Health Information

Technology

Harry J. MartinInformation Systems Manager

Public Health Department

Santa Clara Valley Health & Hospital System

Fall Semester 2014

Goals for talk

High-level overview

Describe concepts of HIT

What are the needs for HIT workforce

What role does HIT play in Health Care Reform

Source: Robert Martin, MPH, DrPH, Associate Director, Coordinating Center for Health Information and Services, CDC; presented at 2007 PHIN Conference

Consumers

Hospital orHealthcare

System

Electronic HealthRecords

ClinicalLabs

Personal HealthRecords

CDC, FDA, USDA, EPA,

VA, DHS, etc.

RX

PharmaceuticalStockpile

State and Local Health Departments

Public HealthLabs

Other SurveillanceSources

Directory

Messaging

Vocabulary

Security

Common Servicesand Components

Data & Information

IdentificationAnalysis

InterventionCommunication

NHINPatient Data

Health Record LocatorData Brokering

National Health Information NetworkSource: Robert Martin, MPH, DrPH, Associate Director, Coordinating Center for Health Information and Services, CDC; presented at 2007 PHIN Conference

Terms

Electronic Medical Record (EMR)

Electronic Health Record (EHR)

Personal Health Record (PHR)

Terms (cont.)

• ONC - Office of the National Coordinator for HIT

• CMS – Centers for Medicare and Medicaid Services

• Meaningful use

• ACO – Accountable Care Organization

Terms (cont.)

Interoperability

Health Information Exchange (HIE)

Computerized Physician Order Entry (CPOE)

E-Prescribing

Clinical Decision Support System (CDSS)

Terms (cont.)

HIE - Health Information Exchange

• Federated Model

• Monolithic Model

RHIO

HITECH Act

But first for a little history….

Bush Administration

Executive orders

• April 2004

Commitment to achieving widespread use of EMRs by 2014

• August 2006

Directs HHS and all federal agencies to ensure that internal programs and external contracts implement relevant HHS recognized interoperability standards

Obama Administration

“To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized … It just won’t save billions of dollars and thousands of jobs – it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.” • January, 2009

Barack Obama: "Address at George Mason University in Fairfax, Virginia," January 8, 2009. Online by Gerhard Peters and John T. Woolley, The American Presidency Project. http://www.presidency.ucsb.edu/ws/?pid=85361.

HITECH

Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA)

• Incentives for EHR adoption ($30B, offset by $20B in savings)

• Direct grants administered by federal agencies ($2B) – ONC-coordinated

HITECH

Other provisions in other areas of ARRA

• Comparative effectiveness research

• NIH and other research funding

• Broadband and other infrastructure funding

Motivations

• Quality – not as good as it could be

• Safety – IOM 2000: 44-98K deaths/yr

• Cost – rising costs are not sustainable

• Inaccessible information – missing information frequent in primary health care

HITECH Vision

National eHealth Colllaborative. 2012. Health IT Orientation: National eHealth Collaborative University.

Where are we today?

CMS and the ONC give providers an additional year to meet MU requiremetns

CMS 2015 payment schedule

• market basket update of 2.9% for providers who in 2013

Submitted QoC data

Demonstrated MU

Just what is “HIT” anyway

Biomedical and health informatics (BMHI)

• Field that seeks the optimal use of information, often aided by technology, to improve individual health, health care, public health, and biomedical research

It’s about information, not technology

Technology is a relatively small piece

• Science behind the application of IT to healthcare

• Practitioners are usually called informaticians

The HIT Equation

Health (people) + information + technology

=

HIT

Expanded use of HIT

Benefits for individual patient care• Improve quality of patient care

• Reduce medical errors

• Reduce health care costs

• Increase administrative efficiencies

• Eliminate duplication of information gathering and testing

• Promote care coordination

• Expand access to affordable care

Expanded use of HIT

Public sector benefits

• Early detection of infectious disease outbreaks around the country

• Improved tracking of chronic disease management

• Evaluation of health care –

determine the value derived from collection of de-identified price and quality information

Health Record

Definitions

Types of Health Records

Electronic Medical Record (EMR)

• Early EMRs – clinicians for Dx and Tx

Maintained by physicians

Electronic Health Record (EHR)

• Longitudinal, full record

Maintained by providers

Personal Health Record (PHR)

• Not covered by HIPAA

Maintained by patient

Organizations

• ONC - Office of the National Coordinator for HIT

• CMS – Centers for Medicare and Medicaid Services

• ACO – Accountable Care Organization

• Meaningful use

Building Blocks

Interoperability

Health Information Exchange (HIE)

Computerized Physician Order Entry (CPOE)

Clinical Decision Support (CDS)

E-Prescribing

Meaningful Use

Meaningful Use

HITECH provides financial incentives for “meaningful use” of HIT

• Incentives for EHR adoption ($36-40B)

• Direct grants ($2B)

Office of the National Coordinator for Health IT (ONC)

EHR Certification and

Meaningful Use

ONC – Office of the National Coordinator for

Health Information Technology - defines the certification criteria for Electronic Health Records (how the EHR must work)

CMS – Centers for Medicare and Medicaid

Services define meaningful use (how the EHR must be used)

What is “meaningful use” of an EHR

Five basic goals for healthcare system1. Improving quality, safety and efficiency

Use CPOE

2. Engaging patients in their care Provide patients with a copy of their PHI

3. Increasing coordination of care Exchange key clinical information with other providers

4. Improving health status of the population Submit electronic data to immunization registries

5. Ensuring privacy and security Protect electronic health information created or maintained in

the EHR

What is “meaningful use” of an EHR

Three requirements:

• Use of certified EHR technology in a meaningful manner

• Utilize certified EHR technology connected for health information exchange (HIE)

• Use of certified EHR technology to submit information on clinical quality measures

Timeline for implementation

Timeframe for implementation of meaningful use criteria

• 2009 – HITECH policies

• 2011 – Stage 1 capture/share data

• 2014 – Stage 2 advanced care with decision support

• 2016 and beyond – Stage 3 Improved Outcomes

Implementation of meaningful use

Implemented through Medicare or Medicaid reimbursement to

• Eligible professionals – up to $44K

(Roughly equal to the cost of converting a physician practice from paper to EHRs.)

• Eligible hospitals - $2 – $9 million or $17,500 / bed

Timeframe for full implementation

• 2014 – advanced care with decision support

Stage 1 Requirements

15 Mandatory Core Measures

5 0f 10 Menu Measures

6 Clinical Quality Measures

• 3 core, 3 menu from a list of 41

Stage 1 Core Measures(15 required)

Improve Quality, Safety and Efficiency, and Reduce Health Disparities

• At least 40% of prescriptions transmitted electronically to the patient’s pharmacy

Engage Patients and Families

• Provide patients clinical summaries within 3 business days for over 50 percent of all office visits

Stage 1 Core Measures(cont.)

Improve Care Coordination

• Perform at least one test to demonstrate the ability to exchange key clinical information with other providers

Privacy and Security

• Conduct or review a security risk analysis and implement security updates as necessary

Menu Set Measures

Improve Quality, Safety, and Efficiency, and Reduce Health Disparities

• Generate at least one report listing patients with a specific condition

Engage Patients and Families

• Send reminders, if desired, for preventive/follow-up care for specified minimum percentages of adult and pediatric patients

Menu Set Measures(cont.)

Improve Care Coordination

• Perform medication reconciliation for more than 50 percent of patient transitions into the care of the physician

Improve Population and Public Health

• Perform at least one test of EHR‘s capability to provide syndromicsurveillance data to public health agencies, and perform a follow-up submission if the test is successful

Clinical Quality Measures(3 core) …

Adult Weight Screening

• % of patients with calculated BMI

• Plan to follow-up if above criteria

Diagnosed Hypertension

• At least 2 Blood Pressure readings

Preventive Care and Screening

• Ask about tobacco usage

• Cessation intervention for smokers

Other Clinical Quality Measures(3 of 41)

Several cancer screening

Anti-platelet therapy for CAD patients

Quality Measures for MU

September 4, 2012 CMS releases final rules for Stage 2:

• Eligible professionals

Need to meet 17 core objectives and 3 of 6 menu objectives = 20 objectives total

• Hospitals

Need to meet 16 core objectives and 3 of 6 menu objectives

Stage 2 Core Measures

Raised the goals

Consolidated Stage 1 Menu Set into Core

• e.g. measures may now have additional components

Stage 2 Core Measures(cont.)

New and Important:

• 5% of patients digitally accessed health information

How: Transferring a CCD to PHR

• 5% sent secure messages to provider

How:DIRECT

Stage 2 vs. Stage 1

Menu set (3 of 6)

All new

More clinically sophisticated

Submit cancer cases to a registry

Electronic access to scans and images

Quality Measures – 9 of 64 required

• Was 6 of 44 in Stage 1)

Funding Initiatives

Funding initiatives

HIT Regional Extension Centers (RECs)

• $643M – 70 RECs; provide guidance, mainly to primary care practices, in achieving meaningful use

State-based health information exchange (HIE)

• $564M – to states to develop HIE programs

Funding initiatives

Beacon Communities

• $235 M to fund 15 communities that provide exemplary demonstration of meaningful use of EHRs

• Awards were announced last year

Strategic health information advanced research projects (SHARP)

• $60 M for 4 collaborative research centers

Funding for Health IT workforce

Key to implementation

• ONC estimates at least 50,000 workers needed to implement the federal HIT agenda

• ONC is funding $118 million for

Community college consortia - $70M

Curriculum Development Centers - $10M

University training grants ($32M)

Competency testing ($6M)

HIT is a core competency

IOM report: modern health care professional must have competency in informatics in order to provide patient-centered care

Evidence-based practice

Apply Quality Improvement

Utilize Informatics

patient-centered care

Who is the health IT workforce?

Historically, three groups of HIT professionals

• Information technology (IT) – usually with computer science or information systems background

• Health information management (HIM) – focus on medical records

• Clinical informatics (CI) – often from healthcare backgrounds (MDs, nurses)

HITECH Milestones(as of 2011)

Source: http://www.healthit.gov/achieving-MU/ONC_Encourage_HealthIT_FS.PDF

2013 Progress Report

EHR Incentive program

• Eligible Hospitals (EH)

85% of eligible hospitals participate

75% have received payments for MU

• Eligible Professionals (EP)

More than 388,000 have registered (73% of all eligible to participate)

More than 230,000 have received payments (44%)

2013 Progress Report

EHR Incentive program

• $12.6 billion paid as of February 2013

• $14.6 billion paid as of April 2013

Progress (cont.)

RECs

• Providing assistance to more than

44% (130K) primary care providers

48% (20K) of nurse practitioners

Health IT marketplace

• Robust market for eHealth IT products

As of March 2013 – 941 vendors with more than 1,700 unique certified EHR products

Progress (cont.)

Rapid Adoption of Advanced Technology

• E-Prescribing – office-based physicians

0.8% in December 2006

53% in January 2013

More than 94% of all pharmacies

Progress (cont.)

Rapid Adoption of Advanced Technology (beyond MU requirements)

• Hospitals

2008 – 9.4 % using advanced functionality

2012 – 44 percent

• Doctors

2008 – 17% using same advanced functionality

2012 – 40 %

Progress (cont.)

Workforce Development

• Community colleges – 17,049 HIT professionals trained (January 2013)

• Universities – 820 post-graduate and masters-level HIT professionals (September 2012)

50,000 HIT jobs created under HITECH

Blue Button

Web-based utility that allows patients to download and share their health information

Developed by VA and HHS for Veterans and Medicare recipients

Simple text file – easier to share

• Human- and

• Machine-readable format

Source: Webinar, Sept. 5, 2012. National eHealth Colllaborative.Health IT Orientation: National eHealth Collaborative University.

Source: Robert Martin, MPH, DrPH, Associate Director, Coordinating Center for Health Information and Services, CDC; presented at 2007 PHIN Conference

Consumers

Hospital orHealthcare

System

Electronic HealthRecords

ClinicalLabs

Personal HealthRecords

CDC, FDA, USDA, EPA,

VA, DHS, etc.

RX

PharmaceuticalStockpile

State and Local Health Departments

Public HealthLabs

Other SurveillanceSources

Directory

Messaging

Vocabulary

Security

Common Servicesand Components

Data & Information

IdentificationAnalysis

InterventionCommunication

NHINPatient Data

Health Record LocatorData Brokering

National Health Information NetworkSource: Robert Martin, MPH, DrPH, Associate Director, Coordinating Center for Health Information and Services, CDC; presented at 2007 PHIN Conference

Merged with HIMSS

Foundation late 2013

Public-private partnership

• Secure and interoperable nationwide health information exchange

• Advance health and improve health care.

Stakeholders

government agencies

health systems

health professionals

academic medicine

patient and consumer

advocates

major payers and

employers

non-profits

technology providers

How IT projects fail

Problematic health IT implementations are well known, with failure often attributable to the lack of understanding of clinical environment

• Ensure all key players are involved from front-line staff to executive management, from programmers to IT project management

Immunization Registry

Incentives / Free-rider problem

Key support from motivated providers

County mandate as a condition of receiving funds for community clinics

HEDIS

Some physicians were concerned about IPAs getting information on their practices (performance measurement reporting) that they could use to penalize them.

Sources

Logos hyperlink to websites.

Websites for HIT Jobs &

Training Health IT No. 1 on list of top 10 'hot' careers

Healthcare information technology tops the list of top 10 'hot careers' for college graduates in 2011, according to a new study from the University of San Diego Extension.

Jobs

Training

HIT Blogs

John Halamka: http://geekdoctor.blogspot.com/

Wes Rishel: http://blogs.gartner.com/wes_rishel/

EMR and HIPAA: http://www.emrandhipaa.com/

HISTalk (ads): http://histalk2.com/

Sphere by Shahid N. Shah, (ads): http://hitsphere.com

The End