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Efforts to Assist Providers and Patients In Using Health IT for High Quality Care

Session #158, February 22, 2017

Thomas A. Mason, MD, Chief Medical Officer

Lisa-Nicole Sarnowski, Acting Deputy Director, Office of Programs & Engagement

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Speaker Introduction

Thomas Mason, MD

Acting Director of Clinical Quality & Safety, Chief Medical Officer

The Office of the National Coordinator for Health IT, US Department of Health and Human Services

Lisa-Nicole (Danehy) Sarnowski, MHS

Acting Deputy Director, Office of Programs and Engagement

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Conflict of Interest

Thomas A. Mason, MD

Lisa-Nicole Sarnowski, MHS

Has no real or apparent conflicts of interest to report.

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Agenda

• Overview of the Health IT Landscape

• Consumer eHealth & Engagement

• Commitment to Assisting Providers

• Available Tools & Resources

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Learning Objectives

• Describe available resources for patients and consumers to assist in

improving how care is being delivered using health IT

• Describe available resources for providers to assist in improving how care is

being delivered

• Identify specific ways providers and patients are using health IT as partners

in care

• Engage consumers, clinicians, and providers on what they need from

ONC/Federal Partners with regards to tools/resources

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Historic Context: Office of the National Coordinator for Health IT (ONC)

• Created in 2004 by executive order by President Bush

• Legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009

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Historical Programs

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Historical Programs: Sample Successes

• 21,000+ health IT workforce students trained through 2013

• 20 health IT curriculum components developed; over 20,000 downloads

• Technical assistance through the REC program to help 145,000+ providers meet Stage 1 meaningful use criteria

– Medicare providers working with RECs were over 1.9x more likely to receive an EHR incentive payment then those who were not partnered with an REC1

– Technical assistance from a REC strongly associated with meaningful use achievement among rural providers2

Sources:

1. GAO, Electronic Health Records: Number and Characteristics of Providers Awarded Medicare Incentive Payments for 2011-2012,

GAO-14-21R (Washington, D.C.: October 24, 2013)

2. Heisey-Grove, Dawn M. "Variation in rural health information technology adoption and use." Health Affairs (2016): 10-1377.

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Progress in the HITECH Era

Possession of certified EHR:

2008* - 17% of physicians and 9% of hospitals

2015 - 78% of physicians and 96% of hospitals

*Data on Basic EHRs only

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Engaging Patients with Health IT: Office-Based Physicians

Percent of physicians that have electronic capabilities to exchange secure

messages with patients and for patients to view, download and transmit their

online medical record, 2015

Source: https://dashboard.healthit.gov/quickstats/pages/physicians-view-download-transmit-secure-messaging-patient-engagement.php

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More Hospitals than Ever Making Information Available Electronically to Patients

24%

14%

40%*

28%*

12% 10%

91%*

82%*

66%* 64%*

95%*87%*

71%* 69%*

0

20

40

60

80

100

View Download Transmit View, Download, andTransmit

Pe

rce

nta

ge

2012 2013 2014 2015

* Significantly different from previous year (p < 0.05) data regarding “Transmit” and “View, Download, and Transmit” were not collected in 2012.

Source: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement: 2012-2015.

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Patient Engagement Beyond VDTElectronic capabilities offered by non-federal acute care hospitals to their patients (excluding view, download, and

transmit), 2013-2015

Source: https://dashboard.healthit.gov/evaluations/data-briefs/hospitals-patient-engagement-electronic-capabilities-2015.php

NOTES: Questions regarding

secure messaging were not

asked in 2013. *Significantly

different from previous year (p

< 0.05).

SOURCE: ONC/American

Hospital Association (AHA),

AHA Annual Survey

Information Technology

Supplement: 2012 - 2015.

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Many Challenges for Patients in Getting their Health InformationFeedback from consumers included:

• Patients surprised by complexity of process

• Process different for each doctor or specialist

• For caregivers, information gathering is a full-time job,

particularly for chronically ill patients

• Requests may not be received or handled correctly, meaning

medical records often not sent

• Lack of understanding and/or clarity around HIPAA can

cause delays

“It felt like a bad

scavenger hunt.”

- Patient

“…it was a web

of insanity.”

- Caregiver

There are real financial and health consequences to the

difficulty in getting medical records from providers.

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Data Access & Use: A Patient’s View

+ Patients enjoy having portal access

+ Become invested in tracking their health

+ Over time, they use more portal features

(labs, appointments, email, Rx)

Told fax/mail is only way to send or receive

information

Data fractured across different portals

Patients don’t proactively try to get their

records together

Strategies

1. Address unnecessary paper creation (human-created issue)

2. Medical community & patient community partnership in e-system of sharing

focused on patient care & outcomes

Findings

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Address Patient Experience from Start to Finish

GOAL TRIGGER TRANSACTION

Getting a second

opinion on treatment

options

Create a new

appointment with a

specialist

Specialist requires

tests and results from

other providers

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Convenience for All

“I sought medical advice from more than 20 physicians . . . each new doctor I’d visit would ask if I had any medical records from the plethora of past hospital and doctor visits – to which I replied, “No. I was never able to attain them!” I’m sure many tests were repeated that year and the lack of EHRs resulted in a lot of similar wheels to be turned. I was also left to rely on my mind’s ability to recall what this or that doctor had once told me. . . .having these records would not only be helpful for my doctors, it would

be convenient for me, too.”

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Access

Sample Outreach and Resource Development Tools

ACCESS Contribute

• Consumer Task Force

• HIPAA Educational Videos

• Draft Model Privacy Notice Update

• Patient Engagement Strategy Guide

• Blue Button Initiative

• Patient-Generated Health Data Framework

• Patient Engagement Playbook

• And many more!

Test Locally, Share Nationally

Advanced HIE

CHP

Workforce

Workforce Training Program

ONC

Train6,000

students

Update 20 existing curriculum

components*

- Health Management Information Systems

- Working with Health IT Systems

- Installation and Maintenance of Health IT Systems

- Networking and Health Information Exchange

- Configuring Electronic Health Records

- Usability and Human Factors

- Planning, Management, Leadership for Health IT

Develop 5 new curriculum components

- Population Health

- Care Coordination & Interoperable Health IT

Systems

- Value-Based Care

- Patient-Centered Care

- Healthcare Data Analytics * Selected topics

7 AWARDEES

$6.7M grant

in 2015

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Workforce Training Program Awardees

• Normandale Community College

– For registration: Contact Tracy.Mastel@normandale.edu or visit https://www.mnhealthit.com/act.html

• Columbia University

– For registration: Visit http://hi-five.dbmi.columbia.edu or contact Raven David (rd2501@cumc.columbia.edu)

• Johns Hopkins University

– For registration: Visit www.mnhealthit.com/act.html or contact pfranci4@jhu.edu.

• Oregon Health & Science University

– Registration open at https://www.surveymonkey.com/r/onc-course

– For more information: Visit http://dmice.ohsu.edu/onc-course/

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Workforce Training Program Awardees (cont.)

• University of Alabama at Birmingham

– For more information and registration: www.uab.edu/healthit

• University of Texas Health Science Center at Houston

– For registration: Visit GO.UTH.EDU/HICATT

• Bellevue College

– For more information: Contact Heather Neikirk (heather.neikirk@bellevuecollege.edu)

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Community Health Peer Learning Program: Harnessing Cross-Sector Data to Advance Community Health

Help to stimulate and advance community progress toward achieving population health objectives through the expanded collection, sharing, and use of electronic health data

All Chicago Making Homelessness History

Children's Comprehensive Care Clinic

Cincinnati Children's Hospital Medical Center

Dignity Health Foundation

Louisiana Public Health Institute

North Coast Health Information Network

Providence Center for Outcomes Research and Education

University Hospitals Rainbow Babies & Children's Hospital

Vanderbilt University Department of Health Policy

Vermont Child Health Improvement Program, University of

Vermont

Essential Access Health

Greater Detroit Area Health Council

Minneapolis Heart Institute Foundation

San Diego Health Connect

The University of Chicago Medicine

Participant communities: SME communities:

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Participant Community Health Challenges

• Maternal & child health

• Mental health

• Housing insecure & homeless

• Chronic vulnerable populations

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Acting Upon & Sharing Learnings

• Participant communities: design Community Action Plans

• SME-led development of five Population Health in-depth learning guides:

1. Collecting Quality Data for Performance Management

2. Transforming Health Information Exchange to Support Regional Population Health Improvement

3. Partner, Community, and Stakeholder Engagement

4. Conducting Impact Analyses for Community-Based Initiatives

5. Strategic and Sustainability Planning

The Advanced Interoperable and Health Information Technology Services to Support Health Information Exchange Program (“Advanced HIE”)

States that received

additional funding

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Working and Tracking Towards Progress

• Progress tracked by target population among three

milestones:

– Expanding the adoption of health IT tools and services that enable

interoperable exchange

– Facilitating send, receive, find, and use of health information

– Increasing integration of health information in interoperable health IT to

support care processes and decision making

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Working and Tracking Towards Progress (cont.)

• Supplemental funding to increase routing of Admission, Discharge, and

Transfer (ADT) messages across existing networks while leveraging existing

electronic and technical infrastructure

• Partnership with grantees to develop and disseminate bright spots, success

stories, resources

• Established Communities of Practice (CoPs)

– Long-term Post-acute Care

– ADT

– Behavioral Health

– Consumer Engagement

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Program Activities and Select Accomplishments to Date

• Expanded adoption to eligible and non-eligible providers

• Implemented directed exchange services

• Advanced adoption and exchange in LTPAC, EMS, behavioral health facilities, public health departments, and others

• Leveraged experience to support other federal projects

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ONC State Innovations Models (SIM):Resource Center

Resources to develop specialized technical assistance as well as comprehensive online health IT tools and resources for State Innovation Model (SIM) awardees

Three key TA areas to help SIMs states meet their health care transformation and payment reform objectives.

1. Interoperability and exchange

2. Shared, longitudinal care planning and care coordination

3. Integrated quality measurement

• E.g.: Health IT-Enabled Quality Measurement Strategic Implementation Guide: provides guidance for the development and execution of a statewide multi-stakeholder health-IT enabled quality measure strategy and accompanying technical framework

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Additional ONC Initiatives

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Sample Resource: Practice Transformation Support for Clinicians Map

Nationwide view of all technical assistance in each state & program specific view

http://dashboard.healthit.gov/dashboards/practice-transformation-support-for-clinicians.php

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Health IT Playbook

• Goals

– Maintain an evolving framework of tools and resources

– Identify and share leading practices and success

stories across various phases of health IT

implementation

– Help to resolve key issues and challenges providers

are experiencing as it relates to health IT optimization

and workflow

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Health IT Playbook Resources & Topic Areas

• The Playbook is organized by relevant health IT topics and subtopics:

– Electronic Health Records

– Certified Health IT

– Health Information Exchange

– Patient Engagement

– Value-based Care

– Privacy and Security

– Quality & Patient Safety

– Care Settings

– Population and Public Health

– Specialists

– Transformation Support

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Sample Resource: Million Hearts® EHR Optimization Guides

• Available on the Million Hearts® Resource Center:

https://www.healthit.gov/providers-professionals/million-hearts

• Vendor-specific guides with step-by-step instructions to facilitate

early detection of at-risk patients, allowing providers to place

them on a corrective path before diagnosis

• Allscripts

• Cerner

• NextGen

• Over 1,000 downloads to date

• ONC encourages collaboration from other EHR vendors in

developing additional guides

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Health IT Playbook Demo & Hearing From You

• All feedback is welcome

• Recommend additional tools and resources to be included

• Feedback on the content

• Feedback on the utility and design

• Help us spread the word! https://www.healthit.gov/playbook/

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Continued Commitment to Helping Providers and Patients Realize the Benefits of Health IT• Connecting providers nationwide for rapid

cycle, peer-based learning

• Ongoing work with the field to identify provider and patient challenges and provide technical assistance

• Repository of technical assistance tools and resources to providers, patients, and other stakeholders

• Publically available curriculum to train current and future health care and health IT workforce

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THANK YOU!ONC would like to extend its heartfelt gratitude to EVERYONE who has and

continues to keep us informed and grounded in the reality your experience of using health IT for high quality care. This includes but is not limited to the Health IT

Fellows; patients/caregivers and consumer advocacy groups; leadership and team members of the Regional Extension Centers, Workforce Grantees, State HIEs,

Beacon Communities, Community HIEs, Community Health Peer Learning Program Participants, AcademyHealth; FACA Task Force and Committee members; and many more unnamed organizations and individuals who are translating the vision of health

IT-enabled high quality care into reality.

We could NOT have developed these resources without you and look forward to continued and new partnerships in the future.

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Questions

Thomas A. Mason, MD

Thomas.Mason@hhs.gov

Lisa-Nicole (Danehy) Sarnowski

Lisa-Nicole.Sarnowski@hhs.gov

@LisaNicole_D

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Additional Resources: Consumers

• Blue Button Initiative

• Consumer Task Force

• HIPAA Access Guidance

• HIPAA Educational Videos

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Additional Resources: Providers• Patient Engagement Playbook

• Health IT Playbook

• Practice Transformation Map

• Million Hearts® EHR Optimization Guides

• SAFER Guides

• Patient Engagement Strategy Guide

• Patient Engagement Playbook

• CHPL

• CHPL User Guide

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Additional Resources: Communities & States• State Health IT Resource Center

• Health IT-Enabled Quality Measurement Strategic Implementation Guide

• Beacon Community Learning Guides

• Report: Identification and Prioritization of Health IT Patient Safety Measures

• ONC Current Grant Programs

• Third-party Resources

– National Governors Association: State Interoperability Roadmap

– George Washington University: Health Information and the Law

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Additional Resources: Health Information Organizations & Innovators• Connecting and Accelerating a FHIR App Ecosystem

– Discovery Site Cooperative Agreement: Awarded to the SMART App Gallery

• Helps providers in the care delivery process by helping them find substitutable apps that can make it easier to use their EHRs

– Provider UX Challenge

• Helps providers in the care delivery process by incentivizing the creation of apps that can make it easier to use their EHRs

– Consumer Health Data Aggregator Challenge

• Helps patients and consumers by improving how care is being delivered using health IT by helping them aggregate their data from disparate sources

• Model Privacy Notice and Adjoining Privacy Snapshot Challenge: Helps consumers by bringing some transparency to app privacy policy

• Move Health Data Forward Challenge: Consumer engagement: Helps consumers with consumer mediated data exchange

• API Task Force

• Blue Button Connector

• Draft Patient-Generated Health Data Framework

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Additional Resources: Workforce & Educators

• Health IT Education Opportunities available NOW!

• Workforce Existing materials are available at https://knowledge.amia.org/onc-ntdc

• Updated materials and newly developed materials will be available June 2017 at https://www.healthit.gov/providers-professionals/workforce-development-programs

• Report: Classification & Identification of Health IT Patient Safety Measures

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Additional Resources: Public Health• Meaningful Use Public Health Webpage

– Recordings and ongoing webinars and initiatives of public health interest such as:

• Joint Public Health Forum and CDC Nationwide Webinar

• Electronic Health Records (EHR) Vendors Collaboration Initiative

• CoP for Leveraging Federal Financial Participation (FFP) for Medicaid Health Information Technology (HIT) Activities

– Questions? Contact the Meaningful Use Public Health Technical Assistance Team at meaningfuluse@cdc.gov

• Permitted Uses & Disclosures: Public Health Activities

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Additional Resources: Privacy & Security• Permitted Uses and Disclosures Fact Sheet series:

– Health Care Operations: https://www.healthit.gov/sites/default/files/exchange_health_care_ops.pdf

– Treatment: https://www.healthit.gov/sites/default/files/exchange_treatment.pdf

• Computable Privacy Page

• Non-Covered Entity Report to Congress

• Guide to Privacy and Security of Electronic Health Information

• HHS Office of Civil Rights