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Health Information

Technology
Harry J. Martin

Information Systems Manager
Public Health Department
Santa Clara Valley Health & Hospital System

Fall Semester 2014

Goals for talk


High-level overview
Describe concepts of HIT
What are the needs for HIT
workforce
What role does HIT play in Health
Care Reform

Source: Robert Martin, MPH, DrPH, Associate Director, Coordinating Center for Health Information and Services, CDC; presented at 2007 PHIN Conference

DHS. Directory Messaging Vocabulary Patient Data Health Record Locator Data Brokering Security Identification Analysis Intervention Communication Data & Information National Health Information Network Source: Robert Martin. USDA. etc. Associate Director. VA.Hospital or Healthcare System Personal Health Records State and Local Health Departments Other Surveillance Sources RX Consumers Electronic Health Records Pharmaceutical Stockpile Common Services and Components Clinical Labs NHIN Public Health Labs CDC. presented at 2007 PHIN Conference . EPA. CDC. FDA. MPH. Coordinating Center for Health Information and Services. DrPH.

Terms  Electronic Medical Record (EMR)  Electronic Health Record (EHR)  Personal Health Record (PHR) .

) • ONC .Terms (cont.Office of the National Coordinator for HIT • CMS – Centers for Medicare and Medicaid Services • Meaningful use • ACO – Accountable Care Organization .

Terms (cont.)      Interoperability Health Information Exchange (HIE) Computerized Physician Order Entry (CPOE) E-Prescribing Clinical Decision Support System (CDSS) .

Health Information Exchange • Federated Model • Monolithic Model   RHIO HITECH Act .)  HIE .Terms (cont.

 But first for a little history…. .

Bush Administration  Executive orders • April 2004  Commitment to achieving widespread use of EMRs by 2014 • August 2006  Directs HHS and all federal agencies to ensure that internal programs and external contracts implement relevant HHS recognized interoperability standards .

Online by Gerhard Peters and John T.ucsb. we will make the immediate investments necessary to ensure that within five years." January 8. 2009. The American Presidency Project.Obama Administration  “To improve the quality of our health care while lowering its cost. . all of America’s medical records are computerized … It just won’t save billions of dollars and thousands of jobs – it will save lives by reducing the deadly but preventable medical errors that pervade our health care system. http://www. Woolley. 2009 Barack Obama: "Address at George Mason University in Fairfax.” • January.edu/ws/?pid=85361. Virginia.presidency.

offset by $20B in savings) • Direct grants administered by federal agencies ($2B) – ONC-coordinated .HITECH  Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA) • Incentives for EHR adoption ($30B.

HITECH  Other provisions in other areas of ARRA • Comparative effectiveness research • NIH and other research funding • Broadband and other infrastructure funding  Motivations • • • • Quality – not as good as it could be Safety – IOM 2000: 44-98K deaths/yr Cost – rising costs are not sustainable Inaccessible information – missing information frequent in primary health care .

Health IT Orientation: National eHealth Collaborative University. 2012. .HITECH Vision National eHealth Colllaborative.

9% for providers who in 2013   Submitted QoC data Demonstrated MU .Where are we today?  CMS and the ONC give providers an additional year to meet MU requiremetns  CMS 2015 payment schedule • market basket update of 2.

Just what is “HIT” anyway  Biomedical and health informatics (BMHI) • Field that seeks the optimal use of information. often aided by technology. and biomedical research   It’s about information. not technology Technology is a relatively small piece • Science behind the application of IT to healthcare • Practitioners are usually called informaticians . to improve individual health. public health. health care.

The HIT Equation Health (people) + information + technology = HIT .

Expanded use of HIT  Benefits for individual patient care • Improve quality of patient care • Reduce medical errors • Reduce health care costs • Increase administrative efficiencies • Eliminate duplication of information gathering and testing • Promote care coordination • Expand access to affordable care .

Expanded use of HIT  Public sector benefits • Early detection of infectious disease outbreaks around the country • Improved tracking of chronic disease management • Evaluation of health care –  determine the value derived from collection of de-identified price and quality information .

Health Record Definitions .

Types of Health Records  Electronic Medical Record (EMR) • Early EMRs – clinicians for Dx and Tx   Maintained by physicians Electronic Health Record (EHR) • Longitudinal. full record   Maintained by providers Personal Health Record (PHR) • Not covered by HIPAA  Maintained by patient .

Office of the National Coordinator for HIT • CMS – Centers for Medicare and Medicaid Services • ACO – Accountable Care Organization • Meaningful use .Organizations • ONC .

Building Blocks      Interoperability Health Information Exchange (HIE) Computerized Physician Order Entry (CPOE) Clinical Decision Support (CDS) E-Prescribing .

Meaningful Use

Meaningful Use

HITECH provides financial incentives
for “meaningful use” of HIT
• Incentives for EHR adoption ($36-40B)
• Direct grants ($2B)

Office of the National Coordinator for
Health IT (ONC)

EHR Certification and
Meaningful Use

ONC –

Office of the National Coordinator for

- defines the
certification criteria for Electronic
Health Records (how the EHR must
work)
CMS – Centers for Medicare and Medicaid
Services define meaningful use (how
the EHR must be used)
Health Information Technology

Improving quality. Improving health status of the population  Submit electronic data to immunization registries 5. Increasing coordination of care  Exchange key clinical information with other providers 4. Ensuring privacy and security  Protect electronic health information created or maintained in the EHR . safety and efficiency  Use CPOE 2.What is “meaningful use” of an EHR  Five basic goals for healthcare system 1. Engaging patients in their care  Provide patients with a copy of their PHI 3.

What is “meaningful use” of an EHR  Three requirements: • Use of certified EHR technology in a meaningful manner • Utilize certified EHR technology connected for health information exchange (HIE) • Use of certified EHR technology to submit information on clinical quality measures .

Timeline for implementation  Timeframe for implementation of meaningful use criteria • 2009 – HITECH policies • 2011 – Stage 1 capture/share data • 2014 – Stage 2 advanced care with decision support • 2016 and beyond – Stage 3 Improved Outcomes .

) • Eligible hospitals .$2 – $9 million or $17.Implementation of meaningful use  Implemented through Medicare or Medicaid reimbursement to • Eligible professionals – up to $44K  (Roughly equal to the cost of converting a physician practice from paper to EHRs.500 / bed  Timeframe for full implementation • 2014 – advanced care with decision support .

Stage 1 Requirements    15 Mandatory Core Measures 5 0f 10 Menu Measures 6 Clinical Quality Measures • 3 core. 3 menu from a list of 41 .

Safety and Efficiency. and Reduce Health Disparities • At least 40% of prescriptions transmitted electronically to the patient’s pharmacy  Engage Patients and Families • Provide patients clinical summaries within 3 business days for over 50 percent of all office visits .Stage 1 Core Measures (15 required)  Improve Quality.

)  Improve Care Coordination • Perform at least one test to demonstrate the ability to exchange key clinical information with other providers  Privacy and Security • Conduct or review a security risk analysis and implement security updates as necessary .Stage 1 Core Measures (cont.

and Reduce Health Disparities • Generate at least one report listing patients with a specific condition  Engage Patients and Families • Send reminders.Menu Set Measures  Improve Quality. and Efficiency. if desired. for preventive/follow-up care for specified minimum percentages of adult and pediatric patients . Safety.

Menu Set Measures (cont.)  Improve Care Coordination • Perform medication reconciliation for more than 50 percent of patient transitions into the care of the physician  Improve Population and Public Health • Perform at least one test of EHR‘s capability to provide syndromic surveillance data to public health agencies. and perform a follow-up submission if the test is successful .

Clinical Quality Measures (3 core) …  Adult Weight Screening • % of patients with calculated BMI • Plan to follow-up if above criteria  Diagnosed Hypertension • At least 2 Blood Pressure readings  Preventive Care and Screening • Ask about tobacco usage • Cessation intervention for smokers .

Other Clinical Quality Measures (3 of 41)   Several cancer screening Anti-platelet therapy for CAD patients .

2012 CMS releases final rules for Stage 2: • Eligible professionals  Need to meet 17 core objectives and 3 of 6 menu objectives = 20 objectives total • Hospitals  Need to meet 16 core objectives and 3 of 6 menu objectives .Quality Measures for MU  September 4.

g.Stage 2 Core Measures   Raised the goals Consolidated Stage 1 Menu Set into Core • e. measures may now have additional components .

Stage 2 Core Measures (cont.)  New and Important: • 5% of patients digitally accessed health information  How: Transferring a CCD to PHR • 5% sent secure messages to provider  How:DIRECT .

Stage 1       Menu set (3 of 6) All new More clinically sophisticated Submit cancer cases to a registry Electronic access to scans and images Quality Measures – 9 of 64 required • Was 6 of 44 in Stage 1) .Stage 2 vs.

Funding Initiatives .

in achieving meaningful use  State-based health information exchange (HIE) • $564M – to states to develop HIE programs . mainly to primary care practices. provide guidance.Funding initiatives  HIT Regional Extension Centers (RECs) • $643M – 70 RECs.

Funding initiatives  Beacon Communities • $235 M to fund 15 communities that provide exemplary demonstration of meaningful use of EHRs • Awards were announced last year  Strategic health information advanced research projects (SHARP) • $60 M for 4 collaborative research centers .

$70M Curriculum Development Centers .Funding for Health IT workforce  Key to implementation • ONC estimates at least 50.000 workers needed to implement the federal HIT agenda • ONC is funding $118 million for     Community college consortia .$10M University training grants ($32M) Competency testing ($6M) .

HIT is a core competency  IOM report: modern health care professional must have competency in informatics in order to provide patientcentered care Evidence-based practice patient-centered care Utilize Informatics Apply Quality Improvement .

Who is the health IT workforce?  Historically. three groups of HIT professionals • Information technology (IT) – usually with computer science or information systems background • Health information management (HIM) – focus on medical records • Clinical informatics (CI) – often from healthcare backgrounds (MDs. nurses) .

PDF .gov/achieving-MU/ONC_Encourage_HealthIT_FS.HITECH Milestones (as of 2011)  Source: http://www.healthit.

000 have received payments (44%) .000 have registered (73% of all eligible to participate) More than 230.2013 Progress Report  EHR Incentive program • Eligible Hospitals (EH)   85% of eligible hospitals participate 75% have received payments for MU • Eligible Professionals (EP)   More than 388.

6 billion paid as of February 2013 • $14.6 billion paid as of April 2013 .2013 Progress Report  EHR Incentive program • $12.

700 unique certified EHR products .Progress (cont.)  RECs • Providing assistance to more than    44% (130K) primary care providers 48% (20K) of nurse practitioners Health IT marketplace • Robust market for eHealth IT products  As of March 2013 – 941 vendors with more than 1.

)  Rapid Adoption of Advanced Technology • E-Prescribing – office-based physicians    0.Progress (cont.8% in December 2006 53% in January 2013 More than 94% of all pharmacies .

Progress (cont.4 % using advanced functionality 2012 – 44 percent • Doctors   2008 – 17% using same advanced functionality 2012 – 40 % .)  Rapid Adoption of Advanced Technology (beyond MU requirements) • Hospitals   2008 – 9.

000 HIT jobs created under HITECH .Progress (cont.049 HIT professionals trained (January 2013) • Universities – 820 post-graduate and masters-level HIT professionals (September 2012)  50.)  Workforce Development • Community colleges – 17.

and • Machine-readable format .Blue Button    Web-based utility that allows patients to download and share their health information Developed by VA and HHS for Veterans and Medicare recipients Simple text file – easier to share • Human.

5. National eHealth Colllaborative. 2012.Health IT Orientation: National eHealth Collaborative University. . Sept.Source: Webinar.

Source: Robert Martin. presented at 2007 PHIN Conference . MPH. Coordinating Center for Health Information and Services. DrPH. CDC. Associate Director.

VA.Hospital or Healthcare System Personal Health Records State and Local Health Departments Other Surveillance Sources RX Consumers Electronic Health Records Pharmaceutical Stockpile Common Services and Components Clinical Labs NHIN Public Health Labs CDC. Directory Messaging Vocabulary Patient Data Health Record Locator Data Brokering Security Identification Analysis Intervention Communication Data & Information National Health Information Network Source: Robert Martin. MPH. USDA. EPA. CDC. Coordinating Center for Health Information and Services. presented at 2007 PHIN Conference . DrPH. etc. Associate Director. DHS. FDA.

Merged with HIMSS Foundation late 2013  Public-private partnership • Secure and interoperable nationwide health information exchange • Advance health and improve health care.          Stakeholders government agencies health systems health professionals academic medicine patient and consumer advocates major payers and employers non-profits technology providers .

How IT projects fail  Problematic health IT implementations are well known. from programmers to IT project management . with failure often attributable to the lack of understanding of clinical environment • Ensure all key players are involved from front-line staff to executive management.

Immunization Registry      Incentives / Free-rider problem Key support from motivated providers County mandate as a condition of receiving funds for community clinics HEDIS Some physicians were concerned about IPAs getting information on their practices (performance measurement reporting) that they could use to penalize them. .

.Sources Logos hyperlink to websites.

Websites for HIT Jobs & Training  Health IT No. according to a new study from the University of San Diego Extension. 1 on list of top 10 'hot' careers Healthcare information technology tops the list of top 10 'hot careers' for college graduates in 2011.  Jobs  Training .

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com . (ads): http://hitsphere.com/ Sphere by Shahid N.com/ HISTalk (ads): http://histalk2.emrandhipaa.HIT Blogs      John Halamka: http://geekdoctor. Shah.com/ Wes Rishel: http://blogs.blogspot.gartner.com/wes_rishel/ EMR and HIPAA: http://www.

The End .