The Role of Health Information Technology Regional Extension Centers in Texas

Goal: Use health communication strategies and health information technology (IT) to improve population health outcomes and health care quality, and to achieve health equity.

Why Are Health Communication and Health Information Technology Important?

Effective use of communication and technology by health care and public health professionals can bring about an age of patient- and public-centered health information and services. By strategically combining health IT tools and effective health communication processes, there is the potential to:

Improve health care quality and safety. Increase the efficiency of health care and public health service delivery. Improve the public health information infrastructure. Support care in the community and at home. Facilitate clinical and consumer decision-making. Build health skills and knowledge.

Berkman ND, DeWalt DA, Pignone MP, et al. Literacy and health outcomes: Summary [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2004 Jan. 8 p. (AHRQ publication; no. 04-E007-1); (Evidence report/technology assessment; no. 87). Available from: http://www.ahrq.gov/clinic/epcsums/litsum.htm

Department of Health and Human Services (US), Office of Disease Prevention and Health Promotion. Health literacy online: A guide to writing and designing easy-to-use health web sites [Internet]. Rockville, MD: Office of Disease Prevention and Health Promotion. Available from: http://www.health.gov/healthliteracyonline/why.htm

The genesis of the e-Record

The IOM Committee on Improving the Patient Record, formed in 1991/ report in 1997. This report sought to

understand why diffusion of information management technology was lacking in medical record systems

Identified impediments and way to overcome them

Suggested improvements, plans, policies and strategies for the integration and use health IT.

Dick RS, Steen EB, Detmer DE. The Computer-Based Patient Record: An Essential Technology for Health Care, Washington, D.C.: National Academy Press; 1997. http://books.nap.edu/books/0309055326/html/index.html

The benefits of EHRs

Care Oriented Rapid retrieval

Contemporary Accurate

Complete information Point of care

Knowledge databases Decision support

Care coordination Referral/followup Remote monitoring

Evaluation Oriented Tracking costs and

value Assessing

performance Monitoring

populations Supporting research Aiding

communications

Committee on Improving the Patient Record (IOM); 1991,1997

Sentinel Publications

Adoption of EHRs

HIT Regional Extension Centers

$642 million allocated to establish 62 HIT regional extension centers nationally to assist Priority Primary Care Providers (PPCP’s) with electronic medical record (EMR) adoption and Meaningful Use

A Priority Primary Care Provider (PPCP) is defined as a physician (Internal Medicine, Family Practice, OB/GYN, Pediatrics) and other healthcare professionals (PA, NP, Nurse Midwife, or dentist) with prescribing privileges in the following settings:

Small group practices (10 or less providers)

Providers affiliated with community health centers and rural health clinics

Providers who serve mainly underinsured and medically underserved populations

Public or critical access hospitals

Four awarded in Texas

EMR consulting available for primary care providers

Texas Regional Extension Centers

West Texas Regional Extension Center

Texas Tech University HSC

$7.1 Million1,133 providers

$35.4 Million

North Texas Regional Extension CenterDFW Hospital Council

$8.4 Million1,498 providers

CentrEast Regional Extension CenterTexas A&M HSC

$5.2 Million1,000 providers

Gulf Coast Regional Extension CenterUT HSC Houston

$15.2 Million2,928 providers

Comprehensive Support throughout the Entire EHR Implementation

Process

Partnering with state and local

HIEs

EHR system selection

Readiness assessment

Practice workflow redesign

HIT education & training

Achieving meaningful use

EHR implementation

Prepare for future pay for performance

Plan Transition Implement Operate & Maintain1 2 3 4

WT-HITREC Strategy:Align with TMF & A&M REC to create standard

WT-HITREC Strategy:Partner with Vendors & Implementation partners

Performance MetricsTexas RECs

Cen-treast

Nortex WTxREC GCREC0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

M3

M2

M1

Balancing Cost with Value

How much am I paying? What am I buying?

Hosp

MD

Rx

Procs

RESULT:Uncoordinated careAntagonistic relationships

Hosp MD Rx Procs

RESULT:Coordinated careCollaborative relationships

PHS

PHS

12 Confidential

It will be a Continued Evolution

Results Distribution

Medication History

Eligibility Checking

Quality Reporting

Disease Management

Medication Compliance

eRx

Electronic Medical Record

Electronic Health Record with Consumer

Access

Public Health Reporting

Public Health Surveillance

Research

Immunization & Disease Registries

Clinical Documentation Alerts to

Providers

Referral Processing

VALUE

DE

GR

EE

O

F

DIF

FIC

ULT

Y

OrderMgmt

The ultimate value is achieved as we move from services that enable the exchange of individual health information to those that improve community health information

Quality of Diabetes Care: Patients Treated by Physicians using EHR vs.

Paper Medical Records

Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article

* Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.001

% of Patients Receiving Care

A significantly higher proportion of patients

being treated by physicians with EHRs

received care that aligns with accepted

treatment standards *

Health Outcomes for Diabetes Patients: Patients treated by Physicians using EHR vs.

Paper Medical Records

A significantly higher proportion of

patients being treated by

physicians with EHRs obtained

better outcomes*

* Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.005

% of Patients Obtaining Outcome Standards

Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article

* Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.001

% of Patients Receiving CareA significantly higher

proportion of patients being treated by

physicians with EHRs received care that

aligns with accepted treatment standards *

Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article

Quality of Diabetes Care at Safety Net Practices: Patients Treated by Physicians using EHR vs. Paper Medical Records

% of Patients Obtaining Outcome Standards

* Even after adjusting for patient demographic characteristics and insurance type, differences remain significant p<0.002

A significantly higher proportion of patients being

treated by physicians with EHRs obtained

better outcomes *

Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article

Health Outcomes for Diabetes Patients at Safety Net Practices: Patients treated by Physicians using EHR vs. Paper Medical Records

Benefits to Rurals

 

· Improve patient safety and quality of care through analysis and automation

· Easily navigate the EHR vendor marketplace, utilize EHR market analysis, confirm vendor certification

· Achieve EHR meaningful use objectives to maximize incentives and minimize financial and administrative burdens

· Navigate the incentive process to help secure payment

· Utilize EHR’s in a meaningful way so patient information is available when and where it is needed

· Access to the collective intelligence of Regional Extension Centers across the country

· Prepare for future pay for performance programs

e-Population Health

Information

DefinitionsDecision Support

Collection Systems & Workflow

MetricsPopulation Outcome

Stage 1 Stage 2 Stage 3 e-Health

Adopt, e-RX, Quality Report or CPOE

Population Monitoring, Surveillance, Research

Rx Interactions, Compliance, Alerts

Clinical Pathways

Ind

ivid

ua

lP

opul

atio

n

Disease OutcomesManagement

Patient Safety Assurance

Care Management

Personal HealthPublic HealthTranslation

Data capture and sharing

Advanced clinical processes

Improved outcomes

Bending the Curve :Achieving Meaningful Use of Health Data

“Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.”

Modified after: Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009

Meaningful Use Workgroup Presentation : Paul Tang & Farzad Mostashari

Better preventive care assessment and public health

functions

Discussion