Community Meeting 101October 16, 2012

Houston

Healthcare in Houston

Healthcare is the largest industry in the US.

Houston is home to the the largest medical complex in the world.

Workers are well-educated, with income that is higher than average.

People from around the world seek care from area facilities.

Healthcare helps drive the IT, biotechnology, and education clusters.

Continues to be a crucial component of the area economy.

60% of all new commercial construction in Houston is Healthcare.

Obama Administration Directive

All U.S. medical records to be computerized within five years; standards created

cut waste, eliminate red tape and reduce the need to repeat expensive medical tests

2d largest Spending item in 2009 Stimulus Package; $40 Billion

National Health Information Network

501c3 non-profit corporation governed by a board appointed by Governor

to serve as a catalyst for the development of a seamless electronic health information infrastructure

Funding – No state funds were ever appropriated to the THSA

Texas Health Services Authority

Problems:• Mix of paper and electronic

• No standardization

• Unmanageable

• Incomplete

• Expensive

Current State ofHealthcare Connectivity

Independent physicians

Silos of Information

Kelsey Gateway

?

(Arms Race)

iHealth Trust Vision 

Trusted third party, non governmental, non stakeholder, neutral community information infrastructure provider

High quality, cost-effective health care for all Houstonians

Interoperable health information to support effective decision making and risk management at all levels

Patient care Population health Administration Performance monitoring and evaluation Policy development

iHealth Trust Vision

iHealth Trust is not controlled by any single entity or segment of the healthcare marketplace

iHealth Trust is a cooperative relationship of entities from across the healthcare provider and insurance spectrum.

iHealth Trust will act as a legal fiduciary of the consumer’s personal healthcare information and will act in the best interests of the community

Potential Benefits:• Portable lifetime health record

• Improved healthcare delivery

iHealth Trust Vision

“Data Liquidity”

Making it easy for the data to move around and do some good for us all

Nobody can make good decisions without good data

Industry uses data 'lock-in' as a tactic to keep their customers captive.

This is NOT a technology problem, it is a sociology problem.

Consumer is effectively “barefoot, pregnant and in the kitchen”; information is power who represents consumer?

Conflicting institutional missions; self interest

Perception of lack of trust Data rights and permissions issues Financing, “why should I pay?” Vendors have silver bullet I’m from the Government……

1863, President Lincoln designated 4ft 8.5inches as the gauge of the transcontinental railroad.

1865, the “golden age” of railroads began.

Community Infrastructure; Utility

Community Infrastructure; Utility

Step 1: Set up account; authorize deposits and withdrawals; get ID card to facilitate registration process & ID

Step 2: Deposit. With your permission, caregivers deposit copies of your medical information into your electronic lockbox

Step 3: Verify & Update your PHR. You verify your information through the Internet or with your physician. You can also add updates or comments.

Step 4: Withdrawals. With your permission, doctors withdraw a copy of your information from your lockbox to take better care of you and your family.

How does the iHealth Trust work?

3 iHealth Trust Windows

Deposit Withdrawal Research

ClearinghouseorRepository

5209 people 1948 (1st generation)

Every 2 years:

Detailed Medical History, Physical, Labs

5124 offspring 1971 (2nd generation)

Every 2 years:

Detailed Medical History, Physical, Labs

3500 offspring 2002 (3rd generation)

Every 2 years:

Detailed Medical History, Physical, Labs

Consider the Boston University Framingham Heart Study…

What will the value be for appropriate access to large-sample, electronically collected, clinical information in the future?

Imagine the shear volume ofpatient medical information withinthe facilities of the Texas Medical Center.

Consider Houston…

Dr. Ernest Bertner,January 30, 1949 - Houston

“As a time saver, a pneumatic tube system will be included that will connect all institutions in the center.”

Why? This was for the purpose of distributing histories of patients and other information that might be needed, as well as a means of communication between departments in the teaching institutions.

Challenges to this initiative.

Conflicting institutional missions; self interest

Perception of lack of trust Data rights and permissions issues Houston iHealth Trust financing Legal issues

Reasons to do this……. Better Healthcare for community & system to manage

uninsured Supports accountability – measuring results Decreases duplication of services Attacks fragmentation – coordinating care Provides aggregate data for community health measurement Helps patients learn self-management strategies. Serves to position Houston as national health leader

Creates Economic Cluster for HIT & Research Provides bridge for genetic research

Leverage HIT arms race happening now Going to happen anyway…….

What we know……

Huge amounts of digital data exist, already formatted electronically, but scattered across many proprietary systems

Huge amounts of digital data is coming

Software and the Internet will make this possible

An integration “big bang” -- getting everybody all of a sudden onto one, single, structured and standard format—can’t and won’t happen.

The doctors MUST participate

Collaboration in Community will be required

What have we done? Business Structure: IRS approved 501 c3 Award by THSA: B&O Plan approved

iHealth Physicians, LLC: Operating Entity Sustainable business model - revenue

Valuable technology offerings Plan not contingent on Stimulus

funding Nimble and market driven

Path to Sustainability

Where do we start?ID the users.

Identify all providers once Centralized identity credentials Centralized clinical credential information Texas sets National Standard

Identify consumers f/k/a patients Providers issue branded credentials Get rid of registration clipboard Put patient at center of system

The journey begins…..

Manfred Sternberg

713-622-4300

manfred@iHealthtrust.org