Using Technology to Bridge the Chasm of Quality in Healthcare

By Stephen H. Carson, MD

Associate Clinical Professor, UCSD

Chief Med Officer, SDCMS Foundation

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

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

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

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

Requester Organizations

PatientContact Points

The Problem TodayPhysicians 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

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

eRx option*Patient information retrieval and more extensive storage*Electronic Rx

CCR option*Data retrieval*Electronic Rx*Centralized record

EMR option*Electronic Rx*Full EMR*CCR 

Hospitals, X-ray, LabsLab, X-ray, discharge summaries, consultant and other reports Medical Groups

Pharmacy Benefit Managers and PharmaciesHealth Plan FormulariesPatient Medication ListsDrug alertsAllergy alertsSure Scripts and Rx Hub

Public Health Dept.Informed San Diego #211Network of CarePublic Health NursesBio-terrorism/ Health AlertsDisease Surveillance

Physician/PatientContinuum

Data onlylabs, X-ray, meds, diagnosis, allergies, immunizations, consultant reports, discharge summaries and more

SDCMS.org*Patient Education*Advocacy*CME*Events Calendar*Physician Resources

Decision Support *Care planning*Clinical advice*Local guidelines

San Diego Medical Information

Network Exchange 

Healthplans *Eligibility*Benefits

              

 

   

SponsorsSDCMS Foundation

CAL Institute for Technology and Telecom

Directory (Phone,

Address, Email, Mapquest)

Patient Education

Links

InfoLine

Dr Tango.com

San Diego Medical Information

Network Exchange (SDMINE)Hosted by

BusinessClearinghouse

Check, Credit Card and Debit verificationSupplies

•PSS

Help Desk

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

Electronic Medical Record - Chart Connect

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

SureScripts *Pharmacy Links/Formulary Information

Electronic Prescribing - DoctorFirst

Clinical Decision Support - EnigmaMedical Group SubPortals

SD Dept. of Public Health•SDIR (immunizations)•eMan•NetworkofCare

•In Multiple Languages

Adam.com

Automatic Appointment Reminder

•Healthplan

Practice Management - Elligence

1MedLink – Single Sign On/Password Management

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

Rx Rx

Physician Practices

Pharmacies

11

Current System Plagued by Serious Quality and Patient Safety Problems

• Patient safety*1.5% to 4.0% of Rx’s 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 time:1 hour per day

*Pharmacy: 4 hours per day

Illegible handwriting

Phone tag and fax tag

Patient waiting in the pharmacy

Illegible handwriting

Phone tag and fax tag

Patient waiting in the pharmacy

Rx

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Rice, Joe MD

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Predictors of Health

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

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