The Impact of Health Information Technology on Quality: Considerations for Long Term Care

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The Impact of Health Information Technology on
Quality Considerations for Long Term Care

• Kevin Warren
• SVP, Operations
• TMF Health Quality Institute

2
Objectives

• Discuss recent literature discussing the impact
  of Health Information Technology (HIT) on Quality
  of healthcare
• Describe current activities performed by Quality
  Improvement Organizations (QIOs) targeting HIT
  adoption and implementation in multiple clinical
  settings
• Discuss potential next steps on the HIT adoption
  pathway for long term care and food for thought

3
HIT and Quality

• Systematic Review Impact of Health Information
  Technology on Quality, Efficiency, and Costs of
  Medical Care
• AHRQ funded literature review (contract no. 2002)
• MEDLINE (1995 January 2004) Cochrane Register
  of Controlled Trials Cochrane Database of
  Abstracts of Reviews of Effects hand-searched
  personal libraries unpublished literature newly
  published articles (April 2005)
• 867 Articles reviewed 257 articles met search
  inclusion criteria
• Approximately 25 of studies were from 4 academic
  institutions
• The Regenstrief Institute
• Brigham and Womens Hospital/Partners Healthcare
• The Department of Veteran Affairs
• LDS Hospital/Intermountain Healthcare
• Review the evidence on the effect of health
  information technology on quality, efficiency,
  and costs of healthcare

Annals of Internal Medicine (May 16, 2006) Vol.
144Issue 10
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Annals Systematic ReviewFindings (Quality)

• The major effect of HIT on quality of care was
  its role in increasing adherence to guideline
  based care and decision support associated with
  preventive (primary and secondary) care
• Improvements in processes of care delivery
  ranged from absolute increases of 5 to 66
  percentage points, with most increases clustering
  in the range of 12 to 20 percent.
• Studies demonstrated the impact of HIT on
  reduction in hospital acquired pressure ulcers,
  post-operative infections, reduction of adverse
  drug events and medication errors.
• Effect on time utilization is mixed
• The major efficiency benefit has been decreased
  utilization of care
• Annals of Internal Medicine (May 16, 2006) Vol.
  144Issue 10

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HIT and Quality

• Evidence Report/Technology Assessment No. 132
• Cost and Benefits of Health Information
  Technology
• Prepared by the Southern California
  Evidence-based Practice Center, Santa Monica, CA
• From 256 articles, 84 were selected that
  addressed study of quality of care as data
  outcome, use of electronic health record, and the
  ambulatory setting
• Structure, Process and Outcome was used as
  review framework
• The studies demonstrate how provider performance
  can be improved when the clinical information
  management and decision support tools are
  available within an EHR system.
• A recurrent theme in these studies was the
  capacity of EHRs to store data and to make those
  data readily accessible, and to help translate
  them into context-specific information that can
  empower providers in their work.
• AHRQ Publication No. 06-E006 (April 2006)

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HIT Impact on Quality Important to Long Term
Care?

• Health Information Technology Are Long Term
  Care Providers Ready?
• Prepared by Health Management Strategies Inc.,
  for the California Healthcare Foundation
• Methods of data collection included literature
  review, focus groups, provider surveys and
  interviews
• Providers do believe HIT can have an impact on
  quality of care delivery and daily operations.
• Providers do not see concrete evidence that it
  (HIT) will have a positive impact on quality of
  care and operational efficiencies in the long
  term care environment.
• Variation among providers as to the valuation of
  HIT benefits to improving quality

Hudak, S., Sharkey, S. (April 2007)
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Objectives

• Discuss recent literature supporting/refuting the
  impact of Health Information Technology (HIT) on
  Quality of healthcare
• Describe current activities performed by Quality
  Improvement Organizations (QIOs) targeting HIT
  adoption and implementation in multiple clinical
  settings
• Discuss potential next steps on the HIT adoption
  pathway for long term care and food for thought

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HIT Role of Quality Improvement Organizations
(8SOW)

• Doctors Office Quality Information Technology
  (DOQ-IT)
• Over 4000 Physician Practices nationwide
• Increasing the adoption of clinical information
  systems
• Adoption of care management process that
  assesses, plans, implements, coordinates,
  monitors, and evaluates options and services to
  meet an individuals health needs
• Small (1-3), medium (4-8), and large (9 or more)
  practices

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HIT Role of Quality Improvement Organizations
(8SOW)

• Inpatient/Rural/Critical Access Hospitals (CAH)
• Engage hospital leadership in the PPS hospitals
  and/or reporting CAHs in using
• Computerized Physician Order Entry
• Barcoding
• Telehealth systems
• QIOs shall provide technical support to hospital
  leadership to help them develop the business case
  and shall educate (identified hospitals) about
  all aspects of
• Infrastructure requirements, funding
  opportunities, staffing requirements, associated
  costs, available applications,network
  partnerships and successful examples)
• CMS Statement of Work Version 020106-A

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HIT Role of Quality Improvement Organizations
(8SOW)

• Home Health
• Work with 8 of state home health agencies to
  implement and/or utilize telehealth as a tool to
  help reduce Acute Care Hospitalization.
• Telehealth as defined for the SOW phone
  monitoring and telemonitoring (use of
  telemonitoring equipment and technology)

CMS Statement of Work Version 020106-A
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HIT Role of Quality Improvement Organizations
(8SOW)

• Nursing Home
• Nursing Home Improvement Feedback Tool (NHIFT)
• Process of Care Documentation and Data Submission
  to QIO Clinical Warehouse
• Skin inspection and pressure ulcer risk
  assessment
• Depression screening and treatment
• Evaluation of and alternatives to Physical
  Restraints
• Pain Assessment and Treatment
• Advancing Excellence Campaign

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Objectives

• Discuss recent literature supporting/refuting the
  impact of Health Information Technology (HIT) on
  Quality of healthcare
• Describe current activities performed by Quality
  Improvement Organizations (QIOs) targeting HIT
  adoption and implementation in multiple clinical
  settings
• Discuss potential next steps on the HIT adoption
  pathway for long term care and food for thought

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• Change would be easy if it werent for all of
  the people.
• Balestracci and Barlow

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Prepare to Protect the Investment
Nursing Home Concerns Survey, bottom line,
quality
Community
Care depends on physicians visit (when available)
Resident information is limited to the chart
No links to community agencies or resources
Lack of specific protocols or lack of staff
awareness to protocols
We tell residents/family how to manage daily
illness (didactic communication)
Uninformed resident and/or family?
Frustrating Interactions
Unprepared staff?
Undesirable Outcomes?
Model based on Ed Wagner, MD Improving Chronic
Care (2000)
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Is Long Term Care Ready?
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The Roadmap
elearning.qualitynet.org
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Care Management

• Full utilization of the technology allows us to
  practice evidence-based medicine every time
• Understanding how to deal with the frail, well,
  chronically unstable, or young present different
  challenges for clinicians
• How do we hope to do this without some
  assistance?
• How do we manage different chronic diseases AND
  keep the patient/resident involved along with
  other caregivers??

Chuck Parker (2007) TOMA Annual Conference
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Care ManagementIn Practice
Culture Change
HIT
Workflow Redesign
Self Management
Patient/Resident Caregivers Care Team
HIT
ClinicalDecisionSupport
Chuck Parker (2007) TOMA Annual Conference
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Organizational Redesign

• There are five main areas of redesign that need
  to be addressed
• Patient/Resident Flow
• Point-of-care (POC) documentation
• Internal and External Communication
• Document Management
• Chart Abstraction / Migration
• How will these changes impact the resident?

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Lessons from other Providers and Programs

• Additional Resources
• State Quality Improvement Organizations (QIOs)
  www.ahqa.org
• Rural and Critical Access Hospitals
• Multiple responsibilities, CPOE, Bar-coding
• Home Health Agencies
• Telehealth, chronic care management
• Physician Offices
• National IT adoption/implementation push, work
  flow
• Others??

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Thank You

• Kevin Warren, MHA, CPHQ
• Senior Vice President, Operations
• TMF Health Quality Institute
• Austin, Texas
• 512-334-1660
• Kwarren_at_txqio.sdps.org