Scenario by jianghongl

VIEWS: 12 PAGES: 73

									 Due to the volume of “hate” e-mail that
 I sometimes receive following one of my
presentations, my attorneys have advised
   that I issue the following disclaimer.
The following presentation is for mature audiences only.

It may contain sarcasm, irony, and facetious metaphors
 that you may find offensive. There may even be data
to suggest that the American health care system is not
 the greatest thing since sliced bread. These remarks
  should not be construed as insults aimed at President
Bush, the Government of Canada, the people of France,
           or pharmaceutical industry techies.

             Viewer discretion is advised.
       Jeanne Scott
        talking-head-in-chief
         health-politics.com



 The Presidential Election
2008 and the Politics of U.S.
   Health Information
Technology: What’s in it for
        You and Me?
               Scenario
Consider this scenario:

A family -- mother, father, two
children -- who live in Grand Rapids,
Michigan are visiting grandparents
retired in Tucson, Arizona. Their
oldest child, a six-year old boy, has a
severe asthma attack. In a panic, an
ambulance is called and the boy
rushed to the nearest hospital.
                    Scenario
At the emergency room the boy’s mother
hands the receptionist the family’s health
identification card. A POS reader scans
the card; the family's health care benefit
plan and eligibility requirements come up
on a monitor.

  •   Is this a Smart Card?
  •   Identifier Issues
  •   Research Database Issues
  •   Practical Needs/Practical Problems
               Scenario
. . . A nurse quickly queries the system
for the boy's current brief medical
record synopsis. . . . The attending
physician notes the boy's history of
asthma, the medications he takes, and
the pertinent results of his most recent
health care encounter.

  •Needed: Development of a
  Computer-Based Patient Record
  •Needed: Master Patient Index
  •Issue: Privacy and Confidentiality
                Scenario
After . . . administering emergency care,
the physician inputs a summary of her
findings, and a prescription for
medication. The physician then closes
and transmits the current transaction. . . .
The family picks up the boy's medication
at a local pharmacy on their way home to
grandmother's house.

  •Needed: Industry Agreement on a
  Computer-Based Patient Record
  •Already On-Line: Pharmacy
  Management Program
               Scenario
. . . the health care EDI system transmits
the boy's new clinical data to his
family’s health plan back in Michigan,
which updates his personal medical
record.


  •Needed: Development of a
  Computer-Based Patient Record
  •Needed: Master Patient Index
  •Issue: Privacy and Confidentiality
              Scenario
Funds to pay for the hospital and
physician's services are transferred
from the family's plan to the health
plans in Arizona to which the physician
and hospital belong . . . . Any out-of-
pocket payment owed by the family is
calculated, and debited to the family's
bank credit card account and credited
to the appropriate accounts. . . .

• Question: What will be the discount?
                 Scenario
The clinical and administrative records of
the encounter are distributed to the
physician's specific monitoring data base .
. . and to the hospital’s management . . .
where, . . . it may be accessed by the
hospital's . . . manager's for evaluation and
use in management decision-making.

  •Needed: Case-Mix and Practice
  Management Tools to Assess Quality
  and Economy
  •Needed: Self-Reporting/Analysis Tools
  to Build HEDIS and Other Report Carding
                Scenario
Stripped of personal identifiers, . . . the
boy's records are sent to a regional
pharmacy database. His updated clinical
record is similarly aggregated with other
clinical data and stored in research files
and in regional data bases where it may
be accessed by researchers and others
for evaluation of the treatments
rendered, outcomes and effectiveness
for future decision-making.
•Challenge: Privacy, Confidentiality
•Challenge: Cookbook Health Care
                 Scenario

At the family’s health plan . . . the data
is compiled and added to the plan’s risk
management database. In Texas, the
physician’s plan records are updated
and her performance is measured
against the plan’s best practices
protocols and childhood asthma disease
management program.

  •Challenge: Building the Virtual
  Capabilities
                 Scenario
Information on the disease status,
treatment, assessment, care and follow-
up is compiled and sent to the local and
state community public health agencies
where it may be used in a variety of
ways in developing community health
standards and reporting.

  •Challenge: Building the Virtual
  Capabilities
U.S. Health Care Facing the
“Perfect Storm”
• Healthcare Costs Rising at Annual Double Digit Rates
• The Number of Uninsured Americans Rises, Despite Generally
  Low Unemployment, Reaching 46.8 Million in 2006
• Employers Increasingly Passing Costs of Health Insurance
  onto Employees Through Higher Deductibles and Co-Pays
• Employers Increasingly Dropping Retirees and Others From
  Their Health Plans
• The Collapse of the US “Employment-Based” Health
  Insurance System, Creating Categories of the “Working Poor”
  with No Coverage
• Hospital Emergency Rooms with 12+ Hour Waits
• 1965-2006: Drug Costs Go From Less than 4% of Total
  Healthcare Cost to Almost 14%
• Medicare Part A Bankruptcy as Early as 2012
• Medicaid Bankrupting the States
• And the list goes on and on …
                        "I fear that we may have
                    already committed more physical
                      resources to the baby-boom
                       generation in its retirement
                    years than our economy has the
                           capacity to deliver."


                      "Congress in the future will
                      have to weigh the benefits
                        of continued access, on
 Alan Greenspan:
November 25, 2005
                      current terms, to advances
                     in medical technology against
                        other fiscal initiatives."
Social Security and Medicare, The Halftime Show
             The Bush Plan For Health Care
•       “Saving Medicare” -- President
        Bush has stated his support
        for raising age to70 and 72,
        “privatizing” Medicare
      –      Ages 51>, Ages 36-50, Age 35<
             (President Bush, April 20, 2005)


•       Coverage for Prescription Drugs for
            America’s Seniors
      –      Controlling the Future Cost of Part D, Now
             Predicted to Exceed $1.2 Trillion over its
             first 10 years
      –      Seniors Feel Part D Falls Short of the
             Need. Can We Afford More? How?
theJeanneScottletter
President Bush Puts His Eggs in the
   Health Savings Account Basket
Expand Health/Medical Savings Accounts:
Allow Individuals and Families to Set Aside
as Much as $5,150 a Year, Tax Free

Bush’s FY2007 Budget would increase the
allowable amount to $10,300
     CDHC Will Only
       Work If …
(a) Meaningful information is made
    available to the consumer… your
    buzzword for the year:
    TRANSPARENCY… for both
    prices and quality

(b) The American population comes to
    ACCEPT it… but we’re dumber
    than bricks
Internet Information is ALWAYS Helpful
Transparency
   "No one knows what they pay
   for their health-care services.
   No one knows cost or quality.
   . . . We don't have any reason
          to care financially."
                   -- Mike Leavitt
    Secretary of Health and Human
                          Services
TRANSPARENCY:
ACCEPTANCE:
The report by the Massachusetts Institute
of Technology reviews data from the
RAND Health Insurance Experiment to
offer insights into current health policy
debates about appropriate levels of cost
sharing. The RAND experiment,
conducted in the 1970s, randomly
assigned families to health plans with
different ranges of coinsurance and
followed them for three to five years to
determine how coinsurance levels
affected their health and use of medical
services. The Kaiser Family Foundation
study found that higher coinsurance rates
reduce use of health services and health
care spending; that coinsurance plans did
not have adverse consequences for
individuals of average health and income
when compared with a plan with no
coinsurance; and that the health of high-
risk people, especially those with low
incomes, there were health benefits when
they were enrolled in plans with no
coinsurance.
ACCEPTANCE:
        September 22, 1993
                                       On September 22, 1993,
 Unnecessary & Ineffective Services,   President Clinton went on
     Including Fraud & Abuse           national television to explain
                                       the details of his health
                                       care reform proposal. In
                                       his speech, he referred to
                                       this pie chart. Of the $1
                   33%                 trillion in annual U.S. health
                                       care spending in 1993 --
                                       less than 50% was actually
                           49%         going to provide needed
      18%                              care. We promptly
                                       rejected the President’s
                                       health care plan -- but
                                       these spending numbers are
                                       still with us in FY2007 when
                                       spending will be $2.2+
Administrative Overhead
                                       trillion.
“We have a V.P of Medical records but we don’t know
    who it is because nobody can locate the file.”
    National Integrated Electronic Health Care Data Network


   Employers                                                                                            Consumers
                                                     Comprehensive Quality
                   States, Public Health
                                                       Measurement Data
                       Departments       Secretary of
     DoD                               Health & Human
                                                                                                         Physicians
                                          Services

                                      Compliance, Certification,
                                            & Oversight                                                   Clinics
  Federal Health
  Care Programs

                             Health Care Information
                                Clearinghouses                           Uniform Indexing                Hospitals
                                                                             Systems



                                                 Interoperability With
                                                   Other Networks
 Purchasing                                                                                             Home Health
Cooperatives          Community-Wide Health                                  Health Care Information     Agencies
                      Management Information                                 Value Added Networks
                        Systems (CHMIS)



                                                                                                       Long Term Care
                                                                                                          Facilities
Health Plans          Center for Disease Control                               Rural Health Care
“In the future Medicare
 will only pay for what
works. It won’t pay for
   what doesn’t work”
         -- Dr. Mark McClellan
    (former) CM2 Administrator
Running for Office     One critical first step is to bring our
       2008              health care system into the 21st
                       century. Right now, technology exists
                     that would allow primary care physicians
                      to push a button and send prescriptions
                     to your pharmacy. It is conceivable that
                     emergency room attendants could access
                          your medical files with handheld
                      computers in the blink of an eye. And,
                      the capability exists to have the latest
                      research in the hands of your doctor in
                        days – rather than years. All these
                        things can be done while protecting
                      patient privacy and in the process save
                           time, money and lives. But the
                       information technology infrastructure
                                simply is not there.

                           -- Sen. Hillary Rodham Clinton, (D-N.Y.)
Running for Office        The federal government needs a
       2008
                     strategy to move as fast as possible to
                       a 21st century intelligent health care
                        system with the first step being an
                      electronic health record for American.
                        … Many healthcare providers worry
                       about the lack of data standards for
                          these technologies, particularly
                         electronic health record systems.
                     Today, if a facility or doctor invests in
                     a sophisticated system, they are unable
                     to electronically share patient data with
                           others … they fear that their
                      technology will be obsolete once there
                     are data standards that connect all the
                                        silos.

                     -- Newt Gingrich, former Speaker of the House
                              http://www.healthtransformation.net/home/
Moving HIPAA to New Levels

      1.Electronic
       Prescriptions
      2.Systemic
       Interoperability
      3.Electronic
       Health Record
      4.Allocation of
       Resources
 The Future
 of Privacy

FDA Approves Implantable Chip for Medical Records
By Diedtra Henderson
AP Science Writer
Wednesday, October 13, 2004; 2:05 PM

WASHINGTON (AP) -- The Food and Drug Administration on Wednesday approved an implantable computer chip that
can pass a patient's medical details to doctors, speeding care. VeriChips, radio frequency microchips the size of a grain
of rice, have already been used to identify wayward pets and livestock. And nearly 200 people working in Mexico's
attorney general's office have been implanted with chips to access secure areas containing sensitive documents.
Delray Beach, Fla.-based Applied Digital Solutions said it would give away $650 scanners to roughly 200 trauma
centers around the nation to help speed its entry into the health care market. A company spokesman would not say how
much implanting chips would cost for humans, even though chips have been implanted in some, including Scott R.
Silverman, the company's chief executive officer.
The company is targeting patients with diabetes, chronic cardiac conditions, Alzheimer's disease and those who
undergo complex treatments like chemotherapy, said Dr. Richard Seelig, Applied Digital Solutions' vice president of
medical applications.
It's the first time the FDA has approved medical use of the device, though in Mexico, more than 1,000 scannable chips
have been implanted in patients. The chip's serial number pulls up the patients' blood type and other medical
information.                                                                            With the pinch of a syringe, the
microchip is inserted under the skin in a procedure that takes less than 20 minutes and leaves no stitches. Silently and
invisibly, the dormant chip stores a code -- similar to the identifying UPC code on products sold in retail stores -- that
releases patient-specific information when a scanner passes over the chip.At the doctor's office those codes stamped
onto chips, once scanned, would reveal such information as a patient's allergies and prior treatments.
The FDA in October 2002 said that the agency would regulate health care applications possible through VeriChip.
Meanwhile, the chip has been used for a number of security-related tasks as well as for pure whimsy: Club hoppers in
Barcelona, Spain, now use the microchip much like a smartcard to speed drink orders and payment.
 Electronic Prescriptions (HIPAA, Phase 2)



  Electronic standards have been developed and
  were published this past August in the Federal
  Register ---
  Physicians, hospitals and pharmacies choosing to
  transmit electronically are required to comply
  with the standards as of January 1, 2008
  Warning: Other changes, and requirements in the pending
  malpractice and already passed medical error legislation virtually
  mandate e-prescribing



theJeanneScottletter
“Systemic Interoperability” (HIPAA, Phase 3)
“Commission on Systemic Interoperability” (“CSI”)
established by the MMA of 2003     (CBS sued over the acronym)


CSI was supposed to establish a strategy to
implement health information technology
standards, including priorities and timeline for
adoption nationally
Reported to Secretary and to Congress in
October 2005 its plan
              The final CSI report estimates it will cost $285B
               over 10 years to build this system




            theJeanneScottletter
           “Outcomes Research” and (gasp)
               Health Care “Rationing”
  MMA authorized Secretary to show:
    •“the appropriate use of best practice guidelines by
    providers and services by beneficiaries”
    •The “reduced scientific uncertainty” in the delivery
    of care through the examination of variations in the
    utilization and *allocation of services,and outcomes
    measurement and research”
    •achieving the “*efficient allocation of resources”
    •“the financial effects on the health care
    marketplace of altering the incentives for care
    delivery and changing the *allocation of resources”
   (* Trust me on this, I’m a lawyer,
 “allocation of resources” = “rationing”)
theJeanneScottletter
S. 1262: “Health Technology to
 Enhance Quality Act of 2005”
 “Health-TEQ” or… Frist-Clinton
    S. 1262, Health-TEQ: Frist-Clinton
•    Establishes (and most importantly funds) a formal “Office of National Health
     Information Technology”
•    Sets Goals for the Office, including: quality improvement; reduced errors;
     promoting “patient-centered medical care; reduced costs and paperwork; collecting
     accurate information on healthcare costs, quality, and outcomes; coordinating care
     among hospitals, laboratories, physician offices, and other entities; improve public
     health reporting (bio-terror attacks); facilitate new health research; and ensure
     privacy protection and security
•    Office Director is to facilitate the adoption of a national system for the electronic
     exchange of health information;
•    The bill would provide $500 million starting in fiscal year 2006 in annual $125
     million increments in three-year 2-1 matching grants to help fund the development
     of regional or local health information technology plans, or RHITs, as well as such
     sums as necessary to fund the grant programs from FY 2007 through FY 2010.
     The funds also could be used to fund 10-year loans to develop RHITs.
•    The bill would require DHHS to certify that the networks complied with privacy,
     interoperability and other standards. RHITs would allow hospitals, doctors and
     nurses to quickly transfer patient information between facilities.
•    In addition, the legislation would provide $2.5 million annually from FY 2007
     through FY 2010 to the Agency for Healthcare Research and Quality to help
     doctors' offices make sound IT investments.
•    Under the bill, Medicare payment "adjustments" would be available to physicians
     and suppliers who participate in the networks, but an amount is not specified.
•    Establishes a Stark “safe harbor” for hospitals to provide physicians with IT
     systems
    The “Final” Senate Version: S. 1418
•   On November 18, 2005, the Senate by unanimous consent, passed the
    “Wired for Health Care Quality Act of 2005” (S. 1418).
•   The legislation would (among other things):
     –   Establish legislatively the Office of the National Coordinator of Health
         Information Technology to coordinate with relevant federal agencies and private
         entities and oversee programs and activities to develop a nationwide interoperable
         health information technology infrastructure.
     –   Require the Secretary to establish the public-private American Health
         Information Collaborative
     –   Require the Collaborative to recommend to the Secretary uniform national policies
         to support the widespread adoption of health information technology, including:
         (1) protecting individually identifiable health information through privacy and
         security practices; (2) preventing unauthorized access to health information; (3)
         notifying patients if their individually identifiable health information is wrongfully
         disclosed; (4) facilitating secure patient access to health information; and (5)
         fostering the public understanding of health information technology.
     –   Deem the standards adopted by the Consolidated Health Informatics Initiative as
         having been recommended by the Collaborative.
     –   Require the Collaborative to annually review existing standards, identify
         deficiencies, omissions, duplication, and overlap, and recommend modifications
         and/or new standards.
     –   Require the Secretaries of HHS, Veteran Affairs, and Defense to jointly review
         the Collaborative's recommendations. Require the Secretary of HHS to provide
         for the adoption by the federal government of any recommended standards, if
         appropriate.
The “Final” Senate Version: S. 1418

     • Prohibit any federal agency from expending federal funds to purchase
     any new health information technology that is inconsistent with adopted
     standards. Requires all federal agencies collecting health data to comply
     with the adopted standards within three years.
     • Require the Secretary to develop criteria to: (1) ensure uniform and
     consistent implementation of any standards voluntarily adopted by
     private entities; and (2) ensure and certify hardware, software, and
     support services compliance with applicable adopted standards.
     • Allow the Secretary to award grants to: (1) facilitate the purchase
     and enhance the utilization of qualified health information technology
     systems; (2) implement regional or local health information plans; and
     (3) carry out demonstration projects to develop academic curricula
     integrating qualified health information technology systems in the clinical
     education of health professionals.
     • Require the Secretary to develop measures of the quality of care
     patients receive and ensure that such measures: (1) are evidence based,
     reliable, and valid; (2) are consistent with the purposes of developing a
     nationwide interoperable health information technology infrastructure;
     (3) include measures of clinical processes and outcomes, patient
     experience, efficiency, and equity; and (4) include measures of overuse
     and underuse of health care items and services.
The “Final” Senate Version: S. 1418
 • Require the Secretary to: (1) adopt and utilize such quality measures; (2) implement
 procedures to accept the electronic submission of quality measurement data; and (3)
 disseminate recommendations and best practices derived from the analysis of quality
 measures.
 • (Sec. 3) Require the Secretary to carry out a study that examines the impact that
 variations among state laws relating to licensure, registration, and certification of
 medical professionals have on the secure electronic exchange of health information.
 • (Sec. 5) Require the Comptroller General to report on the necessity and workability
 of requiring health plans, health care clearinghouses, and health care providers who
 transmit health information in electronic form to notify patients if their individually
 identifiable health information is wrongfully disclosed.
 • (Sec. 6) Require the Secretary to study methods to create efficient reimbursement
 incentives for improving health care quality in federally qualified health centers, rural
 health clinics, and free clinics.
 • (Sec. 7) Require the Secretary, acting through the Director of the Agency for
 Healthcare Quality and Research (AHRQ), to develop a Health Information
 Technology Resource Center to provide technical assistance and develop best practices
 to support and accelerate efforts to adopt, implement, and effectively use
 interoperable health information technology. Requires the Secretary to establish a
 toll-free telephone number or Internet website to provide health care providers and
 patients with a single point of contact regarding health information technology.
 • (Sec. 8) Reauthorize appropriations for grants to reduce statutory and regulatory
 barriers to telemedicine.
                                H.R. 4157
•   On July 27, 2006, the House of Representatives approved the Health
    Information Technology Promotion Act of 2006 (HR 4157). The bill
    passed the by a vote of 270-148, with 138 Democrats opposing. On
    September 5, 2006, the bill was read for a second time and placed on
    Senate Legislative Calendar under General Orders. Calendar No. 587.
•   The legislation would (among other things):
     –   Codify the Office of the National Coordinator for Health Information Technology
         within DHHS and would establish a committee to make recommendations on
         national standards for medical data storage and develop a permanent structure to
         govern national interoperability standards.
     –   Establish (in legislation) the Office of the National Coordinator
     –   Require reports from “American Health Information Community”
     –   Require “Interoperability” planning
     –   Provide grants to IHS to promote HIT to improve coordination of care for
         uninsured, underinsured, and medically underserved
     –   Provide grants to small physician practices for HIT demos.
     –   Require study and report on variation and commonality in state information laws
         and regulations
     –   Establish safe harbors to anti-kickback civil and criminal penalties for provision
         of HIT and training services.
     –   Promote Telehealth Services and EHRs
     –   Study IHEs/RHIOs
•   That’s where it sits today…
H.R. 4157, CBO Cost Estimates
H.R. 4157, CBO Cost Estimates
               But Some Democrats Object


• Essentially the Democratic objections boiled down to
  accusations that Republicans were not going far
  enough with this bill
• Democrats said the bill was essentially toothless
  since it did not authorize funding and does not set a
  deadline for adoption of new technology standards
• Some Democrats also blasted the bill for not
  including enough privacy safeguards such as patient
  consent for information sharing and requirements
  that patients be notified if their data security is
  breached
                       Changing Billing Codes ?

• The final House bill included a House Ways and
  Means Committee-supported provision that would
  increase the number of diagnosis and procedure
  billing codes that providers and insurers use from
  the current 24,000 codes to more than 200,000! But
  insurers say the October 2009 deadline for a
  transition to the new codes is too early to get
  adequate training. They would rather see such a
  move happen by 2012.
What Will a Majority Democratic Congress Do?
 Well, according to Speaker-in-Waiting Nancy Pelosi:

•Revamp Part D to Allow Government to “Negotiate”
Prices with the Drug Companies
  •Currently, the Government Essentially Pays “Retail” Prices
•Close the Part D “Donut Hole”
•Address the Growing Number of Uninsured in America
  •Tax credits and incentives to employers to continue coverage
  •Review alternative coverage proposals:
     •Mandatory Individual Health Insurance with government subsidies
     (the “Massachusetts” plan)
     •Mandatory Employment Coverage (i.e., the “Maryland” plan)
  •During the Bush years, the number of uninsured has increased
  by over 5 million
     House Passes Drug Negotiation Bill




House Democrats celebrating passage of the bill. Representatives Nick Lampson and Christopher S.
     Murphy are pictured on the left. Steven Kagen and Charlie Wilson share a laugh, right.

The vote was 255 to 170, with 24 Republicans joining 231 Democrats in approving the legislation.
•Expand S-CHIP, the Children’s Health Insurance
Program
   •Enrollment has declined during Bush years
•Re-open the Issue of Embryonic Stem Cell Research
•“Investigate” the Health Care Industry:
   •Health Insurer Profits
   •Drug Company Anti-Competitive Activity
       •Blocking Generics, Predatory Pricing Practices
       •(PhRMA gave 15-1 PAC money to Republicans)
   •Non-Profit Hospital Collection and Charity Practices
   •Overpayments to Medicare Managed Care Providers and their
   “Favorable” Status Under Bush

But remember, George W. Bush will still be President and the Dem
“majority” is very, very slim!
             theJeanneScottletter
                       HEALTH CARE REFORM UPDATE
                                        Update #385
                                      November 13, 2006

                                Copyright: Jeanne Scott Matthews, 2006




                                HEADLINE NEWS
                                      (1)
                   ELECTION 2006: THE WINNERS AND LOSERS



                                               ***

WINNERS: Health Care I.T. Companies: Senate Health, Education,
Labor and Pensions Committee ranking member Ted Kennedy (D), who is
expected to become its chaircritter, likely will likely bring up legislation that
would require health care providers to implement electronic health records
systems and standardize EHRs to allow transmission between providers.
                     theJeanneScottletter
                                                   ***
                                                    (4)
  H.R 4157: THE HEALTH CARE INFORMATION TECHNOLOGY LAW EVERYONE SAYS THEY WANT
                                  BUT NO ONE SEEMS ABLE TO PASS
In the last weeks before adjourning to go home to campaign for last week’s elections, House and
Senate negotiators couldn’t reach agreement on health care I.T. legislation. Congressional aides
said the disagreements were based on language in the bill that would have allowed hospitals to
donate I.T. to physicians' offices without fear of prosecution under a law that bars hospitals from
increasing financial incentives to doctors who refer patients to their facilities. It is now unclear what
will happen with the legislation when Congress returns in this coming week. The House bill (HR
4157), approved on July 27, would codify the Office of the National Coordinator for Health
Information Technology within DHHS; establish a committee to make recommendations on national
standards for medical data storage; and develop a permanent structure to govern national
interoperability standards. The legislation also would clarify that current medical privacy laws apply
to data stored or transmitted electronically and would require the DHHS secretary to recommend to
Congress a privacy standard to reconcile differences in federal and state laws. Under the bill, the
number of billing codes health care providers use to file insurance claims would increase from
24,000 to more than 200,000 by October 2010. In addition, the legislation includes an exemption of
anti-kickback laws that would allow hospitals to provide health care I.T. hardware and software to
individual physicians. The Senate bill (S 1418), approved in November 2005, does not include the
provision on billing codes or the exemption of anti-kickback laws. Lawmakers have differences over
the provision on billing codes and the exemption of anti-kickback laws, as well as funding, privacy
protections and interoperability.
Just Between You and Me: While many health care lobbyists are still saying that lawmakers will
resolve differences over the legislation during next week’s lame-duck session, don’t hold your
breath. Democrats are keen on making health care I.T. a “signature” issue for 2008. Ted Kennedy
and Hillary Clinton have their own proposals to make … and to claim credit.
                    theJeanneScottletter
                                                 ***
                                   (5)
U.S. DOCS ARE SLUG-A-BUGS WHEN IT COMES TO ELECTRONIC HEALTH RECORDS
                   AND OTHER HEALTH I.T. APPLIVATIONS
About 28% of U.S. primary care physicians (PCPs) use electronic health records, compared with
98% in the Netherlands, 92% in New Zealand, 89% in the United Kingdom, 79% in Australia and 42%
in Germany, according to a study published last week on the Health Affairs Web site. For the study,
sponsored by the Commonwealth Fund, researchers surveyed more than 6,000 PCPs in seven
nations and found that only Canadian physicians, at 23%, used EHRs at a lower rate than U.S.
physicians. The study also found that 23% of U.S. PCPs had computerized systems to inform them
of potential problems with prescription drug interactions, the lowest rate among physicians in all
nations except Canada. About 93% of Dutch PCPs had such systems, the study found. In addition,
the study found that 15% of U.S. PCPs received computerized alerts to provide patients with test
results, compared with 53% of U.K. physicians, and that 18% of U.S. PCPs used computer systems
to send patients reminders for preventive or follow-up care, compared with 93% of New Zealand and
83% of U.K. physicians. According to the study, 20% of U.S. PCPs had the ability to produce lists of
patients who are due or overdue for tests or preventive care, compared with 82% of New Zealand
and 64% of German physicians. About 19% of U.S. PCPs had computerized systems to assist them
with seven or more functions in clinical care, compared with 87% of New Zealand and 83% of U.K.
physicians, the study found;
                    theJeanneScottletter
                                         ***
                                         (5)
U.S. DOCS ARE SLUG-A-BUGS WHEN IT COMES TO ELECTRONIC HEALTH RECORDS AND OTHER
                             HEALTH I.T. APPLICATIONS

                                                ***

The study also found that:

• 30% of U.S. PCPs had financial incentives to improve the quality of care they provide, compared
with 95% of U.K physicians;
• 40% of U.S. PCPs had arrangements for after-hours care, compared with 95% of Dutch, 90% of New
Zealand, 87% of U.K., 76% of German and 47% of Canadian physicians;
• U.S. PCPs reported the highest rate of patients who had problems with out-of-pocket health care
costs;
• 33% of U.S. PCPs routinely provided patients with chronic diseases written instructions about care
management, compared with 63% of German and 14% of Canadian physicians; and
• 9% of U.S. physicians reported long wait times for diagnostic tests, compared with 57% of U.K. and
51% of Canadian physicians.
• The study concluded that U.S. PCPs have "less capacity to ensure accessible, high-quality or
patient-centered care" than physicians in other nations. "Cohesive, broad-based policy changes“
might improve the U.S. health care system, according to the study.
Large Majorities Expect to Make Investments in Information
    Technology and New Construction in the Short-Term

                       Planned hospital actions in the next 2 to 5 years


    Make a significant investment in IT systems                                  86%

              Initiate new building construction                                 85%

                Increase consumer advertising                              70%

Implement more aggressive collection practices                       48%

       Modify fees for consumers paying OOP                       44%

             Add surgical or operating facilities                 43%

            Open satellite patient care facilities              40%

                              Add hospital beds                38%

Negotiate hospital rates with individual patients              37%

           Purchase physician group practices            24%
      The Argument for HIT
• Potential for improving safety and quality
• Long term costs saving
  – Shorter lengths of stay
  – Reduced duplication
  – Better DSM
• Basis for transformation of clinical processes
• Better compliance by patients, physicians,
  caregivers in practice standards
• Interoperability across continuum
    So when your turned away from the ER at least
    they had your record
HIT: Momentum is Building but….
•   HIT is good thing don’t get me wrong
•   EMR is a PET
•   It won’t save money quickly
•   Expectations are too high, but ……
    –   You gotta spend to save
    –   You create a platform for improvement
    –   We do not have another idea
    –   Strong bi-partisan support conceptually ….. Show me the money
• The power of simple disease registries: what can you
  achieve on 3x5 cards and a telephone
• Will we really do the hard process redesign and culture
  work?
• Interoperability is critical issue across the continuum of
  care, institutions and communities
• What about the vast rabble of American doctors?
• Who is going to do all this work?
Physician Use Of HIT Is On The Rise




SOURCE: Center For Studying Health System Change Data Bulletin #31 June 2006
 Four Scenarios for US Health Care
            2005-2015
                        Individual     Government



                                         Bigger
                         Tiers Я’Us   Government
Minor Delivery System                  by Request
       Reform
                             40%          30%

                                      “Reasonable”
                         Disruptive     National
                         Innovation    Healthcare
Major Delivery System
       Reform                10%          20%
          Issues and Impacts
• High end patients and providers will always do well
• How bad will it be for the rest of us?
• True cost reducing technologies will always have
  appeal
• True clinical breakthroughs that are radically better
  than existing modalities and therapies will always be
  rewarded
• Healthcare is a superior good and will take a larger
  share of national wealth
• But who pays for what and how will be central
  difficult questions for business, government, and
  households around the world forever
• Transforming for good: It’s all about Information
  and Incentives
          Issues and Impacts
• No matter what, we will need better value measures
  and more transparency of measures
• Value based purchasing and P4P will become more
  prevalent and have a powerful influence on providers
  and vendors
• Consumers will become more engaged in value
  decisions but we cannot rely on them absolutely
• The systems of healthcare need to be continuously
  improved to deliver greater value
• Will require clinical skills, process skills, use of
  cutting edge technology and big-time capabilities
• Most of all, it will require vision, values and
  leadership
There’s Not Much We Have to Change….
             Except………

 • Our values
 • Our Strategic Focus: From Pimp
   my Ride to Primary Care and
   Prevention
 • Our Reimbursement System
 • Our Delivery System
 • Our Individual and Collective
   Behavior
 • Our Expectations
  Jeanne Scott
    (703) 371-4894
www.health-politics.com
      From Grandma Jeanne’s World’s
          Smartest Grandchildren
• When my granddaughters Caitlin and Hannah were 7 and
  5, respectively, I started telling them about what I used
  to do when I was their age. "We used to skate outside
  on a pond. I had a swing made from a tire; it hung
  from a tree in our front yard. We picked wild
  raspberries in the woods." Hannah, the littlest one,
  looked up and said to me: “Grandma, I sure wish I'd
  gotten to know you sooner!"
• Elvis, my now 4-year old grandson once asked me,
  "Grandma, do you know how you and God are alike?" I
  mentally polished my halo, while I asked, "No, how are
  we alike?" "You're both old," he replied.
• It was Elvis this year, who called me to wish me a Happy
  Birthday. He asked me how old I was, and I told him,
  "63." He was quiet for a moment, and then he asked,
  "Did you start at 1?"
From Grandma Jeanne’s World’s Smartest Grandchildren

• When Caitlin was just 4, she visited me at my
  office one day and was diligently pounding away on
  an old typewriter I keep to address envelopes and
  the like. She told me she was writing a story.
  "What's it about?" I asked. "I don't know," she
  replied. "I can't read."
• I didn't know if my two and half year old twin
  granddaughters, Maggie and Iris knew their colors
  yet, so I decided to test them. I would point out
  something and ask what color it was. They would
  take turns answering me, and they were always
  correct. But it was fun for me, so I continued.
  At last Iris headed for the door, saying as she
  left, "Grandma, I think you should try to figure out
  some of these yourself!"
From Grandma Jeanne’s World’s Smartest Grandchildren
• Eamon, our five-year-old grandson couldn't wait to tell
  his grandpa about the movie he and I had watched on
  television, "20,000 Leagues under the Sea." The
  scenes with the submarine and the giant octopus had
  kept him wide-eyed. In the middle of the telling, my
  husband interrupted Eamon "What caused the
  submarine to sink?" With a look of incredulity Eamon
  replied, "Grandpa, it was the 20,000 leaks!!"
• One hot summer night, my grandson Eamon and I were
  going in to our condo in NC, we kept the lights off
  until we were inside to keep from attracting pesky
  insects. Still, a few fireflies followed us in. Noticing
  them before I did, Eamon whispered, "It's no use,
  Grandma. The mosquitoes are coming after us with
  flashlights."
• When Eamon asked me how old I was, I teasingly
  replied, "I'm not sure." "Look in your underwear,
  Grandma," he advised. "Mine says I'm four to six."
From Grandma Jeanne’s World’s Smartest Grandchildren

• When Hannah was in second grade, she called me on
  the phone and I asked her what she had learned in
  school that day. "Grandma, we learned how to make
  babies today." More than a little surprised, I tried to
  keep my cool. "That's interesting," I said, "How do
  you make babies?" "It's simple," replied the Hannah.
  "You just change 'y' to 'i' and add 'es'."
• We took Elvis and his sisters Maggie and Iris to a
  demonstration at our local fire department. Sitting in
  the front seat of the fire truck was a Dalmatian dog.
  Several children nearby started discussing the dog's
  duties. They use him to keep crowds back," said one
  youngster. "No, said another, "he's just for good
  luck." Elvis brought the argument to a close. "They
  use the dogs, he said firmly, "to find the fire
  hydrant."

								
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