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Electronic Health Records: What Does The HITECH Act Teach Thailand?


Theera-Ampornpunt N. [Electronic Health Records: What Does The HITECH Act Teach Thailand?]. Presented at: Health Informatics: From Standards to Practice. Thai Medical Informatics Association Annual …

Theera-Ampornpunt N. [Electronic Health Records: What Does The HITECH Act Teach Thailand?]. Presented at: Health Informatics: From Standards to Practice. Thai Medical Informatics Association Annual Conference 2010; 2010 Nov 10-12; Nonthaburi, Thailand. Panel discussion, in Thai.

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  • 1. Electronic Health Records: “อเมริกาเข้มแข็ง” สอนอะไรไทย? อเมรกาเขมแขง นพ.นวนรรน ธระอมพรพนธุ M.S. นพ นวนรรน ธีระอัมพรพันธ์, M S (Health Informatics) ฝ่ายเวชสารสนเทศ คณะแพทยศาสตร์ รพ.รามาธิบดี 11 พฤศจิกายน 2553 SlideShare.net/Nawanan ranta@mahidol.ac.th @Nawanan @ThaiHealthIT Except where referred to or copied from ความคิดเห็นในการบรรยายครั้งนี้ เป็นของผู้บรรยายแต่เพียงผู้เดียว ไม่ใช่ความเห็นของคณะแพทยศาสตร์ รพ.รามาธิบดี หรือมหาวิทยาลัยมหิดล other works สไลด์ประกอบการบรรยายนี้ ใช้สัญญาอนุญาตของครีเอทีฟคอมมอนส์แบบแสดงที่มา-ไม่ใช้เพื่อการค้า-อนุญาตแบบเดียวกัน 3.0 ประเทศไทย http://creativecommons.org/licenses/by-nc-sa/3.0/th/ ยกเว้นงานที่คัดลอกมาจากแหล่งอื่น ลิขสิทธิ์เป็นของผู้นั้น
  • 2. Outline • Electronic Health Records & Health IT • HITECH Act • Meaningful Use of EHRs • Lessons for Thailand
  • 3. Electronic Health Records H lth R d
  • 4. The Challenge - Knowing What It Means Computer-Based Electronic Medical Patient Records Records (EMRs) (CPRs) Electronic Patient Electronic Health Records (EPRs) Records (EHRs) Personal Health Records (PHRs)
  • 5. Electronic Health Records (EHRs) • Electronic documentation of patient care by providers • Sometimes defined as a patient’s life-long records
  • 6. Electronic Health Record (EHR) Systems • Are they just electronic documentation? History Diag- Treat- ... & PE nosis ments • Or do they have some other values?
  • 7. Common “Goals” for Adoption “Go paperless” “Computerize” “Get a HIS” “Digital Hospital” “Di it l H it l” “Have EMRs” “Modernize” “Share d t ” “Sh data”
  • 8. Benefits of Health Information Technology • Literature suggests improvement in health care through – Guideline adherence (Shiffman et al, 1999;Chaudhry et al, 2006) – Better documentation (Shiffman et al, 1999) – Practitioner decision making or process of care (Balas et al, 1996;Kaushal et al, 2003;Garg et al, 2005) – Medication safety (Kaushal et al, 2003;Chaudhry et al, 2006;van Rosse et al, 2009) – Patient surveillance & monitoring (Chaudhry et al, 2006) – Patient education/reminder (Balas et al, 1996) – Cost savings and better financial performance (Parente & Dunbar, 2001;Chaudhry et al, 2006;Amarasingham et al, 2009;Borzekowski, 2009)
  • 9. Functions that Should be Part of EHR Systems • Computerized Medication Order Entry (IOM, 2003; Blumenthal et al, 2006) • Computerized L b t Order Entry (IOM, 2003) C t i d Laboratory O d E t • Computerized Laboratory Results (IOM, 2003) • Physician N t Ph i i Notes (IOM, 2003) • Patient Demographics (Blumenthal et al, 2006) • Problem Li t P bl Lists (Blumenthal et al, 2006) • Medication Lists (Blumenthal et al, 2006) • Discharge Summaries (Blumenthal et al, 2006) Di h S i • Diagnostic Test Results (Blumenthal et al, 2006) • Radiologic R t R di l i Reports (Blumenthal et al, 2006)
  • 10. The Bigger Picture: Health Information Exchange Government G t Hospital A p Hospital B Clinic C Lab Patient at Home
  • 11. Common Denominator • Health Information Technology • Electronic Health Records • Health Information Exchange
  • 12. Ultimate Goal = Health • Don’t implement technology just for technology’s sake. (Yasnoff et al, 2001 and many others) • “Don’t make use of excellent technology. Make excellent use of technology.” (Tangwongsan, Supachai. Personal communication, 2005.)
  • 13. U.S. Adoption of Health IT Ambulatory (Hsiao et al, 2009) Hospitals (Jha et al, 2009) Basic EHRs w/ notes 7.6% Comprehensive EHRs 1.5% 1 5% CPOE 17% • U S lags behind other Western countries U.S. l b hi d th W t ti (Schoen et al, 2006;Jha et al, 2008) • Money and misalignment of benefits is the biggest reason
  • 14. “อเมริกาเข้มแข็ง” ็ (ARRA/HITECH A t) Act)
  • 15. American Recovery & Reinvestment Act • Contains HITECH Act (Health Information Technology for Economic and Clinical Health Act) • ~ 20 billion dollars for Health IT investments Goals: 1. Boost economy (economic health) 2. 2 Widespread adoption of Health IT (clinical health) Quality Patient Safety Costs
  • 16. National Leadership • Office of the National Coordinator for Health Information Technology (ONC -- formerly ONCHIT) David Blumenthal, MD, MPP National Coordinator for Health Information Technology (2009 - Present) Photo courtesy of U.S. Department of Health & Human Services
  • 17. Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.
  • 18. “Meaningful Use” Meaningful Use
  • 19. “Meaningful Use” of A Pumpkin Pumpkin “Meaningful Use” of a Pumpkin Image Source & Idea Courtesy of Pat Wise at HIMSS, Oct. 2009
  • 20. Meaningful Use of EHRs: ONC’s 3-Stage Approach Stage 1 Better - Electronic capture of health information Stage 3 Health - Information sharing Stage 2 Use of - Data reporting p Use of EHRs EHRs to to improve improve processes of outcomes care Blumenthal D, 2010
  • 21. Components of Meaningful Use Regulations • Medicare & Medicaid Incentives for Meaningful Use of EHRs – Centers for Medicare and Medicaid Services (CMS) • Rule on Standards, Implementation Specifications & Certification Criteria g • Certification Programs – Office of the National Coordinator for Health IT (ONC)
  • 22. Meaningful Use Incentives: Stage 1 • 23 Criteria for Hospitals to Pass Proposed Rule • 25 Criteria for Professionals (Clinics) to Pass (Jan. 2010) • Pace & Scope: too ambitious, demanding, inflexible Public Hearing g • Few providers would likely qualify -> Little adoption • C Obj ti (15 criteria, required) Core Objectives it i i d) Final Rule • Menu Set (10 criteria, pick 5) Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501-4.
  • 23. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501-4.
  • 24. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501-4.
  • 25. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501-4.
  • 26. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501-4.
  • 27. Meaningful Use Final Rule: Core Objectives (Selected) • Electronic capture of information – Demographics – Vital signs – Medication list – Allergies – Problem list – Smoking • Medication order entry • Drug-allergy & drug-drug interaction checks • P ti t access to/copy of health information Patient t/ f h lth i f ti
  • 28. Meaningful Use Final Rule: Menu Set (Selected) • Drug formulary checks • Lab results incorporation into EHRs • Generate lists of patients by specific conditions • Medication M di ti reconciliation ili ti • Electronic reporting to governmental agencies • Advanced directives for elderly patients • Patient reminders for certain services (for clinics) • Patient access to health information (for clinics)
  • 29. Final Rule on Standards & Certification Criteria (Selected) • Content Exchange Standards – HL7 CDA Release 2 & CCD – NCPDP SCRIPT • Vocabularies • SNOMED CT – LOINC® – RxNorm ® • Security – NIST-certified encryption algorithms • Et Etc.
  • 30. Critique: q Lessons for Thailand L f Th il d Disclaimer: Personal opinions. Supporting scientific evidence may not be available.
  • 31. Lesson #1 Clear aim toward improved quality & efficiency of health care care.
  • 32. Lesson #2 Large health IT initiatives require leadership from the highest level of government government.
  • 33. Lesson #3 To achieve widespread health IT adoption, adoption substantial financial investment is necessary necessary.
  • 34. Lesson #4 Leadership from a national organization with health informatics expertise is vital to success success.
  • 35. Lesson #5 Criteria for “Meaningful Use” should Meaningful Use be evidence based evidence-based to the extent possible possible.
  • 36. Lesson #6 Criteria for incentives should be realistic and flexible flexible.
  • 37. Lesson #7 Criteria for incentives should be evolutionary. evolutionary
  • 38. Lesson #8 Accept local diversity in technologies & requirements requirements. Don t Don’t aim for homogeneous environment. environment
  • 39. Lesson #9 Leverage existing standards to the extent possible possible. Don t Don’t reinvent the wheel. wheel
  • 40. Lesson #10 Acknowledge that more than one level of interoperability needs to be achieved. achieved
  • 41. Take Home Message • Adoption of health IT still work in progress, even in developed countries • We can learn something from other countries • We need to do something, soon. • Don’t forget to build the workforce!! Don t
  • 42. Useful Online Resources • healthit.hhs.gov • www.himss.org/EconomicStimulus/ • www.amia.org/public-policy/testimony- www.amia.org/public policy/testimony comments-reports • www.nejm.org/doi/full/10.1056/NEJMp0912825 • www nejm org/doi/full/10 1056/NEJMp1006114 www.nejm.org/doi/full/10.1056/NEJMp1006114
  • 43. References (1) • Amarasingham R, Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical information technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med. 2009;169(2):108-14. • Balas EA, Austin SM, Mitchell JA, Ewigman BG, Bopp KD, Brown GD. The clinical value of computerized pp p information services. A review of 98 randomized clinical trials. Arch Fam Med. 1996;5(5):271-8. • Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5. • Blumenthal D,, DesRoches C,, Donelan K,, Ferris T,, Jha A,, Kaushal R,, Rao S,, Rosenbaum S. Health information technology in the United States: the information base for progress [Internet]. Princeton (NJ): Robert Wood Johnson Foundation; 2006 [cited 2010 Oct 14]. 81 p. Available from: http://www.rwjf.org/files/publications/other/EHRReport0609.pdf • Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010 Aug 5;363(6):501-4. • Borzekowski R Measuring the cost impact of hospital information systems: 1987-1994 J Health Econ R. 1987 1994. Econ. 2009;28(5):939-49. • Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care Ann Intern Med. quality efficiency care. Med 2006;144(10):742-52.
  • 44. References (2) • Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293(10):1223-38. • Hsiao C, Beatty PC, Hing ES, Woodwell DA. Electronic medical record/electronic health record use by office- based physicians: United States, 2008 and preliminary 2009 [Internet]. 2009 [cited 2010 Apr 12]; Available from: http://www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.pdf p g p • Institute of Medicine, Board on Health Care Services, Committee on Data Standards for Patient Safety. Key Capabilities of an electronic health record system: letter report [Internet]. Washington, DC: National Academy of Sciences; 2003 [cited 2010 Oct 14]. 31 p. Available from: http://www.nap.edu/catalog/10781.html • Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in U.S. hospitals. N Engl J Med. 2009;360(16):1628-38. • Jha AK, D l D G dt D S tt T B t DW Th Jh AK Doolan D, Grandt D, Scott T, Bates DW. The use of health information technology in seven nations. IInt f h lth i f ti t h l i ti t J Med Inform. 2008;77(12):848-54. • Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch. Intern. Med. 2003 163(12) 1409 16 t di ti ft t ti i A h I t M d 2003;163(12):1409-16.
  • 45. References (3) • Parente ST, Dunbar JL. Is health information technology investment related to the financial performance of US hospitals? An exploratory analysis. Int J Healthc Technol Manag. 2001;3(1):48-58. • Schoen C Osborn R, Huynh PT Doty M, Puegh J Zapert K. On the front lines of care: primary care doctors’ C, R PT, M J, K doctors office systems, experiences, and views in seven countries. Health Aff (Millwood). 2006;25(6):w555-71. • Shiffman RN, Liaw Y, Brandt CA, Corb GJ. Computer-based guideline implementation systems: a systematic review of functionality and effectiveness. J Am Med Inform Assoc. 1999;6(2):104-14 effectiveness Assoc 1999;6(2):104-14. • Van Rosse F, Maat B, Rademaker CMA, van Vught AJ, Egberts ACG, Bollen CW. The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review Pediatrics 2009;123(4):1184 90 review. Pediatrics. 2009;123(4):1184-90. • Yasnoff WA, Overhage JM, Humphreys BL, LaVenture M. A national agenda for public health informatics: summarized recommendations from the 2001 AMIA Spring Congress. J Am Med Inform Assoc. 2001 Dec;8(6):535-545. D 8(6) 535 545