CP1318694-1

Bridging the ChasmBridging the Chasm

Nina Schwenk, MD FACP

Washington DC

April 20, 2009

Nina Schwenk, MD FACP

Washington DC

April 20, 2009

CP1318694-2

Meeting GoalsMeeting Goals

• Establish the value of standards and interoperability to the clinical community

• Identify priorities from a clinical perspective

• Have clinicians clearly articulate their requirements in non-technical terms

• Identify common processes by which the specialty groups can define and communicate information requirements to the HIT community

• Establish the value of standards and interoperability to the clinical community

• Identify priorities from a clinical perspective

• Have clinicians clearly articulate their requirements in non-technical terms

• Identify common processes by which the specialty groups can define and communicate information requirements to the HIT community

CP1318694-3

Thank YouThank You

CP1318694-5

Health Care Information Technology Standards & Interoperability Summit

November 18 - 20, 2008

Health Care Information Technology Standards & Interoperability Summit

November 18 - 20, 2008

Providers invited to summit included: Providers invited to summit included:

• Cleveland Clinic

• Dartmouth

• Health Partners

• Henry Ford Health System

• Kaiser Permanente

• Intermountain Healthcare

• Lahey Clinic

• Mayo Clinic

• Ochsner Health System

• Palo Alto Medical Foundation

• Partners Healthcare

• University of Pittsburgh Medical Center

• Vanderbilt Medical Center

• Virginia Mason Medical Center

CP1318694-6

Health Care Information Technology Standards & Interoperability Summit

November 18 - 20, 2008

Health Care Information Technology Standards & Interoperability Summit

November 18 - 20, 2008

Vendors invited to summit included: Vendors invited to summit included:

• Avaya

• Cerner

• Cisco

• Dell

• Epic

• GE Health Care

• Google

• Hewlett Packard

• IBM

• Intel

• Lawson

• McKesson

• Microsoft

• Oracle

• Siemens

• Sun Microsystems

CP1318694-7

Summit GoalSummit Goal

Through a consensus process identify three to six health care IT-dependent solutions that will overcome critical barriers to patient-centered health care delivery through increased interoperability and application of established national and international standards. Engage participating provider and IT partner groups to work collaboratively to develop these solutions.

Through a consensus process identify three to six health care IT-dependent solutions that will overcome critical barriers to patient-centered health care delivery through increased interoperability and application of established national and international standards. Engage participating provider and IT partner groups to work collaboratively to develop these solutions.

CP1318694-8

Provider SessionProvider Session

CP1318694-9

AgendaAgenda

• Barriers to Patient-Centered Care Delivery

• Using Health IT to Advance Health Care Using Health IT to Advance Health Care Reform: Moving Beyond Theory to Reform: Moving Beyond Theory to Pragmatic SolutionsPragmatic Solutions

Dr. Robert KolodnerDr. Robert Kolodner

• Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery

• Creating an Action Plan for Providers

• Barriers to Patient-Centered Care Delivery

• Using Health IT to Advance Health Care Using Health IT to Advance Health Care Reform: Moving Beyond Theory to Reform: Moving Beyond Theory to Pragmatic SolutionsPragmatic Solutions

Dr. Robert KolodnerDr. Robert Kolodner

• Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery

• Creating an Action Plan for Providers

CP1318694-10

17%

71%

8%

0%

4%

Which of these statements best describes theU.S. health care system today? (select one)Which of these statements best describes theU.S. health care system today? (select one)

1. Complete state of crisis

2. Overall – major problems

3. Some segments with major problems

4. Few segments with major problems

5. No significant problems

1. Complete state of crisis

2. Overall – major problems

3. Some segments with major problems

4. Few segments with major problems

5. No significant problems

CP1318694-11

8.9

6.1

6.2

6.7

6.2

4.9

Rank these entities on the degree they would influence health reform:(Rank each item 1 to 10 with 1 being no influence, 10 being major influence)

Rank these entities on the degree they would influence health reform:(Rank each item 1 to 10 with 1 being no influence, 10 being major influence) Federal government

State government

Health care providers

Health care payers

Employers/non-health organizations

Consumers/individuals

Federal government

State government

Health care providers

Health care payers

Employers/non-health organizations

Consumers/individuals

CP1318694-12

20%

25%

22%

19%

14%

In your opinion, how much influence do you think the following groups have had on increasing medical costs in the United States?(Rank the list in order of influence)

In your opinion, how much influence do you think the following groups have had on increasing medical costs in the United States?(Rank the list in order of influence)

1. Doctors and hospitals

2. Drug companies

3. Medical technology companies

4. Insurance companies

5. People who don’t take care of themselves

1. Doctors and hospitals

2. Drug companies

3. Medical technology companies

4. Insurance companies

5. People who don’t take care of themselves

CP1318694-13

8.9

7.9

5.6

5.0

5.8

6.5

In the next 100 days, how difficult/important will it be for President Elect Obama to address the following topics:(Rank each item 1 to 10 with 1 being not difficult,10 being very difficult)

In the next 100 days, how difficult/important will it be for President Elect Obama to address the following topics:(Rank each item 1 to 10 with 1 being not difficult,10 being very difficult) 1. Healthcare

2. War

3. Illegal immigration

4. Automaker bailout

5. Banking bailout

6. Foreign Policy

1. Healthcare

2. War

3. Illegal immigration

4. Automaker bailout

5. Banking bailout

6. Foreign Policy

Difficulty

CP1318694-14

8.3

8.2

4.5

5.4

7.3

7.2

In the next 100 days, how difficult/important will it be for President Elect Obama to address the following topics:(Rank each item 1 to 10 with 1 being not important, 10 being very important)

In the next 100 days, how difficult/important will it be for President Elect Obama to address the following topics:(Rank each item 1 to 10 with 1 being not important, 10 being very important) 1. Healthcare

2. War

3. Illegal immigration

4. Automaker bailout

5. Banking bailout

6. Foreign Policy

1. Healthcare

2. War

3. Illegal immigration

4. Automaker bailout

5. Banking bailout

6. Foreign Policy

Importance

CP1318694-15

1 2 3 4 5 6 7 8 9 10

10

9

8

7

6

5

4

3

2

1

Healthcare

War

Illegal immigration

Automaker bailout

Banking bailout

Foreign Policy

Importance

Difficulty

CP1318694-16

Barriers to Patient-Centered Care DeliveryBarriers to Patient-Centered Care Delivery

• Health Care Reform Cornerstones•Creating Value•Coordinated Care•Payment Reform•Health Insurance for All

• Health Care Reform Cornerstones•Creating Value•Coordinated Care•Payment Reform•Health Insurance for All

CP1318694-17

Barriers to Patient-Centered Care DeliveryBarriers to Patient-Centered Care Delivery

• Perspectives•Patient•Provider•Purchaser•Payer

• Perspectives•Patient•Provider•Purchaser•Payer

CP1318694-18

CP1318694-19

Using Health IT to Advance Health Care Using Health IT to Advance Health Care ReformReformUsing Health IT to Advance Health Care Using Health IT to Advance Health Care ReformReform

• ““Moving Beyond Theory to Pragmatic Moving Beyond Theory to Pragmatic Solutions”Solutions”

Dr. Robert KolodnerDr. Robert Kolodner

• ““Moving Beyond Theory to Pragmatic Moving Beyond Theory to Pragmatic Solutions”Solutions”

Dr. Robert KolodnerDr. Robert Kolodner

CP1318694-20

Overview of the Federal Health IT Overview of the Federal Health IT Strategic PlanStrategic PlanOverview of the Federal Health IT Overview of the Federal Health IT Strategic PlanStrategic Plan

• Establish a governance structure that Establish a governance structure that coordinates organizational processescoordinates organizational processes

• Protect the privacy and security of patient health Protect the privacy and security of patient health informationinformation

• Enable the movement of health information by Enable the movement of health information by setting standards that allow interoperabilitysetting standards that allow interoperability

• Promote adoption of technologiesPromote adoption of technologies

• Establish a nationwide health information Establish a nationwide health information networknetwork

• Establish a governance structure that Establish a governance structure that coordinates organizational processescoordinates organizational processes

• Protect the privacy and security of patient health Protect the privacy and security of patient health informationinformation

• Enable the movement of health information by Enable the movement of health information by setting standards that allow interoperabilitysetting standards that allow interoperability

• Promote adoption of technologiesPromote adoption of technologies

• Establish a nationwide health information Establish a nationwide health information networknetwork

CP1318694-21

* Information Sharing & Exchange

* Standards & Interoperability

CP1318694-22

Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery

Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery

CP1318694-23

Patients

Providers

Purchasers

Payers

Industry

Regulators

Compliance

Government

Health Care Ecosystem Today

CP1318694-24

Lack of “interoperable”

health care ecosystem

CP1318694-25

Business Case for “Interoperable”Health Care Ecosystem

Business Case for “Interoperable”Health Care Ecosystem

• Value

• Cost

• Coordinated Care

• Innovation

• New Business Opportunities

• Effectiveness and Efficiency

• Intelligence gathering

• Market

• Value

• Cost

• Coordinated Care

• Innovation

• New Business Opportunities

• Effectiveness and Efficiency

• Intelligence gathering

• Market

CP1318694-26

Health Care IT Dependent Opportunities

Health Care IT Dependent Opportunities

• Personal Health Record

• Patient Provided Information

• Vocabulary

• Universal Patient Identifier

• Clinical Data Architecture

• Standard, interoperable core medical information

• Affordability to purchasers and patients/efficiency

• Standard measures of value

• Personal Health Record

• Patient Provided Information

• Vocabulary

• Universal Patient Identifier

• Clinical Data Architecture

• Standard, interoperable core medical information

• Affordability to purchasers and patients/efficiency

• Standard measures of value

• Safety (clinical quality)

• Coordination of care

• Device manufacturer standardization

• Clinical decision support tools

• Medication reconciliation

• Standardized network-to-network interoperability

• Infrastructure vendor collaboration

• EMR vendor collaboration

• Safety (clinical quality)

• Coordination of care

• Device manufacturer standardization

• Clinical decision support tools

• Medication reconciliation

• Standardized network-to-network interoperability

• Infrastructure vendor collaboration

• EMR vendor collaboration

CP1318694-27

(Rank each item 1 to 10 with 1 being low priority, 10 being high priority) (Rank each item 1 to 10 with 1 being low priority, 10 being high priority)

Patient Centered

8.17.7

6.08.6

4.59.0

6.76.6

7.08.7

4.25.2

7.46.6

0.04.1

5.0

Personal Health RecordPatient provided informationVocabularyUniversal patient identifierClinical data architectureCore medical informationAffordability to purchasers and patients /EfficiencyStandard measures of valueSafety (Clinical quality)Coordination of careDevice manufacturer standardizationClinical decision support toolsMedication reconciliationStandardized Network-to-network interoperabilityInter-organizational interoperabilityInfrastructure vendor collaborationEMR vendor collaboration

Personal Health RecordPatient provided informationVocabularyUniversal patient identifierClinical data architectureCore medical informationAffordability to purchasers and patients /EfficiencyStandard measures of valueSafety (Clinical quality)Coordination of careDevice manufacturer standardizationClinical decision support toolsMedication reconciliationStandardized Network-to-network interoperabilityInter-organizational interoperabilityInfrastructure vendor collaborationEMR vendor collaboration

CP1318694-28

(Rank each item 1 to 10 with 1 being low priority, 10 being high priority) (Rank each item 1 to 10 with 1 being low priority, 10 being high priority)

Business Value

7.06.9

7.98.9

6.68.8

6.97.5

7.17.9

6.46.9

7.27.6

0.06.46.4

Personal Health RecordPatient provided informationVocabularyUniversal patient identifierClinical data architectureCore medical informationAffordability to purchasers and patients /EfficiencyStandard measures of valueSafety (Clinical quality)Coordination of careDevice manufacturer standardizationClinical decision support toolsMedication reconciliationStandardized Network-to-network interoperabilityInter-organizational interoperabilityInfrastructure vendor collaborationEMR vendor collaboration

Personal Health RecordPatient provided informationVocabularyUniversal patient identifierClinical data architectureCore medical informationAffordability to purchasers and patients /EfficiencyStandard measures of valueSafety (Clinical quality)Coordination of careDevice manufacturer standardizationClinical decision support toolsMedication reconciliationStandardized Network-to-network interoperabilityInter-organizational interoperabilityInfrastructure vendor collaborationEMR vendor collaboration

CP1318694-29

1 2 3 4 5 6 7 8 9 10

Patient

10

9

8

7

6

5

4

3

2

1

Bu

sine

ss

Personal Health Record

Patient provided information

Vocabulary

Universal patient identifier

Clinical data architecture

Core medical information

Affordability to purchasers and patients /Efficiency

Standard measures of value

Safety (Clinical quality)

Coordination of care

Device manufacturer standardization

Clinical decision support tools

Medication reconciliation

Standardized Network-to-network interoperability

Inter-organizational interoperability

Infrastructure vendor collaboration

EMR vendor collaboration

CP1318694-30

Provider prioritiesto support health care Value and

Coordinated Care

Provider prioritiesto support health care Value and

Coordinated Care• Universal patient identifier

• Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for communication among EMRs, PHRs, medical devices and more.

•Vocabulary•Standardized network-to-network interoperability (i.e. NHIN)•Medication reconciliation

• Universal patient identifier

• Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for communication among EMRs, PHRs, medical devices and more.

•Vocabulary•Standardized network-to-network interoperability (i.e. NHIN)•Medication reconciliation

CP1318694-31

Creating an Action Plan for Providers

Creating an Action Plan for Providers

1. Establish a provider coalition that would drive a collective agenda to advance the top two priorities developed here

2. Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape

3. Advance the top two priorities developed here by integrating with the existing landscape

1. Establish a provider coalition that would drive a collective agenda to advance the top two priorities developed here

2. Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape

3. Advance the top two priorities developed here by integrating with the existing landscape

CP1318694-32

32%

68%

0%

1.1. Establish a stand-alone provider coalition and Establish a stand-alone provider coalition and drive a collective agenda drive a collective agenda

2.2. Establish a provider coalition that works with Establish a provider coalition that works with existing efforts existing efforts

3.3. Integrate individually with the existing Integrate individually with the existing landscape landscape

Three possible options:Three possible options:

CP1318694-33

Creating an Action Plan for Providers

Creating an Action Plan for Providers

Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape

Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape

CP1318694-34

Joint Provider/IT Vendor SessionJoint Provider/IT Vendor Session

CP1318694-35

AgendaAgenda

• Review Provider session outcomes

• Engage IT Vendors in discussion Engage IT Vendors in discussion regarding barriers and solutionsregarding barriers and solutions

• Determine next steps

• Review Provider session outcomes

• Engage IT Vendors in discussion Engage IT Vendors in discussion regarding barriers and solutionsregarding barriers and solutions

• Determine next steps

CP1318694-36

Provider expectations for IT Partners

Provider expectations for IT Partners

Universal patient identifierIT partners must support the use of a voluntary and/or required universal patient identifier

Universal patient identifierIT partners must support the use of a voluntary and/or required universal patient identifier

CP1318694-37

Provider expectations for IT Partners

Provider expectations for IT Partners

Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for exchange among EMRs and PHRs and others.

•Vocabulary•Standardized network-to-network interoperability (i.e. NHIN)•Medication reconciliation

IT partners must support interoperability standards

Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for exchange among EMRs and PHRs and others.

•Vocabulary•Standardized network-to-network interoperability (i.e. NHIN)•Medication reconciliation

IT partners must support interoperability standards

CP1318694-38

8%

25%

81%

75%

11%

0%

1.1. Form two tribes Form two tribes

2.2. Create collective tribe Create collective tribe

3.3. Status quo Status quo

Which way:Which way:

IT Provider

CP1318694-39

Joint Action Plan for Providers and IT Vendors

Joint Action Plan for Providers and IT Vendors

Establish a coalition to advance the top two priorities developed here that connects to the larger landscape

Establish a coalition to advance the top two priorities developed here that connects to the larger landscape

CP1318694-40

Coalition Output to DateCoalition Output to Date

• Letter of support to Congress (HIT funding)• HIT Framework for Action (principles for HIT investment)• Input to the ONC on its Strategic Plan update

• Letter of support to Congress (HIT funding)• HIT Framework for Action (principles for HIT investment)• Input to the ONC on its Strategic Plan update

CP1318694-41

Coalition Output to DateCoalition Output to Date

• Position on “Meaningful Use” provision in the Stimulus Bill• Grant proposal for stimulus funding to further coalition objectives• Invite additional members?

• Position on “Meaningful Use” provision in the Stimulus Bill• Grant proposal for stimulus funding to further coalition objectives• Invite additional members?

CP1318694-42

Thank YouThank You

CP1318694-43

Thank YouThank You