1. Working Session 4: Quality and Efficiency Expanding the Use of Healthcare IT: The United States Initiative and the Development of Healthcare IT in Japan John D. Halamka, MD Chief Information Officer Harvard Medical School Beth Israel Deaconess Medical Center February 26, 2011

2. 2 Agenda Need for a National Healthcare IT Program History of Healthcare IT in the US Major US Healthcare IT Initiative Current State of Healthcare IT in Japan Lessons for development of Healthcare IT Japan

3. 3 Need for a National Healthcare IT Program in US Improve quality of care – High error rates – High variability in care quality – Poor outcomes Improve efficiency of care – Low value: quality/cost – Costs rising much faster than inflation 3

4. Medical, Medication and Lab Errors Among Sicker Adults in US International Comparison AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 2005 and 2007 Commonwealth Fund International Health Policy Survey. EXHIBIT 16 20052007 United States QUALITY: SAFE CARE Percent reporting medical mistake, medication error, or lab error in past 2 years Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 5

5. Duplicate Medical Tests Among Sicker Adults in US International Comparison AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 2005 and 2007 Commonwealth Fund International Health Policy Survey. EFFICIENCY 20052007 United States Percent reporting doctor ordered test that had already been done in past 2 years Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 8

6. International Comparison of Spending on Health 1980–2005 * PPP=Purchasing Power Parity. Data: OECD Health Data 2007, Version 10/2007. Average spending on health per capita ($ US PPP*) Total expenditures on health as percent of GDP 61 EFFICIENCY Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 61

7. 7 History of Healthcare IT in the US From 2001 – 2008 Bush Administration established American Health Information Community – Overall governance healthcare IT governance body Certification Commission for Health Information Technology – Test and certify the functionality of electronic health records Healthcare Information Technology Standards Panel – Harmonize standards for exchange of data among payers, providers, patients, government Funded at $50 million per year Did not provide incentives to accelerate adoption 7

8. Physicians’ Use of Electronic Medical Records in US International Comparison AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom. Data: 2001 and 2006 Commonwealth Fund International Health Policy Survey of Physicians. EFFICIENCY Percent of primary care physicians using electronic medical records 20012006 United States Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 11

9. 19 New National Healthcare IT Initiative in US Obama Administration 2009 – 2011 National policy –Health Information Technology Policy Committee National standards with certification –Health Information Technology Standards Committee Regional extension centers and Health Information Exchanges –$2 billion Incentives to adopt and achieve “Meaningful Use” of Electronic Health Records -- $21 billion Privacy and security protections

10. National Healthcare IT Funding

11. Funding Targeted to Achieve Five Objectives in US $ 23 Billion Total Improve quality, safety, efficiency, and reducing health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Ensure privacy and security for personal health information

12. 12 Current State of Healthcare IT in Japan Information silos in hospitals Little adoption of electronic health records Privacy concerns and other policies which restrict data sharing Lack of incentives to coordinate care Highly variable software functionality and workflow automation 12

13. 25 Goals for a Healthcare IT Initiative in Japan Care coordination for an aging population Cost control Safety improvements Quality measurement Privacy protections 25

14. Working Session 4: Quality and Efficiency Expanding the Use of Healthcare IT: The United States Initiative and the Development of Healthcare IT in Japan John D. Halamka, MD February 26, 2011 jhalamka@caregroup.harvard.edu http://geekdoctor.blogspot.com