Health Information Technology: An Overview of the National Agenda

Agency for Healthcare Research and QualityAgency for Healthcare Research and QualityAdvancing Excellence in Health CareAdvancing Excellence in Health Care • • www.ahrq.govwww.ahrq.gov

Health Information Technology:Health Information Technology:An Overview of the National AgendaAn Overview of the National Agenda

Teresa Zayas Cabán, PhDTeresa Zayas Cabán, PhDSenior Manager, Health ITSenior Manager, Health IT

AHRQAHRQ&&

Alison Rein, MSAlison Rein, MSAcademyHealthAcademyHealth

Academy Health Annual Research Meeting Academy Health Annual Research Meeting June 2, 2007June 2, 2007

Advancing Advancing Excellence in Excellence in Health CareHealth Care

Health Information Technology: Health Information Technology: Why is it Important?Why is it Important?

The most powerful contribution The most powerful contribution information technology can make information technology can make to improving health care quality…to improving health care quality…

Make the right thing to doMake the right thing to do the easy thing to dothe easy thing to do


Health Information Technology: Health Information Technology: Why is it Important?Why is it Important?

Other possible benefits include…Other possible benefits include…– Increased efficiencyIncreased efficiency

– Improved communicationsImproved communications

– Expanded access to informationExpanded access to information

– Enhanced public healthEnhanced public health


Overview of Federal Agencies Overview of Federal Agencies Involved in HIT InitiativesInvolved in HIT Initiatives

AHICHHS

ONC

SAMHSAFDACMSAHRQ VA DOD HRSA NIH


Office of the National Coordinator Office of the National Coordinator for Health IT (ONC)for Health IT (ONC)

Robert M. Kolodner, MD: National CoordinatorRobert M. Kolodner, MD: National Coordinator Primary functions of ONC:Primary functions of ONC:

– Serves as Secretary's principal advisor on development, application, Serves as Secretary's principal advisor on development, application, and use of health IT; and use of health IT;

– Coordinates HHS health IT policies and programs internally - and with Coordinates HHS health IT policies and programs internally - and with other relevant executive branch agencies; other relevant executive branch agencies;

– Develops, maintains, and directs implementation of HHS’ strategic Develops, maintains, and directs implementation of HHS’ strategic plan to guide the nationwide implementation of interoperable health ITplan to guide the nationwide implementation of interoperable health IT


American Health Information American Health Information Community (AHIC)Community (AHIC)

Federal advisory body (FACA rules apply)Federal advisory body (FACA rules apply) Makes recommendations to the Secretary to Makes recommendations to the Secretary to

accelerate the development and adoption of accelerate the development and adoption of health information technology:health information technology:– Chaired by Secretary LeavittChaired by Secretary Leavitt

– Composed of 18 public and private sector membersComposed of 18 public and private sector members


AHIC Work GroupsAHIC Work Groups

November 2005November 2005– Consumer EmpowermentConsumer Empowerment– BiosurveillanceBiosurveillance– Chronic CareChronic Care– Electronic Health RecordsElectronic Health Records

May 2006May 2006– Biosurveillance re-named “Population Health & Clinical Care Biosurveillance re-named “Population Health & Clinical Care

Connections”Connections” Sub-work group added: Biosurveillance Data Steering Sub-work group added: Biosurveillance Data Steering

– Confidentiality, Privacy & SecurityConfidentiality, Privacy & Security August 2006August 2006

– Quality (to address the need for the development of quality measures)Quality (to address the need for the development of quality measures) October 2006October 2006

– Personalized Health (to develop and make recommendations on Personalized Health (to develop and make recommendations on standards for interoperable integration of genomic test information into standards for interoperable integration of genomic test information into PHRs)PHRs)

Advancing Advancing Excellence in Excellence in Health CareHealth Care The Use Case ModelThe Use Case Model

The ONC use cases…The ONC use cases…– Describe events that detail what a system needs to do to achieve a Describe events that detail what a system needs to do to achieve a

specific goal (e.g., allow a provider access to a patient’s medication specific goal (e.g., allow a provider access to a patient’s medication history) history)

– Convey how individuals and organizations interact with the involved Convey how individuals and organizations interact with the involved systemssystems

Developed based on the priorities expressed by the AHICDeveloped based on the priorities expressed by the AHIC Stepwise developmentStepwise development

– Prototype phasePrototype phase Publish high-level overview (does not include all events and actions)Publish high-level overview (does not include all events and actions) Solicit feedbackSolicit feedback

– Detailed phaseDetailed phase Publish full description of events and activities from a variety of Publish full description of events and activities from a variety of

perspectivesperspectives Solicit feedbackSolicit feedback


Select ONC Programmatic Contracts:Select ONC Programmatic Contracts:At A GlanceAt A Glance

ContractContract DescriptionDescription

National Health Information Network Prototypes (NHIN)

To develop and evaluate prototypes for a nationwide health information network architecture that maximize the use of existing resources such as the Internet to achieve widespread interoperability among software applications, particularly electronic health records. These contracts are also intended to spur technical innovation for nationwide electronic sharing of health information in patient care and public health settings.

Best Practices for State-level Regional Health Information Organizations (RHIOs)

To gather information from existing state level RHIOs to determine successful governance, legal, financial and operational characteristics, to develop consensus for best practices for RHIOs, and to disseminate these findings.

Anti-fraud for Electronic Health Records (EHRs)

To explore and describe how the use of health information technology can enhance and expand health care anti-fraud activities.


Select ONC Programmatic Contracts:Select ONC Programmatic Contracts:At A Glance (cont.)At A Glance (cont.)

ContractContract DescriptionDescription

Standards Harmonization Process for Health Information Technology (HITSP)

To develop and test a process for identifying, assessing, endorsing, and maintaining a set of standards required for interoperable health information exchange.

Compliance Certification Process for Health Information Technology (CCHIT)

To develop and evaluate a compliance certification process for health IT, including the infrastructure components through which these systems interoperate.

Measuring the Adoption of Electronic Health Records

To develop a methodology to better characterize and measure the state of electronic health records adoption and determine the effectiveness of policies aimed at accelerating adoption of electronic health records and interoperability.

Advancing Advancing Excellence in Excellence in Health CareHealth Care Best Practices for State RHIOsBest Practices for State RHIOs

Contract to the American Health Information Contract to the American Health Information Management Association (AHIMA)Management Association (AHIMA)

Nine states: California, Colorado, Florida, Indiana, Nine states: California, Colorado, Florida, Indiana, Maine, Massachusetts, Rhode Island, Tennessee, and Maine, Massachusetts, Rhode Island, Tennessee, and UtahUtah

Mission to develop best practices and document Mission to develop best practices and document successful models for state-level (RHIOs) in the areas successful models for state-level (RHIOs) in the areas of governance, structure, financing and health of governance, structure, financing and health information exchange policiesinformation exchange policies

Final Report Final Report www.staterhio.org/documents/Final_Report_HHSP23320064105EC_090106_000.pdfwww.staterhio.org/documents/Final_Report_HHSP23320064105EC_090106_000.pdf


Health Information Technology Health Information Technology Standards Panel (HITSP)Standards Panel (HITSP)

Contract to American National Standards Institute (ANSI) & Healthcare Information & Contract to American National Standards Institute (ANSI) & Healthcare Information & Management Systems Society (HIMSS)Management Systems Society (HIMSS)

Membership open to all stakeholders:Membership open to all stakeholders:– Standards development organizations (SDOs), Standards development organizations (SDOs), – Non-SDOs (e.g., clinicians, payers, vendors, researchers)Non-SDOs (e.g., clinicians, payers, vendors, researchers)– Governmental bodiesGovernmental bodies– Consumer (& labor) groupsConsumer (& labor) groups

Advances ONC agenda by harmonizing standards to enable and support widespread Advances ONC agenda by harmonizing standards to enable and support widespread interoperability among healthcare software applications in the NHINinteroperability among healthcare software applications in the NHIN

Volunteer work force of technical committees that…Volunteer work force of technical committees that…– Identifies gaps, including missing or incomplete standards Identifies gaps, including missing or incomplete standards – Identifies duplications, overlaps, or competition among standards for relevant use casesIdentifies duplications, overlaps, or competition among standards for relevant use cases– Provides listing of all standards satisfying the requirements imposed by the relevant use casesProvides listing of all standards satisfying the requirements imposed by the relevant use cases


Certification Commission for Health Certification Commission for Health Information Technology (HIT)Information Technology (HIT)

Launched in July 2004, private sector collaboration: AHIMA, Launched in July 2004, private sector collaboration: AHIMA, HIMSS, and The National Alliance for Health Information HIMSS, and The National Alliance for Health Information Technology (Alliance)Technology (Alliance)

Three-year contract awarded by HHS in September of 2005 to Three-year contract awarded by HHS in September of 2005 to develop and evaluate certification criteria and create an develop and evaluate certification criteria and create an inspection process for HIT in three areas:inspection process for HIT in three areas:

– Ambulatory EHRs for the office-based physician or provider (immediate Ambulatory EHRs for the office-based physician or provider (immediate past/present)past/present)

– Inpatient EHRs for hospitals and health systems (future: expects to have Inpatient EHRs for hospitals and health systems (future: expects to have certified products available in 2007)certified products available in 2007)

– The Network components through which they interoperate and share The Network components through which they interoperate and share information (distant future)information (distant future)

Mission to accelerate the adoption of health IT by creating an Mission to accelerate the adoption of health IT by creating an efficient, credible and sustainable product certification programefficient, credible and sustainable product certification program


HHS Organizational FocusHHS Organizational Focus

NIHNIH

Biomedical Biomedical research to prevent, research to prevent, diagnose and treat diagnose and treat

diseasesdiseases

CDCCDC

Population health Population health and the role of and the role of

community-based community-based interventions to interventions to improve healthimprove health

AHRQAHRQ

Long-term and Long-term and system-wide system-wide

improvement of improvement of health care quality health care quality and effectivenessand effectiveness


AHRQ Roles and ResourcesAHRQ Roles and Resources

Source: FY 2007 Budget Summary for HHS and BNA Health Care Policy Report 2-13-06Source: FY 2007 Budget Summary for HHS and BNA Health Care Policy Report 2-13-06

Health IT ResearchHealth IT ResearchFundingFunding

• Support advances that improve Support advances that improve patient safety/quality of carepatient safety/quality of care

• Continue work in hospital settingsContinue work in hospital settings• Step up use of Health IT to Step up use of Health IT to

improve ambulatory patient careimprove ambulatory patient care

Our PartnersOur Partners

• CMS – Medicare and MedicaidCMS – Medicare and Medicaid• HRSA – capital and resources, HRSA – capital and resources,

workforceworkforce• ONC – collaboration and ONC – collaboration and

coordination on health ITcoordination on health IT• DoD, VA, IHS, FDA, NIH, DoD, VA, IHS, FDA, NIH,

SAMHSA, SAMHSA,


Over 125 Over 125 projectsprojects and and demonstrationsdemonstrations

Focus on the adoption Focus on the adoption of health ITof health IT

Projects in 43 statesProjects in 43 states BestBest practices that practices that

can improve quality of can improve quality of carecare

AHRQ HIT AHRQ HIT Investment: $166 Investment: $166

MillionMillion

Health IT Research FundingHealth IT Research Funding


National Resource Centerfor Health IT

AHRQ Health IT Portfolio (2004-2007)AHRQ Health IT Portfolio (2004-2007)http://healthit.ahrq.govhttp://healthit.ahrq.gov

Planning1 yr

Implementation3 yr

DemonstratingValue

3 yr

State and Regional Demonstrations of HIE (CO, DE, IN, RI, TN, UT)

5 yr

Current issues: eRx standards pilots;Privacy and security in business practices


The AHRQ Health IT Portfolio: Breadth The AHRQ Health IT Portfolio: Breadth of Technologies Usedof Technologies Used

0

5

10

15

20

25

30

35

40

45

Source: Dixon BE, “The Landscape of the AHRQ Health Information Technology Portfolio.” AMIA 2006 Symposium.

Advancing Advancing Excellence in Excellence in Health CareHealth Care Privacy and SecurityPrivacy and Security

Assess variations in privacy and security business Assess variations in privacy and security business practices, policies, laws and regulations regarding practices, policies, laws and regulations regarding health information exchangehealth information exchange

$17.4 million dollar contract$17.4 million dollar contract 33 states and Puerto Rico33 states and Puerto Rico Regional meetings and TARegional meetings and TA National meeting in March 2007National meeting in March 2007 Final report this summerFinal report this summer


E-prescribingE-prescribinghttp://healthit.ahrq.gov/eRxpilotshttp://healthit.ahrq.gov/eRxpilots

4 awards totaling $6M, January 2006, administrated by AHRQ & 4 awards totaling $6M, January 2006, administrated by AHRQ & CMS: CMS: Report to Congress: April 2007Report to Congress: April 2007

Test eRx systems use of data standards for how efficiently and Test eRx systems use of data standards for how efficiently and effectively eRx information can be transmitted to and from effectively eRx information can be transmitted to and from providers and pharmaciesproviders and pharmacies

Initial standards + 3 eRx foundation standards: Initial standards + 3 eRx foundation standards: Do they work Do they work together?together?

Contractors and site locations Contractors and site locations – Rand Corporation (New Jersey)Rand Corporation (New Jersey)– Brigham and Women’s Hospital (Boston)Brigham and Women’s Hospital (Boston)– SureScripts (Florida, Mass., Nevada, New Jersey, Tenn.)SureScripts (Florida, Mass., Nevada, New Jersey, Tenn.)– Achieve Healthcare Information Technology (Minnesota)Achieve Healthcare Information Technology (Minnesota)



Standards Testing:Standards Testing:– Ready for implementation:Ready for implementation:

Medication History Medication History Formulary and BenefitsFormulary and Benefits Prescription Fill Status NotificationPrescription Fill Status Notification

– Additional testing / clarifications needed:Additional testing / clarifications needed: Prior Authorization Prior Authorization Structured and Codified SigStructured and Codified Sig RxNormRxNorm



Other Key Findings:Other Key Findings:– Standards hold promise, but implementation Standards hold promise, but implementation

issues limit usefulnessissues limit usefulness– Fill status and medication history information Fill status and medication history information

rarely used by physicians (incomplete histories, rarely used by physicians (incomplete histories, poor display of information)poor display of information)

– Provider-based eRx applications do not interface Provider-based eRx applications do not interface directly with pharmacy information systems directly with pharmacy information systems

– Some efficiencies observed, e.g., reduction in Some efficiencies observed, e.g., reduction in telephone time for physicianstelephone time for physicians

– Potential to reduce number of unnecessary Potential to reduce number of unnecessary scripts in long term care facilitiesscripts in long term care facilities


National Resource Center for Health ITNational Resource Center for Health IThttp://healthit.ahrq.govhttp://healthit.ahrq.gov

Lessons learnedLessons learned– Technical AssistanceTechnical Assistance

Knowledge libraryKnowledge library– Summaries of key topicsSummaries of key topics

– Annotated bibliographyAnnotated bibliography

National teleconferencesNational teleconferences


AHRQ Ambulatory Safety AHRQ Ambulatory Safety and Quality Program (2007-2010)and Quality Program (2007-2010)

To improve the safety and quality of To improve the safety and quality of ambulatoryambulatory health care in the United States through the use of health care in the United States through the use of health IThealth IT– Patient safety and quality crises in hospitals are only the “tip of Patient safety and quality crises in hospitals are only the “tip of

the iceberg.” the iceberg.” – Complex information management and coordination across Complex information management and coordination across

multiple settingsmultiple settings

Ambulatory care refers to all types of health services Ambulatory care refers to all types of health services provided by health care professionals on an provided by health care professionals on an outpatient basisoutpatient basis– health care clinician offices (large and small practices), health care clinician offices (large and small practices),

outpatient clinics, community health centers, emergency outpatient clinics, community health centers, emergency departments, urgent care centers, ambulatory surgery departments, urgent care centers, ambulatory surgery centers, and home care entities centers, and home care entities


AHRQ Ambulatory Safety AHRQ Ambulatory Safety and Quality Program (2007-2010)and Quality Program (2007-2010)

Three (health IT) components:Three (health IT) components:– Improving Quality through Clinician Use of Health Improving Quality through Clinician Use of Health

ITIT

– Patient-Centered CarePatient-Centered Care

– Enabling Quality MeasurementEnabling Quality Measurement

Anticipated to start by the end of FY 2007Anticipated to start by the end of FY 2007

Advancing Advancing Excellence in Excellence in Health CareHealth Care Where will we go?Where will we go?

AHRQ Annual Meeting AHRQ Annual Meeting – September 26-28, 2007 Bethesda MDSeptember 26-28, 2007 Bethesda MD

Value ExchangesValue Exchanges

Clinical Decision Support, Consumer Clinical Decision Support, Consumer Engagement, and MedicaidEngagement, and Medicaid


Additional Resources for Future Additional Resources for Future ReferenceReference


Where to Learn More About Federal Where to Learn More About Federal HIT InitiativesHIT Initiatives

Health & Human Services (ONC)Health & Human Services (ONC)http://www.hhs.gov/healthit/http://www.hhs.gov/healthit/

American Health Information CommunityAmerican Health Information Communityhttp://www.hhs.gov/healthit/community/background/http://www.hhs.gov/healthit/community/background/

Centers for Medicare and Medicaid ServicesCenters for Medicare and Medicaid Services http://http://www.cms.hhs.gov/MedicaidInfoTechArchwww.cms.hhs.gov/MedicaidInfoTechArch// http://http://www.cms.hhs.govwww.cms.hhs.gov/MMIS//MMIS/

http://http://www.cms.hhs.gov/MedicaidTransGrantswww.cms.hhs.gov/MedicaidTransGrants// Federal Health ArchitectureFederal Health Architecture

http://www.hhs.gov/fedhealtharch/http://www.hhs.gov/fedhealtharch/ Health Resource & Services AdministrationHealth Resource & Services Administration

http://www.hrsa.gov/healthit/http://www.hrsa.gov/healthit/ Indian Health ServiceIndian Health Service

http://www.ihs.gov/CIO/InfoTech_index.asphttp://www.ihs.gov/CIO/InfoTech_index.asp National Institutes of Health—National Library of MedicineNational Institutes of Health—National Library of Medicine

http://http://www.nlm.nih.govwww.nlm.nih.gov Department of DefenseDepartment of Defense

http://www.defenselink.mil/releases/release.aspx?releaseid=9088http://www.defenselink.mil/releases/release.aspx?releaseid=9088 Department of Veterans AffairsDepartment of Veterans Affairs

http://http://www.myhealth.va.govwww.myhealth.va.gov//

Advancing Advancing Excellence in Excellence in Health CareHealth Care 2006 Use Cases2006 Use Cases

1.1. Consumer Empowerment Consumer Empowerment (www.hhs.gov/healthit/usecases/documents/ConsumerEmpowerment.pdf)(www.hhs.gov/healthit/usecases/documents/ConsumerEmpowerment.pdf)

Broad: Gain wide adoption of a Personal Health Record (PHR) that is easy-to-Broad: Gain wide adoption of a Personal Health Record (PHR) that is easy-to-use, portable, longitudinal, and consumer centereduse, portable, longitudinal, and consumer centered

Specific: Deploy to targeted populations a pre-populated, consumer-directed, and Specific: Deploy to targeted populations a pre-populated, consumer-directed, and secure electronic registration summary and medication historysecure electronic registration summary and medication history

2.2. Electronic Health Records (EHR) – Laboratory Results Reporting Electronic Health Records (EHR) – Laboratory Results Reporting (www.hhs.gov/healthit/usecases/documents/EHRLabUseCase.pdf)

Broad: Support the implementation of interoperable, certified, EHRs while Broad: Support the implementation of interoperable, certified, EHRs while minimizing integration issues for providersminimizing integration issues for providers

Specific: Deploy standardized, widely-available, secure solutions for accessing Specific: Deploy standardized, widely-available, secure solutions for accessing laboratory results and interpretations in a patient-centered manner, for clinical laboratory results and interpretations in a patient-centered manner, for clinical care, by authorized partiescare, by authorized parties

3.3. Biosurveillance – Visit, Utilization, and Lab Result Data Biosurveillance – Visit, Utilization, and Lab Result Data (www.hhs.gov/healthit/usecases/documents/BiosurveillanceUtilizationUseCase.pdf)(www.hhs.gov/healthit/usecases/documents/BiosurveillanceUtilizationUseCase.pdf)

Broad: Implement real-time, nationwide, public health event monitoring and Broad: Implement real-time, nationwide, public health event monitoring and support rapid response management across public health and care delivery support rapid response management across public health and care delivery communitiescommunities

Specific: Transmit essential data from electronically enabled health care delivery Specific: Transmit essential data from electronically enabled health care delivery and public health systems in standardized and anonymized format to authorized and public health systems in standardized and anonymized format to authorized public health agencies with less than one day lag timepublic health agencies with less than one day lag time

4.4. Emergency Responder Emergency Responder (www.hhs.gov/healthit/usecases/documents/EmergencyRespEHRUseCase.pdf)

Advancing Advancing Excellence in Excellence in Health CareHealth Care 2007 Use Cases2007 Use Cases

1.1. Consumer Access to Clinical InformationConsumer Access to Clinical Information (www.hhs.gov/healthit/documents/PrototypeUseCaseCACI.pdf)(www.hhs.gov/healthit/documents/PrototypeUseCaseCACI.pdf)

High level scope: Development of capabilities that would enable consumers to High level scope: Development of capabilities that would enable consumers to access their clinical information via PHRaccess their clinical information via PHR

Three scenarios:Three scenarios: Consumers receive and view clinical informationConsumers receive and view clinical information Consumers create provider lists and establish access permissionsConsumers create provider lists and establish access permissions Consumers transfer PHR informationConsumers transfer PHR information

2.2. Medication ManagementMedication Management (www.hhs.gov/healthit/documents/ProtoypeUseCaseMM.pdf)(www.hhs.gov/healthit/documents/ProtoypeUseCaseMM.pdf) High level scope: Focus on patient medication and allergy information exchange, High level scope: Focus on patient medication and allergy information exchange,

and the sharing of that information between consumers, providers, PBMs, and and the sharing of that information between consumers, providers, PBMs, and payorspayors

Two Settings:Two Settings: InpatientInpatient AmbulatoryAmbulatory

3.3. QualityQuality (www.hhs.gov/healthit/documents/PrototypeUseCaseQuality.pdf)(www.hhs.gov/healthit/documents/PrototypeUseCaseQuality.pdf) High level scope: Captures the integration of data to support quality High level scope: Captures the integration of data to support quality

measurement, enables feedback and reporting into EHRs, and begins to use measurement, enables feedback and reporting into EHRs, and begins to use quality measures to support clinical decision making and public reportingquality measures to support clinical decision making and public reporting

Four prioritized needs:Four prioritized needs: Hospital based quality measures (core set)Hospital based quality measures (core set) Clinician-level measures (core set)Clinician-level measures (core set) Feedback to clinicians (self assessment)Feedback to clinicians (self assessment) Public reportingPublic reporting

Advancing Advancing Excellence in Excellence in Health CareHealth Care Contact Us!Contact Us!

http://healthit.ahrq.gov http://healthit.ahrq.gov

Teresa Zayas Cabán [email protected]

Alison Rein

[email protected]

Health Information Technology: An Overview of the National Agenda

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