Transcript Slide 1

The Future Direction of
Health Care Information
Technology
John Glaser, PhD
CEO, Siemens Health Services
September 20, 2010
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Increasing Growth in Healthcare Costs
Page 2
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Uneven Care Quality
Chronic Disease Under Control: Managed Care Plan Distribution, 2006
Diabetes
Hypertension
Percent of adults with diagnosed diabetes
whose HbA1c level <9.0%
Mean
100
90th %ile
Percent of adults with hypertension whose
blood pressure <140/90 mmHg
10th %ile
Mean
100
90th %ile
10th %ile
88
81
75
73
70
75
68
60
67
60
56
49
50
68
50
66
57
49
53
46
39
30
25
25
0
0
Private
Medicare
Medicaid
Private
Medicare
Medicaid
Note: Diabetes includes ages 18–75; hypertension includes ages 18–85.
Data: Healthcare Effectiveness Data and Information Set (NCQA 2007).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008
3
Factors Contributing to Heightened Pressure
on Health Care – Particularly Costs
 Relentless increases in care costs to individuals and purchasers of
care
 Cost increases occurring against an adverse economic backdrop




Federal government deficits
State government revenue shortages
Lingering economic recession for businesses
Slow job growth, underwater mortgages and evaporated retirement plans for
consumers
 Suspicion that cost increases reflect monopolistic behavior rather than the true
costs of care
 Lack of comparable increases in care quality and safety
 Problematic data on care quality
 Too much care variation
 Data that distinguishes no one
 Overall poor performance on global measures of health
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Techniques for Limiting Growth In
Health Spending and Likely Impact
 Very Limited Impact
 Encourage Greater Use of
Preventive Services (Shortterm)
 • Limited Impact
 Provide Better Price and
Quality Information
 Require Patients To Pay
More
 Restrict Use of Harmful
Care
 Reduce Expense and Waste
of Medical Mal-Practice
System
 Reduce Administrative
Costs of Insurance
 Develop and Use
Government Supported
“Comparative Effectiveness
Studies”
 Greater Impact
 Restructure Payment System -- (Bundled
Payment and Value Based Pricing)
 Restructure Delivery System (Integrated
Care)
 Restrict Use of Marginally Useful Care
 Limit Supply of Expensive Services
 Incentives to Use Preventive Services
(Long-Term)
 Expand and Restructure Primary Care --Create Effective “Medical Homes” for
Patients
 Create a Governmental “High Cost
Reinsurance System” with Effective
Disease Management
 Systems for Chronic Conditions
 Greatest Potential Impact
 Gov. Regulation of Payments To Providers
 Establish Global Budgets
Source: Discussion at The Cash Catalyst Meeting, Stuart H. Altman, 7/15/10
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Health IT as a Critical Enabler for Health Care
Transformation
Technology Adoption and
Use - HITECH
Transformational
Change in Health Care
Delivery and Population
Health - ACA
2004
Page 6
2012?
TIME
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Examples of Meaningful Use
Maintain an up-to-date problem list of current and
active diagnoses
At least 80% of patients seen or admitted have at least
one entry
Record smoking status for patients 13 and older
At least 50% of patients seen or admitted have
“smoking status” recorded
Send reminders to patients per patient preference
for preventive/follow-up care (M)
Reminders sent to 20% of all patients seen that are over
65 years old
Provide patients with an electronic copy of their
health information
At least 50% of patients who request an electronic copy
are provided it within 3 business days
Provide summary of care record for each
transition of care or referral (M)
Summary provided for at least 50% of all transitions of
care or referrals
Capability to provide electronic syndromic
surveillance data to public health agencies (M)
Perform at least one test of capacity to provide such
data
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Crosswalk of Meaningful Use, Standards
and Certification Criteria
Meaningful
Use
Objectives
Certification
Criteria
Standards
E-Rx
Capability to E-Rx
must be included
NCPDP SCRIPT
8.1/10.6 must be used
Provide Patient
Summary Record
Capability to
electronically transmit a
patient summary record
must be included
Continuity of Care
Document (CCD) or
Continuity of Care Record
(CCR) must be used plus
vocabulary standards
Electronically
Submit Data to
Immunization
Registries
Capability to
electronically transmit
immunization data must
be included
HL7 2.5.1 or HL7 2.3.1
and
CVX Code Set
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
CMS Estimates of the Number of Providers who
will be Meaningful Users in 2011
Eligible Professionals
Hospitals
Scenario
2011
2012
2013
Low
10%
13%
15%
High
36%
40%
44%
Low
30%
35%
46%
High
43%
58%
73%
Baselines considerations (2008):
29% of hospitals have some level of medication CPOE (AHA)
4% of eligible professionals have a full function electronic
health record
Page 9
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
The Health Care Reform Legislation focused on Access but
has Significant Payment Reform Provisions
$940 billion over ten years
32 million now covered
Page 10
Closes Medicare donut hole
Copyright
Copyright©©2010
2010Siemens
SiemensMedical
MedicalSolutions
SolutionsUSA,
USA,Inc.
Inc.All
Allrights
rightsreserved.
reserved.
Changing Perspective
Provider-centric  Person-centric
Provider
Specialty
Hospitals &
Clinics
Retail
Clinics
Provider
Provider
Provider
Provider
Academic
Medical
Centers
General
Hospitals
Independent
Physicians’
Practices
Employers
Provider
Provider
Provider
Provider
Facilitated
Patient
Networks
Networks
That Profit
From Health
Implications
• Data/information/knowledge focus (not function/UI focus)
• EHR focus shifts to coordination and collaboration
• Open, standards-based data exchange
• Move towards person controlled data access
Page 11
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
HIT Market Evolution
Stakeholder
Value
High
Market Evolution
Horizon 3 - Guide
Horizon 2 - Orchestrate
Horizon 1 - Exchange
2009
Low
Exchange
• Non-disruptive secure sharing
of normalized patient data
• Respects privacy boundaries
• Directed push dominates
Drivers
• MU stages 2, 3
• Physician recruitment
• Federal/state grants
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2013
2015
2017
Orchestrate
• Builds on Exchange
• Actionable, supports care
Guide
• Builds on Orchestrate
• Provides care-givers with
coordination across settings
• Driven by care guidelines, caregiver arrangements
contextual knowledge at PoC
• Supports translational research
Drivers
• Payment reform, bundled
payments
• ACOs, medical homes
Drivers
• Heightend eimbursement
pressures
• Comparative effectiveness
implementation
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Lower Altitude but Still High Altitude Ramifications
 From now on Medicare/Medicaid payments will be materially based on
effective use of EHRs
 Beginning with meaningful use
 And moving to payment reform
 Meaningful use pressure will “snowball”
 Payment reform and increased care accountability assume meaningful use
 Commercial health plan incentives may be based on an assumption that
meaningful use has been achieved
 Maintenance of certification may have meaningful use requirements
 Will licensure and/or accreditation consider meaningful use status?
 Industry EHR development agenda will be increasingly dominated by
certification, interoperability, meaningful use and ACA requirements
 The Federal agenda will define the EHR
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Lower Altitude but Still High Altitude Ramifications
 The presence of a broadly adopted EHR will cease to be a competitive
differentiator. Differentiation could occur in several areas:
 EHR-leveraged care improvement within the organization and with other
providers
 Care analyses and secondary use of data
 Superior utilization of clinical decision support
 Engagement of the patient in their care
 A wide variety of new “species” will enter the healthcare information
technology market
 They will focus on secondary use of data and delivering “intelligence” to the
care process extending into the EHR
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Health Plans (and others) are Making Moves
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Health Plans (and others) are Making Moves
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Near Term Ramifications for Information
Technology
 Electronic health record
 Core EHR capabilities, e.g., manage a problem list and eprescribing, remain very
relevant
 Other functions increase in importance
 Ability to identify and track a patient across multiple organizations
 Clinical decision support to deliver evidence-based guidelines, reminders, order sets and alerts
 Disease registries to provide analyses of care processes and outcomes for a population
 Care documentation
 Some functions are new
 Technologies to support care coordination and care team collaboration, e.g., discussion rooms and event
messaging
 Health Information Exchange
 Initial exchange efforts will be focused on a well defined set of clinical relationships
 Enable exchange of “directed push” transactions
 Support messaging of patient events, e.g., missed radiology procedure appointment
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Near Term Ramifications for Information
Technology
 Data Management
 Business intelligence tools to support
 Assessment of care quality and costs for cohorts of patients (episodes and bundles)
 Analyses of practice variations
 Examination of care delivery alternatives
 Predictive modeling to identify high risk patients
 Personal Health Records
 Provide patients with access to their EHR data
 Support communication with care team
 Enable direct entry of data
 Provide access to health information and self management tools
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Identifying a CMP Patient
Page 19
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Email and Page Alerts –
Admissions and Discharges
From: Care Management Program Admit Notification
[mailto:[email protected]]
Sent: Thu 01/01/2008 12:00 PM
To: Neagle, Mary
Subject: ABC Patient MRN 123456 Has Been Admitted to the ED at approx 17:26 on
07/10/2008 (AMN)
Neagle, Mary, your patient ABC Patient MRN: 123456 Has Been Admitted to the ED
at approx 12:00 on 01/01/2008 (AMN)
With a Chief Complaint of: CP/ SOB
*** This alert is generated when a patient is REGISTERED in the ED ***
*** Clinical information may not be immediately available ***
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Inpatient Census – Real Time
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
We are in for a Tumultuous but Exciting Period of
Time
 Payment change is THE “disruptive innovation” in care delivery
 The Federal agenda “defines” several aspects of the healthcare information
technology industry:
 Conceptual models of healthcare information technology
 Definition of the electronic health records
 Interoperability and exchanges
 Standards
 Adoption and implementation support (RECs)
 A wide range of new entrants with innovative ideas and diverse interests will
enter the market
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Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Questions
Page 23
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.