Alphabet Soup Has Joined Chicken Soup for Health

1. Alphabet Soup Has Joined Chicken Soup for Health Carol J. Bickford, PhD, RN,BC cbickfor@ana.org

2. Health Care Today • Structure • Process • Outcomes

3. Inpatient Outpatient Ambulatory Care Office Practice Home Care/Home Health Nursing Home Skilled Nursing Care Rehabilitation Longterm Care Assisted Living Telehealth Structure In Flux

4. Care Process Evolving • Hospitals are critical care centers • Same day surgery and home care burden • Remote monitoring • Call for healthcare reform and national coverage • Who pays the bill? CMS, insurance plans, employers, individual pockets

5. First Alphabet Terms • MD, DO, PA • Registered Nurse • Advanced Practice Registered Nurse • CRNA - Certified Registered Nurse Anesthetist • CNM - Certified Nurse Midwife • NP - Nurse Practitioner • CNS - Clinical Nurse Specialist

6. Paper Versus Electronic • Paper record format still predominant • CPR, EMR, EHR finally gaining implementation momentum long after 1991 IOM report • The Computer-Based Patient Record: An Essential Technology for Health Care, Revised Edition (1997, http://www.nap.edu)

9. Outcomes & Quality-JCAHO

10. Outcomes & Quality-NCQA

11. Outcomes & Quality-URAC

12. Outcomes & Quality-URAC

13. Outcomes & Quality-NQF

14. Outcomes & Quality-AHRQ

15. Outcomes & Quality-National Quality Measures Clearinghouse

16. Evidence-based Practice/Medicine • NIH Roadmap-research to practice • National Guidelines Clearinghouse • National Library of Medicine

17. Outcomes & Quality-National Guideline Clearinghouse

20. National Health Information Infrastructure (NHII) • Has been under discussion by National Committee on Vital and Health Statistics (NCVHS) for many years http://www.ncvhs.hhs.gov/ • Includes healthcare provider, population health, and personal health components http://www.ncvhs.hhs.gov/nhiilayo.pdf

21. NHII Includes Work About • CHI - Consolidated Health Informatics • RHIO - Regional Health Information Organizations

22. Office of the National Health Information Technology Coordinator (ONCHIT) • Framework for strategic action • Inform clinical practice; • Interconnect clinicians; • Personalize care; and • Improve population health • David Brailer, MD, PhD, National Health Information Technology Coordinator • http://www.hhs.gov/onchit/

23. Critical Standards Work • HL7 – Health Level 7 – message format and now content • ICD-9 and ICD-10 – diagnosis • CPT-4 – outpatient procedures • HCPCS – inpatient procedures • SNOMED – NLM secured low cost national license • ABCcodes – complementary and alternative care

24. Electronic Format • ASTM E-31, ISO TC-215, ANSI • E-mail and Instant Messaging • ANSI/ARMA 9-2004, Requirements for Managing Electronic Messages as Records

25. Action Plan • Confirm who is your healthcare provider and what are their qualifications • Ask your healthcare provider about their implementation of the EHR • Monitor the NCVHS testimony via webcast or personal attendance

26. Action Plan • Express your concerns/decisions about a unique personal identifier • Monitor CMS, DHHS, HIPAA, and other health related websites for opportunities to provide public comment • Check out ARMA’s Health Industry ISG