How to Develop a Sustainable Community Health Information

Infrastructure

How to Develop a Sustainable Community Health Information

Infrastructure

William A. Yasnoff, MD, PhD, FACMIManaging Partner, NHII Advisors

Founder and President, Health Record Banking Alliance

Health Information Technology WorkshopInstitute for Family Health

July 10, 2009

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“The development of an information technology infrastructure has enormous potential to improve the safety, quality, and efficiency of health care in the United States”

- Institute of Medicine, Crossing the Quality Chasm, 2001

“The development of an information technology infrastructure has enormous potential to improve the safety, quality, and efficiency of health care in the United States”

- Institute of Medicine, Crossing the Quality Chasm, 2001

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Sustainable Community HII

I. Defining the GoalII. A Framework for Understanding

the ChallengesIII. Solution: Health Record Bank

Functions & Operation Rationale Business Model

IV. Next Steps

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Health Information Today Scattered Records

Each person's records are scattered at whatever locations care has been given

Mostly paper Information sharing not effective

Cumbersome, expensive, time-consuming, and fallible

No mechanism to collect patient information from disparate sources

No responsible institution Each patient's complete records (from all

sources) are not available for care Need to create these institutions

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Health Information Today (cont.) Consequences of health information deficit

Medical errors common – 44,000-98,000 preventable deaths/year

(just in hospitals) Quality poor

– only 55% of adults receive recommended care (RAND study)

Costs out of control– rising >10% annually– consuming an increasing proportion of

GDP– now $2+ trillion/year and growing

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Goal: Comprehensive Patient Information at Any Point of Care

All medical records must be electronic Combine multiple scattered records

into complete “master” record Enable rapid review

Graphs Charts Enhancement of relevant information

Automated reminders to improve quality and reduce errors

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II. A Framework for Understanding the Challenges

P - Privacy I - Information U - Usage S - Sustainability

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Privacy & Patient Control Surveys of “information hiding”

2006: 13% of consumers 2007: 17% of consumers

Consumers already control information in their records

Without control, too many will opt out OR politically force system shut down

Choices are today’s system or consumer control -- complete information without consent is not (and should not be) a viable option

Patient control essential

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Privacy Requirements Patient Control

Essential for trust Forces stakeholder cooperation

Trusted Institution Local governance (now) Government regulation (later)

Trusted Architecture Secure repository Operate like classified military

system

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Information Electronic

Need financial incentives for physician electronic health record (EHR systems)

Interpretable Standards very desirable

Transmitted (at no charge) Patient requests for records must

be honored under HIPAA Stored

Central repository (in a community)

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Usage Ensure use in care

? Financial incentives Avoid process disruption in physician

offices Need very high market penetration --> Community implementation

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Sustainability

Subscription fees / sponsorship Advertising Query fees (with patient permission) Alerts & reminders

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III. Solution: Health Record Bank (HRB) Secure community-based repository

of complete health records Access to records completely

controlled by patients (or designee) “Electronic safe deposit boxes” Information about care deposited

once when created Required by HIPAA

Allows EHR incentives to physicians to make outpatient records electronic

Operation simple and inexpensive

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Clinical Encounter

Health Record Bank

Clinician EHRSystem

Encounter Data Entered in EHR

Encounter Data sent to

Health Record Bank

PatientPermission?

NODATA NOT

SENT

Clinician Inquiry

Patient data delivered to

Clinician

YES

optional payment

Clinician’s BankSecure patient

health data files

Health Record Bank Operation

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HRB Rationale Operationally simple

Records immediately available Deposit new records when created Enables value-added services Enables research queries

Patient control --> Trust & privacy Stakeholder cooperation (HIPAA)

Low cost facilitates business model Allows EHR incentive options

Pay for deposits from existing EHRs Provide Internet-accessible EHRs

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HRB Business Model Costs (with 1,000,000 subscribers)

Operations: $6/person/year EHR incentives: $10/person/year

Revenue Advertising: $6/person/year Queries: ? Reminders & Alerts: >=

$12/person/year– “Peace of mind” alerts– Preventive care reminders– Medication reminders

No need to assume/capture any health care savings (!!)

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IV. Next Steps

For-profit HRB startups For-profit HRB establishes

community non-profit for governance Consumers Physicians

For-profit operates HRB under contract from community non-profit Pays fee to non-profit for

governance Provides EHRs or EHR incentives

to physicians

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Health Record Bank Organization

Customer Support

MarketingOperations

HRB Operator Board of Directors

Management

Health Record Bank Operator (for-profit)

regulate via contract

% of revenu

e

RESPONSIBLE FOR: Policy Governance Oversight

RESPONSIBLE FOR: Obtaining Capital Operating HRB

Executive Director

Other Staff(Optional)

Community Non-profits

Community Board of Directors

Many communitiesuse single HRB

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Summary:Sustainable Community HIII. Goal: Comprehensive Electronic RecordsII. Challenges

Privacy (patient control) Information (EHR incentives) Usage (integrate with existing workflow) Sustainability (feasible business model)

III. Solution: Health Record BankIV. Next Steps

Community Health Record Bank providers fund non-profits for governance

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Questions?

William A. Yasnoff, MD, PhD, FACMIwilliam.yasnoff@nhiiadvisors.com703/527-5678

For more information:www.ehealthtrust.com

www.healthbanking.org www.yasnoff.com