toward meaningful use of hit
TRANSCRIPT
Toward Meaningful Use of HIT
Fred D Rachman, MD
Health and Medicine Policy Research Group HIE Forum
March 24, 2010
Why are we talking about technology?
To improve the quality of the care we provide and the health of our communities
12
$18,445,991,718
Critical Care Units
Inpatient Med/Surg
Units
Hospital Outpatient
Departments
Large Group
Practices
Small Physician
Offices
Acute CareAmbulatory Care
1 Billion
8 Million
Volume of Encounters (Annual, U.S.)
Revenue per Encounter$200
$50,000
$1000
Sources: Health Affairs W4-79, 2003; NAMCS Report, CDC, 2002
• 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
• 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
• 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
Effects of Inadequate Information Technology
Patient safety & Medical errors
Incomplete knowledgeof patients
Increasing complexity of clinical care
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)
HITECH: Sources and Uses of Funds
Medicare
Payment
Incentives
~$20B
Medicaid
Payment
Incentives
~$14B
Medicare Carriers and
Contractors
State Medicaid Agencies
Requires 30% share of Medicaid
(except Children’s Hospitals)
CMS
CMS
ProgramFunding
Source
Distribution
AgencyFunding Use Fund Recipients / Beneficiaries
En
titl
em
en
t Fu
nd
s
~$
34
-36
BA
pp
rop
ria
ted
Fu
nd
s
$2
B -
$3
B
Workforce Training
Grants
New Technology
R&D Grants
Medical Health Informatics
EHR in Med School Curricula
Health Care Information
Enterprise Integration Research
Centers
HHS,
NSF
NST,
NSF
Health IT Extension
Program
Health IT Research Center
Regional Extension Centers
HHSAgency
TBD
HIE Planning and
Development
(at least $300M)
EHR Adoption Loan
Program
Planning Grants
Implementation Grants
Loan Funds for States
Loan Funds for Indian Tribes
ONC
ONC
Physicians
• Acute care hospital
• Children’s hospitals
• Nurse Practitioner
• Midwife
Federally Qualified
Health Centers
Re
qu
ire
s “M
ea
nin
gfu
l”u
se o
f E
HR
• Higher Education
• Medical School
• Graduate schools
• Federal Gov’t Labs
Least Advantaged
Providers
• Non-profit
• Consulting
• Vendors
Services
Designated State
Entity
State Gov’t
Indian TribesProvider
Organizations
Loans
• Non-profit
• Consulting
• Vendors
Source: Manatt Health Solutions for the California Health Care Foundation
3/29/2010
Capabilities of Electronic Record
Systems
Basic
– a storage and retrieval system
VS
Advanced
– a sophisticated interactive database
Structured Data Entry
Practice Guideline
Patient Status
Decision Support
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
Improve quality, safety, efficiency and
reduce health disparities
• Order entry
• 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
Improved population and public health
• Interaction with registries
• Ability to submit information for public health surveillance
Improve quality, safety, efficiency and
reduce health disparities
• Order entry
• 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
Engage patients and families
• Encounter summaries
• Access to relevant information by paper and/or electronically
• Access to patient specific education resources
Improve care coordination
• Medication reconciliation
• Ability to exchange information electronically
Improved population and public health
• Interaction with registries
• Ability to submit and receive information for public health surveillance
Ensure adequate privacy and security
protections
• HIPAA compliance
• Compliance with Nationwide Privacy and Security Framework principles.
Advanced Functions involved in Meaningful Use
• Clinical Decision support
• Performance measurement Reporting
• Electronic Prescribing
• Health Information Exchange
• Patient Access
Federal Support for Adoption
• Health Center Controlled Networks
• Direct funds for infrastructure to Health Centers
• Regional Extension Centers
• Loans
• Incentive Payments
• Health Information Exchange
Up to $64,000
Over a 5 year period
covering up to 85% of eligible implementation
costs
Up to $44,000 in Medicare
reimbursements
Over 5 year period
Amounts for
physicians & other
health
professionals
$2 million base amount
Plus increases calculated using similar
methodology as Medicare incentive
(eligible entities include Acute Care and
Children’s Hospitals)
$2 million base amount
Plus increases for annual discharges,
number of inpatient days attributable
to Medicare, and charges attributable
to Medicare
Amounts for
Hospitals
Hospitals, physicians, NPs, dentists, etc.
3rd party entities EHR adoption
State Medicaid agencies for program admin
Hospitals and physiciansPayment
Recipients
State Medicaid agenciesMedicare carriers and contractorsPayment Agent
Federal Incentive Payments
State matching payments (for admin costs)
Federal Incentive PaymentsFunding
mechanism(s)
MedicaidMedicare
Providers must demonstrate “Meaningful Use of Certified EHR Technology” to receive
payments
ARRA Overview: Medicaid and Medicare Incentives
Slide adapted from HIT Policy Committee, Workgroup on Meaningful Use. June 16, 2009
Phasing of requirements
Health Center VendorsNetwork
Health Center Controlled Networks
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.
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
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
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
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
3/29/2010
EHRS
PHR
HIE
The Continuum of Health Information
Individual Practice/Institution
Patient
Larger Health Care System
3/29/2010
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