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David Muntz: "Electronic Health Records and Health IT: Making a Difference"


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  • 1. Electronic Health Records and Health Information Technology:Making a Difference to The Healthcare Delivery SystemDavid S. Muntz, CHCIO, FCHIME, FHIMSSPrincipal Deputy National CoordinatorOffice of the National Coordinator for Health ITDepartment of Health & Human Services
  • 2. Together, We Must TransformThe Healthcare Delivery System• Care transformation• Patient engagement• Population managementJune 12, 2013 1
  • 3. Meaningful UseJune 12, 2013 2Pumpkin Meaningful Use of Pumpkin
  • 4. Primary Goal: Achieve Meaningful UseOf Health Information TechnologyGeneral Requirements That Must Be Met:• Certified EHR is used in a meaningful manner, includingelectronic prescribing• Certified EHR is connected in a manner that allows forthe exchange of health information• Entity is capable of reporting on clinical quality measuresand such other measures as selected by the Secretary ofHealth and Human ServicesIncremental Approach - 3 StagesJune 12, 2013 3
  • 5. • CMS defines the EHRIncentive Programs;• ONC defines the EHRStandards andCertification Criterion;• MU supports the HIPAAprivacy and security rules,already a requirement formost providers.June 12, 2013 4Administration of Meaningful Use
  • 6. How Is the Transformation Funded?• $22.5 Billion of incentives– Eligible professionals and hospitals including critical accessfacilities– Medicare and Medicaid participants• $2 Billion for ONC supported programs:– HIE (Health Information Exchange)– Regional Extension Centers (RECs)– Workforce Training Grants– National Health IT Research Center (HITRC)– Beacon Grants– Strategic Health IT Advanced Research (SHARP) Grants• $10.3 Billion from other Federal partners• Many more billions from the provider communityJune 12, 2013 5
  • 7. Meaningful ConversationJune 12, 2013 6“The formulation of a problem isoften more essential than itssolution, which may be merely amatter of mathematical orexperimental skill.”
  • 8. Major Challenge:Change Management• Workflow• LifeflowJune 12, 2013 7
  • 9. Who are our Federal partners?June 12, 2013 8More tocome…
  • 10. What do hockey and EHRs have in common?June 12, 2013 9
  • 11. Providers Registered forMedicare and Medicaid EHRIncentive Programs as March 31, 2013Source: CMS EHR Incentive Program Data01,0002,0003,0004,0005,000Jun-11Jul-11Aug-11Sep-11Oct-11Nov-11Dec-11Jan-12Feb-12Mar-12Apr-12May-12Jun-12Jul-12Aug-12Sep-12Oct-12Nov-12Dec-12Jan-13Feb-13Mar-13Cumulative number of eligible hospitals registeredEligible Hospitals Registered for the Medicare andMedicaid EHR Incentive Programs0100,000200,000300,000400,000500,000Cumulative number of eligible professionals registeredEligible Professionals Registered for the Medicare andMedicaid EHR Incentive Programs386,024 eligible professionals74%4,333 eligible hospitals86%521,600Total Eligible Professionals5,011Total Eligible HospitalsJune 12, 2013 10
  • 12. Unique Eligible Providers SuccessfullyDemonstrating MU as of April 30, 2013June 12, 2013 11Note: Payments for May 2012 include payments to Medicare Advantage providers.295,205 unique eligible professionals and hospitals have received paymentthrough the Medicare or Medicaid EHR Incentive Programs050,000100,000150,000200,000250,000300,000350,00005,00010,00015,00020,00025,00030,00035,00040,000Jan-11Feb-11Mar-11Apr-11May-11Jun-11Jul-11Aug-11Sep-11Oct-11Nov-11Dec-11Jan-12Feb-12Mar-12Apr-12May-12Jun-12Jul-12Aug-12Sep-12Oct-12Nov-12Dec-12Jan-13Feb-13Mar-13Apr-13CumulativeUniqueProvidersPaidNumbersofUniqueProvidersPaidperMonthMonthly Total Cumulative TotalEP Paid: 291,325 (56%)EH Paid: 3,880 (77%)
  • 13. $22 $16 $26 $31$109$81$116$276$237$387$607$836$564$629$662$623$587$441$406$532$579$716$907$1,402$1,109$809$1,001Cumulative Total$13,710$0$2,000$4,000$6,000$8,000$10,000$12,000$14,000$16,000$0$200$400$600$800$1,000$1,200$1,400$1,600Jan-11Feb-…Mar-…Apr-…May…Jun-11Jul-11Aug-…Sep-…Oct-11Nov-…Dec-…Jan-12Feb-…Mar-…Apr-…May…Jun-12Jul-12Aug-…Sep-…Oct-12Nov-…Dec-…Jan-13Feb-…Mar-…CumulativeAmountPaid(Millions)AmountPaidperMonth(Millions)Payments to All Eligible Professionals and Hospitals Under the Medicare or Medicaid EHR Incentive ProgramsMeaningful Use – All PaymentsAs of March 31, 2013Note: Payments include Medicare Advantage Organizations. Source: CMS EHR Incentive Program DataJune 12, 2013 12
  • 14. Age Discrepancies
  • 15. E-Prescribers On the Surescripts NetworkDecember 2006 – March 2013050,000100,000150,000200,000250,000300,000350,000400,000450,000500,000550,000Dec-06Jan-07Feb-07Mar-07Apr-07May-07Jun-07Jul-07Aug-07Sep-07Oct-07Nov-07Dec-07Jan-08Feb-08Mar-08Apr-08May-08Jun-08Jul-08Aug-08Sep-08Oct-08Nov-08Dec-08Jan-09Feb-09Mar-09Apr-09May-09Jun-09Jul-09Aug-09Sep-09Oct-09Nov-09Dec-09Jan-10Feb-10Mar-10Apr-10May-10Jun-10Jul-10Aug-10Sep-10Oct-10Nov-10Dec-10Jan-11Feb-11Mar-11Apr-11May-11Jun-11Jul-11Aug-11Sep-11Oct-11Nov-11Dec-11Jan-12Feb-12Mar-12Apr-12May-12Jun-12Jul-12Aug-12Sep-12Oct-12Nov-12Dec-12Jan-13Feb-13Mar-13TotalPrescribers EHRPrescribers Stand Alone Prescribers
  • 16. 3164180495905001000150020002500300035004/18/20115/18/20116/18/20117/18/20118/18/20119/18/201110/18/201111/18/201112/18/20111/18/20122/18/20123/18/20124/18/20125/18/20126/18/20127/18/20128/18/20129/18/201210/18/201211/18/201212/18/20121/18/20132/18/20133/18/20134/18/2013Total ProductsTotal Unique ProductsTotal VendorsCertified Health IT Product andVendor Trends (4/18/2013)June 12, 2013 15
  • 17. Online Job Postings Have GrownSubstantially• Supporting activities– Community College Consortia– University Based Training– Curriculum development– Competency ExamJune 12, 2013 16-1,0001,0003,0005,0007,0009,00011,00013,00015,000Jan-07Mar-07May-07Jul-07Sep-07Nov-07Jan-08Mar-08May-08Jul-08Sep-08Nov-08Jan-09Mar-09May-09Jul-09Sep-09Nov-09Jan-10Mar-10May-10Jul-10Sep-10Nov-10Jan-11Mar-11May-11Jul-11Sep-11Nov-11Jan-12NumberofHealthITJobPostingsperMonthHealth IT Implementation & Support Jobs Health IT Clinical User JobsHITECH ActFebruary20094,85014,512SOURCE: ONC analysis of data from O’Reilly Job Data Mart
  • 18. Students Enrolled and Students Completed(Cumulative)June 12, 201317Community College ConsortiaAs of March 31, 2013SOURCE: ONC Data Brief10,00005,00010,00015,00020,00025,00030,00035,000StudnetsCumulative Enrollment Cumulative Completion Cumulative Enrollment (adjusted for attrition)21,53917,52331,801
  • 19. 2974799848 54271345621140 350100200300400500600700800900Clinician/Public HealthLeaderHIM & Exchange Privacy & Security R&D Programmer/Software EngineerHIT Sub-specialistGraduated Enrolled TargetUniversity-Based TrainingAs of January 25, 2013Target: 1,685Graduated: 976Gap to target: 709Enrollment: 764Remaining gap: NoneJune 12, 2013 18
  • 20. HIT Industry – Size Estimates as of2011Source Supposed Market Definition YearSize($billions)Frost & SullivanAmbulatory EHR Revenue2009 1.32012 2.62013 3.02016 1.6Hospital EHR Revenue2009 1.02012 6.5IDC Health InsightsAmbulatory MU (Software & Maintenance Costs)2009 0.62015 1.4Inpatient MU (Software & Maintenance Costs)2009 1.32015 2.4Kalorama EHR + Related Services Revenue2008 12.52009 13.82010 15.72011 17.9Millennium Research Group EHR Revenue2012 5.32013 5.92014 6.62015 7.42016 8.3MarketsandMarketsEHR (end user purchases of components andapplications)2009 2.22015 6.1Global Market DirectUS Health IT (EHR, Practice Management, CPOE,eRx, Labs, Picture archiving, Radiology Images)2008 4.12015 11.5EMR market rose to $20.7B in 2012, report finds.
  • 21. Report: Next EMR OpportunityMay Be in EuropeJune 12, 2013 20New York, October 24, 2012--Europeanelectronic medical records (EMR) marketreached revenues of $6.8 billion in 2012.Kalorama Informations new report, EMR in Europe.
  • 22. The Patient and Consumerpicture source:
  • 23. Back in the Day…June 12, 2013 22“The obedience of apatient to theprescriptions of hisphysician should beprompt and implicit.[The patient] shouldnever permit his owncrude opinions as totheir fitness toinfluence hisattention to them.”- AMA’s Code ofMedical Ethics (1847)
  • 24. And Now…Patient Generated DataJune 12, 2013 23“Patients share the responsibility for their own health care…”- AMA’s current Code of Medical Ethics“Patients can … be a second set of eyes on our medical records. Icorrected the mistakes in my health record…Better to clean it upnow, not when there’s time pressure.”– Dave deBronkart (ePatient Dave)
  • 25. Patient Engagement – The Vision• Unbounded expectations• Untethered Personal Health Records• Patient as a custodian of records• Consumer mediated exchange• Requirements in 2014 Edition– View, download, and transmit– Secure messagingJune 12, 2013 24
  • 26. • Glucometer– Blood sugar• Bathroom Scale– Weight– Water loss/gain• Sphygmomanometer– Blood pressure– PulseNETWORK• Smart Band-Aids- Chemistry• DigestibleRFID PillsFrom Hank Fanberg Texas HIT Summit Jan 2011June 12, 201325
  • 27. The Smart Home26
  • 28. The Smart Car• Seat– Weight– Blood pressure– Breathing rate• Steering Wheel– Pulse– EKG– Blood oxygen (PO2)June 12, 201327Walter, Eilebrecht ET ALPersonal and Ubiquitous ComputingNovember 2010From Hank Fanberg Texas HIT Summit Jan 2011
  • 29. The Smart PatientJune 12, 2013 28FCC Issues Final Rule Allocating Wireless Spectrum for MBANsThe Federal Communications Commission has released a finalrule to allocate wireless spectrum for medical body areanetworks starting Oct. 1, 2012. FCC said the spectrumallocation will help improve patient care and safety byreducing the need to physically connect sensors to patients.Modern Healthcare. September 2012Picture source: Jack E. Brown6/23/2012
  • 30. ONC’s Three A’s for ConsumerEngagementJune 12, 2013 29• Give consumers secure, timelyelectronic access to their healthinformation.Access• Support the development oftools that help consumers totake action using information.Action• Help expectations aboutconsumer (and provider) rolesto evolve.Attitude
  • 31. Consumer Engagement = Better CareJune 12, 2013 3030Suffer a health consequence frompoor communcation among providersExperience a Medical ErrorHospital Readmit within 30 Days36%28%13%19%13%More Activated PatientLess Activated Patient49%AARP Magazine, July/August 2009 findings based on people over 50 years who have atleast one chronic condition.
  • 32. There’s a Gap between Reality &PotentialJune 12, 2013 31• 15% have renewed a prescription online• 10% have a personal health record (PHR)• 8% of consumers have e-mailed their provider
  • 33. Taking the Blue Button Nationwide
  • 34. Security and Privacy are andshould be in the DNA of HIT.June 12, 2013 33
  • 35. Adoption Speed for New IdeasTime to reach 1M consumersJune 12, 2013 35For those with the best ideas, the technology adoption curve in the future will be immediate.16 years71 years10 years9 months2 days21 yearsTechnology Adoption Timeline74 days75 Years 0 DaysSource: Glen Tullman, “Creating a Connected Community of Health,” Allscripts Innovation and Value-Driven Healthcare Summit (2011)
  • 36. Liberating DataJune 12, 2013 36
  • 37. Why is HIT important? Patients are not averages.They are part of a community.59 year-old woman inDallas, TX who wasdiagnosed with glaucomain 1982 and has beentaking Timoptic eye dropsdaily.During the admission, shereceived personalized riskassessment forms, was placed onstandardized order sets.Medication reconciliation wasdone. She was sent to the CathLab for an angiogram. Prior toand after herprocedures, telemetry resultswere entered automatically intothe EHR.Using an EHR with imaging, herphysician was able to review herangiogram with her on the TVscreen in her room and discussthe potential risks of anadditional beta blocker to ensurethe best possible outcome.Personalized dischargeinstructions were given to herspouse. The outcome andprognosis are good.On Sunday, April15, 2012, 10 minutes afterentering the water for thefirst leg of a mini-triathlonshe suffered what waseventually diagnosed as anon-STEMI cardiac event.She was admitted to theHeart Hospital at BaylorPlano.
  • 38. Connect. Communicate. Collaborate.Office of National Coordinator• Browse the ONC website at: HealthIT.govclick the Facebook “Like” button to add us to your network• Contact us at:• Subscribe, watch, and share:@ONC_HealthIT IT and Electronic Health Records Health IT Buzz BlogJune 12, 2013 38
  • 39. Together, we are making a difference!Thank you!Please send comments or questions