1. Health Record Banks: Sustainable Health Information Infrastructure AND Privacy William A. Yasnoff, MD, PhD, FACMI Managing Partner, NHII Advisors World Healthcare Congress on Consumer Connectivity Carlsbad, CA February 23, 2009 © 2009 NH I I ADVISORS

2. 2 2 © 2009 NH I I ADVISORS “ The development of an information technology infrastructure has enormous potential to improve the safety, quality, and efficiency of health care in the United States ” - Institute of Medicine, Crossing the Quality Chasm, 2001 “ The development of an information technology infrastructure has enormous potential to improve the safety, quality, and efficiency of health care in the United States ” - Institute of Medicine, Crossing the Quality Chasm, 2001

3. 3 3 © 2009 NH I I ADVISORS Sustainable HII & Privacy I. Defining the Goal II. Critical Importance of Privacy III. Solution: Health Record Bank  Functions & Operation  Rationale  Business Model IV. Next Steps

4. 4 4 © 2009 NH I I ADVISORS Health Information Today n Scattered Records l Each person's records are scattered at whatever locations care has been given l Mostly paper n Information sharing not effective l Cumbersome, expensive, time-consuming, and fallible l No mechanism to collect patient information from disparate sources n No responsible institution l Each patient's complete records (from all sources) are not available for care l Need to create these institutions

5. 5 5 © 2009 NH I I ADVISORS Health Information Today (cont.) n Consequences of health information deficit l Medical errors common – 44,000-98,000 preventable deaths/year (just in hospitals) l Quality poor – only 55% of adults receive recommended care (RAND study) l Costs out of control – rising >10% annually – consuming an increasing proportion of GDP – now $2+ trillion/year and growing

6. 6 6 © 2009 NH I I ADVISORS Goal: Comprehensive Patient Information at Any Point of Care n All medical records must be electronic n Combine multiple scattered records into complete “master” record n Enable rapid review l Graphs l Charts l Enhancement of relevant information n Automated reminders to improve quality and reduce errors

7. 7 7 © 2009 NH I I ADVISORS II. Critical Importance of Privacy “ Anything you do to make information more accessible for good, laudable purposes will simultaneously make it more accessible for evil, nefarious purposes ” - William A. Yasnoff, New York Times, 2/18/07 (p. 16) “ Anything you do to make information more accessible for good, laudable purposes will simultaneously make it more accessible for evil, nefarious purposes ” - William A. Yasnoff, New York Times, 2/18/07 (p. 16) Therefore, privacy is a much greater concern as more health records are electronic.

8. 8 8 © 2009 NH I I ADVISORS Privacy & Patient Control n Surveys of “information hiding” l 2006: 13% of consumers l 2007: 17% of consumers n Consumers already control information in their records n Without control, too many will opt out OR politically force system shut down n Choices are today’s system or consumer control -- complete information without consent is not (and should not be) a viable option n Patient control essential

9. 9 9 © 2009 NH I I ADVISORS Privacy Requirements n Patient Control l Essential for trust l Forces stakeholder cooperation n Trusted Institution l Local governance (now) l Government regulation (later) n Trusted Architecture l Secure repository l Operate like classified military system

10. 10 © 2009 NH I I ADVISORS III. Solution: Health Record Bank (HRB) n Secure community-based repository of complete health records n Access to records completely controlled by patients (or designee) n “Electronic safe deposit boxes” n Information about care deposited once when created l Required by HIPAA n Allows EHR incentives to physicians to make outpatient records electronic n Operation simple and inexpensive

11. 11 © 2009 NH I I ADVISORS Clinical Encounter Health Record Bank Clinician EHR System Encounter Data Entered in EHR Encounter Data sent to Health Record Bank Patient Permission? NO DATA NOT SENT Clinician Inquiry Patient data delivered to Clinician YES optional payment Clinician’s Bank Secure patient health data files Health Record Bank Operation

12. 12 © 2009 NH I I ADVISORS HRB Rationale n Operationally simple l Records immediately available l Deposit new records when created l Enables value-added services l Enables research queries n Patient control --> l Trust & privacy l Stakeholder cooperation (HIPAA) n Low cost facilitates business model n Allows EHR incentive options l Pay for deposits from existing EHRs l Provide Internet-accessible EHRs

13. 13 © 2009 NH I I ADVISORS HRB Business Model n Costs (with 1,000,000 subscribers) l Operations: $6/person/year l EHR incentives: $10/person/year n Revenue l Advertising: $6/person/year l Queries: ? l Reminders & Alerts: >= $12/person/year – “Peace of mind” alerts – Preventive care reminders – Medication reminders n No need to assume/capture any health care savings (!!)

14. 14 © 2009 NH I I ADVISORS IV. Next Steps n For-profit HRB startups n For-profit HRB establishes community non-profit for governance l Consumers l Physicians n For-profit operates HRB under contract from community non-profit l Pays fee to non-profit for governance l Provides EHRs or EHR incentives to physicians

15. 15 © 2009 NH I I ADVISORS Health Record Bank Organization Customer Support Marketing Operations HRB Operator Board of Directors Management Health Record Bank Operator (for-profit) regulate via contract % of revenue RESPONSIBLE FOR: Policy Governance Oversight RESPONSIBLE FOR: Obtaining Capital Operating HRB Executive Director Other Staff(Optional) Community Non-profits Community Board of Directors Many communities use single HRB

16. 16 © 2009 NH I I ADVISORS Questions? William A. Yasnoff, MD, PhD, FACMI william.yasnoff@nhiiadvisors.com 703/527-5678 For more information: www.ehealthtrust.com www.healthbanking.org www.yasnoff.com