Toward Meaningful Use of HIT

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1 Toward Meaningful Use of HIT Fred D Rachman, MD Health and Medicine Policy Research Group HIE Forum March 24, 2010

2 Why are we talking about technology? To improve the quality of the care we provide and the health of our communities

3

4 $18,445,991,718 12

5 1 Billion Volume of Encounters (Annual, U.S.) $50,000 8 Million $200 $1000 Revenue per Encounter Small Physician Offices Large Group Practices Hospital Outpatient Departments Inpatient Med/Surg Units Critical Care Units Ambulatory Care Acute Care Sources: Health Affairs W4-79, 2003; NAMCS Report, CDC, 2002

6

7 Effects of Inadequate Information Technology Incomplete knowledge of patients Patient data unavailable in 81% of cases; average of 4 missing items per case 18% of medical errors are due to inadequate availability of patient information Patient safety & Medical errors Patients receive only 55% of recommended care 44,000 98,000 annual inpatient deaths due to a preventable medical error Medication errors in 5 18% of ambulatory patients; resulting in 1 in 131 deaths Increasing complexity of clinical care 17 years to translate medical research into medical practice Physician Desk Reference more than doubled in 20 years to 3,075 pages Source: ihealthbeat.org, MHS research

8 HIT functions to support quality Enhanced availability of Information Decision support (active and passive) Expanded options for display of information Performance measurement Reporting (individual and population)

9 HITECH: Sources and Uses of Funds Funding Source Program Distribution Agency Funding Use Fund Recipients / Beneficiaries Entitlement Funds ~$34-36B Appropriated Funds $2B -$3B Medicare Payment Incentives ~$20B Medicaid Payment Incentives ~$14B HIE Planning and Development (at least $300M) EHR Adoption Loan Program Health IT Extension Program Workforce Training Grants CMS CMS ONC ONC HHS Agency TBD HHS, NSF Medicare Carriers and Contractors State Medicaid Agencies Requires 30% share of Medicaid (except Children s Hospitals) Planning Grants Implementation Grants Loan Funds for States Loan Funds for Indian Tribes Health IT Research Center Regional Extension Centers Medical Health Informatics EHR in Med School Curricula Designated State Entity State Gov t Indian Tribes Non-profit Consulting Vendors Loans Services Acute care hospital Children s hospitals Physicians Nurse Practitioner Midwife Federally Qualified Health Centers Non-profit Consulting Vendors Provider Organizations Least Advantaged Providers Requires Meaningful use of EHR New Technology R&D Grants NST, NSF Health Care Information Enterprise Integration Research Centers Higher Education Medical School Graduate schools Source: Manatt Health Solutions for the California Health Care Foundation Federal Gov t Labs

10 Capabilities of Electronic Record Systems Basic a storage and retrieval system Advanced VS a sophisticated interactive database 3/29/2010

11 Practice Guideline Patient Status Decision Support Structured Data Entry

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13 Goals of Meaningful Use Improve quality, safety, efficiency and reduce health disparities Engage patients and families Improve care coordination Improved population and public health Ensure adequate privacy and security protections for personal health information

14 Improve quality, safety, efficiency and Order entry reduce health disparities Medication Safety functionality Summary lists: problems, medications, allergies, directives Seamless management of laboratory results Reminders and prompts to support preventive care and chronic disease management Population management by disease and disparity group

15 Improved population and public health Interaction with registries Ability to submit information for public health surveillance

16 Improve quality, safety, efficiency and Order entry reduce health disparities Medication Safety functionality Summary lists: problems, medications, allergies, directives Seamless management of laboratory results Reminders and prompts to support preventive care and chronic disease management Population management by disease and disparity group

17 Engage patients and families Encounter summaries Access to relevant information by paper and/or electronically Access to patient specific education resources

18 Improve care coordination Medication reconciliation Ability to exchange information electronically

19 Improved population and public health Interaction with registries Ability to submit and receive information for public health surveillance

20 Ensure adequate privacy and security protections HIPAA compliance Compliance with Nationwide Privacy and Security Framework principles.

21 Advanced Functions involved in Meaningful Use Clinical Decision support Performance measurement Reporting Electronic Prescribing Health Information Exchange Patient Access

22 Federal Support for Adoption Health Center Controlled Networks Direct funds for infrastructure to Health Centers Regional Extension Centers Loans Incentive Payments Health Information Exchange

23 ARRA Overview: Medicaid and Medicare Incentives Funding mechanism(s) Payment Agent Payment Recipients Amounts for Hospitals Amounts for physicians & other health professionals Medicare Federal Incentive Payments Medicare carriers and contractors Hospitals and physicians $2 million base amount Plus increases for annual discharges, number of inpatient days attributable to Medicare, and charges attributable to Medicare Up to $44,000 in Medicare reimbursements Over 5 year period Medicaid Federal Incentive Payments State matching payments (for admin costs) State Medicaid agencies Hospitals, physicians, NPs, dentists, etc. 3 rd party entities EHR adoption State Medicaid agencies for program admin $2 million base amount Plus increases calculated using similar methodology as Medicare incentive (eligible entities include Acute Care and Children s Hospitals) Up to $64,000 Over a 5 year period covering up to 85% of eligible implementation costs Providers must demonstrate Meaningful Use of Certified EHR Technology to receive payments

24 Phasing of requirements Slide adapted from HIT Policy Committee, Workgroup on Meaningful Use. June 16, 2009

25 Health Center Controlled Networks Health Center Network Vendors

26 Health Information Technology Extension Program (Extension Program). Provide direct, individualized and on-site technical assistance in selecting a certified EHR, achieving effective implementation enhancing clinical and administrative workflows and adhering to privacy security regulations. Emphasis on individual and small group practices (fewer than 10) and clinicians in public and critical access hospitals, community health centers, and other settings serving predominantly serve uninsured, underinsured, and medically underserved populations.

27 CHITREC Approach Assess current resources for HIT adoption and optimization Map target practices to these resources Identify gaps Develop tools and resources for assessing and addressing needs

28 Comparative Effectiveness Research ARRA Provides $1.1 billion for comparative effectiveness research. $400 million to the Office of the Secretary in HHS $400 million to NIH $300 million to AHRQ

29 Comparative Effectiveness Research Comparative effectiveness research is the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in real world settings. The purpose of this research is to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances

30 The promise Information that follows the patient timely, accessible, complete to enable patient centered, integrated care across all settings Evidence based decision support at point of care for practitioners of all disciplines to assure consistent, high quality care Access to decision support and tools for managing health by/for patients Population based data to advance medical knowledge, understanding of factors influencing health practice and status and drive improvement Transparency of quality information to incentivize quality rather than cost/profit

31 The Continuum of Health Information Individual Practice/Institution EHRS HIE Larger Health Care System PHR Patient 3/29/2010

32 Considerations for leveraging higher level HIT functionality Acceptance of common vision of quality Adoption of evidence based standards against which to judge care quality Agreement to conform to standardized ways of recording data Ability to capture and process relevant data Relevant care elements are captured as structured information Data is clean and consistent 3/29/2010

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