Transcripts For CSPAN Politics Public Policy Today 20130205

CSPAN Politics Public Policy Today February 5, 2013

This transition phase. We saw that only a fairly small percentage of consumers have on line access to their medical records. It is about 26 of people who also had said in ehr. For those that did, their views were very different and their experiences were very different. There were more engaged in their care and more motivated to do something to improve their care and they felt more confident in their clinicians ability to manage their care with them and began to really set up more of a partnership constructs. It will be very interesting to see end stage 2, where the requirement will be applicable applicable the chicken go on line and you can download and you can transmit and i think that will be interesting. From the consumer viewpoint, we are at a point where they are experiencing some tangible benefits. It is early in the program and that is fabulous. I think what is about to happen will the transformational. There is one allegation related to Electronic Health records of which is that by making it easier to bill and maybe by jazzing up the billing a little bit, Electronic Health records are actually increasing the cost of care, not reducing the cost of care. They say that will be part of the problem, not part of the solution. What is your response to that . We have to separate two issues. One is fraud. If someone is documented care that did not occur, whether electronic or not, that is fraud. What the secretary and the attorney general have said is we will take that very seriously. The electronic help records give us tools now to be able to audit and investigate and prosecute fraud in ways we never had before. This second category is just using Electronic Health records as tools. Within the given rules of the road. I think that is a more challenging issue to look at. These trends, as reported, have been going on for a decade in terms of the shift in billing patterns and there is met regulatory approaches that cms has to deal with the shift in the patterns of billing intensity codes. We have asked the Health Policy it committee to see if there are things we can do to minimize inappropriate use of the records but fundamentally, weve got to change how we pay for care. The comfort is not Electronic Health records but a system of reimbursement that says you will be paid based on how many visits you can squeeze in and how many elements you can document as quickly as possible regardless of the outcomes of that care and the patient components. I dont think there is any of events any evidence on the net balance Electronic Health records that this has increased the cost of care. It gets to the cost issue. What is our theory of the case of how electronic help records will reduce costs . It has to be within the context of how health care is paid for them didnt the rand study say that Electronic Health records are increasing the cost of care . Isnt that what the article said . As david knows well, that is not all what the rand said it said there are some journalists that misread, perhaps, the counter that way. To expand on that a little bit, the rand study actually said they had predicted dramatic reductions in the cost of care and their predictions were wrong. Is that correct . I thought the random article itself written by art kellerman was a thoughtful piece. What it actually said was that when the improvements in cost will occur are not after you read a paper or even have to pass a law. It is that you get 90 of adoption of Electronic Health records and interoperable guilty and they give us credit for progress on that. After you left patients get the data and when you pay for care differently. That is what the rand study, if you read the article as few journalists apparently dead [laughter] that is what the study actually says. It is not really a study because there is no real data analysis. It is a prospective peace. Is a prospective peace. Perspective piece. You guys here are about understanding that money may talk but information is power and data matters, evidence matters. It matters what they said. It matters what they actually found per it matters what the data says. I think that is something that is sometimes lost in the public discourse. People are more interested in writing about what the news article said rather than what the research shows. You serve a Critical Role in keeping the discourse honest. That is sometimes a tough task. Let me switch perspective a little bit right now. And turned to christine. There has been an interesting discussion in the lay press about european vs. American privacy laws. For those of you who are not absorbed by this kind of discussion, it is a little bit arcane, but they said that the European Union has a comprehensive set of commercial privacy regulations and the United States has something else. This is not irrelevant to the questions we are discussing because a lot of what we are concerned about in hightech and chr policy are similar. One of the points of discussion has been, with respect to high tech and implementation, whether we have gotten interrupt ability that was expected and promised. Can you talk a little bit, christine, about where we are with respect to the privacy and security protections that we would like to have in place to create the interoperable to we are all looking for . It is a complex issue in terms of the way consumers of view it. We have a brand new final omnibus privacy role that just came out. It has some terrific advancements for consumers. It will address some of the things i think made many of us think twice about electronic records when you go to the doctor for an exam and you get marketing materials a couple of days letter that worse this that were suspicious was specific to what you were there for. Those types of practices are going to be less and less amongst others. I think that is a terrific advancement. From a consumer viewpoint, when you ask consumers if they are worried that electronic shelf records will lead to more breaches, they say yes, absolutely. When you asked those consumers to have a physician that has an electronic record and, even better, if they have Online Access to that record and some level of transparency, their levels of trust are sky high in comparison. They are not among the most privacy protected consumers of this turns out to be a very nuanced and detailed discussion. Our survey showed, the one we did last year, is that there is a direct and significant correlation between the value you deliver to consumers with respect to Information Technology and other concerned about privacy and security. The other piece of this is that most consumers are not necessarily worried if you think about the privacy of the security. They are worried about what happens next and we dont have a comprehensive set of anti discrimination policies in this country that would protect us from those breaches and how that data gets used. But bank that is a concern but the other thing is we did a series of focus groups and we as consumers when you go to a health care system, what is your experience like . Their number one point was care acoordination. This is back in the aca debate and we said we are thinking about some ideas of the national level. How about health Information Technology or patientcentered medical home. Is not which is not a retirement home [laughter] we tested shared Decision Making and i almost fell off my chair when the number one Delivery System solution that spoke to their most pressing concerns was Information Technology. They are absolutely concerned about privacy and security but they also really want the benefits of technology. As they are now able to access and download and transmit their own Health Information, i think their experiences will be changing. Hopefully, positively. This issue of having the systems talk to each other we paid 10 billion to get to adopt the systems but they still dont talk to each other. That has to be challenged on three levels. One is on the technology level. There has to be standards that they agreed to. For being able to exchange complex in formation. It is thousands of data fields. They have to agree on those standards. That has not happened yet. There is not really a push and a way to accelerate consensus among these proprietary standards and vendor interests. We have that now. Stage two, we set out a set of clear and ambitious standards for Information Exchange and all the vendors over the next 10 months or so will be really working very hard to upgrade their systems to be able to meet those standards. That is part one. Part two is, you have to have a business reason to Exchange Information with a hospital across the street. Oftentimes, you can have all the Technology Standards in the world and if it is against the business interests of the hospital, that information will not move and we are seeing not just the accumulation of new pimmit models, this has started the and new payment models. I want them to know the information i have. Bumbled payments are the same thing, aco is the same thing, patients and a medical home these are adding up and the direction in private plans or commercial or state or medicare, the direction, you have to be able to coordinate care better and that is getting the Business Case in place which is not there yet but most ceos can see it is trending in that direction and the third part is trust. You get the cost of the interface down, you get the Value Proposition up, information can flow at the speed of trust. Establishing that trust is the really critical aspect which relates to the privacy and security. We have made it really easy for people when they have a business interest in the course of treatment for a patient, to have the summary and follow the patients. The transformative potential here over the next year is patients everywhere being able to get their own data and shared with whoever they want to share it with. Or whatever app they want to use. There is already an app for that. Making it real for people to be able to exercise hipaa right to get a copy of their Health Information with the same depth of information that conditions have and to be able to maybe not understand about be able to share it with the next provider they want to share it with. That will be they fact on the ground 12 months from now and it is largely not appreciated at the current time. Maybe you could be the joe flacco of information but if you dont have receivers down the field, you are in trouble . What does it feel like from a Delivery System standpoint to create interoperability. You have had Electronic Health records for a long time. Can you do what you want . We have had the luxury of time and we started this in 1999. To go back to synchronized swimming, it is not just the underneath, it is a lot of training that it takes to get to that kind of synchronicity and orchestration. We have had the dreams and visions that were talked about. We are realizing some of those benefits and the patients are telling us it takes a long time. It may take, at a minimum, one year to decide to do something and then get it implemented for a small practice and in a larger system, it is measured in years. Then you start the optimization. Really been a Meaningful Use Program that started may be less than two years ago. It would be unreasonable to expect that we know what has been accomplished. There were statistics earlier about what you can accomplish when you get this system in place. The most exciting and the most fun part about it has been what we have been doing with our patients. The slight twist the policy committee came up with is the engaged patients and families. Not only was this dhr phased in but making sure it gets out of patience and the transformation is that it gets to the patient, the knowledge and the tools we provide for patients to take much stronger interest and much back much more active role in their own health. It has been wonderful. The kinds of feedback we get from our patients, we have more than 3 4 of our positions on live with us. They get a return to their messages they sent on line within a day. That is really transformative in terms of what people feel like in terms of support for their own health. As you know, most of health and health care outside the organization, even for us, this is the only thing that has made that possible. When you ask about the change, that has been an enormous change. We have a ways to go on the technology and standards so there is more we can do. If i can just jump in i agree. The challenge of this town is not the patient. We have a challenge here because we have lots of pressure to really deliver because we see the rand study or the poll that said 47 of Consumers Want to cut it spending and i dont think thats what the data said. We have lots of pressure and i spent time on capitol hill last week and a Senior Committee step just wanted to know when the money will pay off. That is what they want to know. They dont really respond well to things like you need the Business Case and payment reform is coming but there is another thing and were innovating and testing. That does not work. What works is a story like paul or the transformation that has that has already happened among the systems that of done this before. The gap in the larger public dialogue that i am not seeing as much are the success stories, the people who say i could not have done this without Information Technology. I did a lot of things but that was essential. The reason that that narrative is critical is because this is absolutely about culture. It is about the way we engage families and partners. I think we have a gap that we are not accelerate the drive toward a different culture as much as we could and we need exemplars like palo alto and others and small practices. To the Health Policy analysts and researchers out there one request, maybe. It may be easier today to get an article published about how health it has failed to meet expectations and how it has succeeded. Thats probably true, right . Whatever the trend is now the reality is that what we need are not in inflicted stories positive or negative about whether it works or not, it is how. It is not whether, it is how. Too few studies look below the surface of whether it achieved whatever outcome it was supposed to. Obviously it can. It can improve safety, quality, because we have scores of those articles and the evidence is that it does but it is how. How did they do it in such a way as to accomplish that in ways that can be generalized . That is what we really need. This is happening. No one is going back to paper. It is a oneway process. This is inevitable but whether we get the most gains out of it will be depended on how well we implemented and learn from those successful implementations. I am now going to turn to our audience and invite questions about the how, when, why, whether. Use ant have to Electronic Health record to ask a question. You dont even have did know how to program. I see a shadow out there. Is that tom . Thinkont the i dont these are hooked up. I recognize the voice. I am from boston. I have been having a lot of fun experimenting with the notion of open notes and inviting patience to read the records we write. You are famous that you have done a lot. Why dont the patients at the palo alto clinic read the notes that the doctors right . What are the generic issues you think we will face before we get to that point . The software we use right now does not have that feature. I think it will just be a matter of a short time. We are looking including that as part of the use. It is a wonderful contribution. I think we could stand with battered knows because some of the issues we have talked about in terms of documentation, we are having a hearing on this next week to look at documentation in the context of fraud and abuse but cant we make it more useful and meaningful for both providers and patients. We have this documentation rules because we are on this fee doing things and you have to write down what you did. If we could go back to the old days and have it for communicating the interest of the Patients Health and care, it would be more meaningful for all of us. Ironically, aca gives us a chance to do that. The dream would be of we could go back to document in the care process away from the billing process, that would be a win win and that is almost a prerequisite for the meaningful mess of notes to patients. I would like to get our act cleaned up and have meaningful documentation and share with everyone. That would be the dream i would have. There is nothing we are on the way of going there in a big way for the country. Thank you. Next in line . I will keep going i am the president elect of the american osteopathic association. One of her remarks, great perspective, as i was briefly looking through the attendee list, clearly, theres a greater representation here today from academics, government people, policy, deep thinkers. We represent a large contingent of docs in the trenches on the front line and i dont want to forget that perspective here. You raised a core a question about the increasing the cost of care. You said this all takes time and youre both right. What we hear from the docks on the front lines is this is reducing productivity in our arcane system of billing and practice because it takes them longer to document. The paradox is in our arcane system of billing and practice. The Health Record affords the opportunity to create more scrutinized, perot documentation. Lets put from the site for a moment. The whole system is based on complexity of thinking, medical risk, complexity of Decision Making and, all of a sudden, you can create template, a checklist, which we know improves quality and consistency, to go crawled those c

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