Transcript Arkansas - Demographics

HIT and Accountability: Is There a
New Practice Model in Your Future?
William E. Golden, MD FACP
Professor Of Medicine and Public Health, UAMS
Vice President, Quality Improvement, AFMC
Chair, Board of Regents, ACP
Past Director, National Quality Forum
PreQuiz
You go an ATM and
ask for $100.
You Receive $80.
1.
2.
3.
The most appropriate
response:
4.
Nothing – Its OK
It was a reasonable
mistake
Discuss with
management
###***!!!
Second Question
Your aunt goes to the ER
with an acute MI.
She does not receive an
aspirin and a beta
blocker and is sent home
with an LVEF of 25%
1.
2.
3.
4.
The most appropriate
response:
Nothing – Its OK
It was a reasonable
mistake
Discuss with
management
###***!!!
Women’s Health in AR
Pap Smears
 Mammograms
 Chlamydia Testing

Some Is Not a Number
Soon Is Not a Time
© 2004 Institute for Healthcare Improvement
Measuring Provider Efficiency 1.0
http://leapfroggroup.org/news/leapfr
og_news/345254
The Leapfrog Group
Bridges to Excellence
Purchaser Paradigm
Costs
HL
HH
LL
LH
Quality
What Consumers Believe
Information Will Reform the System
 The Market Will Fix Bad Performance

National Voluntary Hospital Reporting
Initiative
Role of Public Data
Valuable to Trustees, Corporate Leaders
 Motivates Investment
 Changes Metrics of Job Evaluations
 Used by the Public?

Program Attributes
Actionable
 Operational and Feasible
 Fair
 Credible and Reliable
 Equitable

Provider Report Cards
Statewide Values
 Practice Specific Information
 Prelude to P4P?

PCPI: Physician Performance Measurement Sets
Adult Diabetes1
Asthma
Chronic Obstructive Pulmonary Disease
Community-acquired Bacterial Pneumonia
Coronary Artery Disease2
Heart Failure2
Hypertension2
Major Depressive Disorder
Osteoarthritis of the Knee3
Prenatal Testing
Preventive Care and Screening Measures:
Colorectal Cancer Screening
Influenza Immunization, Adult
Screening Mammography
Problem Drinking
Tobacco Use Cessation
1 subset of Alliance
2 with ACC & AHA
3 with AAOS
National Quality Forum (NQF)
Public Private Collaboration
 National Steering Committee
 Four Membership Councils

 Providers,
Consumers, Research/QIO,
Purchasers
Strategic Framework Board
 Funded Projects

Clinical Quality Measures
The Challenge. . .
Physicians’ Views on Quality of Care:
Findings from the Commonwealth Fund
National Survey of Physicians
and Quality of Care
Anne-Marie J. Audet, Michelle M. Doty,
Jamil Shamasdin, and Stephen C. Schoenbaum
May 2005
Chart I-1. Use of Information Technologies
Percent indicating “routine” or “occasional” use
100
Yes, used occasionally
80
79
6
Yes, used routinely
58
60
21
40
73
20
37
27
27
9
9
18
17
0
Electronic Electronic
24
28
18
18
21
6
7
Clinical
E-mail
E-mail
with
with
Doctors
Patients
Electronic
Access
Billing
to Test
Medical
Ordering * Decision
Results
Records
Support
* Electronic ordering of tests, procedures, or drugs.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
14
3
Chart II-3. Physicians’ Access to
Patient Panel Data, by Practice Size
Percent indicating “very/somewhat” easy to generate lists of patients by
100
1 Physician
2–9 Physicians
10–49 Physicians
50+ Physicians
75
50
39
46
46
45
27
27
22
25
12
12
20
12
12
0
Diagnosis/Health Risk
Lab Results
Current Medications
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart IV-1. Coordination of Care Problems
Physicians Observe
Coordination of care problems
Percent who
observed problem
sometimes or often
in past 12 months
Patient’s medical record, test results, or other relevant clinical
information were not available at the time of the scheduled visit
72%
Tests or procedures had to be repeated because findings were
unavailable or inadequate for interpretation
34%
Patient experienced a problem following discharge from a hospital because
physician did not receive needed information from the hospital in a timely manner
26%
Patient’s care was compromised because he/she received conflicting
information from different doctors or other health professionals
28%
Patient had a positive test result that was not followed-up appropriately
15%
Patient received the wrong drug, wrong dose, or had a preventable
drug-drug interaction
11%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
WWW.DOQ-IT.ORG
HIT

Arkansas a DOQ-IT Demo State
 ~175
Clinical Sites
8th SOW – HIT in Home Health,
Hospitals, Physician Offices
 Limited Access to Broadband
 Financing, Standard, etc

Current Status of HIT
Computers absent in patient care areas
 Orders for meds, lab tests, radiology still
on paper
 Lack capability for immediate,
automated results
 No intranet communication capability
 Fragmented “stove-pipe” systems

Standardization
AHIC – Health Information Community
 ONCHIT – National Coordinating Office
 CCHIT – Certification Process
 eHI – e Health Initiative

Costs
Hardware
 Software
 Training
 Delays during initial
implementation
 Delays during learning curve

Culture Change

An organization that succeeds…
 Greets
quality measurement with
enthusiasm
 Views change as an opportunity
 Embraces accountability
 Regards performance improvement as an
everyday activity
 Recognizes that HIT implementation is an
organizational change, not an IT project
HIT in Arkansas Hospitals

Of the 81 hospitals surveyed:
 31%
plan to implement HIT <3 years
 .02% have implemented CPOE
 .08% have implemented EHR
 .04% have implemented barcoding
HIT: Home Health Agencies

Of the 170 agencies surveyed:
 14%
plan to implement HIT < 2 years
 13% have implemented an EHR
 .04% have implemented telemonitoring
Where Do All The Data Go?
Who are the Stewards?
The National Vision
A network of interoperable systems
linking clinical, public health and
personal health information that
providers could easily access to more
effectively diagnose, treat and
manage quality care.
Health Information Exchange
(HIE)

Stakeholder Interest Group
 Met
Quarterly
 AHA, AMS, AHCA, DHHS, QualChoice,
Blue Cross,
 Recognized Need for Formal Structure
 “Next Steps” Document in Preparation

NGA RFP
 Legal
Issues Related to HIE
Potential Model for Progress
Figure 1 HIE Committee Structure
Stakeholder
Steering
Committee
Workgroups
Implementation
v
v
v
Work Plan
Training
Support
Technology
v
v
v
Architecture
Applications
NHIN Compliance
Finance
v
v
v
Capital
Sustainability Plan
Network Fee
Structure
Legal/Regulatory
v
v
v
Privacy/Security
Data Usage
Operating
Standards
Contact Information
To find out more, please call us:
Arkansas Foundation for
Medical Care
(877)375-5700