Brent I. Fox, PharmD, PhD Assistant to the Dean for Educational Technology Auburn University Harrison School of Pharmacy

Transcription

1 Brent I. Fox, PharmD, PhD Assistant to the Dean for Educational Technology Auburn University Harrison School of Pharmacy

2 1. Understand key terminology and organizations involved in health information exchange 2. Describe private and federal initiatives to create effective health information exchange 3. Describe key technological and nontechnological barriers to health information exchange 4. Describe the role of regulatory agencies, including boards of pharmacy, as it relates to health information exchange 5. Describe the public s primary concern relating to health information exchange 2

3 Environmental scan Federal initiatives AHIC/ONC Others State level activities Legislation Related issues Looking ahead 3

4 Institute of Medicine (IOM) To Err is Human: Building A Safer Health System (11/99) Crossing the Quality Chasm: A New Health System for the 21st Century (3/01) Health Professions Education: A Bridge to Quality (4/03) Preventing Medication Errors (7/06) 4

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6 2005 Per Capita Spending on Healthcare IT Dollars US Australia Norway Germany Canada UK 6

7 Migrating from Paper to Electronic Data Rigidly structured feels like picking everything from a huge menu Partially structured feels like filling in a form Electronic free text feels like typing or dictating Paper Starting Point the way I do it now 7

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10 ~40% of evacuees on prescription meds before the storm Many displaced hundreds (thousands) of miles Knowledge of their regimen color form? KatrinaHealth.org 150 public and private sector groups (ONC) Secure site, authorized pharmacists and physicians Access to medication lists (incl. doses) before the storm Highlighted need for EHR Identified vulnerabilities in data storage 10

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12 Electronic Medical Record (EMR) CPOE/eRx Laptops and PDAs Bar Codes and RFID Wireless Internet-based resources Internet reporting of outcomes with patients and other providers 12

13 National Survey 2005 vs CPOE System 6.8% to 8.7% of Hospitals BCMA System 9.4% to 13.2% EMR System 38.1% 2006 Pharmacy has access to EMR Data 94% 2006 Smart Infusion Pumps 32% to 37% Pharmacy Personnel Dedicated to IT 26.2%

14 EHR CPOE HIMSS CCHIT HL-7 AMIA BCMA RxNorm ONCHIT AHRQ RHIO SNO-Med POC HITSP erx PHR AHIC ADC/ADM CDSS NHIN 14

15 By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care President Bush, State of the Union Address, 1/20/04 "We will make wider use of electronic records and other health information technology to help control costs and reduce dangerous medical errors " President Bush, State of the Union Address, 1/31/06 15

16 RHIO-based IT systems are connected via a shared architecture Collaborative Care Model All providers have access to up-to-date patient information 16

17 Hospital Or IDN HIS Clinical Data Repository Hospital Or IDN HIS &/Or PHR Patient Reg. Payer MCIS Master Person Index Reg. Lab LIS EMR &/Or Physician Practice Other Local Orgs. IS Record Locator Service Regional and local healthcare focus Combining data governance and connectivity A variety of technical architectures Centralized, de-centralized and hybrids Employing one or more tools such as: Clinical data repository Master person index Record locator service Physician practice EMRs and patient PHRs may connect to exchange data (annotation?) Immature business models to date: may go the way of the CHINs of the past Note: Graphic courtesy of SureScripts 17

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19 Established in Spring 2004; ONC Dr. David Brailer, MD, PhD (May 19, 2006) Dr. Rob Kolodner (National Coordinator) Coordinates federal activities relating to health information technology Two early goals Widespread adoption of EHRs (EMRs) within 10 years Interoperable health information infrastructure 19

20 American Health Information Community Members announced Sept 13, 2005 Advises HHS Secretary Leavitt and the healthcare IT industry Recommends specific actions that will accelerate the widespread application and adoption of interoperable, electronic health records and other health information technology Provides a voice for stakeholders (public and private sector) The Community Public/private partnership by

21 National Health Information Network Standards Harmonization Privacy/Security Solutions Certification Commission for Healthcare Information Technology Health IT Adoption 21

22 Consortia Accenture, Computer Science Corporation, IBM, Northrop Grumman Third NHIN Network Forum Prototypes Business Models Jan 07 Maintenance of confidentiality Confidence 22

23 June standards for exchange of allergy, demographic, lab, and medication data October 06 Interoperability specifications delivered for software to exchange clinical data January standards accepted for three use cases: biosurveillance, consumer empowerment, EHR Coming Additional standards and implementation guides 23

24 Currently, public comment being sought on plans for harmonizing standards Consumer access to clinical data via PHR ER-EHR (EHR for first responders) Quality Security and privacy AHIC vote in December 24

25 Health Information Security and Privacy Collaboration (HISPC) RTI Identify variations in privacy and security practices and laws affecting electronic health information exchange Develop best practices and propose solutions to address identified challenges Increase expertise about health information privacy and security protections at the community level 25

26 Original draft timeline (06) January 4: released RFP March 1: proposals due Performance by subcontractors April 24, 2006 March 30, 2007 May 8 proposal status notification May 23 rd 22 states signed agreements August 2 nd 11 additional states and 1 territory March 07 deadline remains Conference March 5-7: Bethesda 26

27 AHIC Confidentiality, Privacy, and Security Work Group Broad charge: Make recommendations to the Community regarding the protection of personal health information in order to secure trust, and support appropriate interoperable electronic health information exchange. Specific charge: Make actionable confidentiality, privacy, and security recommendations to the Community on specific policies that best balance the needs between appropriate information protection and access to support, and accelerate the implementation of the consumer empowerment, chronic care, and electronic health record related breakthroughs. 27

28 Objectives HIT adoption by investment risks Facilitate interoperability of HIT products within emerging NHIN Enhance availability of HIT adoption incentives AND relief of regulatory barriers Ensure that HIT products and networks protect privacy of personal health information Visible Source: 28

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30 Final Certification Criteria Ambulatory EHR 30+ ambulatory EHRs certified to date Another 30 seeking certification ~60 ambulatory certified (25%) Need for specialty practice certification Will ambulatory and inpatient criteria sets cover all care settings? 30

31 Inpatient Criteria 2007 Subset of functionality rather than all aspects of the inpatient EHR Quality and Safety Support chain focuses on Computerized Provider Order Entry (CPOE), Clinical Decision Support (CDS), Pharmacy, and Medication Administration systems CPOE + emar or emar alone Q & S Adoption Criteria development Public comment 11/27 12/10 (ASHP) Recent round of public comment 2/16 3/16 Draft test scripts March; Pilot test April/May Certification August 31

32 Ambulatory EMR Physician Practice Hospital Or IDN Inpatient EMR Clinical Data Repository Electronic Medical Record Hospital Information System Payer EMR Member Clinical Summary Rx Claims History Patient Personal Health Record EHR Managed Care Information System Payer PHR Clipboard PMR: Current Meds Pharmacy Management System Clinical Lab Information System Image Management System Pharmacy PBM Prescription History Pharmacy Lab Patient Lab History Blood Donor Repository Genetic Profiles Imaging PACS Archive Diagnostic Image Repository 32

33 P H Y S I C I A N P H A R M A C I S T Before Encounter Schedule patient Pull patient chart Review patient chart Encounter Interview patient re: meds Decide medication therapy Write prescription Document Rx in note After Encounter Re-file chart Clarification calls Prescription benefits issues Renewal authorizations Patient Safety & Care Quality & Clinical Practice Efficiency Acquire Prescription Drop Off, Phone, Fax, IVR Insurance ID card Data input into computer Process Prescription Pharmacy DUR Claims: Payer DUR Claims: Eligibility / benefits Order fulfillment / dispense Communicate Review of DUR alerts Handling of payer issues Patient counseling Renewal requests 33

34 Health IT Adoption Initiative GWU, Partners/MGH, Brigham October 06 Meta-analysis of multiple studies and surveys Weaknesses in existing data 24.9% of physicians use EHRs <10% use fully functional EHRs 34

35 EHR adoption, cont. Lack of consensus EHR definition leads to skewed study results Hospital adoption rates are unknown (CPOE 5%) Primary factors impacting adoption Financial incentives and barriers Laws and regulations State of the technology and organizational factors Level of health system integration 35

36 American Academy of Family Physicians Survey to 4000 members 4/2007 (459 responded) 37% of responders using EHR (30% in 2005, 10% in 2003) 13% implementing 25% have no plans to implement Those without EHR 53% cited cost 42% decreased productivity concerns 36

37 Primary driving factors of EHR adoption? >82%: efficiency and convenience 60%: increased revenue (charge capture, manual transcription) 53%: physician and patient satisfaction 37

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41 S 1415, Quality Reform Expansion and Savings Act of 2007 Creates two-year federal grants for local organizations pursuing health quality reform in areas ranging from electronic record-keeping, to early prevention and detection of illness. The grants also could go toward efforts to expand health care coverage. S 1455, National Health IT and Privacy Advancement Act of 2007 Establishes a private, non-for-profit corporation tasked with developing a national, interoperable, secure health IT system. S 1471, Improved Medical Decision Incentive Act of 2007 Refocuses the health care reimbursement system on quality by allowing states to establish "best-practice" guidelines for treating illnesses or conditions. HR 1467, 10,000 Trained by 2010 Act Addresses the shortfall in health informaticists by developing a health care informatics curriculum for undergraduate and master's degree programs, as well as certificate programs. It also would create programs to train current medical professionals, such as physicians, nurses and medical administrators, in the area of health care informatics. 41

42 The Wired bill would Make the National Coordinator for Health IT a more permanent structure in the federal government than what is currently permitted under the executive order creating the position; Establish a public-private group called the Partnership for Health Care Improvements, which would recommend standards for interoperability, implementation specifications and certification criteria; Require all federal health IT purchases to conform to federally adopted health IT standards; Strengthen privacy protections; and Provide grants for the purchase of health IT system for providers demonstrating financial need for states to establish low-interest loan programs for providers to purchase health IT; and to facilitate implementation of local and regional health information exchanges. 42

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44 HHS funded for 1 year (NGA) State level decision makers address efforts for interoperable health information exchange across state lines Priorities State-level privacy and security issues State-law practice of medicine barriers State-level health information organization issues in governance, sustainable financial models, and the role of payors and integration of public health and benefit programs 44

45 Health Information Protection Protection of consumer health information that ensures appropriate interoperable, electronic HIE within states and across states Health Care Practice Regulatory, legal, and professional standards that have an impact on the practice of medicine and create barriers to interoperable, electronic HIE Health Information Communication and Data Exchange Appropriate roles for states participation in interoperable, electronic HIE 45

46 Trust and legal issues when converting to electronic data Authorization patient consent and patient authorization for access HIPAA interpretation variation across states in implementing HIPAA Variation in state laws overlaps and outdated policies in state laws 46

47 Walmart, Intel, and BP planning launch of portable EHR ( ) 10 companies expected Employees will coordinate care among hospitals, pharmacies, and physicians Employee participation is voluntary Providers will be encouraged to adopt EHRs and erx for continued business Privacy groups discourage adoption until protections are in place 47

48 American Health Insurance Plans (AHIP) and Blue Cross and Blue Shield Association (BCBSA) Standards for transferring information when changing coverage Web-based, maintained by the insurer Existing data: claims and administrative data 48

49 Free secure online health record Health education programs and reminders for members Referral service for providers Operated by Medem network, part of AMA 49

50 Survey conducted by Aetna (2185 adults; 3/07) 64% did not know what a PHR is Of those who knew what a PHR was, 11% were actively using one Reasons for not using a PHR 35% - already had their own system 26% - security concerns 18% - did not know how to use it 50

51 Personal Healthcare Data We need to move here Patient Personal Data Public Health Data

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53 Security will remain a priority More wireless, real-time access Increased evidence-based contributions Heightened reliance upon technology to support capture of new evidence Integrated multidisciplinary environments Pharmacy must have a prominent seat at the table

54 Brent I. Fox, PharmD, PhD Assistant to the Dean for Educational Technology Auburn University Harrison School of Pharmacy