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

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


1
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    personal libraries unpublished literature newly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
4
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

5
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)

6
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)
7
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

8
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

9
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

10
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
11
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

12
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

13
  • Change would be easy if it werent for all of
    the people.
  • Balestracci and Barlow

14
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)
15
Is Long Term Care Ready?
16
The Roadmap
elearning.qualitynet.org
17
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
18
Care ManagementIn Practice
Culture Change
HIT
Workflow Redesign
Self Management
Patient/Resident Caregivers Care Team
HIT
ClinicalDecisionSupport
Chuck Parker (2007) TOMA Annual Conference
19
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?

20
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??

21
Thank You
  • Kevin Warren, MHA, CPHQ
  • Senior Vice President, Operations
  • TMF Health Quality Institute
  • Austin, Texas
  • 512-334-1660
  • Kwarren_at_txqio.sdps.org
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