1.1 Visioning and Strategic Planning

Transcript 1.1 Visioning and Strategic Planning

Visioning and Strategic Planning

Health Information Technology Toolkit for Chiropractic Offices

Presenter

• Margret Amatayakul RHIA, CHPS, CPHIT, CPEHR, FHIMSS President, Margret\A Consulting, LLC Schaumburg, IL • Independent consultant, who focuses on achieving value from electronic health records, HIPAA/HITECH, and health information exchange. Developer of tools in Toolkit • Adjunct faculty College of St. Scholastica, Duluth, MN, masters program in health informatics • Founder and former executive director Computer-based Patient Record Institute, associate executive director AHIMA, associate professor University of Illinois • Active participant in standards development, former HIMSS BOD, and co-founder of and faculty for Health IT Certification

Stratis Health

● ● ● Stratis Health is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities Stratis Health works toward its mission through initiatives funded by federal and state government contracts, and community and foundation grants, including serving as Minnesota’s Medicare Quality Improvement Organization (QIO) Stratis Health operates the Health Information Technology Services Center for health care organizations seeking to use health information technology in support of their clinical transformation 3

Agenda • Envision . . . • HIT vs. EHR vs. EMR • Purposes of EHR • Conceptual model of technical concepts • Reality in ambulatory care and acute care • Progress toward the vision

HIT vs. EHR

• •

Health information technology (HIT):

that describes the technology that supports management of health information for many purposes a

general concept

Electronic health record (EHR):

is a

specific set of applications

that provide an “electronic record of health-related information on an individual including patient demographic and clinical health information, such as medical history and problem lists, and has capacity to provide clinical decision support, support physician order entry, capture and query information relevant to health care quality, and exchange electronic health information with and integrate such information from other sources” ( Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009) Hardware that enables system use Software that directs computer devices People to support and use systems Policy that drives adoption of systems Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

Process that helps achieve results 5

EHR

• Encompasses broader view of a health record notion of a location for keeping track of patient care events to a resource with enhanced utility  moving from • Merely automating the form, content, and procedures of current patient records will perpetuate their deficiencies and will be insufficient to meet emerging user needs Institute of Medicine: Computer-based Patient Record: An Essential Technology for Health Care, 1991, 1997 • Longitudinal collection of electronic health information for and about persons; immediate electronic access to person- and population level information by authorized, and only authorized, users; provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care; and support of efficient processes for health care delivery Key Capabilities of an Electronic Health Record System, 2003 6

EHR

vs.

EMR • •

Electronic medical record (EMR) sometimes refers to:

– Physician office EHR – Hospital document imaging system – Non-interoperable record of health-related information

EHR is term used by:

– Federal government, including in HITECH – Institute of Medicine (IOM) – Health Level Seven (HL7) • Primary organization to develop interoperability in health care information systems; adopts the term EHR system – Certification Commission for Healthcare Information Technology (CCHIT) 7

• • • • • • • •

Purposes of EHR

Improve quality of care

: data availability, links to knowledge sources

Enhance patient safety

: context-sensitive reminders/alerts, clinical decision support, automated surveillance, disease management, drug/device recall

Support health maintenance

: preventive care and wellness - patient reminders, summaries, tailored instructions, remote evaluation, home monitoring

Increase productivity:

data capture and reporting formats tailored to user, streamlined workflow support, patient-specific care plans and protocols

Reduce hassle factors:

improve satisfaction for clinicians, consumers, and caregivers - managing schedules, registration, referrals, medication refills, work queues, automatically generating administrative data

Support revenue enhancement

: accurate and timely eligibility and benefits, cost-efficacy analysis, clinical trial recruitment, rules-driven coding support, accountability reporting/outcomes measures, contract management

Support predictive modeling:

health care guidance contribute to development of evidence-based

Maintain patient confidentiality:

as health information is securely exchanged among all stakeholders, including across the continuum of care and with individuals 8

Reality in Ambulatory Care

PACS Images LIS Hospital

- Demographics - Scheduling - Dictation - Transcription - CPOE

eRx Fax Portal PMS Charges Operations Relational Database (or CDR) CDS – POC - CPOE CCR/ CCD Scanning PHR Storage Processor Human-computer interface

External

CDW

e.g.,

D.M. or I z.

Registry

Reality in Hospitals

Other systems Other systems LIS Rx RIS R-ADT/ HIS MD Portal

Remote Monitoring

Storage Processor Interface Engine PFS EDMS EMAR Human computer interface (RN) POC CDS CDR Human computer interface CPOE

Operations Charges CDW

e.g., CMS Hospital Compare 10

CCR/CCD CDR CDSS CDW CPOE Glossary of Terms Continuity of care record/document – standard data content/transmission to send for referrals Clinical data repository – database optimized for processing patient transactions, e.g., posting vital signs Clinical decision support system – software that processes discrete data according to logical rules to provide reminders and alerts Clinical data warehouse – database optimized for translational data analysis, e.g., data mining Computerized provider order entry – system that provides CDS at the point of order entry Discrete (or structured) data = individual values of data that are entered via templates and which are computable; e.g., patient blood pressure; lab result; name of medication; in contrast to unstructured scanned images, narrative notes, dictation EDMS Electronic document management system – document imaging, email, efax, and other digital document (e.g., dictation) storage and retrieval E-MAR/BC-MAR eRx Electronic medication administration record (forms)/bar-code MAR for positive patient identification Electronic prescribing system – supports drug selection & transmits prescription to retail pharmacy Human computer interface = data entry devices, such as workstations, tablets, slates, speech recognition, personal digital assistants (PDAs), and smart phones LIS O/E PACS Laboratory information system that manages operations of a clinical laboratory Order entry system used by nursing staff to transcribe handwritten orders Picture archiving and communication system – for x-rays and other clinical images POC Charting PHR PMS/HIS/PFS RIS Clinical documentation at the point of care, using clinical practice guidelines/critical pathways and CDS Personal health record – patient contributed data in many forms Practice management system/Hospital information system/patient financial services – applications for operations, e.g., scheduling, admitting, billing, etc.

Data vs. Information CDR vs. CDW

Unstructured

information H&P Patient ID Height Weight Labs Patient ID Test Result Orders Patient ID Drug Dose Alert Data Repository Patient ID + Lab Test DKB Height + Result Weight Drug & Dose

Structured data to provide clinical decision support

Data Warehouse

Reality of Today - Vision for Tomorrow

• An EHR is a system that – Collects data from multiple sources – For use in clinical decision making – At the point of care • This definition is elusive for many organizations today • This definition is primarily focused on care delivery. Little demand from providers/supply of product to date for: – Various reporting functions – for quality, P4P, population health – Health information exchange functionality – Personal health record (PHR) support Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

Implementation vs. Adoption • Implementation – software and hardware installation, system build, testing, training, go-live • Adoption – users using system to achieve benefits • “EHR Half Life”

– Half of all who ponder do something about EHR – Half of all who sign a contract implement EHR – Half of all who implement EHR • Implement all components • Achieve full use • Use all functionality Goal of HIT Toolkit is to help you achieve full adoption Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of author.

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Stratis Health 2901 Metro Dr., Suite 400 Bloomington, MN 55425 952-854-3306 1-877-787-2847 (toll free) www.stratishealth.org

Adapted from Stratis Health’s Doctor’s Office Quality – Information Technology Toolkit, © 2005, developed by Margret\A Consulting, LLC. and produced under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.

For support using the toolkit

Stratis Health  Health Information Technology Services 952-854-3306  [email protected]