Marsha K. Millonig, BSPharm, MBAPresident & CEOCatalyst Enterprises, LLC

Advancements in Pharmacy Technology NABP/AACP District III Meeting

Today’s Objectives• Describe the HIT landscape in the United States, how national HIT priorities are

set and the most promising opportunities for pharmacists to “connect” to them.

• Define common HIT terms.

• Provide an overview of federal programs created through the Recovery Act (stimulus bill/HITECH provisions) to accelerate the adoption and “meaningful use” of health information technology.

• Understand opportunities for pharmacists to improve medication use when enabled by HIT interoperability and patient-specific electronic medical record (EMR) access.

• Discuss current and future pharmacy processes that may be supported by HIEs and related opportunities for the profession to advance care through HIE.

• Describe new and emerging technologies that will affect the practice of community pharmacy and their impact on the delivery of patient services.

• Review return on investment and implementation costs trends for new and emerging technology

“You think you understand the situation but what you don’t understand is that the situation just changed.”-----Putnam Investment advertisement

In our professional careers…

• …we have witnessed the transition from the industrial age to the information age.

From typewriters to computers

Moore’s Law…Gordon Moore 1965

• Since the invention of the integrated circuit in 1958, the number of transistors that can be placed inexpensively on an integrated circuit has increased exponentially, doubling approximately every two years.

• Almost every measure of the capabilities of digital electronic devices is strongly linked to Moore's law: processing speed, memory capacity, even the number and size of pixels in digital cameras.

Moore’s law in real life…

• “If we had similar progress in the automotive technology, today you could buy a Lexus for $2. It would travel at the speed of sound, and go about 600 miles on a thimble of gas.”

– John Naisbett

It can be exhausting!

Why is Health IT a Central Strategy for Health Care?

Current Lack of Information:• Leads to 1 in 7 hospital admissions*

– When care providers do not have access to previous medical records

• 12% of physician orders are not executed as written*

• 20% of laboratory tests unnecessary* – Requested because previous studies

are not accessible• Drug errors

– Complicate 1 in 6.5 hospitalizations– Occur in 1/20 outpatient Rxs

* President’s IT Advisory Committee (PITAC)

HIT Evolution

• 1989: Medicare Catastrophic Coverage Act—majority of pharmacies computerized in anticipation

• 1996: HIPAA administrative simplification and standardized code sets, identifiers, EDI

• 2001: SureScripts and RxHub formed to tackle e-prescribing

HIT Evolution• 2003 Medicare Modernization Act and Medicare Part D with

e-prescribing initiative and MTM• 2003: IOM endorses National Health Information

Infrastructure• 2004: President Bush creates National Coordinator for HIT

– How many have there been and who are they?– First draft national strategic framework for HIT– CCHIT created– "We will make wider use of electronic records and other

health information technology to help control costs and reduce dangerous medical errors."-- President Bush, January 31, 2006

HIT Evolution

• 2005: SureScripts becomes agent for CCHIT certification of medication mgmt interoperability requirements

• 2006: CCHIT only official entity recognized by HHS to certify HIT products and systems

• 2007: E-prescribing becomes legal in all 50 states

HIT Evolution

• 2008: SureScripts and RxHub merge

• 2008: CMS issues e-prescribing regulations for MPD

• 2008: Common language for HIT terms: EMR, EHR, PHR, RHIO, HIO, NHIN

• 2008: ONC issues 2008-2012 strategic plan

The Health IT Infrastructure

• ONCHIT

• David Blumenthal

• http://www.hhs.gov/healthit/

• "We will make wider use of electronic records and other health information technology to help control costs and reduce dangerous medical errors."-- President Bush, January 31, 2006

Common Language and Terms

Terms

• EHR

• EMR

• PHR

• HI exchange

• Health information organization

• Regional health information organization

• NHIN

• Released June 2008• Second plan• Lays out the health IT agenda: the Collaboration• 5-year plan: 2008 - 2012• Two goals, eight objectives, 43 strategies

– Measure for each objective– Milestone for each strategy

• Details current activities of Federal agencies

The ONC-Coordinated Federal Health IT Strategic Plan: 2008 - 2012

HIT

Interoperability is common theme

National standards are needed to enable information flow

Principle difference EMR and EHR is interoperable exchange

Control of information distinguishes EHR from PHR

HIE is process; HIO is oversight, RHIO is type of HIO

Summary of Health IT Strategic Goals and Objectives: 2008-2012

Objective 1.1: Facilitate electronic exchange, access, and use of electronic health information, while protecting the privacy and security of patients’ health information.

Objective 2.1: Advance privacy and security policies, principles, procedures, and protections for information access in population health.

Objective 1.2: Enable the movement of electronic health information to support patients’ health and care needs.

Objective 2.2: Enable exchange of health information to support population-oriented uses.

Objective 1.3: Promote nationwide deployment of electronic health records (EHRs) and personal health records (PHRs) and other consumer health IT tools.

Objective 2.3: Promote nationwide adoption of technologies to improve population and individual health.

Objective 1.4: Establish mechanisms for multi-stakeholder priority-setting and decision-making.

Objective 2.4: Establish coordinated organizational processes supporting information use for population health.

Goal 1. Patient-focused Health Care

Goal 2. Population Health

Privacy and Security

Interoperability Adoption Collaborative Governance