Public Health IT

1. Public Health IT Unit 4: Public Health Enabled Electronic Health Records, Decision Support, and Their Role in the Meaningful Use of Health Care Technology Lecture a This material (Comp13_Unit4a) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003. This material was updated by Columbia University under Award Number 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. EHRs, Decision Support, and Meaningful Use of HIT Learning Objectives • Objective 1: Discuss the New York City Department of Health and Mental Hygiene partnership with a commercial EHR vendor and how it created a public health – enabled EHR • Objective 2: Describe the EHR "meaningful use" movement and how it could transform existing clinical / public health practices

3. EHRs, Decision Support, and Meaningful Use of HIT Learning Objectives (Cont’d – 1) • Objective 3: Demonstrate knowledge of public health – oriented clinical decision support including an integrated strategy using multiple tools such as alerts, order sets, smart forms, and quality reporting • Objective 4: Describe the strategies, features, and systems needed for public health agencies to define and build the necessary connections to EHRs as identified by the “meaningful use” legislation • Objective 5: Identify the essential features of four primary public health IT functions including syndromic surveillance, bidirectional immunization registries, public health alerts, ad – hoc reporting, etc.

4. New York City public health goals • Take Care New York advises that every New Yorker take these 10 steps to lead a healthier life: • Have a regular doctor or other health care provider • Be tobacco free • Keep your heart healthy • Know your HIV status • Get help for depression • Live free of dependence on alcohol and drugs • Get checked for cancer • Get the immunizations you need • Make your home safe and healthy • Have a healthy baby

5. Primary Care Information Project (PCIP) • http://www.nyc.gov/pcip • The Primary Care Information Project (PCIP) is a bureau of the NYC Department of Health and Mental Hygiene • PCIP is also the regional EHR extension center for NYC • Since 2005, PCIP has administered the nation’s largest community EHR expansion program

6. Primary Care Information Project (PCIP) (Cont’d - 1) 4.1 Table (Primary Care Information Project, 2010). 4.1 Figure (Primary Care Information Project, 2010).

7. ECW / PCIP partnership • eClinicalWorks (ECW): • A CCHIT – certified vendor providing one integrated system for practice management / EHR / billing / PHR • 2007 partnership between PCIP and eClinicalWorks to develop public health functionality in response to Department of Health initiative: Take Care New York • This experience helped to shape the criteria for meaningful use as envisioned by PCIP’s founder Dr. FarzadMostashari

8. Deal for the providers • We give them… • ECW software • 10 days of onsite training • Data migration services • Business analyst services • Discounted ASP services • Onsite technical assistance • They are responsible for… • Hardware • Staff time spent in training • Lost revenue • Self – tutorial and web – based learning • $4,000 per FTE for technical assistance

9. Additional services • Contemplation • Provider outreach and education • Vendor selection • Group purchasing discounts • Readiness assessments • IT consultation • Partners for financing and workforce development • Implementation • Contract accountability • Project management • Workflow redesign (large practices) • Social networking • Communication outreach

10. Additional services (Cont’d – 1) • Post go live • Revenue cycle optimization • EMR consulting • QI consulting • PCMH preparation • Privacy and security consulting • Workflow redesign (small practices) • Patient portal training • Interfaces (e.g., labs, registries • Pilots • Meaningful use • Quality measures utilization measures • Health Information Exchange • Interoperability • Patient engagement • Biosurveillance

11. 2010 goals • Extend EHRs that support prevention to 2,500 Medicaid providers, over 1.5 million patients • Support EHR – enabled providers in a standardized health information exchange • Design and implement a pay – for – performance incentive program that supports and recognizes preventive measures • Prepare providers to meet “Meaningful Use” requirements

12. NYC REACH Extension Center • The Extension Center must be capable of providing assistance to all providers in a designated region, but priority shall be given to providers that are primary care physicians and / or other health care professionals with prescriptive privileges, such as physician assistants and nurse practitioners

13. NYC REACH Extension Center (Cont’d – 1) • A few of the primary priorities of NYC REACH are: • Assisting providers to adopt an EHR • Providing assistance to reach “Meaningful Use” of the EHR • Enabling the electronic exchange of health information between EHRs • Reporting of quality measures using the EHR

14. Meaningful use as a “launch pad” • The American Recovery and Reinvestment Act (ARRA) provides over $40 billion in health IT incentives to assist and reward providers for achieving “meaningful use” • Primary goal of HIT stimulus • Use timely and easily accessible information to improve the delivery and consistency of effective health care • Adoption of technology is not enough • Five key areas to integrate technology to improve overall health and delivery systems

15. Meaningful Use goals • Goal 1: Improve quality, safety, efficiency, and reduce health disparities • Provide access to comprehensive patient health data for patient’s health care team • Use evidence – based order sets and CPOE e – prescribing • Apply clinical decision support at the point of care • Generate lists of patients who need care and use them to reach out to patients • Report to patient registries for quality improvement, public reporting, etc.

16. Meaningful Use goals (Cont’d – 1) • Goal 2: Engage patients and families • Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health • Goal 3: Improve care coordination • Exchange meaningful clinical information among professional health care team

17. Meaningful Use goals (Cont’d – 2) • Goal 4: Improve population and public health • Submit data (immunization, syndromic surveillance and reportable disease) to public health agencies • Goal 5: Ensure adequate privacy and security protection for personal health information • Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law • Provide transparency of data sharing to patients

18. Improve population and public health: 2011 • Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice • Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice

19. Improve population and public health: 2013 • Receive health alerts from public health agencies • Provide sufficiently anonymized electronic syndrome surveillance data to public health agencies with capacity to link to personal identifiers • Receive immunization histories and recommendations from immunization registries

20. Improve population and public health: 2015 • Dynamic and ad hoc quality reports • Clinical dashboards • Use of epidemiologic data • Automated real – time surveillance • Adverse events • Near misses • Disease outbreaks • Bioterrorism

21. Unit 4: EHRs, Decision Support, and Meaningful Use of HIT, Summary – Lecture a • Significant support was given to providers in New York City by the Health Department to adopt a prevention – oriented EHR capable of sending electronic health data, particularly syndromic surveillance, quality measurement, and immunization histories

22. EHRs, Decision Support, and Meaningful Use of HIT References – Lecture a References: Dr. FarzadMostashari is currently serving as Deputy National Coordinator for Programs and Policy MostashariF, Tripathi M, Kendall M. A tale of two large community electronic health record extension projects. Health Aff (Millwood). 2009 Mar-Apr;28(2):345-56. Primary Care Information Project. Accessed: October 1, 2010 from http://www.nyc.gov/pcip Singh MP. Project Management: Lessons from the Primary Care Information Project. In Medical Informatics. An Executive Primer. Editor Ong K. 2011 Healthcare Information and Management Systems Society (HIMSS), Chicago Ill. Second Edition Chapter 11. 199-214. Charts, Tables, Figures: 4.1 Table: DeLeon S, Shih SC. Tracking the delivery of prevention-oriented care among primary care providers who have adopted electronic health records. J Am Med Inform Assoc. (2011), ahead of print. August 19, 2011. 4.1 Figure: Primary Care Information Project. Accessed: October 1, 2010 from http://www.nyc.gov/pcip.

23. Unit 4: EHRs, Decision Support, and Meaningful Use of HIT, Lecture a This material (Comp 13 Unit 4a) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000013. This material was updated in 2016 by Columbia University under Award Number 90WT0005.