1. Quality Improvement Introduction to Quality Improvement and Health Information Technology Lecture a This material (Comp12_Unit1a) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000013.

2. Introduction to Quality Improvement and Health Information Technology Learning Objectives ─Lecture a Identify the current challenges in healthcare quality. Examine the components of the healthcare system that have an impact on quality. 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

3. Current Healthcare Landscape: Affordable Care Act Became law on March 23, 2010 Increases health coverage for children Mandates health insurance Ends lifetime and most annual limits on care Allows young adults under 26 to stay on their parents’ health insurance Gives patients access to recommended preventive services without cost Other benefits: –50% discounts on brand-name drugs for seniors in the Medicare “donut hole” –tax credits for small businesses that provide insurance to employees 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

4. Systems and Healthcare Reform “Healthcare reform without attention to the nature and nurture of healthcare as a system is doomed …It will at best simply feed the beast, pouring precious resources into the overdevelopment of parts and never attending to the whole — that is care as our patients, their families and their communities experience it.” (Berwick, 2009) “The performance of a system — its achievement of its aims — depends as much on the interactions among elements as on the elements themselves. (Berwick, 2009) “The improvement of health and healthcare depends on systems thinking and systems redesign… ‘Reform’ without systems thinking isn’t reform at all.” (Berwick, 2009) 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

5. Current Healthcare Landscape MEANINGFUL USE Providers show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity. PATIENT-CENTERED MEDICAL HOME Providers organize care around patients, working in teams, coordinating care, and tracking over time. ACCOUNTABLE CARE ORGANIZATION Provider reimbursements are tied to quality metrics and reductions in the total cost of care for assigned population of patients. 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

6. Meaningful Use and QI “Even hospitals with fully functioning EMRs still make extensive use of digitized scans of manually completed forms and textual checklists. With no forms or screens to capture data in a structured way, hospitals fail to report quality measures as a routine byproduct of the practices, relying instead on a retrospective chart abstracting process.” (Holland, 2010) 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

7. Meaningful Use and QI The American Reinvestment and Recovery Act of 2009 “…authorizes the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for eligible professionals and hospitals who are successful in becoming ‘meaningful users’ of certified electronic health record technology …” (The American Reinvestment and Recovery Act of 2009) The HITECH (Health Information Technology for Economic and Clinical Health) Act establishes programs under CMS in coordination with the Office of the National Coordinator to accomplish this charge. 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

8. Goals of Meaningful Use Improve quality, safety, & efficiency Engage patients & their families Improve care coordination Improve population & public health; reduce disparities Ensure privacy & security protections 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

9. 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a Meaningful Use Stages

10. The Patient Centered Medical Home (PCMH) The Patient Centered Medical Home (PCMH) is “an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a healthcare setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.” (Patient-Centered Primary Care Collaborative) 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

11. Joint Principles of the Patient- Centered Medical Home American Academy of Family Physicians (AAFP) American Academy of Pediatrics(AAP) American College of Physicians (ACP) American Osteopathic Association (AOA) 7 Principles of the PCMH 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

12. Seven PCMH Principles Personal physician Physician-directed medical practice –Collective responsibility Whole person orientation –All stages of life, all sites of care Coordinated and integrated care –Assures smooth, continuous, and culturally appropriate care 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

13. Seven PCMH Principles Quality and safety –Optimal patient-centered outcomes; evidence-based practice; CQI; use of CDS; measuring achievement of outcomes, etc. Enhanced access –Ease of access to providers Payment –Recognizes value of the PCMH Coordination, Health IT, Remote Monitoring, Attention to Case Mix, Physician Share in Cost Savings; Payment for Quality 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

14. Patient Centered Medical Home NCQA Scoring Tool 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

15. Accountable Care Organizations ACO: providers and suppliers (e.g., hospitals, physicians, and others involved in patient care) work together to coordinate Medicare covered services. Goal: Medicare beneficiaries receive lower cost, higher quality, and better coordinated care Patient-centered – care decisions are joint between patient & providers Under the proposed rule: –Medicare would continue to cover Medicare services –Benchmarks developed by CMS for each ACO –ACO performance measured to determine if they receive shared savings, or held accountable for losses/poor performance. 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

16. Introduction to Quality Improvement and Health Information Technology Summary ─ Lecture a The quality of care received in the US needs improvement. In the current healthcare environment there are a number of initiatives that aim to improve the care for all Americans through the use of HIT. Meaningful Use Patient Centered Medical Home Accountable Care Organization 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

17. Introduction to Quality Improvement and Health Information Technology References—Lecture a References Affordable Care Act. Available from: www.healthcare.gov/law/index.htmlwww.healthcare.gov/law/index.html Berwick, D. October 30, 2009, speech, Harvard School of Public Health Center for Medicaid Services. Shared Services Program. Available from: https://www.cms.gov/sharedsavingsprogram/ https://www.cms.gov/sharedsavingsprogram/ Endorsing national consensus standards for measuring and publicly reporting on performance; California Academy of Family Physicians Diabetes Initiative Care Model Change Package originally developed by Lumetra Holland, Marc. In Health Information Exchange: From Meaningful Use to Healthcare Transformation. Available from: http://www.himss.org/content/files/Carefx%20_HIE_meaningful-use2.pdfhttp://www.himss.org/content/files/Carefx%20_HIE_meaningful-use2.pdf The National Coalition on Health Care (NCHC, 2007). Available from: http://nchc.org/http://nchc.org/ Patient-Centered Primary Care Collaborative. What We Do (PCMH). Available from: http://www.pcpcc.net/what-we-do Patient Protection and Affordable Care Act (PPACA). Available from: http://www.healthcare.gov/law/index.htmlhttp://www.healthcare.gov/law/index.html President Barack Obama. Barack Obama, speech at George Mason University, January 12, 2009 U.S. Department of Health and Human Services. (June 22, 2011). Up to $500 million in Affordable Care Act funding will help health providers improve care. Retrieved from: http://www.hhs.gov/news/press/2011pres/06/20110622a.html http://www.hhs.gov/news/press/2011pres/06/20110622a.html Charts, Tables, Figures 1.1NCQA Scoring Tool. Produced by the National Committee for Quality Assurance. Available from: http://www.ncqa.org/LinkClick.aspx?fileticket=AHJ2EF4pH6Y%3d&tabid=631&mid=2435&forcedownload=true http://www.ncqa.org/LinkClick.aspx?fileticket=AHJ2EF4pH6Y%3d&tabid=631&mid=2435&forcedownload=true 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a

18. Introduction to Quality Improvement and Health Information Technology References—Lecture a Images Slide 5: Meaningful Use, Patient-Centered Medical Home, Accountable Care Organization. Courtesy of Dr. Anna Maria Izquierdo-Porrera Slide 9: Meaningful Use Stages. Courtesy of Dr. Anna Maria Izquierdo-Porrera 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Quality Improvement Introduction to QI and HIT Lecture a