Improving Healthcare Quality with Information Technology

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Improving Healthcare Quality with Information
Technology

• Scott Young, M.D.
• Agency for Healthcare Research and Quality
• May 2004

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RAND Study Quality of Health Care Often Not
Optimal
Medical errors corrode quality of healthcare
system
Medical Care Often Not Optimal Failure to Treat
Patients Fully Spans Range of What Is Expected of
Physicians and Nurses
Study U.S. Doctors are not following the
guidelines for ordinary illnesses
The American healthcare system, often touted as a
cutting-edge leader in the world, suddenly finds
itself mired in serious questions about the
ability of its hospitals and doctors to
deliver quality care to millions.
.
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Public Concerns About Medical Errors
In the past 12 months, have you personally
suffered personal injury or harm that you feel
resulted from a medical error?
Percent who are very concerned about an error
resulting in injury happening to them or their
family
When receiving health care
in general When going
to a hospital for care When
going to a doctors office for care
When filling a prescription at a pharmacy
When flying on U.S. commercial
airliners When eating food purchased at
the supermarket
No
Dont know/ Refused
Yes
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality National Survey
on Americans as Health Care Consumers An
Update on The Role of Quality Information,
December 2000 (Conducted July 31-Oct. 13, 2000)
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VARIATIONS ARE WIDESPREAD
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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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We have wonderful technology, but some grocery
stores have better technology than our hospitals
and clinics.
Secretary Tommy Thompson Chicago Medical School
Commencement June 7, 2002
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Building the Evidence Base for HIT

• Electronic Health Records
• Shared Online Health Records for Patient Safety
  and Care
• Clinical Decision Support
• Automated Lab Test Follow-up to Reduce Medical
  Errors
• Electronic Prescribing
• Error rates and prescribing practices in
  pediatric clinics
• Use of hand-held devices
• Acceptance, benefits, and barriers in the use of
  hand-held decision support systems in ambulatory
  settings
• Consumer use of the Internet
• Parent-Initiated Prevention Program

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FY 04 Presidents Budget Request

• Improving Health Care Quality and Safety
• The budget proposes 84 million in AHRQ for
  patient safety activities to test and develop new
  interventions that may be reproducible across
  health care systems.
• 60M dedicated to HIT efforts
• 50 million initiative to demonstrate
  hospital-based information technology solutions,
  including an emphasis on small community and
  rural hospitals.
• Additional 10M that will focus on clinical data
  standards (AHRQ ASPE)

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FY 04 HIT Investment

• 60M initiative
• 26M to implement proven technologies in small
  and rural communities where HIT penetration has
  been low
• 24M targeted for developing, implementing, and
  evaluating the use of new and innovative
  technologies to improve patient safety and
  quality of care in diverse health care settings.
  
• 10M targeted for clinical data standards and
  interoperability

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Determining the NeedHIT Expert Meeting July
2003

• Diverse array of 45 potential partners and
  stakeholders
• Federal agencies
• HRSA, VHA, ASPE, CMS, CDC, FDA, IHS
• Experts
• HIT, Patient Safety, Rural
• Stakeholders
• e.g., rural providers, community health center
  providers, rural clinic directors, clinicians,
  vendors

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HIT Expert MeetingGeneral Themes

• Focus on local and community collaboratives
• public/private partnerships
• Develop framework to assess value of specific
  features of HIT in diverse clinical settings
• Assess the role of financial and non-financial
  incentives to adopt HIT
• Develop business case for HIT
• Evaluate emerging health information technologies
  

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Future Directions

• Continue to demonstrate the value of HIT on
  quality and safety in diverse clinical settings
• Build on previous investment share
  implementation lessons and best practices from
  grantees
• Expanded collaboration with public and private
  partners payment and financial incentives for
  HIT in clinical settings

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AHRQs HIT Portfolio

• Research portfolio related to the development,
  evaluation, and diffusion of HIT in clinical
  settings
• Emphasis on the role of HIT in patient safety
• Clinical Informatics to Promote Patient Safety
  (CLIPS)
• HIT grants/contracts
• FY01 18.4M
• FY02 21.8M
• FY03 11.6M
• FY04 60M

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FY 04 Health IT Programs

• Current AHRQ initiatives
• 3 Grant Solicitations
• Health IT Resource Center
• State and Regional HIT Demonstrations
• Indian Health Service EHR Collaboration
• CMS AHRQ Collaboration

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Transforming Healthcare Qualitythrough
Information Technology (THQIT)

• Grant Solicitations
• Value 10M
• assess the value derived from the adoption,
  diffusion, and utilization of HIT
• Planning 7M
• assist healthcare systems and their partners in
  planning for activities that will lead to
  successful HIT implementation
• Implementation 24M
• support organizational and community-wide
  implementation and diffusion of HIT
• http//www.ahrq.gov/fund/grantix.htm

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THQIT Current Status

• Grant applications received April 22, 2004
• Nearly 1,000 letters of intent received
• Applications from every State

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Health IT Resource Center

• Offer assistance grantees
• Types of assistance include
• Technical and expert
• Form collaboration
• Share lessons learned
• Future expansion (both reach and capabilities)

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State and Regional HIT Demonstrations

• Five year initiative
• Offered via contract mechanism
• Applicant must be a State government or duly
  appointed by a State government
• Awards in late summer up to five

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Accelerate the Use and Adoption of Standards and
Technology

• 10M Initiative (AHRQ and ASPE)
• Areas of focus
• Voluntary industry clinical messaging/terminology
  standards
• National standard nomenclature for
  drugs/biologics
• Comprehensive clinical terminology and
  nomenclature standards
• Conduct research regarding activities to advance
  and accelerate the adoption of interoperable IT
  technology

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Care Management Performance Demonstration

• Section 649 of the recent Medicare legislation
• Pay for performance demonstration
• Three-years in duration
• Four sites
• Focus on Medicare beneficiaries with chronic
  conditions

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Secretary ThompsonMarch 21, 2003

• In the modern era, every century has had its
• major advance that has brought medical
• science another giant step forward. . What will
  
• the major advance of the 21st century be?
• I am convinced that the medical revolution
• of our childrens lifetimes will be the
• application of information technology to
• health care.

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Future Directions

• Demonstrate the value of HIT to improve quality
  and safety in diverse clinical settings
• Build on previous investment share
  implementation lessons and best practices from
  grantees
• Expanded collaboration with public and private
  partners

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• For additional questions, please contact
• Dr. Scott Young, syoung_at_ahrq.gov