A sampling of Federal Health IT initiatives

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A sampling of FederalHealth IT initiatives

• Carol Cain, PhD
• Senior Manager, Health IT Portfolio
• Agency for Healthcare Research and Quality
• October 24, 2006

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Diffusion of knowledge
Balas EA, Boren SA., Managing Clinical Knowledge
for Health Care Improvement. Yearbook of Medical
Informatics 2000.
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Major Opportunities for Improvement Still Exist
in Quality

• 81 of Medicare pneumonia patients get blood
  cultures before antibiotics
• 68 get the right antibiotics
• 63 get their first antibiotic in a timely manner
• Yet, only 30 get all of three recommended
  interventions

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and Disparities

• Less than half of AMI patients are given
  counseling to quit smoking
• African Americans and Hispanics are
  significantly less likely to receive such
  counseling

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EHR Adoption GapUnited States Versus Others
Primary Care Physician Office 2002
Source "European Physicians Especially in
Sweden, Netherlands, and Denmark, Lead U.S. in
Use of Electronic Medical Records." Harris
Interactive Health Care News 2(16).
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HHS Health IT Efforts
American Health Information Community How will we
accelerate the development and adoption of
health IT? How will we deliver value to the
health care consumer?
Office of the National Coordinator / National
Health Information Infrastructure How will we
build a nationwide health IT system that allows
the seamless and secure exchange and records?
Agency for Healthcare Research and Quality How
will providers use health IT in hospitals and
ambulatory care settings to improve quality of
health care and patient safety?
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Building a Transparent Health Care System
Cornerstones of Value-Based Health Care
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Office of the National Coordinator for Health
Information Technology

• Established in response to Executive Order 13335,
  April 27, 2004
• Responsible for realizing the Presidents vision
  of Healthcare IT
• Widespread adoption of interoperable EHR by 2014
• Medical information follows the consumer
• Clinicians have complete, computerized patient
  information
• Quality initiatives measure performance and drive
  quality-based competition
• Public health and bioterrorism surveillance are
  seamlessly integrated into care
• www.hhs.gov/healthit

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Health Information Technology Deployment
Coordination
Health Care Industry
Technology Industry
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ONC Major Initiatives
In 2004, President Bush called for the widespread
use of electronic health records (EHRs) within 10
years. Despite the demonstrated benefits to care
delivery, studies have found use of EHRs remains
low among physicians, hospitals and other health
care providers. The Office of the National
Coordinator for Health Information Technology
(ONC) has set the foundation for adoption of
interoperable EHRs through the following major
initiatives

• American Health Information Community
• Standards Harmonization Process
• Compliance Certification Process
• Nationwide Health Information Network

• Privacy and Security Solutions
• Health Information Technology and Health Care
  Anti-Fraud
• Health IT Adoption Initiative
• Proposed Changes to Self-Referral and
  Anti-Kickback Rules

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Agency for Healthcare Researchand Quality (AHRQ)

• Mission
• To improve the quality, safety, efficiency, and
  effectiveness of health care for all Americans

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AHRQ research focusHow it differs

• Patient-centered, not disease-specific
• Dual Focus -- Services Delivery Systems
  Effectiveness research focuses on actual daily
  practice, not ideal situations (efficacy)
• AHRQ mission includes production and use of
  evidence-based information

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Effective Health Care Program (MMA, Sec 1013)

• Top 10 conditions affecting Medicare
  beneficiaries
• 15 million initiative to develop
  state-of-the-art information about effectiveness
  of interventions, including prescription drugs
• Results available for public use via AHRQ website

Arthritis and non-traumatic joint disorders
Cancer
Chronic obstructive pulmonary disease/asthma
Dementia, including Alzheimers disease
Depression and other mood disorders
Diabetes mellitus
Ischemic heart disease
Peptic ulcer/dyspepsia
Pneumonia
Stroke, including control of hypertension
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Clinical Decisions and Communication Science
Center
Translation
Scientific Evidence
Understandable and Usable Information
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AHRQ Health IT Portfoliohttp//healthit.ahrq.gov
Current issues eRx standards pilots Privacy,
security, business practices
State and Regional Demonstrations of HIE 5 yr
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Health IT Research Funding

• Over 125 projects and demonstrations to better
  understand how health IT can improve the safety,
  quality and efficiency of health care
• Projects in 43 states
• Special attention to best practices that can
  improve quality of care in rural, small
  community, safety net and community health center
  care settings

AHRQ HIT Investment 166 Million
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Implementation grants

• Varied technologies
• Bar coding
• Computerized provider order entry (CPOE)
• Disease management registry
• Imaging (PACS)
• Patient-centered care
• Pharmacy
• Telehealth
• 1/2 Rural
• AHRQ-sponsored

• Chronic disease
• Decision support
• Electronic medical records (EMR)
• Medication administration
• Non-traditional settings
• Reduce medical errors/ADEs
• Evidence-based practice measures

Evaluation Toolkit
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Consistent Challenges

• Legal/privacy lack of understanding around
  HIPAA compliance, confidentiality policies, and
  the security of web-based record access
• Buy-in for data sharing Understanding what kinds
  of consent is required, and clarifying security
  and privacy standards that should apply
• Organizational/individual experience with HIT
• Securing appropriate sustainable funding
• Consortium governance
• Grant administration
• Competing priorities
• Staff training and turnover
• Changing culture and workflow to integrate HIT

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http//healthit.ahrq.gov

• Lessons learned
• Expert assistance

• Knowledge library
• Topic summaries
• Annotated references

• Public teleconferences
• Community-Based Health IT Initiatives How Do You
  Make Them Work?
• Are You Ready for EHRs? How to Make that
  Assessment
• Getting Started with Heath IT Implementation

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New Grant Opportunities Upcoming

• FY07 funding announcements coming soon
• In the ambulatory setting, transitions among
  settings, or home health
• AHRQ health IT is embedded in our quality, safety
  and effectiveness initiatives
• Patient-centered care
• Medication management
• Integration of decision support tools
• Enabling quality measurement
• Watch for Ambulatory Patient Safety and Quality

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State and Regional Demonstrations

• 6 contracts
• 30M over 5 years
• Laboratory data
• Pharmacy Data
• Improved Quality and Safety
• Benefit to Medicaid
• Sustainable Model

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HIE v. HIT

• No longer just about putting electronic medical
  records in hospitals
• Electric health information systems across all
  care settings, as well as payers
• Linking them together interoperability for
  health information exchange (HIE)
• For HIE, communities and states (and some
  regions) are developing networked systems
• To do this, its not just about investing in the
  technology (HIT) we must research how to do so
  in a way that
• Maximizes the value we hope to realize
  clinically, economically, and for population
  health
• Assures that security and privacy protections are
  baked into HIE

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HIE Policy Issues

• In addition, a new market is being created, with
  all the technical and policy issues that entails,
  such as
• Standards for data exchange
• Assuring consumer participation and patient
  protections
• Security concerns
• New business arrangements, new relationships
• Disconnect between payment systems and new
  relationships/care delivery models
• Secondary use of data

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Collaboration with ONC

• Privacy and Security Solutions for Interoperable
  Health Information Exchange Contract
• Research Triangle Institute for 17.5 M
• National Governors Association
• 33 States and Puerto Rico
• Identify variations in organization-level
  business privacy and security policies and
  practices
• Preserve privacy and security protections
• Incorporate state and community interests
• Leave behind in states and communities a
  knowledge base about privacy and security issues

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HRSA Health Services and Resources
Administration

• HRSA is the nation's access agency improving
  health and saving lives by making sure the right
  services are available in the right places at the
  right time
• Primary Federal agency for improving access to
  health care services for people who are
  uninsured, isolated or medically vulnerable
• Mission National leadership, program resources
  and services needed to improve access to
  culturally competent, quality health care

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HRSA - Office of HealthInformation Technology
OHIT was formally established in a December 2005
Federal Register notice, including the following
components

• Division of Health Information Technology Policy
• Division of Health Information Technology State
  and Community Assistance
• Office for the Advancement of Telehealth

Office of the Associate Administrator Contact
Cheryl Austein-Casnoff caustein-casnoff_at_hrsa.gov
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OHIT Division of HIT Policy

• Developing a nationwide HIT and telehealth
  strategy for HRSA that focuses on the health care
  safety net and indigent populations.
• Developing HRSAs HIT and telehealth policy.
• Ensures successful dissemination of appropriate
  IT advances, such as EMR systems or provider
  networks, to HRSA programs.
• Works collaboratively with states, foundations,
  national organizations, private sector providers,
  and other Federal departments in order to promote
  the adoption of HIT by HRSAs grantees.

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OHIT Division of HIT State and Community
Assistance (DSCA)

• Develops and coordinates HIT programs and
  policies.
• Provides professional assistance and support in
  developing HIT initiatives among HRSA grantees.
• Administers grant programs to promote and
  evaluate the use of appropriate HIT among
  grantees and others.
• Advises HRSA grantees on strategies to maximize
  the potential of new and existing HIT
  technologies for meeting quality and technical
  assistance objectives.
• Primary responsibility for the Health Center
  Controlled Networks.

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OHIT Office for the Advancement of Telehealth
(OAT)

• Develops and coordinates telehealth grant
  programs and contracts.
• Provides professional assistance and support in
  developing telehealth initiatives.
• Administers and evaluates the use of appropriate
  telehealth technologies among HRSA grantees and
  others.
• Disseminates the latest information and research
  findings relating to telehealth technologies in
  agency programs and underserved areas.
• Provides guidance on telehealth policy through
  the Associate Administrator for OHIT, other HHS
  Offices, and other Federal and state agencies to
  promote cost-effective telehealth programs.

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Intersection of Safety, Quality and Health IT

• Support diffusion of HIT to
• 41 states
• 40 million Americans
• Improve medication safety
• CMS e-prescribing demos
• Provide HIT technical support
  to the safety net
• Community health centers
• Critical access hospitals
• Public hospitals
• Address Privacy and Security

AHRQ
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• Thank you.

• Carol Cain, PhD
• carol.cain_at_ahrq.hhs.gov
• http//www.ahrq.gov
• http//healthit.ahrq.gov