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HITECH, Meaningful Use, and Interoperability

HITECH, Meaningful Use, and Interoperability. HITECH. Health Information Technology for Economic and Clinical Health – HITECH Part of the 2009 American Recovery and Reinvestment Act

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HITECH, Meaningful Use, and Interoperability

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  1. HITECH, Meaningful Use, and Interoperability

  2. HITECH • Health Information Technology for Economic and Clinical Health – HITECH • Part of the 2009 American Recovery and Reinvestment Act • In February 2010 $750 million in grants and contracts went to agencies in 40 states and to 30 nonprofit organizations to “facilitate the exchange of health information.” • Also $225 million to 55 training programs to help train people for jobs in the health care and Health IT sectors.

  3. HITECH • Carrots and Sticks • The carrots: • $14-27 billion will go to physicians, hospitals and other providers in the form of bonuses on their Medicare and Medicaid payments. • Fiscal year 2011 (October 2010) to hospitals • http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MLN_TipSheet_MedicareHospitals.pdf • January 2011 physicians (up to $44,000 per physician under the Medicare portion, $63,000 under Medicaid) • http://www.healthit.gov/providers-professionals/ehr-incentive-payment-timeline • If they can demonstrate that they are making “meaningful use” of health IT in addition to merely purchasing it and installing it. • Then comes the stick • In 2015 or 2016 payments will be replaced by penalties for those not showing meaningful use.

  4. HITECH • Responsibility for implementing provisions held by HHS Office of the National Coordinator for Health IT • Dr. Karen B. DeSalvo, MD, MPH, MSc • Formerly FarzadMostashari, David Blumenthal • August 2010 plan for certifying electronic health record systems was released. • Functional • Interoperable • Secure

  5. Defining Meaningful Use

  6. One Step Forward, Two Steps Back • Federal officials revised the timeline to allow Stage 2 to be extended through 2016 and Stage 3 to begin in 2017 for the providers that have completed at least two years in Stage 2. • Many were reported to be surprised by the complexities' of Stage 2 requirements, and some EHR makers were showing signs of “certification fatigue.”

  7. Defining Meaningful Use • Stage 1 (some started in 2011) • focuses on electronically capturing health information in a coded format • using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured) • implementing clinical decision support tools to facilitate disease and medication management and reporting clinical quality measures and public health information

  8. Stage 1 • Reporting through attestation • Objectives and clinical quality measures • Reporting may be through yes/no or numerator/denominator attestation

  9. Stage 1 • Eligible professionals must complete • 15 core objectives • 5 out of 10 from menu set • 6 clinical quality measures • 3 core and 3 out of 38 from additional set • Hospitals must complete • 14 core objectives • 5 out of 10 from a menu set • 15 clinical quality measures

  10. MU Stage 1 Core Set of Objectives

  11. MU Stage 1 Core Set of Objectives

  12. MU Stage 1 Core Set of Objectives

  13. MU Stage 1 Menu Set Objectives5 of 10

  14. MU Stage 1 Menu Set Objectives5 of 10

  15. Effect of HITECH on EHR Adoption • Significant increase in adoption between 2011 and 2012 • Although a majority of hospitals did not achieve MU • Small and Critical Access hospitals are at the most risk to fail • Low patient volume means fewer resources • Difficulty recruiting and retaining skilled IT personnel • Those that are recruited will be asked to become experts in all areas of IT (hardware, software, networking, security) rather than specializing. • Suitable IT vendor may be tough – vendors will tend to focus on larger institutions with larger budgets

  16. Defining Meaningful Use • Stage 2 (2014) • encourages the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible • Some Stage 1 objectives were either combined or eliminated, most of the Stage 1 objectives are now core objectives under the Stage 2 criteria.

  17. Defining Meaningful Use • For many of these Stage 2 objectives, the threshold that providers must meet for the objective has been raised. • Some new objectives were also introduced for Stage 2, and most of these were introduced as menu objectives for Stage 2.

  18. Stage 2 vs. Stage 1 • New Stage 2 Core Objectives: • Use secure electronic messaging to communicate with patients on relevant health information (for EPs only) • Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR) (for Eligible Hospitals)

  19. Interoperability • Four areas of EHR technology that are important to consider • How applications interact with EHR system users (such as ordering labs) • How systems communicate with each other (such as messaging standards) • How information is processed and managed (such as data import into an EHR) • How consumer devices integrate with other systems and applications (such as tablet PCs for secure messaging)

  20. Interoperability • National Coordinator for HIT: • Interoperability ensures that health-related information flows seamlessly from General Practitioner, to Specialist, to Hospital, to Patient. • Regardless of geographic, organizational, or vendor boundaries • Interoperability refers to the architecture or standards that make it possible for diverse EHR systems to work compatibly in a true information network • One of the key distinctions between Stage 1 and Stage 2 is that the bar is raised for interoperability

  21. Stage 2 vs. Stage 1 • Stage 2 criteria place an emphasis on health information exchange between providers to improve care coordination for patients. • Providers who transition or refer a patient to another setting of care or provider of care must provide a summary of care record for more than 50% of those transitions of care and referrals. • For more than 10% of transitions and referrals must provide a summary of care record electronically. • The physician or hospital that transitions or refers their patient to another setting of care or provider of care must either • a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender's, or • b) conduct one or more successful tests with the CMS-designated test EHR during the EHR reporting period.

  22. Stage 2 vs. Stage 1 • Stage 2 also replaces the previous Stage 1 objectives to provide electronic copies of health information or discharge instructions and provide timely access to health information with objectives that allow patients to access their health information online. • Stage 2 Patient Access Objectives: • Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP (for EPs only) • Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge from the hospital (for Eligible Hospitals)

  23. Stage 2 vs. Stage 1 • There are also new items in the menu lists • Additional Clinical Quality Measures, including 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population and Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Processes/Effectiveness

  24. Stage 1 vs Stage 2 • For more detail on differences see: • http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTablesforEP.pdf

  25. Stage 2 Challenges: • ICD-10 and other reform • Providers and Venders both have lots of plates in the air • Vendor Readiness • For providers to achieve meaningful use, they must use an EHR certified by an ONC-authorized testing body. • Hundreds or even thousands of complete EHRs and EHR modules certified for Stage 1 have not been upgraded to Stage 2 standards, potentially leaving customers in the uncomfortable position of having to change vendors in midstream.

  26. Stage 2 Challenges: • EHR Usability • Part of the certification process includes a usability test, but the rules for this are vague • Testers go out and observe users and then report back to the certifiers. • Also leads to some perverse incentives

  27. Stage 2 Challenges: • Interoperability • A particular sticking point is with laboratories. The Stage 2 rules require EHRs to be capable of accepting coded lab data. But there's nothing compelling laboratories to put lab reports in the correct format • Electronic communication between professionals • Sending PHI over standard email • Irrelevance to Specialists • Many of the requirements (smoking cessation, patient education, preventative care, patient engagement) are foreign to specialists

  28. Stage 2 Challenges: • Patient Engagement and Education • Particularly the provision that calls for 50 percent of patients to be given an electronic means of viewing, transmitting or downloading personal health data and for 5 percent of patients to take it upon themselves to be "engaged" by sending unsolicited electronic messages to their healthcare providers. • What is in it for the patient?

  29. 860 physicians, 63% “meaningful users” • Hypertension and Diabetes patients fared marginally better with MU providers • Asthma and Chronic depression patients fared significantly worse with MU providers • No other significant differences between patients treated by MU and non-MU providers • The hope is that Stage 3 will “pack the punch”

  30. Defining Meaningful Use • Stage 3 (2016 2017) • focuses on promoting improvements in quality, safety and efficiency • Improving quality, safety, and efficiency, leading to improved health outcomes • Decision support for national high-priority conditions • Patient access to self-management tools • Access to comprehensive patient data through patient-centered HIE • Improving population health

  31. Under improving quality:Clinical decision supportOrder trackingDemographics and patient informationCare planning—advance directiveElectronic notesHospital labsUnique device identifiers

  32. Stage 3 Recommendations • Under patients and families in care:View, download and transmitPatient generated health dataSecure messagingVisit summary and clinical summaryPatient education

  33. Stage 3 Recommendations • Under improving care coordination:Summary of care at transitionsNotificationsMedication reconciliation • Under improving population and public health:Immunization historyRegistriesElectronic lab reportingSyndromic surveillance

  34. Conclusions: HITECH • Bridge to Nowhere? • Or a Stepping Stone?

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