Patient Safety & Health IT: A Meaningful Moment David R. Hunt, MD, FACS Office of Provider Adoption Support Office of the National Coordinator for Health IT

“It soon became clear, however, that tacit assumptions -- the substance of dogma-- served as a barrier to effective communication.” Barbara McClintock (1902 – 1992) Nobel Laureate, Medicine (1983) Nobel Banquet, December 10, 1983

mo·ment (mōיmənt) n. [ME. < L. momentum, movement, impulse, brief space of time, importance < movimentum < movere, to MOVE] 1. an indefinitely brief period of time 2. a definite point in time 3. a brief time of being important 4. importance; consequence 5. Mech. the tendency to cause motion about a point or axis

Archimedes of Syracuse ( BC) Mech. the tendency to cause motion about a point or axis

Take Home Messages Meaningful change must be led by clinicians Meaningful success is wholly dependent on partnership Transition requires a system, resources, and courage

(1) ensures that each patient's health information is secure … (2) improves health care quality, reduces medical errors, reduces health disparities… (3) reduces health care costs … (4) provides appropriate information… (5) ensures the inclusion of meaningful public input… (6) improves the coordination of care… (7) improves public health activities… (8) facilitates health and clinical research and health care quality ;…” Section 3001: The National Coordinator shall develop infrastructure that …

improve, ensure, reduce, protect, facilitate, promote, improve… (9) promotes early detection, prevention, and management of chronic diseases; (10) promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved outcomes in health care services; and (11) improves efforts to reduce health disparities. Cont’d…

HITECH Act Define Meaningful Use Support Attainment of Meaningful Use Establish Public Trust Foster Health IT Innovation

Source: CDC/NCHS National Ambulatory Medical Care Survey EHR Use in U.S. Office-based Physicians dashed = 2009 Preliminary est.

Capacity to select contract, install, implement Transition productivity loss Concerns about system obsolescence Finding an EHR to meet needs Uncertainty of return on investment (ROI) Amount of capital needed Major Barriers to Adoption of Electronic Health Records DesRoches, V, et. al.; Electronic Health Records in Ambulatory Care — A National Survey of Physicians N Engl J Med July 2008;359:50-60.

Maslow's Hierarchy of Needs Maslow, Abraham (1954). Motivation and Personality.New York:. Harper. p. 236

Health IT Hierarchy of Implementation Principles, Policies, Procedures, Protections, Enforcement Functional, Reliable, Interoperable Business case, ROI, Financial and Non- financial incentives Adoption & Implementation HIE, Public Health, Efficiency, Research Incentives & Penalties Usable Privacy Engagement Public Good

“…health care reform must focus on improving health and health care value for patients… …Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care.” March 14, 2007—Vol 297, No. 10, pg. 1103

“…health care reform must focus on improving health and health care value for patients… …Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care.” March 14, 2007—Vol 297, No. 10, pg Improved individual and population health outcomes Increased transparency and efficiency Improved ability to study and improve care delivery

Nutrition Quality Basic Science Research Public Heath Education Improved individual and population health outcomes Increased transparency and efficiency Improved ability to study and improve care delivery Meaningful Use of EHRs Payment Reform Comparative Effectiveness Research Prevention & Chronic Disease Management Individual Responsibility Clinical Research Medical Education Health Literacy

Improved individual and population health outcomes Increased transparency and efficiency Improved ability to study and improve care delivery Meaningful Use of EHRs Medicare & Medicaid Incentives and penalties

Improved individual and population health outcomes Increased transparency and efficiency Improved ability to study and improve care delivery Medicare & Medicaid Incentives and penalties Adoption of EHRs Meaningful Use of EHRs Exchange of health information

Regional extension centers Workforce training Medicare & Medicaid Incentives and penalties State grants for health Information exchange Standards & certification framework Privacy & Security framework Adoption of EHRs Meaningful Use of EHRs Exchange of health information Improved individual and population health outcomes Increased transparency and efficiency Improved ability to study and improve care delivery Research to enhance HIT HITECH Act Blumenthal D. Launching HITECH. N Engl J Med Jan 4.

P. Breughel, the Elder, “Turmbau zu Babel,” 1563 Kunsthistorisches Museum, Vienna

“A man who carries a cat by the tail learns something he can learn in no other way.” Mark Twain