Quality Improvement Organizations QIOs: Assisting HIT Adoption

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Quality Improvement Organizations (QIOs)
Assisting HIT Adoption

• Dave Adler
• Director, Government Affairs
• American Health Quality Association

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Americas Quality Improvement Organizations
National Field Force for Quality Improvement

• Medicare-funded, improving care for Americans
• Largest federal investment in health care quality
  improvement
• Program budget less than 0.1 of Medicare
  spending
• Implemented in each state by a private
  contractor, QIO
• 40 organizations working hand-in-hand with
  providers/practitioners in 53 states/territories
• 3-year contract, now in 8th Scope of Work
  (2005-2008)
• Performance-based contracts, evaluated by CMS
• QIOs are making care safer, more effective
• QIO program is evolving

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2005 National Healthcare Quality Report

• Medicares QIO measures for heart disease and
  pneumonia showed a combined rate of improvement
  (9.2) that was almost four times the combined
  rate for all the other measures (2.5).
• --Agency for Healthcare Research and Quality

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Health Information Technology

• Today Americans get only 55 of recommended care
• (McGlynn et al, New England J Medicine, June 26,
  2003)
• HIT is a promising tool
• But HIT alone is not enough
• To avoid errors and improve quality, we must also
  redesign current care system
• Avoid simply automating paper

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QIOs and HIT

• QIOs promote and support adoption of
• Home telehealth for reducing acute care
  hospitalizations
• Goal 30 reduction in hospitalizations
• Computerized physician order entry (CPOE), bar
  coding and telehealth technologies to transform
  hospital care
• HIT in adult primary care practices

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QIOs and Physician Office HIT

• Doctors Office Quality-IT (DOQ-IT) pilot
• QIOs recruited 516 practices in AR, CA, MA, and
  UT
• Money alone will not increase adoption
• Interest in QIO support is high
• Natl Rollout work with 5 of Practices to
• Increase HIT adoption
• Assist with care process redesign
• Help prevent implementation failures
• Build infrastructure--
• for Health Information Exchange
• for Pay-For-Performance

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Results DOQ-IT Off to Strong Start

• 3,534 adult primary care practices participating
• 70 are small practices (1-3 docs)
• 23 are medium practices (4-8 docs)
• 700 Practices treating high proportion of
  underserved patients
• Over 500 EHR installs to begin this month

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Feedback from Utah DOQ-IT Practices

• HealthInsight has provided valuable services
  that will allow for a more efficient
  implementation process. We have been especially
  appreciative of HealthInsights assistance in
  mapping a workflow process. We have used this to
  guide training and purchasing and utilized it to
  discuss functionality of our EMR with the
  vendor.
• Lisa Nichols, Executive Director
• Midtown Community Health Center

• HealthInsight has been a valuable resource in
  helping us plan and manage the monumental
  undertaking of converting to an electronic
  medical record system. We have been able to
  avoid several land mines up to this point by
  having their assistance. It is critical for
  clinics that have few resources to allocate to
  this very beneficial, but expensive and
  exhausting process, to have assistances from QIOs
  such as HealthInsight.
• Marshal Wilde, Administrator
• Utah County Medical Associates

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QIOs and Nursing Homes

• QIOs partner with NHs to improve resident quality
  of care/life. In just 2 years
• 47,000 fewer residents suffered moderate/severe
  pain
• 27,000 fewer residents physically restrained
• Nursing homes receiving extra QIO support did
  better

CMS Data Dec. 2004
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Nursing Home Improvement and Feedback Tool (NHIFT)

• Help nursing homes collect and submit process of
  care data on admissions for
• Skin inspection and pressure ulcer risk
  assessment
• Depression screening and treatment
• Evaluation of necessity/alternatives to
  restraints
• Pain assessment and treatment
• STAR (www.nhqi-star.org) helps nursing homes set,
  achieve performance targets

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From ambulatory to long-term care

• Key steps for QIOs to follow in the process of
  HIT adoption among physician practices
• Assessing provider readiness and functionality
  needs
• Workflow mapping
• Staff training
• Guidelines for incorporating disease management
• Optimal use of software for population health
• Quality reporting
• Quality improvement
• These lessons can inform similar efforts to
  support LTC HIT adoption

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QIOs Health Information Exchange

• 42 QIOs participating or leading HIE
• Neutral independent entity for convening HIE
  stakeholders.
• Engaging diverse stakeholders across health care
  settings and local community
• HIE initiatives should engage long term care
  organizations QIOs are in a strong position to
  help facilitate this interaction
• Report available at www.ahqa.org

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Medicares QIO Program Maximizing Potential

• Institute of Medicine (IOM) QIOs should provide
  hands-on technical assistance in each provider
  setting, including advice and guidance on how to
  bring about, sustain, and diffuse internal system
  design and process changes, particularly those
  related to the use of information technology for
  quality improvement.

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No-Brainer

• From readiness assessments and cost analyses to
  guidance on advanced functionality and workflow
  redesign, physicians can utilize (QIO) expertise
  and experienceat no charge. It is a
  no-brainer for physician practices across the
  country to tap into this valuable resource.
• --NEWT GINGRICH
• Former Speaker of the House
• Founder, Center for Health Transformation
• Testimony to House Federal Workforce and Agency
  Organization Subcommittee
• March 15, 2006

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Next Steps

• Congress
• Support QIO Modernization legislation, including
  QIO role in HIT adoption assistance for ALL
  providers.
• Realign incentives to adopt HIT, improve
  qualitywith help from QIOs
• CMS
• Educate about value of LTC HIT adoption
  assistance, potential role for QIOs

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Contact Info

• Dave Adler
• Director, Government Affairs
• American Health Quality Association
• 1155 21st Street, NW, Suite 202
• Washington, DC 20036
• Ph [phone] x.1572
• Fax [phone]
• Email dadler_at_ahqa.org
• www.ahqa.org