Patient Centered Care Building the Infrastructure Ross D. Martin, MD, MHA Director, Pfizer Healthcare Informatics

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Patient Centered CareBuilding the
InfrastructureRoss D. Martin, MD, MHADirector,
Pfizer Healthcare Informatics
Note These opinions shared are my own and not
necessarily those of Pfizer

• Presentation to University of MarylandSmith
  School of Business CIO Forum
• 3 November 2006

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Outline

• A Quick Review
• Consumer Empowerment
• The role of the Pharmaceutical Industry
• Next Steps

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The US Connectivity Roadmap
Evidence-Based Medicine
National Databases
National Health Information Infrastructure
EMR
eRx
HIPAA
Personalized Medicine

• Algorithm-driven medicine and decision making

• Population-based outcomes and cost information
  readily available to consumers, physicians, payers

• Streamlined information retrieval valuable for
  epidemiology

• Integrated database allow decision support tools

• Gains in accuracy and connectivity enhance safety
  and efficiency

• Electronic transactions for the business of
  healthcare

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Definition of Standards
GENERIC DEFINITION An agreed upon set of
parameters that facilitates a marketplace or
other exchange
SDO Standards Development Organization Usually
accredited by the American National Stnadards
Institute (ANSI) or the International Standards
Organization (ISO)
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Lack of Standards Creates Inefficiencies
but Protects Proprietary Interests
San Francisco
Miami
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Standards Alone Create Efficiencies
but Multiple Networks are Still Required
San Francisco
Miami
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The Promise of Technology Standards
Proprietary Transactions (EDI)
Internet Standards-based XML
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An Interoperable, Interconnected Network
Hospital
Payer
Patient
Pharma
Physician
Hospital
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Interoperability and Standards

• Vocabulary mapping
• International (realm)-specific context

GlobalData Exchanges

• Population health monitoring

National Databases Exchanges

• Vocabulary
• Messaging
• Patient/provider identifiers
• Electronic signatures

Community Data Repositories/Exchanges
Few Standards Required

• Application-to-application customized data mapping

Complexity ?
Unified Office System
Focus on Local Functionality

• User interface
• Clinical tools

Individual Systems/Applications

• Database structure

Storing/Accessing Information
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Broad Charge What are we trying to accomplish?

• Make recommendations to the Community to gain
  widespread adoption of a personal health record
  (PHR) that is easy to use, portable,
  longitudinal, affordable, and consumer centered.
• The critical components that support widespread
  adoption are
• Functionality
• Interoperability
• Consumer awareness
• Business models

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Current StateWhere are we today?

• Lack of consumer awareness and engagement
• Standalone PHRs available, but uptake poor
• Manual entry of data
• Lack of interface with clinical data sources
• Lack of communication tools
• Good experience with integrated PHR/EHR
• Primarily available in integrated delivery
  systems
• Relatively rich functionality, but tethered to
  single provider organization
• Lack of portability
• Lack of a sustainable business model for PHR
  sponsors
• -------------------------------------------
• Overall small fraction of population using PHR

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End-State VisionWhere do we want to end up?
Comprehensive Consumer Experience
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End-State VisionWhere do we want to end up?

• Widespread adoption of PHRs supporting health and
  wellness
• Comprehensive, longitudinal, record about an
  individuals health acquired from all relevant
  sources data
• Timely, understandable, context-sensitive health
  information from trusted sources knowledge
• Tools that support an empowered consumer taking
  an active role in managing his/her health
• Tools to facilitate communication with health
  care team and caregivers
• Uniform privacy protections for personal health
  information that follow the data and give
  patients control of their PHI

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End-State Vision Components Needed

• Interoperability technical standards
• Terminology
• Health information exchange and data portability
  (among PHRs and EHRs)
• Security (including authentication,
  authorization, data access control)
• Interoperable policies
• Uniform privacy protection that transcends local
  and state boundaries
• Authorizations
• Licensure
• Widespread adoption of interoperable EHRs
• Nationwide Health Information Network that
  facilitates sharing of personal health
  information to authorized users under the control
  of consumers

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Mid-State VisionAchievable Goals in 4-6 Years

• Majority of consumers aware of the role and value
  of PHRs as tools to support their health
• Industry standards exist for core functionality
  of PHRs
• CCHIT certification for EHRs include requirement
  of PHR interoperability
• Multiple data streams (e.g., lab, pharmacy, EHRs,
  claims) from health data sources populate PHRs
  following interoperability standards
• Robust privacy protections exist for personal
  health information in PHRs
• Business models and incentives emerging to
  support sustainable operation of PHRs for
  consumers

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Key Enablers for Accelerating Adoption of PHRs

• Public education about PHRs from trusted sources
• Comprehensive privacy protection for portable
  personal health information
• Certification for core PHR functions,
  interoperability, security and access control
• Greater adoption of EHRs and electronic
  prescribing systems among providers
• Automated population of PHRs with clinical data
  from multiple sources employing interoperability
  standards
• Development of standards for consumer-focused,
  evidence-based educational information and
  decision support tools

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Priorities to Drive PHR Adoption

• Near Term
• Lab results
• List of conditions and allergies
• Prescription refills and renewals
• Administrative features
• Reminders for patients

• Subsequent
• Online consultation
• Summaries of health care encounters
• Endorsed educational information
• Decision support
• Patient health outcomes

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Lessons from Today

• The Seven Virtues (Web 2.0)
• Be Generous
• Share
• Be Polite
• Be Open
• Listen
• Respect Individuals
• Diligence Wins

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Current State The Scale of Clinical Research

• 2004/5 biomedical research expenditures
• NIH 28.5B
• Pharma 30.6B
• Biotech 19.8B
• Devices 10.8B
• Other 6.5B
• Total 96.2B
• Costs from Moses et al JAMA 2941333-1342

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PHRs and Clinical Research

• Ross Go to the Whiteboard!

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Thank You!
ross.martin_at_pfizer.com www.rossmartinmd.com