Bridging the Chasm Nina Schwenk MD FACP Washington

Bridging the Chasm Nina Schwenk, MD FACP Washington DC April 20, 2009 CP 1318694 -0

Meeting Goals • Establish the value of standards and interoperability to the clinical community • Identify priorities from a clinical perspective • Have clinicians clearly articulate their requirements in non-technical terms • Identify common processes by which the specialty groups can define and communicate information requirements to the HIT community CP 1318694 -1

Thank You CP 1318694 -2

Health Care Information Technology Standards & Interoperability Summit November 18 - 20, 2008 Providers invited to summit included: • Cleveland Clinic • Mayo Clinic • Dartmouth • Ochsner Health System • Health Partners • Palo Alto Medical Foundation • Henry Ford Health System • Partners Healthcare • Kaiser Permanente • University of Pittsburgh Medical Center • Intermountain Healthcare • Vanderbilt Medical Center • Lahey Clinic • Virginia Mason Medical Center CP 1318694 -4

Health Care Information Technology Standards & Interoperability Summit November 18 - 20, 2008 Vendors invited to summit included: • Avaya • IBM • Cerner • Intel • Cisco • Lawson • Dell • Mc. Kesson • Epic • Microsoft • GE Health Care • Oracle • Google • Siemens • Hewlett Packard • Sun Microsystems CP 1318694 -5

Summit Goal Through a consensus process identify three to six health care IT-dependent solutions that will overcome critical barriers to patient-centered health care delivery through increased interoperability and application of established national and international standards. Engage participating provider and IT partner groups to work collaboratively to develop these solutions. CP 1318694 -6

Provider Session CP 1318694 -7

Agenda • Barriers to Patient-Centered Care Delivery • Using Health IT to Advance Health Care Reform: Moving Beyond Theory to Pragmatic Solutions Dr. Robert Kolodner • Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery • Creating an Action Plan for Providers CP 1318694 -8

Which of these statements best describes the U. S. health care system today? (select one) 1. Complete state of crisis 2. Overall – major problems 3. Some segments with major problems 4. Few segments with major problems 5. No significant problems CP 1318694 -9

Rank these entities on the degree they would influence health reform: (Rank each item 1 to 10 with 1 being no influence, 10 being major influence) Federal government State government Health care providers Health care payers Employers/non-health organizations Consumers/individuals CP 1318694 -10

In your opinion, how much influence do you think the following groups have had on increasing medical costs in the United States? (Rank the list in order of influence) 1. Doctors and hospitals 2. Drug companies 3. Medical technology companies 4. Insurance companies 5. People who don’t take care of themselves CP 1318694 -11

Difficulty In the next 100 days, how difficult/important will it be for President Elect Obama to address the following topics: (Rank each item 1 to 10 with 1 being not difficult, 10 being very difficult) 1. Healthcare 2. War 3. Illegal immigration 4. Automaker bailout 5. Banking bailout 6. Foreign Policy CP 1318694 -12

Importance In the next 100 days, how difficult/important will it be for President Elect Obama to address the following topics: (Rank each item 1 to 10 with 1 being not important, 10 being very important) 1. Healthcare 2. War 3. Illegal immigration 4. Automaker bailout 5. Banking bailout 6. Foreign Policy CP 1318694 -13

I m p o r t a n c e Difficulty CP 1318694 -14

Barriers to Patient-Centered Care Delivery • Health Care Reform Cornerstones • Creating Value • Coordinated Care • Payment Reform • Health Insurance for All CP 1318694 -15

Barriers to Patient-Centered Care Delivery • Perspectives • Patient • Provider • Purchaser • Payer CP 1318694 -16

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Using Health IT to Advance Health Care Reform • “Moving Beyond Theory to Pragmatic Solutions” Dr. Robert Kolodner CP 1318694 -18

Overview of the Federal Health IT Strategic Plan • Establish a governance structure that coordinates organizational processes • Protect the privacy and security of patient health information • Enable the movement of health information by setting standards that allow interoperability • Promote adoption of technologies • Establish a nationwide health information network CP 1318694 -19

ge an ch Ex ility & ab ng ri er ha erop S on & Int ti a rm ards fo In nd * ta S * CP 1318694 -20

Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery CP 1318694 -21

Health Care Ecosystem Today Patients Government Providers Compliance Purchasers Regulators Payers Industry CP 1318694 -22

e” bl ra pe tem ro te ys “in os ec of ck care La th al he CP 1318694 -23

Business Case for “Interoperable” Health Care Ecosystem • Value • • Cost Coordinated Care Innovation New Business Opportunities Effectiveness and Efficiency Intelligence gathering Market CP 1318694 -24

Health Care IT Dependent Opportunities • Personal Health Record • Patient Provided Information • • Vocabulary Universal Patient Identifier Clinical Data Architecture Standard, interoperable core medical information • Affordability to purchasers and patients/efficiency • Standard measures of value • Safety (clinical quality) • Coordination of care • Device manufacturer standardization • Clinical decision support tools • Medication reconciliation • Standardized network-tonetwork interoperability • Infrastructure vendor collaboration • EMR vendor collaboration CP 1318694 -25

Patient Centered (Rank each item 1 to 10 with 1 being low priority, 10 being high priority) Personal Health Record Patient provided information Vocabulary Universal patient identifier Clinical data architecture Core medical information Affordability to purchasers and patients /Efficiency Standard measures of value Safety (Clinical quality) Coordination of care Device manufacturer standardization Clinical decision support tools Medication reconciliation Standardized Network-to-network interoperability Inter-organizational interoperability Infrastructure vendor collaboration EMR vendor collaboration CP 1318694 -26

Business Value (Rank each item 1 to 10 with 1 being low priority, 10 being high priority) Personal Health Record Patient provided information Vocabulary Universal patient identifier Clinical data architecture Core medical information Affordability to purchasers and patients /Efficiency Standard measures of value Safety (Clinical quality) Coordination of care Device manufacturer standardization Clinical decision support tools Medication reconciliation Standardized Network-to-network interoperability Inter-organizational interoperability Infrastructure vendor collaboration EMR vendor collaboration CP 1318694 -27

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Provider priorities to support health care Value and Coordinated Care • Universal patient identifier • Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for communication among EMRs, PHRs, medical devices and more. • Vocabulary • Standardized network-to-network interoperability (i. e. NHIN) • Medication reconciliation CP 1318694 -29

Creating an Action Plan for Providers 1. Establish a provider coalition that 2. 3. would drive a collective agenda to advance the top two priorities developed here Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape Advance the top two priorities developed here by integrating with the existing landscape CP 1318694 -30

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Creating an Action Plan for Providers Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape CP 1318694 -32

Joint Provider/IT Vendor Session CP 1318694 -33

Agenda • Review Provider session outcomes • Engage IT Vendors in discussion regarding barriers and solutions • Determine next steps CP 1318694 -34

Provider expectations for IT Partners Universal patient identifier IT partners must support the use of a voluntary and/or required universal patient identifier CP 1318694 -35

Provider expectations for IT Partners Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for exchange among EMRs and PHRs and others. • Vocabulary • Standardized network-to-network interoperability (i. e. NHIN) • Medication reconciliation IT partners must support interoperability standards CP 1318694 -36

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Joint Action Plan for Providers and IT Vendors Establish a coalition to advance the top two priorities developed here that connects to the larger landscape CP 1318694 -38

Coalition Output to Date • Letter of support to Congress (HIT funding) • HIT Framework for Action (principles for HIT investment) • Input to the ONC on its Strategic Plan update CP 1318694 -39

Coalition Output to Date • Position on “Meaningful Use” provision in the Stimulus Bill • Grant proposal for stimulus funding to further coalition objectives • Invite additional members? CP 1318694 -40

Thank You CP 1318694 -41

Thank You CP 1318694 -42