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Health Information Exchange and Quality

IV HEALTH INFORMATION TECHNOLOGY EXECUTIVE SUMMIT 2013 HIT & HIE Challenges and Opportunities for Healthcare Transformation. Health Information Exchange and Quality. What does this mean for the health care sector?

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Health Information Exchange and Quality

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  1. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation HealthInformation Exchange and Quality

  2. What does this mean for the health care sector? As with any revolution, there will be winners and losers: those who adapt successfully and those who do not. Daniel Masys, one of the early thinkers and conceptual architects of the medical informatics movement, reviews the stakes and the prospects for the future of the workforce in regard to the changes under way. His description of the coming tectonic changes is compelling, as are his suggestions about the evolving roles of physicians and other health professionals. Among health professionals there will certainly be winners and losers, however, and the emergence of new categories of jobs. Failure to communicate effectively will be likely to place a health care provider at an economic disadvantage. The health professional who refuses to use a computer is a justifiably endangered species in this emerging environment.

  3. The Center for Medicare and Medicaid Services (CMS) calls EHRs, “the right step in continued progress of healthcare”. EHR can help hospital monitor, improve and report data on healthcare quality and safety. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  4. HIE REALITY: • HIE environment is under continuous development; • Cooperation must take precedence over competition; • Statewide HIE’s should cooperate with private HIE’s to provide • synergistic services

  5. THE COMMONWEALTH FUND Using Electronic Health Records To Improve Quality And Efficiency: The Experiences Of Leading Hospitals http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1608_SilowCarroll_using_EHRs_improve_quality.pdf USEFUL LESSONS AND INSIGHTS FROM 9 HOSPITALS THAT ARE (WERE) CONSIDERING EHR ADOPTION, RAMPING UP THEIR EHRs TO MEET MEANINGFUL USE CRITERIA, OR TAILORING THEIR HER TO PROMOTE HEALTH CARE QUALITY AND SAFETY IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  6. KEY DRIVERS OF EHR ADOPTION: IMPROVING QUALITY AND CONTINUITY OF CARE - AT MOST HOSPITALS, ADOPTING A COMPREHENSIVE HER WAS PART OF A STRATEGIC PLAN TO INTEGRATE INPATIENT AND OUTPATIENT CARE AND PROVIDE A CONTINUUM OF COORDINATED SERVICES ACROSS THEIR SYSTEM. - THE HER WAS EXPECTED TO IMPROVE COMMUNICATION AMONG PROVIDERS ACROSS CARE SITES - SOME HOSPITALS (INTERVIEWEES) NOTED THAT THESE LEVEL OF COORDINATION WOULD BE NECESSARY FOR FURTHER DELIVERY SYSTEM REFORM (SUCH AS ACOs) IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  7. A BUSINESS CASE FOR HEALTH INFORMATION EXCHANGE IS NOW EMERGING New delivery system and payment models that promote higher quality, cost effective care are proliferating in the market place Through CMS Innovation, the federal government is investing hundreds of millions of dollars in new models of care, including demonstration of Accountable Care Organizations, Advance Primary Care, Patient Centered Medical Home, Home based care and Bundle Payments. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  8. A BUSINESS CASE FOR HEALTH INFORMATION EXCHANGE IS NOW EMERGING A recent study identified 30 ACOs arrangements within 22 health plans and this numbers is expected to grow According to a Recent survey of hospitals And health systems conducted by the Advisory Board, nearly half of respondents expect to have an accountable care organization in place by 2013, and 78 percent plan to do so by 2015. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  9. A BUSINESS CASE FOR HEALTH INFORMATION EXCHANGE IS NOW EMERGING More robust requirements for EHRs and information exchange contained in MU Stage 2 are scheduled to go into effect in October 2013 for hospitals and January 2014 for EP. These new requirements, combined with delivery system and payment models, are increasingly creating the ‘business case’ for clinicians, hospitals, and other providers to begin exchanging data electronically across organizational boundaries. According to a Clinical Survey, a Majority of clinicians believe that electronic exchange of health information will have a positive impact on health care. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  10. A BUSINESS CASE FOR HEALTH INFORMATION EXCHANGE IS NOW EMERGING A clear majority of clinicians surveyed believe that the electronic exchange of health information across care settings will have a positive impact on: the quality of patient care (80 percent) Ability to meet the demands of new care models (78 percent) Ability to participate in third party reporting (72 percent) Positive impact on improving efficiencies in their practice settings (69 percent) Reducing health care cost (57 percent) IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  11. KEY STRATEGIES TO SUCCESSFULLY IMPLEMENT AND OPTIMIZE EHR Strong Leaders who are both forceful and realistic Achieving buy-in from physicians and other staff was cited as a critical challenge by hospitals. While only a minority of staff members was resistant to EHRs per se, many physicians and others had significant concerns about anticipated upheaval and changes in their day to day activities. Their anxiety was compounded by ambiguity about their potential benefits of the new system, as well as wariness about clinical rules being imposed on them. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  12. KEY STRATEGIES TO SUCCESSFULLY IMPLEMENT AND OPTIMIZE EHR AND HIE Involve Clinical Staff in her Design and Implementation All interviewees emphasized that the most important factors in building support for the HER were having clinician staff drive the process and involving as many staff as possible in its design and development. In addition to forming high level implementation teams, key staff members through the hospital were assigned to design teams and committees to help tailor her system to the hospital environment IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  13. KEY STRATEGIES TO SUCCESSFULLY IMPLEMENT AND OPTIMIZE EHR AND HIE Invest Heavily in and Require Training The hospitals faced tremendous logistical challenges in training virtually all hospital staff and clinicians in how to use EHRs. They need to expand their IT staff to work with HER Vendor to customize the system, including adding IT Focused clinicians who could bridge the conversation (effectiveness) between technology and practice. Training needs continued as new staff members are hired and changes/updates are made to the system. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  14. KEY STRATEGIES TO SUCCESSFULLY IMPLEMENT AND OPTIMIZE EHR AND HIE Use EHRs to Aggregate Performance Data Some Hospitals were frustrated by the limitations of EHRs to facilitate reporting, particularly their inability to generate reports for CMS Hospital Compare or Meaningful Use Certification. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  15. KEY STRATEGIES TO SUCCESSFULLY IMPLEMENT AND OPTIMIZE EHR AND HIE Involve Quality Improvement Leaders in Developing and Updating EHRs Hospitals must include quality improvements and accreditation personnel in the selection, design, and tailoring of their HER systems. Several Hospitals noted that their quality staff worked with IT staff to customized dropdown menu choices in the HER to be consistent with many other external (regulations) reporting requirements IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  16. IMPACT OF EHR AND HIE ON QUALITY OF CARE TARGETING ON QUALITY IMPROVEMENT EFFORTS The Hospitals report that a major benefit of their EHRs has been the ability to look at patterns in performance data to identify problems areas, thereby facilitating quality improvement efforts and identifying opportunities for process redesign. Carilion developed 15 automated reports on the use of patient restraints, each identifying different aspects of restraint use such as patient demographics, diagnosis, and time of day used. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  17. IMPACT OF EHR AND HIE ON QUALITY OF CARE PERFORMANCE REPORTING AND ACCOUNTABILITY The Hospitals used their comprehensive EHRs often in conjunction with additional quality reporting programs, to generate performance reports with trends and benchmarks. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  18. IMPACT OF EHR AND HIE ON QUALITY OF CARE IMPROVED COMMUNICATION The Leading Hospitals report the EHR contribute to faster, more accurate communication between providers within the hospital and between ambulatory and hospital settings. Patients’ care plans, medical history, allergy lists, medication records and progress notes are easily accessible, enabling authorized users to see the complete medical story. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  19. IMPACT OF EHR AND HIE ON QUALITY OF CARE CONSISTENT, EVIDENCE-BASED CARE The Leading Hospitals embedded clinical guidelines in their EHR systems At Yale-New Heaven Hospital, about 80% of ordering is guided, with prompts and questions to help clinicians select the best drug or treatment protocol. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  20. EFFICIENCIES AND RETURN ON INVESTMENTS More Time for Patient Care and Quality Improvement Sentara nurses found the EHR-based discharge tool reduced the time spent searching paper records for relevant information; clinicians do not have to return to the unit to access patient records Quality improvements staff found that EHRs made performance reporting faster and more efficient IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  21. EFFICIENCIES AND RETURN ON INVESTMENTS IMPROVING THROUGHPUT AND REDUCING REDUNDANCY The Hospitals report that the EHR improved patient flow, or throughput, because care processes can be streamlined and discharges are more predictable and can happen earlier, leading the shorter lengths of stay and faster bed turnover and reassignment. At Sentara, the time to assign a bed for a newly admitted patient has decreased by 90 minutes, with a 80% reduction in time to admit an emergency department patient. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  22. EFFICIENCIES AND RETURN ON INVESTMENTS CAPTURING CHARGES On aspect of efficiency is being able to bill for all services delivered while minimizing administrative and documentation costs. Gundersen reduced its write-off for care associated with inadequate documentation of services or required Medicare waivers. IV HEALTH INFORMATION TECHNOLOGYEXECUTIVE SUMMIT 2013HIT & HIE Challenges and Opportunities for Healthcare Transformation

  23. Health data sharing networks are crucial to quality improvements, cost containment, and health care accessibility. By enabling the flow of patient data across organizations, data sharing improves almost every aspect of healthcare in America, from insurance markets to better research. With costs rising rapidly and many Americans continuing to lack health care insurance, the development of technology infrastructure and data sharing are vital to modernizing the health care system and integrating data compiled by a number of different organizations. RE: TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE PART I—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE PROGRAM PART II—NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY

  24. Q & A

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