Meaningful Use vs Meaningful Innovation <ul><li>E. Gregory Marchand, M.D. </li></ul><ul><li>Director of Informatics Depart...
Who am I? <ul><li>ER Doc </li></ul><ul><li>Director of Informatics </li></ul><ul><li>A guy who likes stuff...technical stu...
Who am I? <ul><li>...your worst nightmare </li></ul>
What are we going to talk about tonight? <ul><li>“ Meaningful use” has pushed “meaningful innovation” in health care IT ba...
First, a little background
Medicine is high tech...
Advanced Imaging Technologies
Robotic Assisted Surgery
Gamma Knife “Surgery”
Heart valve replacement (without surgery)
Heart “replacements” or aids
...in the delivery of health care
Documentation and data viewing in medicine has not been so much high tech...
 
 
Why has this been so?
Because it works, and that is how we have always done it.
Things needed to change and move into the 20th century
Then the economy moved into the early 20th century
And along came... <ul><li>ARRA </li></ul>American Recovery and Reinvestment Act
Which included... <ul><li>...HITECH </li></ul>Title XIII - Health IT for Economic and Clinical Health Act
HITECH <ul><li>$19.2 Billion earmarked for Health IT </li></ul><ul><li>Provides assistance, tools and resources to provide...
HITECH <ul><li>...with various provisions and regulations </li></ul>
Which brings us to... <ul><li>...Meaningful Use </li></ul>
<ul><li>...provision is made for incentive payments to eligible professionals (EPs), eligible hospitals and critical acces...
Under all three EHR incentive programs, EPs, eligible hospitals, and CAHs must utilize ‘‘certified EHR technology’’ if the...
IncentivePaymentAmount=[InitialAmount]x [Medicare Share] x [Transition Factor] –  Initial amount = $2,000,000 + [$200 per ...
Suffice it to say that there exist criteria for “meaningful use”
<ul><li>ePrescribing </li></ul><ul><li>Alerts and decision support tools </li></ul><ul><li>Data gathering </li></ul><ul><l...
So, how does this affect meaningful innovation?
While there are many complicating factors
but at the end of the day...
 
and
 
For while there is a carrot for health care systems...
<ul><li>...provision is made for  incentive payments  to...eligible hospitals and critical access hospitals (CAHs) who par...
...there is a stick as well
...and requires a  downward adjustment  to Medicare payments to certain MA organizations for professional services provide...
Pressures on health care institutions <ul><li>While they want to be seen as “cutting edge”... </li></ul><ul><li>...More im...
Pressures - Costs <ul><li>Build existing infrastructure to support use of CHT to meet meaningful use </li></ul><ul><li>Thi...
For CHT vendors <ul><li>Work on installing in new institutions </li></ul><ul><li>Upgrading existing installations </li></ul>
So, where does this leave us? <ul><li>Lost growth in “home grown” solutions </li></ul><ul><ul><li>EHRs developed in house ...
So, where does this leave us? <ul><li>Big companies already certified have no incentive to be truly innovative right now <...
So, where does this leave us? <ul><li>With HITECH and Meaningful Use, Health care is being dragged into the EHR world... <...
2010
but at the cost of real and timely innovation in health care technology
True innovative work is being pushed back by at least 3-5 years
What if? <ul><li>Incentives were placed into the market for development of unique and relative EMR, EHR, PHR technologies ...
In closing <ul><li>Meaningful Use has its merits... </li></ul>
...just at a cost
Thank you
Questions or comments...
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Dr. EG Marchand's Presentation to the DC and Baltimore Chapters of the Association of IT Professionals on June 23rd 2011 at Portalli's of Ellicott City, MD

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More information is available at http://www.aitpdc.org.

Many people argue that the health care industry is behind other industries in implementing information technology. One area of focus is electronic health records.

The Health Information Technology for Economic and Clinical Health (HITECH) Act, signed into law on February 17, 2009, as part of the American Recovery and Reinvestment Act (ARRA) of 2009, provides incentives to professionals and hospitals to implement costly hi-tech systems. But to qualify to receive these incentives, professionals and hospitals are required to show they are putting these systems to "meaningful use". But what exactly is meaningful use? And what effect might "meaningful use" have on future innovation in the health care industry?

To discuss the HITECH initiative and its effects, Dr. E. Gregory Marchand, M.D, our speaker, will clarify the issues surrounding this very important effort. Dr. Marchand will discuss how the US Government's description and expectations of "Meaningful Use" while well intentioned can often stifle meaningful innovation in Healthcare Information Technology.

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  • Three principle goals of meaningful use: The use of a certified EHR in a meaningful manner, such as e-prescribing. The use of certified EHR technology for electronic exchange of health information to improve quality of health care. The use of certified EHR technology to submit clinical quality and other measures. What are the requirements for Stage 1 of Meaningful Use (2011 and 2012)? Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs. For eligible hospitals and CAHs, there are a total of 24 meaningful use objectives. To qualify for an incentive payment, 19 of these 24 objectives must be met. There are 14 required core objectives. The remaining 5 objectives may be chosen from the list of 10 menu set objectives.
  • 2015!!!!
  • Millions of dollars lost for CAHs (critical access hospitals). Could close hospitals.
  • Dr. EG Marchand's Presentation to the DC and Baltimore Chapters of the Association of IT Professionals on June 23rd 2011 at Portalli's of Ellicott City, MD

    1. 1. Meaningful Use vs Meaningful Innovation <ul><li>E. Gregory Marchand, M.D. </li></ul><ul><li>Director of Informatics Department of Emergency Medicine </li></ul><ul><li>Washington Hospital Center </li></ul>
    2. 2. Who am I? <ul><li>ER Doc </li></ul><ul><li>Director of Informatics </li></ul><ul><li>A guy who likes stuff...technical stuff </li></ul><ul><li>but can’t write code </li></ul><ul><li>in other words... </li></ul>
    3. 3. Who am I? <ul><li>...your worst nightmare </li></ul>
    4. 4. What are we going to talk about tonight? <ul><li>“ Meaningful use” has pushed “meaningful innovation” in health care IT back at least 3 years </li></ul>
    5. 5. First, a little background
    6. 6. Medicine is high tech...
    7. 7. Advanced Imaging Technologies
    8. 8. Robotic Assisted Surgery
    9. 9. Gamma Knife “Surgery”
    10. 10. Heart valve replacement (without surgery)
    11. 11. Heart “replacements” or aids
    12. 12. ...in the delivery of health care
    13. 13. Documentation and data viewing in medicine has not been so much high tech...
    14. 16. Why has this been so?
    15. 17. Because it works, and that is how we have always done it.
    16. 18. Things needed to change and move into the 20th century
    17. 19. Then the economy moved into the early 20th century
    18. 20. And along came... <ul><li>ARRA </li></ul>American Recovery and Reinvestment Act
    19. 21. Which included... <ul><li>...HITECH </li></ul>Title XIII - Health IT for Economic and Clinical Health Act
    20. 22. HITECH <ul><li>$19.2 Billion earmarked for Health IT </li></ul><ul><li>Provides assistance, tools and resources to providers to allow for implementation and utilization of electronic health records </li></ul>
    21. 23. HITECH <ul><li>...with various provisions and regulations </li></ul>
    22. 24. Which brings us to... <ul><li>...Meaningful Use </li></ul>
    23. 25. <ul><li>...provision is made for incentive payments to eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) who participate in the Medicare and Medicaid programs and who adopt and successfully demonstrate the meaningful use of certified electronic health records (EHR). </li></ul>
    24. 26. Under all three EHR incentive programs, EPs, eligible hospitals, and CAHs must utilize ‘‘certified EHR technology’’ if they are to be considered eligible for the incentive payments.
    25. 27. IncentivePaymentAmount=[InitialAmount]x [Medicare Share] x [Transition Factor] – Initial amount = $2,000,000 + [$200 per discharge for the 1,150 th ‐ 23,000 th discharge] – Medicare Share = Medicare/(Total x Charges) • Medicare = # of inpatient bed days for Part A + # of inpatient bed days for MA beneficiaries • Total = number of Total Inpatient Bed Days • Charges = Total charges minus charges for charity care divided by total charges A simple calculation for incentive payments for hospitals
    26. 28. Suffice it to say that there exist criteria for “meaningful use”
    27. 29. <ul><li>ePrescribing </li></ul><ul><li>Alerts and decision support tools </li></ul><ul><li>Data gathering </li></ul><ul><li>Reporting </li></ul><ul><li>Sharing </li></ul>
    28. 30. So, how does this affect meaningful innovation?
    29. 31. While there are many complicating factors
    30. 32. but at the end of the day...
    31. 34. and
    32. 36. For while there is a carrot for health care systems...
    33. 37. <ul><li>...provision is made for incentive payments to...eligible hospitals and critical access hospitals (CAHs) who participate in the Medicare and Medicaid programs and who adopt and successfully demonstrate the meaningful use of certified electronic health records (EHR). </li></ul>
    34. 38. ...there is a stick as well
    35. 39. ...and requires a downward adjustment to Medicare payments to certain MA organizations for professional services provided by any of their affiliated EPs who are not meaningful users of certified EHR technology, beginning in 2015
    36. 40. Pressures on health care institutions <ul><li>While they want to be seen as “cutting edge”... </li></ul><ul><li>...More imperative to not LOSE money </li></ul><ul><li>...Need for use of Certified Health Technology </li></ul>
    37. 41. Pressures - Costs <ul><li>Build existing infrastructure to support use of CHT to meet meaningful use </li></ul><ul><li>This requires staff to concentrate on support of this as opposed to developing new innovative systems </li></ul>
    38. 42. For CHT vendors <ul><li>Work on installing in new institutions </li></ul><ul><li>Upgrading existing installations </li></ul>
    39. 43. So, where does this leave us? <ul><li>Lost growth in “home grown” solutions </li></ul><ul><ul><li>EHRs developed in house that meet specific needs and workflow well, and may be innovative in use but are not “certified” </li></ul></ul><ul><li>Small companies working outside of certification will not be considered for use in large institutions </li></ul>
    40. 44. So, where does this leave us? <ul><li>Big companies already certified have no incentive to be truly innovative right now </li></ul><ul><li>Focus is on meeting current needs </li></ul>
    41. 45. So, where does this leave us? <ul><li>With HITECH and Meaningful Use, Health care is being dragged into the EHR world... </li></ul>
    42. 46. 2010
    43. 47. but at the cost of real and timely innovation in health care technology
    44. 48. True innovative work is being pushed back by at least 3-5 years
    45. 49. What if? <ul><li>Incentives were placed into the market for development of unique and relative EMR, EHR, PHR technologies </li></ul><ul><li>More of a carrot for the health care tech industry as opposed to a stick for the health care delivery system </li></ul>
    46. 50. In closing <ul><li>Meaningful Use has its merits... </li></ul>
    47. 51. ...just at a cost
    48. 52. Thank you
    49. 53. Questions or comments...

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