Syllabus SI654 Fall 2011 FINAL - · School of Information 4376 North Quad Phone: (734) 615-7435...

Course Syllabus – SI 654: Critical Policy Issues in Health IT

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SI 654: Critical Policy Issues in Health IT

Fall 2011 Syllabus

Mondays 5:30 – 8:30 p.m.

North Quad 2185 Instructor Julia Adler-Milstein Assistant Professor School of Information 4376 North Quad Phone: (734) 615-7435 Email: [email protected] Office Hours: Wednesday 12:30-2:00 p.m.

Course Description This course will use a policy analysis lens to critically examine issues related to the use of information technologies in health care. It will examine key policies and policy issues in three areas: clinical informatics, consumer informatics, and population health informatics. The primary focus will be on the U.S. but international approaches will also be discussed.

Specific topics include an in depth analysis of key regulations and related policy efforts that shape the health informatics field, with significant focus on the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH will also be discussed in the context of broader health reform efforts. Other regulations and policy efforts, such as HIPAA, Stark, and the CMS Innovation Center, will be covered. To provide context for key content, the course will begin with a brief overview of the healthcare system and key players as well as definitions of, and progress to-date in, health informatics.

Learning Objectives

The goal of the course is for students (1) to understand the policies and government-led efforts that impact (both directly and indirectly) health informatics; and (2) to critically analyze these policies in order to understand how they will shape the health informatics landscape as well as to make suggested improvements that are practically and politically feasible. There are specific learning objectives for each session (listed as topics), which you will find below along with the assigned readings for the session.


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Course Requirements Throughout the semester, students will be expected to complete the assigned readings, attend and actively participate during class, and complete three short writing assignments. There will be a midterm, and a final paper. The final paper will inform a mock congressional testimony held during the last class session in which students will be expected to participate. Readings Required readings for the course include:

1) Articles from peer-reviewed journals 2) Regulations & other government documents 3) Websites

Please carefully review any additional instructions associated with a given reading. In some cases, you will be asked to review a given reading at a high-level to get the main ideas. When not specified, you are expected to carefully review the given reading. We will not be able to review all the readings in class but you will be expected to cite them in your writing assignments and on the midterm. Assignments Homework Given that class participation is a critical part of the course and that class participation will be greatly facilitated by having read the assigned material, the main homework assignment is to carefully complete the required reading before each class. Policy Briefs You are required to write three short policy briefs throughout the semester – one for each module OR two for the clinical informatics module and one for either of the other two modules. You can choose your particular topic within the module, based on a specific lecture, and it must be turned in no later than a week following that lecture (e.g., if you write about a topic covered in session 4 on Monday October 3rd, I must have received the brief by the start of class on Monday October 10th). These should be no more than three double-spaced pages that take a particular HIT policy discussed in class and argue for one or more suggested “amendments” (i.e., modifications) to it. You need to clearly (and concisely) argue for why the proposed amendment(s) would improve the policy and why they are politically feasible. More detail on this assignment is available under the “Assignments” link on cTools. Examinations There is a take-home midterm. The examination will test the main concepts discussed in class and will be made up short- and long-answer essay questions. More details about the midterm will be made available during the semester. It will be available on the course website on 10/19 and due by 5 PM on 10/24.

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Testimony Project and Mock Congressional Hearing A major requirement of the course is that you prepare “testimony”. You should write approximately five to seven double-spaced pages, taking a position for or against a policy that is relevant to the material we cover in the course. Although almost all of the course material is about the US health care system, students are welcome to write about analogous issues in other countries. After you turn in the testimony, you will be assigned 4-5 other students’ testimonies to read and prepare at least four questions. We will then spend the last session of the course (November 21st) with a subset of students “testifying” on their topic and those assigned to read those testimonies asking questions in a mock congressional hearing. Those testifying will receive their questions ahead of time to give them a little time to prepare. It is fine for the either the person asking the question or the person giving the answer to have a few notes, but this exercise should be a conversation between two people, not a prepared text. There will be opportunity for give and take, and that’s the fun part! Testimonies are due by 5 PM on Monday November 14th. Testimony reading assignments will be available by 5 PM Wednesday, November 16th and questions on the testimonies you are assigned to read must be submitted by 5 PM Friday November 18th. Grading Criteria Grades are based on a total of 100 points.

• Class participation: 20 points

• Midterm: 20 points

• Policy Briefs: 30 points (10 points each)

• Testimony: 30 points At the end of the semester, I will translate the numerical scores to letter grades with a 97 and above being an A+, 93-96.9 being an A, 90-92.9 being an A-, 87-89.9 being a B+, 83-86.9 being a B, 80-82.9 being a B-, and so on. Letter grades should be interpreted as follows:


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Feedback To You. I will do my best to return assignments to you in a timely fashion and with sufficient comments for you to understand where any gaps in your understanding may lie. Feel free to follow-up with me if you can’t understand (or read!) a particular comment, or if points were miscalculated. Since class participation is 20% of your grade, halfway through the semester I will individually let any students know if they are not participating at an acceptable level. Please also use it as an opportunity to let me know if there are things I can do to facilitate your participation. From You. I highly value your feedback on both the content and structure of the course. There will be two opportunities for formal evaluation. I will conduct an anonymous mid-semester evaluation and there is a formal university-sponsored evaluation at the end of the semester. Outside of these, I welcome you to share feedback with me informally and via whichever channel is most comfortable to you. Don’t be shy! My goal is to teach a course that meets your needs, and I am not always able to tell if I am doing so. Original Work Policy Collaboration. I strongly encourage collaboration while discussing and interpreting the reading assignments. Active learning is effective. Collaboration will be especially valuable in summarizing the reading materials and picking out the key concepts. Plagiarism. All written submissions (midterm, policy briefs, and testimony) must be your own, original work. Original work for narrative questions is not mere paraphrasing of someone else's completed answer and you are not allowed to share written answers with each other prior to submission. Largely duplicate copies of the same assignment will receive an equal division of the total point score from the one piece of work. You may incorporate selected excerpts from publications by other authors, but they must be clearly marked as quotations and must be attributed. If you build on the ideas of prior authors, you must cite their work. You may obtain copy editing assistance, and you may discuss your ideas with others, but all substantive writing and ideas must be your own, or be explicitly attributed to another. For more information, refer to the Rackham Graduate policy on Academic and Professional Integrity for the definition of plagiarism, and associated consequences: http://www.rackham.umich.edu/policies/academic_and_professional_integrity/statement_on_academic_integrity/. Accommodations for Students with Disabilities If you think you need an accommodation for a disability, please let me know at your earliest convenience. Some aspects of this course, the assignments, the in-class activities, and the way we teach may be modified to facilitate your participation and progress. As soon as you make me aware of your needs, we can work with the Office of Services for Students with Disabilities (SSD) to help us determine appropriate accommodations. SSD (734-763-3000; http://ssd.umich.edu/) typically recommends accommodations through a Verified Individualized Services and Accommodations (VISA) form. I will treat any information you provide as private and confidential.


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Date Number Session and Title

9/12 1 A: INTRODUCTION & COURSE OBJECTIVES

INTRODUCTION TO HEALTH INFORMATICS LEGISLATION & REGULATIONS

B: OVERVIEW OF KEY STAKEHOLDERS

HEALTH POLICY ANALYSIS FRAMEWORK

9/19 2 A: KEY STAKEHOLDERS: INTERESTS & INCENTIVES

OVERVIEW OF KEY HEALTH INFORMATICS POLICIES

B: POLICY ANALYSIS EXERCISE: REGULATING HEALTH INFORMATICS

MODULE 1: CLINICAL INFORMATICS

9/26 3 A: POLICY CONTEXT

B: DEFINITIONS, LEVELS OF ADOPTION, AND BARRIERS TO ADOPTION

10/3

10/6

4

5

A: HITECH AND MEANINGFUL USE OF ELECTRONIC HEALTH RECORDS

B: POLICY ANALYSIS EXERCISE: MEANINGFUL USE

A: IMPACT: SAFETY

B: IMPACT: EFFECTIVENESS AND EFFICIENCY

10/10 6 A: HITECH AND HEALTH INFORMATION EXCHANGE

B: POLICY ANALYSIS EXERCISE: STATE HIE COOPERATIVE AGREEMENT PROGRAM

OVERVIEW OF SESSIONS

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MODULE 2: CONSUMER HEALTH INFORMATICS

10/24

10/31

7

8

A: INTRODUCTION TO CONSUMER HEALTH INFORMATICS

B: KEY REGULATIONS: PRIVACY AND SECURITY

NOTE: MIDTERM DUE BY 5 PM

A: HITECH AND HEALTH REFORM: ACCOUNTABLE CARE ORGANIZATIONS AND

MEDICAL HOMES (NOTE: THIS SESSION IS RELEVANT TO MODULES 1 AND 2)

B: POLICY ANALYSIS PERSPECTIVE: INSIDE THE SAUSAGE FACTORY

11/7 9 A: ENGAGING CONSUMERS IN THEIR HEALTH THROUGH INFORMATION

B: POLICY ANALYSIS EXERCISE: CONSENT – OPT-IN/OPT-OUT

MODULE 3: POPULATION HEALTH INFORMATICS

11/9 10 A: INTRODUCTION TO POPULATION HEALTH INFORMATICS

B: FEDERAL PUBLIC HEALTH INITIATIVES AT THE CENTER FOR DISEASE CONTROL

11/14 11 A: PUBLIC HEALTH INFORMATICS: A LOCAL PERSPECTIVE

B: POLICY ANALYSIS EXERCISE: SHAPING PUBLIC HEALTH INFORMATICS IN MICHIGAN

NOTE: TESTIMONY DUE BY 5 PM

CONCLUDING SESSIONS

11/18

12 A: INTERNATIONAL COMPARISONS: HIT IN OTHER DEVELOPED NATIONS

B: INTERNATIONAL COMPARISONS: DEVELOPING AND TRANSITIONAL COUNTRIES

11/21 13 CONGRESSIONAL TESTIMONIES

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Session #1 Introduction and Course Objectives Introduction to Health Informatics Legislation and Regulations Topics: What are the key types of policies that shape health informatics in the US? What process is used to create these policies? Who do the policies target? Readings:

1) Blumenthal, D. and J. P. Glaser (2007). "Information Technology Comes to Medicine." N Engl J Med 356(24): 2527-2534. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1288225011&Fmt=7&clientId=17822&RQT=309&VName=PQD

2) Office of the National Coordinator for Health Information Technology (ONC) website: http://healthit.hhs.gov Please spend 20-30 minutes on this website – understanding who ONC is and what they do.

3) ONC Regulations FAQs: http://healthit.hhs.gov/portal/server.pt/community/onc_regulations_faqs/3163 Please review these questions and answers – many of them get into specifics that we’ll return to later in the course and so focus on a high-level understanding of what types of policies are being discussed and the process for making them.

4) Overview of Rulemaking Process: http://www.archives.gov/federal-register/laws/administrative-

procedure/553.html

Overview of Key Stakeholders Topics: Who are the key healthcare stakeholders? What role do they play in the healthcare system? Readings: (Note: The readings and references for this section are background materials and recommended for those unfamiliar with Medicare, Medicaid, etc. Please read/look-up those that fill gaps in your understanding of key stakeholders in the US healthcare system.)

1) Iglehart, John K. 1999. The American health care system-Medicare. The New England Journal of Medicine; 340(4): 317-332. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=38445395&Fmt=7&clientId=17822&RQT=309&VName=PQD

2) Kaiser Family Foundation. Medicare Fact Sheet:

http://www.kff.org/medicare/upload/8100.pdf


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3) Kaiser Family Foundation. Medicaid Fact Sheet: http://www.kff.org/medicaid/upload/7235-04.pdf

4) Iglehart, John K. 2011. Medicaid at a crossroads. The New England Journal of Medicine

364(17): 1585. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2358411851&sid=1&Fmt=4&clientId=17822&RQT=309&VName=PQD

5) Kaiser Family Foundation. How Private Insurance Works, A Primer:

http://www.kff.org/insurance/upload/How-Private-Insurance-Works-A-Primer-Report.pdf (Sections 1 and 2)

6) J.K. Iglehart, "The National Committee for Quality Assurance," New England Journal of

Medicine 335, no. 13 (1996): 995–999. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=10238481&Fmt=7&clientId=17822&RQT=309&VName=PQD

7) Websites for other key stakeholders:

o Center for Disease Control: www.cdc.gov o American Medical Association: http://www.ama-assn.org/ama/pub/about-ama.page? o American Hospital Association: http://www.aha.org/aha/about/index.html o America’s Health Insurance Plans: http://www.ahip.org/content/default.aspx?bc=31 o American Nurses Association:

http://www.nursingworld.org/FunctionalMenuCategories/AboutANA.aspx o PhRMA: http://www.phrma.org/about/about-phrma o American Association of Retired Persons: http://www.aarp.org/about-aarp/ o HIMSS: http://www.himss.org/ASP/aboutHimssHome.asp o eHealth Initiative: http://www.ehealthinitiative.org/about-us.html o HL7: http://www.hl7.org/about/index.cfm o EPIC: http://www.epic.com/

Health Policy Analysis Framework Topics: What does it mean to analyze policy? What are the key questions that should be asked in health policy analysis? Readings:

1) E.J. Emanuel and L.L. Emanuel, What Is Accountability in Health Care? Annals of Internal Medicine 124, no. 2 (1996): 229–239.http://www.annals.org/content/124/2/229.full.pdf

2) L. Gregory Pawlson and Margaret E. O’Kane. Professionalism, Regulation, And The Market: Impact On Accountability For Quality Of Care. Health Affairs May 2002 vol. 21 no. 3 200-207. http://content.healthaffairs.org/content/21/3/200.long


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Session #2 Key Stakeholders: Interests and Incentives Topics: Who are the key healthcare stakeholders? (revisit) What are their interests and incentives? How does this relate to health informatics (i.e., how would each feel about electronic health records)? Readings: In lieu of readings, please review readings and websites for “Overview of Key Stakeholders” from Session #1. For at least 5 key stakeholders, please try to determine their top priorities, and then how health informatics influences those priorities. Overview of Key Health Informatics Policies Topics: What are the key policies that shape health informatics in the US? When were they enacted? Which stakeholders are affected by the key policies? Readings:

1) Blumenthal, D. (2006). Health Information Technology: What is the Federal Government’s Role? Commission on a High Performance Health System, The Commonwealth Fund. http://www.commonwealthfund.org/Publications/Fund-Reports/2006/Mar/Health-Information-Technology--What-Is-the-Federal-Governments-Role.aspx

2) Blumenthal, D. Stimulating the Adoption of Health Information Technology. New Engl J Med. Apr 9, 2009; 105(3):28-9. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1676868281&Fmt=7&clientId=17822&RQT=309&VName=PQD

Policy Analysis Exercise: Regulating Health Informatics Topics: What are the arguments for and against regulating health IT? What are the key contingencies? How do the arguments for/against regulation in health informatics differ from those for/against regulation in other sectors? Readings:

1) Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, Strom BL. Role of computerized physician order entry systems in facilitating medication errors. JAMA 293(10): 1197-203, 2005 Mar 9. http://jama.ama-assn.org/content/293/10/1197.full

2) Han YY, Carcillo JA, Venkataraman ST, et al. Unexpected increased mortality after

implementation of a commercially sold computerized physician order entry system. Pediatrics 2005;116:1506-1512. http://pediatrics.aappublications.org/content/116/6/1506.full

3) H. Singh, S. Mani, D. Espadas, N. Petersen, V. Franklin, and L. A. Petersen, “Prescription Errors

and Outcomes Related to Inconsistent Information Transmitted through Computerized Order


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Entry,” Archives of Internal Medicine 169, no. 10 (2009): 982-989. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919338/pdf/nihms131429.pdf

4) J. Walker, P. Carayon, N. Leveson, R. Paulus, J. Tooker, H. Chin, A. Bothe, and W. Stewart, “EHR Safety: The Way Forward to Safe and Effective Systems,” Journal of the American Medical Informatics Association 15 (2008): 272-277. http://171.67.114.118/content/15/3/272.full.pdf

5) F. Schulte and E. Schwartz, “FDA, Obama Digital Medical Records Team at Odds over Safety Oversight,” Huffington Post, August 3, 2010. http://huffpostfund.org/stories/2010/08/fda-obama-digital-medical-records-team-odds-over-safety-oversight

6) IOM Report Brief: Medical Devices and the Public’s Health. July 29, 2011: http://www.iom.edu/~/media/Files/Report%20Files/2011/Medical-Devices-and-the-Publics-Health-The-FDA-510k-Clearance-Process-at-35-Years/510k%20Clearance%20Process%202011%20Report%20Brief.pdf

7) Testimony of Jeffrey Shuren, Director of FDA’s Center for Devices and Radiological Health. Health Information Technology (HIT) Policy Committee Adoption/Certification Workgroup. February 25, 2010 http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_910717_0_0_18/3Shuren_Testimony022510.pdf


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Session #3 Policy Context Topics: What are the defining issues in U.S. healthcare? What is the cost of care in the U.S. and how does it compare to other nations? What drives high costs? How many people don’t have access to care (and for how many does cost play a role)? What are the best data on quality and safety of care? Readings:

1) Committee on Quality of Health Care in America. Institute of Medicine. Corrigan JM, Donaldson MS, Kohn LT, (eds). Executive Summary: Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001. http://site.ebrary.com/lib/umich/docDetail.action?docID=10032412&p00=crossing%20quality%20chasm%3A%20health%20system%2021st%20century

2) McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the

United States. N Engl J Med. Jun 26 2003; 348(26):2635-2645. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=351673051&Fmt=7&clientId=17822&RQT=309&VName=PQD

3) Gawande, A. The Cost Conundrum (how I lost friends in McCallen, Texas), New Yorker.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

4) Sisko A et al. National Health Spending Projections: The Estimated Impact of Reform Through 2019. Health Aff October 2010 vol. 29 no. 10 1933-1941. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2167658061&Fmt=7&clientId=17822&RQT=309&VName=PQD

Definitions, Levels of Adoption, and Barriers to Adoption Topics: What are the major technologies that comprise HIT? What is an electronic health record (EHR)? What functionalities must a system include to be called an EHR? Is there a difference between EHR and electronic medical record (EMR)? What is a Personal Health Record? What is Health Information Exchange? What are the rates of adoption and use of these systems? How does adoption vary across providers? What are the major barriers to adoption of HIT systems? Why have some organizations adopted while others have not? What are the main considerations when providers choose to adopt these systems to ensure successful implementation? Readings:

1) DesRoches CM, Campbell EG, Rao SR, Donelan K, et al. Electronic Health Records in Ambulatory Care--A National Survey of Physicians. N Engl J Med. Jul 3, 2008; 359(1):350-60. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1504831421&Fmt=7&clientId=17822&RQT=309&VName=PQD


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2) Jha AK, DesRoches CM, Kralovec P, et al.A Progress Report On Electronic Health Records In U.S. Hospitals Health Aff 2010 29:1951-1957; doi:10.1377/hlthaff.2010.0502. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2167658081&Fmt=7&clientId=17822&RQT=309&VName=PQD

3) Kahn JS, Aulakh V, and Bosworth A. What It Takes: Characteristics Of The Ideal Personal

Health Record. Health Aff. Mar-Apr 2009; 28(2): 369-76. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1672025201&Fmt=7&clientId=17822&RQT=309&VName=PQD

4) Miller RH, Sim I. Physicians' use of electronic medical records: barriers and solutions. Health Aff (Millwood). 2004 Mar-Apr;23(2):116-26. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=579316721&Fmt=7&clientId=17822&RQT=309&VName=PQD

5) Mostashari, F., M. Tripathi, et al. (2009). "A Tale Of Two Large Community Electronic Health Record Extension Projects." Health Aff 28(2): 345-356. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1672025171&Fmt=7&clientId=17822&RQT=309&VName=PQD

6) Simon, S. R., C. S. Soran, et al. (2009). "Physicians' Usage of Key Functions in Electronic Health Records from 2005 to 2007: A Statewide Survey." J Am Med Inform Assoc: M3081. http://jamia.bmj.com/content/16/4/465.full

7) Torda, P., E. S. Han, et al. (2010). "Easing The Adoption And Use Of Electronic Health Records

In Small Practices." Health Aff 29(4): 668-675. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2013981701&Fmt=7&clientId=17822&RQT=309&VName=PQD

8) Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. Health Affairs (Millwood). 2004 Jul-Aug;23(4):184-90. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=661524741&Fmt=7&clientId=17822&RQT=309&VName=PQD


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Session #4 HITECH and Meaningful Use of Electronic Health Records Topics: Given the evidence of the effect of HIT on quality and cost (discussed in prior session) how should policy be informed/designed? What is HITECH and how is it structured? What are the key components of HITECH? What providers are included? What are the primary goals of Meaningful Use? How will these goals be measured? Who is likely to be impacted? What is the process for EHR certification? What does certification accomplish? Readings:

1) Blumenthal, D. (2010). "Launching HITECH." N Engl J Med 362(5): 382-385. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1955840561&Fmt=7&clientId=17822&RQT=309&VName=PQD

2) Regional Extension Center Program Facts: http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=1835

3) Blumenthal, D. and M. Tavenner (2010). "The "Meaningful Use" Regulation for Electronic

Health Records." N Engl J Med: 1006-1114. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2102399491&Fmt=7&clientId=17822&RQT=309&VName=PQD

4) Jha AK. Meaningful Use of Electronic Health Records: The Road Ahead. JAMA. 2010.

http://jama.ama-assn.org/content/304/15/1709.full

5) Hogan, S. O. and S. M. Kissam (2010). "Measuring Meaningful Use." Health Affairs 29(4): 601-606. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2013981601&Fmt=7&clientId=17822&RQT=309&VName=PQD

6) Overview of EHR Certification Process: http://www.cchit.org/sites/all/files/GuideEHRCertification20101222.pdf

7) Specifics of EHR Certification Process: http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf (Pages 1-3 to get a flavor of the process and criteria)

8) Maxson, E., S. Jain, et al. (2010). "The Regional Extension Center Program: Helping Physicians Meaningfully Use Health Information Technology." Annals of Internal Medicine 153(10): 666-670. http://www.annals.org.proxy.lib.umich.edu/content/153/10/666.full.pdf+html


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Policy Analysis Exercise: Meaningful Use Topics: What are the implications of meaningful use to the key types of stakeholders? Readings:

1) Medicare and Medicaid Programs: Electronic Health Record Incentive Program. Final Rule (with comments and responses). July 28, 2010. Begin on Page 14 “C. Stage 1 Criteria for Meaningful Use” and read carefully through middle of Page 16. Then skim through page 68. http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf

2) More detail on “Meaningful Use.” Office of the National Coordinator for Health Information

Technology, Department of Health and Human Services. a. Overview:

http://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp#TopOfPage b. Stage 1 Meaningful Use Criteria for Eligible Professionals

http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf c. Stage 1 Meaningful Use Criteria for Eligible Hospitals

http://www.cms.gov/EHRIncentivePrograms/Downloads/Hosp_CAH_MU-TOC.pdf d. Medicare and Medicaid Incentives Program Overview:

http://www.cms.gov/EHRIncentivePrograms/35_Basics.asp#TopOfPage


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Session #5 HIT Impact: Safety Topics: Where does safety in U.S. health care stand? What makes HIT a compelling tool for improving safety? What is the evidence? How might HIT worsen the safety of healthcare? Readings:

1) Committee on Quality of Health Care in America. Institute of Medicine. Executive Summary (1-22) and 7. Using Information Technology (164-180): Crossing the Quality Chasm. Washington, D.C.: National Academy Press; 2001. http://www.nap.edu/openbook.php?isbn=0309072808

2) Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team

intervention on prevention of serious medication errors. JAMA. Oct 21 1998;280(15):1311-1316. http://jama.ama-assn.org/content/280/15/1311.full

3) Jha AK, Chan DC, Ridgway A, Franz C, and Bates DW. Improving Safety and Eliminating

Redundant Tests: Cutting Costs in U.S. Hospitals. Health Aff. Sep-Oct 2009;28(5):1475-84. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1864073311&Fmt=7&clientId=17822&RQT=309&VName=PQD

4) Parente, S. T. and J. S. McCullough (2009). "Health Information Technology and Patient Safety:

Evidence From Panel Data." Health Aff 28(2): 357-360. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1672025181&Fmt=7&clientId=17822&RQT=309&VName=PQD

5) Review Koppel et al. & Han et al. from Session #2 HIT Impact: Effectiveness and Efficiency Topics: Will adoption and meaningful use of HIT be a major driver in increasing efficiency (reduce costs) and improving the quality of the healthcare system? What are the best “estimates” of the financial impact of HIT on healthcare costs nationally? What are the limitations of these estimates? Does the evidence point to cost savings in the short and long run? Readings:

1. Hillestad R, Bigelow J, Bower A, et al. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff. 2005;24:1103-1117. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=899710741&Fmt=7&clientId=17822&RQT=309&VName=PQD

2. DesRoches, C. M., E. G. Campbell, et al. (2010). "Electronic Health Records' Limited Successes

Suggest More Targeted Uses." Health Aff 29(4): 639-646.


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http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2014389241&Fmt=7&clientId=17822&RQT=309&VName=PQD

3. Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente Electronic Health

Record: Transforming and Streamlining Modalities Of Care. Health Aff. Mar-Apr 2009;28(2):323-33. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1672025141&Fmt=7&clientId=17822&RQT=309&VName=PQD

4. Garg et al. Effects of Computerized Clinical Decision Support Systems on Practitioner

Performance and Patient Outcomes. JAMA 2005. http://jama.ama-assn.org/content/293/10/1223.full

5. McCullough, J. S., M. Casey, et al. (2010). "The Effect of Health Information Technology On Quality In U.S. Hospitals." Health Aff 29(4): 647-654. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2013981661&Fmt=7&clientId=17822&RQT=309&VName=PQD

6. O’Malley, A., J. Grossman, et al. (2009). "Are Electronic Medical Records Helpful for Care

Coordination? Experiences of Physician Practices." Journal of General Internal Medicine 25(3): 177-185. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2371758231&Fmt=6&clientId=17822&RQT=309&VName=PQD

7. The President’s Council of Advisors on Science and Technology (PCAST) report, “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward” http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf (Executive Summary and Sections II and III)


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Session # 6 HITECH and Health Information Exchange Topics: What does HITECH do to promote health information exchange? What are the issues around data standards, data exchange between organizations, and efforts like regional Health Information Organizations (HIOs)? How can health information exchange improve public health? How do standards get selected? Readings:

1) Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health

care information exchange and interoperability. Health Aff. Jan-Jun 2005 Web Exclusives: W5-10-W5-18. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=911043481&Fmt=7&clientId=17822&RQT=309&VName=PQD

2) Grossman JM, Kushner KL, November EA. Creating Sustainable Local Health Information Exchanges: Can Barriers to Stakeholder Participation be Overcome? Center for Studying Health System Change, February 2008. http://www.hschange.com/CONTENT/970/?topic=topic04

3) Adler-Milstein, J., D. W. Bates, et al. A Survey of Health Information Exchange

Organizations in the United States: Implications for Meaningful Use. Annals of Internal Medicine 2011; 154(10): 666-671. http://www.annals.org/content/154/10/666.full

4) Kuperman, G. J. Health-information exchange: why are we doing it, and what are we doing? J Am Med Inform Assoc. 2011. http://jamia.bmj.com.proxy.lib.umich.edu/content/18/5/678.full.pdf

5) Steve Lohr. “Seeing Promise and Peril in Digital Records.” New York Times. July 16, 2011.

http://www.nytimes.com/2011/07/17/technology/assessing-the-effect-of-standards-in-digital-health-records-on-innovation.html?scp=1&sq=%22electronic%20health%20record%22&st=cse

6) Health IT Standards Committee website: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__health_it_standards_committee/1271

Policy Analysis Exercise: State HIE Cooperative Agreement Program Topics: What are the goals of the State HIE Cooperative Agreement Program? What approaches are states taking to facilitate HIE? What shapes these approaches? What is Direct and what role might it play? Readings:

1) Please review the following website: http://directproject.org/

2) “The Direct Project Overview” http://wiki.directproject.org/file/view/DirectProjectOverview.pdf


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3) Please review the following website:

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__state_health_information_exchange_program/1488

4) Blumenthal, D. (2010). Requirements and Recommendations for the State Health Information Exchange Cooperative Agreement Programs. ONC, Washington DC. http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_0_5545_1488_17157_43/http%3B/wci-pubcontent/publish/onc/public_communities/a_e/arra/state_hie_program_portlet/files/state_hie_program_information_notice___final.pdf


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Session #7 Introduction to Consumer Health Informatics Topics: How do consumers feel about managing their health with IT? What are their actual behaviors? How can consumer engagement be increased? Readings:

1) Gunther Eysenbach (2000). Consumer health informatics. BMJ. 320: 1713. http://www.bmj.com/content/320/7251/1713.full

2) Grossman, J. M., T. Zayas-Cabán, et al. (2009). "Information Gap: Can Health Insurer Personal Health Records Meet Patients’ And Physicians’ Needs?" Health Affairs 28(2): 377-389. http://content.healthaffairs.org/content/28/2/377.full.pdf+html?sid=6bce4050-a36e-492e-8083-0b3af1144481

3) Silvestre, A.-L., V. M. Sue, et al. (2009). "If You Build It, Will They Come? The Kaiser Permanente Model of Online Health Care." Health Affairs 28(2): 334-344. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1672025161&sid=7&Fmt=4&clientId=17822&RQT=309&VName=PQD

4) Neupert, P. and C. Mundie (2009). "Personal Health Management Systems: Applying The Full Power Of Software To Improve The Quality And Efficiency Of Care." Health Affairs 28(2): 390-392. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1672025221&Fmt=7&clientId=17822&RQT=309&VName=PQD

5) Hawn, C. (2009). "Take Two Aspirin And Tweet Me In The Morning: How Twitter, Facebook, And Other Social Media Are Reshaping Health Care." Health Affairs 28(2): 361-368. http://content.healthaffairs.org/content/28/2/361.full.pdf+html?sid=aeb4be03-9e52-4aff-ace6-34d62eebb6e1

Key Regulations: Privacy and Security Guest Lecturer: Peter Jacobson Topics: What policies protect the privacy and security of personal health information? What are the key issues with respect to ensuring privacy and security of personal health information? Readings:

1) Summary of Selected Federal Laws and Regulations Addressing Confidentiality, Privacy and Security http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_911059_0_0_18/Federal%20Privacy%20Laws%20Table%202%2026%2010%20Final.pdf


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2) The Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10731_848088_0_0_18/NationwidePS_Framework-5.pdf

3) HIPAA – please review the following: a. http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html b. http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/privacysummary.pdf c. http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html d. http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/index.html

4) ONC: Building Trust in Health Information Exchange – Statement on Privacy and Security

http://healthit.hhs.gov/portal/server.pt?CommunityID=2994&spaceID=11&parentname=CommunityEditor&control=SetCommunity&parentid=9&in_hi_userid=11673&PageID=0&space=CommunityPage

5) ONC: Data Segmentation in Electronic Health Information Exchange (skim) http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_950145_0_0_18/gwu-data-segmentation-final.pdf

6) Dimitropoulos, L. and S. Rizk (2009). "A State-Based Approach To Privacy And Security For Interoperable Health Information Exchange." Health Aff 28(2): 428-434. http://content.healthaffairs.org/content/28/2/428.full.pdf+html?sid=6bce4050-a36e-492e-8083-0b3af1144481


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Session #8 HITECH and Health Reform: Accountable Care Organizations and Patient-Centered Medical Homes Topics: What are accountable care organizations and patient-centered medical homes? How do these support the goals of health reform? How does HITECH support health reform? What is the role of HIT in ACOs and PCMHs? How might HIT support payment reform? Readings:

1) Beeuwkes Buntin M, Jain SH, Blumenthal D. Health Information Technology: Laying The Infrastructure For National Health Reform. Health Affairs June 2010 29:61214-1219; doi:10.1377/hlthaff.2010.0503 http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2061804001&Fmt=7&clientId=17822&RQT=309&VName=PQD

2) Clancy, C. M., K. M. Anderson, et al. (2009). "Investing In Health Information Infrastructure:

Can It Help Achieve Health Reform?" Health Affairs 28(2): 478-482. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1672025351&Fmt=7&clientId=17822&RQT=309&VName=PQD

3) Fisher, E. S., D. O. Staiger, et al. (2006). "Creating accountable care organizations: the extended hospital medical staff." Health Affairs January 2007 26:1w44-w57 http://content.healthaffairs.org/content/26/1/w44.full

4) Fisher, E. S., M. B. McClellan, et al. (2009). "Fostering Accountable Health Care: Moving Forward In Medicare." Health Affairs 28(2): w219-231. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1865634431&sid=6&Fmt=4&clientId=17822&RQT=309&VName=PQD

5) Landon, B. E., J. M. Gill, et al. (2010). "Prospects For Rebuilding Primary Care Using The Patient-Centered Medical Home." Health Affairs 29(5): 827-834. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2037442611&Fmt=7&clientId=17822&RQT=309&VName=PQD

6) Bates, D. W. and A. Bitton (2010). "The Future Of Health Information Technology In The

Patient-Centered Medical Home." Health Affairs 29(4): 614-621. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2013981611&Fmt=7&clientId=17822&RQT=309&VName=PQD

7) Fernandopulle, R. and N. Patel (2010). "How The Electronic Health Record Did Not Measure Up To The Demands Of Our Medical Home Practice." Health Affairs 29(4): 622-628. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2013981621&Fmt=7&clientId=17822&RQT=309&VName=PQD

8) Maxson, E. R., S. H. Jain, et al. (2010). "Beacon Communities Aim To Use Health Information Technology To Transform The Delivery Of Care." Health Affairs 29(9): 1671-1677.


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http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2147669611&Fmt=7&clientId=17822&RQT=309&VName=PQD

Policy Analysis Perspective: Inside the Sausage Factory Guest Lecturer: Chuck Friedman


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Session #9 Federal Strategies to Engage Consumers in their Health through Information Topics: How does meaningful use promote consumer engagement? What is required to make this engagement successful? How does the success of new care delivery models depend on engaging consumers in their health (in particular, ACOs and shared decision making)? How is ONC reaching out to consumers to promote their engagement? Is their approach likely to be successful? Readings:

1) Preliminary description of ONC consumer HIT campaign: http://www.govhealthit.com/news/onc-plans-consumer-health-it-campaign

2) Consumer Consortium on eHealth – slides and meeting notes from most recent meeting (August 9, 2011): http://www.nationalehealth.org/uploadedFiles/Home/Initiatives/Consumer_Consortium_on_eHealth/Consumer%20Consortium%20Aug%209%20work%20group%20presentations.pdf?n=9511 (slides) and http://www.nationalehealth.org/uploadedFiles/Consumer%20Consortium%20Meeting%20Summary%20FINAL%20-%20081611.pdf?n=8340 (meeting notes)

3) Investing in Innovation: http://www.health2news.com/2011/06/08/hhs-and-the-office-of-the-national-coordinator-for-health-information-technology-introduce-new-investing-in-innovations-i2-initiative/

a. Example Challenge 1: http://www.health2news.com/2011/07/21/onc-and-nci-partner-to-launch-exciting-new-challenge/

b. Example Challenge 2: http://www.health2news.com/2011/08/22/announcing-the-aspr-facebook-challenge-apps-for-disaster-preparedness/

Policy Analysis Exercise: Consent – Opt-in/Opt-out Topics: Why is consent important and what role does HIPAA play? What are the various options for consent? What are the pros/cons of each? Readings:

1) HIPAA background on consent: http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/individualchoice.pdf

2) Consumer Consent Options for Electronic Health Information Exchange: Policy Considerations and Analysis

a. http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911198_0_0_18/Cov

erPageandExecutiveSummary032610.pdf

b. http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911197_0_0_18/ChoiceModelFinal032610.pdf (skim to get key ideas)


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Session #10 Introduction to Population Health Informatics Topics: How will HIT play a role in broader population-level challenges, such as biosurveillance and public health research? What is the role of HIT for national health data collection and how HIT might transform the way public health agencies collect and use data? How can the broader goal of improved population health be addressed by EHRs and HIE? How will meaningful use affect population health? Readings:

1) Loonsk JW, McGarvey SR, Conn LA, Johnson J. The Public Health Information Network (PHIN) Preparedness initiative. J Am Med Inform Assoc. Jan-Feb 2006;13(1):1. http://jamia.bmj.com/content/13/1/1.full

2) Yih WK, Caldwell B, Harmon R, et al. National Bioterrorism Syndromic Surveillance

Demonstration Program. MMWR Morb Mortal Wkly Rep. Sep 24 2004;53 Suppl:43-49. http://www.cdc.gov/mmwr/preview/mmwrhtml/su5301a10.htm

3) Lazarus R, Yih K, Platt R. Distributed data processing for public health surveillance. BMC

Public Health. 2006 Sep 19;6:235. http://www.biomedcentral.com/1471-2458/6/235

4) Grannis S, Wade M, Gibson J, and Overhage JM. The Indiana Public Health Emergency Surveillance System: Ongoing Progress, Early Findings, and Future Directions. AMIA Annu Symp Proc. 2006; 2006: 304–308. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839268/

5) Shapiro, J. S., F. Mostashari, et al. (2011). "Using Health Information Exchange to Improve

Public Health." American Journal of Public Health 101(4): 616-623. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2311639961&Fmt=7&clientId=17822&RQT=309&VName=PQD

6) Diamond, C. C., F. Mostashari, et al. (2009). "Collecting And Sharing Data For Population Health: A New Paradigm." Health Affairs 28(2): 454-466. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1672025331&Fmt=7&clientId=17822&RQT=309&VName=PQD

7) Friedman DJ. Assessing the potential of national strategies for electronic health records for

population health monitoring and research. Vital Health Stat 2. 2006 Jan;(143):1-83. http://www.cdc.gov/nchs/data/series/sr_02/sr02_143.pdf

8) Public Health Meaningful Use Criteria: http://www.cdc.gov/ehrmeaningfuluse/ (review each of

the three “Public Health Options” at the bottom of the page) Federal Public Health Initiatives at the Center for Disease Control Topics: What is the CDC doing with respect to informatics? How are they supporting other initiatives discussed in the course?


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Readings:

1) First, please review the following website that contains a high-level overview of CDC activities with respect to health informatics: http://www.cdc.gov/osels/ph_informatics_technology/index.html

2) Next, please select one of the domains under one of the three Divisions that is of interest to you

(domains will be listed on the left-hand sidebar when you click on the links below):

a. Division of Informatics Practice, Policy and Coordination http://www.cdc.gov/osels/ph_informatics_technology/informatics_practice.html

b. Division of Informatics Solutions and Operations http://www.cdc.gov/osels/ph_informatics_technology/diso/

c. Informatics Research and Development Unit

http://www.cdc.gov/osels/ph_informatics_technology/informatics_research_development.html

3) Finally, for the given domain (or particular initiative within that domain), please read about it

and be able to summarize it for the class. A not-so-interesting choice would be the “Help Desk” initiative under the Division of Informatics Solutions and Operations. A more interesting choice would be the “IRDU R&D lab” under the Informatics Research and Development Unit, but please don’t everyone pick this one! (FYI -- the IRDU R&D lab, and other initiatives you might find, will take you to a different website.)


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Session #11 Public Health Informatics: A Local Perspective Guest Lecturer: TBD (from Office for Public Health Preparedness, Michigan Department of

Community Health) Topics: What are the key public health issues in Michigan? How is informatics being used to improve public health in Michigan? What has been successful? What are the key challenges? What role does MDCH play in promoting public health informatics? How does MDCH work with other key stakeholders to promote public health informatics? Readings:

1) Michigan Disease Surveillance System (MDSS) & Michigan Syndromic Surveillance System (MSSS) http://michiganhealthit.org/meaningful_use/publichealth.aspx

2) Michigan Care Improvement Registry (MCIR) http://mcir.org/MeaningfulUse.html.

3) Michigan Health Alert Network (MIHAN) http://www.michigan.gov/mdch/0,4612,7-132-54783_54826_56166_56167-72730--,00.html

Policy Analysis Exercise: Shaping Public Health Informatics in Michigan Topics: We will take an issue or question currently facing the Office for Public Health Preparedness within the Michigan Department of Community Health related to public health informatics and develop/discuss proposed solutions. Readings: TBD


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Session # 12 Guest Lecturer: Chuck Friedman International comparisons: HIT in other developed nations Topics: Where do developed nations stand on the adoption and use of HIT? What activities have promoted progress in four leading countries: UK, Canada, Netherlands, and Australia? What setbacks and challenges have these countries faced? Readings:

1) Schoen C, Osborn R, Huynh PT, Doty M, Peugh J, Zapert K. On the front lines of care: primary care doctors' office systems, experiences, and views in seven countries. Health Affairs. 2006 Nov-Dec;25(6):w555-71. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2212248661&sid=8&Fmt=4&clientId=17822&RQT=309&VName=PQ

2) Hendy J, Reeves BC, et al. Challenges to implementing the national programme for information

technology (NPfIT): a qualitative study. BMJ. 2005:331, 331-336. http://www.bmj.com/content/331/7512/331.full

3) Ashish K. Jha, M.D., M.P.H. and David Blumenthal, M.D., M.P.P. Chapter 7: International

Adoption of Electronic Health Records. In Health Information Technology in the United States: Where We Stand, 2008 Princeton, NJ: Robert Wood Johnson Foundation, 2008. http://www.rwjf.org/files/research/3297.31831.hitreport.pdf (Starts on page 106)

4) Aarts, J. and R. Koppel (2009). "Implementation Of Computerized Physician Order Entry In

Seven Countries." Health Affairs 28(2): 404-414. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1672025241&Fmt=7&clientId=17822&RQT=309&VName=PQD

5) Schoen C, Osborn R, Doty MM, Squires D, Peugh J, Applebaum S. A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Affairs. Nov-Dec 2009;28(6):w1171-83. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2271184031&Fmt=7&clientId=17822&RQT=309&VName=PQD

International comparisons: HIT in developing and transitional nations Topics: What data exists on HIT activities in developing nations? What key evidence gaps need to be filled? What is the framework for thinking about how HIT might be adopted in developing and transitional nations? What impact might these systems have on critical issues such as access to basic care, quality of care, and safety of care? Readings:


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1) Feder, J. L. (2010). "Cell-Phone Medicine Brings Care To Patients In Developing Nations." Health Affairs 29(2): 259-263. http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1970293501&Fmt=7&clientId=17822&RQT=309&VName=PQD

2) Gerber, T. (2009). "Health Information Technology: Dispatches from The Revolution." Health

Affairs 28(2): w390-391. http://content.healthaffairs.org/content/28/2/w390.long


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Session # 13 Final Session: Congressional Testimonies Prepare for mock congressional hearing by reading the testimonies assigned to you and preparing questions.

Syllabus SI654 Fall 2011 FINAL - · School of Information 4376 North Quad Phone: (734) 615-7435...

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