs
• Medi-Cal financing and savings
• Uninsured, county responsibilities
• Private public infrastructure model
• Remote management approaches
• Rapid research and deployment mechanisms
• Focus on chronic care, disabled, rural and
  underserved, and SNF populations
• Reduce risk
• Generate savings
• Need for leadership

From Coye/HealthTech
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GOAL

• Information technology and creation of statewide
  health information data exchange to
• Improve quality and safety of healthcare in
  California
• Improve efficiency and provide cost effective
  healthcare in California