Since the HITECH Act was passed in 2009, healthcare executives have felt the pressure to implement the electronic health record and achieve Meaningful Use status resulting in the flow of incentive dollars over the next five years.

1. Healthcare Highlights
HIT Drivers & Trends
William “ Buddy” Gillespie
Director of Healthcare Solutions
Distributed Systems Services, Inc.
Former VP-CIO & CTO WellSpan Health, Retired
June 9 -10, 2011

2. Agenda
• HITECH & Meaningful Use
• HIT Drivers
• Trends
• Summary

3. Introduction
• Since the HITECH Act was passed in
February, 2009, healthcare executives
have felt the pressure to implement the
electronic health record and achieve
Meaningful Use status resulting in the
flow of incentive dollars over the next
five years.

4. Healthcare-Some Assembly
Required

5. 5

6. HITECH-MU Objectives
• Adoption of certified EHRs
• Meaningful use of EHRs
• Incentive payments to eligible
professionals and hospitals

7. MU at a High Level
• Store, display, and report on key patient data
• Support provider initiatives for safe medication
management
• Assist in identification of problems
• Promote exchange of clinical information
(interoperability) in a standard way that others
can use
• Provide patients with clinical information
electronically
• Protect security and privacy using standards
• Report on clinical quality measures

8. HITECH-MU Objectives
• Investment in nationwide HIT
infrastructure
• Grant money for demonstration
projects & RECs

9. HITECH-MU Outcomes
• High quality, safe, effective, and equitable
care for all
• Seamless patient-centric care
• Realigned incentives and measures that
foster prevention, intervention, coordination,
and effectiveness
• Regional clinical information (HIE)
interoperability on a national backbone

10. Meaningful Use is a Journey
3-Stages over 5-Years

11. Challenges
• Only 20% of Physician Practices have an EHR
• Competing projects on the horizon
– MU
– ICD-10
– HIPAA 5010
– ACO
• Cost of IT Infrastructure
• Lack of Best Practices Use for ITSM
• Current focus on implementing vs. sustaining
technology

12. Physician Use of EHR
Global Perspective

13. Hospitals continue to move up the HIMSS Analytics
EMR Adoption Model
CMS Stage 1 MU
criteria for hospitals
roughly correspond to
Stage 4 of the HIMSS
Analytics EMR
Adoption Model

14. HIT DRIVERS
• Homecare
– Home health care
– Telemedicine
– Remote Patient Montoring
– Fiber

15. HIT DRIVERS
• Mobile devices/wireless access
– iPAD
– Other slate devices
– Smart Phones
– Security
– BIOMED Devices-Integration with
Electronic Health Record

16. HIT DRIVERS
• Clinical documentation and CPOE
– Multiple vendors with semi-mature to mature
products
– Still only small percent adoption by hospital
physicians
– A couple of well-publicized failures/difficult starts
– Studies of ROI and safety benefits are mixed
– Doc’s don’t want to be data entry clerks, slowed
down or continually warned about the obvious
– e-prescribing gaining steam
– Part of Meaningful Use!

17. HIT DRIVERS
• Personal Health Records

18. HIT DRIVERS
• Restructure of Medical Records
Department
– Health Information Management
– Reporting Relationship
– Patient Portal

19. HIT DRIVERS
• ETL & Analytics
– Cloud Hosting
– ONC – MU Templates
– Data Warehouse

20. HIT DRIVERS
• Meaningful use
– Three Stages
– Physician Adoption
– Regional Extension Centers

21. HIT DRIVERS
• ICD-10
– 2013
– Bigger than Y2K?

22. HIT DRIVERS
• HIPPA 5010
– 2012

23. HIT DRIVERS
• Health information exchanges (HIE)
– Models
– Stakeholders
– Sustainability
– Cloud Hosting
– State (PA) Status

24. 24
Health information exchanges will be a growing U.S. healthcare opportunity
through 2015
Source: Boston Consulting Group estimate for IBM, Aug. 2010
The federal government has
distributed more than $650
million to states to develop
state-led HIEs as part of the
ARRA/HITECH law.

25. HIT DRIVERS
• Medical Home
– Smart Medical Devices
• Accountable care organizations (ACOs)
– Rules Published
– Reduced Revenue
– Cost pressure from downward revenue trend
• First 3-years during start up
– Collaboration
• HIE Role
– Competition vs. cooperation between providers
• Hospital
• Physician
– Coordinated services and Patient Experience
– Patient role/provider-patient relationship

26. HIT DRIVERS
• Quality measures
– Six-Sigma
– Clinical Decision Support
– Analytics

27. HIT DRIVERS
• HITECH Privacy and Security
– Fraud/abuse litigation increase
– Breaches on the rise
• OCR website list of breaches
– Breach Notification
• Cost
• Insurance
– Single Sign-on – Account Provisioning
– Encryption
• Portable devices
• USB devices

28. HIT DRIVERS
• IT shift to the cloud
– Private vs. Public
– Phased Approach
• Exchange
• Help Desk
• Contact Center
• Virtualization
– IaaS, PaaS, SaaS
– Bandwidth
– Privacy and Security
– Service Level Agreements
– Cost Benefit
• Operating vs. Capital Investment

30. 30

31. HIT DRIVERS
• Mergers & Acquisitions
– Vendors
• Technical
• ISPs
• Payers into clinical and HIE market
– Providers
• Hospitals
• Physicians
– Payers
• Payers buying HIE vendors

32. HIT DRIVERS
• Other
– Disease management
– Evidence-based medicine
– Personalized medicine
– Genetic testing
– Value-based Reimbursement
– Individual insurance growth
– Medicare payment cuts
– Medicaid expansion

33. HIMSS Survey – HIT Priorities

34. 34
Source: Gartner provide technologies hype cycle, July 2010

35. HIMSS Survey – IT Infrastructure

36. 36
Electronic medical records and digital medical imaging systems will drive data growth – and storage demand

37. HIMSS Survey – Barriers

38. Summary
• PHR disconnect /multiple PHRs –
personal data spread out across all
providers who deliver via their own
PHR
– Google
– Microsoft

39. Summary
• HIT
– Cloud relieves cost pressure to sustain
infrastructure, especially for small entities
with minimal capital
– Analytics (Clinical Decision Support) can be
helpful in determining where care can be
most cost-effectively and quality, delivered
– IT Leadership changing
• CIO
• CTO
• CMIO

40. Summary
• Lack of messaging/information sharing
between hospitals and other care providers
(both in system and outside of system)
– Electronic Health Record Vendors
• EPIC
• Cerner
• AllScripts
• NextGen
• PACS
– Neutral Archive
– Migration to new solutions
– Storage
– Best of Breed vs. Single Solution
– Unified Communications

41. Summary
• Care Continuum
– coordination of care – across the entire continuum of
care (hospital, PCP, home health, LTAC, private
practice, specialist, etc)
– location of care - drive to provide care at lowest cost
location
– ACO and Collaboration
• ACO coordination will be difficult
– reluctance to share financial and patient data with
competition
– desire to keep patient in the same system/network

42. MU
ICD-10
HIPAA 5010
ACO
Train Wreck Pending

43. The Current Trends
in HIT Leadership
and Staffing

44. HIT Staffing Pattern
Responders Could Select up to 3 Percent Continued… Percent
Clinical Application Support 41.7 PC Server Support 10.6
Process/Workflow Design 27.4 Database Administration 10.6
Clinical Informaticist 25.4 Financial Applications Support 9.5
Network and Architecture Support 20.9 Data Security 8.3
IT Security 20.9 We Don’t Currently Have Any
Needs
8.3
Clinical Transformation 20.4 IT Planning 6.8
Systems Integration 16.1 Programming 5.0
Clinical Champions 14.6 Internet/Intranet 4.8
Systems Design and
Implementation
14.3 IT Management 3.8
User Training 14.1 Regulatory/Reimbursement and
Accreditation Issues (e.g. HIPAA
and JCAHO)
3.5
Help Desk 12.1 Don’t’ Know and other .8

45. The Role of the
Healthcare CIO is
Shifting from
Technical Architect to
Process Change Agent

46. The Healthcare CIO
Role is
Changing……from
IT Manager to
Strategic Visionary

47. 2010 Survey

48. 2010 Survey

49. The HIT “Village”
• CIO
• CMIO
• CTO
• CSO
• Chief Innovation
Officer

50. The CMIO’s Role
• A Role in Transition
• Reporting
Relationships
• Clinical Leader for IT
• Gaining Recognition

51. The CMIO’s Role
“CMIOs have a unique role in
advancing clinical systems….the
CMIO must be both visionary and
tactical –keeping one foot solidly
planted in the strategic camp
while periodically getting into the
weeds to keep the project on
track.”
From Chaos to change: the evolving role of the CMIO –
Dearborn Advisors

52. The Rising Role of the CMIO
• Over 1/3 of US health systems have
a Chief Medical Information Officer
(source: CHIME)
• 41 % of CMIOs have staff (source:
Gartner study 2009)
• 91 % of CMIOs are licensed
physicians, 68 % are still practicing
medicine (source – CMIO Magazine
2010)
• 36 % report to CIO

53. The CTO’s Role
• IT Infrastructure
• Technical Background
• Keeps the lights on

54. Thank You