Using Technology to Bridge the Chasm of Quality in Healthcare
Facts Driving SDCMS Foundation Concerns
Medical bills = #1 cause of personal bankruptcy in the U.S
U.S. has 45 million uninsured and 40 million underinsured
U.S. spends 1.5-3X more per capita as countries with universal healthcare and yet the outcomes are no better
Healthplans collectively profited $4 billion last year
Patient are shouldering more of the costs of healthcare with deductibles and copays increasing & benefits decreasing
Plans are dropping out of non-profitable markets.
Corporate corruption / Obscene executive salaries
Medical errors have not decreased despite cost increase
VA-like bidding would yield Medicare savings of $1 billion/yr
On average, 30% of premiums are not spent on patient care

Improve access to quality medical care
Increase the quality of health care
Improve the health of San Diego County residents
Improve patient safety and reduce medical errors
Improve the coordination and timeliness of care
Improve access to all information necessary to make the best decisions for patients at the point of care
Improve health literacy
Help ALL physicians in the county achieve these goals
Physician Goals for Technology

Improve quality, service, and safety of medical care
Increase the efficiency of workflow
Secure single sign on tool to import ALL data to the point of care in an easy to read integrated format
Clinical guidelines and decision support
Continuing education
Patient risk assessment
Community continuity of care records & registries
Automated patient reminders
Eligibility/Benefits/Claims verification
e-Rx: eliminate handwriting error & adverse reactions
Maintain privacy and confidentiality

Barriers to MD Adoption of Technology
Cost: Most of the Savings Accrue to the Healthplans
History of false starts
Time: Physicians are swamped with regulations (HIPAA)
Lack of standards and interoperability (HL-7)
Privacy and Security: Fear of profiling
Stakeholder commitment: Silo mentality & Competition
Healthcare industry in general is slow to change

Physicians are technophiles and recognize the value of Technology in Patient Safety and Quality Improvement

HIPAA Health Insurance Portability and Accountability Act
Administrative Simplification
Common interchange structure
Standard employer/provider identifier
Electronic signature with specific transactions
Data transmission for benefits/claims

Information Privacy
Rights of individuals to records
Authorized uses and disclosures of information
Requires identity authentication of requestor/provider of health records

SureScripts = single portal to all SD Pharmacies Increases the efficiency, quality and safety of prescribing
Based in Alexandria,VA
Formed in August 2001
Formed by:
Strategic industry alliance to:
Promote true electronic connectivity between physicians and pharmacies
Enable widespread prescribing connectivity (local and national)
Reduce medical errors
Current System Plagued by Serious Quality and Patient Safety Problems
Patient safety
*1.5% to 4.0% of Rx’ s have errors with potential for serious patient risk
Quality of care
*1.1 billion scripts never filled
* Patient satisfaction issues
Potential Savings: $ 2 billion / yr
Impact on productivity
*Physician time:1 hour per day
*Pharmacy: 4 hours per day

Illegible handwriting
Phone tag and fax tag
Patient waiting in the pharmacy

Predictors of Health
Racial +/- Ethnic Group
Education Level
Employment status
Geographic Location of Home

Consequences of Poor Health Literacy
Lack of compliance with medical regimen including missed appointments
Medication errors and medication noncompliance
Late diagnosis
Limited preventive care
Malpractice suits

Physicians agree that one of their most important tasks is PATIENT EDUCATION
more than half of our patients are unable to understand

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