1. The Role of Health Information Technology in Health Care Reform Health Reform Congress Washington, D.C. September 23, 2008
Janet M. Marchibroda
Chief Executive Officer
eHealth Initiative and eHealth Initiative Foundation
September 23, 2008

2. What Problems Are We Trying to Solve? Concerns About Quality and Safety
U.S. adults receive about half of recommended health care services.
Barely half of adults (49%) receive preventive and screening tests according to guidelines for their age and sex
Preventable medical errors in hospitals cause 120,000 deaths per year
1.5m preventable adverse drug events every year
September 23, 2008

3. What Problems Are We Trying to Solve
What Problems Are We Trying to Solve? Concerns About Rising Healthcare Costs
Health care spending in the United States is expected to increase from 16% of the gross domestic product—or $2 trillion, to 20% of the GDP—or $4 trillion by 2016
21% of employers report it is "very likely" and 28 percent reported that it was "somewhat likely" that they would increase the amount that employees pay for health insurance in the coming year
Health insurance premiums for workers and their employees have increased by 87% since 2000, while workers' earnings have risen by only 20% over the same time period
September 23, 2008

4. What Problems Are We Trying to Solve
What Problems Are We Trying to Solve? Chronic Disease is Growing Problem
More than 125 million Americans had at least one chronic care condition in 2000, and this number is expected to grow to 157 million by the year 2020.
While 12.7% of the population during the year 2000 was age 65 or older, this number is expected to grow to 20 percent by the year 2030.
People with chronic conditions absorb a majority of healthcare spending in the U.S. accounting for 78% of all health care spending in 1998.
September 23, 2008

5. Concerns About Quality and Safety Consumer Perspectives
Kaiser 2006 survey indicates over half of adults are dissatisfied with the quality of health care
….And almost a third, “very dissatisfied”
54%
31%
Source:  2006 Kaiser Family Foundation “Health Care in America Survey”
September 23, 2008

6. Concerns About Rising Healthcare Costs Consumer Perspectives
Eight in ten are dissatisfied with the cost of health care in this country 
…..With a majority “very dissatisfied”
81%
56%
Source:  2006 Kaiser Family Foundation “Health Care in America Survey”
September 23, 2008

7. Health IT is a Key Strategy for Addressing Health Care Challenges
September 23, 2008

8. Strategies for Addressing Healthcare Challenges
“Transparency” in Quality and Efficiency
Financial Incentives for Improved Health Care (“Pay for Performance”)
Consumer Engagement and Activation
Health Information Technology
September 23, 2008

9. Percent responding “very effective/effective”
Key Strategies for Improving Quality and Safety According to 2007 Commonwealth Fund Survey of Health Care Opinion Leaders
“Below is a list of key strategies that have been proposed for improving quality and safety of care. How effective do you think these strategies are?”
Percent responding “very effective/effective”
Accelerating the adoption of health information technology
Public reporting of provider performance on quality measures
Financial incentives for improved quality of care
Stronger regulatory oversight of provider
National voluntary quality campaigns
Source: Commonwealth Fund Health Care Opinion Leaders Survey, July 2007.

10. Health IT is not an end unto itself…it is a means to an end….
So How Do We Get There?
Health IT is not an end unto itself…it is a means to an end….
September 23, 2008

11. eHealth Initiative Blueprint Our Shared Vision
A high-performing healthcare system:
where all those engaged in the care of the patient are linked together in secure and interoperable environments
where the decentralized flow of clinical health information directly enables the most comprehensive, patient-centered, safe, efficient, effective, timely and equitable delivery of care where and when it is needed most – at the point of care.
September 23, 2008

12. eHealth Initiative Blueprint: Five Key Areas of Focus
Engaging Consumers
Transforming Care Delivery
Improving Population Health
Aligning Incentives
Managing Privacy and Security
September 23, 2008

13. Current Health Care Reform Focus Areas Could Benefit From Health IT Today, But They Don’t….
Billions of dollars are spent each year to:
measure and improve care,
conduct research,
monitor the effectiveness of treatments and safety of medications,
track public health threats,
engage consumers in their own health care, and
manage chronic disease
While these processes rely greatly on health information, few are tapping into the the electronic clinical health information that currently resides in physician offices, hospitals, laboratories, pharmacies and other health care-related organizations.
September 23, 2008

14. Why Not? It’s never been down before… It’s too hard….
We’re still working on the standards….
We can’t get agreement on which priorities we’ll focus on
There’s an entrenched set of players that like it just the way it is….why change?
Concerns about privacy and confidentiality
Disconnect between the care delivery system and the population improvement system
September 23, 2008

15. Our View…. Let’s not let the perfect be the enemy of the good
Experimentation with a few advanced stage initiatives can show that “this can be done”
Numerous iterations of testing and sharing across multiple environments will help us get better
Widen the circle until we get to a critical mass
It’s a different approach….but perhaps one that’s more likely to work
September 23, 2008

16. Our Approach for Building a Sustainable Model for Higher Quality, More Effective Health Care
Develop a Set of Business Cases for Electronic Health Information
Research
Test With Stakeholders
Test and Evaluate Through Learning Laboratories
Natural Experiments
Funded Pilots: National and Community-Based
Tackle
Areas That
Will Have the
Greatest Impact
And Highest Likelihood for
Success
Engage the Commitment of National Actors to Pilot or Implement
Drug Safety
Chronic Care or Disease Management
Consumer Access to Information
Research on Outcomes and Effectiveness
Quality Improvement and Performance Measurement
Build and Disseminate Replicable Tools and Resources to Support Accelerate Adoption
Influence Policy to Support Implementation
September 23, 2008

17. There Are Some National Efforts That Are Making Progress
Food and Drug Administration’s Sentinel Initiative recognizes the need to leverage electronic health information—both clinical and claims data—while effectively managing privacy, to support drug safety for the U.S.
We are making some progress on the quality front, but are struggling with the incorporation of clinical data sets…
Emerging discussion on Comparative Effectiveness, will not work unless we leverage electronic clinical health information
Chronic care management discussion needs the integration of two models: the traditional health plan/DM driven model with the medical home approach…
September 23, 2008

18. Momentum for Change Continues
September 23, 2008

19. Congressional Action An Overview of Three Major Bills
There are three major pieces of health IT legislation in Congress right now:
Wired Act (Senators Kennedy & Enzi, Senate HELP Committee). Stalled in Senate, without major changes except addition of privacy provisions
PRO(TECH)T Act (Representatives Dingell and Barton, Energy & Commerce Committee) reported favorably out of E&C on July 23, E&C released a Committee report on the bill on September 15.
Health-e IT Act (Rep. Stark, Ways & Means Committee). Introduced on September 15. Majority of language is directly from the PRO(TECH)T Act, with the addition of a new section on Medicare incentives, and some changes in standards and privacy.
September 23, 2008

20. Congressional Action An Overview of Three Major Bills
Congress plans to go out of session on September 26; any additional time spent in session in 2008 will likely deal with the financial crisis or funding government operations
A Ways & Means markup of the Health-e IT Act could occur this week, but is far from certain
Most participants in the process see this year’s deliberations as setting the stage for jumping right back into HIT next year, with HIT legislation possibly being tacked onto a comprehensive health care reform bill.
September 23, 2008

21. Medicare Bill Promotes e-Prescribing
The legislation, the Medicare Improvements for Patients and Providers Act of 2008, will
Provide positive incentives for practitioners who use qualified e-prescribing systems in 2009 through 2013.
Require practitioners to use qualified e-prescribing system in 2012 and beyond or face penalties
Reduction in payments of up to 2% to providers who fail to e-prescribe.
Exceptions for low-volume prescribers
Secretary may establish a hardship exception
September 23, 2008

22. eHI’s Recent Analysis of State Legislative Activity
HIT State Legislative Activity Is on the Rise.
In 2007:
208 bills which specifically focus on HIT have been introduced in 50 state legislatures
30 bills passed in 19 state legislatures and signed into law
In 2008 so far:
138 bills introduced in 34 state legislatures in 2008
61 of those bills have been signed into law in 29 state legislatures in 2008
September 23, 2008

23. eHI’s Recent Analysis of State Legislative Activity
September 23, 2008

24. Overview of State Efforts on HIT Legislation
HIT State Legislative Activity Is on the Rise.
State legislatures are increasingly recognizing the importance of IT in driving health and healthcare improvements.
In 2005 and 2006:
38 state legislatures introduced 121 bills which specifically focus on HIT
37 bills were passed in 24 state legislatures and signed into law.
In 2007:
208 bills which specifically focus on HIT have been introduced in 50 state legislatures
30 bills passed in 19 state legislatures and signed into law
In 2008 so far:
141 bills introduced in 34 state legislatures in 2008
61 of those bills have been signed into law in 29 state legislatures in 2008
September 23, 2008

25. Breakdown of State Efforts on HIT Legislation
Legislation (Total)– by Type
State sponsored HIE: 15
Funding: 54
E-Prescribing: 21
Privacy/Security: 24
Standards: 20
Quality Improvement: 23
PHRs: 3
Patient Access: 10
EHRs: 49
Legislation (Enacted)– by Type
State sponsored HIE: 7
Funding: 22
E-Prescribing: 11
Privacy/Security: 9
Standards: 9
Quality Improvement: 6
PHRs: 1
Patient Access: 5
EHRs: 16
September 23, 2008

26. Administration Action
In process of implementing e-prescribing provisions of the Medicare bill
EHR pilots being conducted by CMS
Trial implementation results announced today
Work of AHIC transitioning to private sector
Still awaiting a privacy and security framework
September 23, 2008

27. Presidential Candidate Platforms Obama
Direct Statements about Health IT
Invest $10 billion per year over next five years in broad adoption of standards-based health IT
Phase in requirements for full implementation of health IT
Assure that systems are developed in coordination with providers and front-line workers, including those in rural and underserved areas
Assure that patient privacy is protected
September 23, 2008

28. Presidential Candidate Platforms Obama
Policies That Will Provide Indirect Support
Supporting disease management programs
Supporting coordinated and integrated care, care management programs that encourage team care through implementation of medical home type models that improve coordination and integration of care of those with chronic conditions
Aligning incentives with excellence. Develop and disseminate best practices. Align reimbursement with provision of high quality care
Comparative effectiveness reviews and research. This information is developed by reviewing existing literature, analyzing electronic health care data, and conducting simple, real world studies of new technologies
September 23, 2008

29. Presidential Candidate Platforms McCain
Direct Statements about Health IT
Promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines
September 23, 2008

30. Presidential Candidate Platforms McCain
Policies That Will Provide Indirect Support
Providing quality, cheaper care for chronic disease by emphasizing prevention, early intervention, healthy habits, new treatment models, new public health infrastructure, and the use of information technology
Promoting coordinated care with providers collaborating to produce the best health care. Paying a single bill for high-quality disease care which will make every single provider accountable and responsive to the patient’s needs
Bringing transparency to healthcare costs. Make public more information on treatment options and doctor records, and require transparency regarding medical outcomes, quality of care, costs and prices. Facilitate development of national standards for measuring and recording treatments and outcomes
September 23, 2008

31. Results of eHI’s 2008 Survey on Health Information Exchange at State and Local Levels
September 23, 2008

32. Background on eHI Annual Survey
Since 2004, eHI has conducted an annual survey to provide a comprehensive look at current activities and maturation of HIE
Survey looks at multiple levels of the system: national, state, regional, local levels
Data is used by public agencies such as ONC, AHRQ, CDC and HHS to inform strategies related to health IT
Responses to the survey are self-reported
This year’s survey collected information from 130 respondents from 48 of the 50 states, the District of Columbia, and Puerto Rico
Report provides detailed look at 42 operational efforts
September 23, 2008

33. State of the Field
The number of health information exchange initiatives in each phase of development are evenly dispersed.
Thirty-nine of the initiatives included in the 2008 survey are just getting started with health information exchange, 36 are in the process of implementation, and 42 are operational.
The number of operational health information exchange initiatives has increased considerably.
The 2008 survey results indicate 42 operational health information exchange initiatives—up from the 32 reporting in 2007—indicating a 31% increase. All 32 operational health information exchange initiatives who responded in 2007 continue to be in operation in 2008.
The 2008 survey counts 18 new health information exchange initiatives.
Eighteen new health information exchange initiatives not included in the 2007 survey reported findings in 2008, demonstrating increased interest in and momentum for the use of health information exchange to improve the quality, safety and efficiency of health care in the U.S.
September 23, 2008

34. Number of Operational HIEs 2006-2008
September 23, 2008

35. Growing Impact: Reductions in Health Care Costs
A majority (69%) of the fully operational exchange efforts (29/42) report reductions in health care costs:
19 reduced staff time
11 decreased dollars spent on redundant tests
5 documented a reduction in patient admissions
5 decreased cost of care for chronic care patients
September 23, 2008

36. Growing Impact: Improvements in Care Delivery
About half (52%) of fully operational exchange efforts (22/42) report positive impacts on health care delivery.
16 improved access to test results
13 improved quality of practice life
9 decreased support staff
8 improved compliance with chronic care and prevention guidelines
6 reported better care outcomes for patients
4 reported a decrease in prescribing errors
4 increased recognition of disease outbreaks
September 23, 2008

37. Growing Impact: Positive ROI for Stakeholders
For the first time, a majority (69%) of operational exchange efforts (29/42) report a positive financial return on their investment (ROI) for their participating stakeholders.
13 reported an ROI for hospitals
9 reported an ROI for physicians practices
6 reported an ROI for health plans
5 reported an ROI for independent laboratories
September 23, 2008

38. More Operational HIE Initiatives Are Exchanging Data
Data Currently Exchanged
2008
2007
Labs 26 19
Outpatient Lab Results 25
Outpatient Episodes 23 21
Radiology Results 15
Inpatient Episodes 22 16
Dictation/Transcription 20 14
ED Episodes
Outpatient Prescriptions
Claims 18 13
Pathology
September 23, 2008

39. Continuing to Focus on Supporting Direct Care Delivery
Of the 42 operational health information exchange initiatives:
26 offer clinical messaging
26 offer results delivery
26 offer clinical documentation
16 provide alerts to providers
16 provide consultation/referral services
16 provide enrollment or eligibility checking
September 23, 2008

40. Efforts Continue to Target Population Health as a Goal
Of the 42 operational initiatives:
10 offer disease or chronic care management services
8 offer quality improvement reporting for clinicians
6 offer public health reporting
5 offer quality improvement reporting for purchasers or payers.
September 23, 2008

41. Financing Continues to Be Greatest Challenge
Development of a sustainable business model:
50% of all 130 included in the 2008 survey cited this as a very difficult challenge and an additional 32% citing this as a moderately difficult challenge.
36% of operational initiatives cite the development of a sustainable model as a very difficult challenge, with an additional 36% citing this as a moderately difficult challenge.
September 23, 2008

42. Top Sources of Start- Up Funds for Operational Efforts
Hospitals (48%)
Federal government (48%)
State government (33%)
Private payers (26%)
Philanthropic sources (24%)
September 23, 2008

43. Decreased Dependency of Federal Government
Seventy-one percent of the 42 operational health information exchange initiatives who responded to the 2008 survey communicated that they were no longer reliant on federal funds to support their sustainability. This is up from the 56% in 2007.
September 23, 2008

44. Top Sources of Funds to Support Ongoing Operations – Operational HIEs
Hospitals (62%)
Physician practices (38%)
Federal government (36%)
Private payers (29%)
State government (26%)
Public payers (24%)
September 23, 2008

45. In Summary…About the Survey
We’re making progress, but there is more work to do
Getting to a sustainable business model will require changing what we reward in health care
Current system provides disincentives for sharing information
September 23, 2008

46. Final Thoughts
Driving health care reform and change will require aligning efforts around:
Engaging consumers
Transforming care delivery
Improving population health
Aligning incentives
With the foundational underpinnings of health IT, while assuring privacy and security
September 23, 2008

47. Final Thoughts
Health care IT makes health improvement strategies better….
It’s not an end unto itself
Health IT plays a critical role in key reform efforts:
Measuring and rewarding quality
Monitoring drug safety
Measuring effectiveness
Addressing access
Improving care for those with chronic conditions
We need to do a better job aligning these activities with health IT
September 23, 2008

48. Final Thoughts
This will require finding common ground and building social capital across all the stakeholders in the healthcare system….across multiple stakeholders
This will require focus at multiple levels: national, state and local
The next steps are much harder….but we need to stay the course….
September 23, 2008

49. Final Thoughts
We have an enormous opportunity to drive significant improvements in the quality, safety and efficiency of healthcare
Let us collaborate to move this work forward!
September 23, 2008

50. Chief Executive Officer
Janet Marchibroda
Chief Executive Officer
eHealth Initiative
September 23, 2008