Effects of Health Information Technology on Ambulatory Care: Results from New York State Lisa M....
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Effects of Health Information Technology on Ambulatory Care: Results from New York State Lisa M. Kern, MD, MPH Associate Professor of Public Health and
Effects of Health Information Technology on Ambulatory Care:
Results from New York State Lisa M. Kern, MD, MPH Associate
Professor of Public Health and Medicine, Weill Cornell Medical
College Deputy Director, Health Information Technology Evaluation
Collaborative HITEC
Slide 2
What is Unique about Health IT in New York State? The
Healthcare Efficiency and Affordability Law for New Yorkers (HEAL
NY) $250 million investment in interoperable EHRs began in 2005
With additional matching funds Focused around communities 8 times
larger than the next largest state based investment 2
Slide 3
Why Evaluate? HIT is not just one intervention. Software,
hardware, configuration, training, users and compliance can all
vary across implementation efforts. Understanding what works, what
does not and why is critical for shaping future implementation
efforts. Standardizing evaluations maximizes the lessons learned.
3
Slide 4
Health Information Technology Evaluation Collaborative (HITEC)
Academic collaborative across 4 universities in New York State
Established to conduct rigorous, independent evaluations of New
Yorks health IT initiatives Directed by Drs. Rainu Kaushal, Lisa
Kern and Jessica Ancker 4
Slide 5
Overview of 4 Early Studies 1.An organizational survey of HEAL
1 grantees Funded by the Commonwealth Fund 2.Electronic prescribing
and medication safety Funded by the Agency for Healthcare Research
and Quality (AHRQ) 3.Electronic laboratory result viewing and
quality Funded by AHRQ 4.Development of quality metrics for
interoperable EHRs Funded by AHRQ 5
Slide 6
1. HITEC Survey of HEAL 1 Grantees Organizational assessment of
HEAL 1 grantees At baseline and follow-up (2 years after award
announcement) 100% response rate 100% of grantees still existed
100% implementing or attempting to implement interoperable health
IT Kern, Barrn, Abramson, Patel, Kaushal. Health Affairs. 2009
6
Slide 7
HEAL 1 Grantees with Various Project Goals and the Presence of
Users at Follow-up (N = 26) 26 9 22 17 13 9 17 12 8 Kern, Barrn,
Abramson, Patel, Kaushal. Health Affairs. 2009 7
Slide 8
8 Policy Implications 1.Financial sustainability is a major
concern, despite HEAL NY funding. 2.Concerns about technical issues
and workflow integration are high. 3.Communities require long
periods of time to adopt health IT and HIE. 4.New York State
considered organization and governance to be extremely
important.
Slide 9
2. Electronic Prescribing: Overview Aim: To compare the effects
of 2 e-prescribing applications (stand-alone and integrated into an
EHR) on medication errors Versus paper-based prescribing Design:
Prospective cohort study (pre-post) with concurrent controls Sample
sizes: 78 primary care physicians 13,596 patients 9,452
prescriptions 5,968 medication errors Kaushal, Kern, Barrn,
Abramson. J Gen Intern Med 2010 March. 9
Slide 10
Electronic Prescribing: Results Errors per 100 prescriptions
37.3 38.4 42.5 6.6 26.0 16.0 * * P < 0.001 10
Slide 11
Policy Implications Prescribing errors are very common Stand
alone e-prescribing versus integrated into an EHR 11
Slide 12
3. Electronic Laboratory Result Viewing Aim: To determine any
associations between use of an electronic portal for result viewing
and quality of care Design: Prospective cohort study of 168 primary
care physicians Kern, Barrn, Blair, Salkowe, Chambers, Callahan,
Kaushal. J Gen Intern Med. 2008. 12
Slide 13
3. Electronic Laboratory Result Viewing: Results Electronic
laboratory result viewing was associated with higher quality of
care Adjusted OR in baseline, cross-sectional study: 1.25 (95% CI
1.003 1.57) Adjusted OR in longitudinal study: 1.42 (95% CI 1.04
1.95) Longitudinal study adjusted for the physicians baseline
quality of care Kern, Barrn, Blair, Salkowe, Chambers, Callahan,
Kaushal. JGIM. 2008. 13
Slide 14
Policy Implications Push versus pull provision of clinical
information Push 14
Slide 15
Policy Implications Push versus pull provision of clinical
information Pull 15
Slide 16
4. Quality Metrics for Capturing the Effects of
Interoperability Aim: To develop a set of electronically reportable
quality metrics that capture the expected quality effects of
interoperable EHRs Methods: Literature search Two rounds of
quantitative rating of metrics 36-member national expert panel
Kern, Dhopeshwarkar, Barrn, Wilcox, Pincus, Kaushal. Jt Comm J Qual
Patient Saf, 2009. 16
Slide 17
4. Quality Metrics for Capturing the Effects of
Interoperability Results: Of 1,064 existing metrics, we selected 18
top-scoring metrics We developed 14 novel metrics Focusing on the
portion of quality that overlaps with utilization Lessons learned
have implications for the current national discussion. Kern,
Dhopeshwarkar, Barrn, Wilcox, Pincus, Kaushal. Jt Comm J Qual
Patient Saf, 2009. 17
Slide 18
18 Conclusion Health IT has never been more important Very
large national investment in interoperable EHRs Value hasnt been
clearly demonstrated Best policies for implementation and support
have not been determined. New York States experiences will be
extremely useful in informing national directions.