Innovation in HIT --- Health Information Technology California

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Innovation in HIT --- Health Information
Technology Californias Untapped Health Care
Asset

• Jack Lewin MD
• CEO, California Medical Association
• CCST Meeting-----UC Irvine
• October 2005

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Ironies
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Health Information Technology---Its Time Has
Come

• Practice Management
• Patient and Personal Records
• Quality of Care

4
Some Physicians Are More Able to Participate in
the Quality Agenda Than Others
5
Distribution of Physicians by Practice
ArrangementUS Market, 1984-2001
Percent
43
40
Employees
Self-Employed Group
37
28
23
Self-Employed Solo
Employees include group, hospital, medical
school, government, health plan and ambulatory
physician employees.
Sources AMA Physician Masterfile, 2003, AMA
Physician Socioeconomic Statistics, 2003 Aventis
Pharmaceuticals, 2003
6
Are Consumers Really Interested in Quality of
Care?
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YES But, What is Quality?
8

• Consumerism
• Short-term Health Trend, or the Future?

9
Consumer-Driven Healthcare Trends

• Changes in the health insurance market
• Changes in who pays for healthcare
• Likely market influence of HDHPs/HSAs
• Future physician demographics and solo
  practice
• Influence of purchasing collaboratives
• Consumerism and quality

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How Real is the Quality Problem?
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Distribution of Fee-for-Service Medicare Spending
Among Beneficiaries, 1997
Percent
Fee-for-Service Beneficiaries
Total Fee-for Service Spending
Source Congressional Budget Office
12
Percent of Americans Saying I Have A Chronic
Condition

Source Chronic Illness and Caregiving Survey,
Harris 2000
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RAND Study Quality of Health Care Often Not
Optimal

• Doctors provide appropriate health care only
  about half the time

Percentage of time
E. McGlynn, S. Asch, J. Adams, et al., The
Quality of Health Care Delivered to Adults in the
United States, N Engl J Med, 2003
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Measurement-Based QI Can Make a Difference
Proportions of patients receiving the
appropriate discharge prescriptions

• Intermountain Health Care QI effort on CVD
• Results
• 90 prescription rates
• 27 decrease in unadjusted absolute death rates

Lapp acute, J. M. et. al. Ann Intern Med
2004141446-453
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How Will Costs of Care Interact with Quality?
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The Future Increasing Value

• Competition at the level of the individual
  patient care and disease
• Plans and doctors distinguished by quality
  outcomes
• Potential of Risk-Adjusted Premiums
• Real consumer choice information
• Transparency
• The Need for HIT Systems!!!

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How has practice changed?
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Health Information Technology, Quality, and
Reimbursement Are Interactive Issues

• EHRs
• PMRs
• New practice management systems, CPOE, e-Rx
  etc.
• Democratized interoperability and connectivity
• The Physicians Foundations!

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Actually, Its the Pipeline, Stupid!
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The Patient Safety Institute (PSI)
Improve patient safety, by making the following
available
Patient-Specific Clinical Data
Rx
Acute Care Data
Ambulatory Data
At Point Of Care
Pharmacies
Physicians Treating Patients at Any Location
Clinics Physician Organizations
Reference Laboratories

• Physician-Specific Preferred
• Wired and Wireless Devices
• Palm Pilot
• Windows CE / Pocket PC
• RIIM
• Browser

Acute Care Data
AMR, Rx, Lab
HIS Systems CDR LIS
Ambulatory Data
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PSI The Network
Clinic A
Hospital 1
Hospital 2
PSI Hub
Clinic B
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PSI Response to Physician
Clinic A
3
3
Hospital 1
Hospital 2
PSI Hub
Clinic B
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The Current State of Physicians, Hospitals, and
Health Care

• Lack of Technically Trained Staff
• Lack of Good Info on Best Systems
• Angry About Disappointing Investments
• Costs Out of Reach
• Practice Workflows Antiquated
• Dead Ends
• Isolation vs. Interoperability

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Who Gets The ROI for H.I.T Investment in Health
Care?
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The Holy Grail
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Opportunities for California

• CMS/CBO estimates 81 B national savings if
  HIT solutions were realized- --8B here
• Twice that would be saved (16 B in CA) in
  related care improvements
• The Medi-Cal program could be a major
  beneficiary
• Approaching the Tipping Point

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This is Californias Legacy