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Electronic Health Records and Health Information Technology:
Making a Difference to The Healthcare Delivery System
David S...
Together, We Must Transform
The Healthcare Delivery System
• Care transformation
• Patient engagement
• Population managem...
Meaningful Use
June 12, 2013 2
Pumpkin Meaningful Use of Pumpkin
Primary Goal: Achieve Meaningful Use
Of Health Information Technology
General Requirements That Must Be Met:
• Certified E...
• CMS defines the EHR
Incentive Programs;
• ONC defines the EHR
Standards and
Certification Criterion;
• MU supports the H...
How Is the Transformation Funded?
• $22.5 Billion of incentives
– Eligible professionals and hospitals including critical ...
Meaningful Conversation
June 12, 2013 6
“The formulation of a problem is
often more essential than its solution,
which may...
Major Challenge:
Change Management
• Workflow
• Lifeflow
June 12, 2013 7
Who are our Federal partners?
June 12, 2013 8
More to
come…
What do hockey and EHRs have in common?
June 12, 2013 9
Providers Registered for
Medicare and Medicaid EHR
Incentive Programs as March 31, 2013
Source: CMS EHR Incentive Program ...
Unique Eligible Providers Successfully
Demonstrating MU as of April 30, 2013
June 12, 2013 11
Note: Payments for May 2012 ...
$22 $16 $26 $31
$109
$81
$116
$276
$237
$387
$607
$836
$564
$629
$662
$623
$587
$441
$406
$532
$579
$716
$907
$1,402
$1,10...
Age Discrepancies
E-Prescribers On the Surescripts Network
December 2006 – March 2013
0
50,000
100,000
150,000
200,000
250,000
300,000
350,0...
3164
1804
959
0
500
1000
1500
2000
2500
3000
3500
4/18/2011
5/18/2011
6/18/2011
7/18/2011
8/18/2011
9/18/2011
10/18/2011
1...
Online Job Postings Have Grown
Substantially
• Supporting activities
– Community College Consortia
– University Based Trai...
Students Enrolled and Students Completed
(Cumulative)
June 12, 2013
17
Community College Consortia
As of March 31, 2013
SO...
297
479
98
48 54
271
345
62
11
40 35
0
100
200
300
400
500
600
700
800
900
Clinician/
Public Health
Leader
HIM & Exchange ...
HIT Industry – Size Estimates as of
2011
Source Supposed Market Definition Year
Size
($
billions)
Frost & Sullivan
Ambulat...
Report: Next EMR Opportunity
May Be in Europe
June 12, 2013 20
New York, October 24, 2012--European
electronic medical rec...
The Patient and Consumer
picture source: continuuminnovation.com
Back in the Day…
June 12, 2013 22
“The obedience of a
patient to the
prescriptions of his
physician should be
prompt and i...
And Now…
Patient Generated Data
June 12, 2013 23
“Patients share the responsibility for their own health care…”
- AMA’s cu...
Patient Engagement – The Vision
• Unbounded expectations
• Untethered Personal Health Records
• Patient as a custodian of ...
• Glucometer
– Blood sugar
• Bathroom Scale
– Weight
– Water loss/gain
• Sphygmomanometer
– Blood pressure
– Pulse
NETWORK...
The Smart Home
26
The Smart Car
• Seat
– Weight
– Blood pressure
– Breathing rate
• Steering Wheel
– Pulse
– EKG
– Blood oxygen (PO2)
June 1...
The Smart Patient
June 12, 2013 28
FCC Issues Final Rule Allocating Wireless Spectrum for MBANs
The Federal Communications...
ONC’s Three A’s for Consumer
Engagement
June 12, 2013 29
• Give consumers secure, timely
electronic access to their health...
Consumer Engagement = Better Care
June 12, 2013 3030
Suffer a health consequence from
poor communcation among providers
Ex...
There’s a Gap between Reality &
Potential
June 12, 2013 31
• 15% have renewed a prescription online
• 10% have a personal ...
Taking the Blue Button Nationwide
Security and Privacy are and
should be in the DNA of HIT.
June 12, 2013 33
Adoption Speed for New Ideas
Time to reach 1M consumers
June 12, 2013 35
For those with the best ideas, the technology ado...
Liberating Data
June 12, 2013 36
Why is HIT important? Patients are not averages.
They are part of a community.
59 year-old woman in
Dallas, TX who was
dia...
Connect. Communicate. Collaborate.
Office of National Coordinator
• Browse the ONC website at: HealthIT.gov
click the Face...
Together, we are making a difference!
Thank you!
Please send comments or questions to
David.Muntz@HHS.gov
Making a Difference to The Healthcare Delivery System - David S. Muntz
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Making a Difference to The Healthcare Delivery System - David S. Muntz

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Making a Difference to The Healthcare Delivery System - David S. Muntz

  1. 1. Electronic Health Records and Health Information Technology: Making a Difference to The Healthcare Delivery System David S. Muntz, CHCIO, FCHIME, FHIMSS Principal Deputy National Coordinator Office of the National Coordinator for Health IT Department of Health & Human Services
  2. 2. Together, We Must Transform The Healthcare Delivery System • Care transformation • Patient engagement • Population management June 12, 2013 1
  3. 3. Meaningful Use June 12, 2013 2 Pumpkin Meaningful Use of Pumpkin
  4. 4. Primary Goal: Achieve Meaningful Use Of Health Information Technology General Requirements That Must Be Met: • Certified EHR is used in a meaningful manner, including electronic prescribing • Certified EHR is connected in a manner that allows for the exchange of health information • Entity is capable of reporting on clinical quality measures and such other measures as selected by the Secretary of Health and Human Services Incremental Approach - 3 Stages June 12, 2013 3
  5. 5. • CMS defines the EHR Incentive Programs; • ONC defines the EHR Standards and Certification Criterion; • MU supports the HIPAA privacy and security rules, already a requirement for most providers. June 12, 2013 4 Administration of Meaningful Use
  6. 6. How Is the Transformation Funded? • $22.5 Billion of incentives – Eligible professionals and hospitals including critical access facilities – Medicare and Medicaid participants • $2 Billion for ONC supported programs: – HIE (Health Information Exchange) – Regional Extension Centers (RECs) – Workforce Training Grants – National Health IT Research Center (HITRC) – Beacon Grants – Strategic Health IT Advanced Research (SHARP) Grants • $10.3 Billion from other Federal partners • Many more billions from the provider community June 12, 2013 5
  7. 7. Meaningful Conversation June 12, 2013 6 “The formulation of a problem is often more essential than its solution, which may be merely a matter of mathematical or experimental skill.”
  8. 8. Major Challenge: Change Management • Workflow • Lifeflow June 12, 2013 7
  9. 9. Who are our Federal partners? June 12, 2013 8 More to come…
  10. 10. What do hockey and EHRs have in common? June 12, 2013 9
  11. 11. Providers Registered for Medicare and Medicaid EHR Incentive Programs as March 31, 2013 Source: CMS EHR Incentive Program Data 0 1,000 2,000 3,000 4,000 5,000 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Cumulative number of eligible hospitals registered Eligible Hospitals Registered for the Medicare and Medicaid EHR Incentive Programs 0 100,000 200,000 300,000 400,000 500,000 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Cumulative number of eligible professionals registered Eligible Professionals Registered for the Medicare and Medicaid EHR Incentive Programs 386,024 eligible professionals 74% 4,333 eligible hospitals 86% 521,600 Total Eligible Professionals 5,011 Total Eligible Hospitals June 12, 2013 10
  12. 12. Unique Eligible Providers Successfully Demonstrating MU as of April 30, 2013 June 12, 2013 11 Note: Payments for May 2012 include payments to Medicare Advantage providers. 295,205 unique eligible professionals and hospitals have received payment through the Medicare or Medicaid EHR Incentive Programs 0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 CumulativeUniqueProvidersPaid NumbersofUniqueProvidersPaidperMonth Monthly Total Cumulative Total EP Paid: 291,325 (56%) EH Paid: 3,880 (77%)
  13. 13. $22 $16 $26 $31 $109 $81 $116 $276 $237 $387 $607 $836 $564 $629 $662 $623 $587 $441 $406 $532 $579 $716 $907 $1,402 $1,109 $809 $1,001 Cumulative Total $13,710 $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $0 $200 $400 $600 $800 $1,000 $1,200 $1,400 $1,600 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 CumulativeAmountPaid(Millions) AmountPaidperMonth(Millions) Payments to All Eligible Professionals and Hospitals Under the Medicare or Medicaid EHR Incentive Programs Meaningful Use – All Payments As of March 31, 2013 Note: Payments include Medicare Advantage Organizations. Source: CMS EHR Incentive Program Data June 12, 2013 12
  14. 14. Age Discrepancies
  15. 15. E-Prescribers On the Surescripts Network December 2006 – March 2013 0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 550,000 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 TotalPrescribers EHRPrescribers Stand Alone Prescribers
  16. 16. 3164 1804 959 0 500 1000 1500 2000 2500 3000 3500 4/18/2011 5/18/2011 6/18/2011 7/18/2011 8/18/2011 9/18/2011 10/18/2011 11/18/2011 12/18/2011 1/18/2012 2/18/2012 3/18/2012 4/18/2012 5/18/2012 6/18/2012 7/18/2012 8/18/2012 9/18/2012 10/18/2012 11/18/2012 12/18/2012 1/18/2013 2/18/2013 3/18/2013 4/18/2013 Total Products Total Unique Products Total Vendors Certified Health IT Product and Vendor Trends (4/18/2013) June 12, 2013 15
  17. 17. Online Job Postings Have Grown Substantially • Supporting activities – Community College Consortia – University Based Training – Curriculum development – Competency Exam June 12, 2013 16 -1,000 1,000 3,000 5,000 7,000 9,000 11,000 13,000 15,000 Jan-07 Mar-07 May-07 Jul-07 Sep-07 Nov-07 Jan-08 Mar-08 May-08 Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09 Nov-09 Jan-10 Mar-10 May-10 Jul-10 Sep-10 Nov-10 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 NumberofHealthITJobPostingsperMonth Health IT Implementation & Support Jobs Health IT Clinical User Jobs HITECH Act February2009 4,850 14,512 SOURCE: ONC analysis of data from O’Reilly Job Data Mart
  18. 18. Students Enrolled and Students Completed (Cumulative) June 12, 2013 17 Community College Consortia As of March 31, 2013 SOURCE: ONC Data Brief 10,000 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 Studnets Cumulative Enrollment Cumulative Completion Cumulative Enrollment (adjusted for attrition) 21,539 17,523 31,801
  19. 19. 297 479 98 48 54 271 345 62 11 40 35 0 100 200 300 400 500 600 700 800 900 Clinician/ Public Health Leader HIM & Exchange Privacy & Security R&D Programmer/ Software Engineer HIT Sub-specialist Graduated Enrolled Target University-Based Training As of January 25, 2013 Target: 1,685 Graduated: 976 Gap to target: 709 Enrollment: 764 Remaining gap: None June 12, 2013 18
  20. 20. HIT Industry – Size Estimates as of 2011 Source Supposed Market Definition Year Size ($ billions) Frost & Sullivan Ambulatory EHR Revenue 2009 1.3 2012 2.6 2013 3.0 2016 1.6 Hospital EHR Revenue 2009 1.0 2012 6.5 IDC Health Insights Ambulatory MU (Software & Maintenance Costs) 2009 0.6 2015 1.4 Inpatient MU (Software & Maintenance Costs) 2009 1.3 2015 2.4 Kalorama EHR + Related Services Revenue 2008 12.5 2009 13.8 2010 15.7 2011 17.9 Millennium Research Group EHR Revenue 2012 5.3 2013 5.9 2014 6.6 2015 7.4 2016 8.3 MarketsandMarkets EHR (end user purchases of components and applications) 2009 2.2 2015 6.1 Global Market Direct US Health IT (EHR, Practice Management, CPOE, eRx, Labs, Picture archiving, Radiology Images) 2008 4.1 2015 11.5 EMR market rose to $20.7B in 2012, report finds.
  21. 21. Report: Next EMR Opportunity May Be in Europe June 12, 2013 20 New York, October 24, 2012--European electronic medical records (EMR) market reached revenues of $6.8 billion in 2012. Kalorama Information's new report, EMR in Europe.
  22. 22. The Patient and Consumer picture source: continuuminnovation.com
  23. 23. Back in the Day… June 12, 2013 22 “The obedience of a patient to the prescriptions of his physician should be prompt and implicit. [The patient] should never permit his own crude opinions as to their fitness to influence his attention to them.” - AMA’s Code of Medical Ethics (1847)
  24. 24. And Now… Patient Generated Data June 12, 2013 23 “Patients share the responsibility for their own health care…” - AMA’s current Code of Medical Ethics “Patients can … be a second set of eyes on our medical records. I corrected the mistakes in my health record…Better to clean it up now, not when there’s time pressure.” – Dave deBronkart (ePatient Dave)
  25. 25. Patient Engagement – The Vision • Unbounded expectations • Untethered Personal Health Records • Patient as a custodian of records • Consumer mediated exchange • Requirements in 2014 Edition – View, download, and transmit – Secure messaging June 12, 2013 24
  26. 26. • Glucometer – Blood sugar • Bathroom Scale – Weight – Water loss/gain • Sphygmomanometer – Blood pressure – Pulse NETWORK • Smart Band-Aids - Chemistry • Digestible RFID Pills From Hank Fanberg Texas HIT Summit Jan 2011June 12, 2013 25
  27. 27. The Smart Home 26
  28. 28. The Smart Car • Seat – Weight – Blood pressure – Breathing rate • Steering Wheel – Pulse – EKG – Blood oxygen (PO2) June 12, 2013 27 Walter, Eilebrecht ET AL Personal and Ubiquitous Computing November 2010 From Hank Fanberg Texas HIT Summit Jan 2011
  29. 29. The Smart Patient June 12, 2013 28 FCC Issues Final Rule Allocating Wireless Spectrum for MBANs The Federal Communications Commission has released a final rule to allocate wireless spectrum for medical body area networks starting Oct. 1, 2012. FCC said the spectrum allocation will help improve patient care and safety by reducing the need to physically connect sensors to patients. Modern Healthcare. September 2012 Picture source: Jack E. Brown 6/23/2012
  30. 30. ONC’s Three A’s for Consumer Engagement June 12, 2013 29 • Give consumers secure, timely electronic access to their health information. Access • Support the development of tools that help consumers to take action using information. Action • Help expectations about consumer (and provider) roles to evolve. Attitude
  31. 31. Consumer Engagement = Better Care June 12, 2013 3030 Suffer a health consequence from poor communcation among providers Experience a Medical Error Hospital Readmit within 30 Days 36% 28% 13% 19% 13% More Activated Patient Less Activated Patient 49% AARP Magazine, July/August 2009 findings based on people over 50 years who have at least one chronic condition.
  32. 32. There’s a Gap between Reality & Potential June 12, 2013 31 • 15% have renewed a prescription online • 10% have a personal health record (PHR) • 8% of consumers have e-mailed their provider
  33. 33. Taking the Blue Button Nationwide
  34. 34. Security and Privacy are and should be in the DNA of HIT. June 12, 2013 33
  35. 35. Adoption Speed for New Ideas Time to reach 1M consumers June 12, 2013 35 For those with the best ideas, the technology adoption curve in the future will be immediate. 16 years 71 years 10 years 9 months 2 days 21 years Technology Adoption Timeline 74 days 75 Years 0 Days Source: Glen Tullman, “Creating a Connected Community of Health,” Allscripts Innovation and Value-Driven Healthcare Summit (2011)
  36. 36. Liberating Data June 12, 2013 36
  37. 37. Why is HIT important? Patients are not averages. They are part of a community. 59 year-old woman in Dallas, TX who was diagnosed with glaucoma in 1982 and has been taking Timoptic eye drops daily. During the admission, she received personalized risk assessment forms, was placed on standardized order sets. Medication reconciliation was done. She was sent to the Cath Lab for an angiogram. Prior to and after her procedures, telemetry results were entered automatically into the EHR. Using an EHR with imaging, her physician was able to review her angiogram with her on the TV screen in her room and discuss the potential risks of an additional beta blocker to ensure the best possible outcome. Personalized discharge instructions were given to her spouse. The outcome and prognosis are good. On Sunday, April 15, 2012, 10 minutes after entering the water for the first leg of a mini-triathlon she suffered what was eventually diagnosed as a non-STEMI cardiac event. She was admitted to the Heart Hospital at Baylor Plano.
  38. 38. Connect. Communicate. Collaborate. Office of National Coordinator • Browse the ONC website at: HealthIT.gov click the Facebook “Like” button to add us to your network • Contact us at: onc.request@hhs.gov • Subscribe, watch, and share: @ONC_HealthIT http://www.youtube.com/user/HHSONC Health IT and Electronic Health Records http://www.scribd.com/HealthIT/ http://www.flickr.com/photos/healthit Health IT Buzz Blog June 12, 2013 38
  39. 39. Together, we are making a difference! Thank you! Please send comments or questions to David.Muntz@HHS.gov

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