The CPR Landscape: Current Status and Pressing Needs

1
The CPR LandscapeCurrent Status and Pressing
Needs

• Paul C. Tang, MDNorthwestern Memorial Hospital

2
Outline

• Progress Report on the Computer-based Patient
  Record Since the 1991 IOM Report
• Users and Uses of CPR
• Remaining Impediments
• Role for NCVHS

3
CPR DefinitionIOM

• A CPR is an electronic patient record that
  provides
• complete and accurate data
• alerts
• reminders
• clinical decision support
• links to medical knowledge
• other aids

4
Institute of Medicine ReportFirst Edition, 1991

• Adopt CPR as the standard for all records related
  to patient care
• Establish public/private CPRI to focus national
  agenda
• Provide public/private support for CPR research,
  development, and demonstration
• CPRI Promulgate national standards for data and
  security

5
Institute of Medicine ReportFirst Edition, 1991

• CPRI Review laws and regulations to facilitate
  implementation of CPRs
• Share costs of CPRs among all users of data
• Enhance educational programs on CPRs

6
National Priorities in Health CareChange in
Business Landscape

• Cut costs
• Capitate
• PCP as gatekeeper
• Generate quality reports
• Regulate managed care
• Audit billing practices

7
NCQA WarningIf You Dont Have an Information
System...

• Given the magnitude of the U.S. health care
  enterprise, the need for excellent health plan
  information systems for a variety of reasons is
  clear and yet we do not have them. More often
  than not, information systems are a barrier to
  the efficient, effective use of data to measure
  quality, improve care and service, manage
  finances, and support clinical research.

8
NCQA To Providers and PlansGet One!

• Health plans, purchasers, and providers must
  make a sustained investment of personnel, time
  and resources.
• New sets of performance measures will assume
  that health plans have established the levels of
  automation described in this report.

9
National Priority for DataData Driven Decisions

• Mandates
• Cut costs
• Capitate
• PCP gatekeeper
• Report quality
• Billing compliance

• Data-Enabled
• Manage costs
• Manage disease
• Manage demand
• Measure and improve
• By-product of care

10
Enabling TechnologiesChange in Technology
Landscape

• One world Internet connectivity
• Negroponte 1 B users by 2000
• One interface (viewer)
• Many computers
• Multiple platforms (H/W, OS)
• Legacy systems

11
Status of CPRDevelopment and Implementation
12
Users and CPR FunctionsExample Primary Users and
Functions

• Users
• Physicians
• Nurses
• Patients

• Functions
• Access complete, integrated data
• Provide confidentiality and security
• Ubiquitous access
• Decision support
• Patient education

13
Users and CPR FunctionsExample Secondary Users
and Functions

• Users
• Clinical management
• Administrative management
• Clinical researchers
• Health services researchers

• Functions
• Ability to aggregate data
• Maintenance of confidentiality
• Generate data as by-product of care
• Produce reports

14
IOM RecommendationsMid-Decade Follow Up

• Adopt CPR
• Establish public/pvt CPRI
• Public/private funding of research and
  development
• Share costs of CPRs among users of data

• Still a goal early adopters implementing
• CPRI established, largely privately funded
• Industry 99 CPR vendors at 98 HIMSS Public
  NLM, AHCPR, NIST, DoD, VA
• Still largely borne by users of CPR

15
CPRI Mandates from IOMPromulgate National
Standards

• 1996 National Summit on Health Information
  Solutions
• Collaborative effort (AHIMA, AMIA, CHIM, CHIME,
  HIMSS, MLA)
• Over 80 healthcare senior executive stakeholders
• Consensus on
• Universal Health Identifier
• Confidentiality and Security Laws and Policies
• Terminology Conferences to promote convergence of
  terminology standards

16
CPRI Mandates from IOMPromulgate National
Standards, cont

• Proposed Standards Acceleration Project
• CPRI neutral forum, coordination
• Full-time efforts to developing standards, esp.
  terminology
• GCPR Project
• Complementary government project and national
  standards development

17
CPRI Mandates from IOMPromote Enabling Policies
and Laws

• CPRI Guidelines on security and confidentiality
• Establishing Information Security Policies
• Information Security Education Programs
• Managing Information Security Programs
• Sample Confidentiality Agreements
• Glossary of Terms
• Security Features for CPR Systems
• Electronic Signature Policies
• URL www.cpri.org

18
CPRI Educational ProgramsEnhancing Education on
CPRs

• CPRI HIPAA Implementation Conference
• April 27-28, 1998
• CPRI General Meetings
• e.g., July 9, 1998 on Evaluating CPRs
• CPRI Davies Award Program for Excellence in CPR
  Implementation
• July 10, 1998
• CPRI Terminology Conference II
• Winter 98

19
Pressing NeedsDevelop CPRs and Demonstrate
Results

• Evolve products through use and continual
  enhancement
• Evaluate CPRs to understand and quantify benefits
  and costs
• Communicate results and best practices
• CPRI Davies Award Symposium
• Conferences and media

20
Pressing NeedsInfrastructure

• Standards
• Universal health identifier
• Clinical terminology
• Policies and Laws
• Confidentiality and security
• Cost sharing models
• Leadership and Strategic Planning
• Business needs for information
• High capital costs

21
Recommendations for NCVHSAdvancing Progress
Towards CPRs

• Standards
• UHI Conduct hearings, recommend solution
• Clinical terminology and data model Define
  problem, recommend public funding to achieve
  results by 2001
• Policies
• Confidentiality Keep legislative process on
  track
• Data and cost sharing Propose recommendations to
  HHS for incentives and cost sharing