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
• 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
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