AHRQ: Accelerating adoption of Health Information Technology

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AHRQ Accelerating adoption of Health
Information Technology
Information Technology Association of
America Federal Health IT Committee J. Michael
Fitzmaurice, Ph.D. Agency for Healthcare Research
and Quality U.S. Department of Health and Human
Services March 21, 2006
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AHRQs Mission
Improve the quality, safety, efficiency, and
effectiveness of health care for all Americans.
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AGENDA

• AHRQ and patient safety
• Investments in HIT for HC
• Data Standards Program

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Health Issues

• Costs continue to rise
• NHE is 1.9 trillion in 2004, growing at 7.9
• CPI grew at 3.3 percent in 2004 GDP deflator at
  2.6,
• NHE/GDP is 16 , up from 15.9 (2003) 9.1
  (1980) Smith, C, et. al., National Health
  Spending in 2004, Health Affairs (Jan-Feb,
  2006)
• Quality of health care is not optimal
• Doctors provide appropriate health care only
  about half the time for 30 acute and chronic
  conditions. Beth McGlynn, et al., N Engl J Med,
  June 26, 2003
• 44 core national quality measures grew at 2.8
  percent in 2004 and 2005. 2005 National
  Healthcare Quality Report, AHRQ, December 2005

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Health Issues

• Access improves and diminishes
• Overall, more racial disparities in quality of
  care were narrowing than were widening, and most
  racial disparities in access to care were
  narrowing (affecting blacks, Asians and American
  Indians/Alaska Natives). But for Hispanics, the
  majority of disparities for both quality and
  access were growing wider. 2005 National
  Disparities Report, AHRQ, December 2005
  http//www.ahrq.gov/news/press/pr2006/nhqrdrpr.htm
  
• Largest problems
• lack of health insurance, lack of a primary care
  provider
• Patient Safety costs lives and resources
• Between 44,000 and 98,000 people die in hospitals
  annually due to medical error. IOM, To Err is
  Human, 2000.
• Often preventable hospital injuries and
  complications lead to
• More than 32,000 deaths, 2.4M extra days of care,
  and
• Costs exceeding 9B annually in US. C. Zhan
  Miller (AHRQ), Excess Length of Stay, Charges,
  and Mortality Attributable to Medical Injuries
  During Hospitalization, JAMA, October 8, 2003

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Commonwealth Fund Survey on Medical Errors
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Commonwealth Fund Survey on Medical Errors

• In US, 34 percent of surveyed patients with
  health care problems reported at least one of
  four types of errors
• Experienced a medical mistake in treatment or
  care
• Received the wrong medication or dose
• Received incorrect results for a test
• Experienced delays in notification about abnormal
  test results.
• In US, 48 percent of surveyed patients who saw
  at least 4 doctors in the past two years reported
  at least one of these errors

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Major Opportunities for Quality Improvement Exist

• 81 of Medicare pneumonia patients get blood
  cultures before antibiotics
• 68 get the right antibiotics
• 63 get their first antibiotic in a timely manner
• Yet, only 30 get all of three recommended
  interventions

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NHII

• ONCHIT
• Strategic Framework (July 2004)
• Request for Information (June 2005)
• AHIC
• 4 Contracts (September-November 2005)
• Use case drivers chosen by AHIC
• AHRQ

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National Coordinator for Health Information
Technology David Brailer, MD, PhD

• Appointed National Coordinator for HIT on May 6,
  2004
• Produced Framework for Strategic Action on July
  21, 2004
• Reported on Responses to ONCHITs RFI June 3,
  2005
• Secretary created AHIC his federal advisory
  committee
• Developed/coordinated 4 NHIII contracts by
  November 2005
• Standards HarmonizationANSI/HIMSS 3.3M
• Privacy and Security (AHRQ)RTI 11.5M
• Compliance Certification-CCHIT 2.7M
• NHIN ArchitectureAccenture, CSC, IBM, Northrop
  Grumman 18.6M

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AHRQ HIT Program Funding
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One of 4 NHII Contracts

• Privacy and Security (AHRQ-ONCHIT)
• Research Triangle Institute for 11.5 M
• National Governors Association, a partner
• To identify privacy and security barriers,
  restrictions, and enablers to the development of
  interoperable systems at the state and regional
  levels
• Focus on state privacy laws and practices

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Medicare Modernization Act Requires eRx Pilots

• 4 awards totaling 6M, January 17, 2006,
  Administrated by AHRQ CMS
• Test eRx systems of data standards for how
  efficiently and effectively eRx information can
  be transmitted to and from providers and
  pharmacies
• To reduce adverse drug events and improve
  appropriate use of medications
• To enable providers to obtain formulary
  information and medication history
• To test new ways of naming clinical drugs and
  their ingredients, and providing patient
  instructions
• To assess workflow changes for pharmacies and
  physicians offices.
• Initial standards 3 eRx foundation standards
  Do they work together?
• Contractors and site locations Report due to
  Congress April 2007
• Rand Corporation--New Jersey
• Brigham and Womens Hospital--Boston
• SureScriptsFlorida, Mass., Nevada, New Jersey,
  Tenn.
• Achieve Healthcare Information Technology--Minneso
  ta

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AHRQ GrantsTransforming Healthcare Quality

• AHRQ Planning Grants
• 7M for 35 new grants 5M for 28 grants to rural
  and small communities
• For HC systems and partners to plan to implement
  HIT to promote patient safety and quality of care
• AHRQ Implementation Grants
• 19M for 40 new grants 12M for 25 grants rural
  and small hospitals
• To evaluate the measurable and sustainable
  effects of HIT on improving PS QC.
• 50 cost sharing Maximum 20 of federal funds
  for software and hardware
• AHRQ Demonstrating the Value of HIT Grants
• 12M for 24 new grants 2M for 4 rural grants
• To increase the knowledge and understanding of
  the value of HIT
• Clinical, safety, quality, financial,
  organizational, effectiveness, efficiency
• 6 State Contracts
• Identify and support statewide data sharing and
  interoperability activities.
• 1M/yr for 5 yearseach IN, UT, TN, CO, RI, DE
  (2005)
• National Resource Center for HIT

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AHRQ

• 16 grants for implementation of HIT projects
  awarded in November 2005
• 11 in rural areas 22.3 M over 3 years
• Result of 35 planning grants awarded in FY 2004
• They will seed and nourish the work already
  under way in regions and communities across the
  nation to improve the safety, quality and
  efficiency of health care. (Janet Marchibroda,
  November 14, 2005)

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AHRQ Patient Safety Health Care IT Data Standards
Program

• Funding 10 Million in FY 04 to AHRQ, and in FY
  2005
• Received advice from
• Secretary of HHS -- HHS NHII Office
• NCVHS -- CAHIT -- CHI -- IOM
• Federal standards and program experts
• Private sector (Markle Foundation, eHI, WEDI,
  AMIA, others)
• Their recommendations include
• Drug terminologies -- SNOMED mapping
• Patient safety event reporting
• Meta-data registry -- Landscape
• eRx -- NCVHS/CHI
  standards gaps
• Knowledge representation -- Others
• 70 percent went to standards to help reduce
  adverse drug events

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AHRQ Patient Safety Data Standards Program

• Drug Terminology Development and Mapping
• FDA 4.600 M 4.000 M
• NLM 1.150 M 1.150 M
• Nomenclature and Mapping
• NLM 2.100 M 2.400 M
• Device Nomenclature
• FDA .300 M .300 M
• Patient Safety Reporting Standards
• AHRQ .500 M .400 M
• USHIK (Meta-data Registry)
• CMS .300 M .300 M
• Standards Landscape
• NIST .300 M .300 M

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Drug Safety
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Health System Improvement Case Study

• Drug information takes too long, small print,
  hard to find
• Drug labeling information
• Submission in paper form to FDA
• FDA Approval
• Goes back to manufacturer, and back to FDA till
  approved
• Public Awareness
• Drug package insert of labeling information
• Information location
• Physicians Desk Reference
• Access by information vendors
• Frequent contact with manufacturers
• National Drug Codes
• Some re-used, compresses 11 digit code into 10
  digits
• Delayed receipt of drug codes by FDA from
  manufacturer
• Re-labelers assign codes too

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AHRQ-Funded PS Standard System

• Electronic Product Listing System (ELIPS)an
  inventory of drug products marketed in US
• FDA adopted the HL7 standard for the exchange of
  product labeling information called Structured
  Product Labeling (SPL).
• Used by the pharmaceutical companies for
  providing not only the content of labeling found
  in the package insert but also descriptive
  information on the medicinal product including
• Proprietary product name and code
• Non proprietary name
• Ingredient name(s) and Unique Ingredient Identifie
  r(s) (UNII) and strength
• Dosage form
• Route of administration
• Packaging configurations and codes
• FDA assigns National Drug Codes to new drugs

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Improving Patient Safety
AHRQ Data Standards Program
DailyMed Web Site
SPL/RxNorm
NLM RxNorm Link
Pharmaceutical Manufacturer
FDA Approval
SPL
SPL
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Improving Patient Safety
AHRQ Data Standards Program
DailyMed Web Site
SPL-RxNorm
NLM RxNorm Link
Pharmaceutical Manufacturer
FDA Approval
SPL
SPL
Drug label Information
ELIST HL7-SPL NDC SRS--UNII
RxNorm
Standards
Contraindications Allergies
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AHRQ-Funded PS Standard System

• Substance Registration System
• Develop SRS
• Develop unique ingredient identifiers (UNII)
• To identify active and inactive ingredients
• To be used in ELIST and ELIPS
• Product Data Base for
• NLM distribution via DailyMed
• Health information suppliers
• Public access

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AHRQ-Funded PS Standard System

• RxNorm--National Library of Medicine
• Standard names for
• US prescription drugs
• OTC drugs with L.E. 3 active ingredients
• Selected biologics (i.e., vaccines)
• Linked to
• Active ingredients
• Strengths
• Dose forms
• Dose forms as administered
• Related brand names
• NDCs
• Available to the public on NLMs DailyMed web
  site

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AHRQ-Funded PS Standard System

• Mapped to RxNorm from the terminology of
• VAs National Drug File
• First DataBank
• Medispan
• Micromedix
• Multim

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End Result

• AHRQs funding has paved the way to
• Accelerate development of terminology content
• Provide for more frequent updates than quarterly
• Expand RxNorm to cover
• OTC drugs
• Related products (e.g., vitamins)
• More complete mapping RxNorm and drug info
  vendors
• Training and support mechanisms
• Make this information publicly available

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Interoperability Partnership

• AHRQ
• Patient Safety
• Data Standards Program funding
• FDA
• System Specification and Development
• HL7 SPL standard
• Regulatory changes that are essential
• NLM
• Vocabulary expertise
• Accurate drug information linking (RxNorm)
• DailyMed web site

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Patient Safety and Quality Improvement Act of
2005 (P.L. 109-41)

• Signed into law July 29, 2005 It encourages
  health care providers to contract with one or
  more HHS-accepted Provider Service Organizations
  (PSOs) to
• Collect and analyze data on patient safety events
  (including near misses, close calls, and
  no-harm events)
• Develop and disseminate information to improve
  patient safety and to provide feedback and
  assistance to effectively minimize patient risk
• Provides Federal privilege and confidentiality
  protections against disclosure of information
  that is collected or developed pursuant to a
  provider contract
• Creates a network of patient safety databases
• Accept, aggregate across the network, and analyze
  non-identifiable patient safety work products
  voluntarily reported by patient safety
  organizations, providers, or other entities
• Analyze national and regional statistics,
  including trends and patterns of health care
  errors
• http//www.gpoaccess.gov/plaws/ (
  Public Law 109-41)

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How to Proceed?

• How many states are collecting PSE data?
• Who reports?
• For what events is reporting mandatory?
• What data are states collecting in their PSE
  reporting systems?
• Are these elements standardized and categorized?
• Are they analyzed?
• When will PSOs be designated?
• What data standards are needed?

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Patient Safety Improvements

• More timely information to providers and
  consumers
• More frequent updates of drug information
• Faster dissemination of new drug information
• More legible information to consumers
• Standardized, accurate, linkable information base
  for information vendors
• Information source for decision support systems
• Reduce costs of supplying package inserts
• Unique drug identifiersNDC codes

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AHRQ Accelerating adoption of Health
Information Technology
Information Technology Association of
America Federal Health IT Committee J. Michael
Fitzmaurice, Ph.D. Agency for Healthcare Research
and Quality U.S. Department of Health and Human
Services March 21, 2006