This document discusses the use of electronic health records and health information technology to transform healthcare delivery in the United States. It outlines the goals of meaningful use of health IT, including improved care, patient engagement, and population health management. It also describes the funding provided through HITECH act incentives and how the number of providers adopting and successfully demonstrating meaningful use has grown rapidly in recent years.

1. Electronic Health Records and Health Information Technology:
Making a Difference to The Healthcare Delivery System
David S. Muntz, CHCIO, FCHIME, FHIMSS
Principal Deputy National Coordinator
Office of the National Coordinator for Health IT
Department of Health & Human Services

2. Together, We Must Transform
The Healthcare Delivery System
• Care transformation
• Patient engagement
• Population management
June 12, 2013 1

3. Meaningful Use
June 12, 2013 2
Pumpkin Meaningful Use of Pumpkin

4. Primary Goal: Achieve Meaningful Use
Of Health Information Technology
General Requirements That Must Be Met:
• Certified EHR is used in a meaningful manner, including
electronic prescribing
• Certified EHR is connected in a manner that allows for
the exchange of health information
• Entity is capable of reporting on clinical quality measures
and such other measures as selected by the Secretary of
Health and Human Services
Incremental Approach - 3 Stages
June 12, 2013 3

5. • CMS defines the EHR
Incentive Programs;
• ONC defines the EHR
Standards and
Certification Criterion;
• MU supports the HIPAA
privacy and security rules,
already a requirement for
most providers.
June 12, 2013 4
Administration of Meaningful Use

6. How Is the Transformation Funded?
• $22.5 Billion of incentives
– Eligible professionals and hospitals including critical access
facilities
– Medicare and Medicaid participants
• $2 Billion for ONC supported programs:
– HIE (Health Information Exchange)
– Regional Extension Centers (RECs)
– Workforce Training Grants
– National Health IT Research Center (HITRC)
– Beacon Grants
– Strategic Health IT Advanced Research (SHARP) Grants
• $10.3 Billion from other Federal partners
• Many more billions from the provider community
June 12, 2013 5

7. Meaningful Conversation
June 12, 2013 6
“The formulation of a problem is
often more essential than its solution,
which may be merely a matter of
mathematical or experimental skill.”

8. Major Challenge:
Change Management
• Workflow
• Lifeflow
June 12, 2013 7

9. Who are our Federal partners?
June 12, 2013 8
More to
come…

10. What do hockey and EHRs have in common?
June 12, 2013 9

11. Providers Registered for
Medicare and Medicaid EHR
Incentive Programs as March 31, 2013
Source: CMS EHR Incentive Program Data
0
1,000
2,000
3,000
4,000
5,000
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Cumulative number of eligible hospitals registered
Eligible Hospitals Registered for the Medicare and
Medicaid EHR Incentive Programs
0
100,000
200,000
300,000
400,000
500,000
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Cumulative number of eligible professionals registered
Eligible Professionals Registered for the Medicare and
Medicaid EHR Incentive Programs
386,024 eligible professionals
74%
4,333 eligible hospitals
86%
521,600
Total Eligible Professionals
5,011
Total Eligible Hospitals
June 12, 2013 10

12. Unique Eligible Providers Successfully
Demonstrating MU as of April 30, 2013
June 12, 2013 11
Note: Payments for May 2012 include payments to Medicare Advantage providers.
295,205 unique eligible professionals and hospitals have received payment
through the Medicare or Medicaid EHR Incentive Programs
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
CumulativeUniqueProvidersPaid
NumbersofUniqueProvidersPaidperMonth
Monthly Total Cumulative Total
EP Paid: 291,325 (56%)
EH Paid: 3,880 (77%)

13. $22 $16 $26 $31
$109
$81
$116
$276
$237
$387
$607
$836
$564
$629
$662
$623
$587
$441
$406
$532
$579
$716
$907
$1,402
$1,109
$809
$1,001
Cumulative Total
$13,710
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
CumulativeAmountPaid(Millions)
AmountPaidperMonth(Millions)
Payments to All Eligible Professionals and Hospitals Under the Medicare or Medicaid EHR Incentive Programs
Meaningful Use – All Payments
As of March 31, 2013
Note: Payments include Medicare Advantage Organizations. Source: CMS EHR Incentive Program Data
June 12, 2013 12

14. Age Discrepancies

15. E-Prescribers On the Surescripts Network
December 2006 – March 2013
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
550,000
Dec-06
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Dec-07
Jan-08
Feb-08
Mar-08
Apr-08
May-08
Jun-08
Jul-08
Aug-08
Sep-08
Oct-08
Nov-08
Dec-08
Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
Mar-10
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
TotalPrescribers EHRPrescribers Stand Alone Prescribers

16. 3164
1804
959
0
500
1000
1500
2000
2500
3000
3500
4/18/2011
5/18/2011
6/18/2011
7/18/2011
8/18/2011
9/18/2011
10/18/2011
11/18/2011
12/18/2011
1/18/2012
2/18/2012
3/18/2012
4/18/2012
5/18/2012
6/18/2012
7/18/2012
8/18/2012
9/18/2012
10/18/2012
11/18/2012
12/18/2012
1/18/2013
2/18/2013
3/18/2013
4/18/2013
Total Products
Total Unique Products
Total Vendors
Certified Health IT Product and
Vendor Trends (4/18/2013)
June 12, 2013 15

17. Online Job Postings Have Grown
Substantially
• Supporting activities
– Community College Consortia
– University Based Training
– Curriculum development
– Competency Exam
June 12, 2013 16
-1,000
1,000
3,000
5,000
7,000
9,000
11,000
13,000
15,000
Jan-07
Mar-07
May-07
Jul-07
Sep-07
Nov-07
Jan-08
Mar-08
May-08
Jul-08
Sep-08
Nov-08
Jan-09
Mar-09
May-09
Jul-09
Sep-09
Nov-09
Jan-10
Mar-10
May-10
Jul-10
Sep-10
Nov-10
Jan-11
Mar-11
May-11
Jul-11
Sep-11
Nov-11
Jan-12
NumberofHealthITJobPostingsperMonth
Health IT Implementation & Support Jobs Health IT Clinical User Jobs
HITECH Act
February2009
4,850
14,512
SOURCE: ONC analysis of data from O’Reilly Job Data Mart

18. Students Enrolled and Students Completed
(Cumulative)
June 12, 2013
17
Community College Consortia
As of March 31, 2013
SOURCE: ONC Data Brief
10,000
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Studnets
Cumulative Enrollment Cumulative Completion Cumulative Enrollment (adjusted for attrition)
21,539
17,523
31,801

19. 297
479
98
48 54
271
345
62
11
40 35
0
100
200
300
400
500
600
700
800
900
Clinician/
Public Health
Leader
HIM & Exchange Privacy & Security R&D Programmer/
Software Engineer
HIT Sub-specialist
Graduated Enrolled Target
University-Based Training
As of January 25, 2013
Target: 1,685
Graduated: 976
Gap to target: 709
Enrollment: 764
Remaining gap: None
June 12, 2013 18

20. HIT Industry – Size Estimates as of
2011
Source Supposed Market Definition Year
Size
($
billions)
Frost & Sullivan
Ambulatory EHR Revenue
2009 1.3
2012 2.6
2013 3.0
2016 1.6
Hospital EHR Revenue
2009 1.0
2012 6.5
IDC Health Insights
Ambulatory MU (Software & Maintenance Costs)
2009 0.6
2015 1.4
Inpatient MU (Software & Maintenance Costs)
2009 1.3
2015 2.4
Kalorama EHR + Related Services Revenue
2008 12.5
2009 13.8
2010 15.7
2011 17.9
Millennium Research Group EHR Revenue
2012 5.3
2013 5.9
2014 6.6
2015 7.4
2016 8.3
MarketsandMarkets
EHR (end user purchases of components and
applications)
2009 2.2
2015 6.1
Global Market Direct
US Health IT (EHR, Practice Management, CPOE,
eRx, Labs, Picture archiving, Radiology Images)
2008 4.1
2015 11.5
EMR market rose to $20.7B in 2012, report finds.

21. Report: Next EMR Opportunity
May Be in Europe
June 12, 2013 20
New York, October 24, 2012--European
electronic medical records (EMR) market
reached revenues of $6.8 billion in 2012.
Kalorama Information's new report, EMR in Europe.

22. The Patient and Consumer
picture source: continuuminnovation.com

23. Back in the Day…
June 12, 2013 22
“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)

24. And Now…
Patient Generated Data
June 12, 2013 23
“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)

25. Patient Engagement – The Vision
• Unbounded expectations
• Untethered Personal Health Records
• Patient as a custodian of records
• Consumer mediated exchange
• Requirements in 2014 Edition
– View, download, and transmit
– Secure messaging
June 12, 2013 24

26. • Glucometer
– Blood sugar
• Bathroom Scale
– Weight
– Water loss/gain
• Sphygmomanometer
– Blood pressure
– Pulse
NETWORK
• Smart Band-Aids
- Chemistry
• Digestible
RFID Pills
From Hank Fanberg Texas HIT Summit Jan 2011June 12, 2013
25

27. The Smart Home
26

28. The Smart Car
• Seat
– Weight
– Blood pressure
– Breathing rate
• Steering Wheel
– Pulse
– EKG
– Blood oxygen (PO2)
June 12, 2013
27
Walter, Eilebrecht ET AL
Personal and Ubiquitous Computing
November 2010
From Hank Fanberg Texas HIT Summit Jan 2011

29. The Smart Patient
June 12, 2013 28
FCC Issues Final Rule Allocating Wireless Spectrum for MBANs
The Federal Communications Commission has released a final
rule to allocate wireless spectrum for medical body area
networks starting Oct. 1, 2012. FCC said the spectrum
allocation will help improve patient care and safety by
reducing the need to physically connect sensors to patients.
Modern Healthcare. September 2012
Picture source: Jack E. Brown
6/23/2012

30. ONC’s Three A’s for Consumer
Engagement
June 12, 2013 29
• Give consumers secure, timely
electronic access to their health
information.
Access
• Support the development of
tools that help consumers to
take action using information.
Action
• Help expectations about
consumer (and provider) roles
to evolve.
Attitude

31. Consumer Engagement = Better Care
June 12, 2013 3030
Suffer a health consequence from
poor communcation among providers
Experience a Medical Error
Hospital Readmit within 30 Days
36%
28%
13%
19%
13%
More Activated Patient
Less Activated Patient
49%
AARP Magazine, July/August 2009 findings based on people over 50 years who have at
least one chronic condition.

32. There’s a Gap between Reality &
Potential
June 12, 2013 31
• 15% have renewed a prescription online
• 10% have a personal health record (PHR)
• 8% of consumers have e-mailed their provider

33. Taking the Blue Button Nationwide

34. Security and Privacy are and
should be in the DNA of HIT.
June 12, 2013 33

36. Adoption Speed for New Ideas
Time to reach 1M consumers
June 12, 2013 35
For those with the best ideas, the technology adoption curve in the future will be immediate.
16 years
71 years
10 years
9 months
2 days
21 years
Technology Adoption Timeline
74 days
75 Years 0 Days
Source: Glen Tullman, “Creating a Connected Community of Health,” Allscripts Innovation and Value-Driven Healthcare Summit (2011)

37. Liberating Data
June 12, 2013 36

38. Why is HIT important? Patients are not averages.
They are part of a community.
59 year-old woman in
Dallas, TX who was
diagnosed with glaucoma
in 1982 and has been
taking Timoptic eye drops
daily.
During the admission, she
received personalized risk
assessment forms, was placed on
standardized order sets.
Medication reconciliation was
done. She was sent to the Cath
Lab for an angiogram. Prior to
and after her procedures,
telemetry results were entered
automatically into the EHR.
Using an EHR with imaging, her
physician was able to review her
angiogram with her on the TV
screen in her room and discuss
the potential risks of an
additional beta blocker to ensure
the best possible outcome.
Personalized discharge
instructions were given to her
spouse. The outcome and
prognosis are good.
On Sunday, April 15, 2012,
10 minutes after entering
the water for the first leg
of a mini-triathlon she
suffered what was
eventually diagnosed as a
non-STEMI cardiac event.
She was admitted to the
Heart Hospital at Baylor
Plano.

39. 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
June 12, 2013 38

40. Together, we are making a difference!
Thank you!
Please send comments or questions to
David.Muntz@HHS.gov