The CPR Landscape: Current Status and Pressing Needs

1. The CPR Landscape:Current Status and Pressing Needs Paul C. Tang, MDNorthwestern Memorial Hospital

2. Outline • Progress Report on the Computer-based Patient Record Since the 1991 IOM Report • Users and Uses of CPR • Remaining Impediments • Role for NCVHS

3. CPR DefinitionIOM A CPR is an electronic patient record that provides: • complete and accurate data • alerts • reminders • clinical decision support • links to medical knowledge • other aids

4. Institute of Medicine ReportFirst Edition, 1991 • Adopt CPR as the standard for all records related to patient care • Establish public/private CPRI to focus national agenda • Provide public/private support for CPR research, development, and demonstration • CPRI: Promulgate national standards for data and security

5. Institute of Medicine ReportFirst Edition, 1991 • CPRI: Review laws and regulations to facilitate implementation of CPRs • Share costs of CPRs among all users of data • Enhance educational programs on CPRs

6. National Priorities in Health CareChange in Business Landscape • Cut costs • Capitate • PCP as gatekeeper • Generate quality reports • Regulate managed care • Audit billing practices

7. NCQA WarningIf You Don’t Have an Information System... “Given the magnitude of the U.S. health care enterprise, the need for excellent health plan information systems for a variety of reasons is clear — and yet we do not have them. More often than not, information systems are a barrier to the efficient, effective use of data to measure quality, improve care and service, manage finances, and support clinical research.”

8. NCQA To Providers and Plans:Get One! “Health plans, purchasers, and providers must make a sustained investment of personnel, time and resources.” “New sets of performance measures will assume that health plans have established the levels of automation described in this report.”

9. Mandates Cut costs Capitate PCP gatekeeper Report quality Billing compliance Data-Enabled Manage costs Manage disease Manage demand Measure and improve By-product of care National Priority for DataData Driven Decisions

10. Enabling TechnologiesChange in Technology Landscape • One world: Internet connectivity • Negroponte: 1 B users by 2000 • “One” interface (viewer) • Many computers • Multiple platforms (H/W, OS) • Legacy systems

11. Decision Support MD Order Entry Clinical Data Repository Progress Notes Ubiquity (for authorized use) Continual Care Status of CPRDevelopment and Implementation

12. Users Physicians Nurses Patients Functions Access complete, integrated data Provide confidentiality and security Ubiquitous access Decision support Patient education Users and CPR FunctionsExample Primary Users and Functions

13. Users Clinical management Administrative management Clinical researchers Health services researchers Functions Ability to aggregate data Maintenance of confidentiality Generate data as by-product of care Produce reports Users and CPR FunctionsExample Secondary Users and Functions

14. Adopt CPR Establish public/pvt CPRI Public/private funding of research and development Share costs of CPRs among users of data Still a goal; early adopters implementing CPRI established, largely privately funded Industry: `99’ CPR vendors at ‘98 HIMSS; Public: NLM, AHCPR, NIST, DoD, VA Still largely borne by users of CPR IOM RecommendationsMid-Decade Follow Up

15. CPRI Mandates from IOMPromulgate National Standards • 1996 National Summit on Health Information Solutions • Collaborative effort (AHIMA, AMIA, CHIM, CHIME, HIMSS, MLA) • Over 80 healthcare senior executive stakeholders • Consensus on: • Universal Health Identifier • Confidentiality and Security Laws and Policies • Terminology Conferences to promote convergence of terminology standards

16. CPRI Mandates from IOMPromulgate National Standards, cont • Proposed Standards Acceleration Project • CPRI neutral forum, coordination • Full-time efforts to developing standards, esp. terminology • GCPR Project • Complementary government project and national standards development

17. CPRI Mandates from IOMPromote Enabling Policies and Laws • CPRI Guidelines on security and confidentiality • Establishing Information Security Policies • Information Security Education Programs • Managing Information Security Programs • Sample Confidentiality Agreements • Glossary of Terms • Security Features for CPR Systems • Electronic Signature Policies URL: www.cpri.org

18. CPRI Educational ProgramsEnhancing Education on CPRs • CPRI HIPAA Implementation Conference • April 27-28, 1998 • CPRI General Meetings • e.g., July 9, 1998 on Evaluating CPRs • CPRI Davies Award Program for Excellence in CPR Implementation • July 10, 1998 • CPRI Terminology Conference II • Winter 98

19. Pressing NeedsDevelop CPRs and Demonstrate Results • Evolve products through use and continual enhancement • Evaluate CPRs to understand and quantify benefits and costs • Communicate results and best practices • CPRI Davies Award Symposium • Conferences and media

20. Pressing NeedsInfrastructure • Standards • Universal health identifier • Clinical terminology • Policies and Laws • Confidentiality and security • Cost sharing models • Leadership and Strategic Planning • Business needs for information • High capital costs

21. Recommendations for NCVHSAdvancing Progress Towards CPRs • Standards • UHI: Conduct hearings, recommend solution • Clinical terminology and data model: Define problem, recommend public funding to achieve results by 2001 • Policies • Confidentiality: Keep legislative process on track • Data and cost sharing: Propose recommendations to HHS for incentives and cost sharing