Medical Summit ~ Opening Remarks on the Future of Medicine

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Medical Summit Opening Remarks on the Future of
Medicine
The Honorable Aneesh P. Chopra Secretary of
Technology August 2008 www.healthitcouncil.vi.vi
rginia.gov
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Agenda for Discussion
I. Vision over the Next Five Years
II. Vision over the Next Ten Years
III. Vision over the Next Twenty Years
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Health IT a Driver of Virginias Quality and
Transparency Agenda
Setting the Stage
Disparities in Outcomes
Health Reform Commission
Infant Mortality Rates

1. Access to Care Focused on the uninsured
2. Workforce Focused on nurses, nursing support
   (direct care workers), and physicians
3. Aging / Long Term Care Focused on services for
   the aging and disabled
4. Quality / Transparency / Prevention Focused on
   Pay-for-Performance in Nursing Homes price,
   quality, information transparency and infant
   mortality, tobacco cessation, obesity

Deaths Per 1,000
Southwest Virginia Drug Deaths

• Suffered 264 drug related deaths in 2006 (up 22)
• More than 200 or 75 due to prescription drug
  abuse
• Rate of drug deaths per 100k more than 5 times
  the state average

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Road Map for Health IT
Comprehensive Reform Agenda to Deliver on the
Promise of Health IT
I Organizing Procurement
II Establishing a Policy Framework
III Seeding Innovation
DHRM Public-Private Partnership Fulfill EO42
through innovative partnership to provide health
IT-powered services for state employees Innovati
on Grants Seed capital to advance EMR adoption
across Virginias communities
Enterprise-Wide EMR Establish a public-private
partnership to participate in CMS Pilot for small
practice EMR adoption goal to leverage program
to encourage public sector adoption
Administrative Simplification A public-private
consortium to lower administrative costs,
targeting smaller providers Accountability and
Transparency Apply for Chartered Value Exchange
to improve transparency and quality information
within the Commonwealth
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The Next Five Years
CMS EHR Demonstration Turbo-Charges Small
Practice Purchases

• Purpose Drive adoption of EHRs in primary care
• Virginia one of only 12 sites awarded
• Target Small-medium PCP practices (lt20 MDs)
• Goal Attract 200 practices in VA (100 control,
  100 study)
• Incentives Through additional Medicare
  reimbursement, participating providers will earn
  for
• Year 1 Adoption of CCHIT-certified EHR
• Year 2 Reporting of quality measures
• Year 3-5 Clinical improvements (P4P)
• Value 58,000 per physician or 290,000 per
  practice over five years

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Vision Develop Applications Center of Excellence
in Rural Virginia
EHR Adoption
E-Store for EHRs
Goal Establish a public-private partnership to
support multiple EMR applications in a shared
services center Problem Deliver EMR services
at low-cost in an environment that encourages
rapid best practice adoption Strategy Simplify
EMR acquisition, drive public sector adoption,
and promote rural economic development
In October, 2006, Virginia invested 150K in the
OnePartner Advanced Technology and Applications
Center, expected to employ 40 jobs
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Lower Administrative Costs
Payer-Provider Collaborative to Lower Transaction
Costs
Universal Eligibility Portal
Goal Lower transaction costs associated with
verifying a patients insurance eligibility by
jointly procuring a common portal for Virginia
providers to use when interacting with Virginia
Payers Scope Allow a provider to retrieve
up-to-date eligibility information on a patient
from any participating Virginia health plan from
a single point of entry. Timeline RFI responses
due August 15th, 2008 selection expected
October, 2008 implementation in 2009
The VHEN Charter
Following an initial summit in Richmond with
Virginia payers and providers discussing scope
and focus for a Virginia Administrative Exchange
modeled on NEHEN, the VHEN workgroup formalized a
charter in October 2007. Charter members include
9 Health Plans and 7 Health Systems including
MCV, UVA, Riverside, Anthem-Wellpoint, Aetna, and
DMAS.
Source CORE Patient Identification Survey, 2006
funded, in part, by California HealthCare
Foundation
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The Next Ten Years
Universal Broadband to Become the Foundation of
Health Reform
Case Study
Description Following merger with Centra Health,
SCH saves 48K in telco bill and secures 45
rural health funding by leveraging MBC Tobacco
Commission approves 750k towards broadband
access for qualified rural clinics to match 2.7M
FCC grant Virginia launches Virginia Telehealth
Network to increase services that elevate care
quality through broadband access
Physician Broadband Access 2007 TN Survey
Only 18 of one rural Virginia hospitals medical
staff have access to high-speed broadband service
40
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Urban TN
Rural TN
The Opportunity
In 2007, Governor Kaine formalized the Broadband
Roundtable to better understand emerging
technologies, applications, and financial models
to encourage communities to provide broadband
access.
Represents T-1 Level Service or Above
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Public-Private Partnerships
Evidence-Based Medicine a Key Pillar of
Innovative Programs
Cardiac Care Best Practices Centra Health
Health Plan IT-Related Services Virginia
Department of Human Resources

• DHRM has accepted an unsolicited proposal under
  the PPEA act to provide wrap-around services for
  the Employee Health Plan
• Many firms have proposed to lower costs for the
  Commonwealth by creating a data warehouse with
  business intelligence and a customer service
  center to help advise state employees on the
  intervention that will most likely resolve their
  problem at the lowest cost
• Goal to prevent duplicative care and minimize
  challenges felt by employees navigating the
  complex healthcare system
• DHRMs comprehensive care management vision is
  truly ground breaking. Once operational, it will
  mark COVA as a leader among state employee
  medical plans and private industry Joe
  Marlowe Aon Consulting, May 2008

• Centra awarded Health IT Innovation Grant to
  allow community physicians to participate in
  ACCs National Cardiovascular Data Registry
  (NCDR) Program for Improving Continuous Cardiac
  Care (IC3)
• Centra to provide access to the IC3 program
  through an existing EMR that will allow
  physicians to exchange real-time data and best
  practices in cardiac care
• Centra is matching the Commonwealths investment
  of 150,000 with a 100,000 contribution for a
  total investment of 250,000 for this project

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Missing Clinical Information Affects Care
The Next Twenty Years
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Physicians Increasingly Reluctant to Seek
Information
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Supporting the Diagnosis Decision
A Virginia Story
"One of the things I try to model for my
residents is that I'm trying to learn new things
even though I've been doing this for a long
time."  Pediatrician Stephen Borowitz

• When presented with unusual symptoms that do not
  match the current diagnosis doctors can turn to
  Isabel which is easily accessible on all clinical
  units at UVAHS.
• Isabel can provide a list of diagnoses, some of
  which might be outside the normal pattern doctors
  can fall into.
• It does not replace the decision-making of the
  Doctor but it does provide powerful tools to
  augment the memory of each doctor.

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Hand-washing Mining Data to Save Lives
Identifying the Value of Hand-washing Through
Data Analytics
A 19th Century Super-Cruncher
Institute for Healthcare Improvement
Goal Save 100,000 lives a year Method Look at
how people are dying in hospitals and then
determine if there are any large-scale
statistical evidence that could point the way
towards a solution
As far back as the 1840s, doctors have worked to
analyze data to improve healthcare
interventions. Dr. Semmelweis noticed an
alarmingly high mortality rate for infants born
in his division (18) compared to only 4 in
another OB group.
Results Dr. Berwick found that systematic
hand-washing along with a few other changes could
account for as many as 25,000 lives a year in
just ICU patients.
After careful review, he instituted a mandatory
hand-washing program and observed the mortality
rate fall to 1.8 Unfortunately, his work was
not accepted by his peers, delaying data-driven
medical efforts for over a century
Central Line Catheters Infection Rates
gt125,000
Reduced infections by 90
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Recommended
Current Practice
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Are We Heading Towards Google-Powered
Self-Diagnosis?
Kasparov vs. Deep Blue
Google announces Google Health to help store and
organize personal information
Microsoft launched HealthVault to organize
information, personal records