Transcript Title Arial 40 pts - HFMA Florida Chapter

Health IT, Meaningful Use
and Healthcare Reform
John W. Loonsk, MD FACMI
_experience the commitment TM
Hannah
Hannah = Health IT?
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National HIT - Lots of Moving Parts and Pieces
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Legislation
• HITECH (part of ARRA)
• Affordable Care Act (Health Insurance Reform)
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Rules
• Meaningful Use
• Standards, Specifications, and Certification Criteria
• Interim and Permanent Certification
• Modifications to HIPAA Privacy…Rule
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Programs and Grants
• Nationwide Health Information Network (NHIN)
• Exchange, Connect and Direct
• Health Information Exchange (HIE, HIO, RHIO)
• Designated entities and plans
• SHARP and Workforce Grants
• Regional Extension Centers (RECs)
• Recognized Certification Bodies (RCBs)
• Beacon Communities
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Focus Today – Path Forward
• High
level MU and Incentive Payment
Programs
• Quality
Reporting
• Health
Information Exchange and Data
Availability
• Health
IT for Health Reform
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Road Ahead for Health IT and Health
•
Providers need to invest
•
Disruptive to practice
• Easier, safer, and more strategic to hold data
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Payors benefit most
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Quantity of care dominates
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Patient empowerment - mostly Internet
searching
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Purchasers of care struggle to manage
quality and costs
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Population users stovepiped and secondary
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Limited Health IT use, interoperability and
benefits
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Incentive Payment Programs and Meaningful Use
Medicaid
Medicare
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Meaningful Use
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Incentive payments through Medicaid and/or Medicare to use
(current generation) of EMRs
Use a certified EMR in a “meaningful manner”
• Provide for the electronic exchange of health information
• Submit information on clinical quality, and other, measures
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•
MU measures dialed-back significantly from Notice of
Proposed Rule Making, but point toward major systems efforts
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CPOE, eRx, CDS, problem and med list management, e-copies to patients
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Limited data and technical standards to support MU (in
companion rule)
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Criteria to be updated bi-annually
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Quality Reporting
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Interim final rule had almost 100 quality measures - push back
lead to:
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15 core (required) and 5 of 10 (menu) for hospitals
• 3 core (required) and three additional (menu) for eligible providers
• No specialty-oriented
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Eligible and Critical Access Hospitals
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Emergency Department Throughput
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Ischemic Stroke (+/- Hemorrhagic)
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Time from ED arrival to ED departure for admitted patients
Admission decision time to ED departure time for admitted patients
Discharge on anti-thrombotics, Anticoagulation for A-fib/flutter, Thrombolytic
therapy for patients arriving within 2 hours of symptom onset, Antithrombotic
therapy by day two, Discharge on statins, Stroke education, Rehabilitation
assessment
VTE
•
Prophylaxis within 24 hours of arrival, Intensive Care Unit Prophylaxis,
Anticoagulation overlap therapy, Platelet monitoring on unfractionated heparin,
Discharge instructions, Incidence of potentially preventable
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Quality Reporting
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Folks who really wanted to be doing healthcare
quality and reform work, but got the HIT instead
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No traceability from use of these EMRs to
differences in the quality measures
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Quality measures to be electronically reported
in 2012
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Meaningful Use, right now, isn’t
Estimates that only 1/3 of data available in EHRs
Providers burdened with adoption of EMRs and
doing quality measures
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Confidential
Beacon Community Awardees and Data
Beacon Community
Beacon Community Goals for Population Health in Service Area
Leverage broad community partnerships with hospitals, providers, payers, and government agencies to
Community Services
expand a community-wide care coordination system, which will increase appropriate referrals for
Council of Tulsa, Tulsa,
cancer screenings, decrease unnecessary specialist visits and (with telemedicine) increase access to
Okla.
care for patients with diabetes
Delta Health Alliance, Focus on achieving improvements for diabetic patients by electronically linking isolated systems and
Inc., Stoneville, Miss. practices for care management, medication therapy management and patient education
Expand community connectivity, including long-term care, primary care and specialist providers,
Eastern Maine
to existing Health Information Exchange and promote the use of telemedicine and patient selfHealthcare Systems,
management in order to improve care for elderly patients and individuals needing long-term or home
Brewer Maine
care
Enhance care for patients with pulmonary disease and congestive heart failure by creating a
Geisinger Clinic,
community-wide medical home, promoting Health Information Exchange and extending Geisinger’s
Danville, PA
proven model for practice redesign to independent healthcare organizations throughout region
Improve Diabetes management performance measures by increasing availability, accuracy and
HealthInsight, Salt Lake
transparency of quality reporting, leverage Intermountain Healthcare’s strategies to reduce health
City, Utah
systems costs throughout the region, and improve public health reporting
Indiana Health
Expand the country’s largest Health Information Exchange to new community providers in order to
Information Exchange, improve cholesterol and blood sugar control for diabetic patients and reduce preventable re-admissions
INC., Indianapolis, Ind. through telemonitoring of high risk chronic disease patients after hospital discharge
Inland Northwest
Health Services,
Spokane, Wash.
Focus on increasing preventive services for diabetic patients in rural areas by extending Health
Information Exchange and establishing anchor institutions in close proximity to remote clinics that will
promulgate successes in health IT supported care coordination
Louisiana Public Health Reduce racial health disparities and improve control of diabetes and smoking cessation rates by linking
Institute, New Orleans, technically isolated health systems, providers, and hospitals; and empower patients by increasing
La.
their access to Personal Health Records
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Beacon Community Awardees and Data
Beacon Community
Beacon Community Goals for Population Health in Service Area
Mayo Clinic Rochester,
Minn.
Rhode Island Quality
Institute, Providence,
R.I.
Rocky Mountain Health
Maintenance
Organization, Grand
Junction, Colo.
Enhance patient management and, reduce costs associated with hospitalization and emergency services for patients with
diabetes and childhood asthma and address reduce health disparities for underserved populations and rural communities
Improve the management of patients with diabetes through several health IT initiatives to support Rhode Island’s
transition to the Patient Centered Medical Home model and adapt infrastructure proven to improve childhood
immunizations in order to achieve improvements in adult immunization rates
Enable robust collection of clinical data from health systems, providers, and hospitals in order to inform practice
redesign to improve blood pressure control in patients with diabetes and hypertension, increase smoking cessation
counseling, and reduce unnecessary emergency department utilization and hospital re-admissions
Improve care coordination for patients with diabetes, heart disease, hypertension, and asthma by engaging
patients and providers in bidirectional data sharing through a Health Record Bank, empowering patients and family
members to participate in self-management through patient portals, and expanding access to care managers to facilitate
post-discharge planning
The Regents of the
Expand pre-hospital emergency field care and electronic information transmission to improve outcomes for
University of California, cardiovascular and cerebrovascular disease, empower patients to engage in their own health management through web
San Diego, San Diego, portal and cellular telephone technology, and improve continuity of care for veterans and military personnel through the
Calif.
Veterans Affairs/Department of Defense Virtual Lifetime Electronic Record initiative
Implement a region-wide Health Information Exchange and Patient Health Record solution and utilize secure,
University of Hawaii at
internet-based care coordination and tele-monitoring tools to increase access to specialty care for patients with chronic
Hilo, Hilo, Hawaii
diseases such as diabetes, hypertension, and obesity in this rural, health-professional shortage area
Western New York
Utilize clinical decision support tools such as registries and point-of-care alerts and reminders and innovative
Clinical Information
telemedicine solutions to improve primary and specialty care for diabetic patients, decrease preventable emergency room
Exchange, Inc., Buffalo, visits, hospitalizations and re-admissions for patients with diabetes and congestive heart failure or pneumonia, and
N.Y.
improve immunization rates among diabetic patients
Southern Piedmont
Community Care Plan,
Inc., Concord, N.C.
The Greater Cincinnati
HealthBridge, Inc
HealthBridge and its partners will use its advanced health information exchange program to develop new quality
improvement and care coordination initiatives focusing on patients with pediatric asthma, adult diabetes, and
encouraging smoking cessation.
The Southeastern
Michigan Health
Association (SEMHAT)
This community collaboration will leverage existing and new technologies across health care settings to improve the
availability of patient information at the point of care, regardless of where the patient is in the health system.
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Health Information Exchange (HIE)
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Confusion over what HIE should be
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Existing morass of organizational variants
• Lack of comfort with HIE (NHIN, HIOs, RHIOs, heavy state)
• Defaults to “private HIEs”
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Data standards and specifications
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Not adequate for demonstrable interoperability
• Do add requirements for standard recording of some data
• Integration costs will remain high
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Exchange needs in conflict with privacy and security agenda
“Blue Button” for always being able to download
• Focus information exchange on pushing data from provider to
provider (consent recommendations, NHIN Direct, HIPAA
modifications)
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HIT for Health Insurance Reform
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ACO and Medical Home Needs (and requirements)
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Seamless transitions in care
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Longitudinal, cross-organizational records
• Look-up, data queries
• Managed problem, medication, allergy lists +
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Quality and efficiency management data and services
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Including claims and process data, workflow integration
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Population analytic tools and registries
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Cross-organizational team communications and care
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Including patient communications
Clinical Decision Support
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Questions and Comments
John W. Loonsk, MD FACMI
[email protected]
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