Information Technology: Putting the Patient at the Center of the Information Flow

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Information Technology Putting the Patient at
the Center of the Information Flow

• 25th Annual Rosalynn Carter Symposium on Mental
  Health Policy
• November 6, 2009
• Robert M. Kolodner, MD

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The Ultimate Reason for Health IT
Perspective for you to consider
What quality and value of health care services
do you demand? What quality of health do you
want and deserve?
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Topics For My Brief Remarks

• Current Health Care Challenges
• Future of Health and Care
• Health Information Technology (IT)
• And then there was
• Potential New Health IT Direction
• Caveats Regarding Change

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Section 1

• Current Health Care Challenges
• And Health IT

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Why is Health IT a Central Strategy for Health
Care?

• Current Lack of Information
• Higher Costs
• Leads to 1 in 7 hospital admissions
• When care providers do not have access to
  previous medical records
• 12 of physician orders are not executed as
  written
• 20 of laboratory tests unnecessary
• Requested because previous studies are not
  accessible
• Avoidable Errors
• Drug errors
• Complicate 1 in 6.5 hospitalizations
• Occur in 1/20 outpatient Rxs
• Revolutionizing Health Care Through
  Information Technology Presidents IT
  Advisory Committee (PITAC), 2004

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Problems with Both Safety and Quality
To Err is Human 98,000 patients die from
avoidable errors
The Quality Chasm Every Patient Crossing the
Quality Chasm 2001 IOM
Americans receive on average 55 of the
evidence-based care
N Engl J Med 20033482635-45.
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Quality/Reliability Challenges Remain in Health
Care

• Immunization 55 94
• B-Blocker after an MI 70 98
• Airline Baggage Handling gt 99.99
• Airline Safety gt 99.9999

10-1 10-2 10-3 10-4 10-5 10-6
Frequency of Failures Occurring
From Dr. Jonathan B. Perlin. Used with permission.
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New Freedom Commission on Mental Health
Final Report Achieving the Promise Transforming
Mental Health Care in America
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Privacy and Security Concerns

• Control of information and flow
• Breaches of security and violations of privacy
• Technology leading policy
• Identity Theft/ De-identification
• Secondary uses of data
• Ability to aggregate data
• Lack of understanding about how info is
  currently used
• Genomic data and family history affect family
  members
• Consequences (loss of insurance, work, or other
  forms of discrimination)

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Katrina Impact Of Privacy on People with MH SA
Disorders
www.katrinahealth.org/patients.html
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Community HealthHurricane Katrina Relief

• 50,000 New Orleans VA Patients did not lose their
  medical records, even when they lost their City
• Their VA Electronic Health Records followed them
  around the U.S.!

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Section 2

• The Future of Health and Care

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Transforming Health CareMoving from Treating
to Preventing to Predicting
BIRTH
Injury and Acute Illness
Family History Genetics
Environmental Exposures
Death
Chronic Illness
Lifestyle
Intervene
Predict Avoid
Manage Prevent
1. Adapted from Perlin, Dr. Jonathan B,
Healthcare 1015 beyond Some Thoughts on
Planning Ahead, p. 95
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Perspective of People on Their Future Health
Care

• Stay Healthy
• Prevention
• Increased Self-Care
• Personal Health support
• Convenient Care
• Minimize time and travel
• Tele-care
• Tele-monitoring
• High Quality, Coordinated Care
• Enable care across providers sites
• Allow access to a lifetime of information
  wherever and whenever They choose
• Better Health

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Future Health Care Direction
and

Person-Centered
Patient-Centered
Patient-Focused
Person-Focused
Patient-Centric
Consumer-??
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Section 3

• Health Information Technology (IT)

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Health IT Role in Health Care Transformation
and

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Key Health IT Components to Enable Transformation
A Robust, Interoperable, Health IT Environment

• Electronic Health Records (EHR / EMR)
• Personal Health Records (PHR)
• Population Health Information (Public
  Health, Biosurveillance, Quality Improvement,
  Research, Emergency Preparedness)

• Standards (Data, Technical and Security)
• Interoperable Health Information Exchange
  Network (Nationwide Health Information
  Network - NHIN)

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Health ITUser populations
Individuals
Population Health
Care Providers
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Person-centered
Individuals
Population Health
Care Providers
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However

• This is NOT about technology
• It is about RESULTS
• Improved Health Care Quality
• Containing Health Care Costs
• Improved Health Care Outcomes

• Improved Health

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Section 4

• And then there was

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The American Recovery and Reinvestment Act of
2009
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American Recovery and Reinvestment Act (ARRA)
Health Information Technology for Economic and
Clinical Health Act HITECH Act in H.R.1
http//www.whitehouse.gov/the_press_office/ARRA_
public_review/
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American Recovery and Reinvestment Act (ARRA)
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American Recovery and Reinvestment Act (ARRA)
Estimated 17,200,000,000 net over 10 years
starting in 2011
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Key Acronyms and Phrases for U.S. Health IT
HIT Policy Committee
CCHIT
HITSP
HIT Standards Committee
Meaningful Use
NHIN
Breach notification
ONC
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Section 5

• Potential New Health IT Directionand Impact

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Disruptive Changes Are the Norm
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Clay Christensens Statement

• Head on competition drives prices up.
  Disruption drives cost and prices down.
• HIT Platform Meeting BostonSept 30, 2009

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Disruptive Innovations in (Health) IT

• GENERAL TRENDS
• Users have more capabilities at lower cost
• Users can create their own individual
  environment
• Simple-to-use
• Configuration settings
• Downloads
• Rearrangements of application locations
• Users are creating more of their own content and
  posting it on the web for all to see
• Web 2.0
• Web 3.0
• Health 2.0

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Disruptive Innovations in (Health) IT

• New Business Models
• More Open Source solutions available
• Changing business models user-centered
• Business opportunities through support services
  rather than vendor lock
• Enables users to share solutions more widely and
  accelerate innovation
• HOWEVER
• Open Source ? Free

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Transforming Health
The locus of control" is changing.
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Section 6

• A Few Caveats Regardingthe Pattern of Change

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How Transformational Change Occurs
Health IT Tipping Point
TIME
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Opportunities Created by the World Wide Web
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A Repeating, Predictable Cycle
Cited in Paykel, ES and Coppen A, Eds.
Psychopharmacology of affective disorders. Oxford
University Press. 1979, page 160.
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In Summary
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Health IT Success A Vision for 300 Million

• You have
• Safe, high quality, efficient, convenient
  carewherever you are
• Health IT is woven into the fabric of health care
  delivery nationwide
• Your health information available to you or
  whomever YOU choose anytime, anywhere
• The information to make informed choices to
  improve your health and well-being
• Timely, personalized, context-sensitive health
  information serves as a valuable and useful
  resource
• Trust that your privacy is protected
• And that your health information can be
  aggregated with that of others without
  compromising your privacy

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The Ultimate Reason for Health IT
Health IT is a key enabler for us ALL to get
The quality and value of health care services
we demand The quality of health we want and
deserve
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