Health IT_Why Now_Health Disparities Summit

8/9/2019 Health IT_Why Now_Health Disparities Summit

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Health IT: Why Now?

Thomas Tsang, MD, MPH

Office of the National Coordinator for HITNew York REACH Health Disparities SummitJune 3, 2010


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Qualit context

HITECH goals M nin f l

Healthcare Reform


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What we cant measure cannot bemanaged!


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CDC- 100 000 ex ire from hos ital-ac uired

infections 2009 In 2000, the Institute of Medicine estimated

that up to 98,000 Americans die each year

from preventable medical errors.Medical errors are killing more people per year, in the

U.S., than breast cancer, AIDS, or motor vehicleaccidents.

80 percent of errors were initiated bymiscommunication.

1 Kohn, L., J. Corrigan, and M. Donaldson. To Err Is Human: Building a Safer Health System. Committee of Health Care in America, Institute of Medicine. 2000.2 Institute of Medicine and Centers for Disease Control and Prevention. National Center for Health Statistics: Preliminary Data for 1998 and 1999. 2000.3Smith, Peter, et. al. Missing Clinical Information During Primary Care Visits, The Journal of the American Medical Association. February 2005.4&5 National Coalition on Health Care, Facts About Health Care - http://www.nchc.org/facts/cost.shtml


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National Health Quality Report 2009- Track

Survey data collected from populations (N=11) AHRQ, Medical Expenditure Panel Survey (MEPS) - , CMS, Medicare Current Beneficiary Survey (MCBS) SAMHSA, National Survey of Drug Use and Health (NSDUH)

Data collected from samples of health care facilities (N=8) American Cancer Societ -American Colle e of Sur eons National Cancer Data Base NCDB CDC-NCHS, National Ambulatory Medical Care Survey (NAMCS) CMS, End-Stage Renal Disease Clinical Performance Measurement Program

Data extracted from data systems of health care organizations (N=13) AHRQ, Healthcare Cost and Utilization Project State Inpatient Databases (HCUP SID) CMS, Quality Improvement Organization (QIO) program. Indian Health Service, National Patient Information Reporting System (NPIRS) NIH, United States Renal Data System (USRDS)

Data from surveillance and vital statistics systems (N=5)

- , , , CDC-NCHS, National Vital Statistics System (NVSS) NIH-National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) program


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2009 NHQR Findings

ua ty simproving, but theace is slow

especially for

preventive care andchronic diseasemanagement.


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2009 NHQR Findings

Health care quality needs to be improved

Private No insuranceMeasure insurance (%) (%) Difference

Women ages 40-64 who had a mammogram in the last 2years

74.2 38.3 35.9

Children a es 2-17 who had a dental visit in the calendar 59.6 27.9 31.7year

Adults ages 40-64 with diagnosed diabetes who received adilated eye examination in the calendar year

64.1 35.4 28.7

Adults ages 50-64 who ever received a colonoscopy,sigmoidoscopy, or proctoscopy

47.5 20.7 26.8

Adults with obesity who received advice from a provider toexercise

61 41.2 19.8


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Core Measures Getting Worse

Blacks Asians AI/ANs Hispanics

Adults age 50 and over who report * * * *

Cancer

they ever received a colonoscopy,

sigmoidoscopy, proctoscopy, orfecal occult blood test

ancer ea s per ,population per year for colorectalcancer

* *

Heartdisease

who received recommendedhospital care

Respiratorydiseases

Adults age 65 and over who everreceived pneumococcal vaccination

Hospital patients with pneumonia

* * * *hospital care

National Healthcare Quality Report 2009 AHRQ


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HITECH Vision Furnish tools to begin a major transformation in

Provide best opportunity for each patient tov u w

information exchange

ress e mos press ng o s ac es o a op onand meaningful use of electronic health records


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HIT as a tool and foundation for deliverysystem mprovement

Im rovedQuality &Efficiency

CareDelivery Provider Payment

Innovations

Measurement

HIT FoundationMeaningful Use of EHRs


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Sustainable Health Outcomes:

Quality, Efficiency Population Health

Innovative Care Delivery

Processes and Payment Reform

Electronic Health Records and

Information Exchange


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HITECH goals

o a ou ec no ogy

Improving health and transforming health care throughmeanin ful use of HIT


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Getting to Meaningful UseTo Improve Health Health are

TECHNOLOGYADOPTION

REDESIGN

MEANINGFULMEANINGFULOUTCOMESBetter Health

HEALTH

USEUSE TransformedCare DeliveryReduce

CONSUMERINFORMATION

EXCHANGEHealthDisparities


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Grass Meaningful Use of Grass


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Framework: HIT Policy CommitteesRecommended Five Priorities

Improve quality, safety, efficiency and reducehealthdisparities

Engage patients & families in their health care

mprove care coor na on

Improve population and public health

personal health information


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Meaningful Use


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Meaningful Use Proposed Stage 1bjectives for EPs Eligible Hospitals

.

2. Implement drug-drug, drug-allergy, drug-formulary checks

3. Maintain an up-to-date problem list of current and active

diagnoses based on ICD-9-CM or SNOMED CT

4. Maintain active medication list

.

6.6. Record demographicsRecord demographics

7. Record and chart chan es in vital si ns

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Meaningful Use Proposed Stage 1

8. Record smoking status for patients 13 years and older

9. Incorporate clinical lab-test results into EHR as structured data

10. Generate lists of patients by specific conditions to use for quality

, ,

11. Report ambulatory quality measures to CMS or the States

12. Implement 5 clinical decision support rules relevant to specialtyor high clinical priority, including diagnostic test ordering, along

with the ability to track compliance with those rules

.

payers

14. Submit claims electronically to public and private payers

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Meaningful Use Proposed Stage 1

Ob ectives for EPs & Eli ible Hos itals

15. Provide patients with an electronic copy of their healthn orma on upon reques

16. Capability to electronically exchange key clinical informationamong providers of care and patient-authorized entities

. er orm me ca on reconc a on a re evan encoun ers aneach transition of care

18. Provide summary care record for each transition of care and

19. Capability to submit electronic data to immunization registriesand actual submission where required and accepted

.public health agencies and actual transmission according toapplicable law and practice

.the certified EHR technology through the implementation of

appropriate technical capabilities20


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Additional Meaningful Use Proposed

1. Generate and transmit permissible prescriptions

age ec ves or s n y

electronically

2. Send reminders to patients per patient preference for-

3. Provide patients with timely electronic access to

their health information within 96 hours ofinformation being available to EP

4. Provide clinical summaries for patients for each

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Incentive Payment Timeline

Medicare

EPs may receive payments no sooner than January2011

Eligible hospitals & CAHs may receive payments no

Medicaid EPs

Can otentiall receive a ments as earl as 2010 forA/I/U and hospitals as early as 2011

Medicare Advantage EPs

Will receive payments following determination thatthey are not eligible for full incentive under MedicarePart Bantici ate determination in s rin 2012

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Regional Extension Centers

HITRC

Beacon Communities


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Role of Regional Extension Centers (RECs)

Unbiased guidance on vendor selection andgroup purchasing

Reach out to providers of underservedcommunities

un n n y ninformation exchange

Privacy and security best practices

Everything involved in ensuring meaningfuluse of EHRs


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15 Beacon Communities

Extend advanced health IT

and exchange infrastructure Demonstrate a vision ofthe future where:

,patients are meaningful

users of health IT, and

Leverage data to informspecific delivery system andpayment strategies

measurable & sustainableimprovements in healthcare quality, safety,

efficiency, and populationhealth

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HIT-enabled quality improvementExpectations regarding data collection

E-specifications for quality measures

en er or e care e ca nnova onSuccess of value-based purchasing demos & pilots

measured b HIT- enerated data

Re-admissions reimbursement

PQRI and RHQDAPU

Health-Associated Infections Evolution of the patient-centered medical

home


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Subtitle C-Creating Healthier Communities/Sec. 4201ommun ty rans ormat on rants-grants to

promote individual and community health andprevent the incidence of chronic disease

Sec. 4302 Understanding health disparities; datacollection and analysis-

-workforce

Sec. 6301- Patient-Centered Outcomes Research

ec. ommun y- ase co a ora ve carenetworks.

Sec. 10334- Minorit Health- codifies OMH andelevates the NCMHHD to an Institute


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Dis arities tentativel June 4

Care coordination P l i n li h l h


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Healthcare is local !

Challenge: The power to change the systemis in your hands.


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htt ://healthit.hhs. ov

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Health IT_Why Now_Health Disparities Summit