Himss Overview, Madrid Cio Meeting


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Presentación utilizada por Stephen Lieber, HIMSS Global CEO en la reunión con CIO's organizada en Madrid (Febrero 2010). Introducción de HIMSS Global

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  • IT has become recognized as significant contributor to the delivery of health care HIMSS vision is that healthcare has and utilizes the best in systems (information and management) for the best possible care HIMSS mission: move from that state where HIMSS is the “Gathering Place” to where HIMSS is the source of knowledge, expertise, leadership
  • HR 1 Speaker of the House reserves bill numbers for key pieces of legislation. #1 was reserved for Economic Stimulus.
  • Understanding the level of EMR capabilities in hospitals is a challenge in the U.S. healthcare IT market today. The EMR Adoption Model identifies the levels of EMR capabilities ranging from the initial clinical data repository (CDR) environment through a paperless EMR environment. HIMSS Analytics has developed a methodology and algorithms to automatically score the 5,071 hospitals in our database relative to their progress in implementing the components of an EMR and to provide peer comparisons for care delivery organisations as they strategize their path to a complete EMR and participation in EHR initiatives. The stages of the model are as follows: Stage 0: Some clinical automation may be present, but all three of the major ancillary department systems for laboratory, pharmacy, and radiology are not implemented. Stage 1: All three of the major ancillary clinical systems (pharmacy, laboratory, radiology) are installed. Stage 2: Major ancillary clinical systems feed data to a clinical data repository (CDR) that provides physician and other clinician access for retrieving and reviewing results. The CDR contains a controlled medical vocabulary (CMV), and the clinical decision support/rules engine (CDSS) for rudimentary conflict checking. Information from document imaging systems may be linked to the CDR at this stage. Stage 3: Clinical documentation (e.g. vital signs, flow sheets) is required; nursing notes, care plan charting, and/or the electronic medication administration record (eMAR) system are scored with extra points, and are implemented and integrated with the CDR for at least one service or one unit in the hospital. The first level of clinical decision support is implemented to conduct error checking with order entry (i.e., drug/drug, drug/food, drug/lab conflict checking normally found in the pharmacy). Some level of medical image access from picture archive and communication systems (PACS) is available for access by physicians via the organisation’s intranet or other secure networks outside of the confines of the radiology department. Stage 4: Computerised Practitioner/Physician Order Entry (CPOE) for use by any clinician is added to the nursing and CDR environment along with the second level of clinical decision support capabilities related to evidence based medicine protocols. If one patient service area (not counting the Emergency Department) has implemented CPOE and completed the previous stages, then this stage has been achieved. Stage 5: The closed loop medication administration environment is fully implemented in at least one patient care service area . The eMAR and bar coding or other auto identification technology, such as radio frequency identification (RFID), are implemented and integrated with CPOE and pharmacy to support the five rights of medication administration, thereby maximizing point of care patient safety processes. Stage 6: Full physician documentation/charting (using structured templates) is implemented for at least one patient care service area. Level three of clinical decision support provides guidance for all clinician activities related to protocols and outcomes in the form of variance and compliance alerts. A full complement of radiology PACS systems provides medical images to physicians via an intranet and displaces all film-based images. If a hospital has cardiology PACS, extra points are given. Stage 7: The hospital has a paperless EMR environment. Clinical information can be readily shared via Continuity of Care (CCD) electronic transactions with all entities within health information exchange networks (i.e., other hospitals, ambulatory clinics, sub-acute environments, employers, payers and patients). This stage allows the healthcare organization to support the true sharing and use of health and wellness information by consumers and providers alike. Also at this stage, HCOs use data warehousing and mining technologies to capture and analyze care data, and improve care protocols via decision support.
  • This language is in Statute.
  • It is expected that hospitals and eligible professionals will follow a stepped approach of increasing maturation of the stages. To earn the first incentive, eligible professionals and hospitals must meet the requirements for Stage I. To continue receiving the incentive as the years progress, you must demonstrate advancement through the stages.
  • Page 103 of the NPRM begins a 5-page chart that pulls out the 25 measures and stages. The clinical quality measures are defined beginning on page 123.
  • Note that the patient has the right to request that communication be provided via electronic means.
  • Himss Overview, Madrid Cio Meeting

    1. 1. HIMSS Overview: Global Perspective/ Regional Emphasis February, 2010
    2. 2. History <ul><li>1961: Founded as “HMSS” – a healthcare-focused management engineering professional society </li></ul><ul><li>1987: Added IT professionals </li></ul><ul><li>2001: Added corporate members/strengthened focus on improving healthcare through IT </li></ul><ul><li>2002: Enhanced focus on EHRs and Interoperability </li></ul><ul><li>2004: Added data services and market r esearch capabilities </li></ul><ul><li>2005: Established HIMSS Europe, AsiaPac & Middle East – </li></ul><ul><li>Global Perspective/Regional Emphasis </li></ul><ul><li>2006: Expanded to include focus on business and financial IT </li></ul>
    3. 3. Today <ul><li>26,000+ Individual Members of which 73% work in the field (non-vendors, non-consultants) </li></ul><ul><li>420+ Corporate Members </li></ul><ul><li>90+ committees, task forces, & work groups </li></ul><ul><li>47 Chapters </li></ul><ul><li>Over 200 staff </li></ul><ul><li>Offices: Chicago, Washington DC, Ann Arbor, Brussels, Singapore </li></ul><ul><li>One of the 10 largest not-for-profit healthcare associations worldwide </li></ul><ul><li>Top 5 largest healthcare conference in US (27,000+) </li></ul><ul><li>Largest healthcare IT conferences in Europe, Asia and the Middle East </li></ul>
    4. 4. Strategic Subjects & Settings <ul><li>Subjects </li></ul><ul><li>Interoperability </li></ul><ul><li>IT Adoption </li></ul><ul><li>Privacy & Security </li></ul><ul><li>Quality & P4P </li></ul><ul><li>Financial Systems </li></ul><ul><li>Clinical Informatics </li></ul><ul><li>Patient Safety </li></ul><ul><li>Management Systems </li></ul><ul><li>Standards & architecture </li></ul><ul><li>PHRs </li></ul><ul><li>Settings </li></ul><ul><li>Acute </li></ul><ul><li>Ambulatory </li></ul><ul><li>Life Sciences </li></ul><ul><li>Payer, Banking </li></ul><ul><li>Public Health </li></ul><ul><li>Long-Term Care </li></ul><ul><li>Home Health </li></ul>
    5. 5. HIMSS Strategic Direction <ul><li>Vision </li></ul><ul><li>Better health care through information and management systems </li></ul><ul><li>  </li></ul><ul><li>Mission </li></ul><ul><li>Lead healthcare transformation through the effective use of health information technology </li></ul>
    6. 6. How <ul><li>Engage all stakeholders: IT professionals, CEOs/administrators, physicians, nurses, other providers/clinicians, government, vendors, consultants, financial services </li></ul><ul><li>Develop tools and resources from real life experiences </li></ul><ul><li>Share, teach, learn: locally, regionally, globally </li></ul>
    7. 7. U.S.: Trends, Policy and Meaningful Use
    8. 8. Sound Familiar? <ul><li>The situation and challenges are: </li></ul><ul><ul><li>limited budgets </li></ul></ul><ul><ul><li>rising demand for healthcare services </li></ul></ul><ul><ul><li>increasing chronic diseases </li></ul></ul><ul><ul><li>quality below expectations </li></ul></ul><ul><ul><li>people in countryside with limited access to health care services </li></ul></ul><ul><ul><li>impact of changing demographic </li></ul></ul>
    9. 9. Worldwide Themes <ul><li>Cost: Europe, Asia, North America, Middle East, Africa all say the same: too high </li></ul><ul><li>Quality: Again, all say the same: too low </li></ul><ul><li>Access: patient access to care is uneven and at time unequal regardless of delivery or payment system </li></ul>
    10. 10. Trend: EMR Quality <ul><li>HIMSS Analytics: Electronic Medical Record adoption progress correlates to the quality of care </li></ul><ul><li>Size not a requirement for IT adoption or improved quality </li></ul><ul><li>Quality solutions: coordination of care among providers and computerized test results </li></ul>
    11. 11. EMR Adoption Model Source: HIMSS Analytics TM Database N = 5,170/5,172 0.3% 1.0% 4.5% 3.6% 38.4% 31.4% 7.2% © 2009 HIMSS Analytics Stage 2 CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Stage 3 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology Stage 4 CPOE, Clinical Decision Support (clinical protocols) Stage 5 Closed loop medication administration Stage 6 Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS Stage 7 Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP Stage 1 Ancillaries – Lab, Rad, Pharmacy – All Installed Stage 0 All Three Ancillaries Not Installed 2008 Final 0.3% 0.5% 2.5% 2.5% 35.7% 31.5% 11.5% 15.6% 2009 Q3 13.4%
    12. 12. What’s Happening in the US <ul><li>The Federal Government sees the problem </li></ul><ul><ul><li>Costs, Quality, Access </li></ul></ul><ul><li>Took First Action Last February </li></ul><ul><ul><li>Signed ARRA (Stimulus Bill) </li></ul></ul><ul><ul><li>Established funding incentives </li></ul></ul><ul><li>Issued Implementation Regulations in December </li></ul><ul><ul><li>Will drive Health IT standards </li></ul></ul><ul><ul><li>Will link incentives to Health IT product certification and demonstrated use </li></ul></ul><ul><ul><li>Will establish minimum requirements for functionality, interoperability, and reporting </li></ul></ul>
    13. 13. Meaningful Use Defined <ul><ul><li>Use certified EHR in a meaningful manner (ex. E-Prescribing) </li></ul></ul><ul><ul><li>Utilize certified EHR technology for the electronic exchange of health information to improve the quality of healthcare such as promoting care coordination </li></ul></ul><ul><ul><li>Submit information on clinical quality measures and other measures </li></ul></ul>
    14. 14. 5-Year, 3-Stage Process <ul><li>Stage I (2011) – Electronic capture of health information in a coded format; tracking key clinical conditions for care coordinating; implementing clinical decision support tools; and reporting outcomes for public health purposes. </li></ul><ul><li>Stage II (2013) – Stage I + expanded computerized provider order entry; electronic transmission of diagnostic test results. </li></ul><ul><li>Stage III (2015) – Stage l + Stage II + focus on clinical decision support at a national level by encouraging patient access and involvement; and, improved population health data. </li></ul>
    15. 15. Stage I Requirements <ul><li>Certified EHR technology that includes 25 measures </li></ul><ul><li>Requires Computerized Provider Order Entry (CPOE) for 10% of all hospital orders and 80% of all eligible providers’ orders </li></ul><ul><li>Delineates robust clinical quality measures </li></ul><ul><li>Requires patients be provided with an electronic copy of test results, problem lists, medication lists, and discharge summary upon request. </li></ul><ul><li>Implement five clinical decision support rules relevant to clinical quality measures. </li></ul>
    16. 16. Eligible Hospitals <ul><li>Clinical Data Repository – store, retrieve, and manage laboratory and radiology results. </li></ul><ul><li>Clinical Documentation – nursing and physician in the areas of discharge, transfer, care coordination, problem list, demographic capture, vital signs and BMI, smoking status (for patients 13 years and older). </li></ul><ul><li>CPOE – in the areas of medications, laboratories, radiology/imaging, blood bank, physical therapy, occupational therapy, respiratory therapy, rehabilitation therapy, dialysis, provider consults, and discharge/transfer. </li></ul>
    17. 17. Eligible Hospitals <ul><li>Medication Management - Medication administration for alerts at the point-of-care to accomplish real time drug-drug, drug-allergy, and drug-formulary checks. </li></ul><ul><li>Financial Information Systems – ability to check insurance eligibility and electronically submit claims. </li></ul><ul><li>Patient Communication – create and provide an electronic copy of a patient’s clinical information, discharge instructions and procedures upon request. </li></ul><ul><li>Clinical Decision Support – implement the five automated, clinical rules. </li></ul>
    18. 18. Standards Criteria <ul><li>Relevant Themes </li></ul><ul><li>Creates a floor for standards, implementation specifications, and certification criteria for meaningful use. </li></ul><ul><li>Creates specific standards in 2011 in four areas: </li></ul><ul><ul><li>Vocabulary </li></ul></ul><ul><ul><li>Content exchange </li></ul></ul><ul><ul><li>Transporting of information </li></ul></ul><ul><ul><li>Privacy and security </li></ul></ul>
    19. 19. Real Message <ul><li>Objective is not the installation or adoption of HIT </li></ul><ul><li>Objective is to change the cost curve and quality of care (change the way medicine is delivered and paid for) </li></ul>
    20. 20. What Does this Mean? <ul><li>It does nothing to help multi-national collaboration </li></ul><ul><ul><li>Certification and Standards: CCHIT, Q-Rec, IHE, ISO, etc differences will not be addressed </li></ul></ul><ul><li>It will help multi-national learning from failure and success </li></ul>