Iowa HIMSS Chapter Meeting This is our Time

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Iowa HIMSS Chapter Meeting This is our Time
Healthcare Leadership in the face of Adversity
John C. Wade President JCWade and Associates,
LLC (former CIO Saint Lukes Health
System) (former Chairman HIMSS) September 25,
2008
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Agenda

• Background Information
• Uninsured/underinsured - its impact
• Regional Impact
• National Trend
• Healthcare spending trends
• impact on US economy
• Changing roles of insurance and banking in
  healthcare
• HIMSS and shaping National Issues (former
  Chairs Perspective)
• Current vs. projected
• What Lies Ahead
• Questions

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The Best Place to Get Care, The Best Place to
Give Care
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What Drives the Digital Healthcare Initiatives

• P ATIENT SAFETY PROFITABILITY
• A CCESS TO TIMELY ACCURATE INFORMATION
• T HROUGHPUT CAPACITY
• I MAGE/INFLUENCE IN THE COMMUNITY
• E RROR REDUCTION
• N -TEGRATION
• T ECHNOLOGY PARTNERS

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• Health Industry Issues
• (What Keeps the former HIMSS Chair awake at night)

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Uninsured/underinsured

• Impact
• Regional
• National

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Key Kansas City Statistics(number in thousands)

• Population 1,757
• 20.8 of KS/MO
• 0.063 of USA
• 3.9 Unemployment
• Uninsured (14.6)
• Total 200 - 255
• No Physician Visit 86 - 110
• Births without Prenatal Care 2.2
• Missed InPatient Admits 12.9
• Excess E/R Utilization 54.3

Source Center for Practical Bioethics - June,
2006
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Key Statistics (Projections)(numbers in million)

• Population KC USA
  1.8 281.4
• Uninsured
• Total .25 40.8
• No Physician Visit .11 17.5
• Births w/out Prenatal Care .002
  0.5
• Missed InPatient Admits .013 2.1
• Excess E/R Utilization .054 8.5
• Financial/Social Consequences

Source Center for Practical Bioethics - June,
2006
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Healthcare Spending Trends

• Impact on US Economy

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Revenue and Volume Ambulatory Care vs Acute Care
2.4 Trillion (16.2 GDP)
Critical Care Units
Inpatient Med/Surg Units
Large Group Practices
Hospital Outpatient Departments
Small Physician Offices
Acute Care
Ambulatory Care
Sources Health Affairs W4-79, 2003 NAMCS
Report, CDC, 2002
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Inpatient EMR Adoption

• 2006 2007
• Clinical Data Repository 63.7 67.1
• Clinical Decision Support 52.9 51.6
• Enterprise EMR 46.7 52.8
• Order Entry 85.3 86.2
• CPOE 34.3 38.1
• Physician Documentation 18.8 29.2
• Controlled Medical Vocabulary 9.1 13.7

Source HIMSS Analytics March, 2008
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Ambulatory EHR Adoption Gap
Note each symbol represents 25,000 physicians
Of 700,000US physicians, 500,000 have an
office practice.Of those
Sources AMA Physician Manpower report MGMA
AAFP Forrester Research Cntr for Studying
Health System Change
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Key Healthcare Indicators

• 16.2 - of current GDP supporting Healthcare
• 2.4 Trillion - current supporting Healthcare
• 4.8 - current USA unemployment
• 17.7 - current KC area uninsured
• 36 million - Inpatient admissions per year
• 1 billion - Outpatient Encounters per year

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Key Healthcare Trends

• Projected
• 20.0 - GDP by 2013
• 4.8 Trillion healthcare spending by 2013
• ??? - 2013 USA unemployment
• 60.0mil ? under/ uninsured
• - Inpatient admissions per year
• 2 billion?? O/P encounters per year??

• Current
• 15.4 - current GDP supporting Healthcare
• 2.4 Trillion - current supporting Healthcare
• 4.9 - current USA unemployment
• 56.0 mil - currently uninsured
• 36 million - Inpatient admissions per year
• 1 billion - Outpatient Encounters per year

26.0 - projected GDP supporting Healthcare by
2017
CBO forecasts 2/27/08
J Wades Forecast - Bankruptcy of America
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Changing roles of insurance and banking in
Healthcare

• Case Study KC REE

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Kansas City Regional Electronic Exchange (KC REE)

• A Community-Wide Collaborative Effortto support
  the exchange of secure health information across
  the Kansas City region at an affordable cost to
  all

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KC REE Background

• Version 1 KCREE -- HIPAA Transactions
• Limited to Claims/Eligibility data
• Goal to streamline regional data transmissions
• Governance discussions subsumed KCREE
• Disbanded when market changes started
• Version 2 KC REE
• Start with Claims/Eligibility/Payment data
• Goal - Move gradually to PHR/CHR
• Support move to Ambulatory EMRs for MDs

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The KC Electronic Exchange Landscape of Today
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KC REE Phase II Vision
Greater KC Region
Regional Hospitals
Metro Hospitals
Affiliated Physicians
Patient
Flow of Patients Across Network and KC Region

• Support the seamless flow of patients across
  KCREE provider network
• Enable caregiver access to patient information to
  promote effective safe care
• Be positioned to collaboratively share
  information in the KC region

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ROI NEHEN Transaction Costs - from Dollars to
Pennies
NEHEN
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Evolving Business Model - KCREE
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KC REE Value Proposition

• Reduction in processing costs of 2,040,063
  annually - 6,120,198 in a three-year period.
• Projected savings do not include internal
  efficiencies
• Projections do not include physician office
  transactions

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KC REE EMR ApproachCrawl, Walk, Run
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KCREE Project
KC Community Health Record (HealthE)??
2008/9
III
2007/8
2006/7
KC REE
Clinic (KCCARE) EMR Records
II
MD Office EMR Record
II
I
Financial Institutions
MD Office BillingRecord
MD Office BillingRecord
I
Lab Records
Lab Records
Lab Records
Lab Records
II
Lab Records
Hospital EMR Record
Payor Payment Record
Pharmacy Fill Records
Hospital Billing Record
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Payor Payment Record
Pharmacy Fill Records
Hospital Billing Record
Payor Payment Record
Pharmacy Fill Records
Hospital Billing Record
Payor Payment Record
Pharmacy Fill Records
Hospital Billing Record
Payor Payment Record
Pharmacy Fill Records
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HIMSS - Shaping Public Issues

• What Lies ahead
• Nationally
• Regionally

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What Lies Ahead

• Healthcare Industry Mobility
• Infrastructure
• Convergence
• Voice, Data, Video, Telemetry, Video, Interactive
  Education
• Simplicity
• Devices, Access Methods
• Standards/Standardization
• Process standardization
• Best Practices
• Information Exchange

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What Lies Ahead

• Consumerism
• Security/Privacy
• Opt in/Opt out
• EMR, EHRs, PHRs, RRRs
• Push Inpatient, Outpatient, Home automation
• Trusted Source vs Patient Supplied
• RHIO, Data Bank, HIEs
• Portability of Patient Information

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Role of HIT

• Opportunities are unlimited
• No longer Technology barriers
• Ease of use
• Need to Involve the Caregivers
• Role of the MDs, Associated Caregivers
• Our Role as HIT Professionals
• Enable the providers/patients to share
• Create Patient friendly access methods
• Advocate for change

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Healthcare Costs Life Expectancy
U S A
Natl Center for Life Expectancy
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Health Expenditures - of GDP
Source CECP Health Data 2007
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Deaths per 1,000 live births

• RankCountryValue / - deaths per 1,000 live
  births
• 1. Singapore 2.30deaths 2.Sweden 2.76deaths
• 3. Japan 2.80deaths 4.Hong Kong 2.94deaths
• 5 Iceland 3.27deaths 6.France 3.41deaths
• 7. Finland 3.52deaths 8.Norway 3.64deaths
  
• 9. Malta 3.82deaths 10.Czech
  Republic 3.86deaths
• 11. Andorra 4.03deaths 12.Germany 4.08deaths
  
• 13. Switzerland 4.28deaths 14.Spain 4.31deaths
  
• 15.Macau 4.33deaths 16.Slovenia 4.35deaths
• 17.Denmark 4.45deaths 18.Austria 4.54deaths
  
• 19.Belgium 4.56deaths 20.Australia 4.57deaths
  
• 21.Liechtenstein4.58deaths 22.Canada 4.63deaths
  
• 23.Luxembourg 4.68deaths 24.Netherlands 4.88dea
  ths
• 25.Portugal 4.92deaths 26.United
  Kingdom 5.01deaths
• 27.Ireland 5.22deaths 28.Monaco 5.27deaths
• 29.Greece 5.34deaths 30.San Marino 5.53deaths
  
• 31.Taiwan 5.54deaths 32.New Zealand
  5.67deaths
• 33.Isle of Man 5.72deaths   34.Italy 5.72deaths
  

Source Geography IQ
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Is HIT a National Goal

• ask not what your country can do for you, ask
  what you can do for your country
• John F. Kennedy Inaugural Speech, Jan. 20, 1961
• I believe that this nation should commit itself
  to achieving the goal, before this decade is out,
  of landing a man on the moon and returning him
  safely to the earth
• John F. Kennedy speech to Congress, May 25,
  1961
• becomes the first man to walk on the Moon
• American Neil Armstrong - July 21, 1969

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Is HIT a National Goal

• Achieve an electronic Health Record for all
  residents of the United States by the year 2014
• President George W. Bush Inaugural Speech
  January, 2004

Will we make the goal???

• Its up to US
• Standards, Security Privacy
• Interoperability
• CCHIT Certification
• Reduction of Best of Breed
• Using Technology Partners

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Former HIMSS Chairman

• DREAM

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Des Moines Register Headline

• Iowa HIMSS Attendees Propose a New National
  Goal.

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Des Moines Register Headline

• Iowa HIMSS Attendees Propose a New National
  Goal.
• To the Moon in 8 years

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Des Moines Register Headline

• Iowa HIMSS Attendees Propose a New National
  Goal.
• To the Moon in 8 years
• Full EMRs in 4 years

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Des Moines Register Headline

• Iowa HIMSS Attendees Propose a New National
  Goal.
• To the Moon in 8 years
• Full EMRs in 4 years
• Total PHRs in 6 Years

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This is our Time

• Help your organizations succeed
• Help HIMSS succeed
• Help this country succeed
• Because when we do ---
• We/our families succeed

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Iowa HIMSS Chapter Meeting
Questions?