Innovation in HIT --- Innovation in HIT --- Health Information Health Information Technology Technology

California’s Untapped Health California’s Untapped Health Care AssetCare Asset

Jack Lewin MDJack Lewin MDCEO, California Medical AssociationCEO, California Medical Association

CCST Meeting-----UC IrvineCCST Meeting-----UC Irvine

October 2005October 2005

Ironies

Health Information Health Information Technology---Its Time Technology---Its Time Has Come:Has Come:

• Practice ManagementPractice Management• Patient and Personal RecordsPatient and Personal Records• Quality of CareQuality of Care

Some Physicians Are More Able to Participate in the Quality

Agenda Than Others

Distribution of Physicians by Practice Arrangement

US Market, 1984-2001

20

30

40

50

1984 1988 1991 1995 1999 2001

Employees*Employees*

Self-Employed GroupSelf-Employed Group

Self-Employed SoloSelf-Employed Solo

PercentPercent

* Employees include group, hospital, medical school, government, health plan and ambulatory physician employees.* Employees include group, hospital, medical school, government, health plan and ambulatory physician employees.

43%43%

28%28%

40%40%

37%37%

23%23%

Sources: AMA Physician Masterfile, 2003, AMA Physician Socioeconomic Statistics, 2003; Aventis Pharmaceuticals, 2003

Are Consumers Are Consumers ReallyReally Interested in Quality of Interested in Quality of

Care?Care?

YES*

* But, What is Quality?

Consumerism: Consumerism:

Short-term Health Trend, Short-term Health Trend, or the or the FutureFuture??

Consumer-Driven Healthcare Trends

• Changes in the health insurance marketChanges in the health insurance market• Changes in who pays for healthcareChanges in who pays for healthcare• Likely market influence of HDHPs/HSAsLikely market influence of HDHPs/HSAs• Future physician demographics and Future physician demographics and

solo practicesolo practice• Influence of purchasing collaborativesInfluence of purchasing collaboratives• Consumerism and quality Consumerism and quality

How Real is the Quality Problem?Problem?

50

2

25

9

20

42

5

47

0

10

20

30

40

50

60

70

80

90

100Percent

Fee-for-ServiceBeneficiaries

Total Fee-for ServiceSpending

Distribution of Fee-for-Service Medicare Spending Among Beneficiaries, 1997

Distribution of Fee-for-Service Medicare Spending Among Beneficiaries, 1997

Source: Congressional Budget Office

Percent of Americans Saying“I Have A Chronic Condition” Percent of Americans Saying“I Have A Chronic Condition”

15%

24%

35%

58%66%

0%

10%

20%

30%

40%

50%

60%

70%

18-29 30-39 40-49 50-64 65+Age

Source: Chronic Illness and Caregiving Survey, Harris 2000

RAND Study: Quality of Health Care Often Not Optimal

Doctors provide appropriate health care only about half the time

Percentage of timePercentage of time

Alcohol dependenceAlcohol dependenceHip fractureHip fracturePeptic ulcerPeptic ulcer

DiabetesDiabetesLow back painLow back painPrenatal carePrenatal careBreast cancerBreast cancer

CataractsCataracts

11%11%23%23%

33%33%45%45%

69%69%73%73%76%76%

79%79%

E. McGlynn, S. Asch, J. Adams, et al., The Quality of Health Care Delivered to Adults in the United States, E. McGlynn, S. Asch, J. Adams, et al., The Quality of Health Care Delivered to Adults in the United States, N Engl J MedN Engl J Med, 2003, 2003

Lapp & acute;, J. M. et. al. Ann Intern Med 2004;141:446-453

Proportions of patients receiving the appropriate discharge prescriptions

Measurement-Based QI Can Make a Difference

Intermountain Health Care QI effort on CVD

Results: 90% prescription

rates 27% decrease in

unadjusted absolute death rates

How Will Costs of Care How Will Costs of Care Interact with Quality?Interact with Quality?

The Future: Increasing Value

• Competition at the level of the Competition at the level of the individual patient care and diseaseindividual patient care and disease• Plans and doctors distinguished by Plans and doctors distinguished by quality outcomesquality outcomes• Potential of Risk-Adjusted PremiumsPotential of Risk-Adjusted Premiums• Real consumer choice informationReal consumer choice information• “ “Transparency”Transparency”• The Need for HIT Systems!!! The Need for HIT Systems!!!

How has practice changed?

Health Information Technology, Quality, and Reimbursement Are

Interactive Issues

• EHRsEHRs• PMRsPMRs• New practice management New practice management systems, CPOE, e-Rx etc.systems, CPOE, e-Rx etc.• Democratized interoperability Democratized interoperability and connectivityand connectivity• The Physicians’ Foundations!The Physicians’ Foundations!

Actually, It’s the Pipeline, Stupid!It’s the Pipeline, Stupid!

The Patient Safety Institute (PSI)

Improve patient safety, by making the following available:

Patient-Specific Clinical DataPatient-Specific Clinical Data

AtAtPointPoint

OfOfCareCare

Physicians TreatingPatients at Any

Location

AMR,Rx,Lab

AMR,Rx,Lab

HIS SystemsCDRLIS

HIS SystemsCDRLIS

Physician-Specific Preferred Wired and Wireless Devices• Palm Pilot• Windows CE / Pocket PC• RIIM• Browser

Physician-Specific Preferred Wired and Wireless Devices• Palm Pilot• Windows CE / Pocket PC• RIIM• Browser

Acute Care DataAmbulatory Data

Acute Care Data

Clinics & PhysicianOrganizations

Integrated Delivery Networks, Community Hospitals and

Medical Centers

Ambulatory Data

ReferenceLaboratories

RxPharmacies

PSI – The NetworkPSI – The NetworkPSI – The NetworkPSI – The Network

Hospital 2Hospital 1

Clinic B

Clinic A

PSIHub

PhysicianPatient

PSI – Response to PhysicianPSI – Response to PhysicianPSI – Response to PhysicianPSI – Response to Physician

Hospital 2Hospital 1

Clinic B

Clinic A

PSIHub

3

3

PhysicianPatient

The Current State of Physicians, Hospitals, and Health Care

Lack of Technically Trained StaffLack of Technically Trained Staff

Lack of Good Info on Best SystemsLack of Good Info on Best Systems

Angry About Disappointing InvestmentsAngry About Disappointing Investments

Costs Out of ReachCosts Out of Reach

Practice Workflows AntiquatedPractice Workflows Antiquated

Dead Ends Dead Ends

Isolation vs. InteroperabilityIsolation vs. Interoperability

Who Gets The Who Gets The ROIROI for H.I.T for H.I.T Investment in Health Investment in Health

Care?Care?

The Holy Grail

Opportunities for California

• CMS/CBO estimates $81 B national CMS/CBO estimates $81 B national savings if HIT solutions were realized-savings if HIT solutions were realized---$8B here--$8B here• Twice that would be saved ($16 B in CA) Twice that would be saved ($16 B in CA) in related care improvementsin related care improvements• The Medi-Cal program could be a major The Medi-Cal program could be a major beneficiarybeneficiary• Approaching the ‘Tipping Point” Approaching the ‘Tipping Point”

This is California’s Legacy