Hit Week 2010 Ppt

8/6/2019 Hit Week 2010 Ppt

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Note to presenter: This presentation is meant to assist in educating consumers, HIM

professionals, and other healthcare professionals regarding the importance of

ensuring information integrity in todays complex healthcare environment. This presentation is created to make these individuals aware of current industry efforts,

such as the HITECH Act, information exchange, and electronic health records (EHRs),

that will affect their health information.

Welcome to the session Ensuring Health Information Integrity

My name is ______________and I am _________________ (position, title). This

presentation will focus on the importance of maintaining information integrity in

todays healthcare climate. Numerous ongoing industry efforts that affect health

information today. It is important to understand the impact these efforts will have onhealth information and ensure its integrity for the future.

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In 2006, President George W. Bush set the stage for increased health information

technology (HIT). Calling for EHRs for all Americans by 2014, President Bush set into

motion a rapidly paced EHR implementation schedule. This initial act would be builtupon over the coming years. Americans found themselves in the midst of an EHR

revolution that includes physicians, hospitals, personal health records (PHRs), and

health information exchanges (HIEs). Everywhere we look today the technological

advancements in health information occur by leaps and bounds.

The American Hospital Associations 2007 report Continued Progress: Hospital Use

of Information Technology states that more than 2/3s of hospitals (or 68 percent)

have a fully or partially implemented EHR. These statistics continue to grow each

year.

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So what are some of the current industry statistics?

Currently, the US is the only industrialized nation that does not provide universal healthcare coverage for its citizens. In addition,the US has been unable to benchmark healthcare quality with other developed countries. The US classification system is ICD-9,

whereas the majority of all other countries utilize ICD-10.

Healthcare costs have risen for several years. Expenditures in the United States on healthcare surpassed $2.3 trillion in 2008,more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. The US spends more of the GNP on healthcare than food and the military combined!

Stemming this growth has become a major policy priority because despite the rising numbers associated with healthcare, no clearcorrelation to increase in the quality of care provided can be identified.

The average American worker will see a 10 perdent increase in their health premiums in 2010. Since 2001, this o ut-of-pocketexpense has tripled and one unexpected injury or illness can be financially devastating to a family.

In the end, the most prevailing statistic of all may be the estimated cost for unnecessary medical tests, treatments, and doctorsvisits in the US. At $1.1 trillion dollars annually, the impact on the consumer is staggering. Multiple tests, repeated tests, multiplephysician visits, lengthy hospital stays, and inappropriate surgeries can take its toll on the patient as well as the healthcareprovider. No business can operate successfully in this environment.

In 2008, US healthcare spending was about $7,681 per resident. Without significant healthcare reform, there is generalagreement that health costs are likely to continue to rise in the foreseeable future. Many analysts have cited controllinghealthcare costs as a key tenet for broader economic stability and growth, and President Obama has made cost control a focus of health reform efforts underway.

Although Americans benefit from many of the investments in healthcare, the recent rapid cost growth, coupled with an overalleconomic slowdown and rising federal deficit, is placing great strains on the systems used to finance healthcare, including privateemployer-sponsored health insurance coverage and public insurance programs such as Medicare and Medicaid. Since 1999,family premiums for employer-sponsored health coverage have increased by 131 percent, placing increasing cost burdens onemployers and workers.

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Healthcare reform has been debated for years. There is no right or wrong answer to

some of the ongoing questions surrounding the need for healthcare reform. On the

previous slide we discussed some alarming statistics that are fueling the need forreform. This slide provides additional questions that are occurring at a local, state and

federal level in the ongoing discussions regarding healthcare. Of note, none of these

current questions address the right to information privacy or security. Is this a missing

question?

Note to presenter: This list in not considered inclusive of all healthcare debate

questions. You can use this slide to interact with the audience and poll them for

opinions on each question. In addition, the audience may generate other questions

for consideration. You can pause in the presentation to allow for 5 to 10 minutes of interaction with the audience.

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Legislative efforts in healthcare reform actually began in 1912. Presidential candidate Theodore Roosevelt

coordinated his 1912 campaign around health reform. Unfortunately, Theodore lost that presidential campaign,

and attempts in healthcare reform from 19121949 were blocked by Congress and lobbying by the American

Medical Association.

Debate continued throughout the years with the Republican party favoring a voluntary choice of either

government or private insurance for those over age 65. By 1964 only half of US citizens over the age of 65 had

health insurance. The Medicare program was signed into law on July 30, 1965.

In 1974 President Richard Nixon called again for comprehensive health insurance. His Comprehensive Health

Insurance Act failed. In 1982 President Jimmy Carter proposed a comprehensive healthcare system for the system.

It failed too.

In 1985 the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) was passed to provide some

employees the right to continue health insurance coverage after leaving employment.

The Clinton Administration cited healthcare reform as a major initiative, however their 1993 healthcare plan failed.

In 2004 President George W. Bush signed into law the Medicare Prescription Drug, Improvement and

Modernization Act, which extended coverage to millions of Americans and called for an electronic health record

for all Americans by 2014.

President Barack Obama, as a part of the effort to jump start the US economy in 2009, signed into law the

American Recovery and Reinvestment Act of 2009 (ARRA). This massive sweeping legislation may be the single

largest change in healthcare in 20 years. Calls for certified technology and demonstration of meaningful use has

organizations and providers scrambling to implement EHRs.

An independent study from the Rand Organization put the price tag for ARRA implementation efforts between $75

and $100 billion over 10 years. As the first wave of ARRA incentive payments for implementation of meaningfulEHRs is set to begin in 2011, almost 100 years will have passed since the first coordinated movement to reform

healthcare.

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David Blumenthal, MD, is the current National Coordinator for Health Information

technology. The Office of the National Coordinator for Health Information Technology

(ONC) is at the forefront of the federal governments health IT efforts and is aresource to the entire health system to support the adoption of HIT and the

promotion of nationwide health information exchange to improve healthcare. ONC is

located within the Office of the Secretary for the US Department of Health and

Human Services (HHS).

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Multiple types of technology exist in healthcare today. No single system applies to

each hospital or physician. In addition, many organizations and providers may choose

to have multiple systems that comprise their EHR. The race to provide all Americanswith an EHR is on. Consumers should be aware of the technologies making a

significant impact on their health information today. The technologies on this slide

represent only a small portion.

Healthcare has traditionally been a slow adopter of technology when compared to

other industries. This has resulted in a number of problems for healthcare providers,

with systems in desperate need of modernization. In addition, it creates a disparate

mix of software systems that struggle to share information, and an infrastructure that

hinders growth.

This may no longer be the case due to current industry initiatives such as ARRA

incentives. ARRAs meaningful use is an incentive program, it was established to

incentivize providers and hospitals to adopt electronic health records at a rapid rate

and to utilize functionality that will assist the US in supporting high quality, but cost

effective healthcare.

ARRA has defined three stages for meaningful use. The first stage has been published.

Stages two and three will be more progressive towards a fully electronic health

record. Each organization or provider must meet the defined thresholds in order to

qualify for the incentives.

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The EHR is one of the most widely used components of technology affecting

healthcare. Also known as an EHR, the term is used interchangeably with the

electronic medical record (EMR). According to the Health Information ManagementSystems Society (HIMSS), an EHR is a longitudinal electronic record of patient health

information generated by one or more encounters in any care delivery setting.

Included in this information are patient demographics, progress notes, problems,

medications, vital signs, past medical history, immunizations, laboratory data, and

radiology reports.

Note: Presenter can poll the audience for EHR systems in use or general discussion

regarding EHRs.

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Personal health records (PHRs) are one of the latest technologies to affect healthcare.

Companies such as Google and Microsoft are developing electronic PHRs in an effort

to increase participation and information exchange. As defined by AHIMA, the PHR isan electronic or paper health record maintained and updated by an individual for

himself or herself. PHRs are now offered through the Internet, employers, health

insurance plans, and others as method for an individual to compile and manage their

own health information. The individual is solely responsible for all information that is

entered into or removed from their PHR. They have complete control. An individual

may present his or her PHR to practitioners to assist with treatment and care.

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So, in other words, instead of a provider handing you a piece of paper and then taking

it to the pharmacy to have it filled, its all done for you. You just need to go and pick

up your medication from the pharmacy. This removes two to three steps for patientsand the providers.

Electronic prescribing continues to be a hot topic in the industry, as it provides

providers with incentives for utilizing the technology. In addition, current ARRA

criteria includes computerized physician order entry (e-prescribing in a hospital

setting) as a component of Stage 1 incentives.

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The goal of HIE is to facilitate the secure access, use, and control of health

information in support of patient-centered care delivered in a safe, high quality, cost-

effective, and timely manner. Presently,tThere are at least 193 active initiativesinvolved in HIE; the earliest HIE efforts date back to the 1990s. (Source: eHealth

Initiative's Sixth Annual Survey of Health Information Exchange. 2009)

The recently introduced HITECH legislation provides funding and subject matter

expertise to the transition to interoperable electronic healthcare system at the

community, state, and national level. Consumers, providers and organizations alike

will be affected by this important industry initiative. Organizations are affected as

they submit and retrieve information from the HIE. Providers will be influenced as

they seek up-to-date information from multiple areas with one request and

consumers as they may be questioned regarding the sharing of information with anHIE.

The RAND Corporation states that potential benefits of a connected, interoperable

healthcare system could save an estimated $80 bill ion per year.

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The ARRA legislation provides that eligible professionals and hospitals who make "meaningful use" of certifiedelectronic health records are eligible for incentive payments. The adoption of EHR and HIT in high priority areassuch as electronic prescribing/CPOE, interoperable electronic health records and quality measure reporting can

improve patient safety and the quality of healthcare. As of July 14, 2010, the notice of proposed rulemaking(NPRM) was released defining meaningful use with a 60-day comment period.

Providers and hospitals who wish to participate in the ARRA incentive program must use EHR technology thatmeets certification criteria. The final rule for HIT: Initial Set of Standards, and Certification Criteria for EHRTechnology was released on July 13, 2010 and is effective 30 days from date of publication in the F ederal Register . With the publication of criteria vendors, organizations and providers can begin to assess and reviewtheir systems accordingly.

Hospitals that intend to qualify early for the meaningful use EHR incentive program can first apply in the federalfiscal year 2011, which begins October 1, 2010, less than a year after the rules were first published. Thequalification period in the first year is only 90 days.

Eligible providers (EPs) participating in the meaningful use program will be required to report on quality

measures. The measures defined in the proposed regulation were developed to meet the stated objectives insupport of the health outcome policy priorities

Incentive payments under ARRA are just that, incentives. No organization or provider is required to apply for thisprogram. However, by 2016 those organizations and providers who have not demonstrated meaningful use withEHRs will be penalized.

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According to the Annals of Internal Medicine Report Systematic Review: Impact of

Health Information Technology on Quality, Efficiency, and Costs of Medical Care

technology does add potential benefits to the healthcare industry. This slide reflectsthree of the major efficiencies felt to be gained with health IT. The article goes on to

state that healthcare experts and consumers consider health information

technologies, such as EHRs and computerized provider order entry, to be critical to

transforming the healthcare industry.

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Harris Interactive performed a survey for the Xerox corporation and found that today,

few Americans are using EMRs. Many arent even sure their doctor offers the

technology. One in 10 American adults dont util ize EMR or turn to e-mail to contacttheir doctor. Overall, the general public only has a vague idea, only a very limited

understanding, of what this is about according to Humphrey Taylor, Chairman of the

Harris Poll.

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Ninety-one percent of the public says it would be important to access electronic

personal health records to see what their doctors write down to ensure providers

understand their personal situation. More than eight in 10 Americans (84 percent)are interested in accessing their electronic records to check for mistakes. Even higher

proportions of African Americans and Latinos expressed this concern. Eighty-eight

percent also says that accessing records would be important to reduce the number of

repeated tests and procedures they undergo. In all of these areas, Americans who use

healthcare most often are among the most likely to say these are important benefits

of EHRs.

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AHIMAs professional practice team recently compiled the following list of data content standards. You may

already be working with some items from this list, but not realized were data content standards:

Document content requirements, such as those developed by the HL7 CDA4CDT initiative for history and

physical and consultation reports

Data element definitions and requirements for data sets, such as the uniform hospital discharge data set or

minimum data set

Messages, such as for medication orders

Allowable values for data elements, including clinical terminology and vocabulary standards, such as

Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®); Logical Observation Identifiers, Names

and Codes (LOINC); and International Classification of Diseases (ICD)

Value set bindings used to share data, such as the use of VA/KP problem list subset of SNOMED CT® to assign

problem codes in HL7 continuity of care documents

Mappings between different vocabularies

Survey questions and associated coded responses, such as the use of LOINC for the Brief Psychiatric Rating

Scale (BPRS)

Guideline, protocol, and algorithm formats

Information models that define the context for data standards

NHIN, as envisioned by the federal government, will fast track the providers ability to exchange information

and allow for basic information to be exchanged with other providers over the Internet. It is imperative that the

right information is shared about the right person, ensuring the integrity of the information for patient care.

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Historically, the data quality role has fallen largely on HIM professionals as the

custodians of the paper record. In the electronic record, information management

and technology professionals have the role of ensuring data quality and integrity.

Various quality assessment methods such as total quality management and

continuous quality improvement have helped healthcare professionals focus on

process and workflow. Focus on quality with attention to record completeness,

timeliness, and authenticity are important factors for data integrity, validity, and

reliability.

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A successful transition to an EHR requires data strategies and an effective data quality

program that incorporates documentation improvement and data integrity processes.

For this reason, it is important for the practice to determine what functionality agiven EHR system offers for gathering, accessing, and transferring quality data.

The information should be tracked and reviewed regularly for accuracy so that bad

data are not entered or passed through interfaces into the EHR. The overall plan and

implementation and ongoing monitoring for entering information needs to be clearly

defined to ensure the integrity and validity of the information.

The programs goal is to attain high levels of data integrity for which the organization

is responsible. It must encompass all existing critical databases and, more

importantly, be a part of every project that creates new data or that migrates,

replicates, or integrates existing data. It must address not only the accuracy of data

when initially collected, but also accuracy decay, data completeness, data translation,

accurate access, and accurate interpretation of the data for users.

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Proper training for all users, including the leadership team, is a crucial step for any

implementation. Training provides the guidance and education staff needed to

properly follow all policies and procedures.

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Establishing policies and procedures to help manage and maintain data and

information needs through the transition will help ensure data integrity and validity.

Policy should be clearly defined and readily accessible to all staff.

Data entryWho can enter what type of information, based on role credentialing?

Access to informationWho can view, enter, and scan into the health record?

Addendums, amendments, and corrections Who can make changes and when

changes may be made?

PrintingWho can print, when is printing permitted, what is to be done with the

printed version after use?

Audit processeshow often audits will be conducted, results reported, and errors

corrected.

ScanningThe overall process, the process for outside records (for example,

scanning only those pertinent to care), and what to do with the paper after scanning.

Retention and destructionHow long will the electronic record be kept?

Record completionHow timely entry by all users can be ensured.

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Dr. Charles Friedman recently posted this discussion on the Health IT Buzz Blog. Dr.

Friedman re-emphasizes the need for health IT; but qualifies that statement with the

bottom line. Healthcare, at its simplest, is about caring for Americans. It is this focus,care of the patient, that drives the healthcare industry today. How can we take care

of patients better, and how can we improve treatment plans and encourage

compliance in chronic diseases? Technology developed without that focus will not

yield the results the healthcare industry needs.

As the evolution of healthcare moves forward and technology provides opportunities

to improve processes, there is no doubt that maintaining information integrity is a

key indicator of how well it has succeeded. Without the right information, at the right

time, on the right patient, information cannot be considered to be trustworthy.

Employing technology that encourages trust is the first step in ensuring informationintegrity in the electronic healthcare industry to come.

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Hit Week 2010 Ppt