HITECH Health IT Legislation: Opportunities for the DMAA Community

HITECH Health IT Legislation:Opportunities for the DMAA Community

September 2009 • San Diego, CA

Vince Kuraitis JD, MBA

Better Health Technologies, LLC

http://e-CareManagement.com blog

(208) 395-1197 • [email protected]

Don Storey, MD

RMD Networks

www.rmdnetworks.com

(303) 789-1188 • [email protected]

Overview

1. Recap: DM Community as Leaders or Laggards in HIT Interoperability?

2. Changing Environment

3. ARRA HITECH Act Stimulus Legislation

4. Implications/Opportunities for DMAA Community

1. Recap: DM Community as Leaders or Laggards in HIT Interoperability?

HIT Strategy on Autopilot for the Past Decade

Health Information Technology (HIT) is the Backbone of Prevention and Care Management

• Provides easy access to comprehensive patient records electronically, thus making it easier to see a patient’s medical history

• Helps providers track patient care in order to reduce duplication of services, address patient issues, and coordinate care with care managers

• Offers providers access to reference materials during a patient visit

• Provides clinicians real-time guidance on standards of care• Sends reminders and prompts to patients about visits, tests, and

recommendations and prescriptions

DM Community Pivot Points

• Several industry sectors are uniquely positioned to promote interoperability and liquidity

• Leverage!

– DM is a central role with many touch points

– Knowhow, tools, & technology to improve care processes and create new interventions

– Trust with patients creates opportunity to get patient permission to gather and use data on patients’ behalves

• Interoperability can be disruptive!

Two Scenarios for the DM Community

• Laggards

– Maintain proprietary IT

– Maintain closed business models and proprietary processes

• Leaders

– Embrace interoperable health information exchange

– Embrace open (collaborative) business models and shared care management processes

2. Changing Environment

Challenges With EMR 1.0

• Usability/design– Created to replicate individual paper charts in e-format,

not to manage a panel of patients for optimal health• Implementation

– Changes clinician workflow– Loss of productivity for physicians– Risk of failure/de-install

• Proprietary business model– Lack of interoperability– Dependent on customer lock-in and switching costs

→Result: very low penetration

Proprietary & Confidential Slide # 9

EMR 1.0 (Circa 1990 – 2009)


Modularity: Dis-integration Of The Computer Industry


EHR 2.0 – (2009 - ?)High value, integrated applications facilitating higher quality, coordinated care


EMR 1.0 to Clinical Groupware

EMR 1.0

– Client-server based– Proprietary– Non-interoperable– No connectivity to patients – Monolithic– High capex and operating

expense– MD workflow must adapt

to rigid design

Clinical Groupware

– Web-based– Open– Interoperable– Networked – Platform/application– No capex, low

subscription cost– Flexible design adapts

to MD workflow


How is Value Created in a Network Economy? PHR Case Study

• Examine PHR adoption

– Typical 2- 5%

– Best Practice » Kaiser: 30%

» Group Health Cooperative (GHC): 50%

• Why?


Features/Functionality Of Kaiser and GHC PHR System (As of Mid-2008)


Explanation of Increased PHR Adoption

• Kaiser/GHC PHR platform adoption = early network effects• What’s the killer app? – Wrong question.• How is value created?

» An integrated bundle of apps » Delivered on a unified platform with broad data exchange» Providing high value to patients and doctors » Thereby driving adoption and usage

• How can un-integrated doctors, health plans, and hospitals work together toward a “Virtual-Kaiser”?


3. ARRA HITECH Act Stimulus Legislation

ARRA HITECH Act

• Incentives between 2011 & 2015 = $36 billion.

• Providers must use a “Certified EHR”

• Providers must demonstrate “Meaningful Use” of the EHR

• Penalties for non-adoption after 2015

• Key question: How can DMAA community participate?

Recommendations – Certification/Adoption Workgroup of HIT Policy Committee, August 2009

• Focus Certification on Meaningful Use

• Leverage Certification process to improve progress on Security, Privacy, and Interoperability

• Improve objectivity and transparency of the certification process

• Expand Certification to include a range of software sources: Open source, self-developed, etc.

• Develop a Short-Term Certification Transition plan

Achieving Meaningful UseMeaningful Use Workgroup of HIT Policy Committee, July 2009

“Meaningful Use” Framework Becoming a Focal Point that Links Previously Disparate Initiatives


4. Implications/Opportunities for the DMAA Community

Care Collaboration is a “Must Have”

Source: Michael R. Nelson, Georgetown Center for Culture, Communication, and Technology, 2009

...Enabled by Clinical Groupware PlatformEMR 1.0 supports limited care delivery transformation; clinical groupware provides greater adaptability, multi-purposing to accelerate transformative care delivery changes.

Healthcare Enters the Network Economy:A Fundamental Strategic Shift

Source: Venkatraman, N., Winning in a Network Era: Opportunities & Challenges, 2006

Thank you!

HITECH Health IT Legislation: Opportunities for the DMAA Community

Health & Medicine

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