While American healthcare has been at the confluence of pressures to improve the quality and safety of care, the HITECH and Affordable Care Acts offer a renewed call for the integration of information technology in all aspects of health care delivery. Many clinicians are uncertain about the relationship of these HHS initiatives—to improve quality and promote the adoption, and meaningful use, of health information technology. As we prepare for the second stage of Meaningful Use this discussion will examine our current state, our trajectory, and practical opportunities for clinicians and providers to leverage information technology to improve the quality and efficiency of the care they provide—part of this discussion must include the clear challenges on this path. When viewed in this context, we will better understand the inextricable relationship between the meaningful use of electronic health records, our national healthcare quality agenda, healthcare reform, and the individual capacity of each physician to improve the quality and efficiency of the care delivered through his/her practice.

1. Louis Pasteur 1822-1895
In the field of
Dans les champs de
observation, chance
l'observation le
favors the prepared
hasard ne favorise
mind. esprits
que les
préparés.
Lecture, University of Lille (7 December 1854)
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2. Clinicians' Role in IT
David R. Hunt, MD, FACS
Medical Director, Health IT Adoption & Patient Safety
ONC, Office of the Chief Medical Officer

3. David R. Hunt, MD, FACS has no real
or apparent conflicts of interest to
report

4. Take Home Messages
• Clinicians must lead
• Success is wholly dependent on
partnership
• The path forward requires a
system, resources, and courage
4

5. Where
Adverb: (‘)hwe(Ə)r
1. at, in, or to what place < ~ is the house>
2. at, in, or to what situation, position,
direction, circumstances, or respect
<shows ~ the plan leads>
3. archaic : here, there < <lo, ~ it comes
again – Shak. >
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6. Health care should be:
Safe Efficient
Effective Timely
Patient Equitable
Centered Crossing the Quality Chasm: A New Health
System for the 21st Century (2001)
Institute of Medicine (IOM) ; pg. 39

7. How
Adverb: (‘)haῢ
1. in what manner or way
2. with what meaning: to what effect
3. by what name or title < ~ art thou called>
4. for what reason: why
5. to what degree or extent
6. in what state or condition <~ are you>
7. at what price <~ a score of ewes now>
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8. William Osler, M.D.
(1849 – 1919)

9. HHS Priorities & Clinical
Quality Measures Alignment
All providers must select CQMs from at least 3 of the 6
HHS National Quality Strategy domains:
• Patient and Family Engagement
• Patient Safety
• Care Coordination
• Population and Public Health
• Efficient Use of Healthcare Resources
• Clinical Processes/Effectiveness
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10. Dr. Adam Smith
“Quality, however, is so very
disputable a matter that I look
upon all information of this kind
as somewhat uncertain.”
An Inquiry into the Nature And Causes of the Wealth of Nations
Book One, Chapter 11
1776

11. March 14, 2007—Vol 297, No. 10, pg. 1103
“…health care reform must focus on improving
health and health care value for patients…
…Physicians can lead this change and return the practice of
medicine to its appropriate focus: enabling health and effective
care.”
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12. Clinical Quality Measures
• Conditions that contribute to the morbidity
and mortality of the most Medicare &
Medicaid beneficiaries
• Conditions that represent national
public/population health priorities
• Conditions that are common to health
disparities
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13. EHR Adoption
Office-based Providers
ONC, Health IT Dashboard (July 2012)
Data from the CDC National Ambulatory Medical Care Survey (NAMCS)
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14. Meaningful Use
Eligible Provider Registrations
Total = 267,221
Source: CMS EHR Incentive
Program Data as of 7/31/2012
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15. Payments to Eligible Professionals and
Hospitals Under EHR Incentive Programs
Source: CMS EHR Incentive Program
Office of the National Coordinator for Data as of 7/31/2012
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16. Health IT Workforce Training
Number of students who successfully completed the Community College Consortia Program by state:
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17. Office of the National Coordinator for
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18. Quality of Diabetes Care:
EHR vs. Paper Medical Records
% of Patients Receiving Care
A significantly higher proportion
of patients being treated by
physicians with EHRs received
care that aligns with accepted
treatment standards *
Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of
Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from * Even after adjusting for patient demographic characteristics and insurance type,
http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article differences remain significant; p<0.001

19. Health Outcomes :
EHR vs. Paper Medical Records
% of Patients Obtaining Outcome Standards
A significantly higher
proportion of patients being
treated by physicians with
EHRs obtained better
outcomes*
Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of
Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from * Even after adjusting for patient demographic characteristics and insurance type,
http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article differences remain significant; p<0.005

20. LaSalle D. Leffall, Jr., M.D.
“There are two
diagnoses you will
never make: the
one you don’t
know about and
the one you don’t
think about.”

21. Malpractice Claims and EHRs
The relationship between electronic health records
and malpractice claims.
Quinn MA, Kats AM, Kleinman K, Bates DW, Simon SR.
Arch Intern Med. 2012 Aug 13;172(15):1187-9.
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22. 2011 Nov 10;365(19):1758-9. Epub 2011 Nov 2.
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23. “…in the light of experience as
guided by intelligence.”
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24. Men at some time are
masters of their fates; The
fault, dear Brutus, is not in
our stars, but in ourselves
Julius Caesar I. ii
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25. Louis Pasteur 1822-1895
Dans les champs de
l'observation le hasard
ne favorise que les
esprits préparés.
Lecture, University of Lille (7 December 1854)
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26. Thank You
Contact Information
davidr.hunt@hhs.gov
www.healthit.gov