February 1, 2006 Center for Economic Services

Health Information Technology and the Transformation of Care Delivery

California Council on Science and Technology

February 1, 2006

February 1, 2006 Center for Economic Services

CMA Activity in Health IT

• Patient Safety Institute – in full operation today, exchanging health information between hospitals and doctors in Seattle.

• Participation at the national level

• Physicians’ Foundations activity

• Resource development

• Research and action

February 1, 2006 Center for Economic Services

Patient Safety Institute

Record

Locator approach

• Hospitals and Physicians exchanging

data today. PSI’s technology is open and available for use as a public benefit.

February 1, 2006 Center for Economic Services

National Level Participation

Working With:• ONC• Connecting for Health • eHealth Initiative • CCHIT• Physicians’ Foundations• Quality Performance

Measures development

Focused On:• Technology• Clinical Quality• Standardization• Practice Redesign• Incentives• Knowledge• Resources• Regulations

February 1, 2006 Center for Economic Services

Physicians’ Foundations

• Finding meritorious tools that enable migration from paper to technology

• Information to empower physicians in technology selection

• Strategies to create market forces

• Engaging leaders in the profession to embrace the transformation

February 1, 2006 Center for Economic Services

Challenges

February 1, 2006 Center for Economic Services

0%10%20%30%40%50%60%70%80%90%

100%

1-2 3-5 6-10 11-24 25-99 100+

Administrative staff

Clinical / physician staff

Physician accesses Internet from home

No Internet in Office

Improving, an Access Gap Remains

0%10%20%30%40%

50%60%70%80%90%

100%

1-2 3-5 6-10 11-24 25-99 100+

Administrative Staff

Physician / clinical staff

No computers in office

Access to Computer Access to Internet

February 1, 2006 Center for Economic Services

EHR Market Has No Leader

• Recent CMA survey –72 practices using 49 commercial and 9 home grown “EMR” systems

• 48% of respondents plan to purchase EMR within 4 years– Expense, selection risk

and implementation challenges are serious obstacles

1

2

3

4

5

6

0 5 10 15 20 25 30 35 40 45 50 55

February 1, 2006 Center for Economic Services

Beleagured Physicians

Innovation = Desire X CapacityInnovation = Desire X Capacity

National 75th percentile of productivity is 5,035 visits per year. In California, the first 3,810 are necessary to just cover overhead.

When running that hard, will youOutlay $10-20K for uncertain technology?Lose productivity while learning new processes?Embrace innovation?

Average primary care practice overhead = 60-62%

of revenue

Average revenue outstanding 62%

Average allowed amount:

Medicare - $51; Medi-Cal - $24; WC - $48 Commercial ?

February 1, 2006 Center for Economic Services

Extreme Makeover of the Solo and Small Group Practice• Bring together

– Physicians and staff – Subject matter experts– Well designed technology– Organizational design leadership

• Redesign office flows and pilot these designs• Measure pre and post• Can we eliminate non value added activity and

improve access, satisfaction and capacity?• Can we replicate these results?

February 1, 2006 Center for Economic Services

Opportunities for California

• Explore PSI technology as a potential resource• “Wire” the state• Boost skill development at basic levels of computer use• Increase resources to help safety net providers to

acquire and implement technology• Remember this is a care delivery problem, not just a

technology problem. Investment is needed in people and process as much or more than software and servers.

• Design solutions to address diverse needs, populations and challenges – one size will not fit all.