Americas Voice for Community Health Care

1
(No Transcript)
2
Americas Voice for Community Health Care
The NACHC Mission To promote the provision of
high quality, comprehensive and affordable health
care that is coordinated, culturally and
linguistically competent, and community directed
for all medically underserved people.
3
Health Information Technology
A Primer
Michael Lardiere, LCSW Director, Health
Information Technology Sr. Advisor, Behavioral
Health National Association of Community Health
Centers Date February 13, 2008
4
Objectives

• What is HIT?
• What are the various Forms of HIT?
• Why is HIT useful/necessary?
• What is the Ultimate Goal of Using HIT?
• Where Do We Start? How Do We Know if We are
  Ready?
• Change Management and Workflow Processes
• How Do We Go About Selecting a Vendor/System?
• Are We in this Alone?

5
What is HIT?

• HIT consists of an enormously diverse set of
  technologies for transmitting and managing health
  information for use by
• Consumers
• Providers
• Payers
• Insurers, and
• All the other groups with an interest in
  health and
• health care.

6
What are the Various Components of HIT?

• Applications
• Patient Registries
• Accounting/Practice Management Systems (PMS)
• CPOE/CDS (Computerized Physician Order Entry
  with Clinical
• Decision Support)
• ePrescribing
• Electronic Medical/Health Records (EMRs/EHRs)
• Patient Health Records (PHRs)

7
What are the Various Components of HIT?

• Applications
• Results Reporting
• Electronic Documentation
• Appointment Scheduling
• Patient Kiosks
• Telemedicine
• Interface Engines

8
What are the Various Components of HIT?

• Communications
• Messaging Standards
• HL7, ADT, NCPDP, X12, DICOM, UB92, HCFA, ASTM,
  EDIFACT, etc.
• Coding Standards
• LOINC, ICD-9, CPT, NDC, RxNorm, Snomed CT, etc.

9
What are the Various Components of HIT?

• Process
• HIE (Health Information Exchanges)
• RHIOs (Regional Health Information
  Organizations)
• MPI (Message Passing Interface)
• HIPAA Security/Privacy

10
What are the Various Components of HIT?

• Devices
• Servers
• Desktops
• Laptops
• Tablet PCs
• Mice
• Pens
• Bar Coding

11
Why is HIT Useful/Necessary?

• Healthcare delivery is inherently fragmented
• Multiple Providers/Services Multiple Payers
• More than 360,000 care delivery sites in the US
• Inefficient or Absent communication
• Increased Provider Specialization

12
Why is HIT Useful/Necessary?

• Fragmentation leads to miscommunication and
  errors
• Duplicate Testing
• Medication Lists not reconciled properly causing
  medication
• interactions and ineffective therapy as meds
  are stopped
• pre-maturely
• Poor documentation, illegible handwriting and
  other
• mis-communication causing errors
• Increased healthcare utilization and increased
  cost of care
• Reduced timeliness of care
• Inappropriate or Unnecessary Care
• And many other problems .

13
Why is HIT Useful/Necessary?

• Adverse Drug Events (ADEs) are a leading cause of
  morbidity (and mortality) in the US
• In a meta-analysis of ADEs, 84 were classified
  as preventable
• EX Many of the patients studied with permanent
  disabilities directly resulting from ADEs
  received higher than usual drug dosage
• The average settlement cost in the resulting
• litigations was 4.3 million!

14
Why is HIT Useful/Necessary?

• Improving Quality of Care
• Patient Safety
• Decreasing Medical Errors
• IT solutions can help with clinical decision
  support
• Medication conflicts
• Clinical knowledge differential diagnoses etc.
• Latest lab and test results
• Medication Lists
• List of appointments
• Clinic notes and consult recommendations

15
Why is HIT Useful/Necessary?

• Reducing Health Disparities
• Research results and evidence based guidelines
• Facilitates the Medical Home
• Improved access to and more personalized care
  for the patient and caregivers
• Patient centered care for high-risk patients
  i.e.
• better monitoring

16
Why is HIT Useful/Necessary?

• Timely Payment for Services
• Increasing Efficiency in Care Delivery
• Makes Pay For Performance Obtainable

17
What is the Ultimate Goal of Using HIT?

• To improve the Quality of Health
• Services and Outcomes for All Patients
• Not Only to Collect Data
• Data Used to Track, Alert Manage
• Individual Patient Outcomes
• Population Health Outcomes, and
• Improve Overall Care of All Patients

18
What is the Ultimate Goal of Using HIT?Developed
by Alliance of Chicago Health Services, LLC
19
Where Do We Start? How Do We Know if We are
Ready?

• Assessments
• Organizational Commitment
• Board
• CEO
• Clinical Leadership
• Financial

20
Where Do We Start? How Do We Know if We are Ready?

• Assessments
• Staff
• Computer Knowledge
• Basic Keyboard Skills
• Basic Mouse Skills
• Readiness to Change
• Readiness to Change
• Readiness to Change
• Readiness to Change

21
Where Do We Start? How Do We Know if We are Ready?

• Assessment
• Infrastructure
• Current Computer Hardware
• High Bandwidth Capability
• Offices Wired for Computers
• Examination Rooms Wired for Computers

22
Change Management Workflow Processes

• Opportunities
• Improved Communication
• Redesigned Workflows to meet Organization Goals
• Opportunity to Think Out of the Box
• 80 of Implementation is in Workflow/Process
  Change Management
• 20 in Hardware/Software Implementation
• Improved Teamwork

23
Change Management Workflow Processes

• Implementation Team MUST include ALL Levels of
  Staff
• Project/Champion/Manager Should be selected
• Not Necessarily the IT Guy
• Clinical Champion is Necessary
• Implementation is an Overall Review of the
  Current
• Status Quo with Opportunities for
• Improvement/Revitalization

24
How Do We Go About Selecting a Vendor/System?

• Start with CCHIT http//www.cchit.org
• Speak to other Centers Similar to Yours
  Regarding Their
• Experience with Vendors
• NACHC can Help
• Determine your Most Important Requirements
• Request References from Vendors (5 10)
• Schedule Site Visits that You Choose
• Include Representatives from Your Implementation
  Team
• Determine Hidden Costs
• Engage Legal for Contract Review

25

• Implementation of any HIT Solution is a
  System-Wide Process
• Identify Goals for Success
• Monitor the Goals
• Encourage Input and Recommendations for
  Improvement
• Manage the Process of Continuous Improvement
• Implement Recommendations to Continually Improve
  Your
• Operations and Services

26
Helpful Resources

• Agency for Healthcare Research and Quality HIT
• http//healthit.ahrq.org
• Health Information Management and Systems Society
  
• http//www.himss.org
• California Healthcare Foundation
• http//www.chcf.org
• Certification Commission for Healthcare
  Information Technology
• http//www.cchit.org
• Robert Wood Johnson
• http//www.rwjf.org
• eHealth Initiative
• http//www.ehealthinitiative.org
• NACHC
• www.nachc.com

27

• Michael Lardiere, LCSW
• National Association of Community Health Centers
• Director, HIT
• Sr. Advisor, Behavioral Health
• 7200 Wisconsin Ave, Ste 210
• Bethesda, MD 20814
• 301-347-0400
• 301-347-0459 (fax)
• mlardiere_at_nachc.com
• www.nachc.com