Electronic Health Records: What’s in it for Everyone?

Electronic Health Records: What’s in it for Everyone?


>>>GOOD AFTERNOON. I AM RARELY SPEECHLESS, BUT I’M
IN A STATE OF A SHOCK SEEING THAT WE HAVE THIS MANY PEOPLE
COMING IN PERSON TO HEAR ABOUT ELECTRONIC HEALTH RECORDS ON
SUCH A HOT DAY AND PEOPLE ARE STILL COMING. SO I WAS TRYING TO GIVE PEOPLE
MORE TIME TO COME IN. WELCOME. IT’S 1:00 AND THIS IS A SESSION
AS I SAID ON ELECTRONIC HEALTH RECORDS. CDC PUBLIC GRAND ROUND. JUST TO REMIND PEOPLE THAT WE
HAVE NOW BEEN DOING THIS ALMOST FOR TWO YEARS AND THESE ARE THE
WEB PAGES WHERE YOU CAN WATCH US INTERNALLY AND EXTERNALLY LIVE. TO GIVE YOU A SENSE OF THE TWO
UPCOMING TOPICS IN AUGUST AND SEPTEMBER, AND REMIND YOU THAT
WE WILL BE MOVING TO THE THIRD TUESDAY IN THE MONTH, SAME TIME,
STARTING IN SEPTEMBER. I DO WANT TO SHARE WITH YOU THE
LATEST ABOUT OUR VIEWER SHIP, WHICH IS A HUGE SOURCE OF PRIDE
FOR THOSE OF US WHO WORK ON THIS EVERY MONTH. WE AVERAGE OVER 13,000 TO 14,000
PEOPLE VIEWING US LIVE. AND THEN ADDITIONAL NUMBERS AS
YOU CAN SEE WATCHING THE ARCHIVED EVENTS. AND WE DO HAVE A FEW OF THE
EVENTS THAT HAVE GONE OVER 20,000 OR OVER 15,000. SO THIS COULD BE A RECORD
BREAKER. WE ARE ALIGNING OUR SCIENCE
CLIPS AND THIS MONTH AGAIN, WE HAVE TOPICS IN ELECTRONIC HEALTH
RECORDS IN OUR WEEKLY SCIENCE CLIPS. NOW, FOR A LOT OF PEOPLE, NOT
KNOWS H. NECESSARILY FOR THIS AUDIENCE
BECAUSE I ACTUALLY RECOGNIZE MY AUDIENCE AND THIS IS A LITTLE
BIT DIFFERENT. NOT GOING TO NERDIER, BUT A
DIFFERENT AUDIENCE. ELECTRONICS ARE USUALLY A
DIFFERENT ISSUE, BUT CERTAINLY THIS IS A TOPIC THAT HAS
SURPASSED EVERYBODY’S EXPECTATIONS. AND I THINK YOU ARE EXPECTING TO
HEAR FROM THE GEEK SQUAD TODAY. I’LL HAVE TO DISAPPOINT YOU IN
THAT SENSE. THE QUESTION THAT THE GEEK SQUAD
WOULD SAY IS WE WOULD EXPLAIN WHAT WE DO, BUT IT COULD MELT
YOUR BRAIN. I DO HAVE AN EXAMPLE, HOWEVER. AND HERE IS A MEMO FROM ONE MUCH
OUR SPEAKERS TO ME TWO DAYS AGO SAYING I REDACTED SOME OF OUR
CORRESPONDENCE, BUT IT SAYS ALWAYS AMAZING THAT A BUNCH OF
PEOPLE WHO SAY THEY’RE ALL ABOUT COMMUNICATION CAN’T EXPLAIN
THEMSELVES. AND THIS WAS THE ANSWER TO MY
QUESTION WHAT ARE HEALTH ELECTRONIC RECORDS? YOU CAN PUT IT IN PLAIN
LANGUAGE? AND WE HAD A LITTLE BIT OF A
CHALLENGE THERE. BUT THE SPEAKERS WE HAVE
GATHERED TODAY ARE ABSOLUTELY UNBELIEVABLE. HERE ARE THEIR TOPICS. YOU WILL SEE ABOUT THE
TRANSFORMITY CHANGES FOR PUBLIC HEALTH, YOU WILL HEAR ABOUT THE
VIEW FROM THE TRENCHES AND REALIZE AND IMPLEMENTATION OF
HEALTH INFORMATION EXCHANGES, DIFFERENT LEVELS AT THE STATE
LEVEL, AS WELL, AND THEN WE HAVE THE HEAD OF ALL OF THESE
ACTIVITIES, FARZAD MOSTASHARI, WHO IS HERE WITH US. AND REALLY DELIGHTED TO HAVE ALL
THESE SPEAKERS HERE. HERE IS A PHOTO OF FARZAD WHEN
HE WAS A SMALL CHILD AND YOU CAN SEE THAT HE WAS ALREADY GEARED
IN THIS DIRECTION. SO YOU MAY THINK THAT THESE
PEOPLE, YOU KNOW, JUST I.T. AND ALL OF THIS WOULD HAVE
A CERTAIN SENSE OF STYLE, BUT THEY’RE ACTUALLY FIRST HARRY
POTTER LOVERS WHICH I FOUND OUT ONLY DURING LUNCHTIME, SO I HAVE
NOTHING FUNNY TO SAY ABOUT THAT, BUT I ALSO WANTED TO BRING TO
YOUR ATTENTION HOW SPECTACULARLY GOOD LOOKING THEY ARE. AND YOU KNOW HOW LOOKS ARE
IMPORTANT TO ME AND I POINT OUT WHEN WE HAVE A GOOD GROUP OF
PEOPLE. SO HERE IT IS. ROBERT VERSUS EDWARD NORTON. VERSUS SID MARTIN. AND I THINK THIS IS THE WINNER
IN MEN. FARZAD. WAIT UNTIL YOU SEE THE LADIES. SO HERE IS AMY. AND JAC. SO NOT ONLY ARE THEY SMART AND
GOOD LOOKING, THEY’RE REALLY SUPER PEOPLE. AND I’M SURE YOU WILL ENJOY
HEARING FROM THEM AS MUCH AS I HAVE ENJOYED WORKING WITH THEM. AND BEFORE YOU HEAR FROM THEM, A
FEW WORDS.>>I DON’T WANT TO TAKE TIME
AWAY FROM A TERRIFIC SET OF PRESENTATIONS, SO LET ME JUST
HIGHLIGHT THAT THERE IS AN ENORMOUS PROMISE OF ELECTRONIC
HEALTH RECORDS. BUT AS WE KNOW, THERE ARE MANY
THINGS IN I.T. THAT DON’T LIVE UP TO THEIR PROMISES. OUR CHALLENGE IN PUBLIC HEALTH
IS TO EMBRACE THESE CHANGES, ADAPT WITH THEM, AND FIGURE OUT
HOW WE IN PUBLIC HEALTH CAN HELP PROMOTE AND INTERACT WITH THE
CHANGING WORLD OF ELECTRONIC HEALTH RECORDS AND MEDICAL
INFORMATION THAT’S AVAILABLE TO PROVIDERS, SYSTEMS, AND PATIENTS
ONLINE. ELECTRONIC HEALTH RECORDS ARE
EXPANDING VERY RAPIDLY. THE MEANINGFUL USE CRITERIA HAVE
TREMENDOUS POTENTIAL TO INCREASE THE QUALITY AND IMPACT OF CARE. SYSTEMS LIKE CLINICAL DECISION
SUPPORT, PATIENT REGISTRIES, REMINDER SYSTEMS, HAVE THE
POTENTIAL TO TRANSFORM THE QUALITY OF HEALTH CARE IN THIS
COUNTRY. AND ALSO TO BRIDGE THE GAP
BETWEEN CLINICAL MEDICINE AND PUBLIC HEALTH. WHAT THEY WILL ALSO DO IS CHANGE
THE INTERFACE BETWEEN HEALTH CARE AND PUBLIC HEALTH AND
MEANINGFUL USE PHASE ONE IS FOCUSED ON ELECTRONIC LABORATORY
REPORTING, IMMUNIZATIONS REGISTRY AND SYNDROME OF
SURVEILLANCE. AND IN PHASE TWO, WE HAVE THE
POTENTIAL TO DO EVEN MORE BEHIND HEALTH CARE AND PUBLIC HEALTH
BRINGING THEM CLOSER TOGETHER. IT’S AN ENORMOUS OPPORTUNITY,
BUT WE ALSO HAVE ENORMOUS CHALLENGES. CHALLENGES FISCALLY, CHALLENGES
IN PERSONNEL, CHALLENGES IN LEGACY SYSTEMS, CHALLENGES IN
THE LACK OF FUNDING FOR PUBLIC HEALTH INFORMATION
TRANSFORMATION, BUT WE HAVE TO FIGURE OUT SMART SAVVY EFFECTIVE
WAYS TO BRIDGE THAT GAP AND EMBRACE THE NEW WORLD OF
ELECTRONIC HEALTH RECORDS AND THE INTERACTIONS THAT IT WILL
HAVE WITH THE PUBLIC HEALTH SYSTEM AT ALL LEVELS. SO I WANT TO THANK OUR SPEAKERS
VERY MUCH.>>GOOD AFTERNOON. MY NAME IS SETH FOLDY AND AS
TANIA HAS GIVEN US AN OBJECT LESSON BEING BE CAREFUL WHAT YOU
PUT IN AN E-MAIL BECAUSE YOU’LL END UP SEEING IT ON YOUTUBE
WHICH WILL BE — AND MINE WILL BE THERE LATER THIS AFTERNOON. OBVIOUSLY MY STAFF AND
COLLEAGUES AT PUBLIC HEALTH ACROSS THE COUNTRY KNOW THAT
REMARK IS ABOUT COMMUNICATING. COULDN’T POSSIBLY BE ABOUT SETH. I’LL DESCRIBE WHY IT’S GROWING
SO FAST, HOW THE USE IS CHANGING AND WHY IT’S A TRANSFORMATIONAL
DEVELOPMENT FOR PUBLIC HEALTH. WHAT IS ELECTRONIC HEALTH
RECORD? IT’S A SYSTEMIC COLLECTION OF A
PATIENT’S HEALTH INFORMATION, BUT IT’S MORE THAN JUST
ELECTRONIC FOLDER FULL OF ELECTRONIC NOTES. THIS INFORMATION IS FORMATTED
DIGITALLY SO IT CAN BE USABLE BY INFORMATION SYSTEMS TO DO THINGS
LIKE TRACK CARE WITH STATISTICS AND GRAPHS, TO ISSUE WARNINGS
AND REMINDERS, AND TO FACILITATE COMMUNICATION. FOR EXAMPLE, IN THE PROCESS OF
CREATING A LEGIBLE AND CONVENIENT ELECTRONIC
PRESCRIPTION, THE ELECTRONIC HEALTH RECORD SYSTEM
SIMULTANEOUSLY UPDATES THE MEDICATION LIST WHICH THEN
ALERTS THE DOCTOR TO A POSSIBLE MEDICATION INTERACTION BEFORE
SHE EVEN HAD A CHANCE TO SAY GOOD-BYE TO THE PATIENT. WHEN INFORMATION IS STANDARDIZED
AND CAN BE USED BY MACHINES IN THIS WAY, THESE ARE SOME OF THE
RESULTS THAT CAN OCCUR. HEALTH INFORMATION EXCHANGE OR
HIE IS USED TO SECURELY TRANSMIT THAT KIND OF INFORMATION
ELECTRONICALLY BETWEEN ORGANIZATIONS. FOR EXAMPLE, FOR PRESCRIBING OR
PUBLIC HEALTH REPORTING. THIS REQUIRES IT TECHNICAL
STANDARDS, BUT IT REQUIRES AGREEMENTS ABOUT HOW INFORMATION
MAY AND MAY NOT BE USED, AND HOW CRY
PRIVACY WILL BE MAINTAINED. JAC AND AMY WILL SHARE THEIR
APPROACHES FROM OPPOSITE ENDS OF THE COUNTRY LATER IN 2450ESTHESE
ROUNDS. 2010, FEWER THAN A QUARTER
HEALTH CARE PROVIDERS USED EVEN A BASIC ELECTRONIC HEALTH CARE
RECORD, BUT MANY PROFESSIONALS SAID THAT THEY INTEND TO ADOPT
AND USE AS EARLY AS 2013. WHAT’S DRIVING THE CHANGE? THE HEALTH I.T. FOR ECONOMIC AND
CLINICAL CARE ACT WAS PART OF THE 2009 AMERICAN RECOVERY AND
RENEWAL ACT. IT CREATED HIGH STAKES FINANCIAL
INCENTIVES FOR ACUTE CARE HOSPITALS AND MOST HEALTH CARE
PROVIDERS. AND TO GET THOSE INCENTIVES,
THEY HAVE TO ADOPT EHRs THAT ARE CERTIFIED TO FEDERAL STANDARDS. THEY HAVE TO EXCHANGE
INFORMATION WITH PUBLIC HEALTH AND OTHER PARTNER SYSTEMS. THEY HAVE TO SULLY ACHIEVE
PATIENT CARE AND POPULATION HEALTH OBJECTIVES USING THESE
NEW TOOLS. WHAT IS CALLED MEANINGFUL USE OF
ELECTRONIC HEALTH RECORDS. AND YOU’LL NOTICE HOW THIS
IMPACTS OFFICE PRACTICE WHEN WE HEAR FROM DR. LAMBERTS. THE INCENTIVES ALREADY BEGAN
THIS YEAR AND CASE LATE OVER TIME. AND THEY’RE MAXIMIZED IF
PROVIDERS GET ON BOARD EARLY. SO THE IMPETUS IS FAIRLY STRONG. THE OFFICE OF THE NATIONAL
COORDINATOR FOR H.I.T. ON WHO YOU WILL HEAR FROM EARLY WAS
FUNDED TO ADOPT NECESSARY STANDARDS, TO PROVIDE TECHNICAL
ASSISTANCE, TO SOLVE TECHNICAL CHALLENGES, AND TO ADDRESS
WORKFORCE NEEDS. UNFORTUNATELY, CONGRESS DOES NOT
HUNDRED DOLLARS PUBLIC HEALTH AGENCIES TO ADAPT THEIR SYSTEMS
TO THESE BIG CHANGES, BUT CDC AND OTHER ORGANIZATIONS ARE
USING EXISTING RESOURCES TO HELP. THE HIGH TECH MEANINGFUL USE
PROGRAM SEEKS TO MEET FIVE MAJOR GOALS AND EACH OF THESE GOALS
HAVE VERY SPECIFIC OBJECTIVES THAT HOSPITALS AND PROVIDERS
MUST MEET. TO ADDRESS QUALITY AND SAFETY,
CERTIFIED EHRs HAVE TO BE ABLE TO AUTOMATICALLY GENERATE
QUALITY MEASURES. THIS ENABLES PAYERS TO MORE
EASILY DO STANDARDIZED PAY FOR PERFORMANCE FOR THEIR PROVIDERS. THE CERTIFIED EHR ALSO THEN
HELPS PROVIDERS MEET THESE TARGETS USING QUALITY AND SAFETY
ALERTS AND REMINDERS AND ALSO PATIENT REGISTRIES OR
DIRECTORIES OF PATIENTS WHO MAY SHARE A GIVEN DIAGNOSIS. TO FURTHER ENHANCE POPULATION IN
PUBLIC HEALTH, IN THE FIRST STAGE OF THE MEANINGFUL USE
PROGRAM, ELECTRONIC HEALTH RECORDS MUST ALSO BE ABLE TO
COMMUNICATE LABORATORY RESULTS FOR REPORTABLE CONDITIONS TO
PUBLIC HEALTH AGENCIES. REPORT IMMUNIZATIONS TO
IMMUNIZATION REGISTRIES. AND TO PERFORM SYNDROMIC
REPORTING TO PUBLIC HEALTH AUTHORITIES. OTHER GOALS IS R. TO IMPROVE THE
COORDINATION OF CARE, TO INVOLVE PATIENTS IN THEIR CARE, AND TO
PROTECT PRIVACY AND SECURITY. WIDESPREAD ELECTRONIC USE COULD
HAVE MAJOR PREVENTIVE IMPACT. THE PUBLIC HEALTH REPORTING
OBJECTIVES WILL HELP IMPROVE THE COMPLETENESS AND THE SPEED WITH
WHICH PUBLIC HEALTH RECEIVES SURVEILLANCE INFORMATION. AND IT ALSO MAKES A RICHER SET
OF DATA POTENTIALLY AVAILABLE ABOUT TRENDS IN BOTH HEALTH CARE
AND THE HEALTH OF POPULATIONS. STANDARDIZED ELECTRONIC DATA,
RECEIVING IT IN THIS WAY, HELPS PUBLIC HEALTH PROGRAMS KEEP PACE
WITH THIS FASTER MORE COMPLETE, EVER INCREASING, INFORMATION
LOAD. IT CAN REDUCE THE NEED FOR DATA
ENTRY. IT FACILITATES THE REUSE OF
INFORMATION. AND ANALYSIS OF THAT
INFORMATION. MEANWHILE, IN THE CLINICAL
SETTING, EHR TOOLS LIKE DECISION SUPPORT HELP PROVIDERS REDUCE
THE RISKS OF CARDIOVASCULAR DISEASED, HEALTH CARE ACQUIRED
INFECTIONS AND OTHER PUBLIC HEALTH BATTLES WHEN YOU COMBINE
THE CLINICAL DECISION SUPPORT WITH REAL TIME COMMUNICATION
WITH HUB HEALTH, WE SEE OUR WAY TOWARDS A POSSIBLE FUTURE WHERE
NEAR REAL TIME PUBLIC HEALTH ALERTS ARE DELIVERED TO
PROVIDERS IN THE CONTEXT OF CARING FOR A PARTICULAR PATIENT
WHEN IT’S RELEVANT. THESE OPPORTUNITIES ALSO BRING
REAL CHANGES FOR PUBLIC HEALTH AS YOU’LL HEAR MORE FROM DR. MOSTASHARI. THE CARTOON READS WE HAVE LOTS
OF INFORMATION TECHNOLOGY, WE JUST DON’T HAVE ANY INFORMATION. PUBLIC HEALTH AGENCIES ARE GOING
TO NEED TO UPDATE THEIR INFORMATION SYSTEMS, TO USE THEM
CREATIVELY, AND TO WORK COLLABORATIVELY IF THEY’RE GOING
TO BE ABLE TO RECEIVE AND USE THE INFORMATION COMING FROM
TOMORROW’S HEALTH CARE SYSTEM. AND IF WE DON’T DO SO, WE MAY BE
LEFT BEHIND. THANK YOU VERY MUCH AND NOW I’M
PLEASED TO INTRODUCE DR. ROBERT LAMBERTS. [ APPLAUSE ]
>>MY NAME IS DR. ROBERT LAMBERTS. I’M FROM EVANS MEDICAL GROUP
WHICH IS IN EVANS, GEORGIA, TWO HOURS EAST OF HERE. JUST OUTSIDE OF AUGUSTA. NOW, YOU MAY ALL BE ASKING
YOURSELF THE SAME QUESTION I’VE ASKED MYSELF WHEN CDC ASKED ME
TO DO THESE GRAND ROUNDS. WHY ME? WHAT DO I HAVE THAT IS OF VALUE
TO ALL OF YOU? WELL, FIRST OFF, I AM A DOCTOR
IN REAL LIFE. I AM A PRACTICING PRIMARY CARE
PHYSICIAN. I DO SPEND MOST OF MY TIME IN
THE OFFICE. NOT ONLY THAT, BUT I’M PART OF
THE DYING BREED OF — OR SUPPOSEDLY DYING BREED OF
DOCTORS WHO ARE SELF-EMPLOYED. BUT THERE’S MORE. I DO HAVE GEEK CREDENTIALS. NOT ONLY A DOCTOR, I AM A BOARD
CERTIFIED GEEK. OUR PRACTICE INSTALLED
ELECTRONIC HEALTH RECORDS IN 1996, WHICH WAS QUITE A BIT
BEFORE MOST OTHER PRACTICES DID. BUT 1996 HAD ITS DRAW BACKS, IT
MEANT VERY SLOW COMPUTERS, IT MEANT POOR INFORMATION SUPPORT,
IT MEANT THAT WE DIDN’T HAVE ANY INTERFACES, AND MOST OF ALL, IT
MEANT THAT WE DEALT WITH REAL IMMATURE EHR PRODUCTS. AND THE PRODUCTS WERE DESIGNED
BY ENGINEERS AND REALLY DIDN’T FLOW IN THE EXAM ROOM. BUT I HAD TO MAKE IT WORK
BECAUSE OUR SURVIVAL AS A BUSINESS DEPENDED ON IT. I HAD TO PAY MY STAFF, I HAD TO
PAY MY RENT REGARDLESS OF WHAT THE EHR DID. SO I BECAME OBSESSEDED WITH
CLINICAL WORK FLOW IN THE OFFICE SETTING. I WANTED THE BEST PATIENT
EXPERIENCE, THE BEST QUALITY AND TO MAINTAIN A GOOD LIFESTYLE. WELL, ALL OF THAT HAD A
SURPRISING OUTCOME. I BECAME A LEADER IN ELECTRONIC
HEALTH RECORDS AMONG DOCTORS. SO WHY NOT STAY WITH PAPER
CHARTS? WELL, I HAVE A THREE WORD ANSWER
FOR THAT. ATTENTION DEFICIT DISORDER. I FOUND IT IMPOSSIBLE TO KEEP
TRACK OF THOUSANDS OF PATIENTS GETTING INFORMATION FROM
HUNDREDS OF DIFFERENT SOURCES AND THE PAPER CHARTS. ESPECIALLY WHEN MOST OF THE
INFORMATION I GET FROM THE OUTSIDE WORLD, THE USEFUL
INFORMATION, IS SURROUNDED BY A WHOLE BUNCH OF INFORMATION
THAT’S NOT USEFUL AND WHICH I CALL FLUFF. I STILL COULD HAVE MANAGED WITH
PAPER, BUT THAT MEANT SEEING ABOUT FOUR PATIENTS A DAY,
GETTING HOME LATE AND TRYING TO GET THE DAY LONGER THAN 24
HOURS. THE GOOD NEWS IS THAT WE NOT
ONLY SURVIVED, THAT WE THRIVED. OUR ATTENTION TO CLINICAL WORK
FLOW ALLOWED US TO HAVE VERY HIGH QUALITY AND GOOD INCOME
WITHOUT SACRIFICING OUR PERSONAL LIVES. AND THIS CULMINATED IN 2003 WHEN
WE WON THE HINS AWARD, THE DAVIES AWARD, WHICH AWARDED US
FOR USE OF AN EHR IN A CLINICAL SETTING. NOW, THERE WASN’T A CASH
ADVANTAGE OR A NEW CAR ALONG WITH THIS, UNFORTUNATELY, BUT IT
DID VALIDATE MY ZEAL FOR ELECTRONIC HEALTH RECORDS AND IT
GAVE ME A GREAT BIG SOAP BOX ON WHICH TO EVANGELIZE AMONG THE
DOCTORS AND OTHERS. THIS ACTUALLY GOT QUITE A BIT
EASIER WHEN THE MEANINGFUL USE CRITERIA CAME UP JUST THIS PAST
YEAR. THIS REWARDS CLINICIANS USING
ELECTRONIC HEALTH RECORDS IN A MEANINGFUL WAY UP TO $45,000
OVER THREE YEARS. QUITE AN INCENTIVE. NOW, THE WORD MEANINGFUL, AS I
QUOTE, IS, OF COURSE, DEFINED BY THE GOVERNMENT. WHICH MEANS THAT EVEN FOR OUR
PRACTICE, THIS WAS NOT ALL THAT EASY. HOWEVER, I’VE BEEN ASSURED THAT
WE HAVE PASSED AND THAT OUR CHECK IS IN THE MAIL. SO THE REAL REASON I’M HERE IS
BECAUSE I AM REAL LIFE. I’M NOT THEORETICAL. ACADEMIC THEORY AND PUBLIC
POLICY CRASH LAND IN MY EXAM ROOMS. IF THOSE THEORIES WORK, THEN MY
LIFE AND MY PATIENTS’ LIVES GET BETTER. IF THEY DON’T WORK, WE ALL CAN
BE HURT. I’M ALSO THE BEST CASE SCENARIO
FOR ALL OF THIS. THE DATA EXCHANGE NEEDS TO
HAPPEN. WE WANT TO INTERFACE. WE ARE — OUR PRACTICE REALLY
WANTS TO INTERFACE WITH PUBLIC HEALTH AND WE WILL DO WHATEVER
WE NEED TO TO GET THAT WORKING, IT’S TO OUR ADVANTAGE, TO OUR
PATIENT’S ADVANTAGE. SO IF IT DOESN’T WORK FOR US, I
DON’T THINK IT WILL WORK FOR ANYONE. SO WHAT’S SO GREAT ABOUT EHR? WELL, FIRST OFF, INFORMATION IS
FAR MORE ORGANIZED AND EASIER TO FIND. COMMUNICATION IS EASIER. I E-MAIL LAB RESULTS TO MY
PATIENTS, SEND CONSULTS AND PRESCRIPTIONS ELECTRONICALLY AS
WELL, AND I DO IT, MY NURSES, MY STAFF DON’T DO THOSE THINGS. I DO THOSE IN THE EXAM ROOM
WHILE I’M WITH THE PATIENT. I HAVE REMINDERS BASED ON
ACCURATE INFORMATION FOR CARE AND IT’S DEFINITELY LESS LIKELY
THAT I’LL DUPLICATE CARE. MOST IMPORTANTLY WITH A
CONNECTED ELECTRONIC HEALTH RECORD, I DON’T WORK IN THE
DARK. I CAN KNOW WHEN MY PATIENTS HAVE
BEEN TO THE HOSPITAL, WHEN THEY’VE BEEN TO A SPECIALIST,
WHEN THEY HAD THEIR MEDICATIONS CHANGED AND SUCH. ALL OF THIS CONCEIVABLY WILL
SAVE MONEY. AND IT SHOULD SAVE LOTS OF IT. SO WHAT IS THE RECORD ITSELF? WELL, I KNOW WHAT HAS HAPPENED
WITH MY PATIENTS, I CAN DOCUMENT IT QUICKLY, AND I CAN CREATE A
CARE PLAN VERY EASILY WITH GOOD INFORMATION. BUT THIS IS A BIG DOWN SIDE TO
THE INFORMATION — DOWN SIDE HERE. AND THAT IS TOO MUCH
INFORMATION. OUR SYSTEM REWARDS USING LOTS OF
WORDS. AND THE END RESULT IS LOTS OF
WORDS. AND THOSE WORDS DON’T
NECESSARILY HELP CARE. IN FACT A LOT OF TIMES THEY
STAND IN THE WAY OF IT. IT’S ACTUALLY AND UGLY THING. DESPITE THIS FACT, WE HAVE USE
THE EHR TO GREATLY IMPROVE QUALITY. INFANTS WHO HAVE IMMUNIZATIONS
DUE WHO DON’T HAVE APPOINTMENTS SCHEDULED, PEOPLE WITH
HYPERTENSION WHO ARE DUE FOR VISITS, WE USE SECURE MESSAGING
TO E-MAIL LAB RESULTS TO PATIENTS SAVING STAMPS, STAFF
TIME AND GETTING INFORMATION TO THE PATIENTS MUCH QUICKER. WE ACCESS IMMUNIZATION REGISTRY
ONLINE, GETTING UP-TO-DATE INFORMATION REGARDLESS OF WHERE
THE VACCINES WERE GIVEN. AND MY NURSES VERY MUCH LIKE
THIS. OUR QUALITY NUMBERS ARE NOT ONLY
ABOVE THE NATIONAL AVERAGE, THEY FAR EXCEED THE NATIONAL AVERAGE. OUR PATIENTS ARE HAPPY. I’M NOT LOSING ANY STAFF OVER
THIS. AND WE HAVEN’T HAD TO SACRIFICE
INCOME AND QUALITY OF LIFE. BUT THE ROAD AHEAD IS HARD FOR
EVERYBODY ESPECIALLY FOR OTHER DOCTORS. PART OF THE PROBLEM WITH THIS IS
THAT THE ACCEPTANCE AMONG PHYSICIANS IS NOT HIGH. THEY HAVEN’T ACCEPTED IT BECAUSE
THEY THINK IT MAKES MORE WORK FOR THEM. DATA OWNERSHIP IS A REAL BIG
ISSUE, WHO OWNS THE DATA, IS IT THE PATIENT, THE HOSPITAL, THE
DOCTOR? OR A MIX OF THOSE. HIPAA AND SCARY STORIES ABOUT
PATIENT DATA BEING STOLEN SCARE DOCTORS AND HOSPITALS FROM
SHARINGSHARE SHARING THEIR DATA. AND ELECTRONIC RECORDS
POTENTIALLY MAKE IT EASIER FORLE MALPRACTICE ATTORNEYS TO GO
THROUGH THE CHART AND DOCTORS ARE VERY WELL AWARE OF THIS,
MAYBE JUST A LITTLE PARANOID ABOUT THIS. OBVIOUSLY, I’LL GIVE YOU A
LITTLE TIME TO LOOK AT THAT, OBVIOUSLY I BELIEVE LIFE IS
BETTER WITH AN ELECTRONIC HEALTH RECORD, BUT AS YOU HAVE GUESSED
IT, I AM NOT NORMAL. AS MORE PATIENTS — I’M FAR MORE
PATIENT WITH THE DOWN SIDE OF ELECTRONIC MEDICAL RECORDS THAN
MOST PHYSICIANS. AND I STILL STRUGGLE WITH
SHORTCOMINGS, SO OTHERS WILL STRUGGLE MORE. AND THE BIGGEST SHORT COMING IN
MY VIEW ARE INCENTIVES. THERE IS NOT ENOUGH UP SIDE TO
JUSTIFY THE DOWN SIDE FOR MOST PHYSICIANS. SO WHAT KIND OF INCENTIVES WOULD
DOCTORS NEED? WELL, FIRST OFF, GIVE PHYSICIANS
INFORMATION TO MAKE BETTER CARE DECISIONS AND MAKE IT EASIER TO
DO WHILE KEEPING IT SECURE. SECOND, MAKE SURE THAT
ELECTRONIC HEALTH RECORDS WORK IN THE REAL DOCTOR’S OFFICE,
WORK IN THE EXAM ROOM, NOT JUST WORK FOR ENGINEERS, FOR DATA
GATHERERS OR PAYORS. THIRD, PAY FOR BETTER
DOCUMENTATION AND NOT FOR MORE WORDS. AND FOURTH, EDUCATE THE PUBLIC. SHOW HOW GOOD CARE CAN BE WITH
CONNECTED ELECTRONIC HEALTH RECORD AND THEY WILL DEMAND
BETTER CARE USING ELECTRONIC HEALTH RECORDS. I BELIEVE THAT GOOD USE OF
INFORMATION TECHNOLOGY ALONG WITH REFORM OF OUR HEALTH CARE
PAYMENT SYSTEM WILL BENEFIT PATIENTS, DOCTORS, THE PUBLIC
HEALTH COMMUNITY, AND THE PUBLIC AT LARGE. AND WHO KNOWS? MAYBE I’LL EVEN GET HOME AT A
REASONABLE HOUR. THANK YOU. OUR NEXT SPEAKER IS MS. JAC
DAVIES. [ APPLAUSE ]
>>THANK YOU. I’M JAC DAVIES AND I’M GOING TO
GIVE YOU THE PERSPECTIVE OF AN ORGANIZATION THAT RUNS HEALTH
CARE FACILITIES, HAS IMPLEMENTED A LOT OF ELECTRONIC HEALTH
RECORDS SUBPOENAS AND ALSO OPERATES A REGIONAL HEALTH
INFORMATION EXCHANGE. FIRST LET ME TELL YOU A LITTLE
BIT ABOUT THAT INHS IS A NOT FOR PROFIT COMPANY, WE PROVIDE A
WIDE VARIETY OF SHARED SERVICES. WE’VE CONNECTED 34 HOSPITALS ON
A COMMON INFORMATION SYSTEM AND PROVIDE EHR TO MORE THAN 750
PHYSICIANS, PROVIDERS AND OVER 100 CLINICSES. MOST OF THE ORGANIZATIONS THAT
RECEIVE THESE SERVICES ARE INDEPENDENT OF EACH OTHER AND OF
US. WE’RE A REGIONAL AND COMMUNITY
COLLABORATION, NOT AN INTEGRATED DELIVERY SYSTEM. I’LL SHARE WITH YOU A LITTLE BIT
OF OUR EXPERIENCES, WHAT WE’VE LEARNED AND PROVIDE EXAMPLES OF
HOW THE PUBLIC HEALTH SYSTEM HAS BENEFITED. ICHT NHS HAS EXTENSIVE
EXPERIENCE. WE BEGAN IN 2003 PROVIDING
SERVICES IN WASHINGTON AND NORTHERN IDAHO IN PART BECAUSE
OF THESE EFFORTS MORE THAN 60% OF THE PROVIDERS IN THIS REGION
HAVE ELECTRONIC HEALTH RECORDS WELL ABOVE THE NATIONAL AVERAGE. WE’RE NOW SUPPORTING OFFICES IN
FOUR STATES. THIS ARE A NUMBER OF ISSUES WITH
AN EHR. STARTS WITH THE TYPE OF
INFORMATION IMPLEMENTED, HOW IT’S IMPLEMENTED, AND HOW IT
GETS USED. EARLY EHRs WERE ESSENTIALLY AN
ELECTRONIC FILE CABINET. THEY STORED INFORMATION WELL,
BUT THEY WEREN’T USEFUL FOR DECISION MAKING OR POPULATION
HEALTH CARE WITHIN PRACTICE LET ALONE FOR PUBLIC HEALTH. THIS IS CHANGING IN PART BECAUSE
6 THE MEANINGFUL USE REGULAR REGULATIONS. BUT EHRs MAY NOT BE
SOPHISTICATED ENOUGH TO SUPPORT POPULATION HEALTH NEEDS. EVERY PRACTICE WANTS TO CUSTOM
SIZE THEIR EHRs AND INVARIABLY PHYSICIANS DON’T LIKE THE WAY
SOMETHING WORKS AND THEY DECIDE TO CHANGE IT AND ENTER
INFORMATION A LITTLE BIT DIFFERENTLY. AND ALL THESE ISSUES AFFECT DATA
USEABILITY. EHRs ARE FOCUSED WITHIN A
PRACTICE OR GROUP. IT’S NECESSARY TO SHARE
INFORMATION BETWEEN ORGANIZATIONS, TWO PROVIDERS. HIE IS THE ELECTRONIC
TRANSMISSION OF INFORMATION FROM HEALTH CARE RELATED DATA FROM
ORGANIZATIONS THAT IS DONE ACCORDING TO NATIONAL STANDARDS. INFORMATION EXCHANGE HAS
OCCURRED FOR MANY YEARS BASED ON POINT TO POINT CONNECTIONS. INCREASINGLY, THOUGH, THERE IS
CENTRALIZED SYSTEM OF BEING ESTABLISHED TO MAKE HIE EASIER,
IN PART OF BECAUSE OF THE CHANGES HEALTH CARE ENVIRONMENT
IS CREATING A BUSINESS CASE FOR HIE. THE ENVIRONMENT IS VERY COMPLEX
AND LIKELY TO REMAIN THAT WAY FOR SOME TIME. SOME HIEs ARE ENTERPRISED BASE
AND THEY ALLOW HEALTH CARE ORGANIZATIONS TO SHARE
INFORMATION TO SUPPORT BUSINESS OPERATIONS AND BUSINESS NEEDS. SOME SUCH AS OURS DEVELOPED AT A
COMMUNITY LEVEL, INCLUDING ALLOWING INFORMATION SHARING
BETWEEN UNRELATED MULTIPLE ORGANIZATIONS THAT HAVE DATA
SHARING FOCUSED ON IMMEDIATE CLINICAL CARE. MORE RECENTLY, HIEs ARE BEING
ESTABLISHED AT A STATE LEVEL SUPPORTED IN PART BY HIGH TECH
FUNDING. THE TYPES OF SERVICES AND
GENERAL AVAILABILITY DATA VARY FROM A FOCUS ON CLINICAL DATA TO
AN EMPHASIS ON TRACTIONS SUCH AS ELIGIBILITY. SIMILARLY THE TYPES VARY WIDELY. MOST HIEs WERE STARTED BY
CONNECTING LARGE DATA SOURCES SUCH AS HOSPITALS AND
LABORATORIES, HOWEVER, AS THEY MATURE, THERE’S AN INCREASING
AVAILABILITY OF DATA. REGARDLESS OF THE STRUCTURE,
THERE REALLY HAS BEEN A HUGE GROWTH IN HEALTH INFORMATION
EXCHANGES OVER TIME. A RECENT SURVEY FOUND THAT THE
NUMBER OF OPERATIONAL HIEs HAS TRIPLED FROM ONLY NINE STATES
THAT HAD TWO OR MORE OPERATIONAL HIE INITIATIVE MIS-2005 TO 33
STATES THAT HAVE A TOTAL OF 78 OPERATIONAL HIEs IN 2010. LIKE MANY OTHER HIEs, OUR
COMPANY STARTED BY CONNECTING UP HOSPITALS AND LABORATORIES AND
SHARING THAT INFORMATION DOWN TO PHYSICIANS AND OTHER PROVIDERS. IT’S GROWN NOW FROM SIX
HOSPITALS AND ONE REGIONAL REFERENCE LABORATORY TO COVER 34
HOSPITALS AND THREE RECORDS LABORATORIES INCLUDING TWO
NATIONAL LABS SUCH AS QUEST. I’VE GOT A COUPLE OF EXAMPLES OF
HOW WE’VE USED THAT COMMON SOURCE OF INFORMATION TO BENEFIT
PUBLIC HEALTH. OVER THE MAST TWO YEARS, THEY’VE
PROVIDED EMERGENCY DEPARTMENT DAY IT TAKE AND INPATIENT DATA
TO THE WASHINGTON STATE DEPARTMENT OF HEALTH AND ALSO
HERE TO THE CDC. THIS INCLUDES DEMOGRAPHICS,
DIAGNOSES, PROCEDURE, LAB RESULTS, AND VITAL SIGNS. THE DATA WAS RELATIVELY EASY FOR
THE PUBLIC HEALTH ORGANIZATIONS TO ACCESS BECAUSE IT CAME FROM
ONE ORGANIZATION RATHER THAN HAVING THEM TO GO TO DIFFERENT
HOSPITALS. THE STATE APPROVED ESPECIALLY
VALUE THROUGH THE H1N1 OUTBREAK AND WE’RE USING THE SAME METHOD
TO TRANSMIT VIABLE REPORTS, MANDATORY DISEASE REPORTS TO THE
PUBLIC HEALTH AGENCIES. WE SEND THE DATA DAILY TO THE
STATE DEPARTMENT OF HEALTH AND THEY AGGREGATE IT AND SEND
SUMMARY REPORTS ON TO THE CDC. THE STATE ALSO HAS SYSTEMS IN
PLACE TO MAKE THE DATA AVAILABLE ELECTRONICALLY
ELECTRONICALLY LOCALLY. HERE’S JUST AN EXAMPLE OF HOW
THIS AFFECTED IT. THIS MAP SHOWS THE GEOGRAPHIC
COVERAGE FOR HOSPITAL REPORTING IN WASHINGTON STATE AND THE
SURROUNDING REGION IN 2009 STARTING BEFORE WE MATT LINK TO
THE HIE AND YOU NOTICE THE PER CAPITA RATE FOR EACH COUNTY HAS
THE HIGHEST PART IN WESTERN WASHINGTON AROUND PEUGEOT SOUND. AFTER CONNECTING IT, THE STATE
DEPARTMENT OF HEALTH COLLECTED SIGNIFICANTLY MORE REPORTS FROM
THE RECENT OF THE STATE AND FROM OUTLYING AREAS, AS WELL. IN ADDITION, INPATIENT DATA HAS
SUPPORTED OTHER TYPES OF PUBLIC HEALTH INTERVENTIONS. ONE OF THE THINGS DOH NOTICED
WAS THAT FLU VACCINATION RATES WERE VERY CLOSE FOR PREGNANT
WOMEN AT THE TIME OF THEIR DELIVERY AND BASED ON THAT THE
STATE HEALTH OFFICER WAS ABLE TO SEND A LETTER OUT TO CLINICIANS
ASKING THEM TO EMPHASIZE VALUE SIN NATION FOR PREGNANT AND
POST-PARTUM WOMEN. IN SUMMARY, BOTH EHR AND HIE
PROVIDE UNPRECEDENTED PUBLIC HEALTH ACCESS TO RICH SOURCES OF
POPULATION HEALTH DATA. GROWTH IN THESE TECHNOLOGIES HAS
ACCELERATED DRAMATICALLY, BUT THAT’S NOT A GUARANTEE THAT THE
DATA WILL BE READILY AVAILABLE TO PUBLIC HEALTH AGENCIES. PUBLIC HEALTH ORGANIZATIONS
REALLY NEED TO BE AT THE TABLE IN THEIR COMMUNITIES AND IN
THEIR STATES TO TAKE ADVANTAGE OF THE CHANGES THAT ARE GOING ON
RIGHT NOW. THERE ARE TREMENDOUS PRESSURES
ON HEALTH CARE ORGANIZATIONS AND PROVIDERS TO TRANSFORM THE
ENTIRE HEALTH CARE DELIVERY SYSTEM RATHER THAN INSISTING
THAT HEALTH CARE ORGANIZATIONS MEET SPECIFIC PUBLIC HEALTH
NEEDS, PUBLIC HEALTH OFFICIAL SHOES WORK TO UNDERSTAND WHAT’S
GOING ON RIGHT NOW, HOW ARE THOSE CHANGES AFFECTING HEALTH
CARE, TAKING ADVANTAGE OF THESE CHANGES, AND MEETING HEALTH CARE
PROVIDERS HALFWAY WILL BENEFIT BOTH PUBLIC HEALTH AND THEN ALSO
PROVIDERS IN THE LONG RUN. THANK YOU AND OUR NEXT SPEAKER
IS AMY ZIMMERMAN. [ APPLAUSE ]
>>>GOOD AFTERNOON. I’M AMY ZIMMERMAN AND WHILE I
WON’T SING OR DANCE LIKE CHER, I DO WANT TO SHARE WITH YOU HOW
THE TRANSFORMATION TO ELECTRONIC HEALTH RECORDS WILL IMPACT
PUBLIC HEALTH AND THE OPPORTUNITIES THAT IT PRESENTS. AS RHODE ISLAND STATE HEALTH
INFORMATION TECHNOLOGY COORDINATOR, I HOPE TO SHARE
INSIGHT INTO THE POTENTIAL PUBLIC HEALTH GOALS RELATED TO
HEALTH INFORMATION EXCHANGE AND ELECTRON HE CAN HEALTH RECORDS. THE ROLE THAT THE HEALTH
DEPARTMENTS CAN PLAY IN DRIVING THE ADOPTION OF HEALTH
INFORMATION TECHNOLOGY, RHODE ISLAND’S EXPERIENCE WITH
IMPLEMENTING SOME HEALTH INFORMATION TECHNOLOGY, AND BOTH
THE CHALLENGES AND OPPORTUNITIES FOR PUBLIC HEALTH. SO LIKE DR. LAMBERTS MENTIONED,
I, TOO, AM OFTEN ASKED WHY PROVIDE ELECTRONIC HEALTH
RECORDS. AND IN ADDITION TO THE RESPONSE
OF PROVIDING BETTER SAFER PATIENT CARE, IMPLEMENTING
ELECTRONIC HEALTH RECORDS WILL PROMOTE DATA DRIVEN DECISION
MAKING FOR HEALTH CARE POLICY AND TRANSFORM THE PRACTICE OF
MEDICINE. PROVIDERS WILL NOW HAVE THE
TOOLS AND DATA ACCEPTABLE TO BECOME AMBASSADORS OF PUBLIC
HEALTH, THEY WILL BE ABLE TO MANAGE THEIR PATIENT POPULATION
AS A WHOLE IN ADDITION TO PROVIDING INDIVIDUAL CARE. AND THIS IS VERY CRITICAL FOR
PUBLIC HEALTH FOCUS ON PREVENTION. IF WE HOPE TO ACHIEVE THESE
GOALS LIKE PROVIDER OFFICES AND LARGE HEALTH CARE FACILITIES,
DEPARTMENTS OF HEALTH ALSO NEED TO HAVE THE HUMAN AND TECHNICAL
CAPACITY AND INFRASTRUCTURE TO LEVERAGE ELECTRONIC HEALTH
RECORDS. THIS IS BOTH CHALLENGING AND CAN
BE AN OPPORTUNITY. PUBLIC HEALTH AGENCIES PLAY AN
IMPORTANT ROLE IN DRIVING ELECTRONIC TRANSFORMATION THAT
IS NOW UNDER WAY. AND I WANT TO HIGHLIGHT JUST A
FEW OF THE LESS OBVIOUS ROLES. NOT ALL PUBLIC HEALTH
DEPARTMENTS WILL BE ABLE TO ASSUME ALL OF THESE ROLES OR
FACILITATE THEM. WHILE HEALTH DEPARTMENTS CAN
OFTEN SERVE AS FACILITATORS, THEY ALSO HAVE REGULATORY
RESPONSIBILITY TAKES CAN BE USED AS LEVERS. FOR EXAMPLE, CERTIFICATE OF NEED
PROGRAMS, COMPLIANCE ORDERS, THESE CAN REQUIRE THE ADOPTION
OF ELECTRONIC HEALTH RECORDS OR INVOLVEMENT IN HEALTH
INFORMATION EXCHANGES AS APPROPRIATE. HEALTH DEPARTMENTS CAN ALSO
DEFINE STANDARDS OF CARE, BOARDSES OF MEDICAL HIGH SENSE
SURES CAN EITHER REQUIRE OR PROMOTE THE USE OF EHR AND
WORKING WITH HEALTH INFORMATION EXCHANGES AND THEY CAN EDUCATE
PROVIDERS ABOUT THE POTENTIAL PITFALLS OF NOT USING THE
TECHNOLOGY PROPERLY. HEALTH DEPARTMENTS CAN ALSO HELP
TO ALIGN CLINICAL QUALITY MEASURES SO THAT COMPARABLE DATA
CAN BE AGGREGATED AND ANALYZED. NOW I’D LIKE TO SHARE A LITTLE
BIT OF THE WORK THAT IS UNDER WAY IN RHODE ISLAND. ASSUMING THAT MEASURING PROGRESS
IS CRITICAL TO ACHIEVING SUCCESS, IN RHODE ISLAND, THE
DEPARTMENT OF HEALTH USES ITS PUBLIC REPORTING LAW TO REQUIRE
ALL LICENSED PHYSICIANS TO COMPLETE AN ANNUAL HEALTH
INFORMATION TECHNOLOGIES SURVEY. IF THEY DO NOT RESPOND, THEY’RE
AUTOMATICALLY LISTED AS NOT HAVING AN ELECTRONIC HEALTH
RECORD AND THAT IS ON A PUBLIC WEBSITE. AS YOU CAN SEE, THERE’S BEEN
GRADUAL BUT STUDY INCREASE IN THE ADOPTION RATE AND BASED ON
THIS YEAR’S SURVEY, ABOUT 51% OF THE PROVIDERS HAVE ADOPTED AN
ELECTRONIC HEALTH RECORD, ALTHOUGH THIS IS ASSUMED TO BE
AN UNDERESTIMATE BECAUSE THE RESPONSE RATE WAS 63% MEANING
37% THEN WERE LISTED WHETHER THEY HAD ONE OR NOT AS NOT
HAVING ONE. NOW I’D LIKE TO TALK A LITTLE
BIT ABOUT ELECTRONIC PRESCRIBING. EFFORTS THAT HAVE GONE ON IN
RHODE ISLAND. ELECTRONIC PRESCRIBING REFERS TO
THE ELECTRONIC TRANSMISSION OF A PRESCRIPTION FROM — BETWEEN A
PRESCRIBER AND A DISPENSER AND THE PRESCRIBER USES EITHER AN
ELECTRONIC HEALTH RECORD MODULE OR STAND ALONE SOFTWARE. SURE SCRIPTS IS THE COMPANY THAT
OPERATES THE LARGEST NATION’S NETWORK AND IT WAS INITIALLY
BETA TESTED IN READHODE ISLAND. RHODE ISLAND HAS CONSISTENTLY
BEEN RANKED HAS ONE OF THE TOP THREE STATES AND PROUD TO SAY
THE FIRST STATE IN THE NATION TO HAVE 100%S OF PHARMACIES CAPABLE
OF RECEIVING ELECTRONIC PRESCRIPTIONS. WE ALSO HAVE A STATEWIDE
ELECTRONIC PRESCRIBING COMMITTEE THAT MONITORS THE METRICS USING
SOME OF THE SURE SCRIPTS DATA. FOR EXAMPLE, THE DATA INDICATES
HERE THAT WHILE 78% OF ALL PRESCRIBERS ARE ELECTRON HE
CANNILY PRESCRIBING, ONLY 36% THE PRESCRIPTIONS ARE GOING
THROUGH ELECTRONICALLY. THIS TYPE OF DATA REALLY HELPS
INFORM THE WORK OF THE COMMITTEE TO TRY TO IDENTIFIED BARRIERS
AND COME UP WITH SOME SOLUTIONS. THIS NEXT SLIDE SHOWS THE
PERCENTAGE OF SUBSCRIBERS USING ELECTRONIC HEALTH RECORDS WHICH
IS THE DARK BLUE LINE, VERSUS THOSE USING STAND ALONE
SOFTWARE, THE LIGHT ARE BLUE LINE. AND AS YOU CAN SEE, THE TREND
REALLY CHANGES.ARE BLUE LINE. AND AS YOU CAN SEE, THE TREND
REALLY CHANGES. USE OF STAND ALONE TOOLS ARE
GOING DOWN AND ELECTRONIC HEALTH RECORDS ARE INCREASING, WHICH IS
WHAT WE WANT. NOW I’LL TALK A LITTLE BIT ABOUT
RHODE ISLAND’S HEALTH INFORMATION EXCHANGE EFFORTS. IN RHODE ISLAND, THIS STARTED
BACK ACTUALLY IN THE 1990s WHEN THE DEPARTMENT OF HEALTH CREATED
KIDS NET, WHICH IS A COMPUTERIZED CHILD HEALTH
INFORMATION SYSTEM AND IT INCLUDES OUR IMMUNIZATION
REGISTRY. KIDS NET INTEGRATED PREVENTIVE
HEALTH FROM NINE DIFFERENT PUBLIC HEALTH PROGRAMS AND USED
TO IDENTIFIED PATIENTS NEEDING PREVENT DIFFERENCE SERVICE. THEY CAN GO ON TO A WEB PORTAL
AND ACTUALLY LOOK UP INDIVIDUAL INFORMATION BY PATIENT. KIDS NET DATA IS ALSO USED FOR
COORDINATION OF CARE, FOR QUALITY ASSURANCE, ACTIVITIES
AND TO INFORM POLICY DECISIONS. AND AS YOU CAN SEE HERE, THIS IS
JUST ONE EXAMPLE OF THE USE OF THE DATA IN THE PIE CHART
WHEREBY INTEGRATING THE DATA, IT BECAME EVIDENT THAT 12% OF
CHILDREN IN RHODE ISLAND OVER A TEN YEAR PERIOD HAVE HAD THREE
DIFFERENT PRIMARY CARE PROVIDERS. SO THAT HELPS INFORM SOME OF THE
POLICY DECISIONS AND THE NEED TO COORDINATE CARE. IN 2004 AT THE REQUEST OF THE
COMMUNITY, THE DEPARTMENT OF HEALTH AN APPLIED FOR AND
RECEIVED THE RESEARCH AND QUALITY FUND TO GO BEGIN TO
DEVELOP A STATEWIDE EXCHANGE CALLED CURRENT CARE. THIS WAS DEVELOPED WITH TRANCE
PARENT COMMUNITY GOVERNMENT STRUCTURE AND A LOT OF CONSUMER
ENGAGEMENT. AND THAT RESULTED IN LEGISLATION
REQUIRING A CONSENT MODEL. THIS LAW ALSO GIVES REGULATORY
RESPONSIBILITY TO THE DEPARTMENT OF HEALTH OVER THE HEALTH
INFORMATION EXCHANGE AND AROUND USES OF DATA. SO OUR APPROACH, THIS SLIDE
SHOWS OUR APPROACH TO BUILDING THE STATEWIDE HEALTH INFORMATION
EXCHANGE WHICH IS TO CREATE A LONGITUDINAL HEALTH RECORD FOR
INDIVIDUALS REGARDLESS OF WHERE THE CARE WASSED A HIN SISTERED,
IT PROVIDE ALLOWS PROVIDERS TO VIEW INTEGRATED DATA EITHER
THROUGH A WEB BASED CLINICAL VIEWER OR BY RECEIVING A
CLINICAL SUMMARY THAT WILL BE SENT TO THEM FROM THE HEALTH
INFORMATION EXCHANGE USING THE DIRECT SECURE E-MAIL MESSAGE
THAT’S BEEN CREATED. ONLY CONSENTED DATA CAN FLOW
INTO CURRENT CARE. THE DEPARTMENT OF HEALTH IS
WORKING TO OBTAIN THEIR MEANINGFUL USE DATA. AND DO I WANT TO POINT OUT THAT
THE CONSENT POLICY VARIESES FROM STATE TO STATE. NOW I JUST WANT TO GIVE ANOTHER
EXAMPLE OF HOW IN ROAD I’DHODE ISLAND
WE’VE USED IT FOR PUBLIC HEALTH PURPOSES. WE TRACKED THE USE OF
ANTIVIRALS. ONE OUTCOME WAS DISCOVER
DISCOVERING THAT ABOUT 5% OF THE PATIENTS THAT WERE GIVEN
ANTIVIRAL PRESCRIPTIONS WERE DELAYED IN FILLING IT AND THAT
ALLOWED THE HEALTH DEPARTMENT TO WORK WITH PROVIDERS AND REALLY
EDUCATE THE POPULATION ABOUT THE NEED TO PROMPTLY FILL A
PRESCRIPTION AND TAKE THE ANTIVIRALS RIGHT AWAY. SO AS YOU’VE HEARD AND WILL
CONTINUE TO HEAR, THERE ARE MANY CHALLENGES WITH THIS
TRANSFORMATION THAT IS UNDERWAY. MANY OF THEM ARE WELL-KNOWN AND
HAVE ALREADY BEEN DISCUSSED SUCH AS STAFFING, FUNDING AND CHANGES
IN LEADERSHIPS AND ADMINISTRATION. MANY OF THE TECHNICAL AND
ANALYTICAL CHALLENGES HAVE ALSO BEEN DISCUSSED, FOR EXAMPLE,
WHERE THE DATA IS KEPT IN THE EHR, HOW TO EXTRACT IT AND MAKE
IT COMPARABLE. AND WITHIN UNIQUE CHALLENGE IN
RHODE ISLAND IS THIS ISSUE AROUND CONSENT AND THE ABILITY
WHETHER TO BE ABLE TO GET THE DATA FROM ONE PLACE IN THE
HEALTH INFORMATION EXCHANGE TO THE DEPARTMENT OF HEALTH. OTHER STATES CAN DO THAT, IN OUR
CASE, WE’RE UNABLE TO DO THAT. WHILE CHALLENGES DO EXIST, THERE
ARE MANY OPPORTUNITIES FOR PUBLIC HEALTH. THE EHR AND HIEs CAN PROVIDE AND
IMPROVE INDIVIDUAL AND POPULATION HEALTH AND THEY CAN
REALLY SUPPORT DATA DRIVEN DECISION MAKING FOR ANALYTICS
AND QUALITY IMPROVEMENT. THEIR ADOPTION PROMOTES BETTER
INTEGRATION AND COORDINATION BOTH TECHNICALLY AND
ORGANIZATIONALLY AND I THINK THIS IS VERY IMPORTANT FOR
HEALTH DEPARTMENTS. AND LASTLY, MEANINGFUL USE
ELECTRONIC HEALTH RECORDS AND HEALTH INFORMATION EXCHANGE HAVE
BROUGHT AND CONTINUE TO BRING ATTENTION AND PROVIDE A BETTER
UNDERSTANDING OF WHAT PUBLIC HEALTH IS. THEY ALSO SERVE AS TOOLS TO
SUPPORT AND PROMOTE HEALTH CARE REFORM WHICH I THINK YOU’LL HEAR
MORE ON THAT TOPIC FROM OUR NEXT SPEAKER, MY PLEASURE TO
INTRODUCE FARZAD MOSTASHARI.>>THANK YOU SO MUCH FOR
INVITING ME. ALWAYS A PLEASURE TO BE BACK IN
CDC AND TO BE ADDRESSING MY FORMER COLLEAGUES HERE AT CDC
AND ALSO ONLINE. IT’S AN INCREDIBLE ACCOMPLISH
CHLT THE DISSEMINATION OF THE ONLINE. AND IT’S AN INDICATION I
REMEMBER LISTENING TO THOSE CASSETTE TAPES OF GRAND ROUNDS
AND HOW TECHNOLOGY HAS FUNDAMENTALLY CHANGED HOW WE
DISSEMINATE INFORMATION IS NOT LIMITED TO GRAND ROUNDS
PRESENTATIONS. A FEW YEARS AGO, TOM FRIEDMAN
AND I WROTE A JAMA PERSPECTIVE PIECE ON HEALTH CARE AS IF
HEALTH MATTERED. CHEEKY TITLE. AND WE SAID IN ORDER TO REALLY
IMPROVE HEALTH CARE SO IT PRODUCES HEALTH, WE NEED TO HAVE
SOME THINGS SIMULTANEOUSLY. WE NEED HEALTH I.T., BUT WE ALSO
NEED PAYMENT REFORM. AND WHAT’S AMAZING IS THAT AFTER
SO MANY DECADES, IT’S ACTUALLY HAPPENING NOW. HEALTH I.T. HAS BEEN TRULY
TRANSFORMED THROUGH THE PASS OF THE ACT AS WE HEARD AND THE
HEALTH REFORM HAS TRULY TRANSFORMED THE INCENTIVES IN
THE SYSTEM TO PROVIDE HIGHER QUALITY, MORE EFFICIENT, MORE
COORDINATED CARE. AND THEY CAN WORK
SYNERGISTICALLY TOGETHER. SO WE HEARD A LOT ABOUT THE
PHRASE “MEANINGFUL USE.” IF THERE’S ONE THING YOU TAKE
AWAY, I WANT YOU TO TAKE AWAY THE IMPORTANCE OF THAT CONCEPT
AND THE SIGNIFICANCE OF SUPPORTING THAT DRIVE, THAT
MOVEMENT, IN EVERYTHING THAT WE DO. SO WE START WITH THE OUTCOMES
THAT WE WANT, IMPROVES HEALTH FOR INDIVIDUALS AND POPULATIONS,
AND THE ABILITY TO HAVE A LEARNING HEALTH CARE SYSTEM. THAT IS MEANINGFUL USE. IT’S NOT THE TECHNOLOGY, IT’S
HOW YOU USE TO GET TO THE OUTCOMES YOU WANT. AND, YES, THOSE INCENTIVES AND
PAYMENT ADJUSTMENTS TO COME FOR MEDICARE AND MEDICAID HAVE BEEN
A MAIN VECTOR OF DRIVING INTEREST AND MOVEMENT AFTER 20
YEARS OF IT BEING REALLY VERY SLOW, ONLY AMONG THE EARLIEST OF
THE DOCTORS LIKE DR. LAMBERTS, IT IS NOW BECOMING COMMON PLACE. 90% SAY IT’S THEIR TOP TWO
PRIORITIES FOR THE NEXT TWO YEARS. AND WE KNOW THIS WILL REQUIRE
EXCHANGE, WE SET IN PLACE GRANT PROGRAMS AND CONTRACTS WITH OUR
$2 BILLION TO HELP MAKE THAT HAPPEN AND A FRAMEWORK OF
PRIVACY AND SECURITY. BUT LET’S DRILL DOWN INTO WHAT
MEANINGFUL USE IS. WE HEARD ABOUT THE PUBLIC HEALTH
MEASURES. THIS IS WHAT PEOPLE FOCUS ON
WHEN THEY SAY MEANINGFUL USE IN PUBLIC HEALTH. SYNDROMIC SURVEILLANCE,
INFORMATION REGISTRIES AND ELECTRONIC LAB REPORTING. THAT’S WELL AND GOOD AND
IMPORTANT AND WE’RE ALREADY HEARING FROM MAYBE SOME OF YOUR
LISTENERS IN STATE AND LOCAL HEALTH DEPARTMENTS ABOUT THIS
INCREDIBLE SURGE IN INTEREST ALL OF A SUDDEN FROM HOSPITALS AND
PROVIDERS SAYING I WANT TO HOOK UP TO YOU. AND WE HEAR ABOUT THE CHALLENGES
OF MEETING THAT DEMAND. BUT IT’S NOT JUST ABOUT
ELECTRONIC REPORTING. MEANINGFUL USE IS ALSO ABOUT
HAVING FEWER PEOPLE DIE PREMATURELY FROM CARDIOVASCULAR
DISEASE. ONE POINT HERE IS HEALTH CARE IS
ACTUALLY GOOD ENOUGH NOW THAT THE FACT THAT ONLY HALF THE TIME
DO PEOPLE GET THE BASIC STUFF, THE ASPIRIN, BLOOD PRESSURE,
CHOLESTEROL AND SMOKING, THAT ACTUALLY MATTERS. THAT ACTUALLY MEANS WE’RE
LEAVING LOTS AND LOTS OF LIVES ON THE TABLE THROUGH HEALTH
CARE. SO WHAT DO WE DO TO FIX THAT? YOU CAN’T FIX WHAT YOU CAN’T
SEE. IF WE CAN’T SEE THE QUALITY OF
CARE WE’RE DELIVERING, AND RIGHT NOW HOW DO WE DO IT, EVERY
COUPLE YEARS, BECAUSE PRACTICE DOESN’T KNOW THAT, SAY I’VE GOT
TIME ON MY HANDS TODAY, TODAY I’M GOING TO GO CHART BY CHART
AND JOT DOWN WHETHER THE PATIENT HAS HYPERTENSION AND IT’S WELL
CONTROLLED. SO QUALITY MEASUREMENT IS FIRST
AND WE HAVE TO MAKE IT DONE BY PROVIDER, NOT DONE TO PROVIDERS. THE SECOND IS DECISION SUPPORT
AND REGISTRY FUNCTION. SO DECISION SUPPORT IS NOT
ALERTS FOR EVERYTHING THAT YOU’RE DOING ALL DAY LONG. IT’S TO TELL PEOPLE, REMIND THEM
WHAT’S IMPORTANT. WE HAVE A PATIENT THIS FRONT OF
YOU WITH 15 ISSUES YOU COULD TALK TO THEM ABOUT. WHAT’S THE ONE OR TWO MOST
IMPORTANT THINGS YOU SHOULDN’T FORGET TO DO? REGISTRY FUNCTIONS ARE EVEN MORE
REVOLUTIONARY. REGISTRY FUNCTIONS SAY HEALTH
CARE PROVIDERS DON’T WANT TO DELIVER HEALTH CARE THE WAY
RETAIL SALESPEOPLE SELL SHOES. HEALTH CARE PROVIDERS DON’T WANT
TO BE IN THE BUSINESS OF WAITING UNTIL SOMEONE COMES IN AND THEN
SAYING HOW CAN I HELP YOU? THAT’S SELLING SHOES. WHAT WE REALLY WANT TO DO IS
KNOW WHO THE DENOMINATOR IS. THE GREATEST INVENTION IN MY
BELIEF, THE DENOMINATOR. WHO IS THE COHORT, WHO IS THE
FULL LIST OF PEOPLE WHO HAVE DIABETES, HOW MANY OF THEM HAVE
THEIR BLOOD SUGAR POORLY CONTROLLED AND ARE NOT ON
INSULIN AND HAVE NOT BEEN SEEN AND ARE NOT DUE FOR A VISIT TO
COME? YOU CAN’T DO THAT WITH PAPER. YOU CAN DO IT WITH REGISTRY
FUNCTIONS. BUT THE INFORMATION NEEDS TO BE
OPERATED ON BY THE COMPUTER. STRUCTURED. IT’S THERE. YOU HAVE THE VITALS, YOU HAVE
THE DEMOGRAPHICS, YOU HAVE THE BLOOD PRESSURE, YOU HAVE THE
PROBLEM LIST, YOU HAVE THE MED LIST. YOU NEED THAT BASIC STUFF IN
THERE. AND THAT’S WHAT MEANINGFUL USE
IS. RIGHT NOW WE’RE HALFWAY TO
MEANINGFUL USE. IF A DOCTOR DOES THESE THINGS,
THEY’RE HALFWAY TO BEING A MEANINGFUL USER. SO WHAT ELSE IS IN — SORRY THIS
IS JUST — I’LL JUST SKIP THIS. ALL RIGHT. FINE. THIS SHOWS HOW IMPLEMENTING —
THIS IS A CLINIC IMPLEMENTED A GOLD PLATED EHR IN 2003. NINE MONTHS WITH THE SYSTEM,
THEY’RE DELIVERING 20 DOSES OF NEW
PNEUMO VCHLT ACHLT PNEUMOVAX. THEY RAN OUT THE NEXT MONTH. SOMEONE SHUT OFF THE ALERT BY
MISTAKE AND THEY WERE RIGHT BACK. ANYWAY. SO DECISION SUPPORT DOES WORK. BUT IT WORKS NOT ONLY FOR
IMPROVING CARE PROACTIVELY, IT CAN ALSO HELP US HARM FEWER
PEOPLE BECAUSE HEALTH CARE DOES, POT BECAUSE ANYONE WANTS TO, BUT
BECAUSE OF OUR SYSTEMS, WE HARM TOO MANY PEOPLE. AND THERE ARE SIMPLE THINGS THAT
WE KNOW THESE SYMPTOMS CAN HELP US WITH. IF YOU ENTER YOUR ORDER IN THE
SYSTEM, AT LEASE IT’S LECHBLGABLELECHBLGGIBLE. IF YOU CAN RECONCILE MEDICATIONS
BETWEEN TYPES OF CARE FROM HOME TO HOSPITAL, HOSPITAL TO POST
ACUTE CARE. THESE THINGS WORK. AND THEY’RE PART OF MEANINGFUL
USE. BUT MOST OF HEALTH IS NOT WHAT
HAPPENS IN THE DOCTOR’S OFFICE. THIS IS THE SAME PERSON
ACTUALLY. MOST OF OUR HEALTH IS DETERMINED
BY OUR OPEN BEHAVIORS. YOURS AND MINE. BUT WE HAVE TO HELP THE HEALTH
CARE SYSTEM HAS TO HELP EMPOWER PEOPLE, AT LEAST NOT STAND IN
THE WAY. SO WHAT DOES THAT MEAN? ONE IS GIVE US REMINDERS. WE GET REMINDERS FROM OUR VETS,
FROM OUR DENTIST, FROM OUR MECHANIC. IT’S GREAT IF YOU HAVE A CAT. BUT WHAT IF FOR HEALTH CARE. MORE AND MORE PEOPLE WILL BE
GETTING REMINDERS LIKE DR. LAMBERTS IS DOING BECAUSE OF
MEANINGFUL USE. IT ALSO MEANS PEOPLE HAVING
INFORMATION WHEN THEY NEED IT, WHERE THEY CAN SHARE IT WITH WHO
THEY WANT TO SHARE IT WITH, THEY CAN UNDERSTAND IT. BECAUSE MOST OF US FORGET MOST
OF WHAT WE HEARD IN THE DOCTOR’S OFFICE WITHIN SECONDS OF LEAVING
IT. SO IT MEANS HAVING A SIMPLE
AFTER VISIT SUMMARY. PRINT IT OUT, LOW TECH. IT’S PART OF MEANINGFUL USE. IT ALSO MEANS GIVES PEOPLE
COPIES OF THEIR OWN INFORMATION. MAKING IT OKAY TO ASK FOR YOUR
OWN INFORMATION. IT’S OKAY TO ASK YOUR DOCTOR, TO
ASK THE HOSPITAL, TO ASK THE EMERGENCY ROOM FOR YOUR RECORDS. IT’S EVEN THE LAW. BUT WE NEED TO MAKE THIS MORE
NORMAL. WE NEED TO MAKE IT EASIER, NOT
JUST LEGAL, BUT EASIER FOR PEOPLE TO GET THEIR OWN RECORDS
BECAUSE ALL TOO ON WHICH WHENFTEN WHEN IT
COMES TO CARE COORDINATION, IT’S THE PATIENT WHO SHOWS UP AT THE
SPECIALIST, WHO SHOWS UP IN THE EMERGENCY ROOM, WHO SHOWS UP
BACK WITH THE PRIMARY CARE DOCTOR AND THE DOCTOR SAYS I
DON’T HAVE THE INFORMATION, I DIDN’T GET THE PAPERS. CAN YOU EXPLAIN TO ME WHAT
HAPPENED TO YOU DURING YOUR HOSPITALIZATION? THAT’S NOT FAIR. TO DO THAT WITHOUT GIVING PEOPLE
THE MEANS OF DOING THAT. BUT, YES, WE ALSO NEED TO WORK
WITH THINGS LIKE INFORMATION EXCHANGES TO HELP BUSINESS TO
BUSINESS, PROVIDER TO PROVIDER, PROVIDER TO HOSPITAL, SHARING
THOSE CARE SUMMARIES. SO THAT’S IT. I MEAN, THAT’S WHAT MEANINGFUL
USE IS. I’M NOT HIDING ANYTHING. THAT’S IT. MEANINGFUL USE REALLY IS THE
MOST DISTILLED EXPLANATION THAT WE COULD COME UP WITH OF WHAT IS
THE PATHWAYS, THE ROAD MAP TO DELIVER AND CARE THOSE HIGHER
QUALITY, SAFER, MORE EFFICIENT, MORE COORDINATION. THAT’S REALLY ALL IT IS. AND THAT CANNKS TO THE MOVEMENT
COMING ON THE PAYMENT SIDE, IT ALSO WILL BE HOW PEOPLE WILL BE
ABLE TO THRIVE IN BUSINESS SO THEY DON’T GO BROKE DELIVERING
HIGHER QUALITY MORE COORDINATED CARE. SO THERE’S LOTS OF PUBLIC HEALTH
OPPORTUNITIES. ADDRESSING DISPARITIES. YOU CAN JUST — ALL OF YOU CAN
BE THINKING TO YOURSELF WHAT CAN WE DO WITH ALL THIS DATA AND THE
LINKAGE WITH CLINICAL CARE AND BILATERALITY OF IT. IMPROVING CHRONIC DISEASE CARE
FOR ASSIST MARKS DIETHMAASTHMA, DIABETES AND SO
FORTH. REDUCING PRESCRIPTION DRUG
OVERDOSE DEATH. ALL OF THESE ARE POSSIBLE. BUT THERE ARE REALITIES. BUDGETS, FUNDING, BAND WIDTH,
I.T., STAFFING, WORKFORCE, STATE REQUIREMENT THES
REQUIREMENTS, THINGS WE HAVE TO DO. AND THE WORK JUST STARTS THE DAY
YOU START GETTING THE NEW INFORMATION FLOWS IN. IT’S INCORPORATING THOSE INTO
WORK FLOWS THAT TAKES SO MUCH WORK AND TIME AND EFFORT. PROVING OUT THEIR VALUE. AND MANY OF US AND MANY OF OUR
PARTNERS IN STATE AND LOCAL HEALTH DEPARTMENTS ARE
OVERWHELMED AND JUST WEARY. WE’RE JUST TIRED. WITH ALL THE THINGS THAT ARE
HAPPENING AND ALL THE THINGS WE HAVE TO DO. AND IT CAN BE FRUSTRATING
DEALING WITH THOSE PEOPLE, RIGHT? IF ONLY THEY WOULD JUST STOP
BEING SO NARROW IN THEIR AND UNDERSTAND THAT WHAT THEY HAVE
TO DO FOR PUBLIC HEALTH. WELL, HERE IS THE CLINICAL
REALITY. THEY HAVE ALL THE SAME THINGS. THEY’RE RUNNING FASTER JUST THE
SAME PLACE. THEY HAVE ALL THE SAME ISSUES. AND THEY’RE FRUSTRATED WITH US
PUBLIC HEALTH PEOPLE SAYING TO THEM AND THEY LOOK AT US AND SAY
YOU GUYS JUST THINK ABOUT YOUR THING. SO WHAT’S THE WAY FORWARD HERE? REMINDS ME OF A QUOTE BY WILLIAM
GIBSON SAYS THE FUTURE IS ALREADY HERE. IT’S JUST NOT EVENLY
DISTRIBUTED. SO I THINK EVERYWHERE EVERYONE
WHO CAN START DOING THE EXCITING, FUN, WHOS HAS THE
ENERGY, WHO HAS THE CAPABILITY, WHO HAS THE PARTNERSHIPS FOR
DOING THESE THINGS, DO IT, GO. DO THE TRIALS, PROVE IT. SHOW THE EVIDENCE. THESE ARE NOT JUST THE CENTERS
OF EXCELLENCE IN PUBLIC HEALTH, ALTHOUGH THEY PLAY AN IMPORTANT
ROLE. WE WANT THERE TO BE A NATION OF
HEALTH CARE PROVIDERS WORKING WITH THEIR PUBLIC HEALTH
DEPARTMENTS AND ACADEMIC GROUPS TO CREATE THESE. WE ALSO HAVE STATES, WHOLE
STATES WHERE THEY’RE READY TO MOVE ON SOMETHING, WHETHER IT’S
PRESCRIPTION MONITORING PROGRAMS, GO, DO IT, SHOW IT. AND THEN WE HAVE THE FEW THINGS
THAT WE CAN MAYBE, MAYBE, DO NATIONWIDE. WHICH IS WHAT MEANINGFUL USE AND
THE CERTIFICATION FOR EHR IS. BUT LET’S NOT CONFUSE THESE
LEVELS. LET’S NOT HAVE EVERY BRIGHT IDEA
WE HAVE PUT INTO MEANINGFUL USE. EVERY SAFE THING THAT WORKS,
MAKE IT PART OF IT IT. WE HAVE TO TAKE A FEW THINGS AND
JUST KNOCK THE HELL OUT OF THEM. MAYBE ELECTRONIC LABORATORY. SO HERE’S WHAT I ASK FOR YOU. WE’VE GOT TO MAKE THIS
MEANINGFUL USE THING WORK. WE’VE GOT TO MAKE IT WORK. STAGE ONE, MEANINGFUL USE. WE HAVE TO MAKE THAT WORK. IN THE STATE, IN THE CDC. WE’VE GOT TO BE READY TO
PARTICIPATE. IF THE HEALTH CARE PROVIDERS ARE
DOING THE WORK, WE HAVE TO HOLD UP OUR END OF THE BARGAIN. WE HAVE TO TO HELP THEM HOWEVER
WE CAN FOR OUR SAKE. TWO, WE CAN’T GO TO ALONE. WE HAVE TO COORDINATE. WHAT MEDICAID IS DOING IS REALLY
IMPORTANT, BUT THE STATE HEALTH I.T. COORDINATOR IS REALLY
IMPORTANT. WHAT THE HEALTH INFORMATION
EXCHANGE IS DOING, GOD, IF YOU HAD THE BEACON COMMUNITY, IF YOU
HAD ONE OF THOSE 17 STATES THAT HAVE A BEACON COMMUNITY, IF YOU
HAVE A GRANTEE IN THESE BEACON COMMUNITIES WORKING ON COMMUNITY
TRANSFORMATION GRANTS OR WELLNESS COMMUNITIES, IF WE’RE
NOT WORKING, COORDINATING ACROSS THOSE PROGRAM, SHAME ON US. WE HAVE GOT TO COORDINATE OUR
ACTIVITIES BETTER. I WOULD SAY ASK FOR DATA
SPARINGLY BECAUSE EVERY PIECE OF EVERY BIT OF DATA THAT WE’RE
ASKING FOR IS A HUGE AMOUNT OF WORK AND BURDEN AND WORK FLOW
CHANGES ON THE OTHER PART, BUT GIVE DATA GENEROUSLY. LET’S BE OPEN WITH OUR DATA. LET’S NOT DO PUBLIC HEALTH
EXCEPTIONALISM IN STANDARDS. LET’S NOT DO THAT. BECAUSE THE WORK INVOLVED FROM
THE PERSPECTIVE OF THE PROVIDERS AND VENDORS, IF WE HAVE NATIONAL
STANDARDS, LET’S HAVE NATIONAL STANDARDS. LET’S NOT HAVE WHOLE DIFFERENT
SET OF VOCABULARY, TRANCESPORT STAND
STANDARDS. CHERISH THE INNOVATION, BUT ALSO
CHERISH THE SKEPTICS. WE HAVE BOTH IN THE CROWD, I
SUSPECT. WE NEED BOTH. WE NEED THE PEOPLE WHO KEEP THE
FIRE ALIVE AND THE PEOPLE WHO KEEP IT CROWDED. I’M THE PART THEIR FEET ON THE
GROUND. AND FINALLY FROM US, HOLD US
ACCOUNTABLE. IF WE’RE NOT DOING OUR JOB
COORDINATING, HOLD US ACCOUNTABLE. AND LET’S GO GET THEM. THANK YOU. [ APPLAUSE ]
>>WE DO HAVE TIME FOR SOME QUESTIONS. PLEASE USE THE MICROPHONE AS
WE’RE RECORDING. IF YOU’RE ON A VISION, NOTIFY
YOUR COORDINATOR IF YOU WANT TO ASK YOUR QUESTION. AND IF YOU CAN’T FIND US ANY
OTHER WAY, ASK AT MEANINGFUL [email protected] AND YOU’LL RECEIVE
AN E-MAIL RESPONSE AT SOME POINT IN THE FUTURE FROM STAFF.>>HI. I THINK I’M A BELIEVER AND
SKEPTIC. AND MY QUESTION IS IT TOO
AMBITIOUS THE GOALS WE HAVE SET FOR PUBLIC HEALTH? I BELIEVE MEANINGFUL USE WILL
HAPPEN AND IT’S HAPPENING ALREADY. YET IT MAY BE TOO AMBITIOUS FOR
US. AND THIS COMES FROM USUAL YOU
NEED SOMEBODY WHO HAS CLINICAL TRAINING ANDLE ALSO FORMAL
TRAINING AND IT’S VERY RARE TO FIND THOSE. SOMEBODY HAS TRAINING IN BOTH. AND ONCE YOU FIND THEM, THOSE
KIND OF PEOPLE ARE VERY EXPENSIVE TO MAINTAIN. THEY COST A LOT OF MONEY TO
TRAIN AND ALSO TO KEEP THEM IN ONE PLACE. SO MAYBE BECAUSE OF THIS WE HAVE
TO REASSESS OUR STRATEGY AND MAKE SURE THE GOALS WE’RE
SETTING ARE MEANINGFUL. THINGS WILL CHANGE AND —
>>WE’RE GOING TO ASK THE QUESTION. I’LL START WITH FARZAD AND SEE
IF OTHERS HAVE COMMENTS.>>SO THE QUESTION IS SHOULD
WE — IS MEANINGFUL USE TOO AMBITIOUS, CAN WE REALLY
PARTICIPATE. WE HAVE TO BE SMARTER. THE REALITY IS WE CAN’T — WE’RE
NOT GOING TO HAVE MORE AND MORE FUNDING FOR THIS. WE HAVE TO FIND WAYS OF DOING
MORE WITH LESS. AND A LOT OF THAT MEANS NOT
REDUPLICATING SILOS WITHIN HEALTH DEPARTMENTS WHERE WE HAVE
THE SAME STAFF — DUPLICATE REQUIREMENTS AROUND MAINTAINING
SILOS FOR TESTIMONY V SYSTEMS AND COMMUNITY SYSTEMS AND CHIDE
HOOD SCREENING SYSTEMS AND ON AND ON AND ON. WE ARE SPENDING A LOT ON I.T. IN
HEALTH DEPARTMENTS. WE DO NEED TO BE SMARTER ABOUT
IT, WE NEED TO FIND WAYS THAT ARE PERMISSIBLE TO GIVE
FLEXIBILITY TO THE STATES TO BE ABLE TO DEVELOP AND EXTEND THOSE
RESOURCES.>>AND I WOULD CONCUR THAT FOR
THIS TO BE PRACTICAL, WE STILL HAVE VERY MUCH WORK TO DO TO
CONSTRAIN MESSAGING, MANY OF THE OTHER THINGS THAT FARZAD TALKED
ABOUT. SO WE MAY NEED TO FOCUS ON THE
INITIAL LANES THAT HAVE BEEN SET IN THE EARLY STAGES OF
MEANINGFUL USE AND BE VERY CAUTIOUS ABOUT GOING TOO FAR
BEYOND THEM UNTIL WE DO THE WORK THAT IS IN FRONT OF US. OFF
OVER TO THE OTHER SIDE.>>THANKS FOR AN INTERESTING
PRESENTATION. SO THERE ARE WHAT WE MIGHT CALL
SOME LEGACY SYSTEMS IN THIS FIELD, THINKING OF SOME
COLLABORATIONS THAT GO BACK TWO DECADES, THE KAISERS AND DATA
LINKS, OTHER MODELS INTERNATIONALLY, AS WELL. AND THEY’RE GOING TO BE VERY
IMPORTANT WHEN WE HAVE HIE AND EHR THAT CAN GENERATE RESEARCH
AND SURVEYILLANCESURVEILLANCE. ARE WE SURE THAT WE HAVE THOSE
LINKAGES IN PLACE SO THAT WE CAN LEARN THE LESSONS THAT THEY’VE
ALREADY LEARNED ABOUT THE BENEFITS AND PITT FALLS OF THESE
SYSTEMS?>>I THINK WE HAVE SAY WE’RE NOT
SURE, BUT CONSIDERABLE WORK IS HAPPENING. OMC HAS PULLED TOGETHER FEDERAL
AGENCIES ACROSS — UNITS OF HHS TO WORK ON HOW DO WE TAKE
EXISTING THINGS HIKE SOMELIKE SOME YOU’VE
MENTIONED AND TURNING THEM INTO A LEARNING HEALTH SYSTEM.>>I THINK FROM A STATEHOUSE
DEPARTMENT, IT’S JUST AS IMPORTANT AS FROM THE FEDERAL
PERSPECTIVE. SO WE NEED TO TRAIN OURSELVES IN
HEALTH DEPARTMENTS AT THE STATE LEVEL, BEGIN TO WORK THINGS IN A
MORE ENTERPRISE WAY. SO THE SILO SYSTEMS ARE A
CHALLENGE AND IT TAKES PUSHING PEOPLE TO GET OUT OF THEIR BOX
AND TO THINK ABOUT HOW TO IN A MORE ORGANIZATIONAL PERSPECTIVE
BE ABLE TO HAVE THE SYSTEMS CONNECT AND BOTH
ORGANIZATIONALLY THINK ABOUT HOW TO ORGANIZE STAFF AND
INDIVIDUALS THAT WAY AS WELL AS TECHNICALLY. IT’S NOT EASY AND IT TAKES TIME,
WHICH IS SORT OF THE CHALLENGE SIDE, BUT THERE ARE HUGE
OPPORTUNITIES TO REALLY THINK ABOUT HOW TO DO THIS
DIFFERENTLY. AND I THINK WE HAVE TO BE VERY
OPEN MINDED AND PUSH OTHERS IN OUR DEPARTMENTS OF HEALTH TO BE
ABLE TO DO THAT.>>AND I APOLOGIZE, WE ONLY HAVE
TIME FOR ONE MORE QUESTION AND HOPEFULLY IT WILL BE A YES/NO
QUESTION. JUST KIDDING.>>NO CHANCE. I’M WITH OUR HEPATITIS CENTER
WHICH WE HAVE PLENTY OF SILOS AND WE HAVE PLENTY OF STAND
ALONE SYSTEMS AND WE HAVEBEDDED IN HEALTH
DEPARTMENTS AND MORE AND MORE THE USE OF I.T. IS CRITICAL NOT
NECESSARY FLOI CASE REPORTING, 2000 MONITORING DELIVERY OF
SPLAUR PARTICULARLY TO MARGINALIZED AREAS. THESE APPROACHES ARE CRITICAL TO
THE FUTURE. THE QUESTION IS HOW DO YOU MOVE
FROM WHERE WE ARE TO WHERE WE NEED TO SOMEBODY UT PROBABLY
NEED A COUPLE OF OUTSTANDING EXAMPLES AND SHOW WHAT IT TAKES
TO WHAT THE STATE LEVEL CAN DO. HOW DO WE FIND THE OUTSTANDING
EXAMPLE, HOW DO WE FIND THE RIGHT PARTNER TO MAKE PROGRESS?>>I THINK YOU GAVE A GREAT
ANSWER. AND MY ANSWER IS AT THE PUBLIC
HEALTH CONFERENCE IN AUGUST. YOU WILL FIND THE GREAT EXAMPLES
THAT SHOULD BE EMULATED NATIONWIDE. AND WITH THAT, LET ME BRING UP
TONYA.>>THANK YOU SO MUCH. APOLOGIES FOR A LITTLE BIT
SHORTER DISCUSSION, BUT THE PRESENTATIONS TODAY WERE REALLY
EXTRAORDINARY. SO I HOPE THAT WILL MAKE UP FOR
A LITTLE BIT LESS TIME. WE’LL SEE YOU NEXT MONTH. THANK YOU VERY MUCH. ONE MORE ROUND FOR OUR SPEAKER.

Daniel Ostrander

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6 thoughts on “Electronic Health Records: What’s in it for Everyone?

  1. Rudi Tham says:

    this is important to have nowadays. it could help millions of lives

  2. Peter Groen says:

    Good educational video on EHR solutions and their impact on healthcare. Unfortunately it took 8 minutes to get thru introductions. I would like to add that the free & open source health IT arena is producing a tremendous number of high quality EHR and Public Health software tools, e.g. OpenMRS, OpenEMR, VistA, Epi Info, etc. A good source of info and news these many open health solutions that ought to be shared is Open Health News (OHN) or COSI Open Health – both sites on the web.

  3. TUV2000 says:

    This is interesting information, but your video would be more useful if the description included an indication of who was speaking and also where, when and why.

  4. KJVWordofGod says:

    You won't approve this because I am awake and know your agenda to enslave and depopulate the country and world. Information is power and power is control and that's the endgame. EMR's do absolutely NOTHING for patient care…..They are EXPENSIVE….and easily manipulated and hacked. Whatever happened to HIPPA? LOL…..you people are evil.

  5. Cecilia Mackie says:

    Great work! 🙂 Cecilia xo

  6. oldschool says:

    What about the Guinea pigs what's in it for us

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