AHRQ and Health IT

1. AHRQ and Health IT Public Health Data Standards Consortium J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality March 17, 2004

2. Agency for Healthcare Quality and Research (AHRQ) • To improve the quality, safety, efficiency, and effectiveness of health care for all Americans • Lead Federal agency supporting research into improving patient safety and the quality of health care • Funds Research on • Quality measures -- Medical Expenditure Panel Survey • Strategies for quality improvement -- Decision support tools • Information Technology evaluation, tools, and databases • Patient Safety--new initiative in Health Info. Technology • FY 2004 Budget: $304 M

3. Agenda • Patient Safety • AHRQ’s HIT program • Patient Safety Standards • PHDSC

4. Patient Safety– a Major, National Problem • Leading to extensive • Deaths • Cost • Added suffering • Recognized in IOM reports and by Congress • To err, Chasm, others • AHRQ mandates • Proposed legislation

5. What is? • HIT • Value • Patient Safety • Medical Error • Adverse Event

6. AHRQ’s HIT Program for 2004 • Over $50 million in 2004 funding • Transforming Healthcare Quality through IT • Implementation Grants • Planning Grants • Demonstration Grants • HIT Resource Center • HIT Data Standards

7. AHRQ GrantsTransforming Healthcare Quality • AHRQ Planning Grants • Up to $7M for 35 new grants; $5M to rural and small communities • For HC systems and partners to implement HIT to promote patient safety/quality of care • AHRQ Implementation Grants • Up to $24M for 48 new grants’ $14M for rural and small hospitals • To evaluate the measurable and sustainable effects of HIT on improving PS & QC. • 50% cost sharing, Max 20 percent on computer hardware and software • AHRQ Demonstrating the Value Grants • Up to $10M for 20 new grants; practice-based research networks encouraged to apply • To increase the knowledge and understanding of the value of HIT • Clinical, safety, quality, financial, organizational, effectiveness, efficiency • Submit application by April 22, 2004

8. Patient Safety and Standards • 21 states collect patient safety incident (PSI) data—mostly mandatory, esp. for deaths • Data collections are not uniform or standardized • Coordination is needed to establish trends, baselines, and to learn from the successful efforts of other states

9. Types of Info Collected • Wrong patient--Wrong site surgery • Incorrect procedure/treatment • Retained foreign bodies • Unexpected deaths • Cardiac arrests • Loss of limb or organ • Impairment of limb or bodily functions • Other serious occurrences • New York State D/Health, 2001

10. Issues • Mandatory vs Voluntary Reporting • Non-punitive for reporting • Punitive for reporting • Data Quality • Identify low reporters • Focus on event identification methods • Show that better reporting leads to better quality

11. Issues • Use of the information • Provider advisories • Public reporting • Quality improvement activities • Comparative reporting • Tracking and trending • Provider profiles (need better risk adjusters) • Inform consumers/patients

12. Where’s the Info Support? • Data/systems are not interoperable • Need metadata • Need scalability • Need identifiers • Need health data standards • Need datainformationsystem integration • Need incentives

13. Patient Safety: Data Standards • Developing a standards framework for reporting patient safety incidents • Developing common terminologies • Vocabularies • Code classifications • Mapping terminologies into SNOMED • Implementing standards in patient safety and quality of care

14. Patient Safety Standards Needed • Add-ons to claims transactions for reporting PSI’s? • X12N, claims, e.g., low birth-weight babies • X12N, HL7 claims attachments • Special messages for reporting PSI’s • HL7 hospital messages for internal reporting and aggregation • X12N messages for reporting from hospitals to third parties, say, states • Taxonomies for classifying PSI’s for uniformity in data collection and reporting • Free text for capturing special information not codified • Drive improvements in SNOMED and other medical vocabularies

15. Patient Safety Perspectives • CPOE: Is the Bang worth the Buck? • CPOE costs $5 million+ • What is the value of the harm averted? Sizeable. • Will physicians object to frequent and multiple alerts that reduce productivity? Where’s the incentive? • Would adding nurses improve patient safety more? • Will IT reduce the demands on the interns and residents who work many consecutive hours? • Not a substitute for reducing their excessive hours, but evidence is lacking • Will IT reduce hospital-acquired infections? • Hand washing programs may be most effective here

16. PHDSC • Who: State health departments, state-wide health data organizations, and others • What: Reduce cost and improve the uniformity of collecting data for special needs for • Population health analyses • Consumer information • Health benefits and payment policies • Patient safety incident reporting

17. PHDSC • Why: • To coordinate representation at standards meetings • To reduce the cost of this representation • To establish partnerships for common issues, such as patient safety incident data: • Collections, analyses, reporting, and aggregation • To learn of proposed data standards policies and problematic issues faced by similar programs

18. AHRQ in 2003 • Funded IOM to advise on standards for PS • Report out in November 2003; published soon in 2004 • Funded IOM to develop initial functions for an EHR • Letter report delivered July 31,2003 • Worked with CMS and VA to develop the definition of an EHR as an ANSI standard, beginning with the IOM letter report and moving to HL7: • First ballot, not approved; second ballot out on March 15, 2004 • Responses addressing the negative ballots are being prepared • Maintained support of ANSI HISB for SDO coordination • Started the Patient Safety SIG at HL7 • Joined PHDSC--as a founding member • HHS NHII, Markle Foundation, CAHIT, CHI, NCVHS

19. AHRQ in 2004 • Working in collaboration with HHS NHII • Patient Safety HIT Grants Program • Patient Safety HIT Standards Program • Continuing work on • HL7 Standard for EHR functions • Patient Safety SIG • Support of PHDSC • Others

20. PHDSC This is a place where we bring our issues and our ideas. We avoid 50+ solutions for the the same problem. We find commonality and gain productivity. We work together to obtain change.

21. AHRQ and Health IT Public Health Data Standards Consortium J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality March 17, 2004