OSU Medical Center CEO Steven Gabbe, MD delivers a talk on facilitating learning healthcare systems: Focus on approaches to leverage Health IT investments for advancements in research and personalized healthcare and learning from every patient. This session will focus on the usages of HIT to learn from every patient so that this knowledge can be used to further the practice of medicine. The discussion will address the implications for research, privacy, and HIT to change the paradigm of advancing healthcare discoveries so that it is a continuous process driven through every patient interaction.

1. Bridging Health IT Innovation:Facilitating a Learning Health Care System Steven Gabbe, MD CEO OSU Medical Center April 18, 2011

2. The future of health care The learning health care system How we can bring it together to speed the delivery of better outcomes and safer care Agenda

3. Total healthcare spending $2.5 trillion in 2009, ~17.6% of the GDP; likely to reach $4 trillion by 2016 75-90% spent on managing and treating chronic illnesses that are preventable and effectively managed On a per-person basis, healthcare costs 50% higher than second most costly nation Drugs prescribed are effective in fewer than 60% of treated patients. Costs of development have skyrocketed Health Care: The Need for Transformation 3

4. Bridging Clinical Care, Research and Education Emergence of Accountable Care Organizations Growing demand for personalized medicine Pay for quality/outcomes Fundamental need for data-driven decision making and performance management to meet these needs 4

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6. 6 Predict Prevent Personalize Participate

7. Personalized Health Care is P4 Medicine 7

8. P4 Medicine 8

9. Value in Health Care:Outcome MeasurementDrives Innovation 9 Risk Adjusted Quality Safety OVER TIME Outcomes Value = Cost Full cycleof care Full setof outcomes Porter, M.E. N Engl J Med 2010; 363:2477-81 Appendices 1 and 2

10. 10 The Creation of a Learning Health Care System The Right Care at the Right Time, at the Right Place and then capture the results for clinical improvement

11. 11 The Creation of a Learning Health Care System Research -> Routine Practice Gap is 17 years Need a more efficient, effective,safe healthcare system requiringa more rapid progression of knowledge

12. Objectives of a Learning Healthcare System Learn from every patient encounter Improvecare patientreceives Improve thecare of thepatient’scommunity Improve the care of the patient’s family

13. Apply Biomedical Informatics to Improve Lives Through Personalized Health Care The study and process of efficiently gathering, storing, managing, retrieving, analyzing, communicating, sharing and applying biomedical information to improve the detection, prevention, and treatment of disease 13

14. Learning Health Care System:Only Achievable with an Electronic Medical Record Delivering timely and contextually appropriate data, information, and knowledge in support of basic science, clinical and translational research, clinical care, and public health.

15. P4 Medicine in Biomedical Informatics 15

16. 16 Institution plans a clinical trial for a new drug How a Learning Health Care System Might Operate Track the spread of outbreak of an infectious disease Monitor new drug safety after drug is approved for routine use Obtain clinical data from large group of patients taking a new drug that may reveal a modified dosage needed

17. Federal Health IT Strategic Plan 2011-15 The Adoption and Meaningful use of EMRs Medical practices that have EMRs and put them to “meaningful use” will get higher reimbursement from the government. The Health Information Exchange –Develop a clear path for building a “learning health system” Aggregate, analyze, and leverage health information to improve clinical knowledge transfer across populations 17 Source: Office of the National Coordinator for Health Information Technology (ONC)

18. Rapid Learning Using Electronic Medical Record Databases Rapidly advance the U.S. evidence base for clinical care Fill major knowledge gaps Health care costs The benefits and risks of drugs and procedures Geographic variations Environmental health influences Health of special populations, and personalized medicine 18

19. Community Medical Practices Health ITOrganizations ResearchInstitutes & Industry State Public Health Agencies Achieving a Nationwide Network Biomedical Research Public Health Health Care Quality Improvement Federal Agencies Beacon Communities Academic HealthCenters

20. 20 Building a Learning Health Care System

21. Building Our Learning Health Care Systemat OSU Medical Center 21 Department of Biomedical Informatics Center for IT Innovation in Healthcare (CITIH)

22. EPIC/EHR atOSUMC Integrated Health Information System Ambulatory services installed Big Bang October 15, 2011 Provide patient information at every care site Enhances quality and safety OSU MyChart 22