Health Information Technology: An Overview of the National Agenda

1. Health Information Technology:An Overview of the National Agenda Teresa Zayas Cabán, PhD Senior Manager, Health IT AHRQ & Alison Rein, MS AcademyHealth Academy Health Annual Research Meeting June 2, 2007

2. Health Information Technology: Why is it Important? The most powerful contribution information technology can make to improving health care quality… Make the right thing to do the easy thing to do

3. Health Information Technology: Why is it Important? • Other possible benefits include… • Increased efficiency • Improved communications • Expanded access to information • Enhanced public health

4. AHIC HHS ONC AHRQ CMS FDA VA DOD HRSA NIH SAMHSA Overview of Federal Agencies Involved in HIT Initiatives

5. Office of the National Coordinator for Health IT (ONC) • Robert M. Kolodner, MD: National Coordinator • Primary functions of ONC: • Serves as Secretary's principal advisor on development, application, and use of health IT; • Coordinates HHS health IT policies and programs internally - and with other relevant executive branch agencies; • Develops, maintains, and directs implementation of HHS’ strategic plan to guide the nationwide implementation of interoperable health IT

6. American Health Information Community (AHIC) • Federal advisory body (FACA rules apply) • Makes recommendations to the Secretary to accelerate the development and adoption of health information technology: • Chaired by Secretary Leavitt • Composed of 18 public and private sector members

7. AHIC Work Groups • November 2005 • Consumer Empowerment • Biosurveillance • Chronic Care • Electronic Health Records • May 2006 • Biosurveillance re-named “Population Health & Clinical Care Connections” • Sub-work group added: Biosurveillance Data Steering • Confidentiality, Privacy & Security • August 2006 • Quality (to address the need for the development of quality measures) • October 2006 • Personalized Health (to develop and make recommendations on standards for interoperable integration of genomic test information into PHRs)

8. The Use Case Model • The ONC use cases… • Describe events that detail what a system needs to do to achieve a specific goal (e.g., allow a provider access to a patient’s medication history) • Convey how individuals and organizations interact with the involved systems • Developed based on the priorities expressed by the AHIC • Stepwise development • Prototype phase • Publish high-level overview (does not include all events and actions) • Solicit feedback • Detailed phase • Publish full description of events and activities from a variety of perspectives • Solicit feedback

9. Select ONC Programmatic Contracts:At A Glance

10. Select ONC Programmatic Contracts:At A Glance (cont.)

11. Best Practices for State RHIOs • Contract to the American Health Information Management Association (AHIMA) • Nine states: California, Colorado, Florida, Indiana, Maine, Massachusetts, Rhode Island, Tennessee, and Utah • Mission to develop best practices and document successful models for state-level (RHIOs) in the areas of governance, structure, financing and health information exchange policies • Final Report www.staterhio.org/documents/Final_Report_HHSP23320064105EC_090106_000.pdf

12. Health Information Technology Standards Panel (HITSP) • Contract to American National Standards Institute (ANSI) & Healthcare Information & Management Systems Society (HIMSS) • Membership open to all stakeholders: • Standards development organizations (SDOs), • Non-SDOs (e.g., clinicians, payers, vendors, researchers) • Governmental bodies • Consumer (& labor) groups • Advances ONC agenda by harmonizing standards to enable and support widespread interoperability among healthcare software applications in the NHIN • Volunteer work force of technical committees that… • Identifies gaps, including missing or incomplete standards • Identifies duplications, overlaps, or competition among standards for relevant use cases • Provides listing of all standards satisfying the requirements imposed by the relevant use cases

13. Certification Commission for Health Information Technology (HIT) • Launched in July 2004, private sector collaboration: AHIMA, HIMSS, and The National Alliance for Health Information Technology (Alliance) • Three-year contract awarded by HHS in September of 2005 to develop and evaluate certification criteria and create an inspection process for HIT in three areas: • Ambulatory EHRs for the office-based physician or provider (immediate past/present) • Inpatient EHRs for hospitals and health systems (future: expects to have certified products available in 2007) • The Network components through which they interoperate and share information (distant future) • Mission to accelerate the adoption of health IT by creating an efficient, credible and sustainable product certification program

14. HHS Organizational Focus NIH Biomedical research to prevent, diagnose and treat diseases CDC Population health and the role of community-based interventions to improve health AHRQ Long-term and system-wide improvement of health care quality and effectiveness

15. AHRQ Roles and Resources • Health IT Research • Funding • Support advances that improve patient safety/quality of care • Continue work in hospital settings • Step up use of Health IT to improve ambulatory patient care • Our Partners • CMS – Medicare and Medicaid • HRSA – capital and resources, workforce • ONC – collaboration and coordination on health IT • DoD, VA, IHS, FDA, NIH, SAMHSA, Source: FY 2007 Budget Summary for HHS and BNA Health Care Policy Report 2-13-06

16. AHRQ HIT Investment: $166 Million Health IT Research Funding • Over 125 projects and demonstrations • Focus on the adoption of health IT • Projects in 43 states • Best practices that can improve quality of care

17. Planning 1 yr Implementation 3 yr Demonstrating Value 3 yr National Resource Center for Health IT AHRQ Health IT Portfolio (2004-2007)http://healthit.ahrq.gov Current issues: eRx standards pilots; Privacy and security in business practices State and Regional Demonstrations of HIE (CO, DE, IN, RI, TN, UT) 5 yr

18. The AHRQ Health IT Portfolio: Breadth of Technologies Used Source: Dixon BE, “The Landscape of the AHRQ Health Information Technology Portfolio.” AMIA 2006 Symposium.

19. Privacy and Security • Assess variations in privacy and security business practices, policies, laws and regulations regarding health information exchange • $17.4 million dollar contract • 33 states and Puerto Rico • Regional meetings and TA • National meeting in March 2007 • Final report this summer

20. E-prescribinghttp://healthit.ahrq.gov/eRxpilots • 4 awards totaling $6M, January 2006, administrated by AHRQ & CMS: Report to Congress: April 2007 • Test eRx systems use of data standards for how efficiently and effectively eRx information can be transmitted to and from providers and pharmacies • Initial standards + 3 eRx foundation standards: Do they work together? • Contractors and site locations • Rand Corporation (New Jersey) • Brigham and Women’s Hospital (Boston) • SureScripts (Florida, Mass., Nevada, New Jersey, Tenn.) • Achieve Healthcare Information Technology (Minnesota)

21. E-prescribinghttp://healthit.ahrq.gov/eRxpilots • Standards Testing: • Ready for implementation: • Medication History • Formulary and Benefits • Prescription Fill Status Notification • Additional testing / clarifications needed: • Prior Authorization • Structured and Codified Sig • RxNorm

22. E-prescribinghttp://healthit.ahrq.gov/eRxpilots • Other Key Findings: • Standards hold promise, but implementation issues limit usefulness • Fill status and medication history information rarely used by physicians (incomplete histories, poor display of information) • Provider-based eRx applications do not interface directly with pharmacy information systems • Some efficiencies observed, e.g., reduction in telephone time for physicians • Potential to reduce number of unnecessary scripts in long term care facilities

23. National Resource Center for Health IThttp://healthit.ahrq.gov • Lessons learned • Technical Assistance • Knowledge library • Summaries of key topics • Annotated bibliography • National teleconferences

24. AHRQ Ambulatory Safety and Quality Program (2007-2010) • To improve the safety and quality of ambulatory health care in the United States through the use of health IT • Patient safety and quality crises in hospitals are only the “tip of the iceberg.” • Complex information management and coordination across multiple settings • Ambulatory care refers to all types of health services provided by health care professionals on an outpatient basis • health care clinician offices (large and small practices), outpatient clinics, community health centers, emergency departments, urgent care centers, ambulatory surgery centers, and home care entities 

25. AHRQ Ambulatory Safety and Quality Program (2007-2010) • Three (health IT) components: • Improving Quality through Clinician Use of Health IT • Patient-Centered Care • Enabling Quality Measurement • Anticipated to start by the end of FY 2007

26. Where will we go? • AHRQ Annual Meeting • September 26-28, 2007 Bethesda MD • Value Exchanges • Clinical Decision Support, Consumer Engagement, and Medicaid

27. Additional Resources for Future Reference

28. Where to Learn More About Federal HIT Initiatives • Health & Human Services (ONC) http://www.hhs.gov/healthit/ • American Health Information Community http://www.hhs.gov/healthit/community/background/ • Centers for Medicare and Medicaid Services http://www.cms.hhs.gov/MedicaidInfoTechArch/ http://www.cms.hhs.gov/MMIS/ http://www.cms.hhs.gov/MedicaidTransGrants/ • Federal Health Architecture http://www.hhs.gov/fedhealtharch/ • Health Resource & Services Administration http://www.hrsa.gov/healthit/ • Indian Health Service http://www.ihs.gov/CIO/InfoTech_index.asp • National Institutes of Health—National Library of Medicine http://www.nlm.nih.gov • Department of Defense http://www.defenselink.mil/releases/release.aspx?releaseid=9088 • Department of Veterans Affairs http://www.myhealth.va.gov/

29. 2006 Use Cases • Consumer Empowerment (www.hhs.gov/healthit/usecases/documents/ConsumerEmpowerment.pdf) • Broad: Gain wide adoption of a Personal Health Record (PHR) that is easy-to-use, portable, longitudinal, and consumer centered • Specific: Deploy to targeted populations a pre-populated, consumer-directed, and secure electronic registration summary and medication history • Electronic Health Records (EHR) – Laboratory Results Reporting (www.hhs.gov/healthit/usecases/documents/EHRLabUseCase.pdf) • Broad: Support the implementation of interoperable, certified, EHRs while minimizing integration issues for providers • Specific: Deploy standardized, widely-available, secure solutions for accessing laboratory results and interpretations in a patient-centered manner, for clinical care, by authorized parties • Biosurveillance – Visit, Utilization, and Lab Result Data (www.hhs.gov/healthit/usecases/documents/BiosurveillanceUtilizationUseCase.pdf) • Broad: Implement real-time, nationwide, public health event monitoring and support rapid response management across public health and care delivery communities • Specific: Transmit essential data from electronically enabled health care delivery and public health systems in standardized and anonymized format to authorized public health agencies with less than one day lag time • Emergency Responder (www.hhs.gov/healthit/usecases/documents/EmergencyRespEHRUseCase.pdf)

30. 2007 Use Cases • Consumer Access to Clinical Information(www.hhs.gov/healthit/documents/PrototypeUseCaseCACI.pdf) • High level scope: Development of capabilities that would enable consumers to access their clinical information via PHR • Three scenarios: • Consumers receive and view clinical information • Consumers create provider lists and establish access permissions • Consumers transfer PHR information • Medication Management(www.hhs.gov/healthit/documents/ProtoypeUseCaseMM.pdf) • High level scope: Focus on patient medication and allergy information exchange, and the sharing of that information between consumers, providers, PBMs, and payors • Two Settings: • Inpatient • Ambulatory • Quality(www.hhs.gov/healthit/documents/PrototypeUseCaseQuality.pdf) • High level scope: Captures the integration of data to support quality measurement, enables feedback and reporting into EHRs, and begins to use quality measures to support clinical decision making and public reporting • Four prioritized needs: • Hospital based quality measures (core set) • Clinician-level measures (core set) • Feedback to clinicians (self assessment) • Public reporting

31. Contact Us! http://healthit.ahrq.gov Teresa Zayas Cabán Teresa.ZayasCaban@ahrq.gov Alison Rein Alison.Rein@AcademyHealth.org