The Fundamentals ofHIT


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  • Interoperability = the capacity of one health IT application to share information with another in a computable format.
  • Interoperability = the capacity of one health IT application to share information with another in a computable format.
  • ONC = Office of the National Coordinator – part of Health and Human Services (HHS), which also owns CMS (Centers for Medicare and Medicaid Services)
  • ICD-9-CM:Clinical modification used in U.S. Developed in 1970’s, implemented 1979 Volume 1&2 diagnosis codes (used by all providers) Volume 3 procedure codes (used by hospitals for inpatient reporting) ICD-10: Diagnosis classification system developed by the World Health Organization as a replacement to ICD-9; contains no procedure codesICD-10-CM: U.S. clinical modification for the ICD-10 diagnosis classification system ICD-10-PCS: U.S. procedure classification system developed to replace ICD-9-CM vol 3 ICD-10-CA: Canadian clinical modification for the ICD-10 diagnosis classification systemICD-10-AM: Australian clinical modification for the ICD-10 diagnosis classification system
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  • Copied from - This chart is not an official federal document and has been created for public use and convenience by Robin Raiford, RN-BC, CPHIMS, FHIMSS. Note for CPOE, Vital Signs, Smoking Status, Advance Directives, Patient Reminders – the text reflects ”Unique Patients” but they are listed in “Actions” in an EHR in Table 3 which is how it is noted in this document Please refer to The Official Web Site for the Medicare and Medicaid EHR Incentive Programs for official publications
  • Copied from - This chart is not an official federal document and has been created for public use and convenience by Robin Raiford, RN-BC, CPHIMS, FHIMSS. Note for CPOE, Vital Signs, Smoking Status, Advance Directives, Patient Reminders – the text reflects ”Unique Patients” but they are listed in “Actions” in an EHR in Table 3 which is how it is noted in this document Please refer to The Official Web Site for the Medicare and Medicaid EHR Incentive Programs for official publications
  • HL7 – ANSI, founded in 1987Exchange, management and integration of health information for both clinical and administrative purposesV2 – patient administration, order entry and results, attachments to HIPAA-compliant transactions (not widely used)V3 – adds CDA, RIM, XML formats, vocabulary controlCDA – Clinical Document ArchitectureRIM – Reference Information Model for health careXML – eXtensible Markup Language – allows web-based programs to transport and store data and its metadataXSLT -- eXtensibleStylesheet Language Transformations -- allows transformations from one markup type to anotherANSI - American National Standards InstituteICD – International Classification of DiseasesSNOMED CT - Systematized Nomenclature of Medicine--Clinical Terms (originated by College of Amer. Pathologists)NCPDP -- National Council for Prescription Drug ProgramsCPT -- Current Procedural Terminology (owned by the AMA)LOINC -- Logical Observation Identifiers Names and Codes (owned by Regenstrief Institute, Inc)CCR -- Continuity of Care Record (HIMSS and others own this standard) –HL7 CDA implementation of CCR is CCD r1 (CCR>CCD using XSLT; vice versa not easy) CDA – HL7’s standard exchange format for health records PACS -- Picture Archiving and Communication System (PACS) – technology for the economical storage of and convenient access to images from multiple modalitiesDICOM –Digital Imaging and Communications in Medicine – interoperable PACS format for images, owned by National Electrical Manufacturers Association (NEMA)
  • SAFTInet is a project out of UC Denver that integrates data from multiple health information sources (clinics, practices, hospitals, etc.) for the purposes of comparative effectiveness research (CER).
  • PHI = any individually identifiable health information transmitted by or maintained in electronic media or in any other form or mediumIndividually identifiable = physical or mental health information that can be tied to an individual in any way
  • CAQH (Council for Affordable Quality Healthcare) is an non profit focused on simplifying healthcare administration through industry initiatives that - Promote quality interactions between plans, providers and other stakeholders- Reduce costs and frustrations associated with healthcare administration- Facilitate administrative healthcare information exchange-Encourage administrative and clinical data integrationCAQH launched the Committee on Operating Rules for Information Exchange (CORE) with the vision of giving providers access to eligibility and benefits information before or at the time of service using the electronic system of their choice for any patient or health plan.AHRQ (Agency for Healthcare Research and Quality) – mission  improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Part of the Department of Health and Human Services. Formerly known as the Agency for Health Care Policy and Research.Produces quality indicators, research, white papers, methods, data, and funding.NCQA (National Committee for Quality Assurance) – Private, 501(c)(3) not-for-profit organization dedicated to improving health care quality, founded in 1990. Produces a seal that is a recognized symbol of quality based on rigorous, comprehensive review and annually reporting on performance. Works with large employers, policymakers, doctors, patients and health plans to develop quality standards and performance measures that are used as benchmarks through annual reporting of provider performance. NCQA’s contribution to the health care system is regularly measured in the form of statistics that track the quality of care delivered by the nation’s health plans.NCQA collects quality information from health plans in a system called HEDIS (Healthcare Effectiveness Data and Information Set). This tool, used by more than 90 percent of America's health plans, measures health care and serviceperformance. JCAHO (Joint Commission on Accreditation of Healthcare Organizations) -- independent, not-for-profit organization, founded in 1951Commonwealth fund – funding and research to improve health performance in the US – State-by-state scorecard measures the health system across 42 key indicators of health care quality, access, efficiency, equity, and healthy lives. Colorado is in their top quartile.RWJF – Robert Woods Johnson FundTCHF – The Colorado Health Foundation, and closely associated CHINQF --
  • HCAHPS = Hospital Consumer Assessment of Healthcare Providers and Systems
  • The Fundamentals ofHIT

    1. 1. Fundamentals of HIT Lynne VanArsdale 11/4/2011 UC Denver San Luis Valley Health Information Technology Symposium, November 4, 2011 1
    2. 2. San Luis Valley AHEC Legal NoticeThe material in this tutorial is copyrighted as indicated in each slide footer and anyreferences made by the author.Companies and individuals may only use this material in accordance with copyrightsexpressly stated. Contact the speaker directly for further informationNeither the Author nor the Presenter is an attorney and nothing in this presentationis intended to be nor should be construed as legal advice or opinion. If you needlegal advice or legal opinion, please contact an attorney.The information presented herein represents the Author’s personal opinion andcurrent understanding of the issues involved. The Author, the Presenter and the SanLuis Valley AHEC do not assume any responsibility or liability for damages arising outof any reliance on or use of this information.NO WARRANTIES, EXPRESS OR IMPLIED. USE AT YOUR OWN RISK. 2
    3. 3. Agenda• HIT Alphabet soup – EMR/EHR, MU, PHR, CDSS, CPOE, PHI …• Coding Standards• Health information exchange• Security• Quality metrics• Consumer health data• BI/data warehouse• Public health reporting• Medical devices• Where to find more information 3
    4. 4. HIT – What is it? • Congressional Budget Office (CBO) 2008 definition* of Health Information Technology (HIT): “computer applications for the practice of medicine,” and includes • Electronic Medical Record (EMR) = equivalent to paper-based medical record • Electronic Health Record (EHR) = computer-accessible, interoperable resource of clinical and administrative information pertinent to the health of an individual –Personal Health Record (PHR) = an EHR controlled by the patient –Payer-based Health Record (PBHR) = an EHR owned and administered by the health plan*The Congress of the United States Congressional Budget Office, “Evidence on the Costs and Benefits of Health Information Technology,” May 2008. 4
    5. 5. HIT – What is it?Congressional Budget Office (CBO) definition also includes• Computerized Physician Order Entry (CPOE) = electronic applications that physicians use to order medications, diagnostic tests, and ancillary services • e-Prescribing = electronic transfer of a prescription from the prescribing physician’s office to the pharmacy• Clinical Decision Support Systems (CDSS) = assists physicians with decision making by providing reminders, suggestions and support in diagnosing and treating diseases and conditions• Health Information Exchange (HIE) = electronic movement of any and all health- related data according to an agreed-upon set of interoperability standards, processes and activities across nonaffiliated organizations in a manner that protects the privacy and security of that data; and the entity that organizes and takes responsibility for the process 5
    6. 6. U.S. Health Information PolicyApril 2004 – Presidential Exec Order 13335• Established ONC to fulfill the vision of developing a nationwide interoperable health information technology infrastructure that: • Ensures that appropriate information to guide medical decisions is available at the time and place of care; • Improves health care quality, reduces medical errors, and advances the delivery of appropriate, evidence-based medical care • Reduces health care costs resulting from inefficiency, medical errors, inappropriate care, and incomplete information; • Promotes a more effective marketplace, greater competition, and increased choice through the wider availability of accurate information on health care costs, quality, and outcomes; • Improves the coordination of care and information among hospitals, laboratories, physician offices, and other ambulatory care providers through an effective infrastructure for the secure and authorized exchange of health care information • Ensures that patients’ individually identifiable health information is secure and protected.– ARRA /Economicsigned on(?) HITECH Stimulus! 1/29/2009 established law to support this order 6
    7. 7. Perfect Storm APCD Declining ANSI 5010 HealthPayment Reform ACO, PCMH Bad Rule EconomyICD-10 Meaningful Use CORHIO Stage II HIPAA Implementation 7
    8. 8. ANSI X12 (5010) and ICD-10 Challenges: - Continuity over time (episodes of care, quality metrics, payment issues) - Converting systems - Training people - Billing-focused Opportunities: - Better, fuller information - Enforcement - Payment accuracy & fraud 8
    9. 9. Meaningful Use (MU) / EMR• CMS rule – Medicare vs. Medicaid – Physician vs. hospital – Incentives (now) and penalties (2015 +)• Stages (I now, II due in 2012, III ?)• Criteria – Three tenets: • Adopt certified electronic health record technology • Demonstrate core and menu set requirements • Report on clinical quality measures• Certification – – 1. EMR certification; 2. self-certification for MU of certified EMR • Health care providers must possess all of the meaningful use capabilities, not just those that they intend to report – Office of the National Coordinator for Health Information Technology- Authorized Testing and Certification Body (ONC-ATCB) and CCHIT 9
    10. 10. 10
    11. 11. MU Stage 1, continued…Copied from - This chart is not an official federal document and has been created for public use and convenience by Robin Raiford, RN-BC, CPHIMS, FHIMSS. Note for CPOE, Vital Signs, SmokingStatus, Advance Directives, Patient Reminders – the text reflects ”Unique Patients” but they are listed in “Actions” in an EHR in Table 3 which is how it is noted in this document Please refer to TheOfficial Web Site for the Medicare and Medicaid EHR Incentive Programs for official publications 11
    12. 12. Some Coding Standards (putting medicine in terms computers can understand…)• ANSI X12 5010 (4010, 6020) -- claims• ICD- (9,10,11) – diags and treatments• SNOMED – diags and treatments• HL7 – medical information infrastructure• NCPDP -- pharma• CPT – medical services• LOINC – lab and clinical data• CCR, CDA (CCD) – patient medical info exchange• PACS / DICOM – Images Conformance: Where are we really? 12
    13. 13. Other types of HIT1. Medical device output, input (IEEE 1073)2. Registries3. Office systems – billing, appointments (PMIS, PMOS,…)4. Health business reporting systems5. Public health systems6. Telehealth, telemedicine7. Mobile health8. Intelligence systems9. New innovations … Todd Park: web apps (iTriage), social networks, community dashboards, your ideas…? 13
    14. 14. More Alphabet soup– Interoperability • NwHIN – ONC design for nation-wide HIT infrastructure – Service-Oriented Architecture (SOA) – enables interoperability through published “services” that securely allow info access • CORHIO – Colorado’s Regional Health Info Org – QHN – HIE for Western Slope; BEACON partner • HIE – non-governmental health info exchanges – emerging for ACO’s and other collaboratives (e.g. SAFTInet/DARTnet)– Quality / cost –based aggregations • ACO • PCMH 14
    15. 15. CORHIO Alphabet Soup• QHN = Quality Health Network • CCGC = Colorado Clinical Guidelines• NCHA = Northern Colorado Health Alliance Collaborative (HealthTeamWorks)• AHRQ = Agency for Healthcare Research and • CIVHC = Center for Improving Value in Quality Health Care• PCDP = Point of Care Demonstration Project • CDPHE = Colorado Department of Public• TCHF = The Colorado Health Foundation Health and Environment• MRR = Medical Referral Regions • HCPF = Health Care Policy and Financing• CHI = Colorado Health Institute • CHIP = Children’s Health Insurance Program• CMHC = Community Mental Health Center • MMIS = Medicaid Mgmt Info Systems• BHO = Behavioral Health Organization • SMHP = State Medicaid Health IT Plan• FQHC = Federally Qualified Health Center • MTIA = Medicaid Info Tech Architecture• COREC = CO Regional Extension Center • NTIA = National Telecommunications and Information Administration• CCMCN = Colorado Community Managed Care • CHA = Colorado Hospital Association Network• CFMC = Colorado Foundation for Medical Care • CTN = Colorado Telehealth Network• CCHN = Colorado Community Health Network • CHC = Colorado Community Health Ctrs• CACHIE = Colorado Associated Community • HRSA = Health Resources and Services Health Information Exchange Administration• CHIMA = Colorado chapter of AHIMA • IPA = Independent Practice Association• CHIMSS = Colorado chapter of HIMSS • GDAB = Government Data Advisory Board• COPIC = professional liability insurer • PAHCOM = Professional Association of Health Care Office Management• CTA = Colorado Technology Assoc. (CSIA) 15
    16. 16. CORHIO – Network of Networks 16
    17. 17. Health Information SecurityProtecting personal health information (PHI)• Legislation Health insurance Privacy standard Security standard – HIPAA (1996) Reduce fraud/abuse Employer ID Security and privacy National Provider ID (NPI) – HITECH Interoperability X12 Part of ARRA, 2009 $20B for HIT projects Penalties $100 - $1.5M BA obligations per violation, plus up• **Practice** Security breach notification Enforcement to 10 years in prison Indiv. rights – notice of uses People Indiv right to EHR info request use restriction view/copy/ammend – Information Infrastructure confidential communic. – Physical Infrastructure accounting of disclosures 17
    18. 18. Quality Metrics• Federal / Regulatory / Standards – CAQH Core – Standards for claims/payment – AHRQ – quality metrics and research – NCQA (HEDIS) – health care performance metrics, benchmarks, “seal” – JCAHO – accreditation of health care providers• Funding Institutions – Commonwealth Fund, RWJF, TCHF• Report cards, NQF, LeapFrog, other independents• Community efforts – Colorado Business Group on Health – Colorado Associated Community Health Information Exchange (CACHIE) • Promotes the use of information technology to support quality reporting and improvement 18
    19. 19. Health Information BI / Data Warehouse• Online Transaction Processing (OLTP) vs. Online Analytical Processing (OLAP)• Data warehouse forms the foundation of Clinical Decision Support Systems (CDSS) and closed loop Computerized Physician Order Public Health School Health data data Entry (CPOE) Research Non-profit org data• Business intelligence plays a role in improving data performance (KPI’s) Local Census• Medical data mining data data (epidemiology/surveillance, drug Insurance State analysis, diagnosis, interventions) data data• ACO, PCMH – multitude of data from many sources need to be integrated• Operational data store; Data mart; Extract- Transform-Load (ETL)• Federated data warehouse; virtual data warehouse; network of networks 19
    20. 20. Consumer Health• PHRs – Stand alone, tethered, networked• “got an app for that” – DSS – iTriage (simple DSS with referral), WebMD – Treatment compliance• Social Networks – Communities – Provider - patient• Online data on provider quality and performance – Healthgrades,, HCAHPS, Press Ganey, Angie’s list,• Online wellness programs – Mostly employer-centric – many, many out there 20
    21. 21. Public Health Reporting Vision Health Information Genetic Disorders Exchange Vital StatisticsProvider 1 • Service oriented Communicable Diseases HL7 architecture • ComputerProvider 2 Immunization CDA2 networking Environmental Health • TieredProvider 3 architectures Injury Control X12 • StorageProvider 4 School Health management Chronic Care • Data management Biosurveilance, NCPDP Preparedness • Process management Women & ChildrenProvider X Public Health Laboratory IHE Quality Improvement 21 This diagram was created by Dr. Art Davidson for an HIT class at UC Denver.
    22. 22. Medical Devices• IEEE 1073 – “Medical Information Bus” – Based on OSI 7-layer model 22
    23. 23. More Information•• Presidential Executive Order 13335:• , Office of the National Coordinator:•; ;•;; ;; (SNOMED);;; resources/solutions-managing-your-practice/coding-billing-insurance/;; (DICOM);• Quality:,,, http://www.ncqa .org,,, http://www.commonwealthfu,• Consumer Health: ,,,• HIMSS LinkedIn Group discussion on “Top Ten reasons why EMR/EHR implementations are failing” – over 2200 comments• ANSI/IEEE 1073: Medical Information Bus (MIB) Health Informatics Journal June 1998 4: 72-83• SAFTInet ContinuingEducation/Documents/4-19-2011_Schilling.pdf• Data warehouse: ,,• XML: 23
    24. 24. Please fill out your evaluations on this talk and leavethe completed form in the box next to the doorbefore you leave today.Please send any questions or comments to:Email address of authorThank You! THANK YOU! 24