Health Reform and HIT Federal Support for Adoption Michael Mirro MD, FACC : Chair ACC Informatics Committee CCHIT Advanced Quality WG
Agenda ACC HIT Efforts Federal Financial Incentives a) PQRI b) e-prescribing c) American Recovery Reinvestment Act HIT : IC3 Workflow Solutions Summary
ACC Informatics Committee Efforts Health IT website (www.acc.org/healthit) Updated with ARRA information and relevance to members EHR Toolkit includes helpful hints, advice on contract negotiations, selection tools, educational resources, and Federal EHR incentive program information. E-Prescribing Initiative includes overall benefits, minimum functional criteria, and CMS e-prescribing Incentive Program information Unique Patient Identifiers Principles Document Stance: A mandatory UPI is vital to increasing quality of care for patients and outweighs privacy concerns Used to help advocacy and ACC members when approaching the Hill Currently reaching out to peer organizations for notice and possible collaboration.
ACC Informatics Committee Efforts ACC Data Definitions for Cardiovascular EHR List of data elements that are essential for care in the cardiology domain. Consolidates data definitions from multiple data dictionaries Receiving comments from other ACC committees CardioPath Pilot Project Translates ACC/AHA clinical guidelines into clinical decision support Guideline Adherence Tool web application is available Working with EHR vendors to test proof of concept
The Cost of a Long Life U.S. UC Project for Global Inequality 6
Accelerating EHR Adoption: Government Role Financial Incentives PQRI ARRA e-prescribing
HIT : Federal Incentives PQRI $3,000-5,000/year 2007: 1.5% 2008: 2.0% 2009: 2.0% E-Prescribing $3,000-5,000/year ARRA EHR Funding : $44,000 5 years (plus 10% Bonus $48,400 :Medicaid)
PQRI Requirements Report on PCPI/NQF Endorsed Performance Measures Claims-Based Quality Data : Quality Data Codes (QDC) Maximum Financial Incentive achieved if 3 measures reported on > 80% of eligible encounters Use of CCHIT EHR : Performance Measure (2009)
America Recovery & Reinvestment Act (ARRA): 02/17/09 Total: $790 Billion Healthcare (total): $59 Billion HITECH: $34 Billion Key Components 1.Leadership 2.Funding and incentives 3.Standards 4.Certification 5.Research and development 6.Education and outreach 7.Privacy and security
ARRA Health IT Funding ($34B) $20.8 billion Medicare & Medicaid incentives to providers for EHR adoption $4.7 billion NTIA Broadband Technology $2.5 billion USDA distance learning, telemedicine, broadband technology $2 billion ONCHIT $1.5 billion HRSA for health centers $1.1 billion comparative effectiveness research (AHRQ, NIH, HHS) $500 million Social Security Administration $85 million Indian Health Service health IT $50 million VA information technology
Medicare EHR Incentives and Penalties
Definition of Certified EHR Technology Meeting standards pursuant to ARRA Includes demographic, clinical health information (history, problem lists) Provides clinical decision support Supports order entry Capture, query, reporting on quality (process) E-exchange, integration of health information
Standards Harmonization HITSP NHIN Prototype & Implementation Projects Privacy & Security Policies, Laws, Regulations Role of Certification in the National Health IT Strategy American Health Information Community and AHIC Workgroups Harmonized Standards Network Architecture Privacy Policies Office of the National Coordinator Strategic Direction + Breakthrough Use Cases CCHIT: Certifying Standards Compliance of Health IT Certification of EHRs and HIEs Governance and Consensus Process Engaging Public and Private Sector Stakeholders Accelerated adoption of robust, interoperable, privacy-enhancing health IT 2008 Slide 14 Nov 10, 2008 Certification is a voluntary, market-based mechanism to accelerate the adoption of standards and interoperability
HITECH : $19 Billion Physician Incentives : $17 Billion HHS Discretionary Funds : $2 Billion a) Standards Requirements b) HIE Infrastructure (NHIN) c) Regional Health IT Resource Centers d) State Grants (2010) e) Promote EHR : Quality and DM
Health IT in ARRA Leadership Established Office of National Coordinator - $2B in appropriations Established 2 Federal Advisory Committees HIT Policy Committee recommendations to ONC regarding e-exchange, use of health information HIT Standards Committee - recommendations to ONC regarding standards, implementation specifications, and certification criteria
HIT : e-prescribing Requirements Electronic Transmission of Prescriptive Data (Bi-directional) SureScripts/RxHub Certified Drug-Drug Interaction Reconciliation Drug Allergy Reconciliation CCHIT, AHIC, HITSP Compliance HIPPA Compliance Surrogate Prescriptive Function(e-confirm) Patient Prescriptive Eligibility/Formulary Reconciliation
EHR : Physician Perspective Analog Medical Record : Static Documents Documentation : Guilty until Innocent Physician Time : Cognitive not Clerical Analog Medical Record : Lack of Redundancy EHR : Critical to Guideline Compliance EHR : Cardiac Care Team Communication EHR : Improved Efficiency Chart Pulls
EHR : Patient Perspective One Chart : Secure and Web Based No Need to Repeat History Entry Medications/Allergies : Accessible Imaging &Testing Accessible one Site Alerts for Appropriate Testing Quality Assurance Web Access : Appointments/Refills
EHR : Payer Perspective Improved Documentation Enhanced Clinical Transparency Improved Billing/Coding/Claims Data/Document Transfer Pay-for-Performance Potential
EHR : Burning Platform EHR Adoption: Not if but when EHR: Critical for Quality, Efficiency Pay-for-Performance: Gaining Momentum Demand for Best Practices Demand for Transparency
Health Information Technology Automation Connectivity Clinical Decsion Support Data-Mining Capabilities
Accelerating EHR Adoption: EHR Standards Government Role EHR Vendor Certification Financial Incentives Data Storage and Exchange
Percentage of Office-Based Physicians in the United States Using Electronic Medical Records, 2001-2006 Steinbrook R. N Engl J Med 2008;358:1653-1656
Percentage of Physicians Using Electronic Medical Records (EMRs) According to Practice Size, in 2005 Blumenthal D and Glaser J. N Engl J Med 2007;356:2527-2534
EHR Selection Acceleration of Quality Improvement
Minimally Invasive Investment Web-based EMR Minimal up-front investment Accessible from any PC with a Web browser, anywhere, anytime Incremental, scalable EMR Pay for what you need, when you need it Don t pay for what you don t need Interoperable EMR No/low cost integration Require IHE Certification and proof of interoperability.
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
Health IT: A means to an end Health IT works in real-world clinical settings but some unanswered questions How does Health IT drive safety and quality improvement? How can we ensure that doing the right thing is the easy thing to do? How can we use the power of Health IT to provide better quality measures faster?
No. of EBM Medline References Explosion of Evidence- Based Medicine/Practice 1000 900 800 700 600 500 400 300 200 100 0 1990 1992 1994 1996 1998 2000 Year
Culture Issues : Quality Patients Physicians Hospitals Health Plans Purchasers
Critical Elements : CV EHR Web Based Solution ASP Model for Guideline Software updates Allows differing modes of data input DICOM Functionality Inter-operability (IHE) C-CHIT Certification
TurboCharging the EHR Clinical Decision Support Evidence-based medicine at the point-of-care Congestive Heart Failure Atrial Fibrillation Coronary Artery Disease
ACE-Inhibitors Beta-Blockers Congestive Heart Failure: Quality Indicators Spironolactone (Class III/IV) Assessment LVEF (Echo/Nuclear) TLC : diet/exercise/wt-bp monitoring
Clinical Decision Support Active prompts/reminders to encourage changes in patient management, regardless of reason for visit Reminders drawn established care guidelines Pharmacy decision support draws from patient specific database, which includes age, weight, allergies and lab results Drug utilization review Rules-based triggers
CHF: CV Physician Chart Audit 100 90 80 70 60 50 40 30 20 10 0 MD-A MD-B MD-C MD-D SPLC III/IV ACE-I BBLOC
CHF: CV Physician Chart Audit 100 90 80 70 60 50 40 30 20 10 0 MD-E MD-F MD-G MD-H SPLC III/IV ACE-I BBLOC
CHF: CV Physician Chart Audit 100 90 80 70 60 50 40 30 20 10 0 MD-I MD-J MD-K MD-L SPLC III/IV ACE-I BBLOC
Condition/Problem list reviewed and updated. Observations are collected and entered.
Quality Care Guidelines are reviewed and alerts are presented.
Orders are entered to satisfy alerts.
Prescriptions are printed.
Patient education is printed.
Compliance Data: Year One 100 90 80 70 60 50 40 30 20 10 0 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr Beta Blocker ACE-I SPLCT
Next Steps www.acc.org/healthit www.cchit.org Organizational Change Assessment Develop Implementation Team Develop Training/Implementation Plan Vendor Selection (CCHIT & IHE)
HIT : NCDR IC3 Adoption First Office-Based Registry Designed to Assess Physician Adherence to ACC/AHA Performance Measures Provides Powerful Tool to Assess Clinical Care for CAD and CHF patients A Potential Vehicle to Transform Performance Measurement to Quality Improvement at Point of Care
You could do this on paper Requiring valuable FTE time and introducing the opportunity for error And sending it to the ACC where it will be entered into a database (again introducing the opportunity for error)
Or you could do this electronically The timing is ideal Select EHR vendors now certified for IC3 IC3 satisfies PQRI requirements EHR vendors also incorporate e-prescribing Current CMS bonus payments help offset EHR investment costs EHR adoption incentives start in 2011 and total $44,000 per physician FOR IMPLEMENTED AND MEANINGFUL EHR USE START NOW!
EHR with integrated IC 3 Simplified data collection and reporting Existing data in EHR can populate collection forms As you document encounters in EHR, that data can also populate collection form At conclusion of encounter, completed collection form is submitted and transmitted to ACC for entry into IC 3 database
Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 0 34 36 38 44 50 60 66 82 86 145 150 152 136 144 149 149 174 160 184 168 175 176 179 211 224 264 274 504 531 530 530 578 600 623 624 626 IC 3 Program at ACC IC 3 Program Enrollment 700 600 500 400 Practices Office Sites 300 200 100 0
Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 IC 3 Program at ACC IC 3 Pilot Encounter Records Entered 213,799 200,000 150,000 158,000 109,479 100,000 50,000 0 0 0 0 0 0 0 0 940 1,910 2,466 3,246 4,267 5,722 8,152 10,899 11,500
Fort Wayne Cardiology Is currently the only practice using its EHR for electronic data collection, reporting and population of the IC 3 registry Medical Informatics Engineering Is the only EHR vendor currently offering a fully integrated IC 3 data collection and reporting module Recently signed a strategic agreement with the ACC to foster the adoption of EHR products with integrated IC 3 functionality
Significant opportunity To encourage cardiology practice adoption of EHR systems with integrated quality registry module(s) Timing is ideal ARRA incentives for physician adoption include meaningful use criteria focused on quality reporting The ACC and its vendor partners are ready to provide enthusiastic support
IC 3 is now
How will you spend your $44,000?
Consider a workhorse
Questions??