hit and accountability: is there a new practice model in your future? william e. golden, md facp...

HIT and Accountability: Is There a New Practice Model in Your Future?HIT and Accountability: Is There a

New Practice Model in Your Future?

William E. Golden, MD FACPWilliam E. Golden, MD FACP

Professor Of Medicine and Public Health, UAMSProfessor Of Medicine and Public Health, UAMSVice President, Quality Improvement, AFMCVice President, Quality Improvement, AFMC

Chair, Board of Regents, ACPChair, Board of Regents, ACPPast Director, National Quality ForumPast Director, National Quality Forum

PreQuizPreQuizPreQuizPreQuiz

You go an ATM and You go an ATM and ask for $100. ask for $100.

You Receive $80.You Receive $80.

The most appropriate The most appropriate response:response:

1.1. Nothing – Its OKNothing – Its OK

2.2. It was a reasonable It was a reasonable mistakemistake

3.3. Discuss with Discuss with managementmanagement

4.4. ###***!!!###***!!!

Second QuestionSecond QuestionSecond QuestionSecond Question

Your aunt goes to the ER Your aunt goes to the ER with an acute MI.with an acute MI.

She does not receive an She does not receive an aspirin and a beta aspirin and a beta blocker and is sent home blocker and is sent home with an LVEF of 25%with an LVEF of 25%

The most appropriate The most appropriate response:response:

1.1. Nothing – Its OKNothing – Its OK2.2. It was a reasonable It was a reasonable

mistakemistake3.3. Discuss with Discuss with

managementmanagement4.4. ###***!!!###***!!!

Women’s Health in ARWomen’s Health in AR

Pap SmearsPap Smears MammogramsMammograms Chlamydia TestingChlamydia Testing

© 2004 Institute for Healthcare Improvement

Some Is Not a NumberSoon Is Not a Time

Measuring Provider Efficiency 1.0http://leapfroggroup.org/news/leapfr

og_news/345254

Measuring Provider Efficiency 1.0http://leapfroggroup.org/news/leapfr

og_news/345254

The Leapfrog GroupThe Leapfrog Group

Bridges to ExcellenceBridges to Excellence

Purchaser ParadigmPurchaser Paradigm

HL HH

Costs LL LH

Quality

What Consumers BelieveWhat Consumers Believe

Information Will Reform the SystemInformation Will Reform the System The Market Will Fix Bad PerformanceThe Market Will Fix Bad Performance

National Voluntary Hospital Reporting

Initiative

Role of Public DataRole of Public Data

Valuable to Trustees, Corporate LeadersValuable to Trustees, Corporate Leaders Motivates InvestmentMotivates Investment Changes Metrics of Job EvaluationsChanges Metrics of Job Evaluations Used by the Public?Used by the Public?

Program AttributesProgram AttributesProgram AttributesProgram Attributes

ActionableActionable Operational and FeasibleOperational and Feasible FairFair Credible and ReliableCredible and Reliable EquitableEquitable

Provider Report CardsProvider Report Cards

Statewide ValuesStatewide Values Practice Specific InformationPractice Specific Information Prelude to P4P?Prelude to P4P?

PCPI: PCPI: Physician Performance Measurement SetsPhysician Performance Measurement SetsPCPI: PCPI: Physician Performance Measurement SetsPhysician Performance Measurement Sets

Adult Diabetes1

AsthmaChronic Obstructive Pulmonary Disease

Community-acquired Bacterial PneumoniaCoronary Artery Disease2

Heart Failure2

Hypertension2

Major Depressive DisorderOsteoarthritis of the Knee3

Prenatal Testing

Preventive Care and Screening Measures:Colorectal Cancer ScreeningInfluenza Immunization, Adult

Screening MammographyProblem Drinking

Tobacco Use Cessation

1 subset of Alliance 2 with ACC & AHA 3 with AAOS

National Quality Forum (NQF)National Quality Forum (NQF)

Public Private CollaborationPublic Private Collaboration National Steering CommitteeNational Steering Committee Four Membership CouncilsFour Membership Councils

Providers, Consumers, Research/QIO, Providers, Consumers, Research/QIO, PurchasersPurchasers

Strategic Framework BoardStrategic Framework Board Funded ProjectsFunded Projects

Clinical Quality MeasuresClinical Quality Measures

The Challenge. . .The Challenge. . .

Physicians’ Views on Quality of Care:Findings from the Commonwealth Fund

National Survey of Physiciansand Quality of Care

Anne-Marie J. Audet, Michelle M. Doty,Jamil Shamasdin, and Stephen C. Schoenbaum

May 2005

73

37

18 176 7

6

21

9 918 21

314

0

20

40

60

80

100

Electronic

Billing

Access

to Test

Results

Electronic

Medical

Records

Electronic

Ordering

Clinical

Decision

Support

E-mail

w ith

Doctors

E-mail

w ith

Patients

Percent indicating “routine” or “occasional” use

Chart I-1. Use of Information Technologies

Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.

58

27 27 2428

18

Yes, used routinely

Yes, used occasionally

* Electronic ordering of tests, procedures, or drugs.

*

79

27 27

1212

3946

12 12

46

22 20

45

0

25

50

75

100

Diagnosis/Health Risk Lab Results Current Medications

1 Physic ian 2–9 Physic ians 10–49 Physic ians 50+ Physic ians

Chart II-3. Physicians’ Access toPatient Panel Data, by Practice Size

Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.

Percent indicating “very/somewhat” easy to generate lists of patients by

Patient’s medical record, test results, or other relevant clinical information were not available at the time of the scheduled visit

Tests or procedures had to be repeated because findings were unavailable or inadequate for interpretation

Patient’s care was compromised because he/she received conflicting information from different doctors or other health professionals

Patient experienced a problem following discharge from a hospital because physician did not receive needed information from the hospital in a timely manner

Coordination of care problems

72%

34%

28%

26%

Chart IV-1. Coordination of Care ProblemsPhysicians Observe

Percent who observed problem sometimes or

often in past 12 months

Patient had a positive test result that was not followed-up appropriately 15%

Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.

Patient received the wrong drug, wrong dose, or had a preventabledrug-drug interaction

11%

WWW.DOQ-IT.ORGWWW.DOQ-IT.ORG

HITHIT

Arkansas a DOQ-IT Demo StateArkansas a DOQ-IT Demo State ~175 Clinical Sites~175 Clinical Sites

88thth SOW – HIT in Home Health, SOW – HIT in Home Health, Hospitals, Physician OfficesHospitals, Physician Offices

Limited Access to BroadbandLimited Access to Broadband Financing, Standard, etcFinancing, Standard, etc

Current Status of HIT Current Status of HIT

Computers absent in patient care areasComputers absent in patient care areas Orders for meds, lab tests, radiology still Orders for meds, lab tests, radiology still

on paperon paper Lack capability for immediate, Lack capability for immediate,

automated resultsautomated results No intranet communication capabilityNo intranet communication capability Fragmented “stove-pipe” systemsFragmented “stove-pipe” systems

StandardizationStandardization

AHIC – Health Information CommunityAHIC – Health Information Community ONCHIT – National Coordinating OfficeONCHIT – National Coordinating Office CCHIT – Certification ProcessCCHIT – Certification Process eHI – e Health InitiativeeHI – e Health Initiative

CostsCosts

HardwareHardware SoftwareSoftware TrainingTraining Delays during initial Delays during initial

implementationimplementation Delays during learning curveDelays during learning curve

Culture ChangeCulture Change An organization that succeeds…An organization that succeeds…

Greets quality measurement with Greets quality measurement with enthusiasmenthusiasm

Views change as an opportunityViews change as an opportunity Embraces accountabilityEmbraces accountability Regards performance improvement as an Regards performance improvement as an

everyday activityeveryday activity Recognizes that HIT implementation is an Recognizes that HIT implementation is an

organizational change, not an IT projectorganizational change, not an IT project

HIT in Arkansas Hospitals HIT in Arkansas Hospitals

Of the 81 hospitals surveyed:Of the 81 hospitals surveyed: 31% plan to implement HIT <3 years31% plan to implement HIT <3 years .02% have implemented CPOE.02% have implemented CPOE .08% have implemented EHR.08% have implemented EHR .04% have implemented barcoding.04% have implemented barcoding

HIT: Home Health AgenciesHIT: Home Health Agencies

Of the 170 agencies surveyed:Of the 170 agencies surveyed: 14% plan to implement HIT < 2 years 14% plan to implement HIT < 2 years 13% have implemented an EHR13% have implemented an EHR .04% have implemented telemonitoring.04% have implemented telemonitoring

Where Do All The Data Go?Where Do All The Data Go?

Who are the Stewards?Who are the Stewards?

The National Vision The National Vision

A network of interoperable systems A network of interoperable systems linking clinical, public health and linking clinical, public health and personal health information that personal health information that providers could easily access to more providers could easily access to more effectively diagnose, treat and effectively diagnose, treat and manage quality care. manage quality care.

Health Information Exchange (HIE)

Health Information Exchange (HIE)

Stakeholder Interest Group Stakeholder Interest Group Met QuarterlyMet Quarterly AHA, AMS, AHCA, DHHS, QualChoice, AHA, AMS, AHCA, DHHS, QualChoice,

Blue Cross, Blue Cross, Recognized Need for Formal StructureRecognized Need for Formal Structure ““Next Steps” Document in PreparationNext Steps” Document in Preparation

NGA RFP NGA RFP Legal Issues Related to HIELegal Issues Related to HIE

Potential Model for ProgressPotential Model for Progress

Technologyv Architecturev Applicationsv NHIN Compliance

Financev Capitalv Sustainability Planv Network Fee

Structure

Implementationv Work Planv Trainingv Support

Legal/Regulatoryv Privacy/Securityv Data Usagev Operating

Standards

StakeholderSteering

Committee

Workgroups

Figure 1 HIE Committee Structure

Contact Information

To find out more, please call us:

Arkansas Foundation for

Medical Care

(877)375-5700