Using Technology to Bridge the Chasm of Quality

Using Technology to Bridge the Chasm of Quality in Healthcare By Stephen H. Carson, MD Associate Clinical Professor, UCSD Chief Med Officer, SDCMS Foundation

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 -3 X 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

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

Physician Goals for Technology n Improve quality, service, and safety of medical care n Increase the efficiency of workflow n Secure single “sign on” tool to import ALL data to the point of care in an “easy to read” integrated format n Clinical guidelines and decision support n Continuing education n Patient risk assessment n Community continuity of care records & registries n Automated patient reminders n Eligibility/Benefits/Claims verification n e-Rx: eliminate handwriting error & adverse reactions n Maintain privacy and confidentiality

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

The Problem Today Physicians can require up to 20 separate log on procedures, passwords & agreements to gather data from each patient contact point Lab, X-Ray, Pharmacy Patient Contact Points Requester Organizations Hospital/ER MD Office Health Plan

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

Physician/Patient Continuum Hospitals, X-ray, Labs Lab, X-ray, discharge summaries, consultant and other reports Medical Groups Data only labs, X-ray, meds, diagnosis, allergies, immunizations, consultant reports, discharge summaries and more e. Rx option *Patient information retrieval and more extensive storage *Electronic Rx Healthplans *Eligibility *Benefits San Diego Medical Information Network Exchange CCR option *Data retrieval *Electronic Rx *Centralized record SDCMS. org EMR option *Electronic Rx *Full EMR *CCR *Patient Education *Advocacy *CME *Events Calendar *Physician Resources Decision Support *Care planning *Clinical advice *Local guidelines Public Health Dept. Informed San Diego #211 Network of Care Public Health Nurses Bio-terrorism/ Health Alerts Disease Surveillance Pharmacy Benefit Managers and Pharmacies Health Plan Formularies Patient Medication Lists Drug alerts Allergy alerts Sure Scripts and Rx Hub

Sponsors SDCMS Foundation CAL Institute for Technology and Telecom Directory (Phone, Address, Email, Mapquest) • Healthplan • Physicians • Hospitals • Labs / Xray • Pharmacy • Home Health • Nursing Care Links Info. Line Patient Education • In Multiple Languages Dr Tango. com Adam. com SD Dept. of Public Health • SDIR (immunizations) • e. Man • Networkof. Care San Diego Medical Information Network Exchange (SDMINE) Help Desk Hosted by Electronic Prescribing - Doctor. First Electronic Medical Record - Chart Connect Practice Management - Elligence Med. Plus • Secure Exchange of Medical Information • e. Rx and Continuity of Care Record • Eligibility and Benefit Verification Business Clearinghouse Check, Credit Card and Debit verification Supplies • PSS Automatic Appointment Reminder Sure. Scripts *Pharmacy Links/Formulary Information Clinical Decision Support - Enigma 1 Med. Link – Single Sign On/Password Management Medical Group Sub. Portals

Sure. Scripts = 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 Pharmacies Physician Practices

Current System Plagued by Serious Quality and Patient Safety Problems Rx Rx • Patient safety Rx *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 l Illegible handwriting l Phone tag and fax tag l Patient waiting in the pharmacy 11

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Predictors of Health • • Racial +/- Ethnic Group Income Education Level Literacy Income Employment status Age Geographic Location of Home

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