The Fundamentals ofHIT

Fundamentals of HIT

Lynne VanArsdale11/4/2011UC Denver

San Luis Valley Health Information Technology Symposium, November 4, 2011 1

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The material in this tutorial is copyrighted as indicated in each slide footer and any references made by the author.Companies and individuals may only use this material in accordance with copyrights expressly stated. Contact the speaker directly for further informationNeither the Author nor the Presenter is an attorney and nothing in this presentation is intended to be nor should be construed as legal advice or opinion. If you need legal advice or legal opinion, please contact an attorney.The information presented herein represents the Author’s personal opinion and current understanding of the issues involved. The Author, the Presenter and the San Luis Valley AHEC do not assume any responsibility or liability for damages arising out of any reliance on or use of this information.NO WARRANTIES, EXPRESS OR IMPLIED. USE AT YOUR OWN RISK.

San Luis Valley AHEC Legal Notice

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Agenda• HIT Alphabet soup

– EMR/EHR, MU, PHR, CDSS, CPOE, PHI …• Coding Standards• Health information exchange• Security• Quality metrics• Consumer health data• BI/data warehouse• Public health reporting• Medical devices• Where to find more information

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HIT – What is it?

• Congressional Budget Office (CBO) 2008 definition* of Health Information Technology (HIT): “computer applications for the practice of medicine,” and includes •Electronic Medical Record (EMR) = equivalent to paper-based medical

record•Electronic Health Record (EHR) = computer-accessible, interoperable

resource of clinical and administrative information pertinent to the health of an individual–Personal Health Record (PHR) = an EHR controlled by the patient–Payer-based Health Record (PBHR) = an EHR owned and

administered by the health plan

*The Congress of the United States Congressional Budget Office, “Evidence on the Costs and Benefits of Health Information Technology,” May 2008.

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HIT – What is it?Congressional Budget Office (CBO) definition also includes •Computerized Physician Order Entry (CPOE) = electronic applications that physicians

use to order medications, diagnostic tests, and ancillary services• e-Prescribing = electronic transfer of a prescription from the prescribing

physician’s office to the pharmacy•Clinical Decision Support Systems (CDSS) = assists physicians with decision making

by providing reminders, suggestions and support in diagnosing and treating diseases and conditions•Health Information Exchange (HIE) = electronic movement of any and all health-

related data according to an agreed-upon set of interoperability standards, processes and activities across nonaffiliated organizations in a manner that protects the privacy and security of that data; and the entity that organizes and takes responsibility for the process

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Economic Stimulus! (?)

U.S. Health Information PolicyApril 2004 – Presidential Exec Order 13335• Established ONC to fulfill the vision of developing a nationwide

interoperable health information technology infrastructure that:• Ensures that appropriate information to guide medical decisions is available at the time and

place of care;• Improves health care quality, reduces medical errors, and advances the delivery of

appropriate, evidence-based medical care• Reduces health care costs resulting from inefficiency, medical errors, inappropriate care,

and incomplete information;• Promotes a more effective marketplace, greater competition, and increased choice through

the wider availability of accurate information on health care costs, quality, and outcomes;• Improves the coordination of care and information among hospitals, laboratories, physician

offices, and other ambulatory care providers through an effective infrastructure for the secure and authorized exchange of health care information

• Ensures that patients’ individually identifiable health information is secure and protected.

– ARRA / HITECH signed on 1/29/2009 established law to support this order

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Perfect Storm

ANSI 5010

ICD-10 Meaningful UseStage II

HIPAA

APCD

CORHIO Implementation

Payment Reform ACO, PCMH

Rule

Declining Health

Bad Economy

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ANSI X12 (5010) and ICD-10Challenges:- Continuity over time (episodes

of care, quality metrics, payment issues)

- Converting systems- Training people- Billing-focusedOpportunities:- Better, fuller information- Enforcement- Payment accuracy & fraud

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Meaningful Use (MU) / EMR• CMS rule

– Medicare vs. Medicaid– Physician vs. hospital – Incentives (now) and penalties (2015 +)

• Stages (I now, II due in 2012, III ?)• Criteria

– Three tenets:• Adopt certified electronic health record technology• Demonstrate core and menu set requirements• Report on clinical quality measures

• Certification – – 1. EMR certification; 2. self-certification for MU of certified EMR

• Health care providers must possess all of the meaningful use capabilities, not just those that they intend to report

– Office of the National Coordinator for Health Information Technology-Authorized Testing and Certification Body (ONC-ATCB) and CCHIT

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MU Stage 1, continued…

Copied from http://mycourses.med.harvard.edu/ec_res/nt/26F568D6-E6F3-418A-96B9-497666DEF5C0/MUQuick.pdfDisclaimer - This chart is not an official federal document and has been created for public use and convenience by Robin Raiford, RN-BC, CPHIMS, FHIMSS. Note for CPOE, Vital Signs, Smoking Status, Advance Directives, Patient Reminders – the text reflects ”Unique Patients” but they are listed in “Actions” in an EHR in Table 3 which is how it is noted in this document Please refer to The Official Web Site for the Medicare and Medicaid EHR Incentive Programs for official publications

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Some Coding Standards(putting medicine in terms computers can understand…)

• ANSI X12 5010 (4010, 6020) -- claims• ICD- (9,10,11) – diags and treatments• SNOMED – diags and treatments• HL7 – medical information infrastructure• NCPDP -- pharma• CPT – medical services• LOINC – lab and clinical data• CCR, CDA (CCD) – patient medical info exchange• PACS / DICOM – Images Conformance:

Where are we really?

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Other types of HIT1. Medical device output, input (IEEE 1073)2. Registries3. Office systems – billing, appointments (PMIS, PMOS,…)4. Health business reporting systems5. Public health systems6. Telehealth, telemedicine7. Mobile health8. Intelligence systems9. New innovations … Todd Park: web apps (iTriage), social

networks, community dashboards, your ideas…?

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More Alphabet soup– Interoperability

• NwHIN – ONC design for nation-wide HIT infrastructure– Service-Oriented Architecture (SOA) – enables interoperability

through published “services” that securely allow info access

• CORHIO – Colorado’s Regional Health Info Org– QHN – HIE for Western Slope; BEACON partner

• HIE – non-governmental health info exchanges – emerging for ACO’s and other collaboratives (e.g. SAFTInet/DARTnet)

– Quality / cost –based aggregations• ACO• PCMH

CORHIO Alphabet Soup• QHN = Quality Health Network• NCHA = Northern Colorado Health Alliance• AHRQ = Agency for Healthcare Research and

Quality• PCDP = Point of Care Demonstration Project • TCHF = The Colorado Health Foundation• MRR = Medical Referral Regions• CHI = Colorado Health Institute• CMHC = Community Mental Health Center• BHO = Behavioral Health Organization• FQHC = Federally Qualified Health Center• COREC = CO Regional Extension Center• CCMCN = Colorado Community Managed Care

Network• CFMC = Colorado Foundation for Medical Care• CCHN = Colorado Community Health Network• CACHIE = Colorado Associated Community Health

Information Exchange• CHIMA = Colorado chapter of AHIMA• CHIMSS = Colorado chapter of HIMSS• COPIC = professional liability insurer• CTA = Colorado Technology Assoc. (CSIA)

• CCGC = Colorado Clinical Guidelines Collaborative (HealthTeamWorks)

• CIVHC = Center for Improving Value in Health Care

• CDPHE = Colorado Department of Public Health and Environment

• HCPF = Health Care Policy and Financing• CHIP = Children’s Health Insurance Program• MMIS = Medicaid Mgmt Info Systems• SMHP = State Medicaid Health IT Plan• MTIA = Medicaid Info Tech Architecture• NTIA = National Telecommunications and

Information Administration• CHA = Colorado Hospital Association• CTN = Colorado Telehealth Network• CHC = Colorado Community Health Ctrs• HRSA = Health Resources and Services

Administration• IPA = Independent Practice Association• GDAB = Government Data Advisory Board• PAHCOM = Professional Association of Health

Care Office Management

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CORHIO – Network of Networks

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Health Information SecurityProtecting personal health information (PHI)• Legislation– HIPAA (1996)– HITECH

• **Practice**People– Information Infrastructure– Physical Infrastructure

Health insuranceReduce fraud/abuseSecurity and privacyInteroperability

Privacy standardSecurity standardEmployer IDNational Provider ID (NPI)X12

Part of ARRA, 2009$20B for HIT projectsBA obligationsSecurity breach notificationEnforcementIndiv right to EHR info

Penalties $100 - $1.5M per violation, plus up to 10 years in prisonIndiv. rights – notice of uses request use restriction view/copy/ammend confidential communic. accounting of disclosures

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Quality Metrics• Federal / Regulatory / Standards

– CAQH Core – Standards for claims/payment – AHRQ – quality metrics and research– NCQA (HEDIS) – health care performance metrics, benchmarks, “seal” – JCAHO – accreditation of health care providers

• Funding Institutions– Commonwealth Fund, RWJF, TCHF

• Report cards, NQF, LeapFrog, other independents• Community efforts

– Colorado Business Group on Health– Colorado Associated Community Health Information Exchange (CACHIE)

• Promotes the use of information technology to support quality reporting and improvement

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Local data

Research data

Public Health data

School Health data

Statedata

Censusdata

Non-profit orgdata

Insurancedata

Health Information BI / Data Warehouse• Online Transaction Processing (OLTP) vs. Online

Analytical Processing (OLAP)• Data warehouse forms the foundation of

Clinical Decision Support Systems (CDSS) and closed loop Computerized Physician Order Entry (CPOE)

• Business intelligence plays a role in improving performance (KPI’s)

• Medical data mining (epidemiology/surveillance, drug analysis, diagnosis, interventions)

• ACO, PCMH – multitude of data from many sources need to be integrated

• Operational data store; Data mart; Extract-Transform-Load (ETL)

• Federated data warehouse; virtual data warehouse; network of networks

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Consumer Health• PHRs

– Stand alone, tethered, networked• “got an app for that”

– DSS – iTriage (simple DSS with referral), WebMD– Treatment compliance

• Social Networks– Communities– Provider - patient

• Online data on provider quality and performance– Healthgrades, Consumerhealthratings.org, HCAHPS, Press Ganey, Angie’s list,

• Online wellness programs– Mostly employer-centric – many, many out there

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CDA2

IHE

X12

NCPDP

Quality Improvement

Public Health Laboratory

Vital Statistics

Communicable Diseases

Immunization

Environmental Health

Injury Control

School Health

Chronic Care

Biosurveilance,Preparedness

Genetic Disorders

Women & Children

HL7

Provider 1

Provider 2

Provider 3

Provider 4

Provider X

Health Information Exchange

• Service oriented architecture

• Computer networking

• Tiered architectures

• Storage management

• Data management

• Process management

Public Health Reporting Vision

This diagram was created by Dr. Art Davidson for an HIT class at UC Denver.

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Medical Devices• IEEE 1073 – “Medical Information Bus”

– Based on OSI 7-layer model

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More Information• http://www.cbo.gov/publications/collections/health.cfm • Presidential Executive Order 13335: http://edocket.access.gpo.gov/2004/pdf/04-10024.pdf • http://www.healthit.gov/ , Office of the National Coordinator:

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204 • www.CORHIO.org; http://www.cotelehealth.com/ ; www.nwhin.org • www.x12.org; www.wedi.org; www.himss.org ; http://www.cms.gov/ICD10/;

http://www.ihtsdo.org/ (SNOMED); www.hl7.org; www.ncpdp.org; http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page; www.loinc.org; http://medical.nema.org/ (DICOM);

• Quality: http://www.ahrq.gov, http://www.qualityindicators.ahrq.gov, http://www.caqh.org, http://www.ncqa.org, http://www.jointcommission.org/, http://www.qualityforum.org, http://www.commonwealthfund.org, http://www.rwjf.org/

• Consumer Health: http://www.hcahpsonline.org , www.healthgrades.com, www.pressganey.com, • HIMSS LinkedIn Group discussion on “Top Ten reasons why EMR/EHR implementations are failing”

– over 2200 comments• ANSI/IEEE 1073: Medical Information Bus (MIB) Health Informatics Journal June 1998 4: 72-83 • SAFTInet

http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/GIM/education/ContinuingEducation/Documents/4-19-2011_Schilling.pdf

• Data warehouse: http://www.hdwa.org/ , http://datawarehouse.hrsa.gov/, http://health.data.gov• XML: http://www.w3schools.com/xml/default.asp

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