Transforming Quality and Safety: The Role of Health IT

1
Transforming Quality and Safety The Role of
Health IT
Helen Burstin, MD, MPH Director, Center for
Primary Care, Prevention and Clinical
Partnerships Agency for Healthcare Research and
Quality
ACC Meeting September 18, 2006
2
Health Information Technology

• AHRQ and the clinician-computer interface
• Evidence base for HIT effectiveness
• Transparency and key role of health IT
• Looking ahead

3
AHRQs Mission
Improve the quality, safety, efficiency and
effectiveness of health care for all Americans
4
Explosion of Evidence-Based Medicine/Practice
No. of EBM Medline References
5
Diffusion of knowledge
Balas EA, Boren SA., Managing Clinical Knowledge
for Health Care Improvement. Yearbook of Medical
Informatics 2000.
6
More medical errors in U.S.
Any medical mistake, medical error or test error
in last 2 years
C Shoen et al, Taking the Pulse of Health Care
Systems Experience of Patients with Health
Problems in 6 Countries Commonwealth Fund
International Health Policy Survey of Sicker
Adults, 11/03/05
7
Health IT A means to an end

• AHRQs Role Prove Health IT works in real-world
  clinical settings
• How does Health IT drive safety and quality
  improvement?
• How can we ensure that doing the right thing is
  the easy thing to do?
• How can we use the power of Health IT to provide
  better quality measures faster?

8
HHS Health IT Efforts
American Health Information Community How will we
accelerate the development and adoption of
health IT? How will we deliver value to the
health care consumer?
9
HHS Health IT Efforts
American Health Information Community How will we
accelerate the development and adoption of
health IT? How will we deliver value to the
health care consumer?
Office of the National Coordinator / National
Health Information Infrastructure How will we
build a nationwide health IT system that allows
the seamless and secure exchange and records?
10
HHS Health IT Efforts
American Health Information Community How will we
accelerate the development and adoption of
health IT? How will we deliver value to the
health care consumer?
Office of the National Coordinator / National
Health Information Infrastructure How will we
build a nationwide health IT system that allows
the seamless and secure exchange and records?
Agency for Healthcare Research and Quality How
will providers use health IT in hospitals and
ambulatory care settings to improve quality of
health care and patient safety?
11
AHRQ Roles and Resources

• Health IT Research
• Funding
• Support advances that improve patient
  safety/quality of care
• Continue work in hospital settings
• Step up use of HIT to improve ambulatory patient
  care

Source FY 2007 Budget Summary for HHS and BNA
Health Care Policy Report 2-13-06
12
AHRQ Roles and Resources

• Health IT Research
• Funding
• Support advances that improve patient
  safety/quality of care
• Continue work in hospital settings
• Step up use of HIT to improve ambulatory patient
  care

• Develop Evidence Base for Best Practices
• Four key domains
• Patient-centered care
• Medication management
• Integration of decision support tools
• Enabling quality measurement

Source FY 2007 Budget Summary for HHS and BNA
Health Care Policy Report 2-13-06
13
AHRQ Roles and Resources

• Health IT Research
• Funding
• Support advances that improve patient
  safety/quality of care
• Continue work in hospital settings
• Step up use of HIT to improve ambulatory patient
  care

• Develop Evidence Base for Best Practices
• Four key domains
• Patient-centered care
• Medication management
• Integration of decision support tools
• Enabling quality measurement

• Promote Collaboration
• and Dissemination
• Support efforts of AHIC, ONC, NIH and CMS
• Build on public and private partnerships
• Use web tools to share knowledge and expertise

Source FY 2007 Budget Summary for HHS and BNA
Health Care Policy Report 2-13-06
14
Health IT Research Funding

• Over 125 projects and demonstrations to better
  understand how health IT can improve the safety,
  quality and efficiency of health care
• Projects in 43 states
• Special attention to best practices that can
  improve quality of care in rural, small
  community, safety net and community health center
  care settings

AHRQ HIT Investment 166 Million
15
Online Learning Resources

• AHRQ National Resource Center on Health
  Information Technology
• Lessons learned from the field for providers
• Repository of nearly 6,000 health IT knowledge
  products
• Evaluation toolkit
• Other resources

Launched February, 2006
16
(No Transcript)
17
Challenges in HIT Implementation

• Legal/privacy Lack of understanding around HIPAA
  compliance, confidentiality policies, and the
  security of Web-based record access
• Buy-in for data sharing Understanding what kinds
  of consent is required, and clarifying State and
  Federal security and privacy laws that apply
• Organizational/individual experience with HIT
• Securing appropriate sustainable funding
• Consortium governance
• Grant administration
• Competing priorities
• Staff training and turnover
• Changing culture and workflow to integrate HIT

18
E-Prescribing Standards

• Contracts administered by AHRQ on behalf of
  Centers for Medicaid and Medicare Services
• Pilot testing of electronic prescribing standards
  and how they interact with
  e-prescribing workflow
• Testing will be conducted during 2006
• Results will be reported to Congress in 2007 and
  used to develop final e-prescribing standards

19
Health Information Technology

• AHRQ and the clinician-computer interface
• Evidence base for HIT effectiveness
• Transparency and key role of health IT
• Looking ahead

20
Growing HIT Evidence Base

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

AHRQ Southern California Evidence-Based Practice
Center- RAND Corporation, April, 2006
21
Challenge Low Adoption Rates

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

AHRQ contract 290-00-0017 University of
Minnesota
22
Preliminary Learning from the AHRQ HIT Research
Portfolio

• Computerized Provider Order Entry and Electronic
  Health Records. Study found these technologies
  reduced certain costs in hospitals, increased
  certain quality measures, and increased nursing
  documentation from 0-43 to 65-100
• Patient Safety. About one-third of all orders
  were modified due to clinical decision support
  provided by CPOE and EHR

23
Preliminary Learning from the AHRQ HIT Research
Portfolio

• Online Diabetes Registry. California MDs nearly
  doubled adherence to diabetes treatment
  guidelines. Clinical decision support tools
  alerted clinicians when patients needed exams or
  tests
• Clinical benefits of EHRs. Study focusing on HIV
  patients found that EHRs are less likely than
  paper charts to have missing data. Also led to
  decreased time between patient visits and better
  clinical outcomes

24
CHF Telemonitoring

• St. Vincent Healthcare Foundation in Billings, MN
• Compares remote telemonitoring compared with
  standard care for patients with CHF
• Patient submits daily data (VS, weight, BP,
  Glucose) via phone line and monitored in real
  time with prompts to call doctor if outside
  normal limits
• Patient comment Its like having a doctor right
  here in the house.

25
Health Information Technology

• AHRQ and the clinician-computer interface
• Evidence base for HIT effectiveness
• Transparency and key role of HIT
• Looking ahead

26
Healthcare Transparency Executive Order
Directs Federal agencies to
August 22, 2006

• Increase transparency in pricing to beneficiaries
• Increase transparency in quality to beneficiaries
• Encourage adoption of health information
  technology standards
• Provide options that promote quality and
  efficiency of care

27
Building a Transparent Health Care System
Cornerstones of Value-Based Health Care
Quality Standards Design systems to collect
quality of care information and define what
constitutes quality health care
28
Building a Transparent Health Care System
Cornerstones of Value-Based Health Care
29
Building a Transparent Health Care System
Cornerstones of Value-Based Health Care
30
Building a Transparent Health Care System
Cornerstones of Value-Based Health Care
31
AQA Pilot Project

• Ambulatory Care Quality Alliance project designed
  to increase the transparency of health care
  quality information
• Supported by funding from CMS and AHRQ
• Will combine public and private information to
  measure and report on physician practice
• Will identify high quality providers who deliver
  appropriate care to patients while avoiding
  unnecessary complications and costs

32
AQA Pilot Project

• Last year, AQA, founded in 2004, endorsed a
  starter set of 26 standard performance measures
  that are now being incorporated around the
  country (primarily focused on primary care,
  specialty measures in process)
• When AQA pilot is completed, the health care
  system will have effective models for providing
  consumers with meaningful information that can be
  used to make informed choices about which
  providers will meet their needs

33
6 AQA Pilot Sites
Wisconsin Collaborative for Healthcare Quality
Minnesota Community Measurement
Indiana Health Information Exchange
Massachusetts Health Quality Partners
California Cooperative Healthcare
Reporting Initiative
Phoenix Regional Healthcare Value Measurement
Initiative
34
Health Information Technology

• AHRQ and the clinician-computer interface
• Evidence base for HIT effectiveness
• Transparency and key role of health IT
• Looking ahead

35
IOM Quality Chasm SeriesPreventing Medication
Errors
Adopting a Safety Culture Key Recommendations

• All health care organizations should immediately
  make complete patient-information and
  decision-support tools available to patients and
  clinicians in an interoperable format
• Health care systems should capture information on
  medication safety and monitor this information to
  improve the safety of their care delivery systems
• All prescribers should have plans in place by
  2008 to implement electronic prescribing

36
Opportunity Closing Disparities

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

37
Opportunity P4P Incentives

• Growing number of incentive programs to reward
  improvement in quality and safety performance
• P4P may provide new revenue stream to enable
  purchase of health IT systems
• Without electronic records, providers may not be
  able to participate in P4P contracts

38
Agenda for Advancement

• Tap and collect ongoing resources
• Achieve clinician buy-in
• Understand existing workflow
• Understand health IT impact on workflow
• Integrate data standards
• Have vendors make required changes

39
The Steeep Challenge Ahead

• Health care in the 21st century must be based on
  6 key dimensions
• Safetyavoid injury to patients from the care
  that is intended to help them
• Timelinessreduce waits and harmful delays
• Effectiveness avoiding overuse and underuse
• Efficiencyavoid waste
• Equitabilityprovide care that does not vary in
  quality because of personal characteristics such
  as gender, ethnicity, geographical location, and
  socioeconomic status
• Patient centeredness provide care that is
  respectful of and responsive to individual
  patient preferences, needs, and values

40
New AHRQ Focus on Ambulatory Health IT

• Health care services continue to shift into the
  ambulatory arena
• Ambulatory care and transitions in care are
  high-risk for patient safety
• Patient safety research and improvement has
  focused on hospitals
• Ambulatory care requires
• Complex information management
• Coordination of care for chronically illness and
  elderly

41
FY07 Ambulatory Quality and Safety Program
Objectives

• Improve the safety and quality of drug management
  via the integration and utilization of medication
  management systems and technologies.
• Improve the delivery and utilization of
  evidence-based care in ambulatory settings.
  Specific attention will be given to clinician
  workflow, health information exchange with an
  emphasis on chronic disease.
• Improve the delivery of patient centered care in
  ambulatory care settings, including specific
  focus on transitions of care, personal health
  records, and improved patient-provider
  communication and decision-making.
• Foster the development, deployment, and reporting
  of measures of safety and quality in ambulatory
  care settings and across high risk transitions in
  care.

42

• For additional questions, please contact
• Dr. Helen Burstin helen.burstin_at_hhs.ahrq.gov