Transcript Fitzmaurice_NetworkingHealthInformation_2006_0_18

Networking Health Information Technology
at AHRQ
GSA: Federal Health IT Initiatives--Enabling Collaboration
J. Michael Fitzmaurice, Ph.D.
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
April 18, 2006
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AHRQ’s Mission
Improve the quality, safety,
efficiency, and effectiveness of
health care for all Americans.
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AGENDA
 AHRQ and patient safety
 Investments in HIT for HC
 Data Standards Program
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Health Issues
 Costs continue to rise
– NHE is $1.9 trillion in 2004, growing at 7.9%
– CPI grew at 3.3 percent in 2004; GDP deflator at 2.6%,
– NHE/GDP is 16 %, up from 15.9% (2003); 9.1% (1980)
Smith,
C, et. al., “National Health Spending in 2004…,” Health Affairs (Jan-Feb, 2006)
 Quality of health care is not optimal
– Doctors provide appropriate health care only about half the
time for 30 acute and chronic conditions. Beth McGlynn, et al., N Engl
J Med, June 26, 2003
– 44 core national quality measures grew at 2.8 percent in
2004 and 2005. 2005 National Healthcare Quality Report, AHRQ, December 2005
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Health Issues
 Access improves and diminishes
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“Overall, more racial disparities in quality of care were narrowing than
were widening, and most racial disparities in access to care were
narrowing (affecting blacks, Asians and American Indians/Alaska
Natives). But for Hispanics, the majority of disparities for both quality
and access were growing wider.” 2005 National Disparities Report, AHRQ, December
2005 http://www.ahrq.gov/news/press/pr2006/nhqrdrpr.htm
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Largest problems
 lack of health insurance, lack of a primary care provider
 Patient Safety costs lives and resources
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Between 44,000 and 98,000 people die in hospitals annually due to
medical error. IOM, To Err is Human, 2000.
Often preventable hospital injuries and complications lead to
 More than 32,000 deaths, 2.4M extra days of care, and
 Costs exceeding $9B annually in US. C. Zhan & Miller (AHRQ), Excess
Length of Stay, Charges, and Mortality Attributable to Medical Injuries During Hospitalization,
JAMA, October 8, 2003
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Commonwealth Fund Survey
Medical Errors
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on
Commonwealth Fund Survey
Medical Errors
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In US, 34 percent of surveyed patients with health care problems reported
at least one of four types of errors:
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on
Experienced a medical mistake in treatment or care
Received the wrong medication or dose
Received incorrect results for a test
Experienced delays in notification about abnormal test results.
In US, 48 percent of surveyed patients who saw at least 4 doctors in the
past two years reported at least one of these errors
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National Coordinator for Health
Information Technology:
David Brailer, MD, PhD
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Appointed National Coordinator for HIT on May 6, 2004
Produced Framework for Strategic Action on July 21, 2004
Reported on Responses to ONCHIT’s RFI— June 3, 2005
Secretary created AHIC – his federal advisory committee
Developed/coordinated 4 NHIII contracts by November 2005
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Standards Harmonization—ANSI/HIMSS
$3.3M
Privacy and Security (AHRQ)—RTI
11.5M
Compliance Certification-CCHIT
2.7M
NHIN Architecture—Accenture, CSC, IBM, Northrop Grumman 18.6M
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AHRQ HIT Program Funding
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One of 4 NHII Contracts
 Privacy and Security (AHRQ-ONCHIT)
– Research Triangle Institute for $11.5 M
 National Governor’s Association, a partner
– To identify privacy and security barriers, restrictions,
and enablers to the development of interoperable
systems at the state and regional levels
– Focus on state privacy laws and business practices
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Medicare Modernization Act
Requires eRx Pilots
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4 awards totaling $6M, January 17, 2006, Administrated by AHRQ & CMS
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Test eRx systems of data standards for how efficiently and effectively eRx
information can be transmitted to and from providers and pharmacies
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To reduce adverse drug events and improve appropriate use of medications
To enable providers to obtain formulary information and medication history
To test new ways of naming clinical drugs and their ingredients, and providing patient
instructions
To assess workflow changes for pharmacies and physicians’ offices.
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Initial standards + 3 eRx foundation standards
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Contractors and site locations
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Do they work together?
Report due to Congress: April 2007
Rand Corporation-New Jersey
Brigham and Women’s Hospital-- Boston
SureScripts—
Florida, Mass., Nevada, New Jersey, Tenn.
Achieve Healthcare Information Technology-Minnesota
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AHRQ Grants
Transforming Healthcare Quality
 AHRQ Planning Grants
– $7M for 35 new grants; $5M for 28 grants to rural and small communities
– For HC systems and partners to plan to implement HIT to promote patient safety and quality of care
 AHRQ Implementation Grants
– $19M for 40 new grants’ $12M for 25 grants rural and small hospitals
– To evaluate the measurable and sustainable effects of HIT on improving PS & QC.
– 50% cost sharing; Maximum 20% of federal funds for software and hardware
 AHRQ Demonstrating the Value of HIT Grants
– $12M for 24 new grants; $2M for 4 rural grants
– To increase the knowledge and understanding of the value of HIT
 Clinical, safety, quality, financial, organizational, effectiveness, efficiency
 6 State Contracts
– Identify and support statewide data sharing and interoperability activities.
– $1M/yr for 5 years—each: IN, UT, TN, CO, RI, DE (2005)
 National Resource Center for HIT
– NORC for $18.4 M over 5 years to support AHRQ HIT grantees and contractors
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AHRQ
 16 grants for implementation of HIT projects awarded in
November 2005
– 11 in rural areas $22.3 M over 3 years
 Result of 35 planning grants awarded in FY 2004
 They “will seed and nourish the work already under way in
regions and communities across the nation to improve the
safety, quality and efficiency of health care.” (Janet Marchibroda,
November 14, 2005)
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AHRQ Patient Safety Health Care IT
Data Standards Program
 Funding: $10 Million in FY 04 to AHRQ, and in FY 2005
 Received advice from
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Secretary of HHS -- HHS NHII Office
NCVHS -- CAHIT -- CHI -- IOM
Federal standards and program experts
Private sector (Markle Foundation, eHI, WEDI, AMIA, others)
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Drug terminologies
Patient safety event reporting
Meta-data registry
eRx
Knowledge representation
-- SNOMED mapping
-- Landscape
-- NCVHS/CHI standards’ gaps
-- Others
70 percent went to standards to help reduce adverse drug events
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AHRQ Patient Safety
Data Standards Program
 Drug Terminology Development and Mapping
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FDA
NLM
4.600 M
1.150 M
4.000 M
1.150 M
 Nomenclature and Mapping
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NLM
2.100 M
2.400 M
 Device Nomenclature
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FDA
.300 M
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 Patient Safety Reporting Standards
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AHRQ .500 M .400 M
 USHIK (Meta-data Registry)
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CMS
.300 M
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 Standards Landscape
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NIST
.300 M
.300 M
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Drug Safety
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Health System Improvement:
Case Study
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Drug information takes too long, small print, hard to find
Drug labeling information
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FDA Approval
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Drug package insert of labeling information
Information location
Physicians Desk Reference
Access by information vendors
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Goes back to manufacturer, and back to FDA till approved
Public Awareness
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Submission in paper form to FDA
Frequent contact with manufacturers
National Drug Codes
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Some re-used, compresses 11 digit code into 10 digits
Delayed receipt of drug codes by FDA from manufacturer
Re-labelers assign codes too
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AHRQ-Funded PS Standard System
 Electronic Product Listing System (ELIPS)—an inventory of drug
products marketed in US
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FDA adopted the HL7 standard for the exchange of product labeling information
called Structured Product Labeling (SPL).
Used by the pharmaceutical companies for providing not only the content of
labeling found in the package insert but also descriptive information on the
medicinal product including:
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Proprietary product name and code
Non proprietary name
Ingredient name(s) and Unique Ingredient Identifier(s) (UNII) and strength
Dosage form
Route of administration
Packaging configurations and codes
FDA will begin directly assigning National Drug Codes to new drugs
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Improving Patient Safety
AHRQ
Data Standards Program
SPL-RxNorm
DailyMed
Web
Site
Pharmaceutical
Manufacturer
SPL
Drug label
Information
Contraindications Allergies
FDA
Approval
SPL
NLM
RxNorm Link
Standards
ELIST
HL7-SPL NDC
SRS--UNII
RxNorm
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AHRQ-Funded PS Standard System
 Substance Registration System
– Develop SRS
– Develop unique ingredient identifiers (UNII)
 To identify active and inactive ingredients
 To be used in ELIST and ELIPS
– Product: Data Base for
 NLM distribution via DailyMed
 Health information suppliers
 Public access
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AHRQ-Funded PS Standard System
 RxNorm--National Library of Medicine
– Standard names for
 US prescription drugs
 OTC drugs with L.E. 3 active ingredients
 Selected biologics (i.e., vaccines)
– Linked to
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Active ingredients
Strengths
Dose forms
Dose forms as administered
Related brand names
NDC’s
– Available to the public on NLM’s DailyMed web site
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AHRQ-Funded PS Standard System
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Mapped to RxNorm from the terminology of
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VA’s National Drug File
First DataBank
Medispan
Micromedix
Multim
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End Result
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AHRQ’s funding has paved the way to:
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Accelerate development of terminology content
Provide for more frequent updates than quarterly
Expand RxNorm to cover
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OTC drugs
Related products (e.g., vitamins)
More complete mapping: RxNorm and drug info vendors
Training and support mechanisms
Make this information publicly available
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Interoperability Partnership
 AHRQ
– Patient Safety
– Data Standards Program funding
 FDA
– System Specification and Development
 HL7 SPL standard
– Regulatory changes that are essential
 NLM
– Vocabulary expertise
– Accurate drug information linking (RxNorm)
– DailyMed web site
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Patient Safety and Quality Improvement Act
of 2005 (P.L. 109-41)
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Signed into law: July 29, 2005 It encourages health care providers to contract with
one or more HHS-accepted Patient Safety Organizations (PSOs) to
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Collect and analyze data on patient safety events (including “near misses”, “close calls”,
and “no-harm” events)
Develop and disseminate information to improve patient safety and to provide feedback
and assistance to effectively minimize patient risk
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Provides Federal privilege and confidentiality protections against disclosure of
information that is collected or developed pursuant to a provider contract
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Creates a network of patient safety databases
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Accept, aggregate across the network, and analyze non-identifiable patient safety work
product[s] voluntarily reported by patient safety organizations, providers, or other entities
Analyze national and regional statistics, including trends and patterns of health care errors
http://www.gpoaccess.gov/plaws/
( “Public Law 109-41”)
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How to Proceed?
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How many states are collecting PSE data?
Who reports?
For what events is reporting mandatory?
What data are states collecting in their PSE reporting
systems?
Are these elements standardized and categorized?
Are they analyzed?
When will PSO’s be designated?
What data standards are needed?
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Patient Safety Improvements
 More timely information to providers and consumers
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More frequent updates of drug information
Faster dissemination of new drug information
More legible information to consumers
Reduced costs of supplying package inserts
 Standardized, accurate, linkable information base for
information vendors
 Information source for decision support systems
 Unique drug identifiers—NDC codes, RxNorm
 National leadership in PS event reporting
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Networking Health Information Technology
at AHRQ
GSA: Federal Health IT Initiatives--Enabling Collaboration
J. Michael Fitzmaurice, Ph.D.
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
April 18, 2006
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