Transcript Document

Leveraging Health Information
Technology to Improve Care: Early
Lessons from the ONC HITECH
Programs
Mat Kendall, MPH
Director, Office of Provider Adoption Support (OPAS)
Office of the National Coordinator for Health IT
U.S. Department of Health & Human Services
Presentation Learning Objectives:
• Overview of the Health Information Technology
for Economic and Clinical Health Act (HITECH)
• How ONC is Supporting Providers to Achieve
Meaningful Use of Health IT
• Who is Working To Achieve Meaningful Use and
What Challenges They Are Facing
• How Meaning Use of Health IT is Supporting
Providers to Improve the Care They Deliver to
Their Patients
7/18/2015
Office of the National Coordinator for
Health Information Technology
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HITECH: Catalyst for Transformation
Ultimate Goals :
Better Healthcare
Better Health
Reduced Costs
Paper Records
HITECH Act
Electronic Health Records
Pre 2009
2009
EHR Incentive Program and 62
Regional Extension Centers
2014
Widespread adoption &
meaningful use of EHRs
A system plagued
by inefficiencies
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Office of the National Coordinator for
Health Information Technology
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Meaningful Use as a Building Block
Use information to
transform
Improved
population health
Improve access to
information
Data utilized to
improve delivery
and outcomes
Data utilized to
improve delivery
and outcomes
Patient self
management
Patient engaged,
community
resources
Care coordination
Care coordination
Patient centered
care coordination
Patient informed
Evidenced based
medicine
Team based care,
case management
Basic EHR
functionality,
structured data
Structured data
utilized
Registries for
disease
management
Registries to manage
patient populations
Privacy & security
protections
Privacy & security
protections
Privacy & security
protections
Privacy & security
protections
Stage 1 MU
Office of the National Coordinator for
PCMHs
Health2Information
Technology
Stage
MU
Utilize technology
to gather
information
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Enhanced access and
continuity
3-Part Aim
ACOs
Stage 3 MU
3
3
OPAS Strategic Priorities
Goal: Assist All Providers to Achieve Meaningful Use of EHR Systems
Regional
Extension
Centers (REC)
HealthIT.gov
Provider
Adoption
Optimization
Services
Catalyze IT
Workforce
Development
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Harness MU
to Achieve
Three-Part Aim
Goals
Leverage
Business
Intelligence
Office of the National Coordinator for
Health Information Technology
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62 Regional Extension Centers (RECs)
Cover 100% of the USA
Initial Program Goal:
100,000 priority primary care providers achieve meaningful use (MU) by 2014
Every REC:
• Has a defined service area and
specific number of providers
• Provides unbiased, practical support
throughout process
• Serves as two-way pipeline to federal
and local resources
Approach differs by REC:
• Independent operations
• Affiliation with QIOs and universities
• Partnership with other ONC grantees
(Beacon and HIE)
• Variety of hospital and payer partnerships
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Office of the National Coordinator for
Health Information Technology
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Comprehensive Support Beyond the
EHR Implementation Process
Improve Care Quality:
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Plan:
1
• Assess ACO, PCMH
models
• Conduct readiness
assessment
• Prepare for future pay
for performance
• Identify tools needed for
change (i.e. EHR system,
workflow changes, etc)
• Empower patients in
their own health care
Primary goal:
Give providers as much
support as possible
Operate & Maintain: 4
2
Transition:
• Continuous quality
improvement
• Redesign practice
workflow
• MU Stages 1,2,3
• Perform HIT education
& training
3
Implement:
• Provide technical assistance
• Partner with local stakeholders, HIEs
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Health Information Technology
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Health IT Dashboard for the Medicare and Medicaid
Electronic Health Record Incentive Programs
http://dashboard.healthit.gov/meaningfuluse
•
•
•
•
Map & Dashboard Created by:
Program Administered & Data Provided by:
U.S. Department of Health and Human Services
U.S. Department of Health and Human Services
Office of the National Coordinator for Health Information Technology
Centers for Medicare & Medicaid Services
Office of Economic Analysis, Evaluation, and Modeling
http://healthit.gov
http://dashboard.healthit.gov/
Email: [email protected]
7/18/2015
Office of E-Health Standards and Services
http://cms.gov
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms
Office of the National Coordinator for
Health Information Technology
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Where We Are Today:
Who Are RECs Helping?
Practice Type*
Private Practice 1 – 10
# of Providers
Enrolled with RECs
% of Total RECEnrolled Providers
# of Providers
Demonstrating MU
Proportion of REC
Increase since last
Providers who are
month
131,000
Priority
Primary
Care
demonstrating MU
51,643
35%
Specialty Practice
3,351
2%
Rural Health Clinic
3,665
3%
Critical Access
Hospitals
Private Practice 11+
4,779
>
23,353
Providers
(PPCPs)45%
are enrolled
with
920RECs
27%
> 10,000 specialists also enrolled
2%
1%
1129
31%
2%
3%
1170
24%
2%
627
0%
137
22%
-1%*
Other Underserved
Setting
Rural Hospital
17,432
12%
7,513
43%
3%
2,472
2%
845
34%
2%
Community Health
Center
Practice Consortiums
22,802
16%
5,747
25%
3%
21,515
15%
11,630
54%
3%
Public Hospitals
17,820
12%
6,550
37%
4%
146,106
100%
58,994
40%
2%
TOTAL
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Office of the National Coordinator for
Health Information Technology
ONC CRM data as of May 1, 2013
*Proportional decrease is due to an increase in
providers enrolled in this practice type.
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Who RECs Are Helping:
PPCPs by Specialty
Priority Primary Care Providers
(PPCPs)Enrolled with RECs
Adolescent
Medicine,, 0%
Pediatrics 16%
Family Practice, ,
42%
OB-GYN 12%
> 132,000 Priority Primary Care
Providers (PPCPs) are enrolled
with RECs which is more than
43% of the 303,000 Primary
Care Providers in the U.S.
Internal Medicine,
24%
Gynecology 1%
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General
Practice 4%
Geriatrics,1%
Office of the National Coordinator for
Health Information Technology
Data Source: ONC CRM, September 17, 2012; SK&A Office-based
Providers Database. Q4, 2011
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REC Enrolled Providers by Credential
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ONC CRM data as of March 19, 2013.
Office of the National Coordinator for
Health Information Technology
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RECs are Getting NPs
Registered and Paid
NPs Paid by CMS
RR=1.59*
RR=1.59*
*p<0.0001. ONC CRM data as of March 19, 2013, merged with CMS
Office of the National Coordinator for
7/18/2015
EHR Incentive
Funds data through January 31, 2013.
Health Information Technology
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Who Are RECs Helping?
Specialists
Dentistry, 1,478,
14%
Other Specialty,
3376, 33%
Psychiatry, 1,120,
11%
Surgery, 1,066, 10%
Optometry, 214, 2%
Orthopedics,
691, 7%
Dermatology, 215,
2%
Urology, 218, 2%
Ophthalmology,
308, 3%
Gastroenterology,
Neurology, 359, 3%
310, 3%
Cardiology, 594, 6%
RECs are working with more
than 10,000 Specialists in 38
different specialties in
addition to 132,000 enrolled
PCPs
Opportunity:
- Already working in the
settings (FQHCs, practice
consortiums)
- Some states are paying
RECs to work with Medicaid
Specialists using 90/10
funds
Podiatry, 369, 4%
SOURCE: ONC CRM, 12/7/2012
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Health Information Technology
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REC Success:
160,000
145,522
140,000
•
A GAO report found that Medicare
providers working with RECs were
over 2.3 times more likely to receive
an EHR incentive payment then those
who were not partnered with an REC2
•
REC enrollment rates are higher for
small rural (non-CBSA, 56%) and
micropolitan areas (47%) compared
to urban or metropolitan areas3
•
Since November, 2011 more than
25,000 MU challenges have been
documented by RECs at
approximately 18,000 sites to help
identify common challenges
providers are facing
116,578
120,000
100,000
80,000
60,000
53,582
40,000
20,000
Feb-10
Mar-10
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
0
Enrolled
Live on an EHR
Demonstrating MU
Data Source: ONC CRM Data March 26, 2013
1Source:
Customer Relationship Management (CRM) Tool, maintained by the Office of Provider Adoption and Support (OPAS) at ONC, data as of March, 26th 2013. Provider denominators obtained from the SK&A
Office-based Providers Database, Q4, 2011.
2GAO, Electronic Health Records: Number and Characteristics of Providers Awarded Medicare Incentive Payments for 2011, GAO-12-778R (Washington, D.C.: July 26, 2012).
3 Furukawa M, Samuels C, King J, Adetosoye F, Samy L. Engaging Providers in Underserved Areas to Adopt Electronic Health Records. AJMC, In Press, 2013.
CBSA indicates Core Based Statistical Area. HPSA indicates Health Professional Shortage Area.
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Health Information Technology
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REC are also collecting specific practices level
data on challenges that providers are
experiencing
Primary and Secondary Challenges Categories Being Tracked by RECs
Practice
Issues
Vendor
Issues
Workflow adoption
Upgrade
Provider engagement
Delays in implementation /
installation
Training
Certification
Reports slow / not available
Vendor selection
Administrative
Financial
Staffing
Training / support materials
inadequate/not available
Lack of vendor support
Technical
Inaccurate reports
and/or data
Attestation
Process
Issues
MU
Measures
Calculating patient
volume
Core CQMs
Medicaid program not
up yet
Alternate Core CQMs
Medicaid technical/
administrative
Additional CQMs
Medicare technical/
administrative
Each of the Core /
Menu Set measure
Complete list of Challenges categories,
tertiary
Office of theincluding
National Coordinator
for categories and descriptions
7/18/2015
Health Information Technology
of the categories, is available at healthit.gov/data.
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Top Ten Secondary Category Challenges
• Overall Top Ten Challenges
• Top Ten Newly Reported Challenges
Overall Secondary Challenge
Rank (N) Category
Overall
Rank (N)
Secondary Challenge
Category
1 (1,835)
Provider engagement
1 (134)
MU Measures
3
2 (1,504)
Administrative practice issues
(Paperwork/Planning/Merger)
2 (80)
Administrative practice
issues
2
3 (43)
Provider engagement
5
4 (19)
Medicare technical issues
6
5 (16)
Practice financial issues
12
6 (14)
Technical vendor issues
11
7 (9)
Vendor delays in
Implementation/Installation
8
8 (8)
Medicaid technical issues
13
9(8)
Practice staffing
14
10 (7)
Inaccurate reports and/or
data
7
3 (986)
Practice workflow adoption
4 (931)
Vendor Selection
5 (642)
Vendor delays in
Implementation/Installation
6 (541)
Practice financial issues
7 (482)
Practice staff training
8 (463)
Medicaid technical issues
9 (431)
Technical vendor issues
10 (374)
Reports Slow/Not Available
Office of the National Coordinator for
7/18/2015
Health Information Technology
Data from the ONC CRM as of January 7, 2013. N=number of challenges reported.
Rank Last
Month
15
Top Five Challenges by Practice Type
Rank
CHCs
CAHs
Other
Underserved Practice
Setting
Consortium
1
Practice
Practice
MU Measures
Administrative Administrative
2
MU Measures
3
Workflow
adoption
MU Measures
Private
Practice
1-10
Provider
engagement
Private
Practice
11+
4
Vendor delays Vendor delays
In
In
Implementatio Implementatio
n/Installation n/Installation
5
Medicaid
program not set
up yet
Vendor
selection
Provider
engagement
Workflow
adoption
Practice
Administrative
Workflow
adoption
Vendor
selection
Vendor
selection
Vendor delays
In
Implementatio
n/Installation
Vendor
upgrade
Workflow
adoption
MU Measures
Provider
engagement
Medicaid
Practice
Practice
Practice
MU Measures
financial issues Administrative Administrative
Practice
staffing
Public
Hospitals
Rural Health Rural
Clinic
Hospital
Provider
engagement
Workflow
adoption
Practice
Practice
Practice
Administrative Administrative Administrative
MU Measures
Practice
MU Measures
financial issues
Vendor delays
In
MU Measures
Implementatio
n/Installation
Attestation Process
Office of the National Coordinator for
Vendor
selection
Vendor
selection
Practice Issue
Provider
engagement
Specialty
Practice
Practice
Training
Provider
Engagement
Vendor
selection
Workflow
adoption
Vendor delays
In
MU Measures
Implementatio
n/Installation
Vendor Issue
Top five7/18/2015
based on number of challenges submitted. Data as of December 31, 2012, pulled from the ONC CRM. Non-priority hospitals did not report any
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Health Information Technology
challenges.
What We are Hearing:
Health IT Workforce Shortage
will Stunt Sector Growth
Worker shortage: America’s next healthcare
epidemic.
Today’s epidemic is tomorrow’s pandemic.
7/18/2015
Health IT worker shortage will
stunt sector growth, study says
Office of the National Coordinator for
Health Information
Health ITTechnology
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Address WorkForce Needs:
Community College Consortia
Number of students who successfully completed the Community College Consortia Program by state:
7/18/2015
Last
updated: March 2012
Office of the National Coordinator for
Health Information Technology
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Ways that Health IT Can Be Meaningfully
Optimized to Improve Patient Health
Health Information Technology
New Payment
Models
New/ Improved
Ways of
Delivering Care
Population
Health
Awareness
Improved
Care
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Office of the National Coordinator for
Health Information Technology
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New/ Improved Ways of Delivering Care
New Opportunity
New Needs:
Medical Home
• New approaches to team based care
• Open access scheduling
• New/expanded roles for staff to assist with care coordination
Consumer
Engagement
• New ways of communicating/engaging patients (i.e. portals)
• Teach patients about how they can be more active in their
own care
Health Information
Exchange
Privacy/Security
7/18/2015
• Assistance with implementation and workflow redesign
• Improved coordination/communication among external
health care networks (specialist, nursing homes, etc.)
• Support for secure back up/recovery
• Assistance in educating staff about how to protect data
Office of the National Coordinator for
Health Information Technology
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New Payment Models
New Opportunity
New Needs:
Shared Savings
Programs
• Cost/quality data analytics and risk management
• Continuous quality improvement efforts aimed at improving
quality/cost measures
Comprehensive
Primary Care Initiative
Pioneer ACO
Bundle Payments
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• Care management for at risk patients
• Increased access to preventive care
• Implement patient portals
• Develop new payment arrangements that best improve care
and generate savings for Medicare
• Test concepts on a large scale
• New approaches to billing and delivering care in different
settings (Acute care hospital, Skilled nursing, etc.)
Office of the National Coordinator for
Health Information Technology
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Population Health Awareness
New Opportunity
New Needs:
National Quality
Strategy
• Ensure Health IT is used to address most pressing health care
challenges
• Continuous quality improvement
Million Hearts
• Team approach to care management of patients who are at
risk for heart disease
• Increased access to preventive care
Public Health Support
• Support for new coordination around Immunizations and
other public health priorities
• Education for patients on how to access immunization data
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Office of the National Coordinator for
Health Information Technology
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Training for an
Evolving Health IT Landscape
Sound educational models need to be
developed for different stages of training
• Professional schools to select, support
and train PCMH ready clinicians
• Team work/interdisciplinary training
• Life-long learning of key skills for all
health care workers (IOM Report)
• New education models on-line
• New efforts to collect and disseminate
curricula
•
Office of the National Coordinator for
Health IT
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