the value of healthcare information exchange and ... · {critique of all projections and...
TRANSCRIPT
1
The Value of Healthcare Information Exchange and Interoperability
Davis Bu, MD, MACenter for Information Technology Leadership
Get Connected Knowledge ForumJune 29, 2004
2
OverviewCITL overviewResearch methods & resultsStudy limitationsTake home points
3
CITL Overview
Center for Information Technology Leadership
4
Center for IT Leadership MissionProduce timely, rigorous market-driven technology assessments which:
Help providers invest wiselyHelp IT firms understand value propositionHelp shape public policy
Established at Partners HealthCare in partnership with HIMSS
5
CITL Research TeamEric Pan, MD, MScDavis Bu, MD, MAJulia Adler-Milstein, BADavid Kendrick, MD, MPHEllen Rosenblatt, BSJan Walker, RN, MBABlackford Middleton, MD, MPH, MSc
David Bates, MD, MScDoug Johnston, MA
6
CITL Research Methods and Results
7
HIEI DefinitionProvider-centric encounter-based model of clinical information exchange
Provider
Public Health
Laboratory
Pharmacy Payer
RadiologyOther
Provider
Secondary (out of scope)
Clinical and administrative transactions and data exchange
Between providers and other providersBetween providers and labs, pharmacies, payers, radiology centers, and public health departments
8
HIEI Taxonomy
Secure e-mail of free text or incompatible/proprietary file formats, HL-7 message
Machine-organizable data3
PC-based and manual fax, secure e-mail of scanned documents
Machine-transportable data2
Mail, phoneNon-electronic data1
Automated entry of LOINC results from an external lab into a primary care provider’s electronic health record
Machine-interpretable data4
ExamplesDescriptionLevel
No PC/information technology
Fax/Email
Structured messages, non-standard content/data
Structured messages, standardized content/data
9
Research MethodsLiterature review
Reviewed studies from academic and general/trade literatures; over 600 citations reviewedMarket research
Expert panelDay-long briefing and first assessmentsPhone/email consultationsExpert review of literature findingsEstimates of HIEI impactCritique of all projections and conclusions
Construction of cost-benefit model (influence diagram)
Includes 1,238 nodes
10
HIEI Expert PanelistsDavid J. Brailer, MD, PhD.
Senior Fellow, Health Technology Center. William R. Braithwaite, MD, PhD, FACMI.
Independent Consultant. Paul C. Carpenter, MD, FACE.
Associate Professor of Medicine, Divisions of Endocrinology-Metabolism and Health Informatics Research, Mayo Clinic, Rochester, MN.
Daniel J. Friedman, PhD. Independent consultant.
Robert Miller, PhD. Associate Professor of Health Economics in Residence, Institute for Health & Aging and Department of Social and Behavioral Sciences, UCSF.
Arnold Milstein, MD, MPH. Medical Director, Pacific Business Group on Health. US Health Care Thought Leader, Mercer Human Resource Consulting.
J. Marc Overhage, MD, PhD, FACMI. Investigator, Regenstrief Institute for Health Care. Associate Professor of Medicine, Indiana University School of Medicine.
Scott S. Young, MD, FAAFP. Senior Clinical Advisor, Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services.
Kepa Zubeldia, MD. President and CEO, Claredi Corporation.
11
HIEI Analytical ModelModel financial value with 3 perspectives:
Provider
Public Health
Laboratory
Pharmacy Payer
RadiologyOther
Provider
2) Stakeholder group
1) Individual provider group or hospital
3) National
12
Key HIEI Model AssumptionsLevel 1 is baseline – manual practices
Project the financial impact of cost reduction at Levels 2, 3, and 4 Model payers at Level 4 only
Provider-centricNo secondary transactions considered
Encounter-centric Clinical, administrative, and financial data related to clinical encounters
Financial value of information exchange and interoperability between entities
Not within entities
13
Principal Cost Model ComponentsFor providers:
Number of interfacesInterface costsSystem costs
For stakeholders:Number of interfacesInterface costs
Provider
Public Health
Laboratory
Pharmacy Payer
RadiologyOther
Provider
14
HIEI Cost AssumptionsAssumptions:
No cost for Levels 1 and 2Stakeholder and hospital interface cost at $50K/each. Clinician office interface cost at $20K/eachProviders purchase electronic medical records with interoperability functionality at Levels 3 and 4Cost for stakeholder systems not includedRollout costs include initial system and interface costsInclude annual maintenance costs for systems and interfacesCost for standards development and maintenance not included Payer costs derived from HIPAA Final Impact Analysis
15
Number of Interfaces
Provider(Small Group
Practice)
Other Provider
Labs
Radiology Centers
Public Health
PharmaciesLevel 3Level 3
Provider(Small Group
Practice)
Other Provider
Labs
Radiology Centers
Public Health
Pharmacies
Level 4Level 4
Entity Interface
16
National Implementation Schedule
Assume a 10-year technology rollout and usage scheduleRamp up the adoption of systems and interfaces over the first five years, with 20% adoption per yearRamp up the benefit from technology over five years, beginning with 50% benefit in the first year of adoption and increasing by 10% each yearOn a national basis, the return is then realized as follows:
94%
8
88%
7
52%
4
36%
3
22%
2
10%
1
80%
6
70%
5
98%
9
100%Percent of potential
return realized
10Year
17
How Much Does HIEI Cost?
$275.6B$9.9B
$75.7B
Level 4 Rollout
$320.3B$6.4B
$123.9B
$27.1B$162.9B
Level 3 Rollout
$16.5B$20.2BTotal
$0.5B$0.5BStakeholder interface cost
$5.4B$9.0BProvider and hospital interface cost
$1.6BHospital system cost
$9.1BClinician office system cost
Level 4 AnnualLevel 3 Annual
Fewer provider interfaces required at Level 4 vs. Level 3
Difference in stakeholder interface cost at Level 3 vs. Level 4 due to payer cost (payers only modeled at Level 4)
18
HIEI Principal Sources of BenefitHIEI produces two principal types of benefit
Administrative savingsQuantify the financial value of time saved by transitioning from manual to electronic data exchangeBenefit accrues to all entities that participate in data exchange
Utilization (Avoided redundancy)Reduction in unnecessary lab and radiology testsResults from interoperability between providers and labs, and providers and radiology centersBenefit accrues to the entities who pay for tests: providers and payers
19
HIEI National Net Cost-Benefit
Level 2
Level 3
Level 4
$22B
$24B
$78B
Annual Net Return after
Implementation
$141B
-$34B
$337B
Net Return over 10-year
Implementation
Value of HIE standards is the difference between Level 3 & 4
20
$(200)
$(100)
$0
$100
$200
$300
$400
0 1 2 3 4 5 6 7 8 9 10
Years
10-Year Cumulative Net Return by HIEI Level
Level 1Level 2Level 3Level 4
in b
illio
ns
21
Limitations
22
LimitationsOur model combines evidence from the academic literature, experts, and market dataWe extrapolate to make national projectionsThe model may be incomplete and important determinants missing
23
LimitationsBenefit from secondary transactions beyond provider-centric, encounter-based model not includedSecondary benefit from enhanced data integration not included Costs not included:
Stakeholder system cost (other than Providers and Hospitals)Cost to develop, implement, and maintain standardsVolume discount associated with a national roll-outRevenue loss to labs and radiology from reduction in testsConversion of legacy data
24
LimitationsAdministrative benefits may be difficult to realize
Assume labor savings translate directly into dollar savings Or, newly available resources may be used for non-revenue generating activity
25
Take Home Points
26
Value of HIEI: Key FindingsStandardized, encoded, electronic healthcare information exchange would:
Save the US healthcare system $337B over a 10-year implementation periodSave $78B in each year thereafterTotal provider net benefit from all connections is $34BNet benefits to other stakeholders:
- Payers $22B - Pharmacies $1B- Laboratories $13B - Public Health $0.1B- Radiology centers $8B
Dramatically reduce the administrative burden associated with manual data exchangeDecrease unnecessary utilization of duplicative laboratory and radiology tests
27
To Achieve the Vision of HIEITruly interoperable systems will require:
Federal policy and financial incentives to stimulate adoptionNew organizational structures to facilitate, manage, and provide oversight for HIEPrivate sector investment for lab, radiology, and pharmacy systemsPublic sector support for investment in public health systems, provider systemsAcceptable rules and regulations for data ownership, and sharing, between covered entitiesHIEI Standards
28
For More InformationSee www.citl.orgThe Value of HIEI Full Report
Available through HIMSSIncludes detailed results for individual provider organizations and hospitals
CITL Value of ACPOE Full ReportAvailable from CITL and HIMSS
