information technology: putting the patient at the center of the information flow 25th annual...

Information Technology: Putting Information Technology: Putting the Patient at the Center of the the Patient at the Center of the

Information FlowInformation Flow

25th Annual Rosalynn Carter Symposium 25th Annual Rosalynn Carter Symposium on Mental Health Policyon Mental Health Policy

November 6, 2009

Robert M. Kolodner, MD

The Ultimate Reason for Health ITThe Ultimate Reason for Health IT

What quality and value of health care services do you demand?

What quality of health do you want and deserve?

Perspective for you

to consider:

November 6, 20092Carter Symposium -- Kolodner

Topics For My Brief RemarksTopics For My Brief Remarks

I. Current Health Care Challenges

II. Future of Health and Care

III. Health Information Technology (IT)

IV. And then there was $$$$

V. Potential New Health IT Direction

VI.VI. Caveats Regarding ChangeCaveats Regarding Change

November 6, 2009Carter Symposium -- Kolodner 3

Section 1Section 1

Current Health Care ChallengesCurrent Health Care ChallengesAnd Health ITAnd Health IT

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Why is Health IT a Central Strategy Why is Health IT a Central Strategy for Health Care?for Health Care?

Current Lack of Information:• Higher Costs

– Leads to 1 in 7 hospital admissions* • When care providers do not have

access to previous medical records– 12% of physician orders are not executed as written* – 20% of laboratory tests unnecessary*

• Requested because previous studies are not accessible

• Avoidable Errors– Drug errors

• Complicate 1 in 6.5 hospitalizations• Occur in 1/20 outpatient Rxs

* Revolutionizing Health Care Through Information Technology

President’s IT Advisory Committee (PITAC), 2004 November 6, 2009Carter Symposium -- Kolodner 5

Problems with Both Safety and Problems with Both Safety and QualityQuality

November 6, 2009Carter Symposium -- Kolodner 6

To Err is Human:98,000 patients die

from avoidable errors

The Quality Chasm:Every Patient

“Crossing the Quality Chasm” 2001: IOM

Americans receive on average 55% of the evidence-based

care**

** N Engl J Med 2003;348:2635-45.

Quality/Reliability Challenges Quality/Reliability Challenges Remain in Health CareRemain in Health Care

November 6, 2009Carter Symposium -- Kolodner 7

10-1 10-2 10-3 10-4 10-5 10-6

• Immunization: 55 – 94%• B-Blocker after an MI: 70 – 98%• Airline Baggage Handling: > 99.99%• Airline Safety: > 99.9999%

Frequency of Failures Occurring

From Dr. Jonathan B. Perlin. Used with permission.

New Freedom Commission on New Freedom Commission on Mental HealthMental Health

November 6, 2009Carter Symposium -- Kolodner 8

Final Report: Achieving the Promise: Transforming Mental Health Care in America

Privacy and Security: ConcernsPrivacy and Security: Concerns

• Control of information and flow• Breaches of security and violations of privacy• Technology leading policy• Identity Theft/ De-identification

• Secondary uses of data• Ability to aggregate data • Lack of understanding about

how info is currently used

• Genomic data and family history affect family members

• Consequences (loss of insurance, work, or other forms of discrimination)

November 6, 2009Carter Symposium -- Kolodner 9

Katrina: Impact Of Privacy on Katrina: Impact Of Privacy on People with MH & SA DisordersPeople with MH & SA Disorders

November 6, 2009Carter Symposium -- Kolodner 10

www.katrinahealth.org/patients.html

Community Health:Community Health:Hurricane Katrina ReliefHurricane Katrina Relief

November 6, 2009Carter Symposium -- Kolodner 11

• 50,000 New Orleans VA Patients did not lose their medical records, even when they lost their City

- Their VA Electronic Health Records followed them around the U.S.!

Section 2Section 2

The Future of Health and Care

Transforming Health Care:Transforming Health Care:

Moving from Moving from

Treating to Preventing to PredictingTreating to Preventing to Predicting

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1. Adapted from Perlin, Dr. Jonathan B, Healthcare 1015 & beyond: Some Thoughts on Planning Ahead, p. 95

Perspective of People on Their Future Perspective of People on Their Future HealthHealth CareCare• Stay Healthy

• Prevention

• Increased Self-Care • Personal Health support

• Convenient Care• Minimize time and travel• Tele-care • Tele-monitoring

• High Quality, Coordinated Care• Enable care across providers & sites• Allow access to a lifetime of information –

wherever and whenever They choose

Better HealthNovember 6, 2009Carter Symposium -- Kolodner 14

Future Health Care DirectionFuture Health Care Direction

November 6, 2009Carter Symposium -- Kolodner 15

Person-Centered

Patient-Centered

Patient-Focused

Person-FocusedPatient-Centric

Consumer-??

^̂an

dan

d

Section 3Section 3

Health Information Technology (IT)

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Health IT – Role in Health Care Health IT – Role in Health Care TransformationTransformation

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Health IT solutions must support the needs of

BOTH “perspectives”

Population Health (Public Health, R&D, Quality Improvement,

Emergency Preparedness)

Health Care Transformation (Higher Quality, More Efficient, Patient-

Focused)

^̂an

dan

d

Key Health IT Components to Key Health IT Components to Enable TransformationEnable Transformation

• Electronic Health Records (EHR / EMR)• Personal Health Records (PHR)• Population Health Information

(Public Health, Biosurveillance, Quality Improvement, Research, Emergency Preparedness)

November 6, 2009Carter Symposium -- Kolodner 18

A Robust, Interoperable, Health IT Environment:

• Standards (Data, Technical and Security)• Interoperable Health Information Exchange Network

(Nationwide Health Information Network - NHIN)

Health ITHealth ITUser populationsUser populations

November 6, 2009Carter Symposium -- Kolodner 19

PopulationHealth

Care Providers

Individuals

Person-centeredPerson-centered

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PopulationHealth

Care Providers

Individuals

HoweverHowever

This is NOT about technology…

It is about RESULTS:

• Improved Health Care Quality

• Containing Health Care Costs

• Improved Health Care Outcomes

November 6, 2009Carter Symposium -- Kolodner 21

• Improved HealthImproved Health

Section 4Section 4

And then there was $$$$

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The The American Recovery and American Recovery and

Reinvestment Act Reinvestment Act of 2009of 2009

American Recovery and American Recovery and Reinvestment Act (ARRA)Reinvestment Act (ARRA)

Health Information Technology for Economic and Clinical Health Act

[HITECH Act] in H.R.1

http://www.whitehouse.gov/the_press_office/ARRA_public_review/

November 6, 200924Carter Symposium -- Kolodner

American Recovery and American Recovery and Reinvestment Act (ARRA)Reinvestment Act (ARRA)

November 6, 200925Carter Symposium -- Kolodner

American Recovery and American Recovery and Reinvestment Act (ARRA)Reinvestment Act (ARRA)

Estimated $17,200,000,000 net over 10 years starting in 2011

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Key Acronyms and Phrases for Key Acronyms and Phrases for U.S. Health ITU.S. Health IT

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NHIN

HITSPHIT Policy

Committee

HIT

Sta

nd

ard

s C

om

mit

tee

ONC

CCHIT

Breach notification

Meaningful Use

Section 5Section 5

Potential New Health IT Directionand Impact

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Disruptive Changes Are the Disruptive Changes Are the “Norm”“Norm”

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Clay Christensen’s StatementClay Christensen’s Statement

“Head on competition drives prices up. Disruption drives cost and prices down.”

HIT Platform Meeting – BostonSept 30, 2009

November 6, 200930Carter Symposium -- Kolodner

Disruptive Innovations in (Health) Disruptive Innovations in (Health) ITIT

GENERAL TRENDS:

• Users have more capabilities at lower cost

• Users can create their own individual “environment”• Simple-to-use

• Configuration settings• Downloads• Rearrangements of application locations

• Users are creating more of their own content and posting it on the web for all to see• Web 2.0• Web 3.0• Health 2.0

November 6, 2009Carter Symposium -- Kolodner 31

Disruptive Innovations in (Health) Disruptive Innovations in (Health) ITIT

New Business Models:

• More “Open Source” solutions available• Changing business models – “user-centered”• Business opportunities through support services rather than

“vendor lock”• Enables users to share solutions more widely and accelerate

innovation

HOWEVER• “Open Source” ≠ Free

November 6, 2009Carter Symposium -- Kolodner 32

Transforming HealthTransforming Health

November 6, 2009Carter Symposium -- Kolodner 33

The “locus of control" is changing.

Section 6Section 6

A Few Caveats Regardingthe Pattern of Change

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How Transformational Change How Transformational Change OccursOccurs

November 6, 2009Carter Symposium -- Kolodner 35

TIMETIME

Health IT Tipping Point

Transformational Change in Health Care Delivery & Health

EHR Adoption

Opportunities Created by the World Wide Opportunities Created by the World Wide WebWeb

November 6, 2009Carter Symposium -- Kolodner 36

A Repeating, Predictable A Repeating, Predictable Cycle…Cycle…

November 6, 2009Carter Symposium -- Kolodner 37

Cited in Paykel, ES and Coppen A, Eds. Psychopharmacology of affective disorders. Oxford University Press. 1979, page 160.

November 6, 2009Carter Symposium -- Kolodner 38

In SummaryIn Summary

November 6, 200939Carter Symposium -- Kolodner

Health IT “Success”: A Vision for 300 MillionHealth IT “Success”: A Vision for 300 Million

You have• Safe, high quality, efficient, convenient care

wherever you are• Health IT is woven into the fabric of health care delivery nationwide

• Your health information available to you or whomever YOU choose – anytime, anywhere

• The information to make informed choices to improve your health and well-being

• Timely, personalized, context-sensitive health information serves as a valuable and useful resource

• Trust that your privacy is protected• And that your health information can be aggregated with that of others –

without compromising your privacy

November 6, 2009Carter Symposium -- Kolodner 40

The Ultimate Reason for Health ITThe Ultimate Reason for Health IT

November 6, 2009Carter Symposium -- Kolodner 41

Health IT is a key enabler for us

ALL to get:

The quality and value of health care services we demand

The quality of health we want and deserve