Patient Safety, Health IT, & Outcomes

Transcription

1 Patient Safety, Health IT, & Outcomes David R. Hunt, MD, FACS Medical Director, Health IT Adoption & Patient Safety Office of Clinical Quality & Safety Office of the National Coordinator for Health IT

2 David R. Hunt, MD, FACS I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this activity I do not intend to discuss an unapproved/investigative use of a commercial product/device

3 safe ty: the condition, act or process of freeing n. (sāf tē), [L. salvus] : patients from the risk of harm, injury, or loss the quality or condition of being inherent from their interaction with the health care delivery systemindependent of free from harm, injury, or loss the risk of harm, injury, or loss imposed from their particular disease process Webster s New 21 st Century Dictionary Unabridged

4 Institute of Medicine, 2003 Patient safety is indistinguishable from the delivery of quality care. Paul Tang, et. al. Patient Safety: Achieving a New Standard for Care: November

5 Institute of Medicine Health IT & Patient Safety Commissioned by ONC Published Nov Recommendations 31 Specific activities by HHS through ONC 5

6 INSTITUTE OF MEDICINE Advising the nation/improving health OF THE NATIONAL ACADEMIES Key Findings Health IT can improvepatient patient safety in some areas such as medication safety; however, there are significant gaps in the literatureregarding regarding how health IT impacts patient safety overall Safer implementation and usebegins with viewing health IT as part of a larger sociotechnical system All stakeholders need to work together to improve patient safety 6

7 Make care safer Improve safe use of Health IT

8 Usability: Provider-Centric EHRUSABILITY User Interface & Design Support of Cognitive Workflow 8

9 Learn Improve Lead 9

10 Improve SAFER Guides Designed to help healthcare providers & organizations optimize the safety and safe use of electronic health records (EHRs) Each of the nine SAFER Guides identifies recommended practices, which healthcare organizations can use to self-assess practices associated with safe EHR use. 10

11 Socio-Technical Model for Health IT Adapted by permission from BMJ Publishing Group Limited. Sitting DF and Singh H. A new socio-technical model for studying healthinformation technology in complex adaptive healthcare systems. Quality and Safety in Health Care. 19(Supplement 3): i68-74, October 2010; doi: /qshc

12 SAFER Guides: 9 Domains Structure Contingency Planning System Configuration System Interfaces Process High Priority Practices Organizational Responsibilities Outcomes Computerized Provider Order Entry with Decision Support Test Results Reporting and Follow-Up Clinician Communication Patient Identification 12

13 outˊkumˊ: n. [ME. utcome] : result; consequence; aftermath --SYN. see EFFECT Webster s New 20th Century Dictionary Unabridged

14 AvedisDonabedian, MD ( ) Structure Process Outcome Donabedian, A, Evaluating the Quality of Medical Care. The Milbank Memorial Fund Quarterly, Vol. 44, No. 3, Pt. 2, 1966 (pp ).

15 Quality = Help Safety = Do no harm

16 16

17 Adjusted Relative Risk Postprocedural Event Infection General Adverse Drug Events 17

18 Adjusted Relative Risk Postprocedural Event Infection General Adverse Drug Events 18

19 Adjusted Relative Risk Postprocedural Event Infection General Adverse Drug Events 19

20 CONCLUSIONS From 2005 through 2011, adverse-event rates declined substantially among patients hospitalized for acute myocardial infarction or congestive heart failure but not among those hospitalized for pneumonia or conditions requiring surgery. (Funded by the Agency for Healthcare Research and Quality and others.) 20

21 EHRIncentive Programs 8/4/2014 Office of the National Coordinator for Health Information Technology 21

22 CMS Value-Based Programs 1. Medicare & Medicaid EHR Incentive Program 2. Medicare Physician Quality Reporting System (PQRS) 3. Medicare Electronic Prescribing (erx) Incentive Program 4. Accountable Care Organizations 5. Bundled Payments for Care Improvement 8/4/2014 Office of the National Coordinator for Health Information Technology 22

23 8/4/2014 Office of the National Coordinator for Health Information Technology 23

24 When do I start Stage 2? 8/4/2014 Office of the National Coordinator for Health Information Technology 24

25 Stage 2 Overview 8/4/2014 Office of the National Coordinator for Health Information Technology 25

26 Medicare PQRSIncentive Program 8/4/2014 Office of the National Coordinator for Health Information Technology 26

27 PQRS Voluntary reporting program that provides an incentive payment to practices that satisfactorily report data on quality measures Incentive: 0.5% Part B allowed charges, and additional 0.5% for participation in Maintenance of Certification Program Report measures any one of four ways: Part B claims Qualified reporting registry EHR PQRS vendor 8/4/2014 Office of the National Coordinator for Health Information Technology 27

28 CMS Accountable Care Organization Programs 8/4/2014 Office of the National Coordinator for Health Information Technology 28

29 Accountable Care Organization Programs Medicare Shared Savings Program (cms.gov)-for fee-for-service beneficiaries Advance Payment ACOModel-For certain eligible providers already in or interested in the Medicare Shared Savings Program Pioneer ACOModel-Health care organizations and providers already experienced in coordinating care for patients across care settings ACO: Accelerated Development Learning Sessions-For existing or emerging Accountable Care Organizations (ACOs) to develop a broad and deep understanding of how to establish and implement core functions to improve care delivery and population health while reducing growth in costs. 8/4/2014 Office of the National Coordinator for Health Information Technology 29

30 outˊkumˊ: n. [ME. utcome] : result; consequence; aftermath --SYN. see EFFECT Webster s New 20th Century Dictionary Unabridged

31 Malpractice Claims and EHRs Urology Pulmonary Psychiatry Plasticsurgery Pediatrics Otolaryngology Orthopedics Obstetrics/gynecology Neurosurgery Internal Medicine Generalsurgery Gastroenterology Family Medicine Dermatology 8/4/2014 The relationship between electronic health records and malpractice claims. Quinn MA, Kats AM, Kleinman K, Bates DW, Simon SR. Arch Intern Med Aug 13;172(15): Office of the National Coordinator for Health Information Technology Claims After EHR Adoption Claims Before EHR Adoption

32 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.

33 Thank You Contact Information 33