Quality and Reporting From Office to OR

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Quality and ReportingFrom Office to OR

• David R. Hunt, MD, FACS
• Chief Medical Officer, OHITA
• Office of the National Coordinator for HIT

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Health Care in the U.S. Cost
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(No Transcript)
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Reliability Challenges Remain in Health Care

• Immunization 55 94
• B-Blocker after an MI 70 98
• Airline Baggage Handling gt 99.9999
• Airline Safety gt 99.999999

10-1 10-2 10-3 10-4 10-5 10-6
Frequency of Failures Occurring
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March 14, 2007Vol 297, No. 10, pg. 1103
health care reform must focus on
improving health and health care value for
patients Physicians can lead this change and
return the practice of medicine to its
appropriate focus enabling health and effective
care.
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Why is Health IT a Central Strategy for Health
Care?

• Current Lack of Information
• Leads to 1 in 7 hospital admissions
• When care providers do not have access to
  previous medical records.1
• 12 of physician orders are not executed as
  written1
• 20 of laboratory tests unnecessary
• Requested because previous studies are not
  accessible.1
• Drug errors2
• Complicate 1 in 6.5 hospitalizations
• Occur in 1/20 outpatient Rxs
• Presidents IT Advisory Committee (PITAC)
• Beyond the Industrial Age Moving to an
  Information Age Model for Healthcare, Jonathan
  Perlin, MD, PhD, MSHA, FAOP, Dec. 2006

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Surgical Care Improvement Project
NQF endorsed.
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Surgical Care Improvement ProjectHospital
Voluntary Self-Reporting, Qtr. 3, 2007
Benchmark rates were calculated for all HQA
reporting hospitals in the US based on discharges
using the Achievable Benchmarks of CareTM
methodology (http//main.uab.edu/show.asp?durki14
527).
Benchmark rates represent the average performance
of the top hospitals providing care to 10 of the
surgical population submitted to the clinical
data warehouse.
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Process Map SCIP Inf 1
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Annual Address in Medicine, Yale
UniversityTuesday, June 27, 1904
William Stewart Halsted, M.D.

• We need a system, and surely we shall have it!

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Lister
Bilroth
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The Lister Effect Lower Leg Amputation Mortality
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Quantitative Demonstration of Leadership
Mortality from leg amputation
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Surgical Care Improvement ProjectHospital
Voluntary Self-Reporting, Qtr. 3, 2007
Benchmark rates were calculated for all HQA
reporting hospitals in the US based on discharges
using the Achievable Benchmarks of CareTM
methodology (http//main.uab.edu/show.asp?durki14
527).
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Ongoing Gaps in PerformanceHospital Voluntary
Self-Reporting, Qtr. 2, 2007
Benchmark hospitals and low-performing hospital
groups each provided care to 10 of the US
surgical population reported for each measure.
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Ongoing Gaps in PerformanceHospital Voluntary
Self-Reporting, Qtr. 2, 2007
Benchmark hospitals and low-performing hospital
groups each provided care to 10 of the US
surgical population reported for each measure.
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Changes in National Performance
//
National sample of 39,000 Medicare patients
undergoing surgery in US hospitals during
2001. Bratzler DW, Houck PM, et al. Arch Surg.
2005140174-182.
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Changes in National Performance
//
National sample of 19,497 Medicare patients
undergoing surgery in US hospitals during the
first quarter of 2005.
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Patient Outcomes Can Improve
The overall surgical infection rate fell 27,
from 2.28 (215 infections among 9435 surgical
cases) in the first 3 months to 1.65 (158
infections among 9584 cases) between the first
and the last 3 reporting months.
Dellinger EP, et al. Am J Surg.2005190915.
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National Trends 30-day All Cause
MortalityNon-cardiac surgery
Limited to all Medicare patients undergoing those
operations included in SCIP.
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Change is Underway Drivers of Health IT Adoption
Drivers of Health Information Technology
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Key Health IT Components
A Robust, Interoperable, Health IT Environment
that brings together

• Electronic Health Records (EHR)
• Personal Health Records (PHR)
• Public Health Information

• Standards (Data, Technical and Security)
• Interoperable Health Information Exchange Network
• (Nationwide Health Information Network -
  NHIN)

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EHR Value Proposition

• Cost
• Physician office average cost 20,00/user of
  software, installation, loss of productivity
  hardware additional
• Hospital median costs 17,500/bed (12,000
  ongoing annual operations)
• Misalignment of incentives
• Features
• Usability
• Necessary workflow changes
• Concerns about obsolescence and reinvestment
• Lack of interoperability
• Privacy, Confidentiality, Security, and New Legal
  Exposures

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Cost
Value
Features
EHR
Cost

• Stark Anti-kickback for Donations by Hospitals
  to Small Providers
• Decreased Malpractice Premiums Being Explored
• HRSA grants to promote adoption and effective use
  of HIT in the safety net community
• Medicare Demonstration Announced to Involve up
  to 1,200 Physician Practices to Receive Bonus
  Payments for Reporting Quality Improvements
  From EHR Use

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Current State EHR Adoption US Physicians (2005)
3 times more prevalent in metropolitan areas
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Current State EHR Adoption Hospitals (2007)
lt 50 beds
Rate of hospital use does not represent
physician use only ¼ of implemented hospitals
report 50 MD use (or more)
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Standards
Data, Technical, Security
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AHIC Priorities and Use Case Roadmap
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AHIC Priorities Into Use Cases
Public Feedback
Public Feedback
AHIC workgroup priorities and issues
Priorities and areas clustered for coordination
and synergy
Use case options for AHIC prioritization
Prototype Use Case
Detailed Use Case
Consumer Empowerment Consumer Access to Clinical
Information Prototype Use Case March 22nd, 2007
Use cases (anvendningsfall), stated simply,
allow description of sequences of events that,
taken together, lead to a system doing something
useful.
Kurt Bittner, Ian Spence (2002). Use Case
Modeling. Addison Wesley Professional, 2-3. ISBN
0-201-70913-9. 
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The AHIC Successes

• Standards to allow interoperability will be
  recognized by Secretary Leavitt over the next
  several months
• Laboratory data access by providers
• Medication lists for patients
• Electronic clipboard for patient registration
• Manage community-level health events
• 92 Ambulatory EHRs have been certified (2006
  2007)
• Have begun Enterprise (Inpatient) EHR
  certification this year
• Nationwide Health Information Network advancing
• Trial implementation contracts announced
  October 2007
• Move from prototypes to trial use with data
  exchange among communities and with other
  health-related entities
• More progress in the past 3 years than in the
  TWO decades

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PHR Privacy, Confidentiality, Security

• Privacy
• (L. privatus belonging to oneself, not to the
  state) a right
• Confidentiality
• (L. confidere to trust) a trust
• Security
• (L. securus free from care) a state of being

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Health IT Support for Transforming Health Care
Care
PRIVACY, SECURITY, and CONFIDENTIALITY
Health IT