Health Information Technology:
Where are we? How can we get where we need to go? IT Industry Perspective
Mark Leavitt, MD, PhD, FHIMSS Medical Director Healthcare Information and Management Systems Society Academy Health Annual Research Meeting San Diego, CA – June 6, 2004
Where Are We?
Defining Care Settings
Small Physician Offices
Large Group Practices
Hospital Outpatient Departments
Inpatient Med/Surg Units
Critical Care Units
Ambulatory Care
Acute Care
Revenue and Volume
1 Billion
Volume of Encounters (Annual, U.S.)
$1000 $200
Small Physician Offices Large Group Practices Hospital Outpatient Departments
$50,000
8 Million
Revenue per Encounter
Inpatient Med/Surg Units Critical Care Units
Ambulatory Care
Sources: Health Affairs W4-79, 2003; NAMCS Report, CDC, 2002
Acute Care
Macroeconomic View: Total Healthcare Expenditures
$578 Billion 8.6% growth
*Includes physician services $339 Billion, 6.6% growth, plus prescription drugs/equipment $237 Billion, 11.5% growth
$518 Billion 6.4% growth
Small Physician Offices
Large Group Practices
Hospital Outpatient Departments
Inpatient Med/Surg Units
Critical Care Units
Ambulatory Care
Source: “Health Spending Projections,” Health Affairs W4-79, 2003
Acute Care
Macroeconomic View: Healthcare IT Investment
Ambulatory IT: $2B $578 Billion <1% of Revenues 8.6% growth Acute Care IT: $518 Billion $24B 6.4% growth 5% of Revenues
Small Physician Offices
Large Group Practices
Hospital Outpatient Departments
Inpatient Med/Surg Units
Critical Care Units
Ambulatory Care
Source: Dorenfest & Assoc; Forrester Research
Acute Care
State of EHR Adoption
<5% Full EHR 5% Partial 25% Partial 90% Paper <15% Full EHR <1% Full EHR
56% Partial or In Process 43% Paper
60% Paper
Small Physician Offices
Large Group Practices
Hospital Outpatient Departments
Inpatient Med/Surg Units
Critical Care Units
Ambulatory Care
Acute Care
Sources: HIMSS Annual CIO Survey, Dorenfest & Assoc; Forrester Research; AAFP Member Survey
Why Is IT Adoption So Limited? The Historic Barriers
Financial Barriers
• Reimbursing for volume – not quality, safety, or service – drives provider technology investments away from IT • Providers bear IT costs – but return flows to government, payers, and patients
Regulatory & Legal Barriers
• Privacy concerns and competitive issues hamper development of health information interchange
• Malpractice climate chills movement toward transparency, accountability • Stark laws inhibit hospital-physician IT collaboration
Cultural Barriers
• Most clinicians still trained on paper-based systems
• Training also discourages time away from patient care
• A profession under stress – especially primary care – difficulties coping with change
Technical Barriers
• Healthcare is complex; HCIT systems still imperfect
• Absence of standards, low rate of adoption, lack of interoperability
• Ergonomics and ease-of-use just now becoming adequate for point-of-care
How Can We Get There?
A Shared Game Plan
The Players The Barriers
Financial
Law & Policy Makers
Purchasers & Payers
Providers – Large & Small
HCIT Vendors & Consultants
Regulatory
Cultural
Technical
Leadership Roles
The Players The Barriers
Financial
Law & Policy Makers
Purchasers & Payers
Providers – Large & Small
HCIT Vendors & Consultants
Regulatory
JOB # 1 !
Cultural
Technical
Getting There Together
The Players The Barriers
Financial
Law & Policy Makers
Purchasers & Payers
Providers – Large & Small
HCIT Vendors & Consultants
Regulatory
• Leadership by example
• IT-aware pay-for-performance
Cultural
• High-visibility pilot projects • IT investment stimuli • Differential care reimbursement for effective IT usage
Technical
Getting There Together
The Players The Barriers
Financial
Law & Policy Makers
Purchasers & Payers
Providers – Large & Small
HCIT Vendors & Consultants
Regulatory
• Uniform and workable federal health privacy law • Certified implementation of IT as malpractice defense or risk cap
Cultural
• Stark safe harbor for IT
Technical
Getting There Together
The Players The Barriers
Financial
Law & Policy Makers
Purchasers & Payers
Providers – Large & Small
HCIT Vendors & Consultants
• EHR usage required at all medical schools and residency programs
• Clinical IT part of clinical education
Regulatory
• Form learning communities for implementation and usage knowledge
Cultural
Technical
Getting There Together
The Players The Barriers
Financial
Law & Policy Makers
Purchasers & Payers
Providers – Large & Small
HCIT Vendors & Consultants
• Standards-definition efforts driven by market needs and urgency • Adopt standards within products promptly • Demonstrate interoperability – both within, and between, enterprises
Regulatory
Cultural
• Standards and interoperability certification
Technical
Thank You!
About HIMSS
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The leading non-profit professional society for healthcare information technology 14,000 individual members, 220 corporations Vision: To advance the best use of information and management systems for the betterment of healthcare. Mission: To be the trusted source for knowledge, advocacy, leadership, collaboration and community affiliation
About the Speaker
Dr. Mark Leavitt joined the HIMSS management team in December 2003. His goal at HIMSS is to extend the Society’s benefits and leadership role to ambulatory care settings. He is actively engaged in several industry-wide initiatives to accelerate the adoption of robust, interoperable electronic health records to improve the quality, safety, and efficiency of healthcare.
Dr. Leavitt received his BSEE from the University of Arizona, his PhD from Stanford University, his MD from the University of Miami, and Board Certification in Internal Medicine from the Oregon Health and Sciences University, with subsequent Added Qualifications in Geriatrics. He practiced internal medicine full-time for ten years in Portland, and led a project to launch the implementation of system-wide electronic records at Providence Health System in Oregon. In 1985 he founded MedicaLogic, a pioneering developer of ambulatory electronic health records, leading the company as its CEO and Chairman for 15 years. In 2002 GE Medical Systems acquired MedicaLogic, and Dr. Leavitt fulfilled several positions at GE before being promoted to Vice President of Clinical Initiatives.
In addition to his Fellowship at HIMSS, Dr. Leavitt holds a Clinical Assistant Professorship in the Department of Medical Informatics at the Oregon Health and Science University. He is a past president of the Oregon chapters of HIMSS and the Society of Internal Medicine.