Press Conference: Final Rules to Support Meaningful Use of EHR (07/13/2010)

--> GOOD MORNING EVERYBODY. IT'S NICE TO SEE STANDING ROOM
ONLY CROWD. WE ARE PLEASED YOU COULD JOIN US
TODAY. I AM PLEASED TO HAVE THREE OF
OUR GREAT LEADERS HERE WITH ME, AS WELL AS A WONDERFUL CONSUMER
ADVOCATE TO TALK ABOUT THIS IMPORTANT REGULATION THIS
MORNING. ON THE STAGE ARE DON BERWICK,
OUR NEW ADMINISTRATOR FOR THE CENTERS FOR MEDICAID AND
MEDICARE SERVICES. [APPLAUSE]
DR. DAVID BLUMENTHAL, WHO IS THE NATIONAL COORDINATOR
FOR HEALTH INFORMATION TECHNOLOGY AND SURGEON GENERAL
REGINA BENJAMIN AND I'LL INTRODUCE THE OTHER REGINA IN A
MINUTE. I WANT TO ALSO RECOGNIZE THAT
MANY REPRESENTATIVES OF THE DOCTOR, HOSPITAL, CONSUMER,
PATIENT AND EMPLOYER COMMUNITY ARE HERE TODAY AND PROVIDED
REALLY CRITICAL INPUT INTO THIS REGULATION.
REGINA HOLIDAY, WHO IS ALSO ON STAGE, IS WITH US.
REGINA IS AN ARTIST HERE IN THE DISTRICT OF COLUMBIA AND HAS A
PERSONAL SITUATION THAT REALLY ILLUSTRATES THE CRITICAL NEED
FOR ELECTRONIC MEDICAL RECORDS. THE INPUT OF THOSE OF YOU IN THE
ROOM AND THOUSANDS ACROSS THE COUNTRY, IS VERY CRITICAL IN
TERMS OF THE SUCCESS OF THE PROGRAMS WE ARE ANNOUNCING TODAY
AND THE EFFORTS REALLY TO IMPROVE OUR HEALTH CARE SYSTEM.
YOU HAVE ALREADY GIVEN A WARM WELCOME TO DON BERWICK, BUT IT'S
REALLY APPROPRIATE HE IS HERE WITH US, FINALLY, AS ONE OF THE
COUNTRY'S FOREMOST EXPERTS ON RAISING THE QUALITY OF MEDICAL
CARE, SOMEONE WHO HASN'T JUST WRITTEN ABOUT THIS, BUT WORKS
WITH PROVIDERS ACROSS THE COUNTRY TO IMPLEMENT QUALITY
MEASURES. AND WE ARE SO PLEASED TO HAVE
HIM TAKE THIS IMPORTANT LEADERSHIP ROLE AT CMS.
IF YOUR GOAL IS TO BUILD A HEALTH CARE SYSTEM THAT KEEPS
PATIENTS HEALTHIER AND GIVES CONSUMERS A BETTER BANG FOR
THEIR BUCK, THERE REALLY IS NO ONE ELSE IN THE COUNTRY BETTER
SUITED TO DO THAT AND LEAD THAT EFFORT THAN DR. BERWICK.
WE HAVEN'T WASTED ANY TIME. HE WAS SWORN IN YESTERDAY
AFTERNOON AND WE'RE PUTTING HIM TO WORK RIGHT AWAY.
WE ARE GLAD TO HAVE HIM HERE BECAUSE THIS IS SUCH A CRITICAL
TIME FOR OUR ENTIRE HEALTH CARE SYSTEM, JUST A LITTLE OVER THREE
MONTHS AGO, THE PRESIDENT SIGNED INTO LAW THE HISTORIC AFFORDABLE
CARE ACT. AND A LOT OF THE FOCUS WAS
MAKING OUR HEALTH SYSTEM AND OUR HEALTH INSURANCE MARKETS WORK
BETTER FOR CONSUMERS, AND THERE HAS BEEN A LOT OF PROGRESS MADE
AND A LOT OF FOCUS AND ATTENTION ON THAT AREA, THE PATIENT'S BILL
OF RIGHTS, AND IMPLEMENTED A SERIES OF CHANGES ALREADY IN THE
MARKETPLACE, HEALTH CARE.GOV, OUR NEW WEBSITE THAT WAS
LAUNCHED AND HELPED CONSUMERS FIND THEIR WAY THROUGH THE
MARKETPLACE. THE STATE-BASED INSURANCE PLANS
WHICH HAVE GONE INTO AFFECT THAT WILL PROVIDE AN ADDITIONAL
ALTERNATIVE FOR THOSE AMERICANS WHO ARE OR HAVE BEEN LOCKED OUT
OF THE INSURANCE MARKET BECAUSE OF SOME PREEXISTING HEALTH
CONDITION. BUT IN EQUALLY IMPORTANT AND
UNDERLYING GOAL WAS MOVING AMERICANS TOWARDS A 21st
CENTURY HEALTH CARE SYSTEM WHERE PATIENTS AND DOCTORS TOOK MORE
CONTROL OVER HEALTH CARE. WE KNEW WU COULDN'T DO THAT
WITHOUT A ROBUST NATIONAL SYSTEM OF HEALTH INFORMATION
TECHNOLOGY. ELECTRONIC HEALTH RECORDS ARE
THE FOUNDATION OF A HIGH PERFORMING, HIGH QUALITY HEALTH
CARE SYSTEM. IF YOU WANT TO IMPROVE THE
QUALITY OF CARE, YOU NEED TO BE ABLE ACCURATELY MEASURE WHAT IS
GOING ON. YOU WANT TO PROMOTE GREATER
COORDINATION AMONG DOCTORS. YOU NEED TO QUICKLY MOVE HEALTH
INFORMATION TO WHEREVER IT IS NEEDED AT THE APPROPRIATE TIME.
IF WE WANT TO EMPOWER CONSUMERS TO TAKE HOLD OF THEIR OWN HEALTH
CARE, THEY NEED TO BE ABLE TO ACCESS THEIR OWN HEALTH
INFORMATION WITHOUT CALLING ON MULTIPLE PROVIDERS OFFICES.
ELECTRONIC HEALTH RECORDS MAKE ALL OF THESE TRANSFORMATIONS
POSSIBLE. WHEN THE RECORD IS WELL DESIGNED
AND IMPLEMENTED CORRECTLY, THERE ARE POWERFUL FORCES FOR REDUCING
ERRORS, LOWERING COSTS, RAISING THE QUALITY OF CARE IN AND
CREASING DOCTOR AND PATIENT SATISFACTION AND I SEEN THIS
FIRSTHAND IN HOSPITALS THAT I HAVE BEEN VISITING ALL OVER THE
COUNTRY. EVERY PROVIDER I HAVE TALKED TO
WHO USES AN ELECTRONIC HEALTH RECORD TOLD ME THE SAME THING.
THEY CAN'T IMAGINE PRACTICING MEDICINE ANY OTHER WAY.
THEY WOULD NEVER GO BACK TO A SYSTEM OF PAPER RECORDS.
AND WE ARE PLEASED TO HAVE THE FEDERATION OF AMERICAN HOSPITALS
AS ENTHUSIASTIC SUPPORTERS OF THESE STANDARDS.
WE HOPE THAT OTHER PROVIDER GROUPS SUPPORT THE STANDARDS
ONCE THEY HAD A CANS TO STUDY THEM CLOSELY.
AND WE KNOW THAT TODAY, BECAUSE OF VARIOUS OBSTACLES, ONLY 20%
OF DOCTORS AND 10% OF HOSPITALS EVEN USE BASIC ELECTRONIC
RECORDS. I WAS TELLING MY COLLEAGUES THAT
I HAD AN EXPERIENCE LAST NIGHT ACCOMPANYING A FRIEND WHO WAS IN
AN EMERGENCY SITUATION TO A HOSPITAL HERE IN WASHINGTON.
SAT WITH HER FOR THREE HOURS. FOUR DIFFERENT PROVIDERS CAME
BACK DURING THAT THREE HOURS, TOOK EXACTLY THE SAME HISTORY
OVER AND OVER AGAIN. DRUG HISTORY, CONDITIONS, AND
WROTE IT ALL ON SMALL PIECES OF PAPER, WHICH THEY PACKED IN
THEIR POCKET AND LEFT WITH THEM. AND I THOUGHT, HOW DIFFICULT
THAT SYSTEM IS TO MAKE SURE THAT THE RIGHT INFORMATION GETS TO
THE RIGHT PLACE, AND ALSO HOW RIPE IT IS FOR POSSIBLE
MISTAKES, POSSIBLE ERRORS, POSSIBLY HER NOT REMEMBERING THE
FOURTH OR FIFTH MEDICATION, THE THIRD OR FOURTH TIME SHE WENT
THROUGH IT. SO IT WAS A GOOD REMINDER OF WHY
WE ARE HERE TODAY. LAST YEAR AS PART OF THE
RECOVERY ACT, WE BEGAN MAKING A HISTORIC INVESTMENT IN HEALTH
INFORMATION TECHNOLOGY. THE CENTERPIECE OF THE PROGRAM
IS A PLAN THAT BEGINS IN 2011 WHERE DOCTORS AND HOSPITALS WILL
BE ABLE TO GET INCENTIVE PAYMENTS FOR ADOPTING ELECTRONIC
HEALTH RECORDS. WE BELIEVE THIS UNPRECEDENTED
NATIONAL INVESTMENT CAN CATALYZE A BIG CHANGE IN HOW HEALTH
PROFESSIONALS USE HEALTH INFORMATION TECHNOLOGY.
BUT OUR GOAL HAS NEVER BEEN JUST TO USE TECHNOLOGY FOR THE SAKE
OF TECHNOLOGY, TO TRANSFER EVERYTHING THAT IS ON PAPER TO A
COMPUTER AND CALL IT QUITS. WE ARE PROMOTING ELECTRONIC
HEALTH RECORDS SO THAT THEY CAN BE USED TO DELIVER BETTER CARE
AND GIVE CONSUMERS MORE CONTROL OVER THEIR OWN HEALTH CARE.
AND THAT IS WHY IN ORDER TO RECEIVE THE INCENTIVE PAYMENTS,
HEALTH CARE PROFESSIONALS WILL HAVE TO MEET THE MEANINGFUL USE
STANDARDS THAT ARE BEING ANNOUNCED TODAY.
THE STANDARDS REFLECT THE INPUT OF DOCTORS, NURSES, HOSPITALS,
AND PATIENTS ACROSS THE HEALTH CARE SYSTEM.
ALL TOGETHER, WE RECEIVED MORE THAN 2000 COMMENTS ON THE
PRELIMINARY RULE WE ARE FINALIZING TODAY.
AND WE CAREFULLY WEIGHED ALL OF THAT INPUT.
THANKS TO THE CONTRIBUTIONS OF THE COMMENTERS, WE ARE
ANNOUNCING A RULE TODAY THAT WILL PUSH OUR ENTIRE HEALTH CARE
SYSTEM FORWARD. WE ARE GIVING DOCTORS AND
HOSPITALS THE FLEXIBILITY THEY NEED TO FIND THEIR OWN PATHS.
THIS IS AN HISTORIC MOMENT. TODAY MOST OF US CAN BARELY
REMEMBER THE DAYS WHEN EVERY ITEM AT THE SUPERMARKET HAD A
HANDWRITTEN PRICE STICKER OR HUTO GO TO THE BANK TO FIND OUT
HOW MUCH MONEY YOU HAD IN YOUR SAVINGS ACCOUNT.
HEALTH INFORMATION TECHNOLOGY PROMISES TO BRING THAT SAME
TRANSFORMATION AND CONVENIENCE AND REBIABILITY INTO THE HEALTH
CARE SYSTEM. NOW THE TRANSFORMATION WON'T
HAPPEN OVERNIGHT. BUT THE ANNOUNCEMENT WE ARE
MAKING TODAY SETS US ON A PATH TOWARDS A 21st CENTURY
SYSTEM OF THE FUTURE. NOW I WANT TO HAVE DR. DON
BERWICK, OUR NEW ADMINISTRATOR, TALK ABOUT HEALTH, TECHNOLOGY,
IMPROVING THE WEALTHY OF CARE WHILE KEEPING DOWN COSTS.
DR. BERWICK. [APPLAUSE]
-- THANK YOU VERY MUCH, SECRETARY SEBELIUS FOR YOUR HARD
WORK AND FOR YOUR VERY GENEROUS COMMENTS AND FOR YOUR
LEADERSHIP. AND THANK YOU FOR YOUR WARM
WELCOME. I FEEL REALLY HONORED TO BE
ONBOARD NOW AS THE NEW ADMINISTRATOR OF THE CENTERS FOR
MEDICARE AND MEDICAID SERVICES. I HAVE NEVER BEEN MORE EXCITED IN
MY CAREER ABOUT WHAT IS POSSIBLE.
WHAT IS POSSIBLE FOR THE CARE WE ALL WANT AND FOR BRINGING OUR
WHOLE NATION TO A HEALTHIER STATE OF BEING AND THE HEALTH
CARE SYSTEM ITSELF TO BE A HEALTHIER HELP TORE THAT NATION.
I WELCOME THE MANY GROUPS AND FRIENDS I SEE IN THE AUDIENCE
HERE, PATIENT GROUPS, PHYSICIANS, HOSPITALS, HEALTH
INFORMATION TECHNOLOGY, ORGANIZATIONS, EMPLOYERS,
MEMBERS OF THE MEDIA, IT'S NICE TO SEE YOU-ALL AND I LOOK
FORWARD TO WORKING WITH YOU-ALL. WHAT WE ALL HAVE AT STAKE IS
BIGGER THAN THE INFORMATION TECHNOLOGY AND HEALTH CARE.
IT'S THE FUTURE OF HEALTH CARE ITSELF.
HEALTH CARE INFORMATION TECHNOLOGY PROPERLY MODERNIZES
AND CAN BRING TREMENDOUS BENEFITS TO THE PEOPLE WE ARE
TRYING TO SERVE AND TO THOSE OF US WHYING -- TRYING TO SERVE
THEM THROUGH ACHIEVING SO MANY OF THE OBJECTIVES THAT ARE
OUTLINED IN THIS FINAL RULE. I MUST SAY I'M PLEASED TO BE
JOINING THE VERY SKILLED STAFF AT CMS.
THEY ARE INCREDIBLY DEDICATED PEOPLE.
I LOOK FORWARD TO WORKING WITH THAT TEAM OVER THE LONG HAUL TO
IMPROVE HEALTH CARE FOR EVERYONE.
I CONGRATULATE HHS AND CMS FOR THE PROGRESS THEY MADE IN THIS
FINAL RULE TOWARDS THE PRESIDENT'S GOAL OF HAVING AN
ELECTRONIC HEALTH RECORD AVAILABLE TO ALL AMERICANS BY
THE YEAR 2014. AND FOR MY PART, I INTEND TO
WORK CLOSELY WITH ALL OF YOU AND WITH ALL THE STATES TO BUILD AN
INFRASTRUCTURE THAT WILL ALLOW EVERYBODY ACCESS TO THAT VISION.
THE BENEFITS OF MODERNIZED HEALTH CARE INFORMATION
TECHNOLOGY HELP EVERYONE. IT'S A WIN-WIN RIGHT
ACROSS-THE-BOARD. I REALLY LIKE THE PHRASE,
MEANINGFUL USE. THE WORD MEANINGFUL.
I HAVE BEEN THINKING, MEANINGFUL TO WHOM?
IT'S MEANINGFUL TO THE CARE. MEANINGFUL TO THE PATIENTS AND
MEANINGFUL TO THE PEOPLE WHO HELP THE PATIENT.
I KNOW ABOUT THAT A LOT FROM MY WORK IN THE PAST 20 YEARS TRYING
TO IMPROVE HEALTH CARE, WATCHING HOSPITALS AND PHYSICIANS AND
NURSES. AND THE COMMUNITIES THAT GET TO
USED MODERNIZED TECHNOLOGY DIRECTLY IMPROVE PATIENT SAFETY,
IMPROVE FLOW AND IMPROVE THE DIGNITY OF CARE AND IMPROVE
TRANSPARENCY AND ACCESS TO INFORMATION ON PARTS OF
COMMUNITIES AND PATIENTS AND THROUGH REDUCED COST.
IN A DIFFERENT WAY, I'M SPOILED WITH RESPECT TO THE OBJECTIVES
OF THIS WHEN IT COMES TO HEALTH CARE INFORMATION TECHNOLOGY.
FOR ALL MY YEARS CARING FOR PATIENTS, ALMOST FROM THE VERY
START, I WORKED IN AN ORGANIZATION THAT WAS A PIONEER,
ONE OF THE EARLY ADOPTERS OF ELECTRONIC MEDICAL RECORDS, THE
HARVARD COMMUNITY HEALTH PLAN. WHAT THAT MEANT FOR MY PATIENTS
AND FOR ME WAS BETTER QUAR. BETTER CARE.
EVERY SINGLE TIME I SAW THE PATIENT, THERE WAS A RECORD.
NO LOST RECORDS, NO DELAY. NO WASTING TIME RUMMAGING
THROUGH SHELVES AND FILE ROOMS. I NEVER HAD TO GO HUNTING FOR A
MISSING PIECE OF PAPER WITH A LAB TEST WRITTEN ON IT I NEEDED.
ALL THE RESULTS WERE RIGHT THERE INSTANTLY, AS SOON AS THE LAB
PRODUCED THE RESULT. IF I SENT A CHILD TO SEE A
SPECIALIST, CARDIOLOGIST, NEUROLOGIST, NO PHONE TAG AFTER
THAT. NO WONDERING WHAT HAPPENED.
THE SPECIALIST NOTES WERE THERE FOR ME AND FOR THE FAMILY.
JUST AS SOON AS THE SPECIALIST PREPARED THOSE NOTES.
I GOT AUTOMATED REMINDERS WHEN A KID THAT I WAS CARING FOR WAS
DUE FOR IMMUNIZATION OR OVERDUE FOR A BLOOD TEST.
DOCTORS AND NURSE WHOSE PRACTICE IN THE MODERN INFORMATION
TECHNOLOGY ENVIRONMENT THEY GET INSTANT ACCESS TO THE LATEST
JOURNAL PAPERS. IF THEY PRESCRIBE A MEDICINE,
THAT INTERACTS BADLY WITH ANOTHER THAT THE PATIENT HAPPENS
TO BE ON THAT I FORGOT ABOUT, THEY GET AN ALERT.
AN ALERT SAYS, DO YOU REALLY MEAN TO DO THAT?
IT'S BETTER. IT'S SMOOTHER CARE.
IT'S SAFER, IT'S MORE RELIABLE. IT'S MORE COLLEGEAL.
IT'S BETTER FOR EVERYONE WHEN HEALTH CARE IT IS USED
MEANINGFULLY. I SEEN IT WORK ON QUALITY AND
CLINICALLY. THE QUESTION IS, IF IT'S SO
GOOD, WHY AREN'T WE THERE YET? FOR EVERYBODY?
FOR ALL THE PATIENTS? NOT JUST THE LUCKY ONES IN
MODERNIZED SYSTEMS. IN ALL HOSPITALS, ALL DOCTOR'S
OFFICES AND ALL NURSE'S CARE. THE REASON IS, BECAUSE IT'S
HARD. MOVING FROM LEGACY PAPER SYSTEMS
TO MODERN INFORMATION TECHNOLOGY IS A BIG CHANGE.
NEW HARDWARE, NEW SKILLS, NEW ATTITUDES, NEW ASSUMPTIONS.
IT'S REALLY A NEW CULTURE AND YOU DON'T GET THERE IN ONE STEP.
I KNOW THAT MANY OF YOU IN THIS ROOM, ALONG WITH MY COLLEAGUES,
HAVE BEEN DEBATING IN GOOD FAITH, DETAILS OF WHAT THE NEXT
BEST STEPS OR BEST NEXT STEPS ARE OR HOW FAST WE SHOULD GO OR
WHAT TO FOCUS ON, WHAT COMES FIRST.
AND TODAY'S FINAL RULE REPRESENTS REALLY GOOD PROGRESS
TO GET US TOWARDS THE ULTIMATE ANSWERS WE NEED.
BUT I THINK WHAT IS MOST IMPORTANT TO US ALL IS TO LIFT
OUR EYES A LITTLE BIT AND REALIZE HOW MUCH BETTER OFF WE
ARE GOING TO BE WHEN WE GET TO THE DESTINATION THAT THE
PRESIDENT OUTLINED AND THAT WE KNOW WE CAN GET TO WHEN WE ARE
GETTING THROUGH THE AWKWARDNESS OF THE CHANGE PROCESS WHEN IT'S
BEHIND US. IT'S GOING TO BE BETTER FOR
PATIENTS, SAFER, SMOOTHER, MORE CONTINUITY AND MORE KNOWLEDGE
FOR THEM T WILL BE BETTER FOR PEOPLE WHO CARE FOR PATIENTS.
SAFER, SMOOTHER, LESS FRUSTRATING, MORE TEAMWORK, AND
IT WILL BE LESS COSTLY. AND EXACTLY THE WAY THAT IS WE
ALL WANT TO REDUCE COSTS BY TAKING OUT WAYS, BY REDUCING
BARRIERS AND COMPLEXITY AND BY SMOOTHING THE WAY TOWARDS THE
CARE WE ALL WANT AND NEED. I'M EXITED TO BE PART OF THIS
JOURNEY. THANKS.
[APPLAUSE] -- THANK YOU DR. BERWICK.
AND THE NOW I'D LIKE TO ASK THE LEADER OF THIS EFFORT WHO HAS
REALLY WORKED TIRELESSLY FOR THE LAST YEAR AND A HALF WITH A
AMAZING TIME TO NOT ONLY PUT TOGETHER THIS REGULATION BUT A
SYSTEM THROUGHOUT THE COUNTRY THAT CAN MOVE US FROM THE LEGACY
PAPER SYSTEM TO THE ELECTRONIC AGE OF NEW AND BETTER AND SAFER
MEDICAL CARE. OUR NATIONAL COORDINATOR FOR
HEALTH INFORMATION TECHNOLOGY, DR. DAVID BL OF THE OOMENTHALL
[APPLAUSE] -- THANK YOU SECRETARY SEBELIUS
FOR YOUR LEADERSHIP AND SUPPORT. I WANT TO GIVE MY PERSONAL
STRONG AND WARM WELCOME TO MY OLD FRIEND, DON BERWICK.
IT IS SUCH A WONDERFUL THING TO HAVE HIM HERE AS YOU CAN SEE
FROM HIS REMARKS. HE HAS A KNOWLEDGE OF THE HEALTH
CARE SYSTEM WHICH IS PERSONAL AND INTIMATE AT THE SAME TIME HE
HAS THE BROADEST POSSIBLE PERSPECTIVE.
NO ONE IN MY GENERATION HAS DONE MORE TO IMPROVE THE HEALTH OF
AMERICANS THAN DON. I WANT TO THANK MARILYN AND ALL
HER COLLEAGUES AT THE CENTER FOR MEDICARE AND MEDICAID SERVICES
WHO HAVE WORKED WITH US SO CLOSELY.
IT'S BEEN A GREAT TEAM THAT WE HAVE WORKED TOGETHER ON THIS
RULE. AND THE OTHER WORK-RELATED TO
THE OFFICE OF THE NATIONAL COORDINATOR.
I WANT TO THANK COLLEAGUES FROM THE VETERAN'S ADMINISTRATION WHO
ARE HERE TODAY. DR. ANDREW AND FLETCHER AND
DR. JONES. THEY SET UP A DEMONSTRATION OF A
ELECTRONIC HEALTH CARE RECORD FOR ANYONE WHO WANTS TO SEE ONE.
IT'S IN THE BACK OF THE ROOM. I DON'T SEE IT HERE BUT I'M SURE
STEVE AND HIS COLLEAGUES WILL BE GLAD TO DEMONSTRATE IT FOR YOU
AFTERWARDS. AS A FINAL INTRODUCTORY COMMENT,
I WANT TO NOTE THAT THE DESCRIPTION OF THE FINAL RULE,
AS WELL AS DR. BENJAMIN VERY MOVING PERSONAL STORY, WHICH
YOU'LL HEAR MORE ABOUT IN A MOMENT, IS AVAILABLE ONLINE AT
THE NEW ENGLAND JOURNAL OF MEDICINE.
IT BECAME AVAILABLE AT 10:00 A.M. THIS MORNING.
DON ANTICIPATED THE WAY I WANTED TO INTRODUCE MY REMARKS, WHICH
IS NOT AS A FEDERAL OFFICIAL OR DIRECTOR OF THE OFFICE OF THE
NATIONAL COORDINATOR. BUT AS SOMETHING I HAVE BEEN
MUCH LONGER AND THAT IS, A PRIMARY CARE PHYSICIAN.
AND A USER OF ELECTRONIC HEALTH RECORD.
THE REASON I'M HERE TODAY AND THE REASON WHY I'M SO
ENTHUSIASTIC ABOUT MY WORK IS BECAUSE AS A PHYSICIAN OF A
CERTAIN AGE, I WAS FORCED TO LEARN HOW TO USE AN ELECTRONIC
HEALTH RECORD. AND I SAW IT MAKE MY CARE BETTER
BEFORE MY EYES. I SAW IT PREVENT ME FROM MAKING
WHAT COULD HAVE BEEN TRULY TRAGIC ERRORS IN PRESCRIBING
DRUGS TO WHICH MY PATIENTS WERE ALLERGIC.
I SAW IT ENABLE ME TO AVOID DUEPLICATIVE X-RAY THAT IS WOULD
HAVE EXPOSED MY PATIENTS TO UNNECESSARY RADIATION AND COST
THE HEALTH CARE SYSTEM UNNECESSARY EXPENDATURES.
AND I CAME TO SEE THAT THOSE SMALL VICTORIES, ONE BY ONE,
SPREAD ACROSSDREADS, THOUSANDS, AND MILLIONS OF DECISIONS, MADE
EACH YEAR BENDING THE QUALITY CURVE UP AND BEND THE COST CURVE
DOWN WITHOUT ANY COMPROMISE OR PROFESSIONAL AUTONOMY AND INDEED
BY MAKING PHYSICIANS BETTER AND MORE COMFORTABLE AND NURSES AND
OTHER CLINICIANS BETTER AND MORE COMFORTABLE IN THEIR ROLES.
THAT'S WHY I'M HERE AND THAT'S WHY I HAVE DEDICATED THIS TIME
TO THIS WORK AND I TOTALLY AGREE WITH THE SECRETARY THAT THERE
ARE ALMOST NO PHYSICIANS, NO MATTER HOW DIFFICULT THEY FIND
CERTAIN ASPECTS OF THEIR PERSONAL RECORDS, THERE IS
ALMOST NONE WHO WILL GO BACK ONCE THEY STARTED USING ONE.
THE SECOND THING I'D LIKE TO TALK ABOUT TODAY IS THAT THIS
MEANINGFUL USE RULE IS PART OF A MUCH LARGER PROGRAM.
IT'S AN ESSENTIAL PART OF THAT PROGRAM BUT IT'S ONLY ONE PART.
WE KNOW THAT THERE ARE SERIES OF BARRIERS THAT PREVENT PHYSICIANS
AND HOSPITALS AND OTHER CLINICIANS FROM ADOPTING
ELECTRONIC HEALTH RECORDS AND LAID OUT A PROGRAM TO ADDRESS
EACH ONE OF THOSE BARRIERS OVER THE COMING YEARS.
THE MEANINGFUL USE RULE IS PRIMARILY INTENDED TO ADDRESS
THE FINANCIAL BARRIERS TO THE ADOPTION OF THE ELECTRONIC
HEALTH RECORDS THROUGH MAKING $44,000 AVAILABLE IN INCENTIVE
PAYMENTS TO PHYSICIAN WHOSE BECOME MEANINGFUL USERS OF
ELECTRONIC HEALTH RECORDS, THROUGH THE MEDICARE PROGRAM.
OVER 63,000 DOLLARS THROUGH THE MEDICAID PROGRAM AND MILLIONS OF
DOLLARS HOSPITALS WHO ALSO REACHED THE MEANINGFUL USE
OBJECTIVES. THOSE FINANCIAL BARRIERS ARE
TOUGH AND THEY NEED TO BE OVERCOME AND THIS UNPRECEDENTED
INVESTMENT IS DIRECTED AT THOSE. BUT THERE ARE ALSO IMPORTANT
LOGISTICAL AND TECHNICAL BARRIERS.
BELIEVE ME, I KNOW ABOUT THEM BECAUSE I HAVE TO OVERCOME THEM.
SO WE HAVE PUT IN PLACE OTHER PROGRAMS BETTER DESIGNED TO
ADDRESS THOSE. THE FIRST OF THOSE IS ANOTHER
RULE THAT WE ARE ANNOUNCING TODAY THAT SETS NEW STANDARDS,
IMPLEMENTATION SPECIFICATIONS AND CERTIFICATION CRITERIA FOR
ELECTRONIC HEALTH RECORDS THAT WILL ENHANCE THEIR INNER OPER
BUILTY AND ENSURE PHYSICIANS THAT CERTIFIED ELECTRONIC HEALTH
RECORDS ARE CAPABLE OF MEETING PHYSICIANS AND OTHER CLINICIANS,
CAPABLE OF MEETING THE REQUIREMENTS OF MEANINGFUL USE.
BUT WE ARE ALSO CREATING A NETWORK OF REGIONAL EXTENSION
CENTERS THAT ARE THERE TO HELP DOCTORS SHOULDER-TO-SHOULDER,
ELBOW TO ELBOW AND HELP OTHER CLINICIANS AND HOSPITALS TO
BECOME MEANINGFUL USERS OF ELECTRONIC HEALTH RECORDS.
WE HAVE GIVEN GRANTS TO STATES TO HELP THEM BECOME LEADERS OF
AN EFFORT TO MAKE INFORMATION EXCHANGEABLE WITHIN STATE
BOUNDARIES AND ACROSS STATES. AND WE HAVE SEVERAL OTHER
PROGRAMS LIKE THIS DESIGNED TO PROVIDE THE INFRASTRUCTURE THAT
SUPPORTS LOGISTICAL AIDS THAT ARE NECESSARY TO MAKE MEANINGFUL
USE REALLY POSSIBLE. THE OTHER THING WE ARE DOING
ADDRESSING THE VERY IMPORTANT FOUNDATIONAL REQUIREMENTS THAT
ELECTRONIC HEALTH RECORDS BE PRIVATE AND SECURE.
LAST WEEK, THE OFFICE OF CIVIL RIGHTS RELEASED A NOTICE OF
PROPOSED RULE MAKING THAT WOULD IMPLEMENT HIGH-TECH PROVISIONS,
STIMULATE LEGISLATION PROVISIONS TO INCREASE THE SECURITY OF
ELECTRONIC HEALTH SYSTEMS AND THERE ARE SECURITY REQUIREMENTS
BUILT-IN FOR MEANINGFUL USE MATRIX.
WE KNOW THAT WE HAVE TO HAVE THE SUPPORT OF THE AMERICAN PEOPLE.
THEIR BELIEF AND TRUST IN THE ELECTRONIC HEALTH SYSTEM WE ARE
CREATING, OR IT WILL NOT WORK THE WAY IT CAN.
I'D LIKE TO CONCLUDE BY NOTING THAT I REALLY AMVERY OPTIMISTIC
AND CONFIDENT THAT WE ARE GOING TO BE SUCCESSFUL.
I FIRMLY BELIEVE IT IS JUST A MATTER OF TIME BEFORE CLINICIANS
AND HOSPITALS BECOME THE LEADERS OF THIS EFFORT TO IMPROVE
INFORMATION SYSTEMS IN THE UNITED STATES.
AND THE REASON IS THAT USING INFORMATION IS A CORE CLINICAL
COMPETENCY FOR PROFESSIONALS IN HEALTH CARE.
WE ARE ONLY AS GOOD IN TREATING PATIENTS AS THE INFORMATION WE
HAVE. AND I KNOW THAT PHYSICIANS WILL
SOON BE UNWILLING TO RECORD THE INFORMATION IN ANYTHING OTHER
THAN THE MOST MODERN AND EFFICIENT WAY BECAUSE THAT WILL
BE CONFIDENT AND CONSISTENT WITH WHAT THEY VIEW AS THEIR CORE
PROFESSIONAL RESPONSIBILITIES. WHEN THAT HAPPENS, WE AT THE
OFFICE OF NATIONAL COORDINATOR, WILL BE ABLE TO PASS THE
LEADERSHIP ROLE, SUCH AS IT IS, FROM OURSELVES TO THE
PROFESSION, THE PROFESSION DOCTORS, NURSES, ALL THE OTHER
PROFESSIONS OF MEDICINE AND TO OUR MAJOR HEALTH CARE
INSTITUTION. BUT UNTIL THEN, WE STAND READY
TO WORK WITH ALL OF YOU TO TRY TO MAKE THAT TRANSITION HAPPEN
AS SOON AS POSSIBLE. THANK YOU.
[APPLAUSE] -- THANK YOU DR. BLUMENTHAL FOR
YOUR COMMENTS AND EXTRAORDINARY LEADERSHIP AND THIS EFFORT,
WHICH IS LAUNCHING TODAY BUT HAS MANY MORE IMPORTANT STEPS BEFORE
US. I'D LIKE TO NOW INTRODUCE OUR
GREAT SURGEON GENERAL DR. REGINA BENJAMIN.
ONE IMPORTANT ASPECT OF THE ANNOUNCEMENT TODAY IS THAT THIS
IS NOT A PROGRAM DESIGNED FOR BIG HOSPITALS OR MULTISPECIALTY
PRACTICES. THE STANDARDS ARE DESIGNED SO
THEY CAN WORK JUST AS EASILY FOR A SMALL RURAL DOCTOR'S HOSPITAL
OR A CRITICAL ACCESS -- OR SMALL RURAL OFFICE OR CRITICAL ACCESS
HOSPITAL. AND AS MANY OF YOU KNOW, BEFORE
SHE BECAME SURGEON GENERAL, DR. BENJAMIN RAN ONE OF THOSE
PRACTICES ON THE GULF SHORE. AND SHE HAS A GOOD PERSPECTIVE
ON WHAT THIS ANNOUNCEMENT MEANS FOR COMMUNITY PRACTICES THAT ARE
THE BACKBONE OF OUR HEALTH CARE SYSTEM.
DR. BENJAMIN. [APPLAUSE]
--> THANK YOU SECRETARY. AND I ALSO WOULD LIKE TO WELCOME
DON. HE HAS BEEN A LEADER IN QUALITY
IMPROVEMENT IN HOSPITALS IN LARGE PRACTICES BUT HE ALSO
HELPED FOLKS LIKE ME IN OUR SMALL PRACTICES, PARTICULARLY
OFFICE FREE DESIGN AND OTHER PROJECTS.
SO I'M REALLY LOOKING FORWARD TO WORKING WITH YOU, DON, AND WE
ARE VERY FORTUNATE TO HAVE YOU. PLEA VENTION IS THE FOUNDATION
OF OUR PUBLIC HEALTH SYSTEM -- PREVENTION -- AND IT'S
THE FOUNDATION OF MY WORK AS SURGEON GENERAL.
AND PREVENTION COMES IN MANY WAYS.
SO I'D LIKE TO SHARE WITH YOU PERSONAL EXPERIENCE WITH MY ROLE
WITH THE ELECTRONIC HEALTH RECORDS DURING MY 23 YEARS OF
SOLO PRACTICE IN ALABAMA. IN 1998, HURRICANE GEORGE MADE
LANDFALL ON THE GULF COAST CAUSING OVER 100 MILLION DOLLARS
IN DAMAGE TO ALABAMA ALONE AND MY CLINIC WAS DESTROYED.
I MUSTERED UP ENOUGH RESOURCES TO REBUILD ON HIGHER GROUND,
THIS TIME ON FOUR FOOT STILTS. MEANWHILE, WE MANAGED TO SAVE
OUR DRENCHED RECORDS OF OUR PATIENTS BY CAREFULLY DRYING
THEM IN THE HOT ALABAMA SUN. I WANTED TO INSTALL A ELECTRONIC
HEALTH RECORD BUT MONEY WAS TIGHT AND I HAD TO CHOOSE
BETWEEN THE ELECTRONIC RECORD AND THE LIGHT BILL.
SO WE DIDN'T. THEN IN 2005, HURRICANE KATRINA
HIT BRINGING A 25 FOOT SURGE OF WATER.
WE WERE HIT HARD. THE POPULATION'S 2,500 PEOPLE
HAD UNLIVEABLE HOMES. THE ECONOMY IN THE TOWN WAS
DESTROYED AND THE SHRIMP BOATS WERE LEFT IN THE TREES.
OUR CLINIC AGAIN WAS DESTROYED. BECAUSE I MADE HOUSE CALLS, I
WENT LOOKING FOR OUR PATIENTS BUT THEY DIDN'T HAVE ANY HOMES.
MANY WERE IN SHELTERS AND SMALL CAMPING TENTS ON THE GROUND.
SO WE SET UP A MAKE-SHIFT CLINIC ON THE STAGE OF AN AUDITORIUM
SERVING AS A SHELTER. AND WE PROVIDED BASIC PRIMARY
CARE. MANY PATIENTS LOST A LEG.
THEIR DIABETES SUPPLIES, THEIR ASTHMA MACHINING, ALL OF THAT IN
THE STORM WATERS. WE HAD NOTHING.
I I CUT SHEETS OF COPY PAPER IN FOUR PIECES AND USED THEM AS
PRESCRIPTION PADS. THE PATIENTS AND I HAD TO RELY
ON THEIR MEMORY OR SIMPLY GUESS WHAT THEIR MEDS WERE, WHAT THEIR
ALLERGIES WERE AND THEIR PAST MEDICAL HISTORY.
THE COMMUNITY CAME TOGETHER AND HELPED EACH OTHER AND WITH THE
HELP OF MANY VOLUNTEERS, WE STORED OUR -- RESTORED OUR
BUILDING. WE MOVED NEW FURNITURE AND NEW
EQUIPMENT IN AND OUR, ONCE AGAIN, DRIED OUT CHARTS INTO THE
NEWLY RENOVATED BUILDING IN ORDER TO OPEN ON NEW YEAR'S DAY
OR THE DAY AFTER NEW YEAR'S. BUT THEN ON NEW YEAR'S EVE, THE
NEW BUILDING AND THE NEW EQUIPMENT AND OUR TWO-TIME DRIED
OUT CHARTS, BURNT TO THE GROUND. WE WERE DEVASTATED.
BUT THE COMMUNITY WAS REALLY WONDERFUL.
PATIENTS CAME TOGETHER. THEY CRIED TOGETHER.
AND ELDERLY PATIENT SENT ME, BY HER GRANDDAUGHTER, AN ENVELOPE
WITH 7 DOLLARS IN IT AND A NOTE THAT SAID, TO HELP REBUILD THE
CLINIC. SHE COULDN'T AFFORD IT.
BUT I SAID TO MYSELF, IF SHE CAN FIND 7 DOLLARS, I WOULD FIND THE
REST. BUT THIS TIME WITH AN ELECTRONIC
HEALTH RECORD. WITH THE GENEROUS DONATIONS, WE
WERE ABLE TO INSTALL A INTEGRATED ELECTRONIC HEALTH
SYSTEM. HAVING LOST THE CLINIC THREE
TIMES, I KNEW WE HAD TO HAVE A BETTER WAY OF PRACTICING.
WE NEEDED TO FIND A WAY TO DELIVER HIGH QUALITY HEALTH CARE
TO PEOPLE WHO DIDN'T HAVE A LOT OF MONEY.
FROM THE EXPERIENCES OF THOSE HURRICANES AND THE FIRE, I KNEW
WE HAD TO BE ABLE TO EVACUATE THE CLINIC VERY QUICKLY WHILE
SAFEGUARDING OUR VITAL PATIENT INFORMATION.
WHEREAS I PREVIOUSLY DECIDED AGAINST INSTALLING THE
ELECTRONIC HEALTH RECORD BECAUSE I COULDN'T AFFORD ONE, I
REALIZED NOW I COULDN'T AFFORD NOT TO HAVE ONE.
SO THROUGH THIS CHALLENGING TIME, I LEARNED THAT IT'S REALLY
HARD TO CONVINCE SOME DOCTORS AND SOME NURSES TO CONVERT FROM
THEIR PAPER RECORDS. AND BUT FOR US, IT WASN'T AN
ISSUE. MY STAFF TOLD ME THEY DIDN'T
WANT TO HAVE TO BAKE CHARTS IN THE SUN AGAIN.
THE NEW ELECTRONIC HEALTH RECORD SYSTEM WE IMPLEMENTED ALLOWED US
TO EASILY TRACK AND DOCUMENT OUR PATIENT'S HISTORIES WITH THE
CLICK OF THE BUTTON. WE COULD SEND A PRESCRIPTION TO
THE PHARMACY, REMIND PATIENTS OF UPCOMING MAMMOGRAMS ET CETERA.
AND ALSO WITH ALL OF THAT, WE IMPROVED THE QUALITY OF CARE OF
THE PATIENT. AND IN PRACTICING MEDICINE, IT
BECAME EASIER FOR THE CLINICIAN AND BETTER FOR THE PATIENT.
AND WITH THE AVAILABILITY OF THE NEW INCENTIVES AND PAYMENTS
BEING MADE POSSIBLE BY THIS HEALTH INFORMATION TECHNOLOGY
FOR ECONOMIC AND CLINICAL HEALTH ACT, THE ASSISTANCE OR
TRANSITION TO ELECTRONIC RECORDS WILL BECOME AVAILABLE AND
PARTICULARLY SOME FINANCIAL ASSISTANCE FROM THE EXTENSION
CENTERS. SMALL PRACTICES LIKE MINE SHOULD
NOW HAVE FEWER REASONS TO DELAY THE DECISION THAT SHOULD HAVE
BEEN MADE A LONG TIME AGO. UNTIL THE DAY THAT I ACTUALLY
TURNED ON THE ELECTRONIC HEALTH RECORDS, WE WERE STILL USING
WATERPROOF INK. I HOPE THAT I AND NONE OF THE
OTHER CLINICIANS OR PATIENTS, WILL HAVE TO DEPEND ON
WATERPROOF INK TO PROTECT THEIR RECORDS.
[APPLAUSE] -- WHEN DR. BENJAMIN LEAVES US
TODAY, SHE IS GOING TO GO BACK TO HER HOMETOWN AS PART OF OUR
WORK ON THE GULF CONTINUES. AND WE WISH YOU GODSPEED AND
GOOD LUCK IN THAT EFFORT. YOU HEARD FROM THREE OF OUR TOP
HEALTH LEADERS TODAY. ALSO THREE PRACTICING PHYSICIANS
IN TERMS OF THE ELECTRONIC RECORDS IMPACT ON THEIR
PRACTICE. OUR FINAL SPEAKER TODAY IS NOT A
DOCTOR. AND SHE COMES TO US FROM A
PERSONAL TRAGEDY SHE SUFFERED WHEN HER HUSBAND FRED DIED AT
THE AGE OF 39. BUT OUT OF THAT TRAGEDY, REGINA
HOLIDAY AND HER FAMILY HAVE BECOME AN ADVOCATE FOR OTHER
FAMILIES. EXPLAINING HOW HAVING BETTER
HEALTH INFORMATION CAN SAVE LIVES.
SHE HEADS BEEN THROUGH THIS AND LIVED THROUGH THIS AS A PATIENT
ADVOCATE, AS A SPOUSE IN A TRAGIC SITUATION, AND I VERY
MUCH APPRECIATE REGINA'S COURAGE IN USING HER OWN PERSONAL LOSS
AS A COMPELLING MESSAGE TO CHANGE THE PRACTICE OF MEDICINE
FOR BETTER FOR THE FUTURE FOR OTHER FAMILIES.
SO REGINA HOLIDAY. [APPLAUSE]
-- THANK YOU FOR INVITING ME HERE TODAY.
I'M AN ARTIST, A MOTHER AND I WAS THE WIFE OF A GREAT MAN.
I KNOW IN A VERY PERSONAL WAY WHY PATIENTS NEED ACCESS TO THE
ELECTRONIC MEDICAL RECORD. LAST YEAR AT THIS TIME, I WAS
PAINTING A MURAL, ABOUT 20 BY 50 FEET, ON CONNECTICUT AVENUE, IN
THE DC HEAT. I WAS A NEW WIDOW.
MY HUSBAND HAD DIED OF KIDNEY CANCER ON JUNE 17.
THE PAINTING WAS CALLED, 73 CENTS.
IT DEPICTURED OUR FAMILY LOCKED WITHIN OUR LOOP WITHOUT ACCESS
TO INFORMATION. FROM JANUARY TO MARCH OF 2009,
MY HUSBAND WENT TO HIS DOCTOR WITH COMPLAINTS OF PAIN.
HE WAS SENT HOME WITH PAIN MEDS EACH TIME AND NEVER RECEIVED AN
AFTER VISIT SUMMARY. HE VISITED TWO ERS WITH EXTREME
PAIN AND WAS SENT HOME WITH PAIN MEDS EACH TIME.
BY MID-MARCH, HE WAS TAKING 4 TYPES OF PAIN MEDICATION, TWO
TYPES OF MUSCLE RELAXANTS AND 4 TYPES OF LAXATIVES AND WE HAD NO
DIAGNOSIS. ON MARCH 25, HE WAS HOSPITALIZED
FOR TESTS. ON MARCH 27, THE ONCOLOGIST CAME
IN HIS ROOM AND TOLD HIM WHILE HE WAS ALONE, THAT HE HAD TUMORS
EN GROSSED. THE ONCOLOGIST LEFT HIM FOR FOUR
DAYS. MY IN LAWS AND I SPENT THOSE
DAYS BEGGING THE DOCTORS FOR INFORMATION ABOUT MY HUSBAND.
WE HAD NO ACCESS TO THE WRITTEN RECORD THOUGH WE WERE
CONTINUOUSLY HOSPITALIZED. MY HUSBAND SUFFERED ADDITIONAL
INJURY DUE TO A LACK OF COMMUNICATION BETWEEN STAFF AND
A LACK OF CONSULTATION WITH HIS MEDICAL RECORD.
AFTER FOUR WEEKS OF ENDURING THE UTTER HORROR OF NOT KNOWING WHAT
IS GOING ON, I WENT DOWN TO MEDICAL RECORDS AND I ASKED FOR
A COPY OF HIS ELECTRONIC MEDICAL RECORD.
I WAS TOLD IT WOULD BE 73 CENTS A PAGE AND THERE WOULD BE A 21
DAY WAIT. I WAS ASTOUNDED.
THIS WAS A STATE-OF-THE-ART HOSPITAL.
YET THEY WERE ASKING US TO WAIT 21 DAYS AND SPEND HUNDREDS OF
DOLLARS JUST TO READ FRED'S RECORD.
THE NEXT DAY, THE ONCOLOGIST CAME IN THE ROOM AND SAID, WE
ARE GOING TO SEND YOU HOME ON A PCA PUMP.
THE DOCTOR THEN LEFT THE ROOM AND MY HUSBAND AND I BURST INTO
TEARS. HE TURNED PO ME AND SAID,
REGINA, YOU GO AFTER THEM. YOU TRY TO GET ME CARE.
FIVE DAYS LATER WE WERE TRANSFERRED TO ANOTHER HOSPITAL
WITH AN OUT-OF-DATE AND INCOMPLETE TRANSFER SUMMARY AND
MEDICAL RECORD. FRED WAS DENIED PAIN MEDICATION
AND FOOD FOR SIX HOURS WHILE THE STAFF TRIED TO COBEL TOGETHER A
MEDICAL RECORD USING A PHONE AND A FAX MACHINE.
I EVENTUALLY GOT A COPY OF FRED'S RECORD.
AND DESPITE ITS MANY ERRORS, IT BECAME A VIRTUAL BIBLE TO GUIDE
US THROUGH THE LAST 56 DAYS OF HIS LIFE.
THERE WAS NOT A DAY I DIDN'T REFERENCE IT.
AND THAT INFORMATION HELPED EXTEND HIS LIFE AND TO CREATE A
FRAGILE PIECE WITHIN OUR HEART. FOR THERE IS NO GREATER SORROW
THAN WATCHING YOUR LOVED ONE SUFFER WHILE YOU FEEL HELPLESS
BECAUSE YOU DON'T KNOW WHAT IS GOING ON.
I DON'T HAVE A BACKGROUND IN MEDICINE.
BUT I DO KNOW ENOUGH TO HELP. WITH ACCESS TO HIS RECORD, I
COULD HELP EXPLAIN TREATMENT OPTIONS AND EASE HIS MIND.
THIS IS WHY I PAINT. THIS IS WHY I SPEAK.
SO OTHERS WILL NOT HAVE TO SUFFER AS WE DID.
WE ARE ALL PATIENTS IN THE END. WE ALL DESERVE TO BE TREATED
WITH DIGNITY AND RESPECT. AND I WILL NOT STOP.
I WILL NOT GIVE UP. UNTIL WE GET CHANGE IN THIS
NATION. AND UNTIL PEOPLE ARE TAKEN CARE
OF. AND WE ALL HAVE THE RIGHT TO SEE
OUR OWN INFORMATION. THANK YOU.
[APPLAUSE] [APPLAUSE]
-- REGINA, THANK YOU AGAIN FOR ADDING YOUR POWERFUL VOICE TO
THIS MOVEMENT FORWARD. I WOULD NOW LIKE TO INVITE BOTH
DR. BLUMENTHAL AND MARILYN TABNER FROM CMS TO COME TO THE
STAGE. THEY WORKED ON THIS REGULATION.
IF YOU HAVE QUESTIONS FOR THEM, THEY WILL BE PLEASED TO ANSWER
THEM.
SO THANK YOU ALL FOR BEING HERE.
[APPLAUSE] -- WE ARE GOING TO HAVE MARILYN
TABNER, THE PRINCIPAL DEPUTY ADMINISTRATOR FOR THE CENTER FOR
MEDICARE AND MEDICAID SERVICES AND TONY WHO IS THE DIRECTOR OF
THE OFFICE OF ELECTRONIC STANDARDS AND SEVERANCES.
AND WE ARE GOING TO TAKE QUESTIONS NOW FROM THE MEDIA.
AND IF YOU WOULD LIKE TO ASK A QUESTION, PLEASE RAISE YOUR HAND
AND IDENTIFY YOURSELF. I BELIEVE WE HAVE MICROPHONES.
DO WE HAVE MICROPHONES? YES, THERE IS A MICROPHONE.
THERE IS PROBABLY ONE OVER THERE TOO, YES?
-- JOHN WILLKIN SIN INSIDE HEALTH POLICY.
DR. BURR WICK MENTIONED WITH AN EMR SYSTEM, A DOCTOR WOULD BE
NOTIFIED IF HE HAD PRESCRIBED MEDICATION AND THERE WAS SOME
REASON FOR HIM TO BE NOTIFIED. I DON'T EXACTLY KNOW WHAT THOSE
REASONS WOULD BE. BUT COULD ONE REASON BE THAT
THERE WAS AN FDA WARNING ABOUT THAT DRUG?
IF THERE WERE SOME OFFICIAL GOVERNMENT PHYSICIAN SAYING
THERE COULD BE SOME CONCERNS WITH THAT DRUG?
COULD THAT BE INCLUDED IN THE NOTIFICATIONS?
-- THE WONDERFUL THING ABOUT ELECTRONIC SYSTEMS IS THAT THEY
ARE INTELLIGENT. AND THEY CAN BE DESIGNED TO
ALERT PHYSICIANS OR NURSES FOR OTHER HEALTH CARE PROFESSIONS TO
CONSEQUENCES OF THIS DECISION THAT MIGHT NOT BE KNOWN TO THEM
OR THEY MAY HAVE LOST TRACK OF. AND THE KINDS OF THINGS THAT CAN
BE ALERTED TO WITH RESPECT TO MEDICATION, INCLUDE OF COURSE
ALLERGIES AND I HAVE SEEN THAT. IT COULD INCLUDE INTERACTIONS
BETWEEN MEDICATION THAT THEY SHOULD TAKE INTO ACCOUNT.
IT COULD INCLUDE PROPER DOSAGE. IT COULD INCLUDE BLACK WARNINGS
FROM THE FDA. RECALLS BY THE FDA.
I PERSONALLY HAVE SEEN THAT IN MY OWN PRACTICE, THAT WHERE
DRUGS HAVE BECOME OR HAVE NEW PROBLEMS WITH DRUGS, HAVE BEEN
DISCOVERED AND THAT MY ELECTRONIC HEALTH RECORD ALERTED
ME TO THOSE. SO YES, ELECTRONIC HEALTH
SYSTEMS ARE SEEN OFTEN AS WAYS TO RECORD INFORMATION.
BUT THEY ARE ALSO WAYS TO REACH OUT TO HEALTH PROFESSIONALS WITH
THE LATEST INFORMATION. THEY ARE NOT JUST PASSIVE
REPORTERS. THEY ARE ACTIVE TEACHERS.
POTENTIALLY IF YOU WILL, AND OF COURSE IT'S THE PROFESSIONS AND
THE INSTITUTIONS AND PARTNERSHIPS OF SCIENTISTS AND
GOVERNMENT THAT FILL THE CONTENT OF THOSE ELECTRONIC HEALTH
RECORDS. -- JANET FROM THE WALL STREET
JOURNAL. THANK YOU FOR TAKING MY
QUESTIONS. IF I'M READING THIS CORRECTLY,
IT SOUNDS LIKE YOU RELAXED THE RULES A BIT SO HEALTH CARE
PROVIDERS, IT'S EASIER TO QUALIFY FOR THIS MONEY.
CAN YOU EXPLAIN HOW THE NEW RULES DIFFERS FROM THE PREVIOUS
ONE IN THAT REGARD? -- SURE.
I WOULD BE GLAD TO START AND THEN MARILYN AND TONY CAN ADD
IN. WE RECEIVED OVER 2000 COMMENTS
ON THIS NOTICE OF PROPOSED RULE MAKING THAT PRECEDED THIS FINAL
REGULATION. WE TRIED TO LISTEN TO THOSE
COMMENTS. WE VERY MUCH WANT WELL INTENDED
PROVIDERS TO BE ABLE TO BECOME MEANINGFUL USERS.
SO WE WANT THE OBJECTIVES TO BE BOTH AMBITIOUS BUT ACHIEVABLE,
TO ACHIEVE HEALTH CARE IMPROVEMENTS AND EFFICIENCY
IMPROVEMENTS AND ALSO TO BE SUCH THAN IF YOU TRY YOU CAN GET THE
INCENTIVES. WE HEARD THAT TWO THINGS, AT
LEAST TWO THINGS ABOUT THE RULE. ONE THAT IT WAS TOO IN FLEXIBLE.
IT WAS ALL OR NOTHING OBJECTIVE. WHAT WE DID IS ADDED SOME
CHOICES. THERE ARE NOW A CORE SET OF
OBJECTIVES THAT ALL ELIGIBLE PROFESSIONALS AND ALL HOSPITALS
NEED TO ATTAIN. THERE ARE 15 OF THOSE FOR ELDER
PROFESSIONALS AND 14 FOR HOSPITALS.
THERE ARE AN ADDITIONAL 10 THAT ARE A MENU.
THE A LA CARTE PART, IF YOU WILL.
AND ELIGIBLE PROFESSIONALS AND HOSPITALS CAN CHOOSE FIVE AMONG
THOSE TO BECOME MEANINGFUL USERS.
THE REST WOULD BE DEFERRED TO STAGE 2.
SO THE FIRST THING WE HAVE DONE IS ADDED FLEXIBILITY AND CHOICE
OF THE ALLOWING DIFFERENT PROVIDERS IN DIFFERENT
SITUATIONS TO TAKE DIFFERENT PATHWAYS TO MEANINGFUL USE.
WE ALSO REDUCED SOME OF THE MEASUREMENT LEVELS, THE
ACHIEVEMENT LEVELS REQUIRED IN THE NOTICE OF PROPOSED RULE
MAKING. JUST AS A VERY SPECIFIC EXAMPLE
IN THE NOTICE OF PROPOSED RULE MAKING, ELIGIBLE PROFESSIONALS
HAD TO PRESCRIBE 75% OF THEIR PRESCRIPTIONS ELECTRONICALLY.
IN THE NEW RULE, THAT NUMBER IS 40%.
A NUMBER THAT WE ARRIVED AT BY LOOKING AT THE COMMENTS AND TRY
TO FIGURE OUT WHAT WAS TRULY ATTAINABLE.
WE HAVE READSITUDES THE NUMBER OF CLINICAL DECISION SUPPORT
RULES THAT HAVE TO BE INCLUDED IN MEANINGFUL USE FROM 5-1 AND
THERE ARE A WHOLE RANGE OF OTHER SIMILAR CHANGES IN THE THRESHOLD
LEVELS. TONY, YOU MIGHT WANT TO SAY
SOMETHING ABOUT THE QUALITY REPORTING REQUIREMENT.
--
WE DEFERRED SOME OF THE ADMINISTRATIVE TRANSACTIONS.
IN THE NPRM WE HAD SEVERAL AND DEFERRED THEM TO STAGE TWO.
WE ALSO HAVE TAKEN THE CLINICAL QUALITY MEASURES.
WE HEARD A LOT OF FEEDBACK FROM THE COMMUNITYO THAT.
AND WE HAVE NOW REDUCED THE TOTAL NUMBER OF QUALITY
MEASURES. WE NOW HAVE 44.
AND WE HAVE SIX THAT NEED TO BE MET IN THE PROFESSIONALS AND 15
FOR THE HOSPITALS. WE HAVE ALSO TAKEN SOME OTHER
ACTIONS THAT WE FEEL HAVE MODERATED THE REQUIREMENTS BUT
BY MAINTAINING THE CORE ESSENTIAL ELEMENTS THAT WE WANT
TO MAKE SURE MEANINGFUL USE IS MET OVER THE NEXT SEVERAL YEARS.
--
OTHER QUESTIONS? YES, MA'AM
-- ADEL ALLISON WITH EHS. YOU HAD MENTIONED REDUCTION IN
THE ERX PERCENTAGE FROM 75-40%. IS SOME OF THAT BECAUSE OF THE
I. FR ISSUED BY THE DEA BY
PRESCRIBING CONTROLLED SUBSTANCE?
-- NO, THAT WAS NOT A CONSIDERATION.
IT WAS PURELY A MATTER OF WHAT WE THOUGHT WAS REASONABLE TO ASK
OF THE AVERAGE PHYSICIAN AND THE AVERAGE PROVIDER.
WE EXPECT LATER ON THAT THE PROPORTION OF PRESCRIPTIONS
PROVIDED ELECTRONICALLY WILL CONTINUE TO INCREASE IN FUTURE
STAGES OF MEANINGFUL USE. BUT ONCE AGAIN, WE WANT PEOPLE,
WELL INTENDED PROVIDERS TO BE ABLE TO GET ON THIS ESCALATOR
AND TO STAY ON IT AS WE GET TO MORE SOPHISTICATED AND
BENEFICIAL USES OF ELECTRONIC HEALTH RECORDS.
-- [LOW AUDIO] -- NO, I CAN'T.
BUT I WILL SOON. -- HI.
SUZANNE WITH THE AARP BULLETIN. HOW DO YOU RESPOND TO CONCERNS
THAT THIS IS GOING TO LEAD TO THE GOVERNMENT TELLING MY DOCTOR
HOW TO TREAT PATIENTS OR WILL OTHERWISE RESULT IN RESTRICTIONS
ON CARE? -- I CAN TELL YOU WHEN I USED
THE ELECTRONIC HEALTH RECORD, I NEVER FELT THAT ANYBODY WAS
TELLING ME WHAT TO DO AND I DON'T THINK MOST PHYSICIANS WHO
USE ONE FEEL THAT WAY. WE ARE NOT -- THIS IS A
VOLUNTARY PROGRAM. AND THE OBJECTIVES THAT ARE PART
OF THE MEANINGFUL USE FRAMEWORK WERE RECOMMENDED TO US BY A
FEDERAL ADVISOR COMMITTEE APPOINTED BY THE GENERAL
ACCOUNTING OFFICE AND BY MEMBERS OF CONGRESS FOR THE MOST PART.
THEY REPRESENT SOLID, CLINICAL INSIGHTS INTO HOW ELECTRONIC
RECORDS CAN IMPROVE CARE. AND THE SCIENTIFIC AND CLINICAL
GROUNDING OF THESE MEANINGFUL USING OBJECTIVES ARE VERY
IMPORTANT TO ME PERSONALLY AS A PHYSICIAN AND I MEAN VERY
IMPORTANT TO THEIR CREDIBILITY WITH THE PROFESSION.
THIS IS AS I SAID, I BELIEVE, GOING TO BE A PROFESSIONAL,
PROFESSIONALLY-LED MOVEMENT. NOT A GOVERNMENT-LED MOVEMENT.
BECAUSE USING INFORMATION EFFECTIVELY IS A CORE CLINICAL
COMPETENCE FOR HEALTH PROFESSIONALS.
AND THAT'S WHAT ELECTRONIC HEALTH RECORDS ENABLE YOU TO DO.
-- HI. MIKE WITH THE HILL.
YOU MENTION THE THE INCENTIVES FOR PROVIDERS THAT ADOPT
TECHNOLOGY BUT WHAT ARE THE PENALTIES FOR THOSE WHO DON'T
AND WHEN DO THEY GO INTO AFFECT? -- YOU WANT TO TALK TO THAT,
TONEY? -- IN TERMS OF THE PENALTIES, WE
BASICALLY WILL BE FOLLOWING LEGISLATION, WHICH REQUIRES
ADJUSTMENTS FROM THE MEDICARE SIDE AFTER 2015.
THE MEDICAID SIDE DOES NOT HAVE A CLAUSE IN IT.
-- ONE OF THE -- I'M AMY WITH THE POST.
IN THE CERTIFICATION RULE THAT WAS ANNOUNCED TODAY, YOU TALKED
ABOUT TESTING FOR FUNCTIONALITY. ANYTHINGED IN STANDARDS YOU'RE
ANNOUNCING THAT REQUIRES TESTS OR SAFETY OF THE SYSTEM THAT IS
ARE OVER THERE AND ARE THERE OTHER PROVISIONS TO MONITOR ONCE
THEY HAVE BEEN IMPLEMENTED? -- WE BELIEVE THAT CERTIFICATION
AND THE PROCESS OF CERTIFICATION WILL BE IMPORTANT ASSURANCE OF
FUNCTIONALITY AND OF CAPE ABILITY TO PERFORM MEANINGFUL
USE AND THEREFORE TO IMPROVE CARE AND IMPROVE SAFETY OF CARE.
WE KNOW THAT EVERY STUDY AND EVERY PROFESSIONAL CONSENSUS
PROCESS HAS CONCLUDED THAT ELECTRONIC HEALTH SYSTEMS
STRONGLY AND MATERIALLY IMPROVE PATIENT SAFETY.
AND WE BELIEVE THAT IN SPREADING ELECTRONIC HEALTH RECORDS, WE
ARE GOING TO AVOID MANY TYPES OF ERRORS THAT CURRENTLY PLAYING
THE HEALTH CARE SYSTEM, SOME OF WHICH WERE DESCRIBED BY REGINA
HOLIDAY TODAY. AT THE SAME TIME, WE BELIEVE
THAT WE HAVE A OBLIGATION TO MAKE SURE THAT THE
IMPLEMENTATION OF THOSE OR OF THAT PROCESS IS AS FLAWLESS AS
IT CAN BE. AND WE ARE GOING TO BE -- WE
EXPECT THERE WILL BE POST-CERTIFICATION SURVEILLANCE
THROUGH THE CERTIFICATION PROCESS.
WE WILL COLLECT INFORMATION ABOUT PROBLEMS THAT OCCUR WITH
THE IMPLEMENTATION OF ELECTRONIC HEALTH RECORDS, IF ANY.
AND WE ARE WORKING WITH MANY PARTNERS IN THE FEDERAL
GOVERNMENT TO MAKE SURE THAT WE HAVE ACCURATE INFORMATION ON HOW
THE IMPLEMENTATION PROCESS IS GOING.
WE WILL BE WORKING WITH REGIONAL EXTENSION CENTERS ON THAT AND
STATE GOVERNMENT'S WITH THE PROFESSION.
ONE MORE QUESTION. -- [OFF MIC]
EMPHASIS IS BEING PLACED ON HEALTH INFORMATION EXCHANGE, THE
ABILITY TO GO ACROSS DIFFERENT SYSTEMS AND ACROSS STATES.
-- HEALTH INFORMATION EXCHANGE A VERY, VERY IMPORTANT GOAL OF
THIS POLICY FOR US. IT IS OUR INTENTION THAT HEALTH
INFORMATION SHOULD FOLLOW PATIENTS.
AS IT SHOULD HAVE FOR MR. HOLIDAY.
AND AS IT SHOULD FOR ALL PATIENTS.
IT IS A COMPLICATED THING TO ACHIEVE HEALTH INFORMATION
EXCHANGE BECAUSE TO SOME DEGREE, THE ABILITY TO DO THAT IS ONLY
AS STRONG AS THE WEAKEST LINK IN THE CHAIN.
SO WE ARE EXPECTING HEALTH INFORMATION EXCHANGE IN THE MOST
ROBUST FORM TO OCCUR LATER IN THE IMPLEMENTATION OF MEANINGFUL
USE IN STAGES 2-3 RATHER THAN STAGE ONE BECAUSE THE CAPABILITY
FOR EXCHANGE IS NOT AS STRONG AS IT SHOULD BE RIGHT NOW IN THIS
COUNTRY. AND WE ARE WORKING REALLY HARD
ON THAT IN TERMS OF OUR OWN DEVELOPMENT OF STANDARDS AND
SOFTWARE WITHIN THE OFFICE OF NATIONAL COORDINATOR AND WE
EXPECT FURTHER VERSIONS OF MEANINGFUL USE IN THE STAGE 2
AND 3 TO DEMAND A SUBSTANTIALLY MORE EXCHANGE THAN THE FIRST
VERSION OF MEANINGFUL USE. THANK YOU ALL FOR YOUR
ATTENTION. WE LOOK FORWARD TO HEARING MORE
FROM YOU. [APPLAUSE]