Across the country, health care providers are making significant investments to redesign care processes and strengthen their health information technology (health IT) capabilities with the goal of achieving better care, better health, and lower costs. For the American health care system as a whole, the simultaneous pursuit of all three of these aims is essential to sustaining any one of them.

Over the years, economists and health IT experts have projected a wide range of cost savings from health IT implementation. These kinds of analyses are challenging because they require experts to predict how health IT will influence changes in provider and consumer behavior, and how those changes in behavior in turn influence quality and financial outcomes.

Yet it is still important to understand how health IT can support the nation’s efforts to “bend the cost curve” and ultimately slow the growth of health care spending, while improving outcomes and the health of the population. Within this context, a single health care health IT-enabled intervention that achieves the goal of improving health care quality may be more likely to spread if that intervention has also demonstrated measurable net reductions in health care expenditures.

Roundtable to Promote Value in America’s Health Care System

On October 28, 2011, the Engelberg Center for Health Care Reform at the Brookings Institution and the Office of the National Coordinator for Health Information Technology (ONC) convened a small group of national experts—economists, actuaries, and health IT experts from the private sector and government—to discuss common approaches for understanding the financial impact of clinical interventions that make use of health IT.  At the meeting, entitled the “Roundtable to Promote Value in Health Care,” the expert panelists analyzed the potential financial impacts of health IT-enabled interventions being implemented in three Beacon Communities (in central Pennsylvania , Tulsa , and western Colorado ) and considered lessons for other communities and care delivery organizations embarking on similar care innovations.

“Developing tools for measuring cost impact from multiple perspectives has been an objective for the Engelberg Center for some time,” said Mark McClellan, director of the Engelberg Center for Health Care Reform. “I thought the meeting was hugely productive, and we look forward to sharing the output.”

One of the Problems

The organizations that implement innovative interventions that result in quality improvements and cost reductions are often not the sole beneficiaries of these interventions’ cost savings. Providers often touch patients covered by multiple insurers (such as Medicare, Medicaid, private insurers, and employer-owned health plans), each with its own strategic and financial imperatives. Encounter-based claims data and other information needed to measure holistic cost impact can be inaccessible, leading implementing organizations to take a “wait and see” approach. For example, they may hope that clinical improvements such as reduced readmissions will convince payers or other stakeholders to work with them to sustain the intervention, even though the impact on costs may not be fully demonstrated.

How the Beacon Communities Fit In

The Beacon Community Program funded 17 communities with average three-year awards of $15 million each to demonstrate replicable health IT-enabled interventions that achieve the three-part aim. In many ways, these communities are no different from delivery systems and their partnering organizations that are working on health IT-enabled transformations across the country. However, by participating in the Beacon Program, they have agreed to openly share their processes of change, including their processes for engaging payers in conversations about financial impact and sustainability. Part of our job at ONC is to ensure we learn as much as possible from these innovative communities, and share their lessons effectively with the rest of the country.

What We Accomplished

The Engelberg Center’s roundtable discussion was not intended to serve as a formal evaluation meeting that would render a final evaluation of the Beacon Communities’ current efforts. Rather, the output of this meeting made it easier for Beacon Communities and others engaged in similar work around the country to prospectively study the impact of promising IT-supported care improvement initiatives on overall health care spending.

“This meeting was overdue,” said Aaron McKethan, former director of the Beacon Community Program. “While some of the Beacon Communities are advanced in their payer relationships and in measuring cost savings, there are many implementers out there who are not yet able to show the payer community that claims about the cost effects of their interventions are credible. This creates noise, and it is hard to differentiate between what will have a real sustainable impact, and what will only increase health care spending in the long run.”

George Schneider, chief financial officer at Geisinger Health System, Keystone Beacon Community, added:

“As a health plan as well as a delivery system, Geisinger is a strong believer in the idea that high quality care is efficient care. Providers are partners with insurers in developing innovations in the care delivery process supported by innovations in reimbursement approaches that include payments for quality. We were very pleased to have an opportunity to share our experience in cost measurement with the Roundtable and to learn how other Beacons are addressing critical measurement and partnership issues around paying for quality in their own communities.”

What Are These Beacons doing?

• The Keystone Beacon Community is using health IT to support chronic disease management for persons with frailty and multiple chronic conditions, aiming to reduce avoidable hospital admissions and other preventable forms of health care utilization while improving quality of life for patients;
• The Colorado Beacon Community is training physician practices how to most effectively take advantage of making meaningful use of health IT to improve care;
• The Tulsa Beacon Community is using health IT in new and exciting ways to help doctors in different clinical settings involved in a patient’s care to communicate more effectively about how best to support the patient and his caregiver in receiving optimal care.

These efforts are representative of Beacon Communities more broadly and are similar to initiatives cropping up across the country.

We Want to Hear From You!

We look forward to sharing additional outputs of this meeting and ongoing efforts to learn from all of our Beacon Communities. Stay tuned and please share your comments!

To Learn More

• Beacon Community Program
• HealthIT.gov

Across the country, health care providers are making significant investments to redesign care processes and strengthen their health information technology (health IT) capabilities with the goal of achieving better care, better health, and lower costs. For the American health care system as a whole, the simultaneous pursuit of all three of these aims is essential to sustaining any one of them.¹

Over the years, economists and health IT experts have projected a wide range of cost savings from health IT implementation. These kinds of analyses are challenging because they require experts to predict how health IT will influence changes in provider and consumer behavior, and how those changes in behavior in turn influence quality and financial outcomes. Yet it is still important to understand how health IT can support the nation’s efforts to “bend the cost curve” and ultimately slow the growth of health care spending, while improving outcomes and the health of the population. Within this context, a single health care health IT-enabled intervention that achieves the goal of improving health care quality may be more likely to spread if that intervention has also demonstrated measurable net reductions in health care expenditures.

Roundtable to Promote Value in America’s Health Care System

On October 28, 2011, the Engelberg Center for Health Care Reform at the Brookings Institution and the Office of the National Coordinator for Health Information Technology (ONC) convened a small group of national experts—economists, actuaries, and health IT experts from the private sector and government—to discuss common approaches for understanding the financial impact of clinical interventions that make use of health IT.  At the meeting, entitled the “Roundtable to Promote Value in Health Care,” the expert panelists analyzed the potential financial impacts of health IT-enabled interventions being implemented in three Beacon Communities (in central Pennsylvania , Tulsa , and western Colorado ) and considered lessons for other communities and care delivery organizations embarking on similar care innovations.

“Developing tools for measuring cost impact from multiple perspectives has been an objective for the Engelberg Center for some time,” said Mark McClellan, director of the Engelberg Center for Health Care Reform. “I thought the meeting was hugely productive, and we look forward to sharing the output.”

One of the Problems

The organizations that implement innovative interventions that result in quality improvements and cost reductions are often not the sole beneficiaries of these interventions’ cost savings. Providers often touch patients covered by multiple insurers (such as Medicare, Medicaid, private insurers, and employer-owned health plans), each with its own strategic and financial imperatives. Encounter-based claims data and other information needed to measure holistic cost impact can be inaccessible, leading implementing organizations to take a “wait and see” approach. For example, they may hope that clinical improvements such as reduced readmissions will convince payers or other stakeholders to work with them to sustain the intervention, even though the impact on costs may not be fully demonstrated.

How the Beacon Communities Fit In

The Beacon Community Program funded 17 communities with average three-year awards of $15 million each to demonstrate replicable health IT-enabled interventions that achieve the three-part aim. In many ways, these communities are no different from delivery systems and their partnering organizations that are working on health IT-enabled transformations across the country. However, by participating in the Beacon Program, they have agreed to openly share their processes of change, including their processes for engaging payers in conversations about financial impact and sustainability. Part of our job at ONC is to ensure we learn as much as possible from these innovative communities, and share their lessons effectively with the rest of the country.

What We Accomplished

The Engelberg Center’s roundtable discussion was not intended to serve as a formal evaluation meeting that would render a final evaluation of the Beacon Communities’ current efforts. Rather, the output of this meeting made it easier for Beacon Communities and others engaged in similar work around the country to prospectively study the impact of promising IT-supported care improvement initiatives on overall health care spending.

“This meeting was overdue,” said Aaron McKethan, former director of the Beacon Community Program. “While some of the Beacon Communities are advanced in their payer relationships and in measuring cost savings, there are many implementers out there who are not yet able to show the payer community that claims about the cost effects of their interventions are credible. This creates noise, and it is hard to differentiate between what will have a real sustainable impact, and what will only increase health care spending in the long run.”

George Schneider, chief financial officer at Geisinger Health System, Keystone Beacon Community, added:

“As a health plan as well as a delivery system, Geisinger is a strong believer in the idea that high quality care is efficient care. Providers are partners with insurers in developing innovations in the care delivery process supported by innovations in reimbursement approaches that include payments for quality. We were very pleased to have an opportunity to share our experience in cost measurement with the Roundtable and to learn how other Beacons are addressing critical measurement and partnership issues around paying for quality in their own communities.”

What Are These Beacons doing?

• The Keystone Beacon Community is using health IT to support chronic disease management for persons with frailty and multiple chronic conditions, aiming to reduce avoidable hospital admissions and other preventable forms of health care utilization while improving quality of life for patients;
• The Colorado Beacon Community is training physician practices how to most effectively take advantage of making meaningful use of health IT to improve care;
• The Tulsa Beacon Community is using health IT in new and exciting ways to help doctors in different clinical settings involved in a patient’s care to communicate more effectively about how best to support the patient and his caregiver in receiving optimal care.

These efforts are representative of Beacon Communities more broadly and are similar to initiatives cropping up across the country.

We Want to Hear From You!

We look forward to sharing additional outputs of this meeting and ongoing efforts to learn from all of our Beacon Communities. Stay tuned and please share your comments!

To Learn More

• Beacon Community Program
• HealthIT.gov

When Aurora Health Care—Wisconsin’s largest non-profit health care network—needed assistance with electronic health record (EHR) implementation at one of its area hospitals, it reached out to the Milwaukee Area Technical College (MATC).

Milwaukee Area Technical College is one of the 82 community colleges funded by the Office of the National Coordinator for Health Information Technology’s (ONC) Community College Consortia Program to offer and develop health information technology (health IT) training programs.

Students in the Milwaukee Area Technical College health IT program are being trained to help health care providers across the country adopt EHRs and other health IT tools so they can better and more efficiently care for their patients.

Recruiting Students to Help Accelerate EHR Adoption

Aurora Health Care was in the process of carrying out an accelerated EHR adoption and deployment plan at one of its largest hospitals, and it needed qualified health IT professionals to assist. The hospital was specifically seeking:

• Health IT professionals who could work directly with health care providers, and
• IT professionals who could work on the system or design workflows for the implementation of the EHR system.

To help Aurora fulfill its employment needs, Dr. Richard Ammon, associate dean of health sciences at Milwaukee Area Technical College and director of the college’s Health Information Technology Certificate Program, used the resources of the college to refer students from the health IT program to Aurora Health Care. As a result, Aurora hired 11 MATC health IT recent graduates and students at the area hospital!

“In going through the interview and hiring process, we felt these MATC graduates had more than just the skills the job required, but also came from diverse backgrounds and had strong problem-solving faculties,” said Russ Hinz, director of hospital deployments at Aurora Health Care.

“We are pleased with the individuals we hired from MATC and look forward to future opportunities.”

About the Health IT Program at Milwaukee Area Technical College

MATC’s health IT program is designed to train existing health care, IT, and project management professionals in new and emerging health IT professions. The program helps students leverage their existing experience and apply their new skills in real-world settings.

“Our goal is three-fold,” said Dr. Ammon of MATC. “Recruit students, train them, and help them to make the link between the curriculum that they have learned, their prior experience, and the employer.”

Unique Approach to Helping Students Obtain Health IT Careers

With Aurora Health Care, MATC had a unique opportunity to showcase its students’ previous work experience and current health IT training. To help introduce its students to other potential employers, MATC uses a “trading card” approach. The trading card features a photo of the MATC student as well as a snapshot of his or her professional and academic experience, which MATC distributes at job fairs and health IT-related organizations.

In addition to networking students with companies, using trading cards, and job fairs, MATC also uses a job board to connect students with potential health IT job opportunities.

Bright Future for Health IT Professionals

This story is but one example of how community colleges across the country, part of the Community College Consortia Program, are working hard to train the health IT workforce needed to help America modernize its health care system through health IT. The good news for health IT students is that employers are actively seeking such skilled and qualified health IT workers!

For More Information

• Community College Consortia Program

• Milwaukee Area Technical College HIT Program

For more information on health information technology, visit HealthIT.gov.

When a child suffers an asthma attack at school, getting the right care at the right time is critical. To respond effectively, school employees need more than quick thinking and general training—they need sound policies and specific action plans that address the needs of individual students.The Southeast Minnesota Beacon Community Program, which promotes health information exchange in its 11-county service area, has launched a school asthma management program. The goal is to help schools work with parents and health care providers to create a “cocoon of care” for students who have chronic asthma.

An Asthma Management Toolkit for Schools

The first stage of the program is a web-based asthma management toolkit that offers multiple resources and templates for school administrators, nurses, teachers, and other staff, including:

• A written action plan for every student with asthma, including the student’s medical information, daily management guidelines, and specific steps for responding to worsening asthma symptoms
• Written policies and processes for parental consent
• Specific actions staff members can perform as part of an asthma management program
• School policies and procedures for administering medications, including protocols for emergency response to a severe asthma episode
• Education for staff and students about asthma
• Communication templates

The asthma management toolkit is now available to 48 school districts in southeastern Minnesota, where an estimated 12 percent of the area’s 14,000 students have chronic asthma. Schools are already using toolkit resources to adopt parental consent policies and establish individual treatment protocols for affected students.

“This asthma management toolkit will help districts promote school environments where children with asthma can feel safe, be healthy, and remain active,” says Barbara Yawn, M.D., a Beacon co-investigator and pioneer of the Community Collaborative Asthma Project in Olmsted County. “We are very pleased that Beacon gives us the opportunity to develop reliable ways to share asthma-related information between physicians, parents, school nursing and other staff. It is so important that schools and parents have up-to-date and accurate information immediately available to deal with changes in symptoms or asthma attacks.”

Linking Schools with Parents and Providers

Stage two of the program will incorporate technologies that improve access to students’ medical information, efficiency in emergency response, confidential student tracking, and direct lines of communication with health professionals.

Participating schools will benefit from an electronic portal that stores care plans for individual students (with appropriate consent) and enables electronic incident reporting as well as direct communication with parents and providers.

Here is how the system will work when a student has an asthma attack at school:

• The school nurse has immediate access to the latest asthma action plan from the student’s health care provider. The nurse provides treatment per the plan.
• The nurse electronically logs an incident report of the visit and unplanned intervention and communicates with the parent and the provider.
• If the student visits the nurse’s office following the initial incident, the student’s physician and parents receive an electronic message notifying them of the visit, as well as a request to review and/or update the student’s asthma action plan.

Safeguarding Information

Safeguarding sensitive information is a lynchpin of the program’s design. All exchanges of information about a student will take place with previous consent.

“No one’s health information should be put at risk. That’s why we are developing safeguards and protections to improve security even further,” says Christopher Chute, M.D., Dr. P.H., Mayo Clinic informatics investigator. “All health care information involved in the network is used only with the informed and signed consent of the patient or their parents.”

Right Care at the Right Time

By connecting parents and health care providers, and linking them with technologies to improve care for students, the Southeast Minnesota Beacon Community is helping enable schools across the state ensure that students who have an asthma attack at school get the right care at the right time.

To Learn More

• Asthma Management Toolkit
• Southeastern Minnesota Beacon
• ONC’s Beacon Community Program

For more information on health information technology, visit HealthIT.gov.

Earlier this month, I wrote about some of the most important and notable highlights in the world of health IT and ONC over the past year. The achievements of 2011 built on hard work and progress, which has been underway for many years.The HITECH Act is helping to accelerate this momentum—like a turbocharger in a racecar.

As we start the New Year, I am excited about what the future holds and want to share what I see as five big health IT trends for the year to come.

Meaningful Use Takes Off. We sometimes refer to the stages of Meaningful Use as an escalator because it will get more rigorous and sophisticated over time. We might equally call it the necessary foundation upon which to build a truly 21^st Century health system where care is better coordinated, patient-centered, safer, and where we pay for the right care, not just more care. Successfully attesting to Meaningful Use will not by itself achieve these goals, but it does help ensure providers have the right information at the right time so patients get the right care.

As I mentioned in my previous blog, by the end of November 2011, more than 20,000 eligible professionals and 1,200 hospitals had received payments from the Medicare or Medicaid EHR Incentive Programs. These are pretty good numbers for the first year of a new program, especially when it involves doctors and hospitals making investments in new technology and changes to clinical workflow. There are other good signs that providers are taking up the challenge, including a survey indicating that attainment of Meaningful Use is a top priority for more than two-thirds of hospital executives and a five-fold increase in electronic prescribing by office-based physicians since 2000. My prediction is that at least 100,000 providers will receive Medicare or Medicaid EHR incentive payments by the end of 2012. But, in order for my prediction to come true, the entire health IT ecosystem, including technology vendors, physician and hospital leaders, Regional Extension Centers, state-level health IT coordinators, public health agencies, and many others need to pull together toward getting as many providers to Meaningful Use as possible. Let’s make 2012 the Year of Meaningful Use!

Health Information Exchange Turns a Corner. A key element of the Meaningful Use roadmap is the electronic exchange of important clinical information. With the foundation we have built in Stage 1, increasingly rigorous health information exchange requirements in Stage 2 and payment reform as a constant drumbeat, I think exchange will take off in 2012.

The Direct Project now provides a simple, secure, standardized way to send encrypted health information to trusted recipients over the Internet, enabling providers to meet Stage 1 Meaningful Use exchange requirements. Through intensive collaboration with on-the-ground implementers, the protocol went from concept, to specification, to pilot testing in just a few months, and now we are seeing widespread adoption by EHR and health information exchange  vendors. Increased use of Direct should go a long way toward replacing the slow and inefficient way most providers currently share information via phone, fax, and mail—ultimately improving patient care and outcomes. However, Direct is only the first step in achieving the health information exchange we will need in the future.

Standards development is now focusing on the Nationwide Health Information Network (NwHIN) since the health information exchange requirements will become more rigorous in Stage 2 of Meaningful Use in order to support the care coordination functions and advanced care processes that providers will need to succeed under new payment approaches. As the business value for exchange increases, our standards efforts will bear fruit, reducing the cost and complexity of implementing basic exchange functions like sending a care summary or receiving lab results. With increased value and lowered cost, information will start to flow. But, it will only move at the speed of trust. Here too, ONC efforts are critical. Robust policies that protect information and create public trust will galvanize rapid growth and innovation in health information exchange.

Connecting the Dots on Health IT and Payment Reform. It is widely recognized that fee-for-service payment for health care tends to reward volume while providing little incentive to furnish care in ways that drive toward improved health outcomes or efficiency. All that is changing before our eyes as more health systems move away from fee-for-service and toward payment models that incentivize care coordination, quality improvement, prevention, and more efficient use of resources. New payment models, such as accountable care organizations, patient-centered medical homes, bundled payments, and quality measurement/improvement initiatives may seem disconnected from each other, but they all have a common denominator: Success depends on better information about each patient’s health needs than paper records can provide.

As more providers adopt EHRs and go through the process of attesting to Meaningful Use, I believe they will increasingly see the direct connections between health IT, new payment models, and the ways in which the former can help them succeed with the latter. Moreover, EHRs, health information exchange, and other forms of health IT will increasingly be seen as key enablers within new payment models themselves. We are headed toward a virtuous cycle where payment reform improves the business case for using health IT and greater use of health IT improves the chances that new payment models will succeed.

Consumers Use eHealth to Get More Involved. I believe this year we will see consumers and patients use information technology to become better informed about their health and more engaged with their own care than ever before. In large part, this will happen because it’s becoming easier for consumers to electronically access their own information. Personal health records are becoming easier to use as more data holders make it possible to download information through tools like Blue Button. Many health care providers are setting up patient portals which are directly connected to their EHRs. The Medicare and Medicaid EHR Incentive Programs already require providers to give patients access to their electronic health information, and I anticipate future stages will build on that notion. And the work that is being done on standards and interoperability will help make consumer access to their health information more seamless and more useful.

In addition, developers are coming out with more apps for mobile devices that make it easier for consumers and patients to get information about different diseases and track their own health over time. Along those lines, several Beacon Communities have launched txt4health, a consumer engagement campaign that uses cell phone text messaging to deliver information about diabetes care and management. ONC will diligently keep encouraging the marketplace to develop mobile apps and other consumer-friendly platforms that get patients engaged by sponsoring challenges like the Healthy Apps Challenge. Once consumers start to see their own information, they will be more empowered to be partners in their own care and come to expect that providers will use health IT as a tool to help deliver high-quality care.

Innovation Drives Improvement. Innovation is the lifeblood of technology, whether we are talking about health IT or otherwise. For health IT, innovation is being driven on many fronts, including ways of making EHR systems easier and less expensive to install and maintain, such as software-as-a-service and web-based systems. Mobile devices such as smart phones and tablets are being directly integrated into health IT systems, and I expect this trend will continue to pick up speed as capabilities such as voice recognition are perfected. The growing emphasis on value-based payment models will help fuel innovation around products and services that help providers perform quality measurement/improvement and population health management. There will be increasing emphasis on data analytics and finding ways of using data to support population health management, as well as feed information back into EHRs in ways that support a learning health system.

Innovation will continue to influence and support all the other key factors I’ve mentioned here, and ONC will continue working with the market to foster innovation, including sponsoring challenges and encouraging focused collaboration. One particular aspect of health IT innovation to watch in 2012 is an increased emphasis on advancing the usability of EHRs. ONC has resources concentrated on promoting innovation while encouraging vendors and other stakeholders to learn systematically and act rapidly to continually improve usability.

In summary, I see 2012 as the year in which health IT truly comes of age. While much work still needs to be done, the groundwork is firmly in place for what promises to be a breakthrough year in the adoption and widespread use of health IT in ways that improve care for individuals, improve health outcomes for populations, and increase the value we get from our health care dollars.

I am excited to be a part of it and look forward to seeing these trends (as well as many others) unfold in the year and years ahead. I encourage each of you to get engaged now to help shape our bright future.

For more information on health information technology, visit HealthIT.gov.