MEANINGFUL USE

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MEANINGFUL USE

• September 14, 2009

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THIS IS GOING TO BE VERY, VERY, VERY MESSY

• In 1901, there were 2,000,000 phone users in the
  US
• Cumulative public and private investment was
  500M, or 13B in 2009 dollars (about 6500 per
  user)
• Networks were operated by
• ATT 1.3m
• Independent networks 700k
• Number of independent networks 2,811

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RECOVERY ACT FUNDING FLOWS
Funding Source
Distribution Agency
Program
Funding Use
Fund Recipients / Beneficiaries
Medicare Payment Incentives 20B
CMS
Medicare Carriers Contractors

• Acute care hospital
• Childrens hospitals

Entitlement Funds
Requires Meaningful use of EHR
Physicians
Medicaid Payment Incentives 14B
CMS

• Nurse Practitioner
• Midwife

State Medicaid Agencies
Requires 30 share of Medicaid (except Childrens
Hospitals)
Federally Qualified Health Centers
Designated State Entity
HIE Planning Development (at least 300M)
ONC
Planning Grants
Implementation Grants

• Non-profit
• Consulting
• Vendors

EHR Adoption Loan Program
ONC
Loan Funds for States
State Govt
Loans
Loan Funds for Indian Tribes
Health IT Extension Program
HHS Agency TBD
Provider Organizations
Health IT Research Center
Indian Tribes
Appropriated Funds
Services
Regional Extension Centers

• Non-profit
• Consulting
• Vendors

Least Advantaged Providers
Workforce Training Grants
HHS, NSF
Medical Health Informatics
EHR in Med School Curricula

• Higher Education
• Medical School
• Graduate schools

New Technology RD Grants
NST, NSF
Health Care Information Enterprise
IntegrationResearch Centers

• Federal Govt Labs

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WHY DO SO MANY PHYSICIANS OFFICES LOOK LIKE THIS?
Prescription refill request on fax machine
(Right behind the joke of the day)
Hey Sally! Where is Mrs. Jones x-ray?
Printer with results from one lab
Unopened mail
Courier just dropped off more envelopes
Unsorted results
Web portal (from one hospital)
About to ring with stat results
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THE EHR MARKET IS MOVING, SLOWLY, BUT ALSO
CREATING A DIGITAL DIVIDE IN THE PROCESS
Source CDC Center for Health Systems Change
National Ambulatory Care Survey
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HEALTH IT SPENDING IN ARRA
Various studies and reports Health information
exchanges Regional health IT resource
center Regional health IT extension centers State
implementation and planning grants EHR loan
funds NIST certication infrastructure
47B
2B
45B
Direct payments to individual providers
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US GOVT EXPECTING TO GET 50 PAYBACK ON ARRA
HEALTH IT INVESTMENTS
-13B
35B
1B
Financial benefit 16B
2B
-3B
2B
33B
Net cost 20B
18B
Increased tax revenues
Incentives ONC funding
Savings to government
Cost of administration
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MEANINGFUL USE DOESNT JUST HAPPEN, IT GETS DONE
Illustrative EHR Implementation Value Chain
Overall project management
Readiness assessment planning
Practice transformation workflow planning
System deployment Implementation
Post- implementation support
Reporting, decision support, and performance
measurement
Inter-operating with internal and external
systems
Vendor contracting and management

• Gaps at any point along the way will kill
  adoption

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PAYMENTS MAY NOT COVER THE OUTLAYS AT AN
INDIVIDUAL PHYSICIAN-LEVEL
K
Physician cost
Medicare incentive
Net gap -21K
8
-5
4
-10
-5
2
-5
12
-30
-5
18
-5
2009
2010
2011
2012
2013
2014
2015
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MEANINGFUL USE INTEROPERABILITY REQUIREMENTS
COULD PUSH THE ENTIRE INDUSTRY TOWARD HIE
Meaningful Use objectives requiring health
exchange

• Increases volume of transactions that are most
  commonly happening today
• Lab to provider
• Provider to pharmacy

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ESTIMATED STATE-LEVEL HIE FUNDING ALLOCATIONS
millions
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Measure Process Workflow
Source HIT Standards Committee, 9/15/2009
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MAeHC ARCHITECTURE AND DATA FLOWS
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CLINICAL USE OF DEPLOYED EHRs of Encounters
Documented Clinically in EHRs (Q2 2006 Q2 2008)

Community 1
Community 2
Community 3
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BREAKOUT OF CLINICAL USE MEASUREMENT
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Records Received By MAeHC QDCThrough May 2009
000

• 437,000 total records since Jul 2008
• 57,000 records received in May 2009

Brockton
Newburyport
North Adams
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QUALITY DATA CENTER IS BECOMING A PUBLIC
UTILITY, AS WELL AS A COMMERCIAL PLATFORM
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http//www.maehc.orgMicky Tripathi, PhD
MPPPresident CEOmtripathi_at_maehc.org781-434-79
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