1. 0 Building a Curriculum for Nursing Informatics and QSEN – A National Policy Perspective Judy Murphy, RN, FACMI, FHIMSS, FAAN Deputy National Coordinator for Programs & Policy Office of the National Coordinator for Health IT Department of Health & Human Services Washington DC QSEN Workshop 10.02.2012, 1:30-2:30pm

2. 1 Opportunities & Challenges An Update from the ONC The Time is Now for Health IT Health IT as the Means, not the End Meaningful Use Stage 1 Attestation Update HITECH Program Updates Putting the “I” in Health IT Campaign Consumer eHealth Challenges and Prizes program Meaningful Use of Meaningful Use Feet on the Ground and Eye on the Prize

3. 2 President Bush’s goal in 2004 Executive order established the Office of the National Coordinator for Health Information Technology (ONCHIT) as part of the Dept of Health & Human Services (HHS) –Dr. David Brailer appointed the first National Coordinator “… an Electronic Health Record for every American by the year 2014. By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” - State of the Union address, Jan. 20, 2004 A Bit of History …

4. 3 “To lower health care cost, cut medical errors, and improve care, we’ll computerize the nation’s health records in five years, saving billions of dollars in health care costs and countless lives.” - First Weekly Address Jan. 24, 2009 February 17, 2009 – the American Reinvestment and Recovery Act (ARRA – Stimulus Bill) is signed into law –HITECH component of ARRA provides an incentive program to stimulate the adoption and use of HIT, especially EHR’s –Dr. David Bluementhal appointed the new National Coordinator The Time is Now … President Obama’s goal in 2009

5. 4 IOM Future of Nursing Report Oct 2010 The national focus on HIT continues … PCAST Report Dec 2010 (President’s Council of Advisors on Science & Technology) PPACA Mar 2010 (Patient Protection & Affordable Care Act) “There is no aspect of our profession that will be untouched by the informatics revolution in progress.” - Angela McBride, Distinguished Professor and University Dean Emeritus Indiana University School of Nursing

6. 5 HIT as the means, not the end Dr. David Blumenthal, previous National Coordinator of HIT, emphasizes “HIT is the means, but not the end. Getting an EHR up and running in health care is not the main objective behind the incentives provided by the federal government under ARRA. Improving health is. Promoting health care reform is.” - At the National HIPAA Summit in Washington, D.C. on September 16, 2009

7. 6 Dr. Farzad Mostashari, current National Coordinator of HIT, emphasizes “The goal of implementing health IT is to provide care that is safer, improves the quality of care, creates greater efficiency, and is more coordinated and patient- centered. Technology can help lead the nation to a place where we can "prevent a million heart attacks and strokes in the next five years, where we can reduce hospital acquired conditions by 40% over the next three years, [and] reduce readmissions by 20% over the next three years.“ - At the HIMSS Conference on February 28, 2012 Modernizing health care

8. 7 A Remarkable Journey Meaningful Use

9. 8 Progress of Eligible Professionals Toward EHR Incentive Payments Source: CMS EHR Incentive Program Data as of 7/31/2012

10. 9 Progress of Eligible Hospitals Toward EHR Incentive Payments Source: CMS EHR Incentive Program Data as of 7/31/2012 Note: Totals reflect the number of unique hospitals that have received payments from Medicare or Medicaid.

11. 10 Source: CMS EHR Incentive Program Data as of 7/31/2012 Meaningful Use – All Payments as of July 31, 2012 ($ in Millions)

12. 11 HITECH Framework for MU of EHRs Taken from: Blumenthal, D. “Launching HITECH,” posted by the NEJM on 12-30-2009. 11

13. 12  R egional Extension Centers - 62 to support physician adoption  Health Information Exchange - 56 state programs Standards & Certification interoperability specifications Privacy and Security  Beacon Communities – 17 demonstration projects of EHR value  SHARP Research Projects – 4 HIT adoption breakthrough advances Security – University of Illinois at Urbana Patient-Centered Cognitive Support – University of Texas Application & Network Design - Harvard Secondary Use of EHR Data – Mayo Clinic  Workforce Training Programs to support HIT education University Based Programs – 9 universities Consumer eHealth Community College Consortiums – 5 regions Curriculum Development & Competency Exam  Consumer eHealth Update on ONC Initiatives

14. 13 Health IT Resource Center Work with external communities and shares knowledge Tools Resources Communities of Practice (CoPs) Work with REC community and shares knowledge National Learning Consortium HealthIT.gov

15. 14 FOCUS ON INTEROPERABILITY in Stage 2 Meaningful Use Give providers viable options to meet the expanded Stage 2 MU exchange requirements E-prescribing Transition of Care summary exchange: Create & transmit from EHR Receive & incorporate into EHR Lab tests & results from inpatient to outpatient Public health reporting – transmission to: Immunization Registries Public Health Agencies for syndromic surveillance Public health Agencies for reportable lab results Cancer Registries Patient View, Download and Transmit to 3 rd Party State HIE Program and “health information exchange” (the verb)

16. 15 University of Hawaii at Hilo Southeastern Michigan Health Association Detroit, MI Southeastern Michigan Health Association Detroit, MI Louisiana Public Health Institute New Orleans, LA Louisiana Public Health Institute New Orleans, LA Delta Health Alliance Stoneville, MS Delta Health Alliance Stoneville, MS Geisinger Clinic Danville, PA Geisinger Clinic Danville, PA HealthInsight Salt Lake City, UT HealthInsight Salt Lake City, UT Inland Northwest Health Services Spokane, WA Community Services Council of Tulsa Tulsa, OK Community Services Council of Tulsa Tulsa, OK Mayo Center Clinic Rochester, MN Rhode Island Quality Institute Providence, RI Rhode Island Quality Institute Providence, RI HealthBridge Cincinnati, OH HealthBridge Cincinnati, OH Southern Piedmont Community Care Plan Concord, NC The Regents of the University of California San Diego, CA The Regents of the University of California San Diego, CA Western NY Clinical Information Exchange Buffalo, NY Rocky Mountain HMO Grand Junction, CO Rocky Mountain HMO Grand Junction, CO Eastern Maine Healthcare Systems Brewer, ME Indiana HIE Indianapolis, IN Indiana HIE Indianapolis, IN 17 Beacon Communities

17. 16 17 communities each funded ~$12-15M over 3 yrs to… Build and strengthen the health IT infrastructure and exchange capability - positioning each community to pursue a new level of sustainable health care quality and efficiency over the coming years. Improve cost, quality, and population health - translating investments in health IT in the short run to measureable improvements in the 3-part aim. Innovative - accelerating evidence generation for new approaches in care delivery, performance measurement, and technology integration. Beacon Community Aims

18. 17 Community College Workforce Training Enrollment and Graduation Total Students Enrolled or Completed: 19,831 Attrition Rate: 21.9% Total Students Enrolled or Completed: 19,831 Attrition Rate: 21.9%

19. 18 University-Based Workforce Training Enrollment and Graduation Total Students Enrolled or Completed: 1,577 Percent of Goal: 94% Total Students Enrolled or Completed: 1,577 Percent of Goal: 94%

20. 19 HealthIT.gov website (for providers)

21. 20 HealthIT.gov website (for patients)

22. 21 HealthIT.gov website (for informaticians)

23. 22 Putting the “I” in Health IT Campaign

24. 23

25. 24 ePatient Dave Cancer Survivor and Proud Father

26. 25 Nikolai “ Koyla ” Kirienko Crohn ’ s Disease Patient and Trailblazer

27. 26 Consumer eHealth Pledge Program www.healthit.gov/pledge Over 400 organizations have Pledged to provide access to personal health information for 1/3 of Americans…

28. 27 Consumer Involvement is critical LINK: http://youtu.be/QCc6QgYUFEMhttp://youtu.be/QCc6QgYUFEM

29. 28 ONC’s Challenges and Prizes program spurring private- sector innovation and engaging developers to address health problems that touch every person in America:  Care Transitions  Cancer Research  Heart Disease  Population Health  Sexual Abuse  Disabilities Over 100 new applications developed Winners have received $195,000 in prizes Over 25 new challenges planned Investing in Innovation (i2)

30. 29 Million Hearts – Provider Goals

31. 30

32. 31 Consumer Challenge

33. 32 Consumer Video Challenge Winner Dr Funky's Blood Pressure Management Rx http://bloodpressure.challenge.gov/submissions/7498-dr-funky-s-blood- pressure-management-rx http://bloodpressure.challenge.gov/submissions/7498-dr-funky-s-blood- pressure-management-rx

34. 33 Our National Quality Strategy Aims

35. 34 Health Information Technology Improving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient- Centeredness, Timeliness, Efficiency, and Equity. Better healthcare Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care. Better health Lowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries. Reduced costs $ Health IT: Helping to Drive the 3-Part Aim

36. 35 Vision for the Future Measures Drive Improvement – Real-time – Local ownership with benchmarking – Linked to decision support and patient dashboards Measures Drive Value-Based Purchasing – Reliable – Accurate – Outcomes-based Measures Inform Consumers – Meaningful – Transparent

37. 36 Quality Measurement Enabled by Health IT Released July 2012 Contains a catalog of over 70 activities related to health IT and quality measurement Describes possibilities for the next generation of quality measurement Illustrates challenges facing advancement

38. 37 Stage 2 MU ACO’s “Stage 3 MU” PCMH 3-Part Aim Registries to manage patient populations Team based care, case management Enhanced access and continuity Privacy & security protections Care coordination Privacy & security protections Patient centered care coordination Improved population health Registries for disease management Evidenced based medicine Patient self management Privacy & security protections Care coordination Structured data utilized Data utilized to improve delivery and outcomes Patient informed Patient engaged, community resources Stage 1 MU Privacy & security protections Basic EHR functionality, structured data Utilize technology Access to information Transform health care Meaningful Use as a Building Block

39. 38

40. Best Care at Lower Cost The Path to Continuously Learning Health Care in America September 2012

41. The Result? The U.S. health care system today

42. The Vision Continuous Learning, Best Care, Lower Cost

43. 10 Recommendations Foundational elements 1. The digital infrastructure – Improve the capacity to capture clinical, delivery process, and financial data for better care, system improvement, and creating new knowledge. 2. The data utility – Streamline and revise research regulations to improve care, promote the capture of clinical data, and generate knowledge. Care improvement targets 3.Clinical decision support 4.Patient-centered care 5.Community links 6.Care continuity 7. Optimized operations Supportive policy environment 8. Financial incentives. 9. Performance transparency 10.Broad leadership

44. 43 Resources Browse the ONC website at: HealthIT.govHealthIT.gov click the Facebook “Like” button to add us to your network Contact us at: onc.request@hhs.gov onc.request@hhs.gov Subscribe, watch, and share: @ONC_HealthIT http://www.youtube.com/user/HHSONC Health IT and Electronic Health Records http://www.scribd.com/HealthIT/ http://www.flickr.com/photos/healthit Health IT Buzz Blog

45. 44 Resources iom.edu/bestcare cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms http://healthit.ahrq.gov/HealthITEnabledQualityMeasurement/Snapshot.pdf http://www.ncqa.org/Portals/0/Public%20Policy/PCMH_MU_Graphic_062012.pdf

46. 45 Thank you! For more information, contact: judy.murphy@hhs.gov