Reading the Tea Leaves: Healthcare ITs Top Ten

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Reading the Tea Leaves Healthcare ITs Top Ten

• Iowa HIMSS Chapter Meeting
• April 16th, 2004
• Joyce Sensmeier MS, RN, BC, CPHIMS
• Director of Professional Services

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Major Drivers for Healthcare Providers
Healthcare Providers(and their ITDepartments)
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Major Drivers forHealthcare IT Vendors
HealthcareIT Vendors
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and beyond
2004

• Shifting focus
• Economy recovers
• HIPAA fears diminishing
• Focus on making applications work together
• National interest in Healthcare IT

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Four Essential Elements

• Electronic Health Records
• Clinical Decision Support
• Computerized Provider Order Entry
• Secure, Private, Interoperable
• -gt Health Information Exchange
• Lower Costs, Fewer Errors, Higher Quality
• Presidents Information Technology Advisory
  Committee (PITAC) Draft Report , April 13, 2004

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2004 State of the Union Address

• By computerizing health records, we can avoid
  dangerous medical mistakes, reduce costs and
  improve care.
• President George W. Bush
• January 20, 2004

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Impact on Healthcare IT

• Technology trends can no longer develop in a void
• Systems must connect with each other
• Organizational
• Local
• National
• Global
• Public/Private partnerships needed

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Old trends heat up
1

• Clinical Decision Support
• Provides capability to recognize knowledge as a
  critical asset
• Enables knowledge management
• Evidence-based medicine
• Applying outcomes to practice
• Key is link with documentation and relationship
  to work flow

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Vanderbilt University Medical Center

• Clinical pathways since early 1990s
• PubMed, NLM index to biomedical literature
  available at all work stations
• Clinical IT consulting service
• Do searching, filtering, and make rounds
• Domain experts review the articles and determine
  course for patient
• Developed disease management application

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Clinical Decision Support Workbook

• Designed to help healthcare organizations use
  clinical decision support (CDS) to measurably
  improve outcomes
• Helps readers guide the selection, customization,
  and implementation of the most usable and
  effective CDS interventions to address specific
  clinical or strategic concerns
• http//www.himss.org/asp/cds_workbook.asp

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Documentation bloopers..

• When she fainted, her eyes rolled around the
  room.
• Source Actual medical records charted by busy
  clinicians

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Consumer-driven Healthcare
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• Insurers are responding to consumers demands for
  improved choice, flexibility and service while
  also trying to satisfy employers demands for
  cost efficiency
• Getting more data and information available to
  the consumer so they can make informed decisions

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Humana leads the pack

• SmartSuite -Decision support tool that lets
  people compare plans based on whats important to
  them
• Familiarity, price, benefits, or other
  preferences
• Uses on-line tools such as wizards and
  calculators to help people tailor health benefits
  to suit their personal budget and health needs
• Analyzes aggregate health data
• MD visits, hospital admissions, pharmaceuticals
  and service call centers

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Documentation bloopers..

• The patient stated that she had been constipated
  for most of her life until 1989 when she got a
  divorce.

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Computerized Provider Order Entry (CPOE)
3

• Lots of plans
• Few implementations
• 15 of U.S. hospitals implementing
• 50 of U.S. hospitals are evaluating
• Most expect implementation in 3 years
• Source Dorenfest, S. 2003

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Back to the drawing board

• Cedars-Sinai multimillion-dollar physician
  order-entry systems suspended less than four
  months after it was rolled out
• gt 400 doctors complained that the technology was
  too difficult and time-consuming to use and
  threatened patient safety.
• Success perceived value, intuitive, easy to use

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Documentation bloopers..

• The baby was delivered, the cord clamped and
  cut, and handed to the pediatrician, who breathed
  and cried immediately.

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Disease Surveillance
4

• In January 2002 CDC allocated more than 2
  Billion to anti-terror public health initiatives.
• Public Health Information Network (PHIN)
• Umbrella initiative for public health that will
  make sure that a standards-based approach is
  implemented incorporating the various partners in
  public health

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NEDSS

• National Electronic Disease Surveillance Systems
  (NEDSS) - Base system upon which PHIN rests
• Standards-based electronic lab reporting and
  messaging over the Internet
• Clinical systems can capture diagnostic lab data
  and transmit it electronically to public health
  agencies where potential outbreaks can be spotted

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HIMSS 2004 National Preparedness and Response
Survey

• Over half of the 524 survey respondents rated the
  ability of the health information system to
  detect and respond to a national disaster as fair
• Nearly all respondents identified standards
  development as a critical or very important
  component of a national preparedness and response
  system

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Documentation bloopers..

• The patient was in his usual state of good
  health until his airplane ran out of gas and
  crashed.

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National Standards
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• Building blocks for
• National Health Information Infrastructure (NHII)
• Electronic Health Record
• Integrating the Healthcare Enterprise (IHE)

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Standards mandated for federal use

• Health Level Seven (HL7) - Messaging
• National Council for Prescription Drug Programs
  (NCPDP) - Retail pharmacy
• Institute of Electrical and Electronics Engineers
  (IEEE) - Medical devices
• Digital Imaging Communications in Medicine
  (DICOM) - Imaging
• Logical Observation Identifier Name Codes (LOINC)
  - Clinical lab results reporting

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Documentation bloopers..

• She is numb from her toes down.

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Electronic Health Record (EHR)
6

• Electronic Health Records are needed that
  maximize the amount of information available to
  healthcare providers
• While not creating new work flow or cost issues.
• Presidents Information Technology Advisory
  Committee (PITAC) Draft Report, April 13, 2004

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Health Level Seven - EHR SIG

• Special Interest Group
• Formed January, 2002
• Establishes EHR related priorities for HL7
  Standardization
• Architectural issues working with other
  technical committees
• Functional specification

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The EHR-System defined

• The set of components that form the mechanism
  by which patient records are created, used,
  stored, and retrieved. A patient record system is
  usually located within a health care provider
  setting. It includes people, data, rules and
  procedures, processing and storage devices (e.g.,
  paper and pen, hardware and software), and
  communication and support facilities.
• Source Computer-based Patient Record Institute,
  1991

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HL7 Electronic Health Record System Functional
Model
Direct Care EHR-S functions used for providing
direct health care to, or direct self-care for,
one or more persons.
Supportive EHR-S functions that most frequently
use existing EHR data to support the management
of health care services and organizations
Information Infrastructure Critical backbone
elements of Security, Privacy, Interoperability,
Registry, and Vocabulary.
Courtesy HL7 EHR Special Interest Group
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Continuity of Care Record (CCR)

• Massachusetts Medical Society, HIMSS and American
  Society of Testing Materials (ASTM)
• AMA, AAFP, AAP and Patient Safety Institute
• Models Patient Care Referral form
• Written in Extensible Mark-up Language (XML)
• Passed ASTM ballot in April
• Implementation guide in development

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What the CCR captures

• Records From/To about provider
• Records info to distinguish patient
• Medicare/insurance
• Diagnosis, problems, allergies, vitals..
• Encounter history
• Scheduled tests, procedures

• Header/document identifying info
• Patient identifying information
• Insurance/financial
• Patient health status
• Care Documentation
• Care Plan Recommendation

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Documentation bloopers..

• The patient was to have a bowel resection.
  However, he took a job as stockbroker instead.

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Security
7

• Internet vulnerabilities quadrupled between 2000
  and 20021
• HIPAA Security Rule - April 2005
• Medical Device Security a challenge
• Shift from reactive to proactive
• 1 CERT Coordination Center

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Documentation bloopers..

• She has no rigors or chills, but her husband
  says she was very hot in bed last night.

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Web Services
8

• Standards-based software modules that interact
  with existing applications over the Internet -gt
  data sharing
• Web Services Interoperability (WS-I) Basic 1.0
  Profile
• SOAP - Simple Object Access Protocol
• WSDL - Web services description language
• UDDI - Universal description, discovery and
  integration
• XML 1.0 and XML Schema

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Health Level Seven (HL7)

• Version 3.0 is XML-based
• Reference Information Model
• A modeling approach that builds a standard that
  will guarantee interoperability in both new
  deployments and existing applications
• Enables developers to use and reuse backbone
  classes and their attributes within well-defined
  constraints

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Workflow Automation
9

• Speeds and integrates the full range of available
  clinical, operational and financial IT
• Improves the work lives of clinicians by making
  things run smoother and simpler

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Efficiency at its best

• Grossman Medical Group
• After implementing a workflow automation system
  achieved reduction in 70-75 of paper
• Eliminated 3 full time billing clerks
• 40 increase in efficiency

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A look ahead

• Today Healthcare IT becomes part of the
  national political agenda
• 2004-06 Grants, studies, demo projects
• 2004-06 Push for standards adoption
• 2004-06 Pay-for-performance pilots
• 2006-08 Monetary incentives including
  differential reimbursement for IT use
• 2010 Clinical IT becomes part of the standard
  of practice

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The Promises of Digitization
Financial flat or declining reimbursement,rising
overhead costs
Resources Physician and nurse recruitment,
retention, productivity issues
Purchaser pressuresPay for performance, patient
safety
Regulation/compliance HIPAA, JCAHO, CMS changing
rules and laws
Healthcare Providers
Technology drug discovery, device technology,
genomics
Consumer demands choice, control, communication
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Beyond DigitizationCare Transformation
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Thank You!

• Q A

HIMSS Website www.himss.org