Transcript Healthcare Information Technology

HealthCare Information
Technology
Blackford Middleton, MD, MPH, MSc
Director, Clinical Informatics Research & Development
Chairman, Center for IT Leadership
Overview
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What is Health IT?
How Does Health IT impact healthcare?
What is the Evidence-base for HIT?
What is the Promise of HIT?
Where do we stand on HIT Adoption?
What is the Potential Value of HIT?
How is Health IT Policy Derived Today?
What are Policy Options to Stimulate HIT?
Possible focus areas to move the ball
What is Health IT?
 Hospital – many systems
 Computer-based Provider Order Entry (CPOE)
 Electronic Medication Administration Record (eMAR)
 Clinical Data Repositories
 Ancillary Systems (Lab-chemistry, Lab-micro, Blood Bank, Radiology,
Pharmacy, Pathology, etc.
 Devices: Smart Pumps, Ventilators, EKG, ABGs…
 Financial: Revenue-cycle Management
 Clinic
 Electronic Health Records (Electronic Medical Records)
 Practice Management System
 Patient
 Personal Health Records
 Payors – also may have PHRs
 Free-standing (community): any of the above
How Does Health IT impact
healthcare?
 Information management and processing
 Making the bill
 Processing specimens (ancillary departments)
 Information access
 Hospital information systems, EMRs
 Data analysis -- financial
 Data analysis – clinical operations/research
 Clinical Decision Support
 Information exchange
How Does HIT Improve Healthcare?
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Clinical Processes
 Streamline, structure order process
 Ensure completeness, correctness
 Supply patient data
 Charge display
 Redundant test reminders
 Structured ordering with counterdetailing
 Consequent or corollary orders
Other EMR Process Benefits
 Reduced transcription costs
 Reduced chart pulls
 Improved clinical messaging and
workflow
 Improved charge capture and accounts
receivable
 Improved referral coordination
 Improved patient communication and
service
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Medication Utilization
 Perform drug interaction checks
 Check for duplicate medications
 Brand to generic substitutions
 Calculate and adjust doses based upon
age, weight, renal function
 Alternative cost-effective therapies
 Formulary compliance
 Indication-based ordering
How does healthcare information
exchange impact the bottom line?
 Largely, TBD…
 Expected effects
 Reduced healthcare information management labor
costs
 Reduced duplicative tests and procedures
 Reduced fraud and abuse
 Improved service delivery efficiency
 Improved patient convenience
 Reduced medical error
What is the Promise of HIT?
Beta blocker after AMI
Breast cancer screening
Cervical cancer screening
Cholesterol screening
Cholesterol after AMI
LDL < 130 after AMI
Colorectal cancer screening
Diabetes: HgbA1c done past year
Before
Diabetes: Adequate control
After
Diabetes: Cholesterol measures
Diabetes: Cholesterol controlled
Diabetes: Eye Exam
Diabetes: Renal Exam
Hypertension: BP <= 140/90
Flu shot (over 65)
Pneumococcal vaccine (over 65)
Mental health followup after discharge
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Data Source: Thomson TG, Brailer DJ. The Decade of Health Information Technology: Delivering Consumer-centric and
Information-rich Health Care. Washington, DC: US Department of Health and Human Services; 2004.
100%
Physicians Recognize Value of EMR
• EMR viewed as part of the answer but adoption stuck at 4% for full
functionality (13% basic functionality)1
Positive Survey
Responses
✓
✓
✓
✓
✓
1DesRoches
CM et al. N Engl J Med 2008;359:50-60
EHR Functionality Use by Practice Size
Use of the following: prescription orders, lab orders and viewing, radiology tests
and results viewing and clinical notes
Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record
Keeping among Physicians & Group Practices in the United States, Preliminary Data
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Major Barriers to EHR Adoption
Percent of physicians reporting a “major barrier”
Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record
Keeping among Physicians & Group Practices in the United States, Preliminary Data
How Does HIT Save Money?
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EHR Effects
 Completeness, correctness, decision support, formulary, brand to generic,
duplicate/redundant meds and tests, charge display
 Workflow support, messaging (pt/provider), referral, A/R, team
CPOE Effects
 Reduction in hospitalization/LOS due to ADEs, clinical decision support
HIEI Effects
 Reduction in unnecessary and redundant tests and procedures
 Labor cost savings
Telehealth Effects
 Reduction in patient transport, utilization of hospitals, and physician office visits
PHR Effects
 Administrative time savings
 Reduction in hospitalizations and physician visit utilization
 Improved medication safety
www.citl.org
 Reduction in redundant laboratory tests
CITL HIT Value Assessments
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Net US could save $150B with HIT adoption, or
approximately 7.5% or US Healthcare Expenditure
 The Value of Ambulatory Computerized Order Entry (ACPOE)
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The Value of HealthCare Information Exchange and
Interoperability (HIEI)
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$8.3B Disease Registries; Advanced EHR $17B
The Value of Physician-Physician Tele-healthcare
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$78B/yr
The Value of IT-enabled Chronic Diabetes Management
(ITDM)
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$44B US nationally; $29K per provider, per year
>$20B*
The Value of Personal Health Records
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Approx. $20B
• CITL: 89% of the benefit of EMR adoption does not go to Providers1
www.citl.org
Health Aff (Millwood). 2005;24(5):1269-72.
2Middleton B.
A public-private “Community” was established to serve as
the focal point for America’s health information concerns
and drive opportunities for increasing interoperability
Clinical/Professional Societies
State
Leg.
NGA
Certification
Commission
for Healthcare
Information
Technology
(CCHIT)
American
Health
Information
Community
(AHIC 2.0)
Congress
Vendor
Groups
HIMSS
Healthcare
Information Technology
Standards Panel
(HITSP)
The
Health Information
Security & Privacy
Collaboration
(HISPC)
AMIA
NCVHS
Nationwide Health
Information
Network Architecture
Projects (NHIN)
AHIMA
Advocacy
Groups
The Community is a federally-chartered commission and will provide input and
recommendations to HHS on how to make health records digital and
interoperable, and assure that the privacy and security of those records are
protected, in a smooth, market-led way.
What are Policy Options to Stimulate
HIT?
 Standards acceleration/harmonization, certification
 HITSP, CCHIT
 Incentives for adoption (CMS pilot)
 Grants and loans, tax credits, other subsidies
 Reimbursement incentive
 NHIN re-usable technologies
 ONC NHIN demos
 Clinical decision support knowledge repository
 AHRQ
 IT Workforce training
 AMIA 10x10, HIMSS
 HIT comparative effectiveness research
 AHRQ, ONC, NLM