A sampling of Federal Health IT initiatives

1. A sampling of FederalHealth IT initiatives Carol Cain, PhD Senior Manager, Health IT Portfolio Agency for Healthcare Research and Quality October 24, 2006

2. Clinical Procedure Landmark Trial Current rate of use Flu Vaccine 1968 64% (2000) Pneumococcal Vaccine 1977 53% (2000) Diabetic Eye Exam 1981 48.1% (2000) Mammography 1982 75.5% (2001) Cholesterol Screening 1984 69.1% (1999) Diffusion of knowledge Balas EA, Boren SA., Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000.

3. 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

4. … 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

5. EHR Adoption Gap:United 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).

6. PROVIDERS POLICY PIPES 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?

7. Quality Standards Design systems to collect quality of care information and define what constitutes quality health care Incentives Reward those who provide and purchase high-quality and competitively priced health care Price Standards Aggregate claims information to enable cost comparisons between specific doctors and hospitals Interoperabiliity Set common technical standards for quick and secure communication and data exchange Building a Transparent Health Care System Cornerstones of Value-Based Health Care

8. Office of the National Coordinator for Health Information Technology • Established in response to Executive Order 13335, April 27, 2004 • Responsible for realizing the President’s 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

9. Compliance Certification NHIN Privacy / Security Biosurveillance Consumer Empowerment Chronic Care Electronic Health Records Breakthroughs Standards Harmonization Coordination of Policies, Resources, and Priorities Office of the National Coordinator -Health IT Policy Council-Federal Health Arch. The Community -Workgroups IndustryTransformation Infrastructure Health IT Adoption ConsumerValue Health Information Technology Deployment Coordination Health Care Industry Technology Industry

10. 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 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:

11. Agency for Healthcare Researchand Quality (AHRQ) Mission To improve the quality, safety, efficiency, and effectiveness of health care for all Americans

12. AHRQ research focus:How 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

13. 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 Alzheimer’s disease Depression and other mood disorders Diabetes mellitus Ischemic heart disease Peptic ulcer/dyspepsia Pneumonia Stroke, including control of hypertension

14. Facilitate Informed Transparent Health Care Decisions by: • Patients • Providers • Policymakers Clinical Decisions and Communication Science Center Scientific Evidence Translation Understandable and Usable Information

15. Planning 1 yr Implementation 3 yr Demonstrating Value 3 yr National Resource Center for Health IT AHRQ Health IT Portfoliohttp://healthit.ahrq.gov Current issues: eRx standards pilots Privacy, security, business practices State and Regional Demonstrations of HIE 5 yr

16. 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

17. 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 Implementation grants Evaluation Toolkit

18. 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

19. http://healthit.ahrq.gov • Knowledge library • Topic summaries • Annotated references • Lessons learned • Expert assistance • 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

20. 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”

21. State and Regional Demonstrations • 6 contracts • $30M over 5 years • Laboratory data • Pharmacy Data • Improved Quality and Safety • Benefit to Medicaid • Sustainable Model

22. 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, it’s 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

23. 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

24. Collaboration with ONC • “Privacy and Security Solutions for Interoperable Health Information Exchange” Contract • Research Triangle Institute for $17.5 M • National Governor’s 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

25. 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

26. 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@hrsa.gov

27. 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 HRSA’s 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 HRSA’s grantees.

28. 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.

29. 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.

30. 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

31. Carol Cain, PhD carol.cain@ahrq.hhs.gov http://www.ahrq.gov http://healthit.ahrq.gov Thank you.