Y't'h and welcome to Four
Directions of Wellness.
I'm Roberta Diswood. (Introducing clans) Your personal health record is
one of the most important
records you have. It contains most of your
medical information over the
course of your healthcare.
Many of us may have a need to
access our health record. The Indian Health Service is
making it easier for you,
the patient, to access your
health record, which will allow you to manage
your health better. To explain the new personal
health record system is
Gary Russell-King, Director of Medical Records and
Navajo Area Health Information
Management Consultant. Thanks for being here, Gary.
Go ahead and tell us about
yourself. Hi. I'm Gary Russell-King. I am born for the Red Running
Into the Water People clan and the Zuni People clan.
Well, thank you again. So what is the personal health
record, and what will it allow
me to do as a patient? The personal health record is
actually part of the original
initiative of the electronic health record
mandate that President Obama
put in place back in 2006. The Indian Health Service has
moved forward with the Health
Information Exchange, which now allows our patients
to access any of their IHS
medical records nationwide through this new personal
health record system. So our patients will now be
able to view those health
records online on their
computer or a mobile device, and they'll also be able to
print it up.
And so what exactly will we
be able to see? Some of the key components that
patients will be able to see
right now are... Their laboratory results, radiology results, immunizations, last visit information and
any admission history. All those components will
display and be able to print up
on their personal health record. So will this allow me to be
able to go in and see when my
next appointment will be? Yes.
The system will capture
appointment information, so the patient will be able to
go in and see when their next
and future appointments are
going to be. Okay. That's really good
information. And will this allow me to
contact my doctor? Yes.
The personal health record
system has an electronic
encrypted email system that
will allow our patients to click the button and send a
secure message to their
healthcare provider. So for example if they had a
medical question
about their care that they may have forgotten to
ask the doctor while they were
in the examining room, they can go into that system
and email that doctor a message. Or maybe they want a refill. Or they want to know when their
next appointment is.
So the system does allow that
communication back and forth
between the healthcare provider
and the patient. Okay. So who will have access
to my personal health record? It will be strictly the patient. However, the system will allow
the patient to designate an
alternate individual if they
wish to choose to do so.
When they do that, the patient
can select whether they have
total access to their record or
limited access. So it's really up to the
patient, but it can be set up
that way. So Gary you mentioned
limited access. What do you mean by that? The patient can go into their
personal health record and set
the parameters where it could restrict that
person from seeing maybe their
visit information Or maybe restrict them from
seeing their medication listing.
Or restrict them from seeing
anything else that has to do
with their admission. So that's what the patient can
do is pick and choose what they
want that individual to access. And from that, how do we know
that our personal health record
is secure and protected? The personal health record
system is actually a separate
medical record system under the system of records
for the privacy act. So this record system abstracts
data from the electronic
medical records system, and it's kept on a separate
server which is maintained in
our Rockville, Maryland office.
So It's actually a separate
records system that has all the security
measures in place in order to
make sure that it's safeguarded. How do I obtain access to my
personal health record? Okay. The steps are very simple. The patient will have to go to
the web portal, establish an
account name, a password.
Once they successfully do that,
there's three security
questions that are asked. You know, with any online
applications, they always ask you to set your
security codes in case you
forget your password. Once that individual enrolls
online, one requirement is that they
use their legal name, because that's how the health
information exchange goes and
finds all the health
information at all the IHS sites. So they must use their legal
name when they register.
Once they successfully do that,
they can go to patient
registration at anyone of our
sites, IHS wide, and patient registration will
link their account to their
personal health record. So once that's done, then the
individual will have immediate
access to their
personal health record. Okay. And is there any special
equipment they may need for it? They should have Mozella Fire
Fox or Chrome software
installed on their personal
computer in order to access this
personal health record system.
Okay. And where can I go to
enroll? You can go to any Indian Health
Service site. Most of our sites do have
dedicated offices for their
personal health record
enrollment. They could also stop by patient
registration and pick-up a
brochure, a pamphlet.
And lastly, they could also go
to the IHS website and learn
more about the personal health
record there. And Gary, is there anything
else you want to add before we
leave the show? Yes. We would like to encourage
all of our Indian Health
Service patients to enroll into the personal
health record to have better access and
manage their healthcare. Well, Gary, I want to thank you
for being here today.
This has been Four Directions
of Wellness. Hgonee'. .
Please note this video highlights a variety
of features available within FollowMyHealth. Options may vary depending on the settings
your medical organization and providers select. Let's begin with the Home screen. Your health summary shows your basic information, all of which is updated from your most recent
doctor's visit.
Next we have the Action Center think of this as your To-Do list. It's where
you can view items that need your attention, such as unread messages, forms you need to
fill out or unpaid bills. It's also where you'll be notified if there
are updated items in your health record. The App Center is where you access online
tools such as your Health Journal, wireless scale or glucose monitor.
It's also where you can find customized charts
detailing your health. To add new applications, simply click on the
button in the top right corner that says: 'Add Apps'. Moving over to the top right side of the screen,
you'll see Appointments. This is where you can view upcoming or past
appointments.
Click the plus sign to take further action
such as rescheduling, cancelling or even getting directions to your appointment! If your medical organization is set up for
billing through FollowMyHealth, the Billing section is where you'll be able
to view and pay bills. Click on the 'Make a Payment' button to see
your billing in more depth. Now that we've covered what's in the Home
tab, let's move on to the Inbox. This is similar to any email system you've
already used.
Within the Inbox's 'Sent' or 'Trash' folders,
simply click on a message to open it. Click on the plus symbol and your message
will open in an adjustable window for easier viewing. The next tab, My Health, contains your medical
information, including Conditions, Allergies, Test Results
and Medications. Within each section, you can see detailed
information and perform various tasks.
For example, under Medications, you can quickly
and easily request a prescription refill right here - if one is available. On the final tab, My Info, you'll find your
personal information and insurance listed under 'Demographics', as well as a list of
your available providers. All services provided by your physician are
listed here. Please note, a provider's organization must
be "connected" to FollowMyHealth in order for you to see them in your account.
Lastly, let's take a look at the top of your
screen, right above the tabs. Here we've placed Quick Links for two of the
most commonly-performed tasks: messaging and scheduling appointments. Quick links let you perform the task without
leaving the page you're on. For example, if you're viewing lab results,
you can click on 'Message' and a new window will pop up.
Under Hello Mark, you'll see proxy accounts
if you have them set up for children or dependents. Finally, under My Account, you'll see a number
of options in the drop down menu. Here is where you can connect to new organizations,
set your preferences, view 'Help' topics and perform a number of additional administrative
functions. Wow! In less than 3 minutes you've learned
the basics of FollowMyHealth and are ready to start managing your care.
But don't worry, if you need additional help
you can always access the Patient User Guide or search our Knowledge Base located under
Support..
Accurate medical records, including electronic
health records, or EHR, are the foundation of providing quality healthcare to patients. If an electronic health records company falsely
represents that its software has functions that it actually lacks, patient safety could
be at risk. Senior Counsel John OBrien explains. Data is inputted into an EHR system that reflects
the care that is provided and its very critical, just like in the written, the old
medical records, that everything be accurate.
If there are any defects in that software
program, then critical tests, medical prescriptions may not be accurately processed, and that
could have detrimental effects on patient care. In May 2017, one of the nations largest
electronic health record software companies, eClinicalWorks - and three of its employees
- agreed to pay $155 million to the government to settle alleged violations of the False
Claims Act because the company misrepresented the capabilities of its software. EClinical Works was causing healthcare providers,
who use its software to submit false claims to what is called the Medicare and Medicaid
EHR Incentive Program. And it was doing this because its software
actually didnt meet the criteria required for software to be certified in this program.
This settlement is important because its
the first settlement with an Electronic Health Records software company. So were entering in an entire new area
of healthcare fraud. As part of this settlement, eClinicalWorks
signed a five-year Corporate Integrity Agreement with our office that requires the company
to take several corrective steps to continue to participate in federal healthcare programs. Patients should care about this settlement
because just about everyone of us relies on the accuracy of their Electronic Health Records.
The message that OIG wants to send to the
healthcare community is that we take the certification process for EHR software very seriously. There is no room for manipulating this process
and making false statements during the certification process. OIG will vigilantly, along with its law enforcement
partners, investigate any conduct that places patients safety at risk, and that causes
losses to the federal healthcare programs..
>> Jodi Daniels: Next we will be hearing from Jocelyn Samuels, who is the new director of the Office for Civil Rights. You know, when we talk about consumer engagement in healthcare, often the first thing folks think about or many think about or used to think about is privacy of health information. They have a privacy rule in place for over a decade and while people think about the protections that came with the privacy rule, I think the most powerful thing that HIPAA privacy rules did was some of the patient rights, particularly granting consumer, the right to access own health information. I remember talking to a group of doctors in the early days right after the rules were passed and this was actually seem to be shocking that patients should be able to get copies of their records because the doctors that I spoke with saw those records were their own records and I think it really was the beginning of a culture shift where doctors and patients have a part to play together in reviewing the information and sharing in the treatment decisions and for patients to be engaged with their clinicians.
So as I mention, Jocelyn Samuels is a new director of the office for civil rights which is the office that is responsible for developing, interpreting and enforcing HIPAA security rules, among many other things. (Inaudible) tenure at the department of Health and Human Services Mrs. Samuels was at the department of Justice and prior to that she was Vice President for education and employment at national women's law center in Washington, D.C. Where she was engaged in legislative and policy advocacy to promote enforcement of title seven and title nine.
She previously served as counsel to the late U.S. Senator Edward Kennedy and senior policy attorney at the equal employment opportunity connection. Please join me in welcoming Jocelyn Samuels. >> Jocelyn Samuels: (Applause) Thank you everyone.
I'm so happy to be here today. As you can undoubtedly tell from the letters after my name, I. Am not a doctor, but I have been a patient and I know how important and if you ever had any doubt Emily's story would tell you how extraordinarily important access and empowerment is for patients around the country. So I am really, really delighted that this, my maiden speech on HIPAA topics as director of the office for personal rights is in the context of this fourth annual Consumer Health IT Summit and with all of you in this room I'd like to thank ONC for their partnership, they have helped to pave the way for consumer engagement in the world of emerging health technology and are real leaders in our efforts to ensure that all consumers are empowered to manage and improve their own health through electronic health records.
I'm also delighted that the right to access is front and center in this meeting and I'll be talking a little bit more about that as I go forward. As you know, the health insurance portability and accountability act of 1996 fondly called by some HIPAA, protects the privacy and security of individual health records. Importantly for purposes of consumer engagement and participation in healthcare, HIPAA also guarantees that individuals and their personal represents can see and get copies of their medical records. That right to access, which is which applies whether health information is on paper or electronically is critical as have you heard today to enable individuals to play a more active role in their health care, to manage their treatment decisions and to improve their relationships with their health care professionals.
So let's talk a little bit about how HIPAA helps to make that happen. Obviously for these reasons, the right to access personal health information is the corner stone of the privacy rule under HIPAA. Ocr, the office for civil rights at HHS. Enforces that rule and we are committed to strong protection of the right that guarantees, in fact we recently strengthened patients right to access in two important ways.
First, patients now have an expressed right to gain access to their electronic medical records. Second, patients and their personal representatives soon will have greater rights to get their lab test results directly from the laboratory, rather than through their providers. They will certainly still be able to get those results to their providers but changes issued last February in coordination with CMS and CDC give patients a new option of getting their test reports directly from the laboratory. The deadline for laboratory to comply with the rules is October 6, three weeks from now and will be speaking more in depth on this topic this afternoon on a panel discussion, if you want more information.
We look forward to working with our many lab partners around the country as these rules are implemented and count on them to ensure a smooth patient experience. We're also counting on all of you here today to help to get the word out to patients about their rights and about how to access their medical information. Access to information as we said can enable patients to track their progress, monitor their lab results, communicate with their treatment and adhere to their treatment plans, but patients with only do this if they know they have the right and you are critical partners in the effort to ensure patient education and empowerment. Here is how OCR can help.
We have a number of tools on our website that can provide information for both consumers and providers so that they can learn about their rights. For example, we have a series of chain videos on our YouTube channel that explain patient rights and cover entities obligation, we're just shy of two million views. Million is a lot, but it is not enough. We need to get the word out about those.
At the last IT summit, we issued letter clarifying patient right to access to electronic health information that, letter is on ocr's website and we can provide links to those of you who would like to pass it on. We also have an information is powerful medical campaign, powerful medicine campaign which was awarded 2013 secretary meritorious second highest award the department offers. The campaign aims to increase awareness of HIPAA rights and benefits among HIV positive black men who have sex with men, people who we've referred to by the acronym MSM, black MSMs continue to be disproportionately affected by the HIV epidemic. Although they comprise only 1 percent of the U.S.
Population they represent 25% of new HIV infections. That's why we have directed this campaign specifically at them, black pride parades around the country and presented materials on our website so we can provide tailored information and encouragement to people who are vulnerable to HIV and its terrible impacts. We also have four consumer brochures on our website, one is called your health information privacy rights, another is called privacy security and electronic health records, a third is understanding the HIPAA notice and the fourth is sharing health information with family members and friends. These aren't catchy titles, but they are really important documents that provide important information for consumers on both what their rights are under the law and how they can exercise those rights, they are available on our website in eight different languages and I encourage you to disseminate them widely.
That's part of the way we reach out to consumers, but we're also anxious to ensure that we reach out to providers so that they understand how to comply with their responsibilities under the law. So we've worked with our partners at ONC to launch a model notice of privacy practices which has been down loaded more than 200,000 times. Again, great statistics, but the more broadly we can circulate this, the more helpful we can be to providers who want to ensure that they are in compliance with HIPAA. The tool is a plain language document available in both English and Spanish so that provider consist educate their patients about their rights to their information.
It's a tool under the privacy rule to get the word out and we are happy to make it available as broadly as possible in hope that consumers will find it both easily understandable and fun to read. We value a resource center at Med Scape dot org, called Protecting Patients Rights, that document works to ensure that providers have access to important training materials with the right information at the right time, whether it is on a tablet, a smartphone or a PC, provider consist link to OCR's guidance material and tools to help comply with the rules, all available on an easily easy to access mobile platform, somebody told me to say that, I don't know what that access mobile platform is, but those more sophisticated than I, I'm sure that is something good. We also have training programs available for providers on the Med State dot org site and those are training modules that educate providers about best practices to comply with HIPAA, including mobile device security, privacy requirements, risk analysis and ongoing risk management and of course patients rights, all six modules are available for free, continues medical education and continuing medical education credit. Let me just say one thing about our enforcement responsibilities because obviously we want to do our best to encourage voluntary compliance and to ensure that providers and others understand their responsibilities and comply.
That said, when faced with excuse me, noncompliance, we will take enforcement action of getting all choked up about our responsibilities, we take this responsibility very seriously. In part because of the number of complaints that we received. In fact, complaints about lack of patient access accounted for a third of the HIPAA complaints that we received, so it's clearly a right that consumers pay a lot of attention to and are worried about protecting. That said, we also get significant numbers of complaints that alleged noncompliance under the privacy and security component of the HIPAA rules, we investigate those complaints, we work with the providers to see if we can voluntarily remedy the situation, but we do take as I said enforcement action as necessary.
So for example, we have entered into settlement agreements with Parkview Health System which we investigated after employees left 71 cardboard boxes of medical records unattended and accessible to unauthorized persons on the driveway of a physician's home in a heavily trafficked area. We recently reached a multi million dollar settlement with the New York Presbyterian in Columbia University hospital after lack of technical safeguards resulted in information of 6800 patients being accessible on internet search options, search engines. And finally with infinity health plan reached agreement when protected information of up to 345,000 people was left unsecured when the plan returned multiple photo copiers to a leasing agent without erasing the data contained on copy or hard drives. All of these settlement agreements are available on our website because they offer important educational tools for providers about some of the problems that continue to occur, even more than a decade after the enactment of HIPAA and ways in which they can get themselves into trouble and I urge people to be alert to all of the requirements of the rule to avoid these kinds of breaches and problems that can result in real harm to patients and sanctions for the providers who have engaged in the conduct.
Let me just in closing thank you again for the opportunity to be here and say that obviously patients right to access is a critical component of reinventing healthcare delivery by involving patients directly in the management of their care in ever expanding digital age. We're serious about protecting consumers right to access for their health care information and making sure they know their rights we look forward to working with all of you to ensure that the promise of the law becomes a reality as technology improves and as we work together to ensure better health care for all Americans. Thank you very much. [ Applause ].
>> Jodi Daniels: Thank you, Jocelyn Samuels for your remarks..
Hello, my name is Eric Divine,chief
security officer for Riverside Medical Center. Riverside is located 50 miles south of
Chicago. We are a full-service hospital, Senior Living Center, health and fitness
center. Include over 2,400 employees and service over
350,000 patients a year.
Security in health care is changing
because it needs to change. Process and workflow is requiring
information security. Because of health information exchange,
government regulations are changing for HIPPA and PHI needs to be secured at rest and in transit. The biggest threats to
Riverside, which I think any company has, is the
internal employees.
Employee awareness is typically not
where it needs to be for information security. So our job is to increase awareness and
education for those employees because they are our skin to the body's
defense for information security. Riverside also needs to be concerned
about the personal health information of their patients, whether it be in transit
or at rest, to be encrypted and secured in the data
center, or in our business associates hands. Where Riverside has benefited from using
Kaspersky, has been the accuracy and dependability of their malware suite, their
full disk encryption to thwart any type of physical security
breaches and also we've noticed the increase in
speed due to the resources used while the Kaspersky agents running on a PC, which helps us with all the imaging that
crosses radiologist laptop, workstation, or any ER doctors
PC.
When they need data the fastest. What Kaspersky does to make my job easier is to give me the ability to know my
end-users, my end-points, my network, and everything that sits on that
network. Without knowing your network, you can't
secure devices. It gives us the inventory, the ability to protect, above and beyond
anything we've ever expected.
We're really happy with Kaspersky
solution. We've seen an improvement with end-user results, end-user happiness and in the end, it's all
about the patient and I think that's where Kaspersky shines..
We are now at the last panel of the day before we have our breakout sessions, and I feel like we're coming to a topic that is both near and dear to my heart and really represents sort of the future conversation and effort that we need to be working on as a community. Which is patient generated health data. And integrating patient generated health data into the health records and into the health dialogue.We've talked a lot about access to information, and how blue button can help support access to patient information by patients and their caregivers. We've also talked just now about making sure that access is available through infrastructure and broadband.
And what really I think is the next step is moving from health care system where communicating where we're communicating to patients, to a one where a health care system where we're communicating with patients and where patients are part of the conversation. And this is a dialogue, a bidirectional communication of information, between patients. Their care givers and their physicians, the entire team.So with that, I'm going to introduce Claudia Williams, who I've been working with for many years, even before she was at ONC. Claudia is now a senior adviser on health innovation and technology at the White House Office of Science and technology policy.
Before that, she led ONC state health information exchange strategy and came to ONC before that from the Markle Foundation where she was the director of health policy and public affairs at that, she helped the connecting to health effort. Join me in welcoming Claudia Williams.[Applause]>> Claudia Williams: Hey, everyone. I know we have limited time but I'm actually going to ask to you stand up for two seconds and stretch, because it's been a long haul. And while I do that, could my amazing panelist please come up to the stage, and take a seat.
I'm going to take the chair right here. But anyway, stretch a little, and sit down because this is going to be awesome.So we have come a long way to now be in this beautiful amazing room. I do love the great hall at HHS. But this is a little more gildy and fancy than in the past.
This is amazing. So I did the math last night. And double checked it because it seems quite amazing. So the average American has three visits a year with a doctor.
Each of which lasting doesn't feel like, 20 minutes, feels like less. That's 60 minutes a year.So 99.99% Of the average American's time, you are keeping healthy, staying healthy, you're taking care of yourself, outside of the office of the most of life and most of health happens outside the doctor's office.Yet for too long we've treated the office as the place where decisions get made, where information is gathered and where stuff happens.But stuff is happening else. Where.So what we really want to talk about here today is how do we bring that rich experience, the observations, the data, the insights, the decisions that are happening in life, into the conversation with the clinician. How do we put control and decision making more patient hands through the data they're tracking and interactions with clinicians in life? 99.99% Of the time.So this going to be a great panel.
I want to introduce them. All the way to the left. We have I'm going to use first names, quick introduction. Janet who is cardiologist and also the director of the million heart initiative at HHS.Next, we have Ariel, U.S.A.
Marketing manager for I never know if it's wippings or whippings (ph). Next is NOLANDO, the mother of 2 and pediatrician of the children's hospital and Mike Evans, the director of the ambulatory clinical pharmacy programs at Geisinger. Join me in wishing them a warm welcome. And then I'm going to go on over here.>> Hi, everyone.
So I just want to talk it's a fabulous to have all of you here. NOLANDO, I want to start with you. You're here really to talk about your experience as a mom. And the mom of a child who needed you very much.
Who was born it two months early. Can you talk a little bit about the experience you had tracking her growth after she was born? And what worked and didn't work about that? Talk little about that whole kind of innovation experience you got to participate in.>> I'm WANDO, as you mention, I'm a pediatrician at chock childrens and I'm also a perinatal fellow at UCLA. As you mention I had a daughter who was born two and a half months early. So she was neonatal ICU, for two and a half months.
Toward the end of my time there, I was approached by a team who was working on a study comparing patients that had access to an app that would allow them to enter data about their babies as they had been discharged that could be made available to the pediatricians. After discharged and random eyed to parents who didn't have the app and then parents who were given a Smartphone and had the app. They tracked the baby's weight, mood. And diapers, all of the stuff that is very important to us as pediatricians.
Especially as doctors who receive these we call them NICU graduates. The neonatal ICU, and come out with a lot of chronic diseases, and being able to manage them in outpatient setting can be very daunting. To pediatricians who sometimes have to see 30 to 40 patients a day. And get this NICU graduate with not a lot of data.
And so I was randomized with a group who got Smartphone, data about how much they give us a scale, weigh her every day and enter the data, and there were different components of the app. I'll talk about what was helpful and I. Thought what could have been changed. What's helpful was the weight because not just as a pediatrician, I know that's important to babies that are growing but just as a mom who has lived in the NICU two and a half months.
I knew if your baby was growing in the NICU, that was the most important thing without any other problems, that's the most important thing. So the weight being able to be convey that, was very helpful. And also, a lot of different appointments the baby had to go to. My daughter had a moderately complex course in the NICU.
So she had at least 4 or 5 follow up appointments she had to attend to. And in addition to her pediatrician appointments. So being able to record, those appointments and what was cuss discussed there in the app, and being able to convey to my pediatrician, was very helpful. Even for me, as a medical professional, you would imagine, oh, she's a doctor, she can manage all this data.
And I actually found that it can be quite complex without having all the struggles of, you know, if you have social struggles or setbacks or travel problems. Just being able to manage the different appointments and recommendations and conveying this to your primary care pediatrician who has the responsibilities of negotiating different appointments and keeping track can be daunting. So that was the most helpful part of it. And then other areas I felt like the app tried to collect data on that was so helpful, was collecting data about the babies' moods, you fussy, not.
I understand what the goal was, trying to get ahead, why is she fussy, more fussy now, because of meals and so forth. But that data translated into electronic format I don't know would be helpful to a pediatrician. Babies can be fussy for many different reasons. And so for me as a general pediatrician, the mother said my baby is not acting right.
That's a red flag. They don't have to say very much more. And so pediatrician, I don't feel like we need a computer to tell us a baby is fussy. If the mom says my baby is not acting right, we jump 'on that and go through with it, follow through.
That was my general experience, you know, with the app, from mom perspective, and you know, pediatricians perspective.>> Some of you know our friend in Moore and she describes the experience of tracking her son with cystic fibrosis and arrived at the emergency room and they said he needs IV antibiotics. She said no, this is not what an event looks like for him. He has a cold and she pulled up his data and said look at his baseline, here's the track. And no it took her 24 hours but she finally convinced them that her hunch represented by her data, was correct, and I think what we also hope that will not be a argument but a normal thing to bring the data forward even if they didn't give you a app, did you it on your own.
And that brings us to you, Janet. And I think you bring this amazing experience of sort of thinking about global change in an incredibly important area, cardiac health, and having been a clinician. And I think you have incredible insights how we actually need to change our clinical care model. What's is going to look like, what needs to happen, what needs to shift, and kind of how are we going to get there?>> Thank you for the chance to participate today.
And get to hear the other panelists. Claudia talking about something called million hearts. Initiative of the five year initiative top prevent a million heart attacks and strokes in that 5 year period. One of the key contributors to fewer heart attacks and strokes is control blood pressure.
Right now, in the country, one in three of us adults has high blood pressure. And the chances that it's controlled is about 50 50. 50 50 Chance of actually being safely controlled. And one big contributor to that poor control is that we're using a model, terrible model.
For dynamic variable like blood pressure, which varies moment to moment. We bring someone into an artificial medical setting, usually take one reading, maybe two, and then the patient and the health care professional try to make a decision about treatment based on two random not random, two data points obtained in a nonbaseline setting. Now, really, that's not very good decision making. So when I was approached about an opportunity to listen to experts and patient generated data, blood pressure control jump tops mind because the change that Claudia mentions is that the transference, of blood pressure control, from the medical person to the individual, whose blood pressure is elevated.So that they use the health care professional as a coach or consultant but they actually have the skills they need.
They have the technology they need. And most importantly, they have an active channel to and from their treating provider. So the data and the advice can flow back and forth. That has to be wrapped in a business model that supports that over time.>> Great.
And paint a picture of what that could look like for blood pressure in particular. What data obviously is blood pressure. But how does that get tracked, how does the data get snared what kind of decisions get made. How does the communication occur?>> Yeah, I listen to the previous panel, wonderful, insights there.
And one of them, kept hearing in different forms was let's make sure these data are actionable. One of my earliest thoughts is we need to have some sort of central Web site so all of us can text our blood pressures up to the place somewhere, we always think about the cloud, right? Text our blood pressure up there and then once a blood pressure to exceed the certain set of parameters but trigger goes off and the treating providers is notified. I spent more than two decades of one of those treating providers and if I started getting every blood pressure that my patients chose to send to the cloud, not only I would freak out but everyone in my office, right? Everybody would be go running out. What you want are actionable data.
So that going to the cloud business could work if we had algorithms that said X percentage of blood pressure readings falling outside these parameters, then a trigger goes off.>> Great. Wanda, I want to go back to you for a minute. As now as a physician, how does that experience affect how you doctor and whether you ask your patients to go more tracking at home. And moms I knew did tracking at home or invite that data into your practice?>> I think because I have the experience of being a general pediatrician and also being in training to be a neonatologist, I think the whole experience changed what my expectations were from parents.
I think it's easy for us to say make sure you go to this appointment and this appointment and either way, make sure you keep track of this and this and this. And sometimes he feel like we don't make sure our patients have tools they really need to be successful in taking care of themselves and their children. And so I mean, it's given me a complete 360 view of how I approach patients in terms of when I. Send them out of the NICU, I don't say make sure do you this and this and this.
I say what resources do you have? How can we help you do this. And this is why I feel that patient access to information, information technology, is incredible in terms it of being able to give patients empowerment, as you discussed earlier but also the tools to help them be more successful. And I just want to reiterate what she said, on the panel before, the information, like was said, the data is coming. And it's got to be hashed out in a way that is beneficial to the providers and the patients and their family.
And just, you know, to developers as their thinking about creating an effective ways of comparing data through mobile devices or other platforms, please keep in mind this kind of make it a collaborative effort. Good health for children is really a collaborative effort between provider and, you know, the patients and the children. And for them to really keep that in mind, because it doesn't help for the patients to have all the data and not know what to do with it. Or the provider to have all the data as well.
But not have the information, especially social information about the patient that can help them be more successful.>> Great, thanks.So Ariel, we had a prep call and she said something that was, I think, right on. Which is the observation that patients are there, right? Not every single patient. But the I had a session last week with a guy who has created something called data he's basically tracked every single possible Sensor trackable thing for his type one diabetics over the course of a year and developed hypotheses and developed them. Eating out was unhealthy.
Which is proved. Running marathon would be good. And you know, he literally had a chart with these amazing beautiful graphics. But patients are there.
So what you said in the call was we needed this yesterday. And I was interested to hear part of your business strategy isn't just putting out awesome tools and equipment into the world. But is actually trying to help us with the culture shift and the society shift we need to go through to get to the place we all want to get. Can you talk a little about that? What needs to happen and what are you guys doing to make it happen?>> Absolutely.
So for those unaware, whippings created health device and applications, so that ranges from smart sleep stomach our wireless scale, blood pressure monitor activity trackers, and all the data that the consumers use go up into the cloud and really what we're trying to do is give people these tools, as you know, you heard from previous two panelists that these are the tools that people need. And not only help them track but really improve their health. What's interesting I've observed over the years my company has come out with 6 new devices in this mobile health field, within the year, and it takes so much time for health care and med stop sign catch up. I know the model we have right now is not perfect.
The company started as an only consumer phasing product, and now that I'm out here talking to people like you, and speaking to a lot of medical professionals, to try to improve upon the current solution, we're trying to run a number of pilot programs, one with the American medical group association, where focusing on blood pressure specifically, they have a campaign called measure up pressure down, and we're working with four medical groups across the country, to address the patient physician relationship, with using these tools at home. Outside of the regular doctor's visits. And I think with this, we'll be able to come to some kind of conclusion as to where it stands with sending blood pressure measure that. Patients would take every single day with these home monitors and then the measurements that they're getting for that once a year visit with their clinician.
And you know, finding the perspective from the physician, from the physician and from the patient, as to where we can really make that care giver model work best.>> Great. Mike, you've been engaged with setting pilots at Geisinger as well and in particular focus med rec, we know how important and challenging surprising to have an accurate view of what patients are waiting until a patient in the office with the bag of meds may not be the best way to do that. Or if they don't have the bag of meds. So I've done that before.
Talk about your pilot and the what you're learning and the approach you're taking and kind of again, like this is such a big intractable problem improving blood pressure control and talk with the potential safety benefits as well as what you're doing.>> Sure. So in Geisinger, we have pharmacist based as clinical experts inside the family practice and specialty clinics, so they're not distributing pharmacists. They're clinical pharmacists in seeing patients and in population health. And an important aspect that we've noticed for quite some time is patient adherence to medications chronic medications, is about 50% of the time.
So if you can imagine, if we're trying to control a chronic disease and patient is not taking their blood pressure medicine, we're going to control their hypertension about 50% of the time. But we also noticed medication lists. So meaningful use, we're completing med rec, 99.9% Of the time in the system, but internal study of the med rec is even those completed close to 100% of the time, actually accurate, less than 50% of the time. Not a surprise to anyone in the room, I'm sure.
So our postulate was back in before 2010, was any patient can a patient accurately give us a medical reconciliation and we wanted to do this outside the office visit because as we know, and as Claudia brought up, we have 20 minutes in the office visit. We wanted to see if patients in the comfort of their own home, whatever time they wanted to take, could complete a medication reconciliation, so we com- we developed our own survey. It was a grant from ONC. Working with NORC and we used a patient portal we used a seperate software pushing a questionare that was home developed out to the patient, prior to an office visit, the idea here was to make sure the medication reconciliation was up to date prior to the office visit, that was then if the patient was coming in, we could address their chronic disease that wasn't under control, based off adherence.
One of the postulates again also was, can the elderly do this accurately. And surprisingly, very text savvy. Can and how long will they do T if they're on 25 or 30 medications and yes, these patients are on 25 and 30 medications. Will they take the time to complete the survey accurately at home? Yes, they will.
But then, what do we do with the information? So the previous panel brought up a great question. Now we're generating data. What do we do with it? So you heard me say I have pharmacists, clinical pharmacists based in specialty clinics acting, and working collaboratively with physicians and specialists. We have medications we're having issues with.
Who better of a person top take care of a so if a patient has issue with a prescribed medication, pushed to the pharmacist that are in the clinic. But they have an issue with an OTC, or herbal product, pushing to the nurses in the clinic. Again doing this outside of a office visit. That way when a patient comes, in their medication list is up to date.
The pilot occurred back in 2010. In 2011. Or pushing this across the health system now, finding out that an increase is now efficiency in the clinic. When a patient comes in for 20 minute appointment.
We've done or completed the medication reconciliation prior to. Now the nurses ruling the patient doesn't have to take 15, 20 minutes to do a med rec and also accurate. We're looking at the med rec after the appointment now saying is it complete, accurate, but most importantly back to Janet, is now the patient understand why they're taking the medication, they're going to be adhering to the medication, not going to have poly pharmacy because we're adding another medication at the offices when really it was adherence that was the issue.So it's been many contributing factors and down stream effects from the process. So I'm excited, thanks again to ONC, for inviting here and we're continuing to push forward.
We started with med rec but also looking at asthma, hypertension, Bluetooth and multiple other issues for patients, and finding out that we can actually take care of the patient better when they're at home than in the office. Thank you.>> So we talk interoperability an is a big word for today. And I. Think as we're talking about additional data streams and additional types of data, additional health IT platforms, the question becomes how does this all come together? What do these devices need to interface with the EHR, do we need a new kind of data aggregation model is what are the standards we need? And to some extent I think some of these technical problems get solved when you address the cultural problems and the business problems.
So we have to be a little careful that we don't try to drive solutions that will actually to some extent work themselves out if we can get those other things right.But also interoperability and as the Congressman said, can be both a driver right, it can also help drive forward progress if we can solve problems that allow for lots of other use cases and availability. So I just want your thoughts, each of you, from your own perspective, what is the thing we really should be focusing on from an interoperability standpoint? We don't want to the ocean. What over the next year you would love to see happen in your space, whether that simply that the data are more usable by the Doc or they're syncing up with the EHR. We'll start with Mike.>> Thanks, Claudia.
Multiple issues and I'm not sure where to start because it's an open can of worms as here we're. But I think the last we're here. Payers have to be willing to look at different ways to reimburse clinicians as we're interacting with these patients. As we develop these new delivery systems for health care, the payer system hasn't caught up.
That's the payer has to catch up. Number 2 is, where is the information going to flow back to? Ariel talked about the cloud Does it come back to the cloud depending upon the algorithm, where does it go? The last talked about it, the clinical experts, helping with the decision making. With the information experts to develop the right formula, platform.>> Great, thanks.>> I completely agree. With this on the issue as well.
And coming from the perspective of a provider, I would like to see platform that allow me to share information that I have with my patient to improve their care. And the care of their family and their children. From a parent perspective, I would like to be able to access that data, but also be in the context of being able to communicate with my division.I think I. Would hate to see as byproduct of improved access, to have there be a loss in the doctor patient relationship.
I feel like this access to data for patients and providers should accentuate that relationship. And in many cases it could even be dangerous. If a patient were to be at high risk behavior and be exposed to HIV and get a HIV test, if they have access to the results before they have time to talk to a provider, and get resources, that might not be in the best interest of the patient. And in terms of their missing that doctor patient relationship, to be able to have access to resources and information about what can help them through this process and so forth, and that's just one of many, many different examples of where I feel like it's really critical and important that there is this component of it's a team effort and all the parties need to be on the table and the stakeholders involved to make sure that there's not this unintentional byproduct that could be problematic in the future.>> Ariel?>> Yeah, I mean, that's a really good point about the (indiscernible) side.
For us it would be in an ideal world the best situation if we're able to eventually have these devices be reimbursed by insurance companies and I think the challenging piece is being able to show that what we're doing from the prevention side, actually, you know, gives a very strong ROI on the health care side. So that's something that we need to work towards getting at. And another point I just want to make is with the announcement from Apple last week, with health kit, a lot of people have been asking now to companies like similar companies, you know, what are going to be the challenges now. Is this going to be obsolete, this whole market, is Apple going to take over.
And I think for us it's making it mainstream. And we were an early adopter marketplace and mobile health and health that's all still very knew, but I think that Apple will help to make this more mainstream. That's really the goal that we're trying to get at.>> Great. I agree with all the excellent points that have been made.
And when I would only add to it, this idea of geography. And that I travel, a lot of places and most of the time thank goodness I'm not in a physician's office. And so if I'm thinking about anything, I want to register with my health professional, I want to be able to send that in from wherever I am. It's particularly dear to my heart about blood pressures, because I may have them checked at a church or I.
Might have it at a beauty shop or I might have it checked in a grocery store or pharmacy and I'd love to know those will go where I want them to go. But ideally, I want them in a pattern by the time they get here. Because I think this is about improving the quality of the decision making. This multiple data coming from patients.
It helps us as patients know whether we trust the diagnosis, I do really believe I have high blood pressure? I know because I know what brings mine up and I bring it down because I'm monitoring it. If my health care provider also has, that I think he or she will make a better decision, too.>> Okay. I want to I think Don uses effectively a way to build a movement, a way to build momentum. Which is to paint a picture in data, or paint a picture in words of the feature you want.
So I want to ask each of the panelists to write yourselves write us a postcard from two years from now. And what is it you'll be you know, having fun, at the beach. What is it you'll be with what we've accomplished together and how data are information care and I would ask you to do it in less than a minute.So what's the picture postcard you're going to write back to us in 2 years, and then it's up to all of us to make that happen.Probably Janet will start.>> It's December let's say January of 2017, million hearts curtain has fall then December 2016 and what I'm going to see is a tick downwards in heart attacks and strokes over and above the trends we've seen for 30 years. That is because the nation's blood pressure has come under control.>> Wow.[Applause]>> For me it would be about education.
And we recently just did a survey about what the American public knows about' their vital signs. And it's really low. People just don't know about what vital signs are being taken at their physician's office. And so in two years from now, it's about everyone knowing what those numbers are and income control of it.
>> For me it's I. Believe the health of a nation starts at the child level. Which is one of the reasons I'm a pediatrician. And so in two years from now, it would be heavenly if we would have some sort of a platform, whether it's the blue button or some sort of a platform that really empowers parents to empower their children, to work closely in a collaborative effort with developers and providers to have some sort of way that we can improve health care outcomes for children, with the resources that we have.
In IT.>> From a pharmacist perspective, medication adherence. If we can get patients to be adherent to medications we'll have Janet hypertension under control and the other chronic diseases under control. Using health information technology, push and pull from the patient, to increase medication adherence. By 2016, that would be fantastic.>> Let's make it happen.
And let's give a round warm round of applause to the panel. Thank you all. [Applause].
It's really difficult
to be a life science entrepreneur when you're young
and just graduated from HBS. Commercializing
life science happens at the juncture of good
research, lots of capital, and great passion,
and that's the nexus that the Blavatnik
Fellowship facilitates. Young entrepreneurs have the
imagination and the vision and the risk capacity
to think big, but investors don't
always have the confidence to write big checks for
young first time executives. The Blavatnik Fellowship in
life science entrepreneurship has become this program
for young entrepreneurs who are interested in
science-based businesses, to have a year to
gather the resources, build a team if they
get to that point, and raise the money
to start a company.
If you ask a woman, what is
the most prominent question in her mind today when it
comes to reproductive health, her sound bite might
be, I want to protect my reproductive health to the
extent that I can have children if and when I want to. The form factor of
a tampon gives you access, a unique
singular access, to a woman's reproductive
system like nothing else short of a biopsy. All of these different cells
have specific signatures. And so if we're looking at
endometrial cells, for example, they will have
specific signals that correlate to different
diseases, like endometriosis.
If we're actually
looking at ovarian cells, we may be able to pick up
things like ovarian cancer. In our lab here in Oakland,
it's part wet bench and part dry lab work. You cross over the bridge,
and people are real. And the vibe is great, and
it fits my personality, as well as Jane's.
Our central philosophy has
always been to empower women directly. Through the massive amount of
data that we're collecting, we're building a
pipeline and data analytics that can tell
you whether you're sick or you're healthy. The hope is that once the
medical community becomes familiar enough
with the product, and there's enough data
from thousands and thousands of patients, we would
be able to push this onto the market
direct to consumer, meaning you should be able
to get it and use it just like a pregnancy
test that you do now. We've advanced the prototype
so that it's closer to market.
We've closed our
second clinical trial. And we are on the cusp of
starting our pivotal trial. And so we have started
fundraising for our series A round. I'm Ridhi Tariyal.
My company is NextGen Jane. And I'm in the first class of
Blavatnik Fellows from Harvard Business School. [MUSIC PLAYING].
>>> 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. USE@CDC.GOV 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..
Y't'h and welcome to Four 
Please note this video highlights a variety
Accurate medical records, including electronic
>> Jodi Daniels: Next we will be hearing from Jocelyn Samuels, who is the new director of the Office for Civil Rights. You know, when we talk about consumer engagement in healthcare, often the first thing folks think about or many think about or used to think about is privacy of health information. They have a privacy rule in place for over a decade and while people think about the protections that came with the privacy rule, I think the most powerful thing that HIPAA privacy rules did was some of the patient rights, particularly granting consumer, the right to access own health information. I remember talking to a group of doctors in the early days right after the rules were passed and this was actually seem to be shocking that patients should be able to get copies of their records because the doctors that I spoke with saw those records were their own records and I think it really was the beginning of a culture shift where doctors and patients have a part to play together in reviewing the information and sharing in the treatment decisions and for patients to be engaged with their clinicians.
Hello, my name is Eric Divine,chief
We are now at the last panel of the day before we have our breakout sessions, and I feel like we're coming to a topic that is both near and dear to my heart and really represents sort of the future conversation and effort that we need to be working on as a community. Which is patient generated health data. And integrating patient generated health data into the health records and into the health dialogue.We've talked a lot about access to information, and how blue button can help support access to patient information by patients and their caregivers. We've also talked just now about making sure that access is available through infrastructure and broadband.
It's really difficult
>>> GOOD AFTERNOON. I AM RARELY SPEECHLESS, BUT I'M