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AHRQ and Health IT

Public Health Data Standards ConsortiumJ. Michael Fitzmaurice, Ph.D.

Agency for Healthcare Research and Quality

March 17, 2004

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Agency for Healthcare Quality and Research (AHRQ)

To improve the quality, safety, efficiency, and effectiveness of health care for all Americans

Lead Federal agency supporting research into improving patient safety and the quality of health care

Funds Research on– Quality measures -- Medical Expenditure Panel Survey – Strategies for quality improvement -- Decision support tools– Information Technology evaluation, tools, and databases

Patient Safety--new initiative in Health Info. Technology FY 2004 Budget: $304 M

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Agenda

Patient Safety AHRQ’s HIT program Patient Safety Standards PHDSC

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Patient Safety– a Major, National Problem

Leading to extensive– Deaths

– Cost

– Added suffering

Recognized in IOM reports and by Congress– To err, Chasm, others

– AHRQ mandates

– Proposed legislation

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What is?

HIT Value Patient Safety Medical Error Adverse Event

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AHRQ’s HIT Program for 2004 Over $50 million in 2004 funding Transforming Healthcare Quality through IT

– Implementation Grants– Planning Grants– Demonstration Grants– HIT Resource Center– HIT Data Standards

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AHRQ GrantsTransforming Healthcare Quality

AHRQ Planning Grants– Up to $7M for 35 new grants; $5M to rural and small communities

– For HC systems and partners to implement HIT to promote patient safety/quality of care AHRQ Implementation Grants

– Up to $24M for 48 new grants’ $14M for rural and small hospitals

– To evaluate the measurable and sustainable effects of HIT on improving PS & QC.

– 50% cost sharing, Max 20 percent on computer hardware and software AHRQ Demonstrating the Value Grants

– Up to $10M for 20 new grants; practice-based research networks encouraged to apply

– To increase the knowledge and understanding of the value of HIT» Clinical, safety, quality, financial, organizational, effectiveness, efficiency

Submit application by April 22, 2004

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Patient Safety and Standards

21 states collect patient safety incident (PSI) data—mostly mandatory, esp. for deaths

Data collections are not uniform or standardized Coordination is needed to establish trends,

baselines, and to learn from the successful efforts of other states

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Types of Info Collected

Wrong patient--Wrong site surgery Incorrect procedure/treatment Retained foreign bodies Unexpected deaths Cardiac arrests Loss of limb or organ Impairment of limb or bodily functions Other serious occurrences

– New York State D/Health, 2001

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Issues

Mandatory vs Voluntary Reporting– Non-punitive for reporting– Punitive for reporting

Data Quality– Identify low reporters– Focus on event identification methods– Show that better reporting leads to better quality

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Issues

Use of the information– Provider advisories– Public reporting– Quality improvement activities– Comparative reporting– Tracking and trending– Provider profiles (need better risk adjusters)– Inform consumers/patients

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Where’s the Info Support?

Data/systems are not interoperable– Need metadata– Need scalability– Need identifiers– Need health data standards– Need datainformationsystem integration– Need incentives

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Patient Safety: Data Standards

Developing a standards framework for reporting patient safety incidents

Developing common terminologies– Vocabularies– Code classifications

Mapping terminologies into SNOMED Implementing standards in patient safety and

quality of care

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Patient Safety Standards Needed Add-ons to claims transactions for reporting PSI’s?

– X12N, claims, e.g., low birth-weight babies– X12N, HL7 claims attachments

Special messages for reporting PSI’s– HL7 hospital messages for internal reporting and aggregation– X12N messages for reporting from hospitals to third parties, say, states

Taxonomies for classifying PSI’s for uniformity in data collection and reporting

Free text for capturing special information not codified Drive improvements in SNOMED and other medical

vocabularies

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Patient Safety Perspectives CPOE: Is the Bang worth the Buck?

– CPOE costs $5 million+– What is the value of the harm averted? Sizeable.– Will physicians object to frequent and multiple alerts that reduce

productivity? Where’s the incentive? Would adding nurses improve patient safety more? Will IT reduce the demands on the interns and residents

who work many consecutive hours? – Not a substitute for reducing their excessive hours, but evidence

is lacking Will IT reduce hospital-acquired infections?

» Hand washing programs may be most effective here

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PHDSC

Who: State health departments, state-wide health data organizations, and others

What: Reduce cost and improve the uniformity of collecting data for special needs for – Population health analyses

– Consumer information

– Health benefits and payment policies

– Patient safety incident reporting

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PHDSC Why:

– To coordinate representation at standards meetings – To reduce the cost of this representation– To establish partnerships for common issues, such as patient

safety incident data: » Collections, analyses, reporting, and aggregation

– To learn of proposed data standards policies and problematic issues faced by similar programs

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AHRQ in 2003 Funded IOM to advise on standards for PS

– Report out in November 2003; published soon in 2004 Funded IOM to develop initial functions for an EHR

– Letter report delivered July 31,2003 Worked with CMS and VA to develop the definition of an EHR as an ANSI

standard, beginning with the IOM letter report and moving to HL7: – First ballot, not approved; second ballot out on March 15, 2004– Responses addressing the negative ballots are being prepared

Maintained support of ANSI HISB for SDO coordination Started the Patient Safety SIG at HL7 Joined PHDSC--as a founding member HHS NHII, Markle Foundation, CAHIT, CHI, NCVHS

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AHRQ in 2004

Working in collaboration with HHS NHII Patient Safety HIT Grants Program Patient Safety HIT Standards Program Continuing work on

– HL7 Standard for EHR functions

– Patient Safety SIG

– Support of PHDSC

– Others

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PHDSCThis is a place where we bring

our issues and our ideas.

We avoid 50+ solutions for the the same problem.

We find commonality and gain productivity.

We work together to obtain change.

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AHRQ and Health IT

Public Health Data Standards ConsortiumJ. Michael Fitzmaurice, Ph.D.

Agency for Healthcare Research and Quality

March 17, 2004