Post on 12-Jan-2016
transcript
HealthCare Information HealthCare Information Technology Technology
Blackford Middleton, MD, MPH, MScDirector, Clinical Informatics Research & Development
Chairman, Center for IT Leadership
OverviewOverview
What is Health IT? How Does Health IT impact healthcare? What is the Evidence-base for HIT? What is the Promise of HIT? Where do we stand on HIT Adoption? What is the Potential Value of HIT? How is Health IT Policy Derived Today? What are Policy Options to Stimulate HIT? Possible focus areas to move the ball
What is Health IT?What is Health IT?
Hospital – many systems Computer-based Provider Order Entry (CPOE) Electronic Medication Administration Record (eMAR) Clinical Data Repositories Ancillary Systems (Lab-chemistry, Lab-micro, Blood Bank, Radiology,
Pharmacy, Pathology, etc. Devices: Smart Pumps, Ventilators, EKG, ABGs… Financial: Revenue-cycle Management
Clinic Electronic Health Records (Electronic Medical Records) Practice Management System
Patient Personal Health Records
Payors – also may have PHRs Free-standing (community): any of the above
How Does Health IT impact How Does Health IT impact healthcare?healthcare?
Information management and processing Making the bill Processing specimens (ancillary departments)
Information access Hospital information systems, EMRs
Data analysis -- financial Data analysis – clinical operations/research Clinical Decision Support Information exchange
How Does HIT Improve Healthcare?How Does HIT Improve Healthcare?
Clinical Processes Streamline, structure order process Ensure completeness, correctness Supply patient data Charge display Redundant test reminders Structured ordering with counter-
detailing Consequent or corollary orders
Other EMR Process Benefits Reduced transcription costs Reduced chart pulls Improved clinical messaging and
workflow Improved charge capture and accounts
receivable Improved referral coordination Improved patient communication and
service
Medication Utilization Perform drug interaction checks Check for duplicate medications Brand to generic substitutions Calculate and adjust doses based upon
age, weight, renal function Alternative cost-effective therapies Formulary compliance Indication-based ordering
How does healthcare information How does healthcare information exchange impact the bottom line?exchange impact the bottom line?
Largely, TBD… Expected effects
Reduced healthcare information management labor costs
Reduced duplicative tests and procedures Reduced fraud and abuse Improved service delivery efficiency Improved patient convenience Reduced medical error
What is the Promise of HIT?What is the Promise of HIT?
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Beta blocker after AMI
Breast cancer screening
Cervical cancer screening
Cholesterol screening
Cholesterol after AMI
LDL < 130 after AMI
Colorectal cancer screening
Diabetes: HgbA1c done past year
Diabetes: Adequate control
Diabetes: Cholesterol measures
Diabetes: Cholesterol controlled
Diabetes: Eye Exam
Diabetes: Renal Exam
Hypertension: BP <= 140/90
Flu shot (over 65)
Pneumococcal vaccine (over 65)
Mental health followup after discharge
Before
After
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Beta blocker after AMI
Breast cancer screening
Cervical cancer screening
Cholesterol screening
Cholesterol after AMI
LDL < 130 after AMI
Colorectal cancer screening
Diabetes: HgbA1c done past year
Diabetes: Adequate control
Diabetes: Cholesterol measures
Diabetes: Cholesterol controlled
Diabetes: Eye Exam
Diabetes: Renal Exam
Hypertension: BP <= 140/90
Flu shot (over 65)
Pneumococcal vaccine (over 65)
Mental health followup after discharge
Before
After
Data Source: Thomson TG, Brailer DJ. The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care. Washington, DC: US Department of Health and Human Services; 2004.
Physicians Recognize Value of EMRPhysicians Recognize Value of EMR
1DesRoches CM et al. N Engl J Med 2008;359:50-60
•EMR viewed as part of the answer but adoption stuck at 4% for full functionality (13% basic functionality)1
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Positive SurveyResponses
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EHR Functionality Use by Practice SizeEHR Functionality Use by Practice Size
Use of the following: prescription orders, lab orders and viewing, radiology tests and results viewing and clinical notes
Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record Keeping among Physicians & Group Practices in the United States, Preliminary Data
Major Barriers to EHR AdoptionMajor Barriers to EHR Adoption
Percent of physicians reporting a “major barrier”
Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record Keeping among Physicians & Group Practices in the United States, Preliminary Data
How Does HIT Save Money? How Does HIT Save Money?
EHR Effects Completeness, correctness, decision support, formulary, brand to generic,
duplicate/redundant meds and tests, charge display Workflow support, messaging (pt/provider), referral, A/R, team
CPOE Effects Reduction in hospitalization/LOS due to ADEs, clinical decision support
HIEI Effects Reduction in unnecessary and redundant tests and procedures Labor cost savings
Telehealth Effects Reduction in patient transport, utilization of hospitals, and physician office visits
PHR Effects Administrative time savings Reduction in hospitalizations and physician visit utilization Improved medication safety Reduction in redundant laboratory tests
www.citl.org
CITL HIT Value AssessmentsCITL HIT Value Assessments
Net US could save $150B with HIT adoption, or approximately 7.5% or US Healthcare Expenditure The Value of Ambulatory Computerized Order Entry (ACPOE)
$44B US nationally; $29K per provider, per year
The Value of HealthCare Information Exchange and Interoperability (HIEI) $78B/yr
The Value of IT-enabled Chronic Diabetes Management (ITDM) $8.3B Disease Registries; Advanced EHR $17B
The Value of Physician-Physician Tele-healthcare >$20B*
The Value of Personal Health Records Approx. $20B
www.citl.org • CITL: 89% of the benefit of EMR adoption does not go to Providers1
2Middleton B. Health Aff (Millwood). 2005;24(5):1269-72.
A public-private “Community” was established to serve as A public-private “Community” was established to serve as
the focal point for America’s health information concerns the focal point for America’s health information concerns and drive opportunities for increasing interoperabilityand drive opportunities for increasing interoperability
Healthcare Information Technology
Standards Panel (HITSP)
Nationwide Health Information
Network Architecture Projects (NHIN)
The Health Information Security & Privacy
Collaboration (HISPC)
Certification Commission
for Healthcare Information Technology
(CCHIT)
American Health
Information Community(AHIC 2.0)
The Community is a federally-chartered commission and will provide input and recommendations to HHS on how to make health records digital and
interoperable, and assure that the privacy and security of those records are protected, in a smooth, market-led way.
The Community is a federally-chartered commission and will provide input and recommendations to HHS on how to make health records digital and
interoperable, and assure that the privacy and security of those records are protected, in a smooth, market-led way.
CongressNCVHS
NGA
HIMSS
AMIA
AHIMA
Clinical/Professional Societies
Advocacy Groups
State Leg.
VendorGroups
What are Policy Options to Stimulate What are Policy Options to Stimulate HIT?HIT?
Standards acceleration/harmonization, certification HITSP, CCHIT
Incentives for adoption (CMS pilot) Grants and loans, tax credits, other subsidies Reimbursement incentive
NHIN re-usable technologies ONC NHIN demos
Clinical decision support knowledge repository AHRQ
IT Workforce training AMIA 10x10, HIMSS
HIT comparative effectiveness research AHRQ, ONC, NLM