1. HTTP://WWW.YOUTUBE.COM/WATCH_POPU P?V=R13UYS7JGLG Information Technology in Healthcare

2. Introduction One of the most common themes in just about every current or recent past plan to reform healthcare has been the reliance on IT to deliver  Lower Costs  Fewer errors  Better outcomes  Increased overall system efficiencies

3. Introduction One of the main expected drivers is electronic medical records But that is not the only area  Improved information on diagnosis  Coordination  Delivery Estimated to result in $261 billion in savings over 10 years Is that a lot?

4. American College of Physicians and AmericanEHR Partners: “Challenges with Meaningful Use: EHR Satisfaction & Usability Diminishing” Satisfaction and usability ratings for certified electronic health records have decreased since 2010. Overall, user satisfaction fell 12 percent from 2010 to 2013. The percentage of clinicians who would not recommend their EHR to a colleague increased from 24 percent in 2010 to 39 percent in 2013. Clinicians who were "very satisfied" with the ability for their EHR to improve care dropped by 6 percent compared to 2010, while those who were "very dissatisfied" increased by 10 percent. Thirty-four percent of users were "very dissatisfied" with the ability of their EHR to decrease workload — an increase from 19 percent in 2010. In 2013, 32 percent of the responders had not returned to normal productivity compared to 20 percent in 2010. Dissatisfaction with ease-of-use increased from 23 percent in 2010 to 37 percent in 2013, while satisfaction with ease-of-use dropped from 61 to 48 percent

5. Introduction We have a long way to go  About 40% of physicians and 27% of hospitals are using basic electronic health records  But we’ve made progress – just 4 years ago these percentages were 20% and 10%, respectively  However, relatively few are meaningfully applying health IT to advance care coordination, aide clinical decision making, or report health outcomes. So there is potential but no guarantees

6. Introduction Ask Heath care executives if they feel good about the quality, accessibility, and timeliness of clinical and business data at their organization and the answer is generally – NO Why? Or why is healthcare so far behind?

7. Why does Healthcare Lag in IT? 1. Large number of small organizations 2. Incentives are misaligned  Better management of chronically ill may actually cost providers money.  Goals of physicians may be different from goals of hospital  Higher quality/more efficient care may not result in increased “customers” 3. Fragmented system 4. Network externality 5. Complexity of care  Health care vs. Banking What is happening to try to resolve this?

8. HITECH Health Information Technology for Economic and Clinical Health – HITECH  Part of the 2009 American Recovery and Reinvestment Act  In February 2010 $750 million in grants and contracts went to agencies in 40 states and to 30 nonprofit organizations to “facilitate the exchange of health information.”  Also $225 million to 55 training programs to help train people for jobs in the health care and Health IT sectors.

9. HITECH Carrots and Sticks  The carrots:  $14-27 billion will go to physicians, hospitals and other providers in the form of bonuses on their Medicare and Medicaid payments. Fiscal year 2011 (October 2010) to hospitals January 2011 physicians (up to $18,000) If they can demonstrate that they are making “meaningful use” of health IT in addition to merely purchasing it and installing it.  Then comes the stick  In 2015(6?) payments will be replaced by penalties for those not showing meaningful use.

10. HITECH Responsibility for implementing provisions held by HHS Office of the National Coordinator for Health IT  Dr. Karen B. DeSalvo, MD, MPH, MSc  Formerly Farzad Mostashari, David Blumenthal  August 2010 plan for certifying electronic health record systems was released.  Functional  Interoperable  Secure

11. Defining Meaningful Use http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Stage_2.html First Pay ment Year 2011201220132014201520162017 2011Stage1*Stage1 Stage2 Stage 3 2012Stage1*Stage 1Stage2*Stage2 Stage 3 2013Stage1*Stage1Stage2 2014Stage1*Stage1 2015 * Indicates 3 months

12. What is MU? To receive an EHR incentive payment, providers have to show that they are “meaningfully using” their EHRs.  Stage 1  13 (hospitals) or 14 (professionals) core objectives that must be met  5 objectives from a menu of 10  Focus is on having technology in place and collecting data  Stage 2 – 2014 for those who started in 2011  Similar criteria must be met  But focus is on using the data  Stage 3  Focus on achieving improvements in quality, safety, and efficiency

13. Move to ICD-10 ICD-10-CM codes used in documenting diagnoses (cm=clinical modification)  3-7 characters in length and total 68,000  ICD-9-CM are 3-5 digits and number over 14,000 ICD-10-PCS are the procedure codes and are alphanumeric  7 characters in length and total about 87,000 procedures  ICD-9-CM procedure codes are only 3-4 numbers in length and total about 4,000 codes

14. Specificity looks like this… ICD-10-CM Many possible codes S72301A Unspecified fracture of shaft of right femur, initial encounter for closed fracture S72322A Displaced transverse fracture of shaft of left femur, initial encounter for closed fracture S72326A Nondisplaced transverse fracture of shaft of unspecified femur, initial encounter for closed fracture S72301G Unspecified fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing S72322G Displaced transverse fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing S72326G Nondisplaced transverse fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing S72302A Unspecified fracture of shaft of left femur, initial encounter for closed fracture S72323A Displaced transverse fracture of shaft of unspecified femur, initial encounter for closed fracture S72331A Displaced oblique fracture of shaft of right femur, initial encounter for closed fracture S72302G Unspecified fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing S72323G Displaced transverse fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing S72331G Displaced oblique fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing S72309A Unspecified fracture of shaft of unspecified femur, initial encounter for closed fracture S72324A Nondisplaced transverse fracture of shaft of right femur, initial encounter for closed fracture S72332A Displaced oblique fracture of shaft of left femur, initial encounter for closed fracture S72309G Unspecified fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing S72324G Nondisplaced transverse fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing S72332G Displaced oblique fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing S72321A Displaced transverse fracture of shaft of right femur, initial encounter for closed fracture S72325A Nondisplaced transverse fracture of shaft of left femur, initial encounter for closed fracture S72333A Displaced oblique fracture of shaft of unspecified femur, initial encounter for closed fracture S72321G Displaced transverse fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing S72325G Nondisplaced transverse fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing S72333G Displaced oblique fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing ICD-9-CM 821.01 Fracture of femur, shaft, closed

16. Benefits Codes in ICD-10 are more specific, which means…  Improved care management of beneficiaries  Clinical data with greater specificity  Reliable and robust clinical data that can be used to make intelligent, data driven decisions  More accurate payments  Reduced number of miscoded, rejected and improper reimbursement claims  Better data for fraud and abuse monitoring

17. Benefits Cont’d Better understanding of the value of new medical procedures Improved disease management Better understanding of healthcare outcomes More ICD codes to address global disease emergencies