information technology: putting the patient at the center of the information flow 25th annual...
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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
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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
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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
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• 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
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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)
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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
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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
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• 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
November 6, 200926Carter Symposium -- Kolodner
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
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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
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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.
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In SummaryIn Summary
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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