Efforts to Assist Providers and Patients In Using Health IT for High Quality Care

Session #158, February 22, 2017

Thomas A. Mason, MD, Chief Medical Officer

Lisa-Nicole Sarnowski, Acting Deputy Director, Office of Programs & Engagement

Speaker Introduction

Thomas Mason, MDActing Director of Clinical Quality & Safety,

Chief Medical Officer

2

Lisa-Nicole (Danehy) Sarnowski, MHS Acting Deputy Director,

Office of Programs and Engagement

Conflict of Interest

Thomas A. Mason, MD

Lisa-Nicole Sarnowski, MHS

Has no real or apparent conflicts of interest to report.

3

Agenda

• Overview of the Health IT Landscape

• Consumer eHealth & Empowerment

• Commitment to Assisting Providers

• Available Tools & Resources

4

Learning Objectives

• Describe available

resources for patients and

consumers to assist in

improving how care is

being delivered using

health IT

• Describe available

resources for providers to

assist in improving how

care is being delivered

• Identify specific ways

providers and patients

are using health IT as

partners in care

• Engage consumers,

clinicians, and providers

on what they need from

ONC/Federal Partners

with regards to

tools/resources

5

Commitment to Helping Providers and Patients Realize the Benefits of Health IT

6

Historic Context: Office of the National Coordinator for Health IT (ONC)

• Created in 2004 by executive order by President Bush

• Legislatively mandated in the Health Information Technology

for Economic and Clinical Health Act (HITECH Act) of 2009

President Bush’s goal in 2004

“...an Electronic Health Record for every

American by the year 2014. By computerizing health

records, we can avoid dangerous medical mistakes,

reduce costs, and improve care.”

State of the Union address

Jan 20, 2004

7

Historical Programs

8

Sources:

1. GAO, Electronic Health Records: Number and Characteristics of Providers Awarded Medicare Incentive Payments for 2011-2012,

GAO-14-21R (Washington, D.C.: October 24, 2013)

2. Heisey-Grove, Dawn M. "Variation in rural health information technology adoption and use." Health Affairs (2016): 10-1377.

Historical Programs: Sample Successes

• Community HIE grantees

partnering with National CDC

Early Hearing Detection and

Intervention program

• 21,000+ health IT workforce

students trained through 2013

• 20 health IT curriculum

components developed;

over 20,000 downloads

• Technical assistance through REC

program to help 145,000+ providers

meet Stage 1 meaningful use criteria

» Medicare providers working with RECs

were over 1.9x more likely to receive an

EHR incentive payment then those who

were not partnered with an REC1

» Technical assistance from a REC strongly

associated with meaningful use

achievement among rural providers2

9

Progress in the HITECH Era

Possession of certified EHR:

2008* - 17% of physicians and 9% of hospitals

2015 - 78% of physicians and 96% of hospitals

*Data on Basic EHRs only10

Engaging Patients with Health IT: Office-Based Physicians

Percent of physicians that have electronic capabilities to exchange secure messages with patients and for patients to view, download and transmit their online medical record, 2015

Source: https://dashboard.healthit.gov/quickstats/pages/physicians-view-download-transmit-secure-messaging-patient-

engagement.php

11

24%

14%

40%*

28%*

12% 10%

91%*

82%*

66%* 64%**

95%*

87%*

71%* 69%*

0

20

40

60

80

100

View Download Transmit View, Download, andTransmit

Perc

en

tag

e

2012 2013 2014 2015

More Hospitals than Ever Making Information Available Electronically to Patients

* Significantly different from previous year (p < 0.05) data regarding

“Transmit” and “View, Download, and Transmit” were not collected in 2012.

Source:

ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement: 2012-2015.

12

Patient Engagement Beyond VDT

Electronic capabilities

offered by non-federal

acute care hospitals to

their patients (excluding

view, download, and

transmit), 2013-2015

Notes:

Questions regarding secure

messaging were not asked in 2013.

*Significantly different from

previous year (p < 0.05).

Source:

: ONC/American Hospital Association

(AHA), AHA Annual Survey

Information Technology

Supplement: 2012 – 2015.

13

Many Players, Many Challenges in Information Exchange

• Process different for each doctor or specialist

• Patients surprised by complexity of process

• For caregivers, information gathering is a

full-time job, particularly for chronically ill

patients

• Requests may not be received or handled

correctly, meaning medical records often not sent

• Lack of understanding and/or clarity

around HIPAA can cause delays

There are real financial and health consequences to the difficulty in getting medical records from providers.

14

“It felt like a bad scavenger hunt.”

- Patient

“…it was a web of insanity.”

- Caregiver

Data Access & Use: A Patient’s View

Findings

• Patients enjoy having portal access

• Become invested in tracking their health

• Over time, they use more portal features

(labs, appointments, email, Rx)

• Told fax/email is only way to send or

receive information

• Data fractured across different portals

• Patients don’t proactively try to get their

records together

Strategies

1. Address unnecessary

paper creation

(human-created issue)

2. Medical community &

patient community

partnership in

e-system of sharing

focused on patient care

& outcomes

15

Address Patient Experience from Start to Finish

Getting a second opinion on treatment options

Create a new appointment with a specialist

16

Specialist requires tests and results from

other providers

GOAL TRIGGER TRANSACTION

Source:

http://dashboard.healthit.gov/evaluations/data-briefs/hospitals-patient-engagement-electronic-capabilities-

2015.php

Convenience for All

“I sought medical advice from more than 20 physicians . . .

each new doctor I’d visit would ask if I had any medical records

from the plethora of past hospital and doctor visits – to which I

replied, “No. I was never able to attain them!” I’m sure many

tests were repeated that year and the lack of EHRs resulted in a

lot of similar wheels to be turned. I was also left to rely on my

mind’s ability to recall what this or that doctor had once told me.

. . .having these records would not only be helpful for my doctors,

it would be convenient for me, too.”

17

Sample Outreach and Resource Development Tools

• Consumer Task Force

• HIPAA Educational Videos

• Draft Model Privacy Notice Update

• Patient Engagement Strategy Guide

• Blue Button Initiative

• Patient-Generated Health Data Framework

• Patient Engagement Playbook

• And many more!

18

Test Locally, Share Nationally

19

Advanced HIE

CHP

Workforce

Workforce Training Program

20

Train

6,000Students

Update 20 existing components*

- Health Management Information Systems- Working with Health IT Systems- Installation and Maintenance of Health IT

Systems- Networking and Health Information Exchange- Configuring Electronic Health Records- Usability and Human Factors- Planning, Management, Leadership for Health

IT

Develop 5 new components

- Population Health- Care Coordination & Interoperable Health IT

Systems- Value-Based Care- Patient-Centered Care- Healthcare Data Analytics

* Selected Topics

7 AWARDEES

$6.7MGrant in 2015

ONC

Workforce Training Program Awardees

• Normandale Community College

» For registration: Contact Tracy.Mastel@normandale.edu or visit

https://www.mnhealthit.com/act.html

• Columbia University

» For registration: Visit http://hi-five.dbmi.columbia.edu or contact Raven David

(rd2501@cumc.columbia.edu)

• Johns Hopkins University

» For registration: Visit www.mnhealthit.com/act.html or contact

pfranci4@jhu.edu.

• Oregon Health & Science University

» Registration open at https://www.surveymonkey.com/r/onc-course

» For more information: Visit http://dmice.ohsu.edu/onc-course/

»

21

Workforce Training Program Awardees (cont.)

• University of Alabama at Birmingham

» For more information and registration: www.uab.edu/healthit

• University of Texas Health Science Center at Houston

» For registration: Visit GO.UTH.EDU/HICATT

• Bellevue College

» For more information: Contact Heather Neikirk

(heather.neikirk@bellevuecollege.edu)

22

Community Health Peer Learning Program: Harnessing Cross-Sector Data to Advance Community Health

Participant communities:

• All Chicago Making Homelessness History

• Children's Comprehensive Care Clinic

• Cincinnati Children's Hospital Medical Center

• Dignity Health Foundation

• Louisiana Public Health Institute

• North Coast Health Information Network

• Providence Center for Outcomes Research and Education

• University Hospitals Rainbow Babies & Children's Hospital

• Vanderbilt University Department of Health Policy

• Vermont Child Health Improvement Program,

University of Vermont

SME communities:

• Essential Access Health

• Greater Detroit Area

Health Council

• Minneapolis Heart

Institute Foundation

• San Diego Health

Connect

• The University of

Chicago Medicine

23

Help to stimulate and advance community progress toward achieving population health

objectives through the expanded collection, sharing, and use of electronic health data

Participant Community Health Challenges

• Maternal & child health

• Mental health

• Housing insecure & homeless

• Chronic vulnerable populations

24

Acting Upon & Sharing Learnings

• Participant communities: design Community Action Plans

• SME-led development of

five Population Health in-depth learning guides:

1. Collecting Quality Data for Performance Management

2. Transforming Health Information Exchange to Support Regional

Population Health Improvement

3. Partner, Community, and Stakeholder Engagement

4. Conducting Impact Analyses for Community-Based Initiatives

5. Strategic and Sustainability Planning

25

Sample Resource: Million Hearts® EHR Optimization Guides

• Available on the Million Hearts® Resource Center:

https://www.healthit.gov/providers-

professionals/million-hearts

• Vendor-specific guides with step-by-step

instructions to facilitate early detection of at-risk

patients, allowing providers to place them on a

corrective path before diagnosis

• Allscripts

• Cerner

• NextGen

• Over 1,000 downloads to date

• ONC encourages collaboration from other EHR

vendors in developing additional guides

26

Advanced Interoperable Health Information Technology Services to Support Health Information Exchange Program (“Advanced HIE”)

27

States that received additional funding

Working and Tracking Towards Progress

• Progress tracked by target

population among three milestones:

» Expanding the adoption of health

information exchange technology, tools, services,

and policies that enable interoperable exchange

» Facilitating the send, receive, find, and use capabilities

to access health information from external sources and

incorporate into these into care provider workflows

» Increasing integration of health information

in interoperable health IT to support care

processes and decision making

28

Working and Tracking Towards Progress (cont.)

• Supplemental funding to

increase focus on Admission,

Discharge, and Transfer (ADT)

messages across existing

networks while leveraging

existing electronic and

technical infrastructure

• Partnership with grantees

to develop and disseminate

bright spots, success

stories, resources

• Established Communities of

Practice (CoPs)

» Long-term Post-acute Care

» ADT

» Behavioral Health

» Consumer Engagement

29

Program Activities and Select Accomplishments to Date

• Expanded adoption to eligible

and non-eligible providers

• Implemented directed

exchange services

• Advanced adoption and

exchange in LTPAC, EMS,

behavioral health facilities

• Leveraged experience to

support other federal projects

30

ONC State Innovations Models (SIM): Resource Center

Resources to develop specialized technical assistance as well as comprehensive online

health IT tools and resources for State Innovation Model (SIM) awardees

Three key TA areas to help SIMs states meet their health care

transformation and payment reform objectives.

1. Interoperability and exchange

2. Shared, longitudinal care planning and care coordination

3. Integrated quality measurement

– E.g.: Health IT-Enabled Quality Measurement Strategic Implementation Guide:

provides guidance for the development and execution of a statewide multi-stakeholder

health-IT enabled quality measure strategy and accompanying

technical framework

31

Additional ONC Initiatives

32

Sample Resource: Practice Transformation Support for Clinicians Map

Nationwide view of all technical assistance

in each state & program specific view

http://dashboard.healthit.gov/dashboards/practice-transformation-support-for-clinicians.php

33

Health IT Playbook

• Goals

» Maintain an evolving framework of tools and resources

» Identify and share leading practices and success stories across various phases of health IT implementation

» Help to resolve key issues and challenges providers are experiencing as it relates to health IT optimization and workflow

34

Health IT Playbook Resources & Topic Areas

The Playbook is organized by

relevant health IT topics and subtopics:

» Electronic Health Records

» Certified Health IT

» Health Information Exchange

» Patient Engagement

» Value-based Care

» Privacy and Security

» Quality & Patient Safety

» Care Settings

» Population and

Public Health

» Specialists

» Transformation Support

35

Sample Resources: Patient Safety

• Identification and Prioritization of

Health IT Patient Safety Measures

- Final report published in February 11, 2016

• Measurement Priority Areas*:Includes 12 Measurement Areas in Priority Order

- Safe Health IT: Addressing Safety Concerns Unique to Technology

- Using Health IT Safely: Ensuring the Safe Use of Technology and Avoiding

Unintended Consequences

- Improving Patient Safety: Using Health IT to Make Care Safer

* This report is funded by the Department of Health and Human Services

under contract HHSM-500-2012-00009I, Task Order HHSM-500-T0016

Source:

http://www.qualityforum.org/Publications/2016/02/Identification_and_Prioritization_of_HIT_Patient_Safety_Measures.aspx

36

healthit.gov/SAFERGuide

Health IT Playbook Demo & Hearing From You

• All feedback is welcome

• Recommend additional tools

and resources to be included

• Feedback on the content

• Feedback on the utility and design

• Help us spread the word!

https://www.healthit.gov/playbook/

37

Continued Commitment to Helping Providers and Patients Realize the Benefits of Health IT

• Connecting providers nationwide

for rapid cycle, peer-based learning

• Ongoing work with the field to

identify provider and patient

challenges and provide technical

assistance

• Repository of technical assistance

tools and resources to providers,

patients, and other stakeholders

• Publically available curriculum to

train current and future health care

and health IT workforce

38

THANK YOU!

ONC would like to extend its heartfelt gratitude to

EVERYONE who has and continues to keep us informed

and grounded in the reality your experience of using

health IT for high quality care. This includes but is not

limited to the Health IT Fellows; patients/caregivers

and consumer advocacy groups; leadership and team

members of the Regional Extension Centers, Workforce

Grantees, State HIEs, Beacon Communities, Community

HIEs, Community Health Peer Learning Program

Participants, AcademyHealth; FACA Task Force and

Committee members; and many more unnamed

organizations and individuals who are translating the

vision of health IT-enabled high quality care a reality.

We could NOT have

developed these

resources without

you and look forward

to continued and

new partnerships

in the future.

39

Questions

Thomas A. Mason, MD

Thomas.Mason@hhs.gov

Lisa-Nicole (Danehy) Sarnowski

Lisa-Nicole.Sarnowski@hhs.gov

40

Additional Resources: Consumers

• Blue Button Initiative

• Consumer Task Force

• HIPAA Access Guidance

• HIPAA Educational Videos

41

Additional Resources: Providers

• Patient Engagement Playbook

• Health IT Playbook

• Practice Transformation Map

• Million Hearts® EHR Optimization Guides

• SAFER Guides

• Patient Engagement Strategy Guide

• Patient Engagement Playbook

• CHPL

• CHPL User Guide

42

Additional Resources: Communities & States

• State Health IT Resource Center

• Health IT-Enabled Quality Measurement Strategic

Implementation Guide

• Beacon Community Learning Guides

• Report: Identification and Prioritization of Health IT Patient Safety Measures

• ONC Current Grant Programs

• Third-party Resources

» National Governors Association: State Interoperability Roadmap

» George Washington University: Health Information and the Law

43

Additional Resources: Health Information Organizations & Innovators

• Connecting and Accelerating

a FHIR App Ecosystem

» Discovery Site Cooperative Agreement: Awarded

to the SMART App Gallery

– Helps providers in the care delivery process

by helping them find substitutable apps

that can make it easier to use their EHRs

» Provider UX Challenge

– Helps providers in the care delivery process

by incentivizing the creation of apps that

can make it easier to use their EHRs

» Consumer Health Data Aggregator Challenge

– Helps patients and consumers by improving

how care is being delivered using health IT

by helping them aggregate their data from

disparate sources

• Model Privacy Notice

and Adjoining Privacy

Snapshot Challenge:

Helps consumers by bringing some

transparency to app privacy policy

• Move Health Data Forward

Challenge: Consumer

engagement: Helps consumers

with consumer mediated data

exchange

• API Task Force

• Blue Button Connector

• Draft Patient-Generated Health

Data Framework

44

Additional Resources: Workforce & Educators

• Health IT Education Opportunities available NOW!

• Workforce Existing materials are available at

https://knowledge.amia.org/onc-ntdc

• Updated materials and newly developed materials

will be available June 2017 at

https://www.healthit.gov/providers-

professionals/workforce-development-programs

• Report: Classification & Identification of Health IT

Patient Safety Measures

45

Additional Resources: Public Health

• Meaningful Use Public Health Webpage

» Recordings and ongoing webinars and

initiatives of public health interest such as:

– Joint Public Health Forum and CDC Nationwide Webinar

– Electronic Health Records R) Vendors Collaboration Initiative

– CoP for Leveraging Federal Financial Participation (FFP)

for Medicaid Health Information Technology (HIT) Activities

» Questions? Contact the Meaningful Use Public Health

Technical Assistance Team at meaningfuluse@cdc.gov

• Permitted Uses & Disclosures: Public Health Activities

46

Additional Resources: Privacy & Security

• Permitted Uses and Disclosures Fact Sheet series:

» Health Care Operations:

https://www.healthit.gov/sites/default/files/exchange_health_care_

ops.pdf

» Treatment:

https://www.healthit.gov/sites/default/files/exchange_treatment.pd

f

• Computable Privacy Page

• Non-Covered Entity Report to Congress

• Guide to Privacy and Security of Electronic Health Information

• HHS Office of Civil Rights

47