David R. Hunt, MD, FACS

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Health IT Meaningful Transitions

• David R. Hunt, MD, FACS
• Chief Medical Officer and Acting Director, OHITA
• Office of the National Coordinator for HIT

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transition

• n. L. transitio a pasing over
• a passing from one condition , form, stage,
  activity, place, etc. to another
• the period when this occurs
• a word, phrase, sentence or group of sentences
  that relates a preceding topic with a succeeding
  one.

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Medicine used to be simple, ineffective and
relatively safe. Now it is complex, effective
and potentially dangerous.
Sir Cyril Chantler

• The role and education of doctors in the delivery
  of healthcare.
• Hollister Lecture delivered at the Institute of
  Health Services Research, Northwestern
  University, Illinois, USA. October 1998. Lancet
  1999353117881.

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Take Home Messages

• Meaningful change must be led by clinicians
• Meaningful success is wholly dependent on
  partnership
• Transition requires a system, resources, and
  courage

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Energy of Activation for a Reaction (Ea)
A
Ea without catalyst

B
Ea with catalyst
Energy
Energy Released by Reaction
AB
Time
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Energy of Activation for a Reaction (Ea)
Without Recovery Act

Payer
With Recovery Act
Energy
Efficiency and Quality
Care
Time
7
Large Practices (gt 11 docs)
EHR Adoption by Practice Size
Small Practices (lt5 docs)
42
37
21
4
Percentage of physicians
With notes, Rx orders, ability to order and
obtain lab results
Medium Practices (gt 6-10 docs)
Physicians
DesRoches, V, et. al. Electronic Health Records
in Ambulatory Care A National Survey of
Physicians N Engl J Med July 200835950-60.
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Change is Underway Drivers of Health IT Adoption
Drivers of Health Information Technology
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(No Transcript)
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Section 3001 The National Coordinator shall
develop infrastructure that

1. ensures that each patient's health information
   is secure
2. improves health care quality, reduces medical
   errors, reduces health disparities
3. reduces health care costs
4. provides appropriate information
5. ensures the inclusion of meaningful public
   input
6. improves the coordination of care
7. improves public health activities
8. facilitates health and clinical research and
   health care quality

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improve, ensure, reduce, protect, facilitate,
promote, improve
Contd

• (9) promotes early detection, prevention, and
  management of chronic diseases
• (10) promotes a more effective marketplace,
  greater competition, greater systems analysis,
  increased consumer choice, and improved outcomes
  in health care services and
• (11) improves efforts to reduce health
  disparities.

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Major Barriers to Adoption of Electronic Health
Records
Capacity to select contract, install, implement
Transition productivity loss
Concerns about system obsolescence
Finding an EHR to meet needs
Uncertainty of return on investment (ROI)
Amount of capital needed
DesRoches, V, et. al. Electronic Health Records
in Ambulatory Care A National Survey of
Physicians N Engl J Med July 200835950-60.
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And I realize today that if your vision is your
vision, that and a quarter gets you a cup of
coffee. But if you can make your vision your
customer's vision, then you have a business.
Michael Saylor, CEO Microstrategy

• Washington Post
• January 9, 2002

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Maslow's Hierarchy of Needs
Maslow, Abraham (1954). Motivation and
Personality.New York. Harper. p. 236
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Health IT Hierarchy of Implementation
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Major Barriers to Adoption of Electronic Health
Records
Capacity to select contract, install, implement
Transition productivity loss
Concerns about system obsolescence
Finding an EHR to meet needs
Uncertainty of return on investment (ROI)
Amount of capital needed
DesRoches, V, et. al. Electronic Health Records
in Ambulatory Care A National Survey of
Physicians N Engl J Med July 200835950-60.
17
reckoning that all such matters should be kept
secret

• Hippocrates

Privacy
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Privacy
Principles, Policies, Procedures, Protections
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Iago Who steals my purse steals trash t is
something, nothingT was mine, t is his, and
has been slave to thousandsBut he that filches
from me my good nameAnd makes me poor indeed.

• Othello. Act iii. Sc. 3

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SEC. 3012. HEALTH INFORMATION TECHNOLOGY
IMPLEMENTATION ASSISTANCE.

• Health Information Technology Extension Program-
• To assist health care providers to adopt,
  implement, and effectively use certified EHR
  technology that allows for the electronic
  exchange and use of health information

(c) Health Information Technology Regional
Extension Centers- (1) IN GENERAL- The Secretary
shall provide assistance for the creation and
support of regional centers (in this subsection
referred to as regional centers') to provide
technical assistance and disseminate best
practices and other information learned from the
39 Capacity to implement
41 Transition productivity loss
44 Concerns of obsolescence
54 Finding an EHR to meet
needs
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SEC. 3016. INFORMATION TECHNOLOGY PROFESSIONALS
IN HEALTH CARE .
(a) In General- The Secretary, shall provide
assistance to institutions of higher education
(or consortia thereof) to establish or expand
medical health informatics education programs,
including certification, undergraduate, and
masters degree programs, for both health care and
information technology students to ensure the
rapid and effective utilization and development
of health information technologies (in the United
States health care infrastructure).
39 Capacity to implement
41 Transition productivity loss
44 Concerns of obsolescence
54 Finding an EHR to meet
needs
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Margaret Thatcher
No one would remember the Good Samaritan if he
only had good intentions. He had money as well.
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SEC. 4101. INCENTIVES FOR ELIGIBLE PROFESSIONALS.
(a) INCENTIVE PAYMENTS.Section 1848 of the
Social Security Act (42 U.S.C. 1395w4) is
amended (o) INCENTIVES FOR ADOPTION AND
MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY.
(i) with respect to covered professional
services furnished by an eligible professional
during a payment year (as defined in subparagraph
(E)), if the eligible professional is a
meaningful EHR user
50 Uncertainty of ROI
66 Amount of capital needed
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SEC. 4101. INCENTIVES FOR ELIGIBLE PROFESSIONALS
(a) (2) (A) (i) MEANINGFUL USE OF CERTIFIED EHR
TECHNOLOGY- The eligible professional
demonstrates to the satisfaction of the
Secretary, in accordance with subparagraph
(C)(i), that during such period the professional
is using certified EHR technology in a meaningful
manner, which shall include the use of electronic
prescribing as determined to be appropriate by
the Secretary
50 Uncertainty of ROI
66 Amount of capital needed
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(a) (2) (A) (ii) INFORMATION EXCHANGE- The
eligible professional demonstrates to the
satisfaction of the Secretary, the electronic
exchange of health information to improve the
quality of health care, such as promoting care
coordination.
50 Uncertainty of ROI
66 Amount of capital needed
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(a) (2) (A) (iii) REPORTING ON MEASURES USING
EHR- in a form and manner specified by the
Secretary, on such clinical quality measures and
such other measures as selected by the Secretary

50 Uncertainty of ROI
66 Amount of capital needed
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Tower of Babel
P. Breughel, the Elder, Turmbau zu Babel,
1563 Kunsthistorisches Museum, Vienna
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May you find what you are looking for
Proverb, Parable, Allegory, or News?
May you come to the attention of those in
authority
_________
May you live in interesting times
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DavidR.Hunt_at_hhs.gov

• 202-205-8118

http//healthit.hhs.gov/