America’s Voice for Community Health Care

2. America’s Voice for Community Health Care The NACHC Mission To promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved people.

3. Health Information Technology A Primer Michael Lardiere, LCSW Director, Health Information Technology Sr. Advisor, Behavioral Health National Association of Community Health Centers Date: February 13, 2008

4. Objectives What is HIT? What are the various Forms of HIT? Why is HIT useful/necessary? What is the Ultimate Goal of Using HIT? Where Do We Start? How Do We Know if We are Ready? Change Management and Workflow Processes How Do We Go About Selecting a Vendor/System? Are We in this Alone?

5. What is HIT? HIT consists of an enormously diverse set of technologies for transmitting and managing health information for use by Consumers Providers Payers Insurers, and All the other groups with an interest in health and health care.

6. What are the Various Components of HIT? Applications Patient Registries Accounting/Practice Management Systems (PMS) CPOE/CDS (Computerized Physician Order Entry with Clinical Decision Support) ePrescribing Electronic Medical/Health Records (EMRs/EHRs) Patient Health Records (PHRs)

7. What are the Various Components of HIT? Applications Results Reporting Electronic Documentation Appointment Scheduling Patient Kiosks Telemedicine Interface Engines

8. What are the Various Components of HIT? Communications Messaging Standards HL7, ADT, NCPDP, X12, DICOM, UB92, HCFA, ASTM, EDIFACT, etc. Coding Standards LOINC, ICD-9, CPT, NDC, RxNorm, Snomed CT, etc.

9. What are the Various Components of HIT? Process HIE (Health Information Exchanges) RHIOs (Regional Health Information Organizations) MPI (Message Passing Interface) HIPAA Security/Privacy

10. What are the Various Components of HIT? Devices Servers Desktops Laptops Tablet PCs Mice Pens Bar Coding

11. Why is HIT Useful/Necessary? Healthcare delivery is inherently fragmented Multiple Providers/Services & Multiple Payers More than 360,000 care delivery sites in the US Inefficient or Absent communication Increased Provider Specialization

12. Why is HIT Useful/Necessary? Fragmentation leads to miscommunication and errors Duplicate Testing Medication Lists not reconciled properly causing medication interactions and ineffective therapy as meds are stopped pre-maturely Poor documentation, illegible handwriting and other mis-communication causing errors Increased healthcare utilization and increased cost of care Reduced timeliness of care Inappropriate or Unnecessary Care And many other problems ….

13. Why is HIT Useful/Necessary? Adverse Drug Events (ADEs) are a leading cause of morbidity (and mortality) in the US In a meta-analysis of ADEs, 84% were classified as preventable EX: Many of the patients studied with permanent disabilities directly resulting from ADEs received higher than usual drug dosage The average settlement cost in the resulting litigations was $4.3 million!

14. Why is HIT Useful/Necessary? Improving Quality of Care Patient Safety Decreasing Medical Errors IT solutions can help with clinical decision support: Medication conflicts Clinical knowledge – differential diagnoses etc. Latest lab and test results Medication Lists List of appointments Clinic notes and consult recommendations

15. Why is HIT Useful/Necessary? Reducing Health Disparities Research results and evidence based guidelines Facilitates the Medical Home Improved access to and more “personalized” care for the patient and caregivers Patient centered care for high-risk patients – i.e. better monitoring

16. Why is HIT Useful/Necessary? Timely Payment for Services Increasing Efficiency in Care Delivery Makes Pay For Performance Obtainable

17. What is the Ultimate Goal of Using HIT? To improve the Quality of Health Services and Outcomes for All Patients Not Only to Collect Data Data Used to Track, Alert & Manage Individual Patient Outcomes Population Health Outcomes, and Improve Overall Care of All Patients

18. What is the Ultimate Goal of Using HIT?Developed by Alliance of Chicago Health Services, LLC

19. Where Do We Start? How Do We Know if We are Ready? Assessments Organizational Commitment Board CEO Clinical Leadership Financial

20. Where Do We Start? How Do We Know if We are Ready? Assessments Staff Computer Knowledge Basic Keyboard Skills Basic Mouse Skills Readiness to Change Readiness to Change Readiness to Change Readiness to Change

21. Where Do We Start? How Do We Know if We are Ready? Assessment Infrastructure Current Computer Hardware High Bandwidth Capability Offices Wired for Computers Examination Rooms Wired for Computers

22. Change Management & Workflow Processes Opportunities Improved Communication Redesigned Workflows to meet Organization Goals Opportunity to Think “Out of the Box” 80% of Implementation is in Workflow/Process Change Management 20% in Hardware/Software Implementation Improved Teamwork

23. Change Management & Workflow Processes Implementation Team MUST include ALL Levels of Staff Project/Champion/Manager Should be selected Not Necessarily the IT Guy Clinical Champion is Necessary Implementation is an Overall Review of the Current Status Quo with Opportunities for Improvement/Revitalization

24. How Do We Go About Selecting a Vendor/System? Start with CCHIT http://www.cchit.org Speak to other Centers Similar to Yours Regarding Their Experience with Vendors NACHC can Help Determine your Most Important Requirements Request References from Vendors (5 – 10) Schedule Site Visits that You Choose Include Representatives from Your Implementation Team Determine Hidden Costs Engage Legal for Contract Review

25. Implementation of any HIT Solution is a System-Wide Process Identify Goals for Success Monitor the Goals Encourage Input and Recommendations for Improvement Manage the Process of Continuous Improvement Implement Recommendations to Continually Improve Your Operations and Services

26. Helpful Resources Agency for Healthcare Research and Quality – HIT http://healthit.ahrq.org Health Information Management and Systems Society http://www.himss.org California Healthcare Foundation http://www.chcf.org Certification Commission for Healthcare Information Technology http://www.cchit.org Robert Wood Johnson http://www.rwjf.org eHealth Initiative http://www.ehealthinitiative.org NACHC www.nachc.com

27. Michael Lardiere, LCSW National Association of Community Health Centers Director, HIT Sr. Advisor, Behavioral Health 7200 Wisconsin Ave, Ste 210 Bethesda, MD 20814 301-347-0400 301-347-0459 (fax) mlardiere@nachc.com www.nachc.com