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Improving Healthcare Quality and Safety by Leveraging Health Information Technology and Health Infor

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Title: Improving Healthcare Quality and Safety by Leveraging Health Information Technology and Health Infor


1
Improving Healthcare Quality and Safety by
Leveraging Health Information Technology and
Health Information ExchangeOverview of Whats
Happening Nationally and Within States and
Communities Across the U.S.
  • Wisconsin eHealth Board on
  • Healthcare Quality and Patient Safety
  • Janet M. Marchibroda
  • Chief Executive Officer
  • eHealth Initiative and Foundation

2
Overview of Discussion
  • Background
  • Overview of Whats Happening at the National
    Level
  • Review of Whats Happening in States and
    Communities Across the U.S.
  • Key Take-Aways for Wisconsin Stakeholders

3
eHealth Initiative and Foundation Mission and
Focus
  • Mission Improve the quality, safety, and
    efficiency of healthcare through information and
    information technology
  • Areas of Focus
  • Focus on states, regions and communities as the
    center of implementation aligning national
    standards with local solutions
  • Develop and drive adoption of sustainable model
    for healthcare transformation through
    quality-based incentives
  • Advocate for continued favorable national
    policies

4
Our Diverse Membership
  • Consumer and patient groups
  • Employers, healthcare purchasers, and payers
  • Health care information technology suppliers
  • Hospitals and other providers
  • Pharmaceutical and medical device manufacturers
  • Pharmacies, laboratories and other ancillary
    providers
  • Practicing clinicians and clinician groups
  • Public health agencies
  • Quality improvement organizations
  • Research and academic institutions
  • State, regional and community-based health
    information organizations

5
eHI is the Go-to Organization For State and
Regional HIT and Health Information Exchange
Efforts
Advocacy
Grants
eHealth Initiative and Foundation
Knowledge
Hands-on Help
6
eHIs Primary Activities
  • Improve the quality, safety, and efficiency of
    healthcare through information and information
    technology by
  • Developing and disseminating knowledge or common
    principles, policies and best practices for
    supporting transformation through HIT and health
    information exchange
  • Providing seed funding for emerging state,
    regional and community-based multi-stakeholder
    initiatives
  • Providing hands-on help or technical assistance
    to emerging collaborative efforts at the state,
    regional and local level
  • Advocating for continued favorable national
    policies related to HIT and health information
    exchange

7
eHIs Accomplishments Supporting Communities
  • Nearly 2,000 stakeholders involved in
    approximately 200 states, regions and communities
    engaged in health information exchange have been
    involved in our efforts. We now have over 500
    eHealth Initiative Connecting Communities
    Members
  • eHI directly supported health information
    technology policy and planning initiatives in
    seven states, including Arizona, California,
    Kansas, Louisiana, Minnesota, New York, and Ohio,
    supporting public and private sector leaders who
    are building multi-stakeholder consensus on the
    principles, policies, and plans for supporting
    local innovation and building health information
    exchange network capabilities. Five additional
    states will be added to the portfolio in 2006
  • eHIs newly awarded 4 million contract from DHHS
    will help to support health information exchange
    development among the Gulf states

8
eHIs 2005 Accomplishments Supporting Communities
  • The eHealth Initiative Foundation through its
    cooperative agreement with HRSA provided funding
    to nine communities engaged in health information
    exchange this year (one in Wisconsin), with
    significant learning and results.
  • We are getting ready to award our next round of
    awards to regions and communities over the next
    month, which will provide seed funding to those
    who have engaged employers, plans and practicing
    clinicians in their markets to pilot test
    incentives that reward both quality and health
    information exchange capabilitiesproviding
    learning laboratories for sustainable models for
    both quality and HIT.
  • eHI developed common principles for
    transformation through health information
    exchange, which will be launched within a
    tool-kit in early 2006, helping communities
    navigate the organizational, financial, practice
    transformation, health information policy, and
    technical aspects of health information exchange.

9
eHIs 2005 Accomplishments Supporting Communities
  • The Connecting Communities Online Learning Center
    was expanded considerably offering hundreds of
    resources and tools related to health information
    exchange to thousands of stakeholders each month.
  • eHI lent its expertise and experience to the work
    of the Agency for Healthcare Research and Quality
    National Resource Center for Health Information
    Technology, offering technical assistance to
    AHRQs over 120 grantees and recipients of state
    contracts
  • eHI involved in one of the ONC contracts for the
    development of prototypes for a Nationwide Health
    Information Network and exploring alignment and
    input into the other three contracts

10
eHI State HIT Policy Initiative
11
eHIs Tool-Kit for Transformation through Health
Information Exchange will Help States and
Communities
  • A comprehensive on-line, interactive resource
    that walks a community through the six critical
    components of success
  • Getting started Assessing environment, engaging
    stakeholders, developing shared vision and goals
  • Organization and governance, legal issues
  • Value creation, financing and sustainability
  • Policies for information sharing
  • Practice transformation and quality improvement
  • Technical implementation

12
Understanding the National Agenda around Health
Information Exchange
  • Enormous momentum around improving quality,
    safety and efficiency through clinical exchange
    within Administration, Congress, and the private
    sector
  • Key themes
  • National standards for interoperability
  • Alignment of value based purchasing with HIT
    infrastructure required to get there
  • Government as catalyst
  • Public-private sector collaboration

13
Signs of Momentum for HIT and Health Info
Exchange Activities in Congress
  • 12 bills introduced in 2005
  • Most bi-partisan
  • Unprecedented collaboration between the
    Republicans and Democrats on the importance of
    leveraging HIT and the mobilization of
    information to address healthcare challenges
  • One with most promise is S. 1418. Similar bill
    introduced by House this year

14
Senate 1418 Wired for Healthcare Quality Act
Passed in Nov. 2005
  • Key Elements
  • Authorizes ONCHIT
  • Authorizes public-private AHIC to advise
    Secretary, recommend actions, and standards
  • Grants to providers, states and for
    regional/local HIT plans
  • Demonstration program to integrate IT into
    clinical education
  • Development of quality measures and government
    capability to accept electronically reported
    measures
  • Creation of health information technology
    resource center

15
Senate 1418 Wired for Healthcare Quality Act
  • Competitive Grants for Qualified HIT
  • For not-for-profit hospitals, federally qualified
    health centers, individual or group practices or
    other health care providers
  • Must adopt standards, implement and report
    quality measures, agree to notify patients of
    wrongful disclosure, demonstrate need, and
    provide matching funds (1 for every 3)
  • Preference given to rural, frontier or
    underserved areas or eligible entities that will
    link qualified HIT to local or regional health
    information plans

16
Senate 1418 Wired for Healthcare Quality Act
  • Competitive Grants for Implementation of Regional
    or Local HIT Plans
  • Requirements
  • Participation by multiple stakeholders within a
    community
  • Principle mission or purpose is to use
    information technology to improve health care
    quality and efficiency
  • Facilitate electronic exchange of health
    information within the local or regional area and
    among local and regional areas
  • Adopt standards
  • Demonstrate financial need
  • Agree to notify patients if their individually
    identifiable information is wrongfully disclosed
  • Matching funds (1 for every 2 of Federal funds)

17
Senate 1418 Wired for Healthcare Quality Act
  • Competitive Grants for State Loan Programs to
    Facilitate HIT
  • Establish qualified State loan fund
  • Require that loan recipients
  • Submit a strategic plan to the HHS Secretary
  • Require that health care providers receiving
    loans adopt standards, implement and report
    quality measures, agree to notify patients of
    wrongful disclosure, use the national resource
    center for HIT, and provide matching funds (1
    for every 1)
  • Preference given to states that adopt value-based
    purchasing programs to improve health care quality

18
Signs of Momentum for HIT and Health Information
Exchange Activities in Administration
  • AHIC public-private community formed to provide
    input to Sec. Leavitt re how to make health
    records digital and interoperable and assure that
    privacy and security are protected
  • Overseeing work in four break-through areas
    that will create realizable benefits to consumers
    in two to three years
  • Biosurveillance
  • Chronic care
  • Consumer empowerment
  • Electronic health records

19
Signs of Momentum for HIT and Health Information
Exchange Four DHHS Contracts
  • Standards Harmonization. 3.3 million contract to
    ANSI for convening Health Information Technology
    Standards Panel (HITSP) to review standards under
    development and develop a roadmap for single set
    of standards
  • Compliance Certification. 2.7 million contract
    to Certification Commission for HIT to develop
    process and criteria for inspecting EHRs and
    other HIT
  • Privacy and Security. 11.5 million contract to
    Health Information Security and Privacy
    Collaboration overseen by RTI International who
    will work sith states to assess and develop plans
    to address variations in organization-level
    business policies and state laws that affect
    privacy and security practices that may serve as
    barriers to health information exchange
  • Nationwide Health Information Network. Four
    contracts totaling 18.6 million to four
    consortia led by Accenture, CSC, IBM and Northrop
    Grumman to develop a blueprint for how a
    generalized network would share information
    across the U.S.

20
Overview of Activities at State, Regional and
Local Levels
21
Why Focus on States and Communities?
  • Wide-spread recognition of the need for health
    information technology and exchange/
    interoperability at the national level
  • While national standards are needed, healthcare
    indeed is local and leadership is needed at the
    state, regional and community levels across the
    country to drive implementation
  • Need for collaboration and development of
    consensus on a shared vision, goals and plan is
    needed among multiple, diverse stakeholders at
    the state and regional level

22
What is Health Information Exchange?
  • Health information exchange provides the
    capability to electronically move clinical
    information between disparate healthcare
    information systems while maintaining the meaning
    of the information being exchanged.
  • The goal of health information exchange is to
    facilitate access to and retrieval of clinical
    data to provide safer, more timely, efficient,
    effective, equitable, patient-centered care.

23
Why Health Information Exchange?
  • U.S. healthcare system highly fragmented.data is
    stored often in paper formin silos, across
    hospitals, labs, physician offices, pharmacies,
    and insurers
  • Public health agencies forced to utilize phone,
    fax and mail to conduct public health
    surveillance, detection, management and response
  • Physicians spend 20 - 30 of their time searching
    for information10 - 81 of the time, physicians
    dont find the information they need in the
    patient record
  • Clinical research hindered by paper-based,
    fragmented systems costly and slow processes

24
Value for Patients
  • The true promise of coordinated care along the
    entire care continuum, and improved relationships
    with all care givers
  • The ability to better manage their personal
    health information and records
  • The ability to improve the physician-patient
    dialogue and relationship

25
Value for Clinicians
  • Doing well while doing good
  • Gaining a deep understanding of their individual,
    group and practices performance in delivering
    quality care to patients
  • Initiating and tracking QI programs
  • Better management and coordination of their
    patients care

26
Value for Purchasers and Payers
  • Real-time, relevant, fair, and equitable
    information on the quality of services delivered
    by all clinicians
  • Ability to better engage employees and their
    family members in managing their care

27
Survey of Over 100 State, Regional and
Community-Based Initiatives
  • 109 respondents from 45 states and the District
    of Columbia
  • Covered aspects related to goals, functionality,
    organization and governance models, information
    sharing policies, technical aspects, funding and
    sustainability

28
Key Findings from Survey
  • Health information exchange activity is on the
    rise.there are more efforts, and those that are
    out there are maturing
  • Of the 109 health information exchange efforts in
    the survey
  • 40 are in the implementation phase and
  • 25 fully operational
  • Nine were fully operational in 2004

29
Stage of Health Information Exchange Programs
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Stage 6
  • 12
  • Recognition of the need for HIE among multiple
    stakeholders in your state, region, or community
  • 14
  • Getting organized
  • Defining shared vision, goals, objectives
  • Identifying funding sources
  • Setting up legal governance structures
  • 15
  • Transferring vision, goals, objectives to
    tactics and business plan
  • Defining needs and requirements
  • Securing funding
  • 37
  • Well under-way with implementation technical,
    financial, and legal
  • 12
  • Fully operational health information organization
  • Transmitting data that is being used by
    healthcare stakeholders
  • Sustainable business model
  • 11
  • Demonstration of expansion of organization to
    encompass a broader coalition of stakeholders
    than present in the initial operational model

30
Key Findings from Survey
  • The key driver moving states, regions and
    communities toward health information exchange is
  • Perceived provider inefficiencies (77 of all
    respondents)
  • Rising healthcare costs also seen as important
    driver (60 of all respondents)

31
Key Drivers for Health Information Exchange
32
Key Findings from Survey
  • Organization and governance structures are
    getting more formalized and shifting to
    multi-stakeholder models with the involvement of
    providers, purchasers and payers
  • 60 of advanced stage are incorporated
  • 70 are non-profit models

33
How are HIE Efforts Organized?
34
HIE Efforts are Forming Legal Structures
35
Key Findings from Survey
  • Organization and governance structures are
    getting more formalized and shifting to
    multi-stakeholder models with the involvement of
    providers, purchasers and payers
  • Providers continue to play the most dominant role
    but see an increase in others health plans
    (28), local public health departments (45),
    QIOs (35), employers (22), patient consumer
    groups (29)

36
Whos Involved?
37
Key Findings from Survey
  • Organization and governance structures are
    getting more formalized and shifting to
    multi-stakeholder models with the involvement of
    providers, purchasers and payers
  • Clear shift towards leadership by neutral,
    multi-stakeholder entity (55)

38
Who is Leading These Efforts?
39
Key Findings from Survey What are They Doing?
  • Primary focus continues to be on supporting care
    delivery
  • Clinical documentation
  • Reminders
  • Results delivery

40
Health Information Exchange Initiatives What Are
They Doing?
41
Key Findings from Survey What are They Doing?
  • Advancements in functionality to support
    improvements in quality and safety are evident.
    In addition to traditional uses to support care
    delivery, a number are now expanding
    functionality
  • 32 currently providing disease or chronic care
    management services (with additional 21
    expecting to within six months)
  • 27 are currently supporting quality performance
    reporting efforts (with additional 18 expected
    within six months)

42
Growing Focus on Disease Management, Quality
Reporting
43
Key Findings from Survey What are They Doing?
  • Health information exchange efforts are
    delivering more information and increasingly
    using standards for data delivery
  • More than 50 are exchanging or expecting to
    exchange outpatient and inpatient episodes, lab
    results, ED episodes, pathology and enrollment
    and eligibility
  • 76 of advanced stage are using HL7 as messaging
    standards and 41 are using LOINC for laboratory
    reporting

44
Most Significant Challenges
45
Most Difficult Challenges
  • Securing upfront funding- 91 of all respondents
    cited securing upfront funding as either a very
    difficult or moderately difficult challenge.
  • Developing a sustainable business model- 84 of
    all respondents cited developing a sustainable
    business model as a very difficult or moderately
    difficult challenge.

46
Most Difficult Challenges
  • Engaging health plans- 74 of respondents
    perceived the engagement of health plans as a
    very difficult or moderately difficult challenge.
  • Accurately linking patient data- 80 of
    respondents indicated that accurately linking
    patient data was a very or moderately difficult
    challenge.

47
Key Findings from Survey
  • Funding sources for both upfront and ongoing
    operational costs still rely heavily upon
    government funds
  • 46 of all respondents cited federal government
    contracts as current revenue source
  • 48 of advanced stage cite federal government as
    source for ongoing operations

48
Federal Government Still Key Funding Source
49
Federal Government Still Key Funding Source
50
Key Findings from Survey
  • But alternative funding sources for ongoing
    sustainability are beginning to emerge.
  • Advance payments from hospitals (38)
  • Physician practices (33)
  • Public health (19)
  • Labs (15)
  • Payers (15), and
  • Purchasers (9)

51
New Models for Sustainability Emerging
52
Emerging Guiding Principles
53
Characteristics of Successful Health Information
Exchange Initiatives
  • Governed by a diverse and broad set of
    stakeholders within the region or community
  • Develop and assure adherence to a common set of
    principles and standards for the technical and
    policy aspects of information sharing -
    addressing the needs of every stakeholder
  • Develop and maintain a model for sustainability
    that aligns the costs with the benefits of HIE
    and
  • Use metrics to measure performance from the
    perspective of patient care, public health,
    provider value, and economic value.

54
Emerging Guiding Principles
  • Approach for Getting Organized
  • Convened by trusted, neutral party
  • Engage all of the stakeholders in your region
    clinicians, hospitals, laboratories, community
    health centers, pharmacies, health plans,
    employers, patient groups, public health, and the
    state and local government
  • Get clear upfront on your shared vision, goals
    and objectives, and principles for working
    together
  • Focus on value
  • Link to the challenges of your region or
    community
  • Incremental approach

55
Emerging Guiding Principles
  • Approach for Technical Aspects
  • Utilize national standards as they emerge
  • Build in your policies for information sharing as
    you build your technical architecture!
  • Connectivity built on the Internet and other
    existing networks
  • Environment is private, secure
  • Minimally invasive approach leverages existing
    systems - no rip and replace
  • Accurate patient identification based on uniform
    and standardized methodologies

56
Emerging Guiding Principles
  • Engaging Practicing Clinicians in the Changes
    Required
  • Innovation and investment will be needed to
    support small physician practices in migration
  • Reduce burden of multiple reporting systems
  • Build reporting into current work-flow
  • Improve trust by leveraging emerging
    certification processes
  • Realign incentives to promote adoption

57
Emerging Guiding Principles
  • Financing and Sustainability
  • Must create value for all participants, both
    globally and for each stakeholder interest
  • Look for incremental value gains projects that
    will immediately return value as you move
    towards your longer-term goal
  • Incentive amounts offered should be meaningful
  • Purchaser or payer sponsors of the incentive
    program should represent a meaningful proportion
    of the clinicians patient panel
  • Any applications covered by the program should be
    interoperable and standards-based

58
Emerging Guiding Principles
  • Financing and Sustainability.
  • Coordination and collaboration within the region
    or community is critical.
  • Physician practices ordinarily contract with a
    large number of purchasers and payers.
  • Incentives offered by a small number of
    purchasers or payers generally are not effective
  • Reduce the potential for the free rider effect
  • Most of the data required to deliver care within
    physician practices resides somewhere else
    (hospital, lab, pharmacy, health plan, etc.)

59
Emerging Guiding Principles
  • Financing and Sustainability
  • Rapidly emerging interest in aligning quality
    improvement initiatives with the HIT and health
    information exchange infrastructure required

60
eHIs Parallel Pathways Aligning Incentives with
Quality and HIT
  • Aligning Incentives with
  • Quality capabilities
  • Physician HIT capabilities
  • Health information exchange capabilities

Quality and Value
Quality Expectations
Health Info Exchange Capabilities
Physician Practice HIT Capabilities
Financial Incentives
61
Aligning Quality Expectations with HIT and HIE
Capabilities
Reporting of Outcomes
H
Incentives
Implementation of HIT
L
Time
Phase 1
Phase 2
Phase 3
Quality self-assessment HIT implementation Chart
data reporting HIE formation
Use of HIT e-reporting of outcomes QI
initiatives HIE operational
Continued QI Full e-reporting of outcomes
62
The Private Sector has Many Programs in Place
  • Physician-based
  • Bridges To Excellence has a program focused on
    adoption of systems of care, including
    HIT.enormous uptake across the country
  • The Integrated Healthcare Association in CA
    rewards physician groups for ambulatory POE and
    eRX systems
  • Hospital-based The Leapfrog Group has launched
    a new national program that rewards good outcomes
    and adoption of CPOE systems

63
Many Health Plans have Incorporated Incentives as
Well
  • CareFirst BCBS they licensed BTE and are
    expanding their program to reward many practices
    in the DC Virginia areas
  • UHC, CIGNA, Aetna they are all recognizing
    physicians that adopt and use HIT to varying
    degrees

64
Key Take-aways
  • Health information technology is here and
    interoperability is the name of the game
  • Rapid changes in policy at the national, state
    and local levels
  • Every stakeholder group is trying to figure out
    how this fits within their strategy
  • National standards are emerging to support
    interoperability- stay in tune with thembuild
    them in as they get defined

65
Key Take-aways
  • Value-based purchasing will be here soon.keep
    this in mind as you proceed
  • Engaging your purchasers and health plans is
    criticalwithout them you dont have a
    sustainable business model
  • Remember that most of healthcare is delivered by
    small physician practicesengage them, and engage
    them early

66
Key Take-aways
  • Most important thing is to stay focused build
    your incremental roadmap based on value. at the
    end of the day, value is the only thing that
    matters
  • Mobilizing health information is going to
    dramatically improve the quality and safety of
    healthcare in the U.S.

67
  • Janet M. Marchibroda
  • Chief Executive Officer
  • eHealth Initiative and Foundation
  • www.ehealthinitiative.org
  • 1500 K Street, N.W., Suite 900
  • Washington, D.C. 20005
  • 202.624.3270
  • Janet.marchibroda_at_ehealthinitiative.org
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