Making the Connection: Value-Driven Health Care, Health Information Technology, and Quality Care
Department of Veterans Affairs Enterprise Architecture Open Management Meeting—Bridging the Gap: Current Landscape of Privacy, FDA Studio, Grand Junction, CO, February 1, 2008
Good morning everyone. I wish I could be with you in Grand Junction, which is one of the most beautiful places on the planet, with Colorado National Monument, Grand Mesa National Forest, and all of the other attractions and activities there in the Grand Valley. Since I can't, I very much appreciate the opportunity to speak to you by video about the potential of health information technology.
Clearly, the Department of Veterans Affairs (VA) is way ahead of the curve on this issue. Many of us in government, and in the private sector for that matter, can and should be learning from what you are doing to engage health care leaders in joint efforts to champion the vision for VA health care.
As you can see, I am wearing my red jacket today. This address is being taped on Friday, February 1, and it is National Wear Red Day, the day on which the American Heart Association's Go Red for Women campaign calls attention to the need for ongoing research and education about women and heart disease.
Heart disease is the number one killer of both women and men in the United States. We're all for any effort that can help change this dynamic, and it's very possible that future developments in health IT could lead to changes on this and any number of additional issues that we face in health care today.
Let's face it. Our health care system is broken. We've made great progress over the last several years, but we have a long way to go.
Secretary Leavitt often frames this discussion by saying that we actually don't have a health care system. What we have is a large, robust, rapidly growing health care sector. Millions of Americans provide health care or work in related businesses, but there is nothing that connects them to a system. It's a serious problem when you consider that health care, perhaps the most critical service, is one of the last vestiges of the paper-driven era.
Here's the vision for health care: Over the next decade or so we will have a real system in which doctors, hospitals, pharmacies, and labs will be connected electronically. Patients will have access to cost and quality comparisons on doctors and hospitals. These comparisons will be based on standards developed by the medical family. Ultimately, we will have health care competition based on value.
A revamped system will be built on four cornerstones:
- Quality standards: Systems that collect quality of care information and define what constitutes quality health care.
- Price standards: Aggregate claims information to enable cost comparisons between specific doctors and hospital.
- Incentives: Rewards for those who provide and purchase high-quality and competitively priced health care.
- Software standards: Common technical standards that allow for various products to talk to each other and exchange information securely.
The key to successful standards is consensus, not government-mandated standards, but active agreement across a wide spectrum of stakeholders about what works.
That essential element of consensus is what led us to create the American Health Information Community (AHIC) about 2 years ago. AHIC is a voluntary advisory organization that brings together providers, vendors, consumers, payers, and government to steer health IT toward the common goal of better patient care.
On January 22, Secretary Leavitt announced that AHIC will be transitioned from HHS to the Brookings Institution in Washington, DC. The goal is for AHIC to operate at Brookings as an independent entity that can bring together the best attributes and resources from the public and private sectors. We all think this can be the most effective approach to building a nationwide health information system that supports the health and well-being of the people in the United States.
Another goal is to develop a Federal network prototype that supports secure analyses of electronic information across multiple organizations. This will enable us to study risks, effects, and outcomes of various medical therapies.
The long-term goal is a coordinated partnership of multiple research networks that provide information that can be quickly queried and analyzed.
There are two prototypes that have received grants for these networks:
- The first is one that has the potential to be of benefit to more than 350,000 patients in Colorado.
- The second involves the HMO Research Network developing a "Virtual Data Warehouse" in a plan that could impact millions of people.
On the ground, there has been significant progress in some facilities; in others there is little or no existing infrastructure to the point where we're talking about collecting bits of information on pieces of paper in folders. It is not uncommon to see hospital staff members with arms lined with yellow post-it notes, so that when they get back to their stations they can enter all of the information into a computer workstation. We also have facilities with electronic health records (EHRs) that are not linked to other hospitals in the same chain, much less the outside world. So what we can see stops when the patient exits the hospital, and we are blind to the frequent errors and disconnects that accompany transitions in care.
One of the primary expectations for electronic medical records is to make certain data from providers available for use to increase quality management, tracking, and improvement. This kind of convergence is taking place to some degree. We are beginning to see that the potential benefits of electronic records range from integrating evidence-based recommendations for preventive services (screening exams) with patient data to disease management that can change the incidence of chronic conditions and their complications.
AHRQ is committed to promoting informed consideration of EHRs and other electronic tools that can help to prevent medical errors by centralizing health information for patients and supporting information sharing. We have made a substantial investment in this area with a research portfolio of more than $215 million and supporting about 200 projects across the country. We recognize that if our Nation is to realize the full potential of information technology, all of us, especially practitioners, need more information as soon as it can be made available.
We have several joint projects with VA facilities. We recently awarded a $1.5 million Ambulatory Safety and Quality grant to the Veterans Medical Research Foundation in San Diego, CA. The grant is to be used to examine the effects of a Web-based intervention designed for patients with obstructive sleep apnea syndrome. In addition, AHRQ's Center for Education and Research on Therapeutics at the Critical Path Institute in Arizona is engaged in a continuing collaboration with the VA to address adverse drug reactions and drug-drug interactions (DDIs).
A recently published study examined the prevalence of 25 clinically important drug-drug interactions in the ambulatory care clinics of the Department of Veterans Affairs medical centers. This study found an overall rate of 2.15 percent for potential DDIs. Another study investigated prescribers' rationales for overriding drug-drug interaction alerts and to determine whether these reasons were helpful to pharmacists as part of prescription order verification. Findings from these studies are now being used to enhance educational efforts designed to reduce DDIs and improve patient safety.
We are also partners with the VA on the Patient Safety Improvement Corps. This program seeks to improve patient safety by providing the skills and tools to identify the root causes of adverse medical events.
Obviously, electronic health records and other forms of health IT [information technology] will not solve all of the problems on their own. They are means to an end. When designed, implemented, and used properly, they can help us make the most of our investment in health care. We need to use our existing health care resources much better than we do today. We need to spend our health care dollars more effectively. We need to focus on quality and value. And we need to enable every American to acquire affordable health care insurance.
Americans understand these challenges. I think this is a big part of why we're seeing a growing national debate on these very complex health care issues and on creating an information-rich health care system. It's a transformation that begins with information technology. But, as I said, health IT itself is just the starting point. The real change is the new, far-reaching results we can achieve when the correct health IT systems are in place.
Health information technology is about making the right thing to do the easy thing to do. And this can happen in a variety of ways:
- Electronic health records make our health information available when and where it's needed.
- E-prescribing can improve safety and reduce medical errors.
- Clinical decision support can be available "on demand" to help doctors and nurses diagnose or treat a difficult condition.
- Personal health records can help providers and the patients work more closely together.
But health IT can also do something else. It can help us learn. In the clinic, it can give providers real-time feedback to help them continually improve the effectiveness of their care. In the community, it can help bring together stakeholders to look at patient outcomes and work toward improvement. And on the broadest level, it has the potential to be a kind of information "nervous system," enabling us to learn directly from the health delivery system itself.
Overall, health care quality last year increased by about 3 percent, which is in line with what we've experienced in the years since the quality and disparities reports were introduced. Every year, we have seen modest improvements of about 3 percent.
I will applaud any positive movement. At the same time, our own statistics from the annual National Healthcare Quality Report show that, at an annual growth rate of 3 percent, it would take us about 20 years to close the gap between the best quality care and what we routinely receive today. We need to move much faster.
Accelerating the pace of improvement is a goal that we at the Agency for Healthcare Research and Quality take very seriously. And it has become clear to us that, as the complexity of our system grows, the providers have to leverage health IT to improve patient safety and health outcomes.
Many of us have come to trust the technology enough to bank, pay bills, and shop online. That's the level of trust we want in health IT.
This is a massive undertaking that has the potential to change the way we practice medicine and the question we have to ask ourselves about the work that will be required to automate and personalize the system is: Is it worth the expense and the effort?
How much better can health care be with a system that allows us to better educate our patients about their medical conditions and to work in consistent, evidence-based partnerships that help us respond, even be proactive in some instances, and to learn?
Fortunately, the VA knows the answers. You understand the benefits of practicing medicine as a team sport. In the end, it's all about good quality, patient-centered care.
And now we have patients who have easy and quick access to the same kinds of information that their providers have. At times, they know about new drugs for treating their conditions before their providers. And they have expectations.
I don't think we can even come close to determining all the benefits of health information technology at this point. But we're really just beginning.
Overall, we know that the penetration of health IT is somewhere in the area of 15 to 20 percent. We also know that 90 percent of the billing side of health care is electronic; so there should be no doubt about our ability to do this on the clinical side.
The key for us is to make sure that we take advantage of all available lessons learned—inside and outside of the health care system—as we move forward, so that we can make the most of the opportunity to make 21st Century health care an information-rich, patient-focused enterprise in a value-driven environment.
Thank you, and enjoy your meeting.