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Transforming U. S. Health Care:The Role of Information Technology: 

Transforming U. S. Health Care: The Role of Information Technology Michael L. Cowan MD Senior Vice President Healthcare Solutions

Healthcare in the 21st Century: 

Healthcare in the 21st Century Cost Quality Access Information Technology The Universe is simple, it’s the explanations that are complicated - Albert Einstein

U.S. Healthcare Market Failure: : 

U.S. Healthcare Market Failure: POOR RESPONSE TO COST PRESSURES (ju jitsu) WEAK PREMIUM FOR QUALITY ECONOMIC DISINCENTIVES UNINSURED POPULATION 'ENTITLEMENT' TO HEALTHCARE WEAK DEMAND FOR INFO TECH

MARKET FAILURE:How Did This Happen?: 

MARKET FAILURE: How Did This Happen? 'SAVING MONEY, SAVING LIVES' Newt Gingrich 'YOUR MONEY OR YOUR LIFE' David M. Cutler

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Good Health Reduces Healthcare Consumption Lifestyle Risk Factors Smoking Alcohol Excess Obesity Poor Diet Risky behavior Sedentary Lifestyle Healthcare Resource Consumption Risky Behavior Chronic Condition Avoidable Disease 3-5 years 20 40 60 78 $$$

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Mankind is not Finished Evolving

Obesity Trends* Among U.S. AdultsBRFSS, 1985: 

Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI  30, or ~ 30 lbs overweight) No Data andlt;10% 10%-14% 15-19% 20% Source: Mokdad AH, et al. J Amed Assoc 1999;282:16.

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Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI  30, or ~ 30 lbs overweight)

Obesity Trends* Among U.S. AdultsBRFSS, 1990: 

Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI  30, or ~ 30 lbs overweight)

Obesity Trends* Among U.S. AdultsBRFSS, 1992: 

Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI  30, or ~ 30 lbs overweight)

Obesity Trends* Among U.S. AdultsBRFSS, 1994: 

Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI  30, or ~ 30 lbs overweight)

Obesity Trends* Among U.S. AdultsBRFSS, 1996: 

Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI  30, or ~ 30 lbs overweight)

Obesity Trends* Among U.S. AdultsBRFSS, 1997: 

Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI  30, or ~ 30 lbs overweight)

Obesity Trends* Among U.S. AdultsBRFSS, 1998: 

Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI  30, or ~ 30 lbs overweight)

Obesity Trends* Among U.S. AdultsBRFSS, 1999: 

Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI  30, or ~ 30 lbs overweight)

Obesity Trends* Among U.S. AdultsBRFSS, 2000: 

Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI  30, or ~ 30 lbs overweight)

Obesity Trends* Among U.S. AdultsBRFSS, 2001: 

Obesity Trends* Among U.S. Adults BRFSS, 2001 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. (*BMI  30, or ~ 30 lbs overweight for 5’4' woman)

Transformational Forces:“Tectonic Plates”: 

Transformational Forces: 'Tectonic Plates' Individual Health Paradigms andamp; Behaviors U.S. Health Care not a 'System' nor a 'Market' Islands of Excellence in a Sea of Miscommunication No single point solution * How these come together is the real trick……..

Health Care Information in the 21st Century: 

Health Care Information in the 21st Century

Health Information in the 21st Century: 

Health Information in the 21st Century

Health Information in the 21st Century: 

Health Information in the 21st Century

Health Information in the 21st CenturyNational Coordinator for Health Information TechnologyElectronic Health Record (HER) for all : 

Health Information in the 21st Century National Coordinator for Health Information Technology Electronic Health Record (HER) for all April 2004

National Health Information Network(NHIN): 

National Health Information Network (NHIN) The promise: Quality Cost Access……? Consumer Involvement Public Health AND Homeland Security

Health Information in the 21st Century“BUZZ”: 

Health Information in the 21st Century 'BUZZ' Office of the National Coordinator for Health Information Technology Medicare Modernization Act (MMA) of 2003 eHealth Initiative (EHI) Electronic Health Initiative (IHE) Certifying Commission for Health Information Technology (CCHIT) Markle Foundation Connecting for Health Many other initiatives, Private, State, Local and Federal RFI November 2004

Health Information in the 21st Century(Truth in Advertising): 

Health Information in the 21st Century (Truth in Advertising) National Health Information Network (NHIN)

NHIN RFI NOVEMBER 2004HHS-ONCHIT >600 Responses: 

NHIN RFI NOVEMBER 2004 HHS-ONCHIT andgt;600 Responses 24 Questions 4 Categories Definition; major design principles, success metrics Technical Model; standards and policies to achieve interoperability Organizational and business model; management and operations Financial, regulatory, legal considerations

National Health Information Network RFI: 

National Health Information Network RFI HHS received andgt;600 responses Interoperability Consortium 8 members Spontaneous formation Voluntary membership 'Logos at the door'

Interoperability Consortium Membership: 

Interoperability Consortium Membership - Cisco HP IBM CSC Intel Accenture Microsoft Oracle

Overview: 

Overview Governance Operational Adoption

Interoperability Consortium Governance: 

NHIN Contracting Technical standards and policy Standards Compliance Oversight Standards based Participation RHIOs HISPs Interoperability Consortium Governance

Interoperability ConsortiumNHIN Operations: 

Interoperability Consortium NHIN Operations Open standards Permission-based access Semantically interoperable HL7v3 Messaging Health Care is 'Local' Critical Information (CCI) Patient Access andamp; Control Anonymized Aggregation Opt in/Opt out Identifier

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How Does All This Actually Work?: 

Patient Encounters How Does All This Actually Work? Health Entity One Health Entity Two Health Entity Three Health Entity N

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Patient Encounters Health Entity One Health Entity Two Health Entity Three Health Entity N

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Patient Encounters Health Entity One Health Entity Two Health Entity Three Health Entity N EHR for Susan Vance, DOB 2/3/45?

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Patient Encounters Health Entity One Health Entity Two Health Entity Three Health Entity N Susan Vance’s EHR

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Patient Encounters Health Entity One Health Entity Two Health Entity Three Health Entity N Update Susan Vance’s EHR

NHIN: Adoption Strategies: 

NHIN: Adoption Strategies ONCHIT Strategy Development Interoperability Standards NHIN/RHIO Public/Private Structure Public/Private Oversight Bodies Federal Adoption Incentives Legislative andamp; Regulatory Financial ROI Conducive Environment Federal Agency Leadership VA DoD HHS

NHIN: Next StepsWhat Can YOU Do?: 

NHIN: Next Steps What Can YOU Do? Avoid 'Best of Breed' Solutions (Instant Legacy Systems) Enterprise Architecture Open Standards Interoperability Scalability Multiple Uses for Electrons

Model RHIO (Madigan Army MEDCEN – VA): 

Model RHIO (Madigan Army MEDCEN – VA) VA Hospital Madigan Army Hospital RHIO HTB PHIN Oblix Oracle Database Clinicals

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New Applications Business Intelligence J2EE The Healthcare Transaction Base

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SUMMARY

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A

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