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HIT Return on Investment: Evaluating Progress in a Sea of Change John Hsu, MD, MBA, MSCE AHRQ Conference 27 September 20

HIT Return on Investment: Evaluating Progress in a Sea of Change John Hsu, MD, MBA, MSCE AHRQ Conference 27 September 2007. HIT Background. Great potential for transforming clinical care, especially for patients with chronic diseases Adoption of HIT across the U.S. is limited but growing

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HIT Return on Investment: Evaluating Progress in a Sea of Change John Hsu, MD, MBA, MSCE AHRQ Conference 27 September 20

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  1. HIT Return on Investment: Evaluating Progress in a Sea of Change John Hsu, MD, MBA, MSCE AHRQ Conference 27 September 2007

  2. HIT Background • Great potential for transforming clinical care, especially for patients with chronic diseases • Adoption of HIT across the U.S. is limited but growing • Actual benefits of HIT unclear: • Initial benefits of HIT depend on how routinely and systematically clinicians use the HIT tools and resulting information • Little information on HIT effects in the ambulatory setting with commercially-available systems • Actual benefits and costs of HIT are difficult to quantify • Comprehensive identification • Methodological challenges

  3. Preliminary Results - IMPACT Study Impact of Information Technology on Clinical Care: An Evaluation of the Technology on Quality, Safety and Efficiency of Chronic Disease Care John Hsu, MD, MBA, MSCE (KP DOR) Ilana Graetz (KP DOR) Huihui Wang (KP DOR) Jie Huang, PhD (KP DOR) Mary Reed, DrPh (KP DOR) Bruce Fireman, MA (KP DOR) Joseph Selby, MD, MPH (KP DOR) Yvonne Zhou, PhD (KP) Jim Bellows, PhD (KP CMI) Naomi Bardach, MD (UCSF) Julian Wimbush (UCB) Tom Rundall, PhD (UCB) Robert Miller, PhD (UCSF) Richard Brand, PhD (UCSF) Funding: AHRQ R01HS015280

  4. Overview • Design: • Longitudinal study with quasi-experimental changes in exposure to HIT, and using a pre-post analytic design with concurrent controls • Study Period: 2004-2008 • Population: IDS Members with any of five chronic diseases in January 2004 (Asthma, CAD, DM, HF, Htn) • Data: • Automated databases • Annual surveys

  5. Basic HIT Tools

  6. KP HealthConnect Ambulatory Suite

  7. Potential Benefits of HIT • Improved information availability (value of information) • Clinical benefits • Financial benefits: e.g., greater efficiency, lower administrative costs, better coding Benefits predicated on clinician use of HIT tools

  8. HIT Use

  9. HIT Implementation and Use * Among office visits in department of Medicine or Family Practice

  10. CPOE Implementation and Use * New prescriptions are defined as new prescriptions doctor wrote, can be refills for existing drugs or completely new drugs

  11. HIT Use • Implementation ≠ use • Use of one type of HIT ≠ use of all HIT tools

  12. Information Quality

  13. Data Availability: Diagnoses Completed on Visit Date * Among office visits in department of Medicine or Family Practice

  14. Clinical Benefits

  15. Methodological Challenges for Assessing Clinical Benefits • Measures of use • Temporal trends - concurrent control groups • Patient- and physician-level differences • Reliable pre-implementation clinical data - differentiating documentation vs. care • Multi-level effects • Adequate power

  16. Methods • Study Period: 04/2004-12/2006 • Study Population • Active KPNC members who continuously enrolled during the study period • 18 years and older as of 04/01/2004 • In diabetes registry as of 1st quarter of 2004 • Members in 5 medical centers where KPHC implemented before 07/2006 during the study period • In teams which existed all the time during the study period • With at least one LDL measurement in pre-HIT period and one in post-HIT period • Predictor Measures: Presence of HIT (HealthConnect) • Model: Mixed model with random effects at PCP and Patient level, adjusted for patient age, gender, race/ethnicity, neighborhood SES, time of measurement and Medical centers

  17. Definitions of Presence of HIT Definition 1: Medical center level KPHC rollout schedule • HIT=0: before KPHC was implemented at the first team in the medical center • HIT=1: within six months after KPHC was implemented at the first team in the medical center • HIT=2: six months after KPHC was implemented at the first team in the medical center Definition 2: Primary care team level actual use • HIT = 0: low use (<80% at team level) of eChart or KPHC • HIT = 1: starting from the first month when eChart used >=80% • HIT = 2: starting from the first month when KPHC used >=80%

  18. Mean LDL in Each Month in KPNC

  19. Association between HIT and LDL

  20. Costs

  21. Investment • Investment costs • Equipment • Personnel/productivity • Training • Maintenance costs • IT support staff • Future upgrades • Continued training

  22. Other Relevant Features

  23. Dynamic Environment • Changes in HIT • Decision support • Information use • Changes in Care Delivery • Clinical coordination • Delivery system • Changes in Medical Therapy • Information on effectiveness • Dissemination of new knowledge • Changes in the Market • Payment features, e.g., risk adjustment, reporting, performance incentives • Payment mix

  24. Conclusions • Benefits • Some potential clinical benefits related to better information at the point-of-care • Unclear benefits associated with improvements in clinical information at the system level • Transaction benefits perhaps easiest to quantify • Financial benefits depend market and reimbursement mix • Costs • Investment costs beyond equipment costs can be difficult to quantify • Maintenance costs also important • Dynamic/changing systems and markets....

  25. Summary: Need for Better Empirical Studies

  26. HIT as Basic Infrastructure

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