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California Council on Science and Technology

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Title: California Council on Science and Technology


1
  • California Council on Science and Technology
  • Steve Ryan
  • February 3, 2005

2
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

3
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

4
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

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

6
(No Transcript)
7
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

8
Summary
  • HIT is HOT AREA in Health Care
  • President Bush David Brailer
  • California leaders
  • Goals
  • Improve quality and safety
  • Reduce cost and improve efficiency

9
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

10
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

11
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
12
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

13
HIT and Physicians
  • 90 - Personal use of internet
  • lt20 (?5) EMR

14
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

15
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

16
Patient Confidentiality
  • Early concerns, e.g.
  • Local newspaper access to medical histories
  • HIPAA
  • Human Interaction
  • Patient and Physician (HC Provider)

17
  • Consumers favor IT in areas of HC but in some
    areas frequently prefer and demand high touch
    approaches

18
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

19
Models
  • Mayo IBM
  • Enabling Legislation
  • Delaware
  • Florida
  • Wyoming

20
California Status
  • Trails Other States
  • Pockets of EMR Implementation
  • Kaiser

21
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

22
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

23
Health Information Network
  • High quality care
  • Safer care
  • Lower cost
  • Reduce
  • Duplicate Diagnostic Tests
  • Unnecessary Admissions

24
Patient Safety Institute
  • Create integrated statewide
  • Clinical Information
  • Sharing Networks
  • Jack Lewin, M.D. CMA EVP/CEO

25
System Benefits
  • Patient-specific individual medicine
  • Disease surveillance
  • Research
  • Pay for units
  • Pay for performance (outcomes)

From Lewin/PSI
26
FDA/Pharmaceutical Benefits
  • FDA surveillance of past approval (Phase 4)
  • Pharmaceutical Industry
  • Costs and profits
  • Safety

From Lewin/PSI
27
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
28
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
29
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
30
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
31
Molly Coye Health Tech Convened
  • Stakeholders
  • Payors - Insurance
  • Providers - MDs
  • - Hospitals
  • - Pharmaceuticals
  • Government
  • Technology - CISCO
  • - Oracle
  • - HP

From Coye/HealthTech
32
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
33
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
34
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

35
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
36
The Tipping Point Are We There Yet?
37
Emergence of Health Data Exchange in California
From Coye/HealthTech
38
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
39
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
40
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
41
California Health Information Exchange Project -
Organization
STATEWIDE UMBRELLA ORGANIZATION
From Coye/HealthTech
42
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
43
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
44
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
45
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
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