HIT and Accountability: Is There a New Practice Model in Your Future?

1. HIT and Accountability: Is There a New Practice Model in Your Future? William E. Golden, MD FACP Professor Of Medicine and Public Health, UAMS Vice President, Quality Improvement, AFMC Chair, Board of Regents, ACP Past Director, National Quality Forum

2. You go an ATM and ask for $100. You Receive $80. The most appropriate response: Nothing – Its OK It was a reasonable mistake Discuss with management ###***!!! PreQuiz

3. Your aunt goes to the ER with an acute MI. She does not receive an aspirin and a beta blocker and is sent home with an LVEF of 25% The most appropriate response: Nothing – Its OK It was a reasonable mistake Discuss with management ###***!!! Second Question

4. Women’s Health in AR • Pap Smears • Mammograms • Chlamydia Testing

9. Some Is Not a Number Soon Is Not a Time

12. Measuring Provider Efficiency 1.0http://leapfroggroup.org/news/leapfrog_news/345254 The Leapfrog Group Bridges to Excellence

13. Purchaser Paradigm

15. What Consumers Believe • Information Will Reform the System • The Market Will Fix Bad Performance

16. National Voluntary Hospital Reporting Initiative

17. Role of Public Data • Valuable to Trustees, Corporate Leaders • Motivates Investment • Changes Metrics of Job Evaluations • Used by the Public?

18. Program Attributes • Actionable • Operational and Feasible • Fair • Credible and Reliable • Equitable

19. Provider Report Cards • Statewide Values • Practice Specific Information • Prelude to P4P?

20. PCPI: Physician Performance Measurement Sets Adult Diabetes1 Asthma Chronic Obstructive Pulmonary Disease Community-acquired Bacterial Pneumonia Coronary Artery Disease2 Heart Failure2 Hypertension2 Major Depressive Disorder Osteoarthritis of the Knee3 Prenatal Testing Preventive Care and Screening Measures: Colorectal Cancer Screening Influenza Immunization, Adult Screening Mammography Problem Drinking Tobacco Use Cessation 1 subset of Alliance 2 with ACC & AHA 3 with AAOS

21. National Quality Forum (NQF) • Public Private Collaboration • National Steering Committee • Four Membership Councils • Providers, Consumers, Research/QIO, Purchasers • Strategic Framework Board • Funded Projects

22. Clinical Quality Measures

24. The Challenge. . .

25. Physicians’ Views on Quality of Care:Findings from the Commonwealth FundNational Survey of Physiciansand Quality of Care Anne-Marie J. Audet, Michelle M. Doty,Jamil Shamasdin, and Stephen C. Schoenbaum May 2005

26. Chart I-1. Use of Information Technologies Percent indicating “routine” or “occasional” use Yes, used occasionally 79 Yes, used routinely 58 28 27 27 24 18 * * Electronic ordering of tests, procedures, or drugs. Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.

27. Chart II-3. Physicians’ Access toPatient Panel Data, by Practice Size Percent indicating “very/somewhat” easy to generate lists of patients by Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.

28. Chart IV-1. Coordination of Care ProblemsPhysicians Observe Percent who observed problem sometimes or often in past 12 months Coordination of care problems Patient’s medical record, test results, or other relevant clinical information were not available at the time of the scheduled visit 72% Tests or procedures had to be repeated because findings were unavailable or inadequate for interpretation 34% Patient experienced a problem following discharge from a hospital because physician did not receive needed information from the hospital in a timely manner 26% Patient’s care was compromised because he/she received conflicting information from different doctors or other health professionals 28% Patient had a positive test result that was not followed-up appropriately 15% Patient received the wrong drug, wrong dose, or had a preventabledrug-drug interaction 11% Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.

29. WWW.DOQ-IT.ORG

30. HIT • Arkansas a DOQ-IT Demo State • ~175 Clinical Sites • 8th SOW – HIT in Home Health, Hospitals, Physician Offices • Limited Access to Broadband • Financing, Standard, etc

31. Current Status of HIT • Computers absent in patient care areas • Orders for meds, lab tests, radiology still on paper • Lack capability for immediate, automated results • No intranet communication capability • Fragmented “stove-pipe” systems

32. Standardization • AHIC – Health Information Community • ONCHIT – National Coordinating Office • CCHIT – Certification Process • eHI – e Health Initiative

33. Costs • Hardware • Software • Training • Delays during initial implementation • Delays during learning curve

34. Culture Change • An organization that succeeds… • Greets quality measurement with enthusiasm • Views change as an opportunity • Embraces accountability • Regards performance improvement as an everyday activity • Recognizes that HIT implementation is an organizational change, not an IT project

35. HIT in Arkansas Hospitals • Of the 81 hospitals surveyed: • 31% plan to implement HIT <3 years • .02% have implemented CPOE • .08% have implemented EHR • .04% have implemented barcoding

36. HIT: Home Health Agencies • Of the 170 agencies surveyed: • 14% plan to implement HIT < 2 years • 13% have implemented an EHR • .04% have implemented telemonitoring

37. Where Do All The Data Go? Who are the Stewards?

38. The National Vision A network of interoperable systems linking clinical, public health and personal health information that providers could easily access to more effectively diagnose, treat and manage quality care.

39. Health Information Exchange (HIE) • Stakeholder Interest Group • Met Quarterly • AHA, AMS, AHCA, DHHS, QualChoice, Blue Cross, • Recognized Need for Formal Structure • “Next Steps” Document in Preparation • NGA RFP • Legal Issues Related to HIE

40. Potential Model for Progress

41. Contact Information To find out more, please call us: Arkansas Foundation for Medical Care (877)375-5700