Opening Keynote: Connie Delaney, PhD, RN, Director, Biomedical Health Informatics, Dean, Nursing School, University of Minnesota, Member, ONC HITPC
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The document outlines key discussions from the IHT2 Health IT Summit regarding health IT challenges and solutions, emphasizing data utilization and collaboration in healthcare. It presents principles for behavioral change and sustainability in outcomes, highlighting the importance of patient-centered measures and the integration of quality metrics into EHR systems. Additionally, it discusses the strategic goals of health IT within the broader context of improving healthcare quality, reducing costs, and fostering innovation.
![microscopic macroscopic
Clinical Consumer
Research Health
Informatics Informatics
Human Health
& Disease
[translational
bioinformatics]
molecular and tissues & individual populations
cellular processes organs patients](https://image.slidesharecdn.com/conniedelaneyiht2-120827161319-phpapp01/85/Opening-Keynote-Connie-Delaney-PhD-RN-Director-Biomedical-Health-Informatics-Dean-Nursing-School-University-of-Minnesota-Member-ONC-HITPC-21-320.jpg)
![Vision [framework]
A system that is designed to generate and apply the best evidence for
the collaborative health care choices of each patient and provider; to
drive the process of new discovery as a natural outgrowth of patient
care; and to ensure innovation, quality, safety, and value in health care.
(Charter of the Institute of Medicine Roundtable on Value & Science-
Driven Health Care)](https://image.slidesharecdn.com/conniedelaneyiht2-120827161319-phpapp01/85/Opening-Keynote-Connie-Delaney-PhD-RN-Director-Biomedical-Health-Informatics-Dean-Nursing-School-University-of-Minnesota-Member-ONC-HITPC-41-320.jpg)
Opening Keynote: Connie Delaney, PhD, RN, Director, Biomedical Health Informatics, Dean, Nursing School, University of Minnesota, Member, ONC HITPC
- 1. iHT2 Health IT Summit in Phoenix Connie White Delaney, PhD, RN, FAAN, FACMI May 18, 2011
- 2. welco me Industry leaders & senior executives, CIO, CMO, CMIO, Physician, Practice Manager, VP and Director of IT 1. Discuss HIT challenges and potential solutions in the months ahead. 2. Discuss leveraging data to drive evidence based healthcare and improve outcomes 3. Discuss collaboration across care settings and missions.
- 3. 4 Principles for Behavioral Change 1. Social norms 2. Foot in the Door 3. Reciprocity 4. “Diderot Effect”
- 5. Outcomes Sustainability transforming care to improve 4 Principles for outcomes Behavioral Change manage transitions decrease costs 1. Social norms assure care appropriateness 2. Foot in the Door engage in disease 3. Reciprocity prevention/health promotion 4. “Diderot Effect” people centered
- 6. 1. Social norms 2. Foot in the Door 3. Reciprocity 4. “Diderot Effect”
- 7. 1. Social norms 2. Foot in the Door Robert Tagalicod, Robert Anthony, and Jessica Kahn 3. Reciprocity HIT Policy Committee, January 10, 2012 4. “Diderot Effect” Implementation Report (1/12) States launched as of January 2012: 42 # of States that disbursed incentives: 33 VT ME WA MT ND NH MN MA Note: ME, OR NY ID SD WI RI MA, DE, VT MI WY PA CT and NY IA NE OH NJ have also IN DE NV UT IL WV VA MD disbursed CO CA KS MO KY DC incentives NC TN as of 12/31 OK SC AR AZ NM GA MS AL TX LA FL AK Planning Territories SMHPs Submitted AS HI SMHPs Final Approval CNMI IAPDs Pending GU IAPDs Approval PR Launched USVI 8 http://www.cms.gov/EHRIncentivePrograms/ Incentives Disbursed
- 8. 1. Social norms 2. Foot in the Door Robert Tagalicod, Robert Anthony, and Jessica Kahn 3. Reciprocity HIT Policy Committee, January 10, 2012 4. “Diderot Effect” December 2011 December 2011 YTD YTD Providers Paid Payments Providers Paid Payments Eligible Professional 4,997 $ 86,946,000 15,255 $ 274,590,000 Medicare Only Hospital 4 $ 5,600,870 38 $ 56,782,557 Medicare & Medicaid Hospital (Medicare Payment) 189 $ 369,136,265 566 $ 1,052,839,955 TOTAL 5,190 $ 464,683,136 15,859 $ 1,384,212,512 For final CMS reports, please visit: http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp 8
- 9. 1. Social norms 2. Foot in the Door Robert Tagalicod, Robert Anthony, and Jessica Kahn HIT Policy Committee, January 10, 2012 3. Reciprocity 4. “Diderot Effect” Providers Paid by Month Providers Paid 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 9
- 10. 1. Social norms 2. Foot in the Door Robert Tagalicod, Robert Anthony, and Jessica Kahn 3. Reciprocity HIT Policy Committee, January 10, 2012 4. “Diderot Effect” Incentive Payments by Month $800,000,000 Incentive Payments $700,000,000 $600,000,000 $500,000,000 $400,000,000 $300,000,000 $200,000,000 $100,000,000 $0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
- 11. Providers Included in MU Analysis Robert Tagalicod, Robert Anthony, and Jessica Kahn HIT Policy Committee, January 10, 2012 At the time of the analysis: • 33,595 Medicare EPs had attested • 33,240 Successfully • 355 Unsuccessfully (89 previously unsuccessful resubmitted) • 842 Acute Care and Critical Access Hospitals had attested • All successfully • Official data should be sourced and cited from the CMS website, updated monthly (http://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp) 11
- 12. Updated Work Plan for Developing Recommendations for Stage 3 (Tang et al, 2012 ) • Nov 9: Reported on Oct 5 Hearing; input from HITPC • Nov 30: Sec announced intent to delay stage 2 to 2014 – => IF we were to assume stage 3 begins 2 years after stage 2 (await NPRM and Final Rule), HITPC MU recommendations would be needed by mid-2013 • Need lead time for HITSC work if relevant standards need to be adopted or developed – 4Q12 for HITSC-sensitive MU recommendations – 2Q13 for policy-only MU recommendations • January 2012 @ HITPC: Initial HITSC recommendations for HITPC review related to quality measure development – Planned joint workshop with HITSC/ONC/CMS on Quality Measures
- 13. Initial Recommendations for HITSC Group 1 for Immediate Action – Could Impact Stage 2
- 14. Recommendations for HITSC Rec 1: Certification of CQM Reports (Tang et al, 2012) • Problem: 1. Many healthcare organizations use reporting systems (vs. EHRs) to generate quality reports for public reporting and quality improvement 2. MU certification rules state that the healthcare organizations must use the certified EHR to report the CQM measures to CMS 3. EHR vendors hardwire CQM calculations without knowing local clinical workflows, causing workflow work arounds 4. Not all CQMs are relevant to all certified HIT systems • Proposed Solution: – HIT vendor products should be certified for all CQMs relevant to the scope of the product – Providers should be permitted to use non-certified systems to generate CQM reports, as long as all the data used in the calculation of the measure are derived from certified HIT systems – All submitted CQMs are subject to audit – CQM reporting systems should be tested (subject to audit) based on a standardized test data set
- 15. Initial Recommendations for HITSC Group 2 – Longer Lead Time Required
- 16. Initial Recommendations for HITSC Recommendation 2: “CQM Platform” (Tang et al, 2012) • Problem: 1. Clinical Quality Measures (CQMs) are being “hard wired” into EHRs, which require upgrades in order to implement or revise 2. EHR vendors are pre-defining data elements used in calculating CQMs, which impact clinical workflows of clinicians 3. Healthcare organizations do not have an easy way to report on quality-improvement measures (vs. just CQMs) • Proposed Solution: – By stage 3, EHR vendors should develop a “CQM platform" onto which new and evolving CQMs can be added to an EHR without requiring an upgrade to the EHR system. – Longer term, such platforms should be capable of incorporating CQM "plug-ins" that can be shared, and that allow organizations to localize data fields that fit local work flow. – We recommend that HITSC develop certification criteria to encourage/require this CQM platform as part of MU
- 17. Initial Recommendations for HITSC Rec 3: Patient-Reported Data and CQMs (Tang, 2012) • Problem: 1. Most CQMs are written for clinicians, pertinent to diseases 2. Most CQMs do not incorporate information meaningful for consumers • Proposed Solution: – Some CQMs should incorporate patient-reported data and outcomes – HIT vendors should develop secure, patient-friendly systems that allow direct entry of patient-reported data that can be incorporated into CQM reports – Patients should be able to access CQM reports
- 18. Initial Recommendations for HITSC Rec 4: Delta Measures (Tang et al, 2012) • Problem: 1. Most CQMs report risk-adjusted population means 2. Patients seek measures that would apply to “people like me” • Proposed Solution: – Some CQMs should report on percent of patients improving (“delta measures”) vs. only reporting risk-adjusted population means – EHR vendors should be able to calculate delta measures
- 19. Follow-Up Actions on New CQM Recommendations (Tang et al, 2012) • Form joint HITPC/HITSC work group, including CMS, ONC, CQM stakeholders • Conduct hearing on longer term CQM actions (CQM platform, new CQM concepts) – QM supply chain – QM consumer issues (informed by NCVHS February hearing on Measures that Matter to Consumers) – HIT vendor considerations • All-day working session following hearing
- 20. Summary (Tang et al, 2012) • Re: Certification Policies: We recommend that clinical quality measures should be based on clinical data from certified EHRs, and reported using standard definitions, subject to audit. CQMs can be reported to CMS from non-certified systems as long as the above is true. • Re: CQM Reporting: Vendor-neutral CQM platforms that accept “CQM plug-ins” should be developed to support evolving quality measurement • Re: Patient-centered CQMs: New CQMs that are meaningful to patients should be developed, and patient-reported data should be captured and reported using HIT
- 21. microscopic macroscopic Clinical Consumer Research Health Informatics Informatics Human Health & Disease [translational bioinformatics] molecular and tissues & individual populations cellular processes organs patients
- 22. What is the CTSI? CTSI is part of is part of a national Clinical and Translational Science Award (CTSA) consortium created to accelerate laboratory discoveries into treatments for patients. The CTSA program is led by the National Institutes of Health's National Center for Research Resources.
- 23. Health Knowledge Discovery & Dissemination Community Bench Practice Bedside
- 24. CTSA Institutions, 2006 - 2011 NCRR Fact Sheet: Clinical and Translational Science Awards, Summer 2011, www.ncrr.nih.gov
- 25. CTSA UMN: What We Do • Biomedical Informatics – Provides infrastructure, expertise, and training in Biomedical Informatics. • Clinical Translational Research Services – Provides research services, support, and collaboration, including project management, research coordination, clinical procedures, and biostatistics. • Education, Training, and Research Career Development – Provides trainees with opportunities to enhance quality and productivity. • Office of Community Engagement for Health – Helps researchers link to community interests and researcher partners. • Office of Discovery and Translation - Develops novel research methods, tools, and technologies.
- 27. U of Minnesota AHC Information Exchange (AHC IE)
- 28. Complete the Informatics Infrastructure • Network All Care Sites – Tie all Providers into the Health Information Infrastructure • Information Exchange • Standards • Link Care Teams – All Health Workers plus Citizens/Patients as real Partners on the Care Team
- 29. How do we achieve interoperable healthcare information systems? (Fridsma/ Humphreys, 2012) Enable Curate a stakeholders to portfolio of come up with standards, simple, shared services, and solutions to policies that common accelerate information Team information Accuracy & exchange Compliance convened to exchange challenges solve problem Solutions & Usability Enforce compliance with validated information exchange standards, services and policies to assure interoperability between validated systems
- 30. How do we achieve interoperable healthcare information systems? (Fridsma/ Humphreys, 2012) •Enable stakeholders to come up with simple, shared solutions to common information exchange challenges •Curate a portfolio of standards, services, and policies that accelerate information exchange •Enforce Compliance with validated information exchange standards, services and policies to assure interoperability between validated systems Office of the National Coordinator for 30 Health Information Technology
- 31. Defining the Nationwide Health Information Network (Fridsma/ Humphreys, 2012) A set of services, standards and policies that enable secure health information exchange over the Internet. Office of the National Coordinator for 31 Health Information Technology
- 32. Diagram of NwHIN Portfolio 1.0 (Fridsma/ Humphreys, 2012) INTEROPERABILITY STACK NwHIN Building Blocks Vocabulary & SNOMED-CT LOINC ICD-10 RxNorm Code Sets Consolidated Lab Results IG HL7 v.2.5.1 Content CDA Quality Reporting Public Health Structure Lab Results Reporting Care Summaries Transport SMTP-Direct SOAP-Secure Based Exchange Web Services Security X.509 - Digital SAML Certificates DNS, LDAP- UDDI-Certificate Certificate Provider Services Certificate & Service Authority Directories Discovery Discovery Office of the National Coordinator for 32 Health Information Technology
- 33. NLM Vocabulary Portfolio (Fridsma/ Humphreys, 2012) • Support maintenance, dissemination, free US use – SNOMED CT – LOINC • Develop, maintain, disseminate, use in services research – RxNorm (in cooperation with FDA, VA, drug information providers) – MeSH, NCBI Taxonomy – UMLS Metathesaurus (includes all above, HIPAA codes, many more) • Create associated products, tools for users, e.g., – Vocabulary subsets, mappings, extensions – Lexical & mapping tools, browsers, download sites, APIs • Provide customer service – Documentation, training materials, query response, licensing • Contribute to US HIT standards coordination, policy development
- 34. ONC-NLM Interagency Agreement (Fridsma/ Humphreys, 2012) • Sets priorities for NLM vocabulary work in support of meaningful use, e.g., – Additions to SNOMED CT, LOINC, RxNorm – High priority subsets and mappings – Tools for value set development, maintenance – Enhanced APIs • Provides additional funding for some activities
- 35. • Health People 2020 • HealthyPeople.gov • National Quality Strategy (March 21 2011) • http://www.hhs.gov/news/press/2011pres/03/20110321a.ht ml • Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe. • Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care. • Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.
- 37. • Two goals of Partnership for Patients (HealthCare.gov) April 12, 2011 are to: • Keep patients from getting injured or sicker. • 2013, preventable hospital-acquired conditions decrease by 40% compared to 2010 • ~1.8 million fewer injuries to patients (> 60,000 lives saved over three years) • Help patients heal without complication. • 2013, preventable complications during a transition from one care setting to another decreased so that all hospital readmissions reduced by 20% compared to 2010 • ~1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.
- 38. 21st Century Healthcare System • Robust information infrastructure • Widespread use of evidence-based medicine • Aligned incentives & regulatory requirements • Workforce skilled in: – Evidence-based health – Information & communication technologies – Process improvement “ ”
- 39. Future: Manage Change Supported by Information Technology & Informatics • Build Knowledgeable Teams • Manage the Base of • Reinvent Workflow Knowledge • Integrate Innovations • Complete the HIT & • Remove ‘Outdated’ Practices Informatics Infrastructure • Reduce Variation • Change Management & Work Redesign • Improve Safety/Quality while Reducing Costs • Enhance Clinical Decision Support
- 40. Policy Federal Advisory Committees • Health IT Policy Committee – Makes recommendations to the National Coordinator for Health IT on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information. • Health IT Standards Committee – Focuses on the standards to implement the policies recommended by the Health IT Policy Committee Relationship to CMS
- 41. Vision [framework] A system that is designed to generate and apply the best evidence for the collaborative health care choices of each patient and provider; to drive the process of new discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care. (Charter of the Institute of Medicine Roundtable on Value & Science- Driven Health Care)
- 42. Health IT in the HHS Strategic Plan HHS’ Strategic Plan Health IT objective in HHS Plan Goal 1: Transform Health Care Goal 2: Advance Scientific Knowledge and Innovation Goal 3: Advance the Health, Safety, and Well- Being of the American People Goal 4: Increase Efficiency, Transparency, and Accountability of HHS Programs Goal 5: Strengthen the Nation’s Health and Human Services Infrastructure and Workforce 42
- 43. Federal Health IT Strategic Plan: 2011-2015 Federal Health IT Strategic Plan Pre-decisional Draft – Do Not Disclose 43
- 44. Evolution of the Strategic Framework to the Strategic Plan Context • The Framework was well underway prior to the release of the Affordable Care Act Similarities: • Largely the same priorities and vision • Focus on Outcomes Differences: • Structurally different • Reflects impact of the Affordable Care Act • Makes empowering individuals a goal Strategic Plan Goal I: Achieve Adoption and Information Exchange through Meaningful Use of Health IT Goal II: Improve Care, Improve Population Health, and Reduce Health Care Costs through the Use of Health IT Goal III: Inspire Confidence and Trust in Health IT Goal IV: Empower Individuals with Health IT to Improve their Health and the Health Care System Goal V: Achieve Rapid Learning and Technological Advancement 44
- 45. 4 Principles for Behavioral Change 1. Social norms 2. Foot in the Door 3. Reciprocity 4. “Diderot Effect”