This document provides an overview and agenda for the iHT2 2013 Health IT Summit opening keynote. The keynote covers the impact of meaningful use on health IT and driving better healthcare, better health, and reduced costs. It also discusses innovation and transformation in health IT, including increasing venture capital funding and the growing size of the health IT industry. The keynote then focuses on the Sharp health system's journey in developing population health strategies and using technologies like their patient portal and health information exchange. It closes by emphasizing that health reform has catalyzed the need for care models that demand health IT and technology.

1. Opening Keynote
iHT2 2013 Health IT Summit
Bill Spooner, SVP/CIO
Tuesday, March 26, 2013

2. AGENDA
• HITECH and Health Reform
– What David Muntz (probably) would have shared!
• Innovation and Transformation
• The Sharp Journey
• Closing Messages
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3. What David Muntz (probably)
would have shared . . .

4. Impact of Meaningful Use
Health IT: Hardwiring the 3-Part Aim
Better healthcare Improving patients’ experience of care within the Institute of
Medicine’s 6 domains of quality: Safety, Effectiveness, Patient-
Centeredness, Timeliness, Efficiency, and Equity.
Better health Keeping patients well so they can do what they want to do.
Increasing the overall health of populations: address behavioral
risk factors; focus on preventive care.
Reduced costs Lowering the total cost of care while improving quality, resulting
$ in reduced monthly expenditures for Medicare, Medicaid, and
CHIP beneficiaries. Supporting new models of payment.
Health Information Technology
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5. Who is helping?
• The public – patients and consumers
• The IT industry – HIT professionals and EHR vendors
• The Health Care industry – all participants across the
continuum
• Professional and consumer organizations
• Numerous and diverse Federal agencies
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6. Venture Capital Funding for Health IT
Reaches $1.4 Billion for 2012
• July 2012, Dow Jones VentureSource
– Predicted investments at $724.11 Million for 2012
• January 2013, Rock News
– Venture capital investments for 2012 estimated at $1.4 Billion
– 46% more money
– 56% more deals
• January 11, 2013, Transparency Market Research
– Global mHealth will grow at a compounded annual rate of
41.5% in the next five years
– Will reach $10.2 billion by 2018
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7. HIT Industry – Size Estimates
Size
Source Supposed Market Definition Year ($
billions)
2009 1.3
Ambulatory EHR Revenue 2012 2.6
Frost & Sullivan 2013 3.0
2016 1.6
2009 1.0
Hospital EHR Revenue 2012 6.5
2009 0.6
Ambulatory MU (Software & Maintenance Costs) 2015 1.4
IDC Health Insights
2009 1.3
Inpatient MU (Software & Maintenance Costs)
2015 2.4
2008 12.5
2009 13.8
Kalorama EHR + Related Services Revenue 2010 15.7
2011 17.9
2012 5.3
2013 5.9
Millennium Research Group EHR Revenue 2014 6.6
2015 7.4
2016 8.3
EHR (end user purchases of components and 2009 2.2
MarketsandMarkets applications) 2015 6.1
US Health IT (EHR, Practice Management, CPOE, 2008 4.1
Global Market Direct eRx, Labs, Picture archiving, Radiology Images) 2015 11.5
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8. The Patient and Consumer
picture source: continuuminnovation.com
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9. Back in the Day…
“The obedience of a
patient to the
prescriptions of his
physician should be
prompt and implicit.
[The patient] should
never permit his own
crude opinions as to
their fitness to
influence his
attention to them.”
- AMA’s Code of
Medical Ethics (1847)
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10. And Now…
“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. I
corrected the mistakes in my health record…Better to clean it up
now, not when there’s time pressure.”
– Dave deBronkart (ePatient Dave)
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11. • Sphygmomanometer • Digestible
– Blood pressure RFID Pills
– Pulse
NETWORK
• Glucometer
– Blood sugar
• Bathroom Scale
• Smart Band-Aids – Weight
- Chemistry – Water loss/gain
From Hank Fanberg Texas HIT Summit Jan 2011 11

12. The Smart Home
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13. The Smart Patient
FCC Issues Final Rule Allocating Wireless Spectrum for MBANs
…wireless spectrum for medical body area networks starting Oct. 1, 2012…
Modern Healthcare. September 2012
Picture source: Jack E. Brown
6/23/2012
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14. Consumer Engagement = Better Care
13%
Hospital Readmit within 30 Days 28%
19%
Experience a Medical Error 36%
Suffer a health consequence from 13%
poor communcation among providers 49%
More Activated Patient
Less Activated Patient
AARP Magazine, July/August 2009 findings based on people over 50 years
who have at least one chronic condition. 14
14

15. There’s a Gap between Reality & Potential
• 15% have renewed a prescription online
• 10% have a personal health record (PHR)
• 8% of consumers have e-mailed their
provider
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16. Many C-suite Executives and Boards are
Skeptical of the Value of HIT Investment
“Some healthcare CEOs refer to IT as that “I estimate that about half of our IT
black hole you pour money into… never investment generates value . . . I just
seeing results.” can’t figure out which half.”
- Healthcare CEO - Healthcare CEO
“While [the system] has helped [us]
boost patient safety and medication
administration processes, [we have] put
quality of care and improving safety
ahead of ROI and time savings.”
- VP of Quality and Care Management
2010 Lecture by Lynn Vogel, PhD, at CHIME Boot Camp
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17. Defining the Value Proposition for
Information Technology Investments
• Health IT
– Is a significant expense in an increasingly resource constrained
environment
– Is moving from dread to desire (expectation)
– Requires a new agility that didn’t exist and cannot necessarily be
supported on existing foundations
• New priorities have intensified competition for limited
resources (e.g., clinic acquisitions, robotics, genomics)
• With our IT investments, we have not excelled at
– Defining value
– Measuring value
– Meeting deadlines
– Getting comprehensive community buy-in
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18. Similarities & Differences (Moody and Walsh 1999)
Time Decreases Value Integration Increases Value
Operational Decision
Support
Information Information
Potential Potential
Value ($) Value ($)
Statutory
Time Increase in Integration
Sharing Increases Value Use Increases Value
Information
Value ($) Value ($)
Number of People Sharing Number of People Using
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19. Connect. Communicate. Collaborate.
Office of National Coordinator
• Browse the ONC website at: HealthIT.gov
click the Facebook “Like” button to add us to your network
• Contact us at: onc.request@hhs.gov
• Subscribe, watch, and share:
@ONC_HealthIT
http://www.youtube.com/user/HHSONC
Health IT and Electronic Health Records
http://www.scribd.com/HealthIT/
http://www.flickr.com/photos/healthit Health IT Buzz Blog
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20. Innovation and Transformation

21. John Glaser on Innovation
Practical innovation—the kind of innovation that genuinely improves patient care or
workflow and can be implemented by an organization today—is based on four cornerstones:
• The Right Culture
– Organizational fabric, directed at business or clinical value
• The Right Questions
– Vision, strategy, process, technology
• The Right Processes
– Portfolio, idea input, evaluation, pilots, impact assessment
• The Right Tools in support of innovation
Technology has no inherent ability to “cause” innovation. Its innovation
value is determined by the context of its potential use.
HHN Feb. 2008
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22. Innovation and Transformation
• "Innovation" is Dead. Herald The Birth of
"Transformation" as The Key Concept for 2009
– Bruce Nussbaum, December 31, 2008
• Innovation and Transformation: a Lifecycle Model
– Coffman and Kaufman, Innovation Labs, LLC
• Innovation as the fuel of Transformation!
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23. Transformative (?) Alliances
• Davita acquires Healthcare Partners
• United Healthcare acquires Monarch
• Cleveland Clinic & Community Health Systems partner
• Aetna and United acquire I.T. firms
• UPMC and Advisory Board form Evolent Health
• Walmart and pharmacy chains expand Primary Care
• Health Systems align
– Trinity and Catholic Healthcare East
– Hoag and St Joseph’s
– Catholic Health Initiatives and Peace Health
– Others
• Hospitals acquire physician practices
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24. The Sharp Journey

25. Sharp HealthCare
• Largest health care system in San Diego
– 2 affiliated medical groups, 7 hospitals, 3 skilled
nursing facilities, a health plan, 21 outpatient
clinics, 5 urgent care centers, home health,
hospice, and home infusion programs
– Market share leader and only health care system
that increased market share each of the past 11
years
• Largest private employer in San Diego
– 15,000 employees, 2,600 affiliated physicians,
2,300 volunteers
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26. Sharp HealthCare
• Grew from one hospital in
1955 to an integrated health
care delivery system
– Aligned physician partners
– Integrated I.T. systems and
infrastructure
– Centralized system support
services
– Over 25 years experience in
managing care under population-
based payment structures
– Sharp Health Plan, a 65,000
member, Knox Keene licensed
commercial health plan
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27. Sharp’s Population Health Strategy
Care coordination and population health
management are not new concepts at Sharp
Since 1980’s New in 2012
35,000
246,000
20,000
32,000
Capitated Capitated Commercial Pioneer ACO
Senior Commercial ACO Beneficiaries
Enrollees Enrollees Members (Medicare)
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28. Priority I.T. Requirements for ACO’s
• Master Person Index - Registry
– Methodology for effective patient identification
• E.H.R.
• Population Health/ Analytics
– Evaluate all aspects of quality, access and cost of care.
• Health Information Exchange
– View the complete record across all providers
• Patient Portal
– Advance patient engagement, “stickiness”
• Case/Care Management
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29. Health Information Exchange

30. Patient Portal
Key Facts:
• Launched in February 2010
• 100,000 patients signed up
• Nearly 18,000 on mobile mySharp
launched in May 2012
• 750,000 logins in FY2012
– 195,000 lab results
– 150,000 secure messages
– 60,000 appointments scheduled
– $2.3 million patient payments
• CCHIT cert for Visit Summaries
In-house Developed
• Cold Fusion
• Oracle middleware
• Links:
– Allscripts, Cerner EHRs, GE PM
– GE Practice Managemnt
– dbMotion HIE
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31. Portal for Smart Device
 mySharp Mobile
― App for iPad, iPhone and by late Spring Android mobile devices
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32. NeHC Patient Engagement Framework
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33. Joseph M. Smith, MD, PhD, March 20, 2013
House Energy and Commerce Committee
Subcommittee on Health
http://www.westhealth.org/institute/interoperability
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34. Other Innovations!
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35. Exploratory with Qualcomm Life
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36. Illustrative Timelines for Key Initiatives
ICD-10, MU, & Health Reform
Federal Fiscal Year FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016
ICD-10 Transition Transition to ICD-10 Partial ICD Code Set Freeze ICD-10 Implementation
Transition to 5010 5010 Operational Transition to Next Standard
Administrative
Simplification Eligibility and Claim Status Remittance & Claims
Health Plan ID
Meaningful
Stage 1 Stage 2 Stage 3
Use of EHRs
Accountable Care Organizations
Base/Performance Period Value Based Purchasing
Health
Reform Base/Performance Period Readmission Payment Penalties
Initiatives Bundled Payment
Base/Performance Period Hospital-Acquired Conditions
Accounting for Disclosures
HIPAA Privacy
Changes Patient Copy of Electronic Records
ICD-10 Implementation 36

37. Messages
• Health reform a catalyst
– Care models demand technology
– Technology creates opportunities
– Reduced reimbursement require efficient, effective solutions
• Feds have promoted technology advance
– HITECH and CMMI grants
– Meaningful Use
• Feds have slowed technology advance
– Priority required of health reform programs
• Great time to be an I.T. professional
– Investment in skills training increasing
– Work environment more important than ever
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