VA Health Informatics 101 Industry Expert Perspective Series

VA Health Informatics 101 Industry Expert Perspective Series Ernie Hood Senior Research Director Advisory Board Company Funded by the Office of the National Coordinator for Health IT U.S. Department of Health and Human Services ARRA Grant # 90CC07701 1

Why are we here? 2

Some Health Care Basic Numbers What percent of the U.S. population accounts for what % of health care costs? 80% of population generates 20% of the cost 10% of population generates 70% of the cost 1% of population generates 30% of the cost 3

Health Care? “Inconsistent practices & inconsistent results” (Berwick) – 55% of diabetics receive inadequate care (Rand study NEJM June 2003) – Half of America’s heart attack victims do not receive proper follow-up care (IOM, Crossing the Quality Chasm, 2001) – Nearly 55% of older women with a fracture did not receive osteoporosis meds after diagnosis (Journal of Bone & joint Surgery 12/03) – 135 doctors diagnosed the same patient and recommended 82 different treatments (Strong Medicine, 1993) Physician population aging & overwhelmed – There are more than 20,000 medical journals and nearly 10,000 articles on clinical trials published annually (National Library of Medicine 2001) 4

How can IT help Health Care? Electronic Records Physician Decision Support Patient Safety Research Quality Improved Coordination 5

How Users Adapt to New Technology 6

Clinician Use of EHR Technology – the Reality 7

EHR History 1960-1999 8

EHR History 2000-2010 9

Electronic Health Records Components Work Flow Documentation Support Work Flow Management Order Entry (CPOE) Safety Checks (drug/drug, drug/allergy, etc) Clinical Decision Support (Alerts, Order Sets, Practice Guidelines, etc) Registry Support Clinical Quality Reporting Medical Records Database Clinical Documentation Diagnosis Problem List Medication List Allergy List Demographics Vitals (Ht, Wt, BP) Immunizations Test Results Drug Formulary Links to other Record Systems e.g. PACS, Document Imaging, etc 10

Stages of EMR Adoption HIMSS Analytics EMR Adoption Model 11

Questions? 12

Data Standards 13

Billing & Reimbursement 14

Data Standards - Websites Handy Sources CPT4, HCPS, ICD-9: http://www.ama-assn.org/ama/pub/physician-resources/solutionsmanaging-your-practice/coding-billing-insurance/cpt.page ICD-10: https://www.cms.gov/icd10/ and http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1 0368 66.hcsp?dDocName bok1 036866 SNOMED: http://www.nlm.nih.gov/research/umls/Snomed/core subset.html LOINC: http://loinc.org/ NDC: http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438.htm 15

Technical Data Standards Handy Sources HL7: http://www.ama-assn.org/ama/pub/physician-resources/solutionsmanaging-your-practice/coding-billing-insurance/cpt.page X12: https://www.cms.gov/icd10/ SNOMED: http://www.nlm.nih.gov/research/umls/Snomed/core subset.html LOINC: http://loinc.org/ NDC: http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438.htm 16

Questions? (Data Standards) 17

Patient Portals/PHRs 18

Patient Access to Records Sneaking a Peak? OR Prying it out of your Provider? 19

Sample Patient Portal Features Clinical Features Email your Care Team Get your Lab Results Fill your Prescriptions View your Medical Record View your child’s record Online Appointing Fill out a Health Risk Assessment Access a Health Care knowledgebase Interact with other patients “like me” Health Plan Features Email Customer Service View your co-pays View your deductable status Pay your bills 20

Tethered Portal 21

Online Test Results & Clinical Information 22

Information Therapy (lx) “Ix” is effective, more affordable, and with less side effects than “Rx” The same information, from the exam room to the living room 23

Personal Health Records From the Online Journal of Nursing 24

Personal Health Record From e-caremanagement.com 25

Questions? (Patient Portals) 26

Health Information Exchange 27

Health Information Exchange (HIE) 28

HIE Components 29

NHIN 30

Advice for Students 1. Be Curious – Ask why 2. Go to the Source – Go to where the work takes place 3. Trust, but Verify – Don’t be afraid to go to the source documents 31

Questions? (HIE) 32