Using Technology to Bridge the Chasm of Quality in Healthcare

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Using Technology to Bridge the Chasm of Quality
in Healthcare
By Stephen H. Carson, MD Associate Clinical
Professor, UCSD Chief Med Officer, SDCMS
Foundation
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Facts Driving SDCMS Foundation Concerns

• Medical bills 1 cause of personal bankruptcy
  in the U.S
• U.S. has 45 million uninsured and 40 million
  underinsured
• U.S. spends 1.5-3X more per capita as countries
  with universal healthcare and yet the outcomes
  are no better
• Healthplans collectively profited 4 billion last
  year
• Patient are shouldering more of the costs of
  healthcare with deductibles and copays increasing
  benefits decreasing
• Plans are dropping out of non-profitable markets.
• Corporate corruption / Obscene executive salaries
• Medical errors have not decreased despite cost
  increase
• VA-like bidding would yield Medicare savings of
  1 billion/yr
• On average, 30 of premiums are not spent on
  patient care

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SUMMARY OF FOUNDATION PRIORITIES

• Improve access to quality medical care
• Increase the quality of health care
• Improve the health of San Diego County residents
• Improve patient safety and reduce medical errors
• Improve the coordination and timeliness of care
• Improve access to all information necessary to
  make the best decisions for patients at the point
  of care
• Improve health literacy
• Help ALL physicians in the county achieve these
  goals

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Physician Goals for Technology

• Improve quality, service, and safety of medical
  care
• Increase the efficiency of workflow
• Secure single sign on tool to import ALL data
  to the point of care in an easy to read
  integrated format
• Clinical guidelines and decision support
• Continuing education
• Patient risk assessment
• Community continuity of care records registries
• Automated patient reminders
• Eligibility/Benefits/Claims verification
• e-Rx eliminate handwriting error adverse
  reactions
• Maintain privacy and confidentiality

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Barriers to MD Adoption of Technology

• Cost Most of the Savings Accrue to the
  Healthplans
• History of false starts
• Time Physicians are swamped with regulations
  (HIPAA)
• Lack of standards and interoperability (HL-7)
• Privacy and Security Fear of profiling
• Stakeholder commitment Silo mentality
  Competition
• Healthcare industry in general is slow to change
• Physicians are technophiles and recognize the
  value of Technology in Patient Safety and Quality
  Improvement

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The Problem Today
Physicians can require up to 20 separate log on
procedures, passwords agreements to gather data
from each patient contact point
Lab, X-Ray, Pharmacy
Hospital/ER
MD Office
Health Plan
Patient Contact Points
Requester Organizations
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HIPAA Health Insurance Portability and
Accountability Act

• Administrative Simplification
• Common interchange structure
• Standard employer/provider identifier
• Electronic signature with specific transactions
• Data transmission for benefits/claims
• Information Privacy
• Rights of individuals to records
• Authorized uses and disclosures of information
• Requires identity authentication of
  requestor/provider of health records

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Hospitals, X-ray, Labs Lab, X-ray, discharge
summaries, consultant and other reports
Physician/Patient Continuum
Medical Groups
Data only labs, X-ray, meds, diagnosis,
allergies, immunizations, consultant reports,
discharge summaries and more
Healthplans Eligibility Benefits
San Diego Medical Information Network Exchange  
eRx option Patient information
retrieval and more extensive storage Electronic
Rx
Public Health Dept. Informed San Diego
211 Network of Care Public Health
Nurses Bio-terrorism/ Health Alerts Disease
Surveillance
CCR option Data retrieval Electronic
Rx Centralized record
     
Pharmacy Benefit Managers and Pharmacies Health
Plan Formularies Patient Medication Lists Drug
alerts Allergy alerts Sure Scripts and Rx Hub
SDCMS.org Patient Education Advocacy CME Event
s Calendar Physician Resources
Decision Support   Care planning Clinical
advice Local guidelines
EMR option Electronic Rx Full EMR CCR 
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Sponsors
Help Desk
San Diego Medical Information Network Exchange
(SDMINE)
SDCMS Foundation CAL Institute for Technology
and Telecom
Hosted by

Business
Directory (Phone, Address, Email, Mapquest)
Clearinghouse
Electronic Prescribing - DoctorFirst

• Healthplan

Check, Credit Card and Debit verification
Electronic Medical Record - Chart Connect

• Physicians
• Hospitals
• Labs / Xray
• Pharmacy
• Home Health
• Nursing Care

Supplies
Practice Management - Elligence

• PSS

Automatic Appointment Reminder

• MedPlus
• Secure Exchange of Medical Information
• eRx and Continuity of Care Record
• Eligibility and Benefit Verification

Links
InfoLine
Patient Education

• In Multiple Languages

SureScripts Pharmacy Links/Formulary
Information
Dr Tango.com
Adam.com
Clinical Decision Support - Enigma
SD Dept. of Public Health

• SDIR (immunizations)
• eMan
• NetworkofCare

Medical Group SubPortals
1MedLink Single Sign On/Password Management
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SureScripts single portal to all SD Pharmacies
Increases the efficiency, quality and safety of
prescribing

• Based in Alexandria,VA
• Formed in August 2001
• Formed by
• NACDS
• NCPA
• Strategic industry alliance to
• Promote true electronic connectivity between
  physicians and pharmacies
• Enable widespread prescribing connectivity (local
  and national)
• Reduce medical errors

Pharmacies
Physician Practices
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Current System Plagued by Serious Quality and
Patient Safety Problems
Rx

• Patient safety
• 1.5 to 4.0 of Rxs have errors with potential
  for serious patient risk
• Quality of care
• 1.1 billion scripts never filled
• Patient satisfaction issues
• Potential Savings 2 billion / yr
• Impact on productivity
• Physician time1 hour per day
• Pharmacy 4 hours per day

Rx

• Illegible handwriting
• Phone tag and fax tag
• Patient waiting in the pharmacy

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Dr. Rice
Welcome Dr. Rice
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Welcome Dr. Rice
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Rice, Joe MD
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Welcome Dr. Rice
Rice, Joe M.D.
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Welcome Dr. Rice
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Welcome Dr. Rice
Joe Rice M.D.
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Welcome Dr. Rice
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Predictors of Health

• Racial /- Ethnic Group
• Income
• Education Level
• Literacy
• Income
• Employment status
• Age
• Geographic Location of Home

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Consequences of Poor Health Literacy

• Lack of compliance with medical regimen including
  missed appointments
• Medication errors and medication noncompliance
• Late diagnosis
• Limited preventive care
• Malpractice suits
• Physicians agree that one of their most important
  tasks is PATIENT EDUCATION
• HOWEVER
• more than half of our patients are unable to
  understand
• PHYSICIAN COMMUNICATION