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Health IT, Meaningful Use and Healthcare Reform

Health IT, Meaningful Use and Healthcare Reform. John W. Loonsk, MD FACMI. Hannah. Hannah = Health IT?. National HIT - Lots of Moving Parts and Pieces. Legislation HITECH (part of ARRA) Affordable Care Act (Health Insurance Reform) Rules Meaningful Use

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Health IT, Meaningful Use and Healthcare Reform

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  1. Health IT, Meaningful Use and Healthcare Reform John W. Loonsk, MD FACMI

  2. Hannah Hannah = Health IT?

  3. National HIT - Lots of Moving Parts and Pieces • Legislation • HITECH (part of ARRA) • Affordable Care Act (Health Insurance Reform) • Rules • Meaningful Use • Standards, Specifications, and Certification Criteria • Interim and Permanent Certification • Modifications to HIPAA Privacy…Rule • Programs and Grants • Nationwide Health Information Network (NHIN) • Exchange, Connect and Direct • Health Information Exchange (HIE, HIO, RHIO) • Designated entities and plans • SHARP and Workforce Grants • Regional Extension Centers (RECs) • Recognized Certification Bodies (RCBs) • Beacon Communities

  4. Focus Today – Path Forward • High level MU and Incentive Payment Programs • Quality Reporting • Health Information Exchange and Data Availability • Health IT for Health Reform

  5. Road Ahead for Health IT and Health HITECH Incentives? • Providers need to invest • Disruptive to practice • Easier, safer, and more strategic to hold data • Payors benefit most • Quantity of care dominates • Patient empowerment - mostly Internet searching • Purchasers of care struggle to manage quality and costs • Population users stovepiped and secondary • Limited Health IT use, interoperability and benefits + HealthInsurance Reform? PHRs? + ACO’s and Medical Homes? + + =

  6. Incentive Payment Programs and Meaningful Use Medicaid Medicare

  7. Meaningful Use • Incentive payments through Medicaid and/or Medicare to use (current generation) of EMRs • Use a certified EMR in a “meaningful manner” • Provide for the electronic exchange of health information • Submit information on clinical quality, and other, measures • MU measures dialed-back significantly from Notice of Proposed Rule Making, but point toward major systems efforts • CPOE, eRx, CDS, problem and med list management, e-copies to patients • Limited data and technical standards to support MU (in companion rule) • Criteria to be updated bi-annually

  8. Quality Reporting • Interim final rule had almost 100 quality measures - push back lead to: • 15 core (required) and 5 of 10 (menu) for hospitals • 3 core (required) and three additional (menu) for eligible providers • No specialty-oriented • Eligible and Critical Access Hospitals • Emergency Department Throughput • Time from ED arrival to ED departure for admitted patients • Admission decision time to ED departure time for admitted patients • Ischemic Stroke (+/- Hemorrhagic) • Discharge on anti-thrombotics, Anticoagulation for A-fib/flutter, Thrombolytic therapy for patients arriving within 2 hours of symptom onset, Antithrombotic therapy by day two, Discharge on statins, Stroke education, Rehabilitation assessment • VTE • Prophylaxis within 24 hours of arrival, Intensive Care Unit Prophylaxis, Anticoagulation overlap therapy, Platelet monitoring on unfractionated heparin, Discharge instructions, Incidence of potentially preventable

  9. Quality Reporting • Folks who really wanted to be doing healthcare quality and reform work, but got the HIT instead • No traceability from use of these EMRs to differences in the quality measures • Meaningful Use, right now, isn’t • Quality measures to be electronically reported in 2012 • Estimates that only 1/3 of data available in EHRs • Providers burdened with adoption of EMRs and doing quality measures

  10. Confidential

  11. Beacon Community Awardees and Data

  12. Beacon Community Awardees and Data

  13. Health Information Exchange (HIE) • Confusion over what HIE should be • Existing morass of organizational variants • Lack of comfort with HIE (NHIN, HIOs, RHIOs, heavy state) • Defaults to “private HIEs” • Data standards and specifications • Not adequate for demonstrable interoperability • Do add requirements for standard recording of some data • Integration costs will remain high • Exchange needs in conflict with privacy and security agenda • “Blue Button” for always being able to download • Focus information exchange on pushing data from provider to provider (consent recommendations, NHIN Direct, HIPAA modifications)

  14. HIT for Health Insurance Reform • ACO and Medical Home Needs (and requirements) • Seamless transitions in care • Longitudinal, cross-organizational records • Look-up, data queries • Managed problem, medication, allergy lists + • Quality and efficiency management data and services • Including claims and process data, workflow integration • Population analytic tools and registries • Cross-organizational team communications and care • Including patient communications • Clinical Decision Support

  15. Questions and CommentsJohn W. Loonsk, MD FACMIJohn.Loonsk@CGI.COM

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