The Role of Health Information Technology in “Crossing the Quality Chasm” – The Purchaser’s Perspective Steve Wetzell April 25, 2002

The Leapfrog Group’s Mission Trigger a giant leap forward in quality, customer service, and affordability of healthcare by:  Making the American public aware of a small number of compelling and easily understood advances in patient safety  Specifying a simple set of purchasing principles designed to promote these safety advances, as well as overall customer value

Today More than 100 large health care purchasers More than 31 million Americans More than $52 billion in health care expenditures

Why Does The Quality Chasm Exist? Purchasers — Not Buying Right Plans — Not Letting Provider Value Show Through Providers — Not Seeing Business Case for Reengineering Consumers/Patients — Not In the Quality Game New thinking needed to “leapfrog” gridlock in the health care marketplace

Why Is Health Information Technology Lagging Behind Other Industries? See previous slide.

IOM’s Six Goals – We’ve Got the Map, Now All We Need is a Road. Safe – Who else is prescribing meds for my patient? Effective – Try keeping track of 2,000 patients and 7,000 protocols in your head. Patient Centered – Online same day appointments in our lifetime. Timely – When was she supposed to come in for her mammogram? Efficient – I wonder if anyone has taken an x-ray - oh well, I’ll just call radiology and order one… Equitable – Who’s got access, who gets treatment – the mother of all chart reviews.

Information Technology – The Foundation for 21 st Century Health Care Measuring and reporting: –Quality –Efficiency –Patient experience Timely, efficient and accurate transactions Communicating among key stakeholders Clinical decision support Reducing errors

Organized effort to buy right –Purchasing principles that strongly reward higher provider value –Purchaser accountability –Push via plans or directly Create a Business Case for Providers Emphasize tangible safety leaps Mobilize Consumers and Patients Leapfrog Purchaser Strategy

Initial Safety ‘Leap’ Summary An Rx for Rx –Computer Physician Order Entry (CPOE) –Up to 8 in 10 serious drug errors prevented Sick People Need Special Care –ICU Daytime Staffing with CCM Trained M.D. or risk-adjusted outcomes comparison –> 10% mortality reduction Practice Makes Perfect –Evidence-based Hospital Referral (EHR) or risk-adjusted outcomes comparison –> 20% mortality reduction for 7 complex treatments

What are the Three Leaps Worth? Annual Gain Projected by Dartmouth:  522,000 serious med errors  58,300 deaths  58,300 X disabilities $9.6 billion per year (if fully implemented in U.S. urban hospitals)

Leapfrog Purchasing Principles - Building the Business Case for Health Information Technology Educate and inform enrollees Compare at the provider level Reward superior provider value Initially highlight 3 tangible safety Leaps Annually increase provider rewards

Measuring and Reporting CPOE Progress Six Roll-Out Regions reporting : Atlanta, California, East Tennessee, Minnesota, St. Louis and Seattle- Tacoma-Everett 497 urban hospitals invited to submit results voluntarily More than half, 256 hospitals (52%) submitted responses 53 percent meet at least one of Leapfrog’s standards for the safety practices Seattle-Tacoma-Everett – 100% participation from 25 invited hospitals 52 percent meet at least one of Leapfrog’s standards

CPOE Results – 6 Regions The Standard Computer Physician Order Entry (CPOE) Up to 8 in 10 serious drug errors prevented The Result 2.3% of the responding hospitals have fully implemented CPOE An additional 32% say they have specific plans to implement such systems by 2004

We Have Met the Enemy, and It is Us… Purchasers have to stop focusing solely on discounts. New emphasis on consumerism creates great opportunities. NQF work has the potential to be a real driver. CMS and seniors – The Nuclear Purchasers If we demand value, there will be no choice. It’s not the money, it’s the money.

That’s one small step for all of us, one giant leap for patient safety.