Comp5 Unit3b Lecture Slides

History of Health Information Technology in the U.S.

The HITECH ActLecture b – Meaningful Use, Health Information Exchange and Research

This material Comp5_Unit3 was developed by The University of Alabama Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000023

Meaningful Use, Health Information Exchange and Research

Learning Objectives• Discuss the barriers to adoption of Health IT that the HITECH Act is

designed to address• Discuss how the following ARRA/HITECH requirements relate to previous

developments in health IT:– Certified electronic health records– Concept of meaningful use including e-prescribing, clinical decision support,

interoperability and HIE, structured documentation of quality measures– Incentives to providers– Education of clinicians– Workforce development

• Give examples of how the HITECH provisions support healthcare reform efforts

• Discuss the overall vision for the effects of the HITECH Act

2Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. The HITECH Act

Lecture b

Barriers to Improving Quality and Reducing Costs

• Low Adoption – Cost– Impact on productivity– Manpower

• Adoption is not enough– Must be used appropriately

• Information must be shared– Standards

• Lack of agreement– Privacy and Confidentiality

• Public and professional concerns



Lecture b

The HITECH VISION



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Incentives

• Why incentives are needed– Cost – Productivity loss

• Cost savings with health IT– Reductions in length of stay if medication errors are

prevented– Savings from sharing information

• prevent duplicate test ordering• prevent errors from drug interactions • save clinician time in gathering information



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Incentives

• Carrot and Stick– Better incentives for

being early adopters– Decrease over time– Eventually penalties for

non-use



Lecture b

Incentives

• Carrot and Stick– Better incentives for

being early adopters– Decrease over time– Eventually penalties for

non-use • Adoption not enough

– Must be used appropriately



Lecture b

The HITECH VISION



Lecture b

(Courtesy Office of the National Coordinator for Health Information Technology)

Meaningful Use

• Focus on improving outcomes of care– HIT Policy Committee and public comments

influenced final rule– Escalating expectations



Lecture b

Meaningful Use

• Focus on improving outcomes of care– HIT Policy Committee and public comments

influenced final rule– Escalating expectations

• Stages – Stage 1 released in July 2010– Stage 2 released in September 2012



Lecture b

Meaningful Use

• Major current criteria– Computerized Provider Order Entry (CPOE)– Clinical Decision Support (CDS)– Electronic Prescribing (E-prescribing)– Structured documentation of quality measures– Up-to-date Problem Lists and Diagnoses– Provide patients with health information electronically – Information exchange– Report clinical quality measures to CMS



Lecture b

Computer-based Provider Order Entry

• Orders for medications, laboratory tests, referrals etc.

• Replaces paper order slips• Takes longer for the physician, but can speed

the overall process of fulfilling the order• Increases legibility, reduces ‘call backs’• Can prevent some errors, but without decision

support, will not do as much



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Clinical Decision Support

• Systems designed to provide support to the clinician making clinical decisions

• Usually at the point of care when the decisions are made

• Examples: references, drug interactions, alerts, reminders, order sets

• Can be helpful at all stages of care



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E-prescribing

• Some or all of the following:– Electronic order entry by physician for medications– Clinical Decision Support (formularies, drug

dosing, drug interactions, guideline recommendations)

– Direct transmission to pharmacy• Stand-alone or integrated into EHR



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Structured Documentation

• Physicians document electronically• Lab data captured in structured form• Quality data extracted



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Structured Documentation

• Physicians document electronically• Lab data captured in structured form• Quality data extracted • Challenges in capturing and/or extracting

– Different systems– Unstructured text files– Non-standard definitions of terms– Variable technical standards

• Takes more time than scribbling a few notes!



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Other Parts of Meaningful Use

• Up-to-date problem lists and diagnoses• Providing patients with health information

electronically • Information exchange• Submit data to registries



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Other Parts of Meaningful Use

• Transitions of care• Reporting clinical quality measures• Core and Menu Objectives

– Eligible providers– Hospitals



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ONC Beacon Communities

• Communities with strong health IT infrastructure

• Funding to expand and strengthen capabilities

• Quality and cost focus• Model communities to demonstrate

meaningful use



Lecture b

(Photo by Andrew Bossi)

Barriers to Improving Quality and Reducing Costs

• Low Adoption – Cost– Impact on productivity– Manpower

• Adoption is not enough– Must be used appropriately

• Information must be shared– Standards

• Lack of agreement– Privacy and Confidentiality

• Public and professional concerns



Lecture b

The HITECH VISION



Lecture b

Courtesy Office of the National Coordinator for Health Information Technology

ONC-Funded Health Information Exchange

• To share information, systems need to “talk to each other” and “be understood”– Interoperability– Lack of agreed-upon standards

• Demonstration projects for interoperability• Grants to states for information exchange



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Standards

• Standards “harmonization”– Technical – Vocabulary– Health Information Technology Standards Panel

(HITSP) HIT Standards Committee• Privacy and security issues

– Strengthening of current rules• Certification of EHRs



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Certified Electronic Health Records

• Certification– Temporary Certification Program

• ONC-Authorized Testing and Certification Bodies (ATCBs)

– Permanent Certification Program’• Accredited Testing Laboratories (ATLs)• ONC-Authorized Certification Bodies (ONC-ACBs)

– Focus on functions for meaningful use



Lecture b

The HITECH VISION



Lecture b

(Courtesy Office of the National Coordinator for Health Information Technology)

SHARP Grants

• Strategic Health IT Advanced Research Projects– Security of Health Information Technology – Healthcare Application and Network Platform

Architectures

Source: (Stead & Lin, 2009)



Lecture b

SHARP Grants

• Strategic Health IT Advanced Research Projects– Security of Health Information Technology – Healthcare Application and Network Platform

Architectures – Patient-Centered Cognitive Support – Secondary Use of EHR Data



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Leadership

• Office of the National Coordinator for Health Information Technology (ONC)

• HIT Policy Committee• HIT Standards Committee



Lecture b

The HITECH ActSummary

• Leadership• Certified Electronic Health Records• “Meaningful Use”• Incentives• Health IT manpower• Interoperability and information exchange• Privacy and Security



Lecture b

The HITECH ActReferences – Lecture b

References Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med. 2009; 360;15:1477-9. Available

from: http://content.nejm.org/cgi/reprint/360/15/1477.pdf Blumenthal D and Tavenner M. The “Meaningful Use” regulation for electronic health records. N Engl J Med 2010;

363:501-504. Available from: http://www.nejm.org/doi/full/10.1056/NEJMp1006114Centers for Medicare & Medicaid Services. EHR Incentive Programs. Available from:

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html Office of the National Coordinator. Celebrating the first anniversary of the HITECH Act and looking to the future.

2010. Available from: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911674_0_0_18/FINAL_ONC-HITECH-Anniversary.pdf

Stead WW, Lin HS (eds). Computational technology for effective health care. Immediate steps and strategic directions. Washington, DC: The National Academies Press, 2009.

ImagesSlides: 4, 8, 21, 25: Courtesy of the Office of the National Coordinator for Health Information Technology. Available

from: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911674_0_0_18/FINAL_ONC-HITECH-Anniversaryf

Slide 6, 7: Microsoft clip art; Used with permission from Microsoft.Slide 19: Andrew Bossi CC-By-SA-2.5, 2.0, and 1.0 Available from:

http://en.wikipedia.org/wiki/File:NJ_LBI_Lighthouse_06.JPG


History of Health Information Technology in the U.S The HITECH Act

Lecture b

Comp5 Unit3b Lecture Slides

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