using technology to bridge the chasm of quality in healthcare by stephen h. carson, md associate...
TRANSCRIPT
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Using Technology to Bridge the Chasm of Quality in Healthcare
By Stephen H. Carson, MD
Associate Clinical Professor, UCSD
Chief Med Officer, SDCMS Foundation
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Facts Driving SDCMS Foundation Concerns
• Medical bills = #1 cause of personal bankruptcy in the U.S• U.S. has 45 million uninsured and 40 million underinsured • U.S. spends 1.5-3X more per capita as countries with universal
healthcare and yet the outcomes are no better• Healthplans collectively profited $4 billion last year• Patient are shouldering more of the costs of healthcare with
deductibles and copays increasing & benefits decreasing• Plans are dropping out of non-profitable markets.• Corporate corruption / Obscene executive salaries• Medical errors have not decreased despite cost increase• VA-like bidding would yield Medicare savings of $1 billion/yr• On average, 30% of premiums are not spent on patient care
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SUMMARY OF FOUNDATION PRIORITIES
• Improve access to quality medical care• Increase the quality of health care • Improve the health of San Diego County residents• Improve patient safety and reduce medical errors• Improve the coordination and timeliness of care• Improve access to all information necessary to make the
best decisions for patients at the point of care• Improve health literacy• Help ALL physicians in the county achieve these goals
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Physician Goals for Technology
Improve quality, service, and safety of medical care Increase the efficiency of workflow Secure single “sign on” tool to import ALL data to the
point of care in an “easy to read” integrated format Clinical guidelines and decision support Continuing education Patient risk assessment Community continuity of care records & registries Automated patient reminders Eligibility/Benefits/Claims verification e-Rx: eliminate handwriting error & adverse reactions Maintain privacy and confidentiality
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Barriers to MD Adoption of Technology
• Cost: Most of the Savings Accrue to the Healthplans• History of false starts• Time: Physicians are swamped with regulations (HIPAA)• Lack of standards and interoperability (HL-7)• Privacy and Security: Fear of profiling• Stakeholder commitment: Silo mentality & Competition• Healthcare industry in general is slow to change
Physicians are technophiles and recognize the value of Technology in Patient Safety and Quality Improvement
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Requester Organizations
PatientContact Points
The Problem TodayPhysicians can require up to 20 separate log on procedures, passwords
& agreements to gather data from each patient contact point
Lab, X-Ray, Pharmacy
Hospital/ER MD Office Health Plan
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HIPAA Health Insurance Portability and Accountability Act
• Administrative Simplification– Common interchange structure– Standard employer/provider identifier– Electronic signature with specific transactions– Data transmission for benefits/claims
• Information Privacy– Rights of individuals to records– Authorized uses and disclosures of information– Requires identity authentication of
requestor/provider of health records
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eRx option*Patient information retrieval and more extensive storage*Electronic Rx
CCR option*Data retrieval*Electronic Rx*Centralized record
EMR option*Electronic Rx*Full EMR*CCR
Hospitals, X-ray, LabsLab, X-ray, discharge summaries, consultant and other reports Medical Groups
Pharmacy Benefit Managers and PharmaciesHealth Plan FormulariesPatient Medication ListsDrug alertsAllergy alertsSure Scripts and Rx Hub
Public Health Dept.Informed San Diego #211Network of CarePublic Health NursesBio-terrorism/ Health AlertsDisease Surveillance
Physician/PatientContinuum
Data onlylabs, X-ray, meds, diagnosis, allergies, immunizations, consultant reports, discharge summaries and more
SDCMS.org*Patient Education*Advocacy*CME*Events Calendar*Physician Resources
Decision Support *Care planning*Clinical advice*Local guidelines
San Diego Medical Information
Network Exchange
Healthplans *Eligibility*Benefits
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SponsorsSDCMS Foundation
CAL Institute for Technology and Telecom
Directory (Phone,
Address, Email, Mapquest)
Patient Education
Links
InfoLine
Dr Tango.com
San Diego Medical Information
Network Exchange (SDMINE)Hosted by
BusinessClearinghouse
Check, Credit Card and Debit verificationSupplies
•PSS
Help Desk
•Physicians•Hospitals•Labs / Xray•Pharmacy•Home Health•Nursing Care
Electronic Medical Record - Chart Connect
MedPlus•Secure Exchange of Medical Information•eRx and Continuity of Care Record•Eligibility and Benefit Verification
SureScripts *Pharmacy Links/Formulary Information
Electronic Prescribing - DoctorFirst
Clinical Decision Support - EnigmaMedical Group SubPortals
SD Dept. of Public Health•SDIR (immunizations)•eMan•NetworkofCare
•In Multiple Languages
Adam.com
Automatic Appointment Reminder
•Healthplan
Practice Management - Elligence
1MedLink – Single Sign On/Password Management
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SureScripts = single portal to all SD Pharmacies Increases the efficiency, quality and safety of prescribing
• Based in Alexandria,VA• Formed in August 2001• Formed by:
– NACDS– NCPA
• Strategic industry alliance to:– Promote true electronic
connectivity between physicians and pharmacies
– Enable widespread prescribing connectivity (local and national)
– Reduce medical errors
Rx Rx
Physician Practices
Pharmacies
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11
Current System Plagued by Serious Quality and Patient Safety Problems
• Patient safety*1.5% to 4.0% of Rx’s have errors
with potential for serious patient risk
• Quality of care*1.1 billion scripts never filled
* Patient satisfaction issues
• Potential Savings: $ 2 billion / yr
• Impact on productivity*Physician time:1 hour per day
*Pharmacy: 4 hours per day
Illegible handwriting
Phone tag and fax tag
Patient waiting in the pharmacy
Illegible handwriting
Phone tag and fax tag
Patient waiting in the pharmacy
Rx
RxRx
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Dr. RiceWelcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
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Welcome Dr. Rice
Rice, Joe MD
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Welcome Dr. Rice
Rice, Joe M.D.
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Welcome Dr. Rice
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Welcome Dr. Rice
Joe Rice M.D.
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Welcome Dr. Rice
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Predictors of Health
• Racial +/- Ethnic Group• Income• Education Level• Literacy• Income• Employment status• Age• Geographic Location of Home
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Consequences of Poor Health Literacy
• Lack of compliance with medical regimen including missed appointments
• Medication errors and medication noncompliance• Late diagnosis• Limited preventive care• Malpractice suits
Physicians agree that one of their most important tasks is PATIENT EDUCATION
HOWEVER more than half of our patients are unable to understand
PHYSICIAN COMMUNICATION