health information exchange: value, incentives, and how to get there. david c. kendrick, md, mph...
TRANSCRIPT
Health Information Exchange: Value, Incentives, and How to get
there.
David C. Kendrick, MD, MPHAsst. Provost for Strategic Planning, OUHSC
Medical Director for Community Medical InformaticsOU School of Community Medicine
Greater Tulsa Health Access Network
Agenda
• HIE Ongoing benefits: Value aside from ARRA– Financial– Clinical
• New, one-time opportunities: ARRA Incentives in Oklahoma Terms
• How do we get there?
OK
2007 COMMONWEALTH FUND ReportState Scorecard Summary of Health System Performance
2009 State of the State’s Health Summary
Oklahoma is the only state where the death Oklahoma is the only state where the death rate has gotten worse…..rate has gotten worse…..
800
850
900
950
1,000
1,050
1980 1985 1990 1995 2000 2005
Tulsa
US
Some Factors1. Economic downturn
healthy people and jobs left Oklahoma
2. Poverty remained3. Heart Disease –
(Diabetes)4. Cancer 5. Access to Care6. Obesity
Age-adjusted Death Rates
Past 25 Years
Current Situation
PayersDemographicsMedical claims
Pharmacy claimsCase mgmt records
Doctor officesEHR
ClaimsRx
Case mgmtCommunity outreach
Rx
Imaging
Hospitals (inpt)
ER/UC
Public Health
Other PCPs
Specialists
Ancillary carePT/OT/Aud/Diet
Labs
Manual connection (mail, fax)Electronic connection
Safety Net Clinics and community
agencies
Patient
What’s the value of HIE?
• 2004: Harvard Center for IT Leadership published a report on the value of health information exchange• $77B in annual savings through Health IT• Prompted, in part, the creation of the Office of the
National Coordinator for Healthcare IT (ONCHIT), the Health IT “Czar”
• 2006: GKFF commissioned an OK-specific evaluation of the value of HIE
Motivation
• Clinicians have incomplete knowledge of their patients – Relevant patient data not available in 81% of
ambulatory visits Tang 1994 – 18% of medical errors that lead to ADEs due to
missing patient information. Leape JAMA 1995
• Medicare patients see an average of 5.6 different providers each year= 5.6 silos of data
• What is the value of HIE for Oklahoma?
HIE Expert Panelists• David Brailer, MD, PhD
– Santa Barbara County Care Data Exchange, Health Technology Center• William Braithwaite, MD, PhD
– Independent consultant, “Dr HIPAA”• Paul Carpenter, MD
– Associate Professor of Medicine, Endocrinology-Metabolism and Health Informatics Research, Mayo Clinic
• Daniel Friedman, PhD– Independent public health consultant
• Robert Miller, PhD– Associate Professor of Health Economics, UCSF
• Arnold Milstein, MD, MPH– Pacific Business Group on Health, Mercer Consulting, Leapfrog Group
• J Marc Overhage, MD, PhD– Regenstrief Institute, Associate Professor of Medicine, Indiana University
• Scott Young, MD– Senior Clinical Advisor, Office of Clinical Standards and Quality, CMS
• Kepa Zubeldia, MD– President and CEO, Claredi Corporation
HIE Value Construct
Providers Hospitals
Pharmacies
Radiology Centers
Other Providers
Public Health Agencies
Payers
Clinical Laboratories
HIE Value Construct
Providers Hospitals
Pharmacies
Radiology Centers
Other Providers
Public Health Agencies
Payers
Clinical Laboratories
Avoided redundant tests, Electronic test ordering and results
delivery
Avoided ADEs, drug utilization savings,
automated transaction sets
Avoided redundant imaging, Electronic imaging ordering
and results delivery
Electronic Rx, refills, interaction checking,
adherence data
Electronic submission of
reportable conditions and vital
statistics
Electronic referrals, consultation letter
delivery, chart requests
ProviderProvider
Value to Oklahoma
Providers Hospitals
Pharmacies
Radiology Centers
Other Providers
Public Health Agencies
Payers
Clinical Laboratories $99
$116
$16
$10
$39
$39
$127
$136$1.5
$1.5
$123
$141
$ Millions
ProviderProvider
Value by Stakeholder: Oklahoma
Providers Hospitals
Pharmacies
Radiology Centers
Other Providers
Public Health Agencies
Payers
Clinical Laboratories $99
$116
$16
$10
$39
$39
$127
$136$1.5
$1.5
$123
$141
$ Millions
Adverse Drug Event (ADE) Clinical ResultsPer
PhysicianOklahoma
Preventable ADEs Avoided 8.9 25,000Preventable life-threatening ADEs
Avoided0.59 1,700
Avoided ADE-related visits 5.6 16,000Avoided ADE-related hospitalizations 0.82 2,300
Net value of HIEImplementation
Years 1-10Annual, Steady-State
Starting Year 11Benefit $ 1.6 Billion $ 250 MillionCost $ 0.7 Billion* $ 42 Million*Net Value $ 0.9 Billion $ 210 Million
*Software as a service, Cloud computing, and Interoperability standards have lowered the cost of implementation and maintenance by an order of magnitude
Implementation Years 1-10
Annual, Steady-State Starting Year 11
Benefit $ 6.4 Billion $ 990 MillionCost $ 2.7 Billion* $ 160 Million*Net Value $ 3.7 Billion $ 830 Million
Implementation Years 1-10
Annual, Steady-State Starting Year 11
Benefit $ 2.0 Billion $ 310 MillionCost $ 1.1 Billion* $ 71 Million*Net Value $ 0.9 Billion $ 240 Million
Tulsa:
Oklahoma City:
Oklahoma:
But wait, there’s more . . .• CMS and Medicaid Incentive payments for
“Meaningful use of an EHR”:– $44,000 to Medicare providers, $63,000 to Medicaid– Formula-driven bonus to hospitals: $2-11M per hospital
• What does this mean to OK?– Assume 9,000 MD’s, DO’s, PA’s, NP’s are eligible– Assume the following hospital bed distribution:
Facility Admissions BedsLess Than 50 = 80 51,060 2,074From 50-199 = 51 146,885 4,595
From 200-399 = 9 223,154 2,555400 or more = 6 157,088 3,250
146 STATE TOTALS 578,187 12,474
CMS wants EMR and HIE adoption . . .
*Assume N=9,000 MDs, DOs, PAs, and NPs focused 30% of the time on Medicare patients, and 12,474 hospital beds
National: Meaningful Use guidance
• In order to qualify for bonus payments (and avoid penalties)– By 2011, the following must be exchanged:• Doctors: Problem lists, medication lists, allergies, test
results• Hospitals: Discharge summaries, procedures, problem
lists, medication lists, allergies, and test results– By 2013, the following must be exchanged:• Doctors: Share all care transition data across the
community electronically• Hospitals: Share all care transition data electronically
HIE Progress to date• Early summer: Small working group met and produced a document:
– Outlined 14 “Items for consideration”• July 30th: Major stakeholder’s meeting. ~35 people
– Reduced “Items for consideration” from 14 to only 3:• Meet requirements established by Federal legislation for funding• Establish planning process, including HIT Policy Committee• Identify the State Designated Entity
– Agreed that OHCA could be the temporary custodial State Designated Entity until the planning process is complete or October 16, whichever comes first.
• August 14: OKHITECH Summit held, wide invitation list, comments and feedback sought
• August 14-21: Online comment period• August 20: State HIE Cooperative Agreement Program (SHIECAP) Released
State HIE Cooperative Agreement Program (SHIECAP)
• Governor must identify State Designated Entity• Each applicant must have a State Coordinator for
Healthcare IT• Focus: State Strategic Plan and Operational Plan• States without plans can spend as much as 6
months on a planning process• Applicants who fail to submit acceptable plans
will be subsumed into other nearby states
State HIE Cooperative Agreement Program (SHIECAP)
• Approval: Merit-driven• Funding: (mostly) Formula-driven– $4M base for 50 successful applicants– Additional funding up to $36M per applicant apportioned
thusly:• applicant region‘s population (5%), • number of PCPs (40%), • Acute Care Hospitals (30%), and • Medically Underserved and Rural Providers (25%). • A final 10% of the total funds will be apportioned based on an
assessment of the relative HIT need of the region, as determined by evaluation of the Letter of Intent.
– Oklahoma’s likely take: $6-8M
Deadlines and current status
• September 11: Letter of Intent Due– State Designated Entity- Done, at least temporarily– Review of existing capabilities statewide– Report of total expenditures to date in 5 key areas
• October 16: Final application due– Details of planning process– Key individuals identified to execute the process
• December 15: Award announcements• January 15: Work begins
Thanks!