Introduction
Better Health
Jacob Reider
@jacobr
Doug Fridsma?
Self Identity?
EHR Vendor
Office of the National Coordinator for Health Information Technology
11
Healthy People
Health and Human Services Operating Divisions: Administration for Children and Families (ACF) Administration on Children, Youth and Families (ACYF) Administration on Aging (AoA) Agency for Healthcare Research and Quality (AHRQ) Agency for Toxic Substances and Disease Registry (ATSDR) Centers for Disease Control and Prevention (CDC)
Centers for Medicare and Medicaid Services Food and Drug Administration (FDA) Health Resources and Services Administration (HRSA) Indian Health Service (IHS) National Institutes of Health (NIH) National Cancer Institute (NCI) Office of the Inspector General (OIG) Substance Abuse and Mental Health Services Administration (SAMHSA)
Staff Divisions: Assistant Secretary for Administration (ASA) Assistant Secretary for Financial Resources (ASFR) Assistant Secretary for Legislation (ASL) Assistant Secretary for Public Affairs (ASPA) Assistant Secretary for Planning and Evaluation (ASPE) Assistant Secretary for Preparedness and Response (ASPR) Center for Faith-Based and Neighborhood Partnerships (CFBNP) Departmental Appeals Board (DAB) Intergovernmental External Affairs (IEA) Office for Civil Rights (OCR) Office on Disability (OD) Office of the General Counsel (OGC) Office of Global Affairs (OGA) Office of the Inspector General (OIG) Office of Medicare Hearings and Appeals (OMHA)
National Coordinator for Health Information Technology (ONC) Assistant Secretary for Health, Office of the Assistant Secretary for Health (ASH) Surgeon General
Meaningful Use
the short version
HITECH ACT
• $28B • Hospitals and “Eligible Providers” • “Meaningful Use” of certified Electronic Health
Records
HITECH ACT
2008 2014
10%
100%
Hospitals
Practices
3 Stages
1. ADOPT ✔
2. EXCHANGE
3. IMPROVE
Meaningful Use
3 Stages
1. ADOPT ✔
2. EXCHANGE ✔
3. IMPROVE
Portal
Portal
3 Stages
1. ADOPT ✔ 2011-14
2. EXCHANGE ✔ 2014-17
3. IMPROVE
Measurement
Office of the National Coordinator for Health Information Technology
31
Clinical Quality Measures – on paper
Office of the National Coordinator for Health Information Technology
32
Quality Measures
Office of the National Coordinator for Health Information Technology
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Research • What’s happening?
Guidelines • What
SHOULD Happen
Quality Measures
• Did it happen?
CDS • It will
happen
Clinical Decision Support
Osheroff ’s 5 Rights
the Right Information… Evidence-based, useful for guiding action and answering questions
…to the Right Stakeholder… Both clinicians and patients
…in the Right Format… Alerts, Order Sets, answers, etc.
…through the Right Channel… Internet, mobile devices, clinical information systems
…at the Right Point in the Workflow to influence key decisions/actions Osheroff, Teich, Levick et. al. Improving outcomes with CDS: an implementer's guide, 2nd edition. HIMSS. 2012.
Office of the National Coordinator for Health Information Technology
36
✔
3-Part Aim
Reduced cost
$ $ $ $$$
Better health Better care
3-Part Aim
Reduced cost
$ $ $ $$$
Better health Better care
Technology
Quality Measure
Expectation
EHR Capability
Quality (measurement) Chasm 2.0
Quality Measure
Expectation
EHR Capability
Quality (measurement) Chasm 2.0
Coupled, “Hard-Coded” CDS
What We Don’t Want
IT Maturity
Who loves computers?
Safety
Diagnosing Organizational Culture
• All tribes have a dominant cultural stage.
• The stage is evident from language, behavior, and relationship structures within the organization.
• Higher cultural stages outperform lower cultural stages.
• Organizations can move up one stage at a time.
• “Stage Inflation” - What is the actual stage, not what do you want it to be (people often inflate their organization’s stage by one).
5 Stages of Culture % of Tribes at each Stage
Low Performing High Performing
The History of the CIO
“You IT people don’t get it” “Why the ^%$# didn’t I get invited to that &^%$ meeting?” “This &^%$ system isn’t going to work – I told you so…”
Transforming
• What is best for YOU
• What are my strengths and how do we work best together?
What Stage is your Organization?
• What is the language and behavioral patterns?
• What are the typical relationship structures?
• People trained in Tribal Leadership can detect the Stage within a few minutes of walking into a work group
Tip Take the Culture Meter Survey on triballeadership.net
Natural Group
Thriving Organization ?
How do you create a Stage Four or Five culture so you can leverage the full power of your tribe to have a
thriving and high performing organization?
How to Leverage the Tribal Culture?
Access to Greatness
Enlightened
• What is best for the patients and providers and what role should I play?
• How do we discover what is best for all participants and non-participants in health? How can we inspire best efforts?
The History of the CIO
What if?
What if there is no “medical record?" What if there is no “progress note?" What is there is no “document?" What if there is no “visit" What if there is no “doctor?" What if there is no “diagnosis" What if there is no such thing as “non-compliant?" What if the primary user is the individual? What if we stopped saying “user?" What if we stopped saying “patient?"
1816
"What a ridiculous idea,” "We doctors are called upon for our brilliant medical minds. To say we should carry some frivolous tool around with us is absolutely ridiculous and below us."
Measurement
Office of the National Coordinator for Health Information Technology
93
Worry Score
What’s next?
• Today
– Note Bloat
• Tomorrow
– Observations
What’s next?
• Today
– Encounters
• Tomorrow
– Relationships
What’s next?
• Today
– Computers
• Tomorrow
– Devices
“Those who say it can’t be done should get out of the way of those doing it” Chinese Proverb