1. Doctors’ Office Quality-HIT: Transforming Healthcare at its Root
Thank you for allowing me to update you on our strategy for health information technology
Congratulations on nominating Mike Leavitt
His support of health information technology in Utah is well-regarded
Karen M. Bell, MD, MMS
Division Director, Quality Improvement Group, CMS
eHI Health Information Technology Summit
Washington, DC 8 September 2005

2. The President’s Vision
Medical information follows the consumer so they are at the center of their care
Clinicians have complete patient history, computerized ordering and electronic reminders
Quality initiatives measure performance and drive quality-based competition
Public health and bioterrorism surveillance are seamlessly integrated into care
Clinical research is accelerated and post-marketing surveillance expanded
We envision a future in which medical information follows the consumer and information tools guide medical decisions
(1) Clinicians have appropriate access to a patient’s medical history, including
MEDICAL RECORDS
MEDICATION HISTORY
LAB RESULTS AND
RADIOGRAPHS BUT ALSO
PREFERENCES AND OTHER PERSONAL ITEMS
(2)Clinicians order medications with computerized systems THAT
ELIMINATE HANDWRITING ERROS AND AUTOMATICALLY CHECK FOR DOSES THAT ARE TOO HIGH OR TOO LOW, FOR HARMFUL INTERACTIONS WITH OTHER DRUGS AND FOR ALLERGIES.
(3)Clinicians receive electronic reminders THAT
WILL ALLOW THEM TO APPLY MEDICAL EVIDENCE TO THEIR TREATMENT DECISIONS
THIS....
This is not about technology.
It is about how health information technology can move us toward a better future.
It is about how health information technology can enable transformation of health care –not from the top down, but from the inside out.
Using the most conservative statistics, the number of people who will be injured from ambulatory medical errors today will exceed 2000.
The number of people who will die from inpatient medical errors in American during the time of your meeting today is 120.

3. Healthcare in America Is a Behemoth
Caregivers
Organized care-delivery entities
Local / State / National authorities
Health Services (e.g. – freestanding labs)
Public health surveillance
Medical research
Regional / socioeconomic care disparities
Payers
Employers
Pharmaceutical industry
HIT – vendors, infrastructure, integration, solutions, tools
Electronic and paper-based information workflow
Regional information sharing groups
Standards & Interoperability groups

4. Market Failure Barriers and Challenges
Payers (including Medicare) don’t reward efficiency or quality
Negative business case for typical health IT adopter
Significant EHR adoption gap based on organization size
Market failure from negative network externalities
First mover disadvantage for health IT buyers
Short-term losses from adoption of standards
High failure risk for business reengineering
Failure rate for EHR implementation exceeds 30%
Variable availability of expertise
Limited capacity for interoperability
Standards are not rigorous and lag behind commercialization
No viable health information exchange infrastructure
So, if this is so obvious and supported, why isn’t this happening already?
Cost is blocking adoption:
60 –70% of large physician groups and hospitals have EHRs
Groups like Mayo, Cleveland Clinic, Kaiser, Austin Clinic
Hospitals like Columbia Presbyterian, Mass General
Small hospitals and physician offices that serve 75% of the market
are not putting electronic records in place (<5%)
They lose money on this - $36k per MD per year
Interconnectedness isn’t happening
Products can’t communicate
No “medical internet” or secure network to connect them
Nearly all benefits we want are dependent on interconnectedness
We have limitations on our ability to address these barriers
Medicare reimbursement unintentionally rewards errors
Limits on spending (FY05 appropriation for HIT zero)
concerns about FY06
Silos across agencies and lack of authority to consolidate budgets and programs to get results

5. Medicare’s Scopes of Work
Mandated by Social Security Act
Three year contractual cycles with QIOs
Started with peer review and beneficiary protection
Currently focusing on and demonstrating improvement on core set of quality measures
Moving towards sustainable change in the delivery of care, meeting IOM aims

6. 8th Scope of Work:
Support HIT adoption across all types of providers
Redesign Care Processes to better coordinate and integrate care within and across settings, including patients’ homes
Measure, Report, and Improve performance
Change Culture of care to focus on patients needs

7. DOQ-IT: 8th SOW Focus on MD Offices
Primary Care
Small to medium sized practices
At least 5% of practice sites in each state/territory
Reflects % underserved in each state

8. DOQ-IT: Developed as a Special Study
Awarded to Lumetra, September 2003 to prepare for 8th SOW
Focus on adoption and use of any type of HIT
Consultant Model
Tool development
Piloted in AR, CA, MA, UT
Refined for national rollout
QIOs consult on readiness assessment, office workflow analysis, office redesign, business case of HIT, selection of appropriate features and functions, contractual relationships with appropriate vendors.

9. DOQ-IT: Lessons Learned, Adaptions
States are Unique
Primary Focus: Interoperable EHRs
New Opportunities for Office Based Care Management
Cost an issue, but not insurmountable

10. #1: States are Unique
Provider Structure large integrated systems vs autonomous individuals
Payer Structures --- FFS vs Managed Care; P4P programs
Consumer interest -- reflected in local newspapers
Current HIT penetration
Current IT infrastructure

11. Environmental Scans Added to 8th SOW
Assesses receptivity of environment to MD adoption
Directs unique strategy in each state
Defines opportunity for QIO to convene and facilitate multistakeholder interests.

12. #2: Focus on Interoperable EHRs
Initial intent: e-lab, e-prescribing, registries, or electronic health record
IOM’s 2003 Core EHR functionalities
National standards for interoperability, architectures, and functions due in December, 2005
Larger, well supported vendors with significant markets likely to comply
IOM’s core functionalities:
Avaialability of Patient Specific Health Data
Results Management
Order Entry/Management
Decision Support
Electronic Communications and Connectivity
Patient Supports (information and home management)
Administrative Processes
Reporting and Population Health Management

13. Ongoing Work With vendor community With certifying commission
Development of reporting capabilities
Will assure that certified interoperable EHRs will be supported by QIO community
QIO engagement in local Health Information Exchange projects

14. #3 Incorporate Care Management
Review data from populations of patients
Initiate patient contacts
Careplan development
Enhanced patient engagement
Ongoing development in this arena throughout 8th SOW

15. #4: Cost is an Issue, but Surmountable
Buyers’ collaboratives
Value not just financial
Supported by P4P in some states
CMS P4P Demo will support
Widespread recognition of importance of adopting electronic health records
CMS crafting P4P strategy to improve quality

16. DOQ-IT Pilot: Current Status
>1000 practice sites officially engaged
>3500 physicians
Most have completed readiness assessments
Between 5% and 30% have selected and/or implemented an EHR
About 10% had EHR and are working on care process improvements
November, 2004 to August, 2005

17. DOQ-IT: Next Steps Nationwide rollout through 8th SOW
Continued feedback from pilot states
Further development of QIO convening role
DOQ-U curriculum directly available online
Integration with work of ONCHIT and certifiying commission: interoperability
Prepare for 9th SOW -- focus on the patient; providing information and care across the silos of our delivery system.

18. Thank you for your attention!