1. Presented to the LA/Orange County Regional Consortium May 20 th, 2010 Healthcare Information Systems Rajiv Kapur, Ph.D.

2. Discussion Topics The Case for Healthcare Information Systems Primer: Healthcare Information Systems Understanding Meaningful Use of EHRs and CMS incentive program Meaningful Use and HIT jobs HIT Training Program

3. The Case for Healthcare Information Systems Medical errors (reduces with HIT) Incomplete charting/Deficiency Management (improves with HIT) Accessibility (HIT provides greater accessibility) Efficiency (HIT more efficient) Quality (HIT improves quality) Storage space for medical records (not applicable to HIT) Cost for maintaining paper records (not applicable to HIT) Standardization of records (not applicable to HIT) Accuracy of information (HITs provide more accurate info) Immediate availability of records on remote sites (HIT provides greater accessibility) Supply management and patient billing (better with HIT) Discharge instructions (better facilitated through HIT) Ability to standardize and exchange key data sets across the U.S. (only possible through HIT)

4. Discussion Topics The Case for Healthcare Information Systems Primer: Healthcare Information Systems Understanding Meaningful Use of EHRs and CMS incentive program Meaningful Use and HIT jobs HIT Training Program

5. Primer: Healthcare Information Systems Health care comprises of three different organization types: provider-based (hospitals and physician clinics), supplier-based (pharmaceuticals) payer-based (Blue Cross). HIS vendors provide a majority of IT needs for provider-based health care. On the other hand supplier-based and payer-based health care IT needs are principally custom developed by the individual entities. Today’s focus is on provider based HIT– inpatient, outpatient and ambulatory care – due to it’s growth over the next 5 years through an infusion of over $20B of incentive monies through CMS (Medicare and Medicaid).

6. Primer: Healthcare Information Systems Over the past 30 years hospitals and health systems have principally automated business, financial and ancillary systems (labs, radiology and pharmacy). Over the last 10 years hospitals have gradually begun to automate their EHRs (Electronic Health Records). This process has been recently accelerated with the introduction of Meaningful Use of EHRs linked to CMS incentive payments. Over the past 20 years physicians and their offices have principally focused on billing systems. Over the last 10 years physician offices have begun to automate their scheduling and registration systems. This process has been recently accelerated to include EHRs with the introduction of Meaningful Use of EHRs linked to CMS incentive payments.

7. Primer: Healthcare Information Systems There are over 50 hospital information system vendors that support acute care (such as patient registration, scheduling, billing, electronic medical record, point of care documentation, instrument interface and standard data exchange) and over 250 ambulatory care information systems that support physician billing and medical record operations. These vendors provide different areas of focii and lack architectural integrity and standardization. However, using the 80/20 rule we can see that three acute care vendors– Meditech, Cerner and Epic; and three ambulatory care vendors – NextGen, Allscripts and GE/Centricity support a majority of hospital and physician systems. Therefore it is possible to implement a HIS vendor-centered training program (if necessary) for technical and non-technical healthcare personnel in the design and understanding of healthcare systems.

8. Discussion Topics The Case for Healthcare Information Systems Primer: Healthcare Information Systems Understanding Meaningful Use of EHRs and CMS incentive program Meaningful Use and HIT jobs HIT Training Program

9. Federal Case for Health Information Systems: CMS Incentive Program The American Recovery and Reinvestment Act of 2009 (ARRA) was signed into law by President Obama on February 17, 2009. The law includes the Health Information Technology for Economic and Clinical Health Act, or the "HITECH Act," which established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of certified electronic health records (EHR) technology. On Jan 13 th 2010 CMS published the NPRM (notice of proposed rule making) to memorialize ARRA’s HITECH definition of MU (meaningful use) of EHRs (electronic health records) and a financial incentive program to encourage the adoption of MU. NPRM details the implementation of EHRs in three progressively advanced stages which stretch over 6 years starting FFY 2011 and ending FFY 2016.

10. Federal Case for Health Information Systems: CMS Incentive Program ARRA provides incentives to an eligible hospital that is a “meaningful EHR user.” The law requires a “meaningful EHR user” to: Use certified EHR technology, including e-prescribing Engage in the exchange of health information to improve quality and promoting care coordination Report on measures using EHR What incentive payment can a hospital with 10,000 Medicare discharges, a 35% Medicare Share, expect to earn from CMS? Incentive Total (over 4 years of eligibility)= $3.5M Y1 = $1,400,000; Y2 = $1,050,000; Y3 = $700,000; Y4 = $350,000 This incentive is for Medicare patients only. Hospitals can generally expect similar incentives for Medicaid (MediCal in California) patients. However if a hospital does not become a meaningful user of EHRs by FFY 2015 they will start losing Medicare and Medicaid payments.

11. Discussion Topics The Case for Healthcare Information Systems Primer: Healthcare Information Systems Understanding Meaningful Use of EHRs and CMS incentive program Meaningful Use and HIT jobs HIT Training Program

12. Meaningful Use and HIT Jobs According to Dr. John Halamka, CIO of Harvard Medical and Chair of the HITSP (Healthcare Information Technology Standards Panel) and Co-chair of the HIT Standards Committee. “Unlike other countries where the government is creating its own infrastructure and dictating which systems the medical community must use, the Obama Administration’s health IT program uses federal dollars to give an adrenaline boost to the market. It does this in 3 ways: incentives to providers who use IT to achieve higher quality, lower cost of care; non-proprietary standards to create a level playing field for users and sellers of software and hardware systems; unbiased certification of software to provide assurance that it meets basic quality, safety and efficiency standards.” Dr. Halamka adds, “Qualified staff is getting harder to find. Over the next few years, there is likely to be a competition for trained healthcare IT professional, similar to the Dot Com era. The states can really help by adding additional resources to community colleges for staff development as we prepare for 50,000 new HIT jobs.”

13. Discussion Topics The Case for Healthcare Information Systems Primer: Healthcare Information Systems Understanding Meaningful Use of EHRs and CMS incentive program Meaningful Use and HIT jobs HIT Training Program

14. HIT Training Requirements Non-technical personnel: understand health care information systems in the context of health care operations; analysis and design of information systems through the system life cycle; emerging technologies in health care; and legal and social issues related to health care. Technical personnel: structured project management techniques, system specifications, system design, process optimization using quantitative tools to effectively implement IT systems in healthcare systems (Hospitals and physician office settings) for improved productivity, cost and quality of care.

15. Certificate 1 for Health Professionals (RNs, MDs, Administrators) 1.Introduction to Health Care Information Systems  Presents an overview of healthcare information. Focuses on the application of computerized information systems to the activities within health care organizations, including patient care delivery, patient records, administration, patient charges and billing, research, security, and what is needed to design and implement an appropriate health information infrastructure. 2.Information System Design and Analysis  Discusses the planning, analysis, design, and implementation of computer- based information systems, focusing on the methodologies and procedures used in organizational problem solving and systems development. Topics include the systems development life cycle; project management; requirements analysis and specification; feasibility and cost-benefit analysis; logical and physical design; prototyping; system validation, deployment, and implementation review. Additional topics include platform and database selection and integration issues, CASE tools, end-user training, maintenance, and object-oriented analysis and design.

16. Certificate 1 for Health Professionals (RNs, MDs, Administrators) 3. Emerging Technologies in Healthcare  Explores the administrative and research applications of computers in today’s health-care delivery system.  Discusses emerging trends in the field of health-care informatics. 4. Legal and Social Issues in Healthcare Information Systems  Explores the complex social and legal issues in today’s health- care organizations and their impact on information systems.  Examines the laws and ethics dictating systems needed to ensure legal compliance, patient confidentiality, and security.

17. Certificate 2 for Health Technology Professionals 1.Introduction to healthcare systems  Understand healthcare language  Introduction to CMMI (Capability Maturity Model Integration) and application to healthcare systems – including:  Project Management  Risk Management  Requirements Management  Measurement and Analysis  Configuration Management  Decision Analysis and Resolution 2.Overview of popular Information Systems - functional design  Understand EHRs (Electronic Health Records) and Meaningful Use of EHRs.  Models for economic analysis  Design and use of information systems  Privacy and Security of PHI (Private Health Information)

18. Certificate 2 for Health Technology Professionals 3.Understanding database management systems  Structured data-sets  Data standards throughout health care – their meaning and significance  Integrate information and biomedical systems  Information exchange across data sets and entities 4.Life Cycle Analysis in the context of system design and implementation  Tools and techniques to assess process flow and map user requirements with system functional capabilities and workflow design  Use of the following tools - simulation modeling, Linear Programming (LP), forecasting, queuing theory and yield management - to optimize healthcare systems.  Capstone project that includes selection, design and implementation of information systems (to satisfy a proposed case study)

19. Reference www.cms.gov/Recovery/11_HealthIT.asp Questions? Healthcare Information Systems – Training Certification