UNYPHIED

1
UNYPHIED

• Synopsis
• Of
• First Annual
• Connecting Communities for Better Health
• Conference
• Washington D.C.
• June 24-25, 2004

2
Agenda

• About eHealth Initiative
• About the Conference
• General Sessions
• Breakout Sessions
• Summary Conclusions
• Recommendations
• QA

3
About eHealth Initiative

• Our MissionThe missions of both the eHealth
  Initiative and its Foundation for eHealth are the
  same to drive improvement in the quality, safety
  and efficiency of healthcare through information
  and information technology.

4
About eHealth Initiative

• Our VisionConsumers, health care providers, and
  those responsible for population health will have
  ready access to timely, relevant, reliable and
  secure information and services through an
  interconnected, electronic health information
  infrastructure to support better health and
  healthcare.

5
About eHealth Initiative

• Our Strategic Priorities
• 1.  Align incentives and promote public and
  private sector investment in improving Americas
  healthcare through information technology (IT)
  and an electronic health information
  infrastructure
• Drive investment in research related to the value
  of IT in addressing quality, safety and
  efficiency challenges
• Fund strategic demonstration projects
• Develop policy options to both align incentives
  and enable public and private sector investment
• Dramatically increase national awareness of the
  role of IT

6
About eHealth Initiative

• Our Strategic Priorities
• 2.  Develop the field to enable more widespread
  and effective implementation of IT and an
  electronic health information infrastructure
• Engage national experts to aggregate and develop
  knowledge, resources, and tools for key
  challenges areas related to IT and a health
  information infrastructure
• Provide resources and tools to help communities
  and stakeholders implement IT and a health
  information infrastructure through the Connecting
  Communities for Better Health Community Learning
  Network and Resource Center
• Expand information sharing beyond the U.S. by
  facilitating a global dialogue on the challenges
  and strategies for implementing an electronic
  health information infrastructure through the
  Leadership in Global Health Technology
  Initiative.

7
About eHealth Initiative

• Our Strategic Priorities
• 3.  Continue to drive the adoption of standards
  to promote an interoperable, interconnected
  healthcare system through work with key partners.

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About the Conference

• Structured as breakout sessions flanked by
  general sessions in the beginning and at the end
• 18 Vendor booths 5 Community posters
• Software
• Hardware
• Consulting
• Community Posters

9
About the Conference

• Breakout sessions covered many topics
• Technology
• Public Health Partnerships
• Private Sector Solutions
• Legal Regulatory
• ePrescribing
• Engaging Patients
• Engaging Employers
• Engaging Clinicians
• Clinical Knowledge Not Attended

10
General Sessions

• Panel of representatives from communities that
  are at some point down the path of a community
  wide health care data exchange
• Lessons learned
• Bold Vision
• Radical Incrementalism 6-month chunks

11
General Sessions

• Lessons learned (continued)
• Technology is complex dont underestimate
• 2 schools of thought on CDE
• Not for profit Switzerland
• Trusted 3rd party
• Get it funded
• Development Implementation Phase Grants
• Ongoing support
• Membership
• By the click

12
General Sessions

• Lessons learned (continued)
• Identify community leaders and get them involved
• Create Strategic Plan first
• Need people with vision and a passion for the
  mission
• Take advantage of vendor talent
• Be as inclusive as possible

13
General Sessions

• Lessons learned (continued)
• 90 of 30B in HC transactions are on paper
• HIEI Healthcare Information Exchange
  Interoperability will save U.S. 337B over next
  10 yrs.
• Providers 34B
• Electronic medical records can save primary care
  providers an estimated 86,400 over five years,
  compared to traditional paper-based methods.
  Benefits include, reduced drug-spending,
  reductions in radiology, decreased billing
  errors, and improved charge capture for billing.
• Payers 22B
• Labs 13B

14
General Sessions

• AARP John Rother, Dir. Policy Strategy
• Huge potential of IT in health reform
• Consumer plays central role in his/her healthcare
• AARP wants to be directly involved
• Patient owns the data legally, morally, and
  ethically

15
General Sessions

• HRSA Health Resources Services Administration
• TeleVillage
• TeleHealth
• TeleMedicine
• OAT Grants Office for the Advancement of
  TeleHealth
• http//telehealth.hrsa.gov

16
Breakout Sessions

• Technology
• 2-schools of thought
• Napster-like model (Massachusetts)
• Connect not collect
• Brokered Peer-to-peer
• Pointers DB
• Hub structure (Santa Barbara)
• CDE starting to collect information to perform
  analytics
• Patient identification is difficult

17
Breakout Sessions

• Leveraging Public Health
• 80 of ER encounters are reported to Dept. of
  Health in NYC now, after 9/11
• NEDSS National Electronic Disease Surveillance
  System
• This broad initiative is designed to
• To detect outbreaks rapidly and to monitor the
  health of the nation
• Facilitate the electronic transfer of appropriate
  information from clinical information systems in
  the health care system to public health
  departments
• Reduce provider burden in the provision of
  information
• Enhance both the timeliness and quality of
  information provided

18
Breakout Sessions

• Leveraging Public Health
• PHIN Public Health Information Network
• HAN Health Alert Network
• NY Academy of Science Syndromic.org

19
Breakout Sessions

• Private Sector Solutions
• Learnings
• Understand the goals of the stakeholders around
  the table
• Engage patients early
• Passionate, zealot driver
• Get consultant whos done this before
• Methodology
• Governance
• Technology Selection - RFP

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Breakout Sessions

• Private Sector Solutions
• Learnings (continued)
• Vendor
• Dont let vendor decide shape of solution
• Turn it over to them for implementation
• Form an organization structure to contract with
  the vendor
• Leverage an ASP model
• Plan for long term sustainability
• Membership or per click

21
Breakout Sessions

• Private Sector Solutions
• Learnings (continued)
• Get a big of the data to get big of savings
• Architecture needs to be light, standard, robust,
  and scalable
• Contractual performance measures
• Treat vendor as partner, as part of the team
• Employers get immediate return, go to the big
  ones in your area

22
Breakout Sessions

• Private Sector Solutions
• Learnings (continued)
• Be all inclusive, let them self-opt out
• Include pharmaceutical companies
• IT vendor can be a broker of the information
  assets if they are a trusted 3rd party, but
  better off if a NFP contracts with the vendor
• NFP needs to insulated from politics
• NFP needs to be run like a For Profit

23
Breakout Sessions

• Legal Regulatory Issues
• Decide on purpose of LHII up-front
• MOU between participants
• Funding
• Leadership
• Plan for real revenues

24
Breakout Sessions

• Legal Regulatory Issues
• Governance
• User Agreement duties and rights of members
• Liabilities indemnification
• Proper use of network
• Ownership of network and data
• IP
• Revenue of analytics

25
Breakout Sessions

• Legal Regulatory Issues
• Vendor agreement
• Rewards penalties
• Restrictions on referrals
• Anti-kickback statute Stark statute
• Stark has an exception for IT provided to
  physician for community-wide health initiatives

26
Breakout Sessions

• Electronic Prescribing
• Planning and Implementation to Achieve Success
  and Maximize value
• Electronic prescribing all systems that use
  a computer to enter, modify , review or
  communicate drug prescriptions
• Stages of eRx (reference only to full EHR
  integration)
• Careful design including implementation

27
Breakout Sessions

• Value of eRx
• Reduction in error rate, ADEs
• Time savings/ workflow improvement
• Reduced pharmacy call backs
• Decision support, alerts
• Formulary compliance
• Patient medication lists
• Reduced influence of detailing and DTC

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Breakout Sessions

• eRx Implementation Issues
• Provider perspective/buy-in
• Practice needs, users and access
• Compatibility with other systems and pharmacy
  communication
• Start up/training and migration to EMR
• Stand alone vs. EHR
• Vendor selection

29
Breakout Sessions

• eRx Implementation Issues (contd)
• Eligibility driven formulary mapping
• Assessing compliance
• Shared medication lists
• Address all implementation issues prior to
  purchase !

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Breakout Sessions

• Engaging Patients and Consumers
• Lack of awareness of quality gap
• Favorable alignment of forces
• President Bush EO
• Congressional leadership
• Market factors
• Corporate board/committee activism

31
Breakout Sessions

• Personal Health Record
• Patient can see, add, consolidate, control
• No minimum data set
• Various types depending on the application or
  sponsor
• institutional gateway
• portable continuity record
• medication management only
• untethered

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Breakout Session

• Desirable Features of PHR
• Personal control
• Comprehensive
• Longitudinal
• Break the glass function
• Tethered

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Breakout Sessions

• Physician concerns of PHR
• Quality of information
• Ability to modify or add
• Liability for content
• Read only?
• Trustworthy data e.g. PDF

34
Breakout Sessions

• Implications of PHR for Future
• Seamless linking of all data sources
• New models of self/chronic care
• Cultural transformation

35
Breakout Sessions

• Engaging the Employer
• Critical importance of healthy workforce to
  productivity
• Employers are IT believers (business devotes 8.5
  of operating budget to IT vs. 1.5 4 for
  healthcare)
• Business leaders failed in waiting so long to
  develop incentives for IT

36
Breakout Sessions

• Engaging Employers (contd)
• Multiple efforts underway now to reform
  healthcare using IOM aims
• Leapfrog
• Bridges to Excellence
• P4P, tiered networks
• Value based purchasing
• Private - Public collaboration

37
Breakout Sessions

• Engaging Employers (contd)
• Problem of free ride
• Potential for employers to reduce fragmentation
  of IT through board and committee participation
• Plan for future align incentives, educate
  employees/policy makers, contract for connectivity

38
Breakout Sessions

• Engaging Clinicians
• Value of IT and information exchange
• Barriers to overcome
• affordability
• workflow concerns
• compatibility/interoperability
• data stewardship

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Breakout Sessions

• Making the Business Case to Physicians
• ROI concerns
• who makes the investment?
• who gets the benefit?
• Patient safety
• Office efficiency
• The right thing to do
• Incremental steps or whole enchilada

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Breakout Sessions

• Physician Use of EHR in the Future
• Apprentice model of training
• Incentives for use
• Pay for performance
• Profile information
• Peer pressure
• Government mandates?

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Summary Conclusions

• Goals, Objectives, Strategy, Ownership,
  Governance up-front
• Engage Community
• Radical Incrementalism
• Funding

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Recommendations

• Establish all planning pieces
• Inclusion
• Vision
• Strategic Plan
• Objectives
• Ownership
• Governance
• Funding

43
QA