Keynote presentation from Meaningful Use and HIT Innovation conference - April 26, 2013

1. What's on the Horizon,
How HIT Supports Practice
Transformation and Chronic
Disease Management
Don Nease, MD
Vice Chair for Research - Dept of Family Medicine
Director of Practice Based Research - Colorado Health Outcomes
University of Colorado - Anschutz Medical Campus
Meaningful Use & HIT Innovation Conference
Quality Health Network - Grand Junction, CO - April 26, 2013

2. conflicts
• Senior Medical Director - Crimson Care
Registry,The Advisory Board Company, Inc.

3. overview
• why are HIT and transformation linked?
• yardsticks
• the far horizon
• what’s it going to take to get there?

4. HIT and transformation

5. aren’t we all doing a
great job?

7. Clarke TC, et.al.Trends in Adherence to
Recommended Cancer Screening:The US Population
and Working Cancer Survivors. Front Oncol.
2012;2:190.

8. not exactly...

9. ideally...in the era of
"measured" care...
• HIT provides the speed gun both...
• at the point of care
• and for your population as a whole
• and gives you tools to address the gaps

10. lessons from EPIC
• Colorado based RCT on quality
improvement
• Tested 2 styles of practice improvement
• Facilitated RAP model - 15 practices
• Facilitated IPIP model - 10 practices
• with registry based targets
• Guess who did better...

11. practices need targets!

12. is this surprising?

13. measurement matters
• priorities
• progress
• performers
• process

14. what are our yardsticks?
• need two:
• patient
• population

15. yardsticks

16. current status of EMRs

17. would you buy an EMR from this
man?

18. "Within ten years, we want most
Americans to have electronic health care
records—that means your records,"
President Bush - 27 May 2004

19. “As President, I will invest $10 billion per
year for five years to move the U.S. health
care system to broad adoption of standards‐
based electronic health information
systems...
Candidate Barack Obama - 2008
"Within ten years, we want most
Americans to have electronic health care
records—that means your records,"
President Bush - 27 May 2004

21. as of May 2012...
• 62,226 total
eligible providers
attested
• 12.2 percent
• calculated based
on estimated
509,328 potential
Wright A, Henkin S, Feblowitz J, McCoy AB, Bates DW, Sittig DF. Early results of the meaningful use
program for electronic health records. N Engl J Med. 2013 Feb 21;368(8):779–80.

22. as of Jan 2013
• 115,918 attestations - CMS data
• 23% of a potential 509,328
• a one and three quarter times increase
over 7-8 months

23. “User satisfaction with electronic health records
has decreased since 2010”

24. AmericanEHR survey
• Overall, user satisfaction fell
12 percent from 2010 to
2012.
• The percentage of clinicians
who would not recommend
their EHR to a colleague
increased from 24 percent
in 2010 to 39 percent in
2012.
• 32 percent of the
responders had not
returned to normal
productivity compared to 20
percent in 2010.
http://www.americanehr.com/about/News/13-03-05/

25. Adler-Milstein J, Green CE, Bates DW. A survey analysis suggests that
electronic health records will yield revenue gains for some practices and losses
for many. Health Affairs. 2013 Mar;32(3):562–70.

26. and yet...
Xierali IM, Hsiao C-J, Puffer JC, Green LA, Rinaldo JCB, Bazemore AW, et al.
The rise of electronic health record adoption among family physicians. The
Annals of Family Medicine. 2013 Jan;11(1):14–9.

27. • trend suggests 80% adoption by end of
2013 among FM
• adoption vs. attestation
• could signal a large bolus of attesters
yet to come - last year to enter is 2014
• but will EMR’s provide our yardsticks?

29. "The truth is
out/in there"

30. • ER docs were early adopters
• Now moving into “niche solutions”
• Niche solutions have higher
physician direct documentation
and reported accuracy.
• Niche solutions also
outperform enterprise
EMRs in improving patient care.
• This via better layouts, less
entry errors, more prompts and
alerts.
• A top concern and request for
improvement is clinical decision
support.
on the edge...
http://www.klasresearch.com/news/pressroom

31. Once providers try a third
party solution to help with
clinical decision making few go
back to building it themselves
http://www.klasresearch.com/news/pressroom/2013/cds

32. • EMRs challenged to provide
decision support (patient yardstick)
• Will this improve???
• Billing trumps for now

33. • EMR vendors may be close to ceding
this ground
• Payers are investing huge amounts in
buying analytics vendors
• Big data is become a big deal

34. registry or chronic disease
management systems

35. http://www.slideshare.net/gigaom/gigaom-research-sector-roadmap-healthcare

36. • Trends and drivers
• Affordable Care Act and accountable care
organizations
• The experience in non-healthcare sectors
with big data
• Dramatic growth in health data with the
need to manage and use it
• Fraud and inefficiencies
• End of the blockbuster-drug era
http://www.slideshare.net/gigaom/gigaom-research-sector-roadmap-healthcare-

37. • Challenges
• Unstructured data
• Enterprise-wide data management
policies
• Shortage of health informatics and data
sciences specialists
• Ownership, stewardship and governance
of data
• Interoperability and legacy systems
http://www.slideshare.net/gigaom/gigaom-research-sector-roadmap-
healthcare-and-big-data-in-2012

38. • Big questions looming...
• will existing leaders adapt?
• EMR/CDS/pop. health
• is there a role for non-
profit/public utility models?
• especially for data acquisition

39. on the far horizon...

40. “Patient engagement is the
blockbuster drug of the century.”
National Coordinator for Health IT
Dr. Farzad Mostashari
Dr. Farzad Mostashari
Dr. Farzad Mostashari
Dr. Farzad Mostashari

41. patient engagement
• In the EMR
• Via companion tools
• Apps, etc.

42. EMR engagement
• A major piece of Stage 3 Meaningful use
• Most vendors already have some capacity
• If we build it will they come???

43. Stage 3 engagement
• submit patient-generated health
information to improve performance on
high priority health conditions, and/or to
improve patient engagement in care
• provide patients with the ability to request
an amendment to their record online

45. works today
????
????

48. Connection to Health
• CU based, NIH funded RCT of a web-based
tool to assist with self-management
support
• Also testing how much facilitation helps
with integrating CTH into practice
• Looking for practices now!

49. • Provides a download of
your (patient) electronic
data
• Currently somewhat
limited -VA/Medicare
• Vendors getting very
interested

51. no...we are not done
with transformation

52. • tools fit the workflow
• documentation =
collection of
meaningful data
• same tools and data
support point of care
decision support and
population outreach
choose your yardsticks
wisely

53. Nobody can go back and start a
new beginning, but anyone can start
today and make a new ending."
--Maria Robinson,American writer

54. discussion?