A sampling of FederalA sampling of FederalHealth IT initiativesHealth IT initiatives
Carol Cain, PhDCarol Cain, PhDSenior Manager, Health IT PortfolioSenior Manager, Health IT Portfolio
Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality
October 24, 2006October 24, 2006
Diffusion of knowledgeDiffusion of knowledge
69.1% (1999)69.1% (1999)19841984Cholesterol Cholesterol ScreeningScreening
75.5% (2001)75.5% (2001)19821982MammographyMammography
48.1% (2000)48.1% (2000)19811981Diabetic Eye ExamDiabetic Eye Exam
53% (2000)53% (2000)19771977Pneumococcal Pneumococcal VaccineVaccine
64% (2000)64% (2000)1968 1968 Flu VaccineFlu Vaccine
Current rate of Current rate of useuse
Landmark TrialLandmark TrialClinical Clinical ProcedureProcedure
Balas EA, Boren SA., Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000.
Major Opportunities for Improvement Major Opportunities for Improvement Still Exist in Quality… Still Exist in Quality…
81% of Medicare 81% of Medicare pneumonia patients pneumonia patients get blood cultures get blood cultures before antibioticsbefore antibiotics
68% get the right 68% get the right antibioticsantibiotics
63% get their first 63% get their first antibiotic in a timely antibiotic in a timely mannermanner
Yet, only 30% get Yet, only 30% get all of three all of three recommended recommended interventionsinterventions
Quality of Pneumonia Treatment for Elderly, 2002
63.1 67.981
29.6
0102030405060708090
100
Received 1stdose of
antibiotic within4 hours of
hospital arrival
Receivedrecommended
antibioticsconsistent with
currentguidelines
Have bloodcultures
collected beforeantibiotics areadministered
Received allrecommended
treatmentregimens
Measure
Per
cent
age
of p
atie
nts
Source: Centers for Medicare & Medicaid Services, Quality Improvement Organization Program, 2002.
… … and Disparitiesand Disparities
Less than halfLess than half of of AMI patients are AMI patients are given counseling given counseling to quit smokingto quit smoking
African African Americans and Americans and HispanicsHispanics are are significantly less significantly less likely to receive likely to receive such counseling such counseling
Percent of AMI patients given smoking cessation counseling while hospitalized, 2002
49.52 51.04 54.3548.39
39.9331.43
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
Total US White NativeAmerican
Asian AfricanAmerican
Hispanic
**Significantly lower than whites, p<.01
****
EHR Adoption Gap:EHR Adoption Gap:United States Versus OthersUnited States Versus Others
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Portugal
France
Spain
United States
Greece
Ireland
Luxembourg
Italy
Belgium
Germany
Austria
Finland
United Kingdom
Denmark
Netherlands
Sweden
Primary Care Physician Office 2002
Source: "European Physicians Especially in Sweden, Netherlands, and Denmark, Lead U.S. in Use Source: "European Physicians Especially in Sweden, Netherlands, and Denmark, Lead U.S. in Use of Electronic Medical Records." of Electronic Medical Records." Harris Interactive Health Care NewsHarris Interactive Health Care News 2(16). 2(16).
HHS Health IT EffortsHHS Health IT Efforts
POLICYPOLICY PIPESPIPES PROVIDERSPROVIDERS
American Health American Health Information Information CommunityCommunity
How will we accelerate How will we accelerate the development and the development and adoption of health IT?adoption of health IT?
How will we deliver How will we deliver value to the health care value to the health care consumer?consumer?
Office of the National Office of the National Coordinator / National Coordinator / National Health Information Health Information InfrastructureInfrastructure
How will we build a How will we build a nationwide health IT nationwide health IT system that allows the system that allows the seamless and secure seamless and secure exchange and records?exchange and records?
Agency for Healthcare Agency for Healthcare Research and QualityResearch and Quality
How will providers use How will providers use health IT in hospitals health IT in hospitals and ambulatory care and ambulatory care settings to improve settings to improve quality of health care quality of health care and patient safety? and patient safety?
Quality StandardsQuality StandardsDesign systems to collect quality Design systems to collect quality
of care information and define of care information and define what constitutes quality health carewhat constitutes quality health care
IncentivesIncentivesReward those who provide and Reward those who provide and
purchase high-quality and purchase high-quality and competitively priced health carecompetitively priced health care
Price StandardsPrice StandardsAggregate claims information to Aggregate claims information to
enable cost comparisons between enable cost comparisons between specific doctors and hospitalsspecific doctors and hospitals
InteroperabiliityInteroperabiliitySet common technical standards Set common technical standards
for quick and secure for quick and secure communication and data exchangecommunication and data exchange
Cornerstones of Value-Based Health CareCornerstones of Value-Based Health Care
Building a Transparent Building a Transparent Health Care SystemHealth Care System
Office of the National Coordinator for Office of the National Coordinator for Health Information TechnologyHealth Information Technology
Established in response to Executive Order 13335, Established in response to Executive Order 13335, April 27, 2004April 27, 2004
Responsible for realizing the President’s vision of Responsible for realizing the President’s vision of Healthcare IT:Healthcare IT: Widespread adoption of interoperable EHR by 2014Widespread adoption of interoperable EHR by 2014 Medical information follows the consumerMedical information follows the consumer Clinicians have complete, computerized patient informationClinicians have complete, computerized patient information Quality initiatives measure performance and drive Quality initiatives measure performance and drive
quality-based competitionquality-based competition Public health and bioterrorism surveillance are seamlessly Public health and bioterrorism surveillance are seamlessly
integrated into careintegrated into care
www.hhs.gov/healthitwww.hhs.gov/healthit
Consumer Value
Standards Harmonization
ComplianceCertification
NHIN
Privacy / Security
Health ITAdoption
Infr
astr
uct
ure
Ind
ust
ry T
ran
sfo
rmat
ion
Health Information Technology Health Information Technology Deployment CoordinationDeployment Coordination
Tec
hn
olo
gy
Ind
ust
ry
Biosurveillance Consumer Empowerment
Chronic Care Electronic HealthRecords
Breakthroughs
Health Care Industry
Coordination of Policies, Resources, and Priorities
Office of the National Coordinator -Health IT Policy Council
-Federal Health Arch.
The Community-Workgroups
ONC Major InitiativesONC Major Initiatives
• American Health Information Community
• Standards Harmonization Process
• Compliance Certification Process
• Nationwide Health Information Network
• Privacy and Security Solutions
• Health Information Health Information Technology and Technology and Health Care Anti-FraudHealth Care Anti-Fraud
• Health IT Adoption InitiativeHealth IT Adoption Initiative
• Proposed Changes to Self-Proposed Changes to Self-Referral and Referral and Anti-Kickback RulesAnti-Kickback Rules
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:
Agency for Healthcare ResearchAgency for Healthcare Researchand Quality (AHRQ)and Quality (AHRQ)
MissionMission
To improve the quality, safety, To improve the quality, safety, efficiency, and effectiveness efficiency, and effectiveness
of health care for all of health care for all AmericansAmericans
AHRQ research focus:AHRQ research focus:How it differs How it differs
Patient-centered, not disease-specificPatient-centered, not disease-specific
Dual Focus -- Services + Delivery Dual Focus -- Services + Delivery Systems Effectiveness research focuses Systems Effectiveness research focuses on actual daily practice, not ideal on actual daily practice, not ideal situations (“efficacy”)situations (“efficacy”)
AHRQ mission includes production AHRQ mission includes production andand use of evidence-based informationuse of evidence-based information
Stroke, including control of hypertensionPneumoniaPeptic ulcer/dyspepsiaIschemic heart diseaseDiabetes mellitusDepression and other mood disordersDementia, including Alzheimer’s diseaseChronic obstructive pulmonary disease/asthmaCancerArthritis and non-traumatic joint disorders
Effective Health Care Effective Health Care Program (MMA, Sec 1013)Program (MMA, Sec 1013)
Top 10 conditions affecting Medicare beneficiariesTop 10 conditions affecting Medicare beneficiaries $15 million initiative to develop state-of-the-art information $15 million initiative to develop state-of-the-art information
about effectiveness of interventions, including prescription about effectiveness of interventions, including prescription drugsdrugs
Results available for public use via AHRQ websiteResults available for public use via AHRQ website
Translation
Facilitate Informed Transparent Health Care Decisions by: Patients Providers Policymakers
Clinical Decisions and Clinical Decisions and Communication Science CenterCommunication Science Center
ScientificEvidence
Understandableand UsableInformation
National Resource Centerfor Health IT
AHRQ Health IT PortfolioAHRQ Health IT Portfoliohttp://healthit.ahrq.govhttp://healthit.ahrq.gov
Planning1 yr
Implementation3 yr
DemonstratingValue
3 yr
State and Regional Demonstrations of HIE5 yr
Current issues: eRx standards pilotsPrivacy, security, business practices
Health IT Research FundingHealth IT Research Funding
Over 125 projects and Over 125 projects and demonstrations to better demonstrations to better understand how health IT understand how health IT can improve the safety, can improve the safety, quality and efficiency of quality and efficiency of health carehealth care
Projects in 43 statesProjects in 43 states Special attention to best Special attention to best
practices that can improve practices that can improve quality of care in rural, quality of care in rural, small community, safety small community, safety net and community health net and community health center care settingscenter care settings
AHRQ HIT AHRQ HIT Investment: Investment: $166 Million$166 Million
Implementation grantsImplementation grants
Varied technologiesVaried technologies Bar codingBar coding Computerized provider order entry Computerized provider order entry
(CPOE)(CPOE) Disease management registryDisease management registry Imaging (PACS)Imaging (PACS) Patient-centered carePatient-centered care PharmacyPharmacy TelehealthTelehealth
1/2 Rural1/2 Rural
AHRQ-sponsoredAHRQ-sponsored
Chronic diseaseChronic disease Decision supportDecision support Electronic medical records Electronic medical records
(EMR)(EMR) Medication administrationMedication administration Non-traditional settingsNon-traditional settings Reduce medical errors/ADEsReduce medical errors/ADEs Evidence-based practice Evidence-based practice
measuresmeasures
Evaluation ToolkitEvaluation Toolkit
Consistent ChallengesConsistent Challenges
Legal/privacy: Legal/privacy: lack of understanding around HIPAA lack of understanding around HIPAA compliance, confidentiality policies, and the security of compliance, confidentiality policies, and the security of web-based record accessweb-based record access
Buy-in for data sharing: Buy-in for data sharing: Understanding what kinds Understanding what kinds of consent is required, and clarifying security and privacy of consent is required, and clarifying security and privacy standards that should applystandards that should apply
Organizational/individual experience with HITOrganizational/individual experience with HIT Securing appropriate sustainable funding Securing appropriate sustainable funding Consortium governanceConsortium governance Grant administrationGrant administration Competing prioritiesCompeting priorities Staff training and turnoverStaff training and turnover Changing culture and workflow to integrate HITChanging culture and workflow to integrate HIT
http://healthit.ahrq.govhttp://healthit.ahrq.gov
Knowledge libraryKnowledge library Topic summariesTopic summaries Annotated referencesAnnotated references
Public teleconferencesPublic teleconferences Community-Based Health IT Initiatives: How Do You Community-Based Health IT Initiatives: How Do You
Make Them Work? Make Them Work? Are You Ready for EHRs? How to Make that Are You Ready for EHRs? How to Make that
AssessmentAssessment Getting Started with Heath IT ImplementationGetting Started with Heath IT Implementation
Lessons Lessons learnedlearned Expert Expert
assistanceassistance
New Grant Opportunities UpcomingNew Grant Opportunities Upcoming
FY07 funding announcements coming soonFY07 funding announcements coming soon In the ambulatory setting, transitions among settings, In the ambulatory setting, transitions among settings,
or home healthor home health AHRQ health IT is embedded in our quality, AHRQ health IT is embedded in our quality,
safety and effectiveness initiativessafety and effectiveness initiatives Patient-centered carePatient-centered care Medication managementMedication management Integration of decision support toolsIntegration of decision support tools Enabling quality measurementEnabling quality measurement
Watch for “Watch for “AmbulatoryAmbulatory Patient Safety and Patient Safety and Quality”Quality”
State and Regional State and Regional DemonstrationsDemonstrations
6 contracts6 contracts $30M over 5 years$30M over 5 years Laboratory dataLaboratory data Pharmacy DataPharmacy Data Improved Quality and SafetyImproved Quality and Safety Benefit to MedicaidBenefit to Medicaid Sustainable ModelSustainable Model
HIE v. HITHIE v. HIT
No longer just about putting electronic medical No longer just about putting electronic medical records in hospitalsrecords in hospitals Electric health information systems across Electric health information systems across allall care care
settings, as well as payers settings, as well as payers Linking them together – interoperability for Linking them together – interoperability for health health
information exchange (HIE)information exchange (HIE) For HIE, communities and states (and some regions) For HIE, communities and states (and some regions)
are developing networked systemsare developing networked systems To do this, it’s not just about investing in the To do this, it’s not just about investing in the
technology (HIT) technology (HIT) ; we must research how to do so in ; we must research how to do so in a way thata way that Maximizes the value we hope to realize – Maximizes the value we hope to realize –
clinically, economically, and for population healthclinically, economically, and for population health Assures that security and privacy protections are Assures that security and privacy protections are
“baked into” HIE “baked into” HIE
HIE Policy IssuesHIE Policy Issues
In addition, a new market is being created, In addition, a new market is being created, with all the technical and policy issues that with all the technical and policy issues that entails, such asentails, such as Standards for data exchangeStandards for data exchange Assuring consumer participation and patient Assuring consumer participation and patient
protectionsprotections Security concernsSecurity concerns New business arrangements, new relationships New business arrangements, new relationships Disconnect between payment systems and new Disconnect between payment systems and new
relationships/care delivery modelsrelationships/care delivery models Secondary use of dataSecondary use of data
Collaboration with ONCCollaboration with ONC
““Privacy and Security Solutions for Interoperable Privacy and Security Solutions for Interoperable Health Information Exchange” ContractHealth Information Exchange” Contract Research Triangle Institute for $17.5 M Research Triangle Institute for $17.5 M
National Governor’s AssociationNational Governor’s Association 33 States and Puerto Rico33 States and Puerto Rico
Identify variations in organization-level business Identify variations in organization-level business privacy and security policies and practicesprivacy and security policies and practices
Preserve privacy and security protectionsPreserve privacy and security protections Incorporate state and community interestsIncorporate state and community interests Leave behind in states and communities a knowledge Leave behind in states and communities a knowledge
base about privacy and security issuesbase about privacy and security issues
HRSA – Health Services and HRSA – Health Services and Resources AdministrationResources 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 HealthHRSA - Office of HealthInformation TechnologyInformation Technology
• Division of Health Information Technology Policy
• Division of Health Information Technology State and Community Assistance
• Office for the Advancement of Telehealth
OHIT was formally established in a December 2005 Federal Register notice, including the following components:
Office of the Associate Administrator
Contact: Cheryl Austein-Casnoff
OHIT – Division of HIT PolicyOHIT – 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 OHIT – Division of HIT State and Community Assistance (DSCA)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 OHIT – Office for the Advancement of Telehealth (OAT)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, Intersection of Safety, Quality and Health ITQuality and Health IT
AHRQ
Support diffusion of HIT to: •41 states•40 million Americans
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.Thank you.
Carol Cain, PhDCarol Cain, [email protected]@ahrq.hhs.gov
http://www.ahrq.govhttp://www.ahrq.govhttp://healthit.ahrq.govhttp://healthit.ahrq.gov
