Transformative Technology: The Role of Health IT in Improving

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Transformative Technology: Transformative Technology: The Role of Health IT in Improving The Role of Health IT in Improving

Health Care QualityHealth Care Quality

Carolyn M. Clancy, MD, DirectorCarolyn M. Clancy, MD, DirectorAgency for Healthcare Research and Quality Agency for Healthcare Research and Quality

The National Council of State LegislaturesThe National Council of State LegislaturesSpring, 2006 Health Chairs MeetingSpring, 2006 Health Chairs Meeting

Washington, D.C., Washington, D.C., June 8, 2006June 8, 2006

Federal Health IT Federal Health IT InitiativesInitiativesAHRQ’s role and AHRQ’s role and resourcesresourcesImplications for Implications for quality and safety quality and safety improvementimprovementChallenges and Challenges and opportunitiesopportunitiesQ & AQ & A

Transformative TechnologyTransformative Technology

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Federal Health IT InitiativesFederal Health IT Initiatives

NIHNIH

VHAVHA

DoDDoD

AHRQAHRQONCONCAHICAHIC

NHIINHII

IHSIHS


NIHNIH

VHAVHA

DoDDoD

AHRQAHRQONCONC

IHSIHS

NHIINHIIAmerican

Health Information Community

Federal advisory bodyFederal advisory body

EE--health recordshealth records

Chronic careChronic care

BioBio--surveillancesurveillance

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NIHNIH

DoDDoD

AHRQAHRQAHICAHIC

IHSIHS

NHIINHIIOffice of the

National Coordinator

Leadership on Leadership on development and development and implementation of HIT implementation of HIT infrastructureinfrastructure

Advise HHS Secretary Advise HHS Secretary on HIT initiativeson HIT initiatives

VHAVHA


VHAVHADoDDoD


IHSIHS

NHIINHIINational

Institutes of Health

Nat’l Library of Medicine Nat’l Library of Medicine MedlineMedline PlusPlus online online

medical database medical database

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NIHNIH

DoDDoD

AHRQAHRQAHICAHIC

IHSIHS

NHIINHIIVeterans

Health Administration

Cares for 5M veteransCares for 5M veterans

MyHealtheVet EHR and MyHealtheVet EHR and ee--RX systemRX system

Personal Health JournalPersonal Health Journal

ONCONC


NIHNIH

VHAVHA


IHSIHS

NHIINHIIDept. of Defense

AHLTA electronic AHLTA electronic health record systemhealth record system

Digitally captures Digitally captures 300,000 outpatient 300,000 outpatient visits per weekvisits per week

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NIHNIH

VHAVHADoDDoD


NHIINHIIIndian Health

Services

Cares for over 2M American Cares for over 2M American Indians and Alaska NativesIndians and Alaska Natives

Resource and Patient Resource and Patient Management System EHRManagement System EHR


NIHNIH

VHAVHADoDDoD


IHSIHS

National Health

Information Infrastructure

Developing a common set of Developing a common set of technical standards to technical standards to assure interoperability assure interoperability (inter(inter--agency HHS effort)agency HHS effort)

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NIHNIH

VHAVHADoDDoD

ONCONCAHICAHIC

IHSIHS

Agency for Healthcare

Research and Quality

Funds Health IT R&DFunds Health IT R&D

Provides technical assistanceProvides technical assistance

Shares knowledge and findingsShares knowledge and findings

NHIINHII

HHS Health IT EffortsHHS Health IT Efforts

POLICYPOLICY

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?

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POLICYPOLICY PIPESPIPES




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 of records?exchange of records?


POLICYPOLICY PIPESPIPES PROVIDERSPROVIDERS




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 of records?exchange of 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 the settings to improve the quality of care and quality of care and patient safety? patient safety?

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AHRQ Roles and ResourcesAHRQ Roles and Resources

Health IT ResearchHealth IT ResearchFundingFunding

•• Support advances Support advances that improve patient that improve patient safety/quality of caresafety/quality of care•• Continue work in Continue work in hospital settingshospital settings•• Step up use of HIT to Step up use of HIT to improve ambulatory improve ambulatory patient carepatient care

Source: FY 2007 Budget Summary for HHS and BNA Health Care PolicSource: FY 2007 Budget Summary for HHS and BNA Health Care Policy Report 2y Report 2--1313--0606

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Develop Evidence Base Develop Evidence Base for Best Practicesfor Best Practices

Four key domains:Four key domains:

•• Medication safetyMedication safety•• PatientPatient--centered carecentered care•• Medication managementMedication management•• Integration of decision Integration of decision support toolssupport tools





Develop Evidence Base Develop Evidence Base for Best Practicesfor Best Practices

Four key domains:Four key domains:

•• Medication safetyMedication safety•• PatientPatient--centered carecentered care•• Medication managementMedication management•• Integration of decision Integration of decision support toolssupport tools

Promote CollaborationPromote Collaborationand Disseminationand Dissemination

•• Support efforts of AHIC, Support efforts of AHIC, ONC, NHII and Centers ONC, NHII and Centers for Medicare and for Medicare and Medicaid ServicesMedicaid Services•• Build on public and Build on public and private partnershipsprivate partnerships•• Use web tools to share Use web tools to share knowledge and expertiseknowledge and expertise


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Health IT Research FundingHealth IT Research Funding

Over 100 grants to Over 100 grants to hospitals, providers, and hospitals, providers, and health care systems to health care systems to promote access to health promote access to health information technologyinformation technologyProjects in 43 statesProjects in 43 statesSpecial 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

Online Learning ResourcesOnline Learning Resources

AHRQ National Resource AHRQ National Resource Center on Health Center on Health Information TechnologyInformation TechnologyLessons learned from the Lessons learned from the field for providersfield for providersKnowledge library with Knowledge library with links to over 5,000 health links to over 5,000 health IT information resourcesIT information resourcesEvaluation toolkitEvaluation toolkitOther resourcesOther resources

http://wwwhttp://www. . healthit.ahrq.govhealthit.ahrq.gov

Launched February, 2006Launched February, 2006

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Implications for ImprovementImplications for Improvement

Reengineer processes to improve Reengineer processes to improve patient safetypatient safety

As we migrate to a health IT infrastructure, As we migrate to a health IT infrastructure, put effective processes in place at the put effective processes in place at the same timesame timeAugment health IT applications for error Augment health IT applications for error reduction, CPOE and other decision reduction, CPOE and other decision support toolssupport toolsBuild in the necessary disciplines and Build in the necessary disciplines and team approachesteam approaches

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Outpatient Advanced CPOE and EMROutpatient Advanced CPOE and EMRAvoid 2.1 million adverse drug eventsAvoid 2.1 million adverse drug eventsInpatient CPOE and EMRInpatient CPOE and EMRDecrease serious medication errors by 55%Decrease serious medication errors by 55%Healthcare information exchange and Healthcare information exchange and interoperability between settingsinteroperability between settingsImprove decisionImprove decision--making at the pointmaking at the point--ofof--care care through complete information accessthrough complete information access

Source: CITL

Implications for ImprovementImplications for Improvement

EE--Prescribing StandardsPrescribing Standards

Contracts administered by AHRQ on behalf of Contracts administered by AHRQ on behalf of Centers for Medicaid and Medicare ServicesCenters for Medicaid and Medicare ServicesPilot testing of electronic prescribing Pilot testing of electronic prescribing standards and how they interact with standards and how they interact with ee--prescribing workflowprescribing workflowTesting will be conducted during 2006Testing will be conducted during 2006Results will be reported to Congress in 2007 Results will be reported to Congress in 2007 and used to develop final eand used to develop final e--prescribing prescribing standardsstandards

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New AHRQ CPOE ResearchNew AHRQ CPOE Research

Facilities with Computerized Facilities with Computerized Prescriber Order Entry (CPOE) Prescriber Order Entry (CPOE) systems report fewer hospitalsystems report fewer hospital--based errorsbased errorsMore CPOE outpatient errors More CPOE outpatient errors reportedreportedStudy suggests CPOE could Study suggests CPOE could cause new errors due to faulty cause new errors due to faulty computer interface, lack of computer interface, lack of decision support, and common decision support, and common human error due to distraction human error due to distraction or lack of knowledge or or lack of knowledge or experience experience

C Zhan, M A Keyes et al, 2/06 C Zhan, M A Keyes et al, 2/06 American Journal of HealthAmerican Journal of Health--System PharmacySystem Pharmacy

Health IT and Patient SafetyHealth IT and Patient Safety

Tap and collect ongoing resourcesTap and collect ongoing resources

Convince clinicians to buy inConvince clinicians to buy in

Understand existing workflowUnderstand existing workflow

Understand HIT impact on workflowUnderstand HIT impact on workflow

Data standards/integrationData standards/integration

Get vendors to make needed changesGet vendors to make needed changes

Agenda for advancementAgenda for advancement

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Lagging investment in Health ITLagging investment in Health IT

$100$100

$200$200

$0$0GermanyGermanyU.K.U.K. CanadaCanada U.S.A.U.S.A.

$192.79$192.79

$31.85$31.85$21.20$21.20

$0.43$0.43

Source: Health Affairs/Commonwealth Fund, May, 2006Source: Health Affairs/Commonwealth Fund, May, 2006

Per capita spending on Per capita spending on health information technology health information technology (Through 2005)(Through 2005)

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Challenge: Low Adoption RatesChallenge: Low Adoption Rates

Only 14.1 percent of all medical group Only 14.1 percent of all medical group practices use an electronic health recordpractices use an electronic health recordOnly 12.5 percent of practices with five or Only 12.5 percent of practices with five or fewer FTE physicians have EHRsfewer FTE physicians have EHRs

AHRQ contract 290AHRQ contract 290--0000--0017 0017 –– University of MinnesotaUniversity of Minnesota

Another Digital Divide?Another Digital Divide?

100%100%

0%0%

50%50%

Prevalence of Electronic Prevalence of Electronic Claims SystemsClaims Systems

Integrated Integrated Delivery Delivery

Networks/Networks/LaboratoriesLaboratories

PharmaciesPharmaciesPhysician Physician OfficesOffices

80%80%94%94%

PayersPayers

93%93%90%90%

Prevalence of Electronic Prevalence of Electronic Health RecordsHealth Records


NetworksNetworks

SingleSingleHospitalsHospitals

7%7%

20%20%13%13%9%9%

PhysicianPhysicianPracticesPractices

12%12%

AMBULATORY INPATIENT


NetworksNetworks

Single Single HospitalsHospitals

Source: BioMed Central Medical Informatics and Decision Making WSource: BioMed Central Medical Informatics and Decision Making Website, January 17, 2006ebsite, January 17, 2006

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The HIT Security ChallengeThe HIT Security Challenge

67% of Americans are 67% of Americans are concerned about the concerned about the privacy of their personal privacy of their personal medical records*medical records*Patchwork of state laws Patchwork of state laws and business regulations and business regulations complicate privacy complicate privacy landscapelandscapeAlong with ONC, AHRQ is Along with ONC, AHRQ is facilitating discussion and facilitating discussion and sharing knowledge to sharing knowledge to ensure health IT balances ensure health IT balances privacy with portability and privacy with portability and accessaccess *California Health Care Foundation National *California Health Care Foundation National

Consumer Health Privacy Survey 2005Consumer Health Privacy Survey 2005

New Privacy/Security InitiativeNew Privacy/Security Initiative

22 states working with RTI to address privacy 22 states working with RTI to address privacy and security questions affecting interoperable and security questions affecting interoperable heath information exchangesheath information exchangesAHRQ and ONC will jointly manage $17.23 AHRQ and ONC will jointly manage $17.23 million contract to fund all proposals with million contract to fund all proposals with technical merit submitted to RTI last Januarytechnical merit submitted to RTI last JanuaryRTI will work in partnership with the National RTI will work in partnership with the National Governors AssociationGovernors Association

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Growing HIT Evidence BaseGrowing HIT Evidence Base

Health IT helps improve Health IT helps improve quality of care in large health quality of care in large health care organizations that create care organizations that create their own systems and devote their own systems and devote substantial resources to EHR, substantial resources to EHR, CPOE,eCPOE,e--prescribing, and prescribing, and other applicationsother applicationsHIT has potential to enable HIT has potential to enable dramatic transformation of dramatic transformation of health care safety, health care safety, effectiveness and efficiencyeffectiveness and efficiency

Costs and Costs and Benefits of Benefits of

Health Health Information Information TechnologyTechnology

AHRQ Southern CaliforniaAHRQ Southern CaliforniaEvidenceEvidence--Based Practice CenterBased Practice Center--

RAND Corporation, April, 2006RAND Corporation, April, 2006

HIT and Improved QualityHIT and Improved QualityStudies from benchmark institutions demonstrates that Studies from benchmark institutions demonstrates that health IT can improve the quality of care by:health IT can improve the quality of care by:

–– Assisting in provider decision makingAssisting in provider decision makingProviding evidencedProviding evidenced--based guidelines at point of carebased guidelines at point of careRealReal--time access to information (pharmacy, lab, etc.)time access to information (pharmacy, lab, etc.)Resource management toolsResource management tools

–– Facilitating population level data collection and analysisFacilitating population level data collection and analysisSystem/Organizational clinical monitoring and System/Organizational clinical monitoring and improvementimprovementPublic health monitoring and trackingPublic health monitoring and tracking

–– Contributing to healthcare efficienciesContributing to healthcare efficienciesReduction in redundant healthcare utilization (e.g. Reduction in redundant healthcare utilization (e.g. testing)testing)Reduced administrative burdensReduced administrative burdens

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ValueValue--Based PurchasingBased Purchasing

Growing number of incentive Growing number of incentive programs to reward programs to reward improvement in quality and improvement in quality and safety performancesafety performanceP4P may provide new revenue P4P may provide new revenue stream to enable purchase of stream to enable purchase of health IT systemshealth IT systemsWithout electronic records, Without electronic records, providers will not be able to providers will not be able to participate in P4P contractsparticipate in P4P contracts

VALUEVALUE--BASEDBASEDPURCHASING��PURCHASING��

AQA Pilot ProjectAQA Pilot Project

Ambulatory Care Quality Alliance will, for the Ambulatory Care Quality Alliance will, for the first time, combine public/private information to first time, combine public/private information to measure and report on physician practice for measure and report on physician practice for purchasers and consumerspurchasers and consumersWill measure quality and identify high quality Will measure quality and identify high quality providersprovidersSix pilot sites in California, Indiana, Six pilot sites in California, Indiana, Massachusetts, Minnesota, Arizona and Massachusetts, Minnesota, Arizona and Wisconsin enabled by robust health Wisconsin enabled by robust health information exchange systemsinformation exchange systemsSupported by CMS and AHRQSupported by CMS and AHRQ

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Opportunity: Closing DisparitiesOpportunity: Closing Disparities

Health IT is not only for big Health IT is not only for big health planshealth plansHuge opportunity to help Huge opportunity to help racial, ethnic and racial, ethnic and socioeconomic minorities socioeconomic minorities get access to EHRs, eget access to EHRs, e--Rx, Rx, telemedicine and other telemedicine and other applicationsapplicationsAftermath of Katrina Aftermath of Katrina showed significance of showed significance of health IT in protecting and health IT in protecting and accessing patient recordsaccessing patient records

Experts agree that the best Experts agree that the best type of computer for your type of computer for your individual needs is the one that individual needs is the one that comes on the market about two comes on the market about two days after you purchase some days after you purchase some other computer.other computer.-- Dave BarryDave Barry

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Federal Health IT Federal Health IT InitiativesInitiativesAHRQ’s role and AHRQ’s role and resourcesresourcesImplications for quality Implications for quality and safety and safety improvementimprovementChallenges and Challenges and opportunitiesopportunitiesQuestions & AnswersQuestions & Answers


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Transformative Technology: The Role of Health IT in Improving