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