Health Information Technology Workshop Institute for Family Health

Health Information Technology Workshop Institute for Family Health July 10, 2009 How to Develop a Sustainable Community Health Information Infrastructure n n n William A. Yasnoff, MD, Ph. D, FACMI Managing Partner, NHII Advisors Founder and President, Health Record Banking. HAlliance N I I ADVISORS © 2009

“The development of an information technology infrastructure has enormous potential to improve the safety, quality, and efficiency of health care in the United States” - Institute of Medicine, Crossing the Quality Chasm, 2001 2 N H I I © 2009 ADVISORS

Sustainable Community HII Defining the Goal II. A Framework for Understanding the Challenges III. Solution: Health Record Bank q Functions & Operation q Rationale q Business Model IV. Next Steps I. 3 N H I I © 2009 ADVISORS

Health Information Today n n n 4 Scattered Records l Each person's records are scattered at whatever locations care has been given l Mostly paper Information sharing not effective l Cumbersome, expensive, time-consuming, and fallible l No mechanism to collect patient information from disparate sources No responsible institution l Each patient's complete records (from all sources) are not available for care l Need to create these institutions N I © 2009 H I ADVISORS

Health Information Today (cont. ) n 5 Consequences of health information deficit l Medical errors common – 44, 000 -98, 000 preventable deaths/year (just in hospitals) l Quality poor – only 55% of adults receive recommended care (RAND study) l Costs out of control – rising >10% annually – consuming an increasing proportion of GDP N – now $2+ trillion/year and growing I © 2009 H I ADVISORS

Goal: Comprehensive Patient Information at Any Point of Care n n 6 All medical records must be electronic Combine multiple scattered records into complete “master” record Enable rapid review l Graphs l Charts l Enhancement of relevant information Automated reminders to improve quality and reduce errors N I © 2009 H I ADVISORS

II. A Framework for Understanding the Challenges P - Privacy n I - Information n U - Usage n S - Sustainability n 7 N H I I © 2009 ADVISORS

Privacy & Patient Control n n n 8 Surveys of “information hiding” l 2006: 13% of consumers l 2007: 17% of consumers Consumers already control information in their records Without control, too many will opt out OR politically force system shut down Choices are today’s system or consumer control -- complete information without consent is not (and should not be) a viable option Patient control essential © 2009 N H I I ADVISORS

Privacy Requirements n n n 9 Patient Control l Essential for trust l Forces stakeholder cooperation Trusted Institution l Local governance (now) l Government regulation (later) Trusted Architecture l Secure repository l Operate like classified military system © 2009 N H I I ADVISORS

Information n n 10 Electronic l Need financial incentives for physician electronic health record (EHR systems) Interpretable l Standards very desirable Transmitted (at no charge) l Patient requests for records must be honored under HIPAA Stored l Central repository (in a community) © 2009 N H I I ADVISORS

Usage n n 11 Ensure use in care l ? Financial incentives Avoid process disruption in physician offices l Need very high market penetration l --> Community implementation N H I I © 2009 ADVISORS

Sustainability n n 12 Subscription fees / sponsorship Advertising Query fees (with patient permission) Alerts & reminders N H I I © 2009 ADVISORS

III. Solution: Health Record Bank (HRB) n n n 13 Secure community-based repository of complete health records Access to records completely controlled by patients (or designee) “Electronic safe deposit boxes” Information about care deposited once when created l Required by HIPAA Allows EHR incentives to physicians to make outpatient records electronic Operation simple and inexpensive © 2009 N H I I ADVISORS

Health Record Bank Operation Encounter Data sent to Health Record Bank Clinician’s Bank Patient data delivered to Clinician optional payment Secure patient health data files Clinician EHR System YES Encounter Data Entered in EHR 14 Clinical Encounter Patient Permission? Clinician Inquiry NO DATA NOT SENT Health Record Bank N H I I © 2009 ADVISORS

HRB Rationale n n 15 Operationally simple l Records immediately available l Deposit new records when created l Enables value-added services l Enables research queries Patient control --> l Trust & privacy l Stakeholder cooperation (HIPAA) Low cost facilitates business model Allows EHR incentive options l Pay for deposits from existing EHRs l Provide Internet-accessible EHRs © 2009 N H I I ADVISORS

HRB Business Model n n n 16 Costs (with 1, 000 subscribers) l Operations: $6/person/year l EHR incentives: $10/person/year Revenue l Advertising: $6/person/year l Queries: ? l Reminders & Alerts: >= $12/person/year – “Peace of mind” alerts – Preventive care reminders – Medication reminders No need to assume/capture any health care savings (!!) © 2009 N H I I ADVISORS

IV. Next Steps n n n 17 For-profit HRB startups For-profit HRB establishes community non-profit for governance l Consumers l Physicians For-profit operates HRB under contract from community non-profit l Pays fee to non-profit for governance l Provides EHRs or EHR incentives to physicians N I © 2009 H I ADVISORS

Health Record Bank Organization Community Non-profits RESPONSIBLE FOR: Policy Governance Oversight Community Board of Directors Executive Director Other Staff(Optional) regulate via contract % of revenue HRB Operator Board of Directors Management 18 Marketing Operations Customer Support Many communities use single HRB Health Record Bank Operator (for-profit) RESPONSIBLE FOR: Obtaining Capital N H Operating HRB I © 2009 I ADVISORS

Summary: Sustainable Community HII I. II. III. IV. 19 Goal: Comprehensive Electronic Records Challenges q Privacy (patient control) q Information (EHR incentives) q Usage (integrate with existing workflow) q Sustainability (feasible business model) Solution: Health Record Bank Next Steps q Community Health Record Bank providers fund non-profits for N governance I © 2009 H I ADVISORS

Questions? For more information: www. ehealthtrust. com www. healthbanking. org www. yasnoff. com William A. Yasnoff, MD, Ph. D, FACMI william. yasnoff@nhiiadvisors. com 703/527 -5678 20 © 2009 N H I I ADVISORS