Moving Toward HITECH Healthcare EHR Adoption at the Dawn of a New Era

What is the HITECH Act? Part of the 2009 American Recovery & Reinvestment Act (ARRA) Provides incentives to push hospitals and “eligible professionals” toward EHR adoption Goals include:  Improve quality, safety, & efficiency  Engage patients  Improve care coordination  Ensure adequate privacy & security protection  Improve population & public health

Technology Terminology Electronic Health Records (EHRs) ◦ Electronic collection of patient information such as demographic data, progress notes, medication & medical history Computerized Physician Order Entry(CPOE) ◦ Process in which a physician records his or her patient treatment instructions in an electronic format, which is then communicated over a computer network to the medical staff or departments charged with carrying out those orders Clinical Decision Support Tools ◦ Means of supporting clinician decision-making to improve care qu ality

Meaningful Use Only providers who are “Meaningful Users” of EHRs qualify for incentives Meaningful Use criteria: ◦ Become more stringent over time ◦ Are currently in “Stage 1” for ◦ Differ for hospitals and eligible professionals  Meet 14 set core objectives  Meet an additional 5 objectives from a “menu set”  One menu set objective must address public health goals

Meaningful Use Core Objectives Fourteen Core Objectives for Meaningful Use 1. Use CPOE for medications for more than 30% of patients 2. Implement drug-drug & drug-allergy interaction checks 3. Record demographics (race/ethnicity, gender, date of birth, etc.) 4. Maintain up-to-date problem list 5. Maintain active medication list 6. Maintain active medication allergy list 7. Record and chart changes in vital signs (e.g. height, weight, blood pressure) 8. Record smoking status in people 13 years and older 9. Implement clinical decision support tool 10. Report 15 hospital clinical quality measures to CMS 11. Give patients electronic copy of their health information on request 12. Give patients electronic copy of discharge instructions on request 13. Have capability of electronic clinical information exchange among providers 14. Protect electronic information through appropriate technical capabilities

Meaningful Use Menu Set Objectives Menu Set of Objectives for Medicare Meaningful Use 1. Implement drug-formulary checks 2. Record Advance directives for patients age 65 or older 3. Incorporate clinical lab-test results into certified EHR as structured data 4. Generate list of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach 5. Use EHR to identify patient-specific education resources & provide to patient 6. Perform medication reconciliation when patient comes from another setting 7. Provide summary of care record for each patient transitioned to new setting 8. Capability to submit electronic data to immunization registries and actual submission in accordance with law & practice 9. Capability to submit electronic data on reportable lab results to public health agencies & actual submission in accordance with law & practice 10. Capability to submit electronic syndromic surveillance data to public health agencies & actual submission in accordance with law & practice

Multiple Programs & Multiple Providers Medicare ◦ Applies to hospitals & eligible professionals ◦ Incentive timeline: ◦ Requires meaningful use Medicaid ◦ Applies to hospitals & eligible professionals ◦ State implementation w/CMS approval ◦ More lenient incentive timeline ◦ Requires meaningful use starting the 2 nd year

The Potential of HIT What Might We Expect from Widespread HIT Adoption? 15 Percent decrease in odds of fatal hospitalization for all medical conditions 9 Percent decrease in odds of death from myocardial infarction 55 Percent decrease in odds of death from coronary artery bypass graft 16 Percent decrease in odds of complications 110 Dollars saved per admission when hospital has high score on computerization of test results 132 Dollars saved per admission when hospital has high score on CPOE 538 Dollars saved per admission when hospital had high score on decision support tools

The Potential of HIT, cont. CPOE ◦ eliminate 200,000 adverse drug events per year ◦ Save $1 billion annually Preventive Services technology prompts ◦ Estimated 39, ,233 lives saved annually Efficiency savings: $77 billion Better performance on quality measures ◦ VA’s VistA yielded superior performance on preventive care measures & diabetes care measures

EHR Stumbling Blocks Administrative Challenges ◦ Multi-Campus Hospital Issue  CMS uses provider number for identification  Some systems use 1 number for all of their hospitals  Some use unique provider numbers for each hospital ◦ Attaining Meaningful Use  Stringent all-or-nothing requirements  Short timeline  Future requirements unknown

EHR Stumbling Blocks, Cont. High Costs ◦ EHRs very expensive ◦ Access to capital issues ◦ Incentives don’t come close to cost ◦ Incentives paid after implementation Workforce ◦ 51,000 qualified HIT professional shortage ◦ HIT vendors competing with providers

Suggestions for Stakeholders Support legislation that resolves administrative stumbling blocks Urge policymakers to address the failure of CMS to allow existing, fully-functional yet uncertified EHR system to qualify for incentives Advocate for rule-making strategy that defines expected capabilities of end product so providers can prioritize health IT initiatives Continue to support workforce initiatives that will produce an adequate supply of HIT professionals