HEALTH INFORMATION TECHNOLOGY � FEDERAL RESEARCH INITIATIVES

							HEALTH INFORMATION TECHNOLOGY –
  FEDERAL RESEARCH INITIATIVES
        Susan M. Christensen

      Steering Committee on Telehealth and
              Healthcare Informatics
                   Capitol Hill
                February 23, 2005
  Agency for Healthcare Research
           and Quality

The mission of the Agency for
Healthcare Research and Quality
is to improve the quality, safety,
efficiency, and effectiveness of
health care for all Americans.
             RAND Study: Quality of Health
                Care Often Not Optimal
  Patients’ care often deficient, study says.
  Proper treatment given half the time.
  On average, doctors provide appropriate health care only half the
  time, a landmark study of adults in 12 U.S. metropolitan areas suggests.

                                              Medical errors corrode
Medical Care                                  quality of healthcare system
Often Not                                           The American healthcare system,
                                                    often touted as a cutting-edge
Optimal                                             leader in the world, suddenly
Failure to Treat Patients                           finds itself mired in serious
 .                                                  questions about the ability of its
Fully Spans Range of                                hospitals and doctors to deliver
What Is Expected of                                 quality care to millions.
Physicians and Nurses
VARIATIONS ARE
 WIDESPREAD
              Diffusion of knowledge

Clinical                   Landmark Trial             Current rate of
Procedure                                             use
Flu Vaccine                1968                       64% (2000)
Pneumococcal               1977                       53% (2000)
Vaccine
Diabetic Eye Exam     1981                            48.1% (2000)
Mammography           1982                            75.5% (2001)
Cholesterol Screening 1984                            69.1% (1999)



Balas EA, Boren SA., Managing Clinical Knowledge for Health
Care Improvement. Yearbook of Medical Informatics 2000.
                            How Hazardous Is Health Care?
                                          DANGEROUS               REGULATED                   ULTRA-SAFE
                                            (>1/1000)                                          (<1/100K)
                            100,000                 HealthCare
                                                                          Driving
Total lives lost per year




                             10,000


                              1,000
                                                                                        Scheduled
                                                                                         Airlines
                               100
                                                     Mountain            Chemical                   European
                                10
                                                     Climbing          Manufacturing                Railroads
                                                 Bungee                 Chartered                    Nuclear
                                                 Jumping                  Flights                     Power
                                 1
                                      1     10        100      1,000     10,000     100,000   1,000,000 10,000,000

                                                 Number of encounters for each fatality
            Role Of IT In Reducing Medical Errors

    Percent who say…                                                                  Have you or a family member ever
                                                                                      created your own set of medical
                                                                                      records to ensure that you and all
 The coordination among the
                                                                                      of your health care providers have
different health professionals
    that they see is a problem                                            69%         all of your medical information?


                                                                                             Yes
 They have seen a health care
 professional and noticed that
                                                                 48%
  they did not have all of their                                                                         32%
          medical information


They had to wait or come back
      for another appointment                                                            1%                              67%
                                                          32%
 because the provider did not                                                       Don’t
         have all their medical                                                     know
                    information                                                                                                       No



Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality / Harvard School of Public Health National Survey on Consumers’
Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 – September 5, 2005).
    Potential of IT for Assessing
               Quality
 IT can enhance the precision and
  decrease the cost of measurement –
  i.e., getting to the “right” measures
 IT can also enhance translation of
  strategies to improve quality (e.g.,
  decision support)
 IT can greatly enhance the timeliness
  of data collection – link to incentives?
            Investment Strategy: Key
                   Attributes
 Defined deliverables:
    –   Improvements in care (Quality and Safety)
    –   Efficiencies
    –   Effectiveness
 Diverse vehicles:
    –   Traditional research (Transforming Healthcare Quality
        through Information Technology (THQIT) Value)
    –   R & D Activities (THQIT Implementation and State HIT)
    –   Implementation (Planning, Implementation and State HIT)
 Anticipate stakeholder needs:
    –   Short-term (Standards, eRx grants, privacy, legal)
    –   Mid-term (Prescription drug program, P4P/Q)
    –   Future (Regional Health Information Organizations)
      AHRQ: FY ’04 HIT Portfolio
 $60M initiative:
   – $26M: to implement proven technologies in
     small and rural communities where HIT
     penetration has been low
   – $24M: targeted for developing,
     implementing, and evaluating the use of
     new and innovative technologies to improve
     patient safety and quality of care in diverse
     health care settings
   – $10M: targeted for clinical data standards
     and interoperability
            Selected FY ‘04
             HIT Initiatives
 Transforming Healthcare Quality through
    Information Technology (THQIT):
        3 Grant Solicitations
        Focus on community partnerships
   National Resource Center for Health IT
   State and Regional HIT Demonstrations
   CMS – AHRQ collaboration
   Indian Health Service – RPMS Project
   Privacy and Legal Framework
                       Statistics
 THQIT Grants:
   –   ~1,000 letters of intent to apply
   –   Value                25 projects
   –   Planning             38 projects
   –   Implementation       40 projects
 State Program
   – 43+ Letters of Interest
   – Five Awardees
 National Resource Center
   – $18.5 Million contract
        Value Grants: Highlights

 http://www.ahrq.gov/research/hitfact.htm
 CDSS in nursing homes on medication
    ordering
   State-wide rollout of e-prescribing
   EHR and/or web-based patient program for
    diabetics
   Human factor analyses and CPOE
    implementation
   Tele-ICU monitoring on outcomes and costs
   Health information exchange in ambulatory
    care
    Planning Grants: Highlights

 Area-wide EHR in remote Alaska
 Regional planning for health IT in Michigan’s
  upper peninsula
 Electronic sharing of behavioral health
  information in Nebraska
 Unified EHR for hospitals, private providers, and
  hospice in rural New York State
 Community-driven effort to bring community
  health centers and hospitals together to share
  data in Hawaii.
           Implementation Grants:
               Highlights
 Community-wide EHR to improve asthma
  care for inner-city children in Connecticut
 Emergency department EHR across
  Louisiana’s critical access hospitals
 Electronic radiology initiative across three
  hospitals in rural Maine
 CPOE in an inner-city, minority community in
  Ohio
 Patient-centered medication information
  system to improve health of chronically ill
  elders in rural Oregon
       State & Regional HIT Demonstrations:
                  Prototype RHIOs

 Five-year state-based contracts:
   – Help states develop secure statewide networks
   – Ensure privacy of health information
   – Make an individuals’ health information more
      available to health care providers

 FY04: Five states awarded $1M/year
   – Colorado
   – Indiana
   – Rhode Island
   – Tennessee
   – Utah
    AHRQ National Resource Center for
      Health Information Technology
 Provide technical & expert support to
  health IT grantees, contractors and selected
  other federal grantees
 Contract award to NORC (up to $18.5M over 5
  yrs)
   – In partnership with:
         Vanderbilt University
         Center for IT Leadership (Partners)
         Indiana University
         Foundation for the eHealth Initiative
         CSC
         Burness Communications
              Clinical Data Standards
                 $10M Investment
 Further standards development work to allow systems to
  share important health information.
 Focus on gaps in the following four areas:
   – voluntary industry clinical messaging and terminology
     standards
   – national standard nomenclature for drugs and biological
     products
   – standards related to comprehensive clinical terminology
     and nomenclature
   – research related to accelerating the adoption of
     interoperable health IT systems.
 Examples include:
       RxNorm/Daily Med
       Device Nomenclature
       ePrescribing
      Future Program Emphasis
 Regional collaborations
   – Regional Health Information Organizations
   – Linkage with existing and future initiatives (e.g.
      payment or quality)
 Delineate Privacy and Legal Framework
 Synergize ongoing and future medication &
  therapeutic initiatives
   – ePrescribing (grants to physicians, MMA eRx
     programs)
   – Chronic Disease Programs
   – Integrate decision support with eRx
 Create avenues enhancing technical and
  resource support for stakeholders
       Future Research Emphasis

 Measure Development
   – Development of measures that are valid, reliable,
     clear and understood by all stakeholders
   – Cooperation by researchers, purchasers and
     providers in development
   – Key players – AHRQ, CMS, JCAHO, NCQA, NQF

 Ability to evaluate value to stakeholders and
  investors
   – Fiscal
   – Non fiscal
        Private Sector Partners
   Academic Institutions
   Provider Organizations
   Hospital Community
   Device and Therapeutic Industry
 HIT Industry
 Purchasers
 Payers
           Public Partners
 Centers for Medicare and Medicaid
  Services
 Office of the National Coordinator for
  Health IT
 National Institutes of Health
 Food and Drug Administration
 Centers for Disease Control & Prevention
 State and Local Governments
 Tribes and Tribal Governments
 Federal Initiatives - Ambulatory

 Physician Group Practice
  –200+ FTE practices
  –Management of chronic disease

 Doctors Office Quality-IT Project
  –Integrate Health IT into office practice
  –“Real-time” improvement in care
     Medicare Modernization ACT
   Medicare Chronic Care Improvement Program (Section 721)
    –   “next generation” chronic care management in FFS Medicare
    –   Requires collection and analysis of clinical data across care
        settings
    –   Payment based on clinical improvement, beneficiary
        satisfaction and cost savings
   Medicare Health Care Quality Demonstration Programs
    (Section 646) 5-yr program to examine health delivery
    factors that encourage improved quality of care
     – To be administered via contract by a “health care group”
     – AHRQ, CMS and NIH will coordinate design and
         support efforts.
   Medicare Care Management Performance Demonstration
    (section 649)
     – Pay for Performance Demonstration in up to four states
     – Pay incentives to primary care physicians that use HIT
         to improve quality of care
     – AHRQ/CMS design and evaluation teams
For additional questions, please contact:
           Susan Christensen
        schristensen@ahrq.gov
             703.489.2284