1. History of Health Information Technology in the U.S. The HITECH Act Lecture b – Meaningful Use, Health Information Exchange and Research This material Comp5_Unit3 was developed by The University of Alabama Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000023

2. Meaningful Use, Health Information Exchange and Research Learning Objectives 2 Discuss the barriers to adoption of Health IT that the HITECH Act is designed to address Discuss how the following ARRA/HITECH requirements relate to previous developments in health IT: –Certified electronic health records –Concept of meaningful use including e-prescribing, clinical decision support, interoperability and HIE, structured documentation of quality measures –Incentives to providers –Education of clinicians –Workforce development Give examples of how the HITECH provisions support healthcare reform efforts Discuss the overall vision for the effects of the HITECH Act Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

3. Barriers to Improving Quality and Reducing Costs Low Adoption –Cost –Impact on productivity –Manpower Adoption is not enough –Must be used appropriately Information must be shared –Standards Lack of agreement –Privacy and Confidentiality Public and professional concerns 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

4. The HITECH VISION 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

5. Incentives Why incentives are needed –Cost –Productivity loss Cost savings with health IT –Reductions in length of stay if medication errors are prevented –Savings from sharing information prevent duplicate test ordering prevent errors from drug interactions save clinician time in gathering information 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

6. Incentives Carrot and Stick –Better incentives for being early adopters –Decrease over time –Eventually penalties for non-use 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

7. Incentives Carrot and Stick –Better incentives for being early adopters –Decrease over time –Eventually penalties for non-use Adoption not enough –Must be used appropriately 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

8. 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b (Courtesy Office of the National Coordinator for Health Information Technology) The HITECH VISION

9. Meaningful Use Focus on improving outcomes of care –HIT Policy Committee and public comments influenced final rule –Escalating expectations 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

10. Meaningful Use Focus on improving outcomes of care –HIT Policy Committee and public comments influenced final rule –Escalating expectations Criteria for 2011-2012 (Stage 1) –Released in July 2010 –Later stages expected in 2012 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

11. Meaningful Use Major current Stage 1 criteria –Computerized Provider Order Entry (CPOE) –Clinical Decision Support (CDS) –Electronic Prescribing (E-prescribing) –Structured documentation of quality measures –Up-to-date Problem Lists and Diagnoses –Provide patients with health information electronically –Information exchange –Report clinical quality measures to CMS 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

12. Computer-based Provider Order Entry Orders for medications, laboratory tests, referrals etc. Replaces paper order slips Takes longer for the physician, but can speed the overall process of fulfilling the order Increases legibility, reduces ‘call backs’ Can prevent some errors, but without decision support, will not do as much 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

13. Clinical Decision Support Systems designed to provide support to the clinician making clinical decisions Usually at the point of care when the decisions are made Examples: references, drug interactions, alerts, reminders, order sets Can be helpful at all stages of care 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

14. E-prescribing Some or all of the following: –Electronic order entry by physician for medications –Clinical Decision Support (formularies, drug dosing, drug interactions, guideline recommendations) –Direct transmission to pharmacy Stand-alone or integrated into EHR 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

15. Structured Documentation Physicians document electronically Lab data captured in structured form Quality data extracted 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

16. Structured Documentation Physicians document electronically Lab data captured in structured form Quality data extracted Challenges in capturing and/or extracting –Different systems –Unstructured text files –Non-standard definitions of terms –Variable technical standards Takes more time than scribbling a few notes! 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

17. Other Parts of Meaningful Use Up-to-date problem lists and diagnoses Providing patients with health information electronically Information exchange Reporting quality measures Core and Menu Objectives –15 core measures –5 of 10 menu objectives 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

18. ONC Beacon Communities Communities with strong health IT infrastructure Funding to expand and strengthen capabilities Quality and cost focus Model communities to demonstrate meaningful use 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b (Photo by Andrew Bossi)

19. Barriers to Improving Quality and Reducing Costs Low Adoption –Cost –Impact on productivity –Manpower Adoption is not enough –Must be used appropriately Information must be shared –Standards Lack of agreement –Privacy and Confidentiality Public and professional concerns 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

20. The HITECH VISION 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b Courtesy Office of the National Coordinator for Health Information Technology

21. ONC-Funded Health Information Exchange To share information, systems need to “talk to each other” and “be understood” –Interoperability –Lack of agreed-up on standards Demonstration projects for interoperability Grants to states for information exchange 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

22. Standards Standards “harmonization” –Technical –Vocabulary –Health Information Technology Standards Panel (HITSP)  HIT Standards Committee Privacy and security issues –Strengthening of current rules Certification of EHRs 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

23. Certified Electronic Health Records Certification –ONC Authorized Testing and Certification Bodies (ATCBs) Certification Commission for Healthcare Information Technology (CCHIT) Five other approved ATCBs as of December, 2010 –Focus on functions for meaningful use 23 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

24. The HITECH VISION 24 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b (Courtesy Office of the National Coordinator for Health Information Technology)

25. SHARP Grants Strategic Health IT Advanced Research Projects –Security of Health Information Technology –Healthcare Application and Network Platform Architectures Source: (Stead & Lin, 2009) 25 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

26. SHARP Grants Strategic Health IT Advanced Research Projects –Security of Health Information Technology –Healthcare Application and Network Platform Architectures –Patient-Centered Cognitive Support –Secondary Use of EHR Data 26 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

27. Leadership Office of the National Coordinator for Health Information Technology (ONC) HIT Policy Committee HIT Standards Committee 27 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

28. The HITECH Act Summary Leadership Certified Electronic Health Records “Meaningful Use” Incentives Health IT manpower Interoperability and information exchange Privacy and Security 28 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S. The HITECH Act Lecture b

29. The HITECH Act References – Lecture b 29 Health IT Workforce Curriculum Version 3.0/Spring 2012 History of Health Information Technology in the U.S The HITECH Act Lecture b References Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med. 2009; 360;15:1477-9. Available from: http://content.nejm.org/cgi/reprint/360/15/1477.pdf Office of the National Coordinator. Celebrating the first anniversary of the HITECH Act and looking to the future. 2010. Available from: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911674_0_0_18/FINAL_ONC-HITECH- Anniversary.pdf http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911674_0_0_18/FINAL_ONC-HITECH- Anniversary.pdf Blumenthal D and Tavenner M. The “Meaningful Use” Regulation for Electronic Health Records. N Engl J Med 2010; 363:501-504. Available from: http://www.nejm.org/doi/full/10.1056/NEJMp1006114http://www.nejm.org/doi/full/10.1056/NEJMp1006114 Images Slide: 4, 8, 20, 24: Courtesy of the Office of the National Coordinator for Health Information Technology. Available from: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911674_0_0_18/FINAL_ONC-HITECH- Anniversaryfhttp://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911674_0_0_18/FINAL_ONC-HITECH- Anniversaryf Slide 6, 7: Microsoft clip art; Used with permission from Microsoft. Slide 18: Andrew Bossi CC-By-SA-2.5, 2.0, and 1.0 Available from: http://en.wikipedia.org/wiki/File:NJ_LBI_Lighthouse_06.JPG http://en.wikipedia.org/wiki/File:NJ_LBI_Lighthouse_06.JPG