A sampling of Federal Health IT initiatives Carol Cain, PhD

Senior Manager, Health IT Portfolio

Agency for Healthcare Research and Quality October 24, 2006

Diffusion of knowledge

Clinical Procedure Flu Vaccine Pneumococcal Vaccine Diabetic Eye Exam Mammography Cholesterol Screening Landmark Trial

1968 1977 1981 1982 1984 Balas EA, Boren SA., Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000.

Current rate of use

64% (2000) 53% (2000) 48.1% (2000) 75.5% (2001) 69.1% (1999)

Major Opportunities for Improvement Still Exist in Quality…

Quality of Pneumonia Treatment for Elderly, 2002

100 90 80 70 60 50 40 30 20 10 0

63.1

67.9

81 29.6

Received 1st dose of antibiotic within 4 hours of hospital arrival Received recommended antibiotics consistent with current guidelines Have blood cultures collected before antibiotics are administered Received all recommended treatment regimens

Measure Source:

Centers for Medicare & Medicaid Services, Quality Improvement Organization Program, 2002.

    81% of Medicare pneumonia patients get blood cultures before antibiotics 68% get the right antibiotics 63% get their first antibiotic in a timely manner

Yet, only 30% get all of three recommended interventions

… and Disparities

Percent of AMI patients given smoking cessation counseling while hospitalized, 2002

100.00

90.00

80.00

70.00

60.00

50.00

40.00

30.00

20.00

10.00

0.00

49.52

51.04

54.35

48.39

39.93

** 31.43

** Total US White Native American **Significantly lower than whites, p<.01

Asian African American Hispanic  

Less than half

of AMI patients are given counseling to quit smoking

African Americans and Hispanics

are significantly less likely to receive such counseling

EHR Adoption Gap: United States Versus Others

Sweden Netherlands Denmark United Kingdom Finland Austria Germany Belgium Italy Luxembourg Ireland Greece United States Spain France Portugal 0%

Primary Care Physician Office 2002

10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Source: "European Physicians Especially in Sweden, Netherlands, and Denmark, Lead U.S. in Use of Electronic Medical Records." Harris Interactive Health Care News 2(16).

HHS Health IT Efforts

POLICY PIPES American Health Information Community

How will we accelerate the development and adoption of health IT?

How will we deliver value to the health care consumer?

Office of the National Coordinator / National Health Information Infrastructure

How will we build a nationwide health IT system that allows the seamless and secure exchange and records?

PROVIDERS Agency for Healthcare Research and Quality

How will providers use health IT in hospitals and ambulatory care settings to improve quality of health care and patient safety?

Building a Transparent Health Care System

Cornerstones of Value-Based Health Care

Quality Standards Design systems to collect quality of care information and define what constitutes quality health care Price Standards Aggregate claims information to enable cost comparisons between specific doctors and hospitals Interoperabiliity Set common technical standards for quick and secure communication and data exchange Incentives Reward those who provide and purchase high-quality and competitively priced health care

Office of the National Coordinator for Health Information Technology



Established in response to Executive Order 13335, April 27, 2004



Responsible for realizing the President’s vision of Healthcare IT:

 Widespread adoption of interoperable EHR by 2014  Medical information follows the consumer   Clinicians have complete, computerized patient information Quality initiatives measure performance and drive quality-based competition  Public health and bioterrorism surveillance are seamlessly integrated into care

www.hhs.gov/healthit

Health Information Technology Deployment Coordination

Health Care Industry

Breakthroughs

Standards Harmonization Compliance Certification NHIN Privacy / Security Health IT Adoption Biosurveillance Consumer Empowerment Chronic Care Electronic Health Records

Coordination of Policies, Resources, and Priorities Office of the National Coordinator -Health IT Policy Council -Federal Health Arch.

The Community -Workgroups Consumer Value

ONC Major Initiatives

In 2004, President Bush called for the widespread use of electronic health records (EHRs) within 10 years. Despite the demonstrated benefits to care delivery, studies have found use of EHRs remains low among physicians, hospitals and other health care providers. The Office of the National Coordinator for Health Information Technology (ONC) has set the foundation for adoption of interoperable EHRs through the following major initiatives: • • • • • American Health Information Community Standards Harmonization Process Compliance Certification Process Nationwide Health Information Network • • • Privacy and Security Solutions Health Information Technology and Health Care Anti-Fraud Health IT Adoption Initiative Proposed Changes to Self Referral and Anti-Kickback Rules

Agency for Healthcare Research and Quality (AHRQ) Mission

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

AHRQ research focus: How it differs

 Patient-centered, not disease-specific  Dual Focus -- Services + Delivery Systems Effectiveness research focuses on actual daily practice, not ideal situations (“efficacy”)  AHRQ mission includes production

and

use of evidence-based information

Effective Health Care Program (MMA, Sec 1013)

   Top 10 conditions affecting Medicare beneficiaries $15 million initiative to develop state-of-the-art information about effectiveness of interventions, including prescription drugs Results available for public use via AHRQ website Arthritis and non-traumatic joint disorders Cancer Chronic obstructive pulmonary disease/asthma Dementia, including Alzheimer’s disease Depression and other mood disorders Diabetes mellitus Ischemic heart disease Peptic ulcer/dyspepsia Pneumonia Stroke, including control of hypertension

Clinical Decisions and Communication Science Center

Scientific Evidence Translation Understandable and Usable Information Facilitate Informed Transparent Health Care Decisions by: Patients Providers Policymakers

AHRQ Health IT Portfolio

http://healthit.ahrq.gov

Current issues:

eRx standards pilots Privacy, security, business practices

State and Regional Demonstrations of HIE 5 yr Planning 1 yr Implementation 3 yr Demonstrating Value 3 yr National Resource Center for Health IT

Health IT Research Funding

   Over 125 projects and demonstrations to better understand how health IT can improve the safety, quality and efficiency of health care Projects in 43 states Special attention to best practices that can improve quality of care in rural, small community, safety net and community health center care settings

AHRQ HIT Investment: $166 Million

Implementation grants



Varied technologies

 Bar coding  Computerized provider order entry (CPOE)  Disease management registry   Imaging (PACS) Patient-centered care  Pharmacy  Telehealth        Chronic disease Decision support Electronic medical records (EMR) Medication administration Non-traditional settings Reduce medical errors/ADEs Evidence-based practice measures  

1/2 Rural

AHRQ-sponsored

Evaluation Toolkit

Consistent Challenges



Legal/privacy:

lack of understanding around HIPAA compliance, confidentiality policies, and the security of web-based record access 

Buy-in for data sharing:

standards that should apply Understanding what kinds of consent is required, and clarifying security and privacy       

Organizational/individual experience with HIT

Securing appropriate sustainable funding Consortium governance Grant administration Competing priorities Staff training and turnover Changing culture and workflow to integrate HIT

http://healthit.ahrq.gov

   Lessons learned  Expert assistance Knowledge library  Topic summaries  Annotated references Public teleconferences  Community-Based Health IT Initiatives: How Do You Make Them Work?  Are You Ready for EHRs? How to Make that Assessment  Getting Started with Heath IT Implementation

New Grant Opportunities Upcoming

  FY07 funding announcements coming soon  In the ambulatory setting, transitions among settings, or home health AHRQ health IT is embedded in our quality, safety and effectiveness initiatives     Patient-centered care Medication management Integration of decision support tools Enabling quality measurement  Watch for “ Ambulatory Quality” Patient Safety and

State and Regional Demonstrations

       6 contracts $30M over 5 years Laboratory data Pharmacy Data Improved Quality and Safety Benefit to Medicaid Sustainable Model

HIE v. HIT

   No longer just about putting electronic medical records in hospitals  Electric health information systems across all care settings, as well as payers  Linking them together – interoperability for

health information exchange (HIE)

For HIE, communities and states (and some regions) are developing networked systems To do this, it’s not just about investing in the

technology (HIT)

; we must research how to do so in a way that  Maximizes the value we hope to realize – clinically, economically, and for population health  Assures that security and privacy protections are “baked into” HIE

HIE Policy Issues

 In addition, a new market is being created, with all the technical and policy issues that entails, such as   Standards for data exchange Assuring consumer participation and patient protections    Security concerns New business arrangements, new relationships Disconnect between payment systems and new relationships/care delivery models  Secondary use of data

Collaboration with ONC

 “Privacy and Security Solutions for Interoperable Health Information Exchange” Contract  Research Triangle Institute for $17.5 M   National Governor’s Association 33 States and Puerto Rico  Identify variations in organization-level business privacy and security policies and practices    Preserve privacy and security protections Incorporate state and community interests Leave behind in states and communities a knowledge base about privacy and security issues

HRSA – Health Services and Resources Administration

  

HRSA is the nation's access agency – improving health and saving lives by making sure the right services are available in the right places at the right time

Primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable

Mission

– National leadership, program resources and services needed to improve access to culturally competent, quality health care

HRSA - Office of Health Information Technology

OHIT was formally established in a December 2005 Federal Register notice, including the following components: • • • Division of Health Information Technology Policy Division of Health Information Technology State and Community Assistance Office for the Advancement of Telehealth

Office of the Associate Administrator Contact: Cheryl Austein-Casnoff [email protected]

OHIT – Division of HIT Policy

• Developing a nationwide HIT and telehealth strategy for HRSA that focuses on the health care safety net and indigent populations.

• Developing HRSA’s HIT and telehealth policy.

• Ensures successful dissemination of appropriate IT advances, such as EMR systems or provider networks, to HRSA programs.

• Works collaboratively with states, foundations, national organizations, private sector providers, and other Federal departments in order to promote the adoption of HIT by HRSA’s grantees.

OHIT – Division of HIT State and Community Assistance (DSCA)

• Develops and coordinates HIT programs and policies.

• Provides professional assistance and support in developing HIT initiatives among HRSA grantees.

• Administers grant programs to promote and evaluate the use of appropriate HIT among grantees and others.

• Advises HRSA grantees on strategies to maximize the potential of new and existing HIT technologies for meeting quality and technical assistance objectives.

• Primary responsibility for the Health Center Controlled Networks.

OHIT – Office for the Advancement of Telehealth (OAT)

• Develops and coordinates telehealth grant programs and contracts.

• Provides professional assistance and support in developing telehealth initiatives.

• Administers and evaluates the use of appropriate telehealth technologies among HRSA grantees and others.

• Disseminates the latest information and research findings relating to telehealth technologies in agency programs and underserved areas.

• Provides guidance on telehealth policy through the Associate Administrator for OHIT, other HHS Offices, and other Federal and state agencies to promote cost-effective telehealth programs.

Intersection of Safety, Quality and Health IT

Support diffusion of HIT to:

•

41 states

•

40 million Americans AHRQ Improve medication safety

•CMS e-prescribing demos

Provide HIT technical support to the safety net

• Community health centers • Critical access hospitals • Public hospitals •

Address Privacy and Security

Thank you.

Carol Cain, PhD

[email protected]

http://www.ahrq.gov

http://healthit.ahrq.gov