HITECH Health IT Legislation: Opportunities for the DMAA Community September 2009 • San Diego, CA Vince Kuraitis JD, MBA Better Health Technologies, LLC http://e-CareManagement.com blog (208) 395-1197 • vincek@bhtinfo.com Don Storey, MD RMD Networks www.rmdnetworks.com (303) 789-1188 • dstorey@rmdnetworks.com

Overview Recap: DM Community as Leaders or Laggards in HIT Interoperability? Changing Environment ARRA HITECH Act Stimulus Legislation Implications/Opportunities for DMAA Community

Recap: DM Community as Leaders or Laggards in HIT Interoperability?

Changing Environment

ARRA HITECH Act Stimulus Legislation

Implications/Opportunities for DMAA Community

1. Recap: DM Community as Leaders or Laggards in HIT Interoperability?

HIT Strategy on Autopilot for the Past Decade

Health Information Technology (HIT) is the Backbone of Prevention and Care Management Provides easy access to comprehensive patient records electronically, thus making it easier to see a patient’s medical history Helps providers track patient care in order to reduce duplication of services, address patient issues, and coordinate care with care managers Offers providers access to reference materials during a patient visit Provides clinicians real-time guidance on standards of care Sends reminders and prompts to patients about visits, tests, and recommendations and prescriptions

Provides easy access to comprehensive patient records electronically, thus making it easier to see a patient’s medical history

Helps providers track patient care in order to reduce duplication of services, address patient issues, and coordinate care with care managers

Offers providers access to reference materials during a patient visit

Provides clinicians real-time guidance on standards of care

Sends reminders and prompts to patients about visits, tests, and recommendations and prescriptions

DM Community Pivot Points Several industry sectors are uniquely positioned to promote interoperability and liquidity Leverage! DM is a central role with many touch points Knowhow, tools, & technology to improve care processes and create new interventions Trust with patients creates opportunity to get patient permission to gather and use data on patients’ behalves Interoperability can be disruptive!

Several industry sectors are uniquely positioned to promote interoperability and liquidity

Leverage!

DM is a central role with many touch points

Knowhow, tools, & technology to improve care processes and create new interventions

Trust with patients creates opportunity to get patient permission to gather and use data on patients’ behalves

Interoperability can be disruptive!

Two Scenarios for the DM Community Laggards Maintain proprietary IT Maintain closed business models and proprietary processes Leaders Embrace interoperable health information exchange Embrace open (collaborative) business models and shared care management processes

Laggards

Maintain proprietary IT

Maintain closed business models and proprietary processes

Leaders

Embrace interoperable health information exchange

Embrace open (collaborative) business models and shared care management processes

2. Changing Environment

Challenges With EMR 1.0 Usability/design Created to replicate individual paper charts in e-format, not to manage a panel of patients for optimal health Implementation Changes clinician workflow Loss of productivity for physicians Risk of failure/de-install Proprietary business model Lack of interoperability Dependent on customer lock-in and switching costs Result: very low penetration Proprietary & Confidential Slide #

Usability/design

Created to replicate individual paper charts in e-format, not to manage a panel of patients for optimal health

Implementation

Changes clinician workflow

Loss of productivity for physicians

Risk of failure/de-install

Proprietary business model

Lack of interoperability

Dependent on customer lock-in and switching costs

Result: very low penetration

EMR 1.0 (Circa 1990 – 2009) Proprietary & Confidential Slide #

Modularity: Dis-integration Of The Computer Industry Proprietary & Confidential Slide #

EHR 2.0 – (2009 - ?) High value, integrated applications facilitating higher quality, coordinated care Proprietary & Confidential Slide #

EMR 1.0 to Clinical Groupware EMR 1.0 Client-server based Proprietary Non-interoperable No connectivity to patients Monolithic High capex and operating expense MD workflow must adapt to rigid design Clinical Groupware Web-based Open Interoperable Networked Platform/application No capex, low subscription cost Flexible design adapts to MD workflow Proprietary & Confidential Slide #

EMR 1.0

Client-server based

Proprietary

Non-interoperable

No connectivity to patients

Monolithic

High capex and operating expense

MD workflow must adapt to rigid design

Clinical Groupware

Web-based

Open

Interoperable

Networked

Platform/application

No capex, low subscription cost

Flexible design adapts to MD workflow

How is Value Created in a Network Economy? PHR Case Study Examine PHR adoption Typical 2- 5% Best Practice Kaiser: 30% Group Health Cooperative (GHC): 50% Why? Proprietary & Confidential Slide #

Examine PHR adoption

Typical 2- 5%

Best Practice

Kaiser: 30%

Group Health Cooperative (GHC): 50%

Why?

Features/Functionality Of Kaiser and GHC PHR System (As of Mid-2008) Proprietary & Confidential Slide #

Explanation of Increased PHR Adoption Kaiser/GHC PHR platform adoption = early network effects What’s the killer app ? – Wrong question. How is value created? An integrated bundle of apps Delivered on a unified platform with broad data exchange Providing high value to patients and doctors Thereby driving adoption and usage How can un-integrated doctors, health plans, and hospitals work together toward a “Virtual-Kaiser”? Proprietary & Confidential Slide #

Kaiser/GHC PHR platform adoption = early network effects

What’s the killer app ? – Wrong question.

How is value created?

An integrated bundle of apps

Delivered on a unified platform with broad data exchange

Providing high value to patients and doctors

Thereby driving adoption and usage

How can un-integrated doctors, health plans, and hospitals work together toward a “Virtual-Kaiser”?

3. ARRA HITECH Act Stimulus Legislation

ARRA HITECH Act Incentives between 2011 & 2015 = $36 billion. Providers must use a “Certified EHR” Providers must demonstrate “Meaningful Use” of the EHR Penalties for non-adoption after 2015 Key question: How can DMAA community participate?

Incentives between 2011 & 2015 = $36 billion.

Providers must use a “Certified EHR”

Providers must demonstrate “Meaningful Use” of the EHR

Penalties for non-adoption after 2015

Key question: How can DMAA community participate?

Recommendations – Certification/Adoption Workgroup of HIT Policy Committee, August 2009 Focus Certification on Meaningful Use Leverage Certification process to improve progress on Security, Privacy, and Interoperability Improve objectivity and transparency of the certification process Expand Certification to include a range of software sources: Open source, self-developed, etc. Develop a Short-Term Certification Transition plan

Focus Certification on Meaningful Use

Leverage Certification process to improve progress on Security, Privacy, and Interoperability

Improve objectivity and transparency of the certification process

Expand Certification to include a range of software sources: Open source, self-developed, etc.

Develop a Short-Term Certification Transition plan

Achieving Meaningful Use Meaningful Use Workgroup of HIT Policy Committee, July 2009

“ Meaningful Use” Framework Becoming a Focal Point that Links Previously Disparate Initiatives Proprietary & Confidential Slide #

4. Implications/Opportunities for the DMAA Community

Care Collaboration is a “Must Have” Source: Michael R. Nelson, Georgetown Center for Culture, Communication, and Technology, 2009

...Enabled by Clinical Groupware Platform EMR 1.0 supports limited care delivery transformation; clinical groupware provides greater adaptability, multi-purposing to accelerate transformative care delivery changes.

Healthcare Enters the Network Economy: A Fundamental Strategic Shift Source: Venkatraman, N., Winning in a Network Era: Opportunities & Challenges , 2006

Thank you!