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Key Initiatives on Health Information Technology


IT has barely touched patient care.' Where is US Health Care and IT? So ... Strong leadership to address legal, societal, organizational, and cultural issues ... – PowerPoint PPT presentation

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Title: Key Initiatives on Health Information Technology

Key Initiatives on Health Information Technology
  • AHIMA Long-Term Care Health IT Summit
  • August 22, 2005
  • Susan Christensen
  • Agency for Healthcare Research and Quality

  • Current State
  • What is HIT Were Talking About?
  • Federal Leadership Broadly
  • Standards
  • Federal Activities More Focused
  • Pending Legislation
  • Appendix More detail, drilling down into
    standards, implications for LTC

Current State
  • Health care, particularly LTC, is fragmented by
    provider, time and payer, creating opportunities
    for errors, including
  • incomplete/contradictory health information over
    time and at points of transition
  • medication errors
  • delivery of unnecessary services
  • This fragmentation is also a barrier to
    coordinated care, chronic care management, and
    outcomes measurement, hindering
    patient-centeredness, efficiency, equity and
    research for quality improvement

Beyond Ready Essential to Change
  • Crossing the Quality Chasm (IOM, 2001) six
    specific aims for improvement health care should
    be safe, effective, patient-centered, timely,
    efficient, and equitable.
  • The committee believes IT must play a central
    role in the redesign of the health care system if
    a substantial improvement in … quality is to be
    achieved during the coming decade.
  • …IT has barely touched patient care.

Where is US Health Care and IT?
So What Is HIT?
  • National health information infrastructure is not
    a centralized government database, but rules for
    the road that offer a way to connect distributed
    health data in the framework of a secure network.
    (IOM, 2001) We need
  • National standards to protect privacy
  • National consensus on comprehensive standards for
    the definition, collection, coding, and exchange
    of clinical data
  • Strong leadership to address legal, societal,
    organizational, and cultural issues
  • Public knowledge of IT issues and benefits

Federal Leadership
  • Presidents Executive Order 13335 (April 2004)
    federal leadership for the development of a
    nationwide interoperable electronic health
    information system
  • Created Office of the National Health Information
    Technology Coordinator in HHS
  • Vision
  • Appropriate clinical information available at
    time and place of care
  • Increased EBM and patient safety
  • Reduction of costs from service duplication
  • Improved care coordination across continuum of
  • ONCHIT required to develop a national strategic
    plan to support
  • Public-private collaboration to develop, adopt
    and implement standards
  • Evaluate benefits of HIT
  • Address privacy and security issues
  • ONCHIT serves as principal advisor to Secretary
    on national HIT policy, coordinates federal
    activities, and coordinates public-private
    outreach and consultation

  • In July, the Secretary announced the creation of
    American Health Information Community (AHIC),
    chaired by the Secretary
  • Formed under auspices of FACA, AHIC will provide
    input and recommendations to HHS on how to make
    health records digital and interoperable and
    assure that privacy and security are protected
  • Representatives of DoD, VA and other federal
    agencies with large stake in healthcare IT
  • 17 Commissioners currently soliciting
    nominations from consumer groups, providers,
    payers, hospitals, vendors, privacy interests,
    and any other member of public
  • Dissolution within two to five years with goal of
    creating self-sustaining, private sector

HIT Standards
  • The use of HIT standards will enable
  • Exchange of information across clinicians,
    institutions, and payers
  • Reuse of information
  • To realize the Presidents vision and support
    interoperable information exchange and reuse,
    standards are needed
  • Terminology
  • Messaging
  • Definition of EHR functions
  • Privacy, security, and reliability

Importance of Content and Messaging Standards
  • Content standards permit a common, agreed-upon,
    detailed vocabulary and code for all medical
  • Messaging standards provide a format for the
    information being sent so computers can read a
    message and know
  • - Who is the sender and intended receiver
  • - What information is being sent
  • - Where is the information in the message

Activities Related to HIT Standards
  • Public and private sectors have worked to develop
    and endorse various standards, including
  • Federal Government entered into a licensed with
    the College of American Pathologists (CAP) to
    make SNOMED-CT freely available to U.S. health
    care entities.
  • The Federal Consolidated Health Informatics (CHI)
    Initiative worked in sync with the healthcare
    industry and endorsed content and messaging
    standards for use in federal healthcare

Four Major HHS RFPs
  • To implement the Department's health IT strategy,
    HHS issued four requests for proposals (RFPs).
  • Develop, create prototypes for, and evaluate a
    process to unify and harmonize industry-wide
    health IT standards
  • Develop, create prototypes for, and evaluate a
    conformance certification process for health IT,
    including the infrastructure or network
    components through which health IT systems
  • Assess and develop plans to address variations in
    organization-level business policies and state
    laws that affect privacy and security practices
    which may pose challenges to interoperable health
    information exchange.
  • Develop, and create prototypes for, and evaluate
    a nationwide health information network (NHIN)
    architecture for widespread health information
    exchange that can be used to test specialized
    network functions, security protections and
    monitoring, and demonstrate feasibility of
    scalable models.

Other HHS HIT Activities
  • DOQ-IT - promote adoption and use of IT in
    small/medium physician offices via QIOs
  • Medicare Care Management Performance
    Demonstration (MMA Section 649) Demonstration
    to reward reward physicians for using HIT and
    clinical outcomes add-on to the fee schedule
  • Medicare Chronic Care Improvement (MMA Section
    721) Population-based chronic care management
    with reimbursement based on clinical improvement,
    patient satisfaction, and cost savings results

HHS Research
  • Federal Patient Assessment Tools (starting with
    the NH Minimum Data Set)
  • CMS Research Enhancing clinical utility of the
  • ASPE/CMS Research Standardizing MDSv3 content
  • Upcoming
  • RFP to pilot test additional standards needed for
    e-prescribing as required under the MMA (CMS)
  • Convene e-prescribing meetings to discuss next
    steps (including in NHs) (AHRQ)
  • Evaluation Design of the Business Case for Health
    Information Technology in LTC (ASPE)
  • Information Exchange at Times of Transition (ASPE)

Selected FY 04 AHRQ HIT Initiatives
  • Transforming Healthcare Quality through
    Information Technology (THQIT)
  • 3 Grant Solicitations planning, implementation,
    and value assessment
  • Focused on community partnerships
  • http//
  • 60M initiative
  • 26M to implement proven technologies in small
    and rural communities where HIT penetration has
    been low
  • 24M targeted for developing, implementing, and
    evaluating the use of new and innovative
    technologies to improve patient safety and
    quality of care in diverse health care settings
  • 10M targeted for clinical data standards and

State and Regional HIT Demonstrations
  • Five-year state-based contracts
  • Help states develop secure statewide networks
  • Ensure privacy of health information
  • Make an individuals health information more
    available to health care providers
  • FY04 Five states awarded 1M/year
  • Colorado
  • Indiana
  • Rhode Island
  • Tennessee
  • Utah

AHRQ National Resource Center for Health
Information Technology
  • Provides technical and expert support to health
    IT grantees, contractors, and selected other
    federal grantees (HRSA, CMS, IHS)
  • Contract award to NORC (up to 18.5M over 5
    years), In partnership with
  • Vanderbilt University
  • Center for IT Leadership (Partners)
  • Indiana University
  • Foundation for the eHealth Initiative
  • CSC
  • Burness Communications
  • http//

AHRQ Activities Today
  • AHRQ is in process of contracting for a national
    assessment of privacy and security practices at
    the business level, developed in response to
    HIPAA, state law, and other concerns, that
    challenge the development of interoperable health
    information exchange
  • Likely single contractor to manage subcontracted
    work in up to 40 states
  • Stakeholders at the local/regional level will
    work to identify these practices and to develop
    solutions that can be generalized to the national

HIT Research in LTC
  • Private Sector Research
  • - EHR functional model and standards (HL7 DSTU)
    and MFS for LTC (HL7)
  • EHR implementation in 1 NH (Cherry)
  • AHRQ Research
  • HIT applications (e.g., CPOE), transitions across
    care settings, and care planning
  • E-prescribing in NHs (e.g., Gurwitz)
  • ASPE Research
  • Pilot test to standardize NH MDS (Apelon)

ASPE Research Mayo Study
  • Toward a National Health Information
    Infrastructure A Key Strategy for Improving
    Quality in Long-Term Care
  • Do leading terminology and classification systems
    provided content coverage to support clinical
    decision-making and quality of care oversight in
    nursing homes as recommended by clinical experts
    and as reflected in the literature?
  • SNOMED CT relatively complete
  • ICF and ICNP very little
  • Does the content of the federally required
    nursing home minimum data set (MDS) provide the
    information needed to understand quality of care
    in nursing homes in the three selected domains?
    Very limited coverage
  • To what extent is the content of MDS captured by
    three terminology systems? Most is not captured

ASPE Research Colorado Study
  • Case Studies of Electronic Health Records in
    Post-Acute and Long-Term Care Recommendations
  • The content of federally-required patient
    assessments instruments data sets should be
    information that would otherwise be routinely
  • Integrate health information technology standards
    into the development and modification of
    federally mandated data sets
  • Work to fill the gaps in the disability content
    in existing standardized, codeable terminologies.

Colorado Study, contd
  • Engineer, implement, refine, and disseminate to
    the public, the specifications for an electronic
    care transfer document that would embed the
    clinical content needed at times of transfers
    from acute care hospitals to nursing homes
  • Develop a method for the timely exchange of this
    information in environments with or without
    interoperable EHRs.
  • Examine the costs and benefits to nursing home
    patients, providers, the health system, and
    payers of implementing interoperable electronic
    medication management and administration systems
    in nursing homes and develop options for
    promoting the use of these systems.

Other Study Findings Include
  • Federal patient assessment forms create a barrier
    to HIT interoperation because content is not
    comparable across settings, always clinically
    relevant, and standardized (Mayo).
  • Health information systems in PAC/LTC were not
    interoperable with more robust EHRs (UCHSC).
  • Highly valued functions of the EHRs in PAC/LTC
    include real time information at times of
    transition, CPOE, and automated medication
    administration record (UCHSC).
  • Patient assessment tools can be conformed with
    HIT standards (Apelon).

Legislation Senate (S. 1418)
  • Establishes American Health Information
    Collaborative - public-private consultation on
    standards development
  • Codifies Office of the National Coordinator for
  • Provides grant funding for
  • Implementation of regional/local HIT Plans
  • Physicians, hospitals or other healthcare
  • State loan programs for sustainability
  • Total grants 125 million in FY06, 150 million
    in FY07 and such sums as needed thereafter
  • Establishes Center for Best Practices to provide
    technical assistance and develop best practices
    to support and accelerate efforts to adopt,
    implement, and effectively use interoperable HIT
  • Reauthorizes incentive grants for telemedicine

Legislation House
  • Health Information Technology Promotion Act
    Ways Means Health Subcommittee still in
    draft/not introduced yet
  • Codifies ONCHIT, establishes safe harbor,
    requires adoption of ICD-10-CM and -PCS codes
  • Study of state privacy/confidentiality laws and
    report on recommendations for harmonization
  • No upfront or ongoing funding for health
    information exchanges or providers
  • Introduction after recess
  • Energy Commerce Committee drafting bill may
    include funding/grant provisions
  • Follow legislation at

  • 1. ASPE/Disability, Aging, and LTC Policy
    Reports http//
  • 2. HL7 http//
  • 3. CHI Reports
  • http//
  • 4. Executive Order http//
  • 5. ONCHIT http//
  • 6. CCHIT

  • For additional information, please contact
  • Susan Christensen,
  • 703.489.2284

  • CHI Domains with No Standard
  • Physiology
  • Medical Devices and Supplies
  • History and Physical
  • Disability
  • Multimedia
  • Population Health

  • What are the implications of the standards
    development activity for patients with chronic
    illness and disability who are served by multiple
    providers across settings?
  • Example most NH residents are treated by
    attending physicians not employed by the NH and
    have community and hospital-based practices.
  • When acquiring health IT products, physicians and
    LTC providers (e.g., NH, HHA) should consider
    standards-based software products that will
    support and promote electronic information
    exchange across providers/settings.

  • What are the implications for clinicians who
    treat patients with chronic illnesses/disabilities
    if physicians use certain HIT and/or designated
    health service entities exchange HIT items or
    services with physicians?
  • To support low-cost interfacing and maximize HIT
    functionality, use of standards-based systems
    will be essential.

HHS E-Rx NPRM (2/4/05)
  • Proposed MMA Part D E-Rx standards include
  • Standards to support messaging between
    prescribers, dispensers, and Part D sponsors.
  • Standards support the exchange of information for
    all prescribing transactions (except the
    prescription fill status notification
    transaction) including prescription requests and
    responses related to new, refills, change, and
    cancellation prescription request and response

  • What are the implications for e-prescribing on
    behalf of patients in LTC or PAC?
  • Prescription workflow in NHs includes physician,
    NH, pharmacy, insurer(s)
  • Are additional standards needed to support these

NCPDP LTC Workgroup (WG14)
  • NCPDP creates and promotes standards for data
    transfer to and from the pharmacy.
  • WG 14 guides and advises payers and providers of
    the LTC industry and institutional pharmacy
    programs and their agents on standards
    implementation, supports data processing
    initiatives, and provides design alternatives for
    standards used within the LTC
  • NCPDP WG 14 is examining the LTC prescribing
    workflow and identifying gaps in standards.