Physician Perspective : The New HIT Landscape

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1 Physician Perspective : The New HIT Landscape Michael J Mirro MD, FACC, FACP, CCDS Fort Wayne Cardiology/Parkview Physician Group Medical Director: Parkview Research Center Chair: ACC Informatics Committee Chair: HRS Informatics Workgroup Co-Chair : CCHIT Advanced Quality Workgroup Member : NQF HIT Utilization Expert Panel

2 Health Information Technology Automation (document management) Connectivity(health Information exchange) Clinical Decision Support Data-Mining Capabilities

3 HIT : Evolutionary Change Principles Focus on Care Improvement (Iterative Improvement-Technology Secondary) Seek Incremental Gain Incremental Effort Design for Human and Organizational Factors Cognitive Function Support : All Caregivers Record Available Data : a) Care Improvement b) Process Improvement c) Research

4 Benefits of HIT Adoption Improve Quality Reduce Medical Errors (e-prescribe) Improve Efficiency (HIE) Mitigate Medical-Legal Risk Promote Data Mining for Comparative Effectiveness Improve Health Outcomes

5 Health Information Technology Tools The Most Important Instruments to Practice Medicine in the 21 st Century

6 Mortality in the 20 th Century Better treatment of cardiovascular disease, low birth-weight infants Reduced infectious disease mortality (clean water, sewers, antibiotics, better nutrition)

7 The Core HIT Idea Adoption Meaningful Use Outcomes

8 Slow HIT Adoption Lack of Capital of Private Practice Unclear ROI Lack of System Standardization Lack of Interoperability Standards Large Vendor Community promoting Silo approach to HIT Systems Developed for Billing/Coding and Charge Capture not Clinical Elements

9 Poor Health Information Technology Tools Lacks cognitive support for clinicians Does not integrate well into clinical workflow Does not take advantage of human-computer interaction principles Leads to poor designs, potential errors HIT could actually worsen future healthcare (

10 Electronic Health Records as a Foundation Technology Adoption Transformational Change in Health Care Delivery & Population Health ? TIME

11 Accelerating EHR Adoption: EHR Standards Government Role EHR Vendor Certification Financial Incentives Data Storage and Exchange

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13 If you want to promote better coordination between doctors, you need to be able to quickly move health information wherever it s needed. If you want to empower consumers to take charge of their health care, they need to be able to access their health information without calling up five different doctor s offices. Kathleen Sebelius Secretary of Health and Human Services

14 American Recovery and Reinvestment Act (2009) HITECH (Healthcare Information Technology for Economic and Clinical Health) Act Provides a framework to incent hospitals and providers to use HIT in a meaningful way Defines a timetable and expectations for the demonstration the Meaningful Use of HIT Establishes 5 Focus Areas for the Meaningful Use of Health IT

15 Meaningful Use is Being Defined and Will Follow an Ascension Path Over Time HIT-Enabled Health Reform HITECH Policies 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes)

16 CMS Final Rule Stage * 1. Capturing health information in a coded format 2. Using the information to track key clinical conditions 3. Communicating captured information for care coordination purposes 4. Reporting of clinical quality measures and public health information Capture information. Stage * 1. Disease management, clinical decision support 2. Medication management 3. Support for patient access to their health information 4. Transitions in care 5. Quality measurement 6. Research 7. Bi-directional communication with public health agencies Report information Stage 3 TBD* 1. Achieving improvements in quality, safety and efficiency 2. Focusing on decision support for national high priority conditions 3. Patient access to selfmanagement tools 4. Access to comprehensive patient data 5. Improving population health outcomes Leverage information to improve outcomes *Indicates payment year in which each Stage is first introduced. Actual compliance timeframe depends on an EP s first payment year.

17 Achieving MU : Eligible Provider Adopt an ATCB certified EHR and use it Demonstrate use of Clinical Decision Support Demonstrate Health Information Exchange Demonstrate Electronic Quality Reporting

18 Meaningful Life

19 What Do I Need to Do Now? 1. Get a certified EHR (use in >80% of patients) Consider Regional Extension Center (REC) assistance 2. Implement the MU requirements e-prescribe! Adapt your workflow to accomplish MU Select the quality metrics you plan to measure Select the Menu Set objectives you plan to fulfill Use your certified EHR per the MU specifications for at least 3 months (first year) 3. Register for incentives 4. Attest to performance 5. Deposit check in bank

20 Adoption Barriers Cost Inflexible EHR software Inflexible EHR vendors Practice disruption Invasive EHR solutions

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22 Fort Wayne Cardiology Single Specialty : 24 Physicians Staff : 5 RN-NP and 180 Nurses & Techs Two Health System Locations Two Main Offices & 11 Clinic sites HIT Adoption : 1996 Hospital Integration Completed 2009

23 EHR Selection Functionality and Usability

24 Initial EHR Adoption Steps Organize Change Assessment Implement Plan Develop HIT Implementation Teams Identify Physician Champions Shift Focus of Workflow on Resistant Users Select HIT Vendor (CCHIT & IHE) Incremental Approach

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26 HIT and Aviation Complex Tool Sets Training Essential to Success Implementation Plan Key Good Technology cannot Succeed without Infrastructure Support Technology Upgrades require Retraining Good and Poor Technology Design Exist

27 Comments?

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