This session showcased concrete examples of how information technology-enabled Patient Centered Medical Home (PCMH) care models have led to improvements in health outcomes. Panelists discussed their use of strategies and tools (such as registries, clinical decision support and panel management) to increase IT-enabled PCMH-effectiveness in a variety of healthcare settings, and how to support better uptake and spread of promising practices. Questions the panelists addressed include:

What are the high yield HIT investments to optimize PCMH cost, quality and population health outcomes?

What are the key operational learnings for practices across the country?

What should other stakeholders (i.e., payers, employers, state government, vendors) consider to improve IT-enabled PCMH performance?

Slides from presentation:

To protect Americans from potential medical errors associated with the use of information technology in patient care, a new report by the Institute of Medicine calls for greater oversight by the public and private sectors.  The report examines a broad range of health information technologies, including electronic health records, secure patient portals, and health information exchanges, but not software for medical devices. 

The secretary of the U.S. Department of Health and Human Services should publish a plan within 12 months to minimize patient safety risks associated with health IT and report annually on the progress being made, the report says.  The plan should include a schedule for working with the private sector to assess the impact of health IT on patient safety.  However, if the secretary determines that progress toward improving safety is insufficient within a year, the U.S. Food and Drug Administration should exercise its authority to regulate these technologies.  Concurrently, FDA should begin planning the framework needed for potential regulation so that the agency is ready to act if necessary.

 

"Just as the potential benefits of health IT are great, so are the possible harms to patient safety if these technologies are not being properly designed and used," said Gail L. Warden, president emeritus of Henry Ford Health System and chair of the committee that wrote the report.  "To protect patients, industry and government have a shared responsibility to ensure greater transparency, accountability, and reporting of health IT-related medical errors."   

 

The federal government is investing billions of dollars to encourage hospitals and health care providers to adopt health IT so that all Americans can benefit from the use of electronic health records by 2014, but demonstrated improvements in care and safety are not yet established, the report says.  Some of these technologies have significantly improved the quality of health care and reduced medical errors.  However, concerns about potential harm are emerging as health care providers increasingly rely on health IT to deliver care. 

 

Little published evidence exists that quantifies the magnitude of the risk associated with health IT problems, partly because many technology vendors discourage the free exchange of safety-related information in their contracts with health care providers.  But serious errors involving these technologies -- including medication dosing errors, failure to detect fatal illnesses, and treatment delays due to poor human-computer interactions or loss of data -- have led to several reported patient deaths and injuries.

                       

HHS should establish a mechanism for both technology vendors and users to report health IT-related deaths, injuries, or unsafe conditions, the report says.  Reporting events related to patient safety should be mandatory for vendors and voluntary, confidential, and nonpunitive for care providers.  In addition, Congress should establish an independent federal entity to investigate patient deaths, injuries, or potential unsafe conditions associated with health IT.  Based on those investigations, the entity could make nonbinding recommendations, allowing flexibility for HHS, health care organizations, vendors, and other experts to determine the best course forward. 

 

A new Health IT Safety Council should be funded by HHS to evaluate criteria and develop methods for assessing and monitoring safety and measuring impacts of health IT on safety, the report says.  The agency should also ensure that health IT vendors support the free exchange of information and not discourage health care providers from sharing patient safety concerns, including screen shots.  Nondisclosure agreements in contracts between vendors and health care providers and "hold harmless" clauses that shift the liability of unsafe health IT features to care providers greatly discourage information sharing.  

 

HHS should establish quality management principles and risk management processes in designing and implementing health IT products, which can be complex and difficult for doctors and nurses to use.  Alerts in technology systems should be designed to have lower false-alarm rates and computer interfaces need to be more intuitive for users.

                       

The study was sponsored by the U.S. Department of Health and Human Services.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  For more information, visit http://national-academies.org.

 

Academic medical centers have a greater likelihood to meet Stage 1 meaningful use criteria

When it comes to meeting Stage 1 of meaningful use, new research from HIMSS Analytics reported a 16 percent increase, from 25 to 41 percent in the seven months from February to September 2011, in hospitals being well positioned to meet Stage 1 of meaningful use. The data collected for this new HIMSS Analytics report, “Summary of Meaningful Use Readiness,” indicates more eligible hospitals are likely to succeed in meeting the criteria for this first stage of meaningful use, an important step as healthcare providers strive to become meaningful users of health information technology.

In addition, data from the Centers for Medicare & Medicaid Services show continued growth as well in the number of eligible hospitals moving toward or meeting Stage 1 of meaningful use. As of Sept. 30, 2011, CMS reported 2,215 eligible hospitals have registered for Medicare and Medicaid EHR incentive programs; 564 hospitals (158/Medicare and 406/Medicaid) have received payment for meeting Stage 1 of meaningful use, as of this same date.

The recent data from HIMSS Analytics also shows four percent of U.S. hospitals have achieved Stage 6 on the EMRAM model, up from 2.6 percent a year ago with the percentage of hospitals achieving Stage 7 increasing in the same time period, from 0.8 percent to 1.1 percent. Thus, as noted in the report, “….As more hospitals move toward meeting Stage 1 of meaningful use, an analysis of the movement of hospitals through the HIMSS Analytics EMR Adoption ModelSM (EMRAM) suggests that U.S. hospitals are continuing to advance their EMR capabilities to meet new market demands and requirements….”

Just over one-third of the hospitals represented in this study (39 percent) scored within Stage 3 of the HIMSS Analytics EMR Adoption ModelSM (EMRAM), and about 17 percent of the respondents have achieved either Stage 6 or Stage 7 on the EMRAM model, explained John P Hoyt, FACHE, FHIMSS, Executive Vice President, Organizational Services, HIMSS.

“Our research indicates that all facilities – including Stage 7 hospitals – need to remain focused on implementing all of the necessary security and privacy measures as they strive to achieve meaningful use,” said Hoyt. “We see hospitals working across the country to meet Stage 1 of meaningful use, and we are pleased at the progress they are making, even though it varies.”

HIMSS Analytics will continue to track the ability of hospitals to meet the meaningful use criteria, which represents HIMSS’ ongoing effort to support and drive the change to improve the delivery of patient care with a smarter, more efficient healthcare system through the adoption of health IT.

The following are the key findings from the HIMSS Analytics report:

More hospitals have the capability to meet Stage 1 of meaningful use. This study collected data from 778 hospitals from Feb. 1 – Sept. 30, 2011. Results show 10 percent of hospitals are now ready to achieve Stage 1 of meaningful use, meeting all 14 core and 5 of the required menu items. In addition, 31 percent of hospitals have the capability to meet 10 or more of the process core measures and at least five of the menu items for Stage 1 of meaningful use.

Close to 50 percent of hospitals conducted a security risk analysis. Based on the results of this research, almost half of all responding hospitals conducted a security risk analysis as part of their risk management process, with six of the 12 Stage 7 hospitals, and only 45 percent of all hospitals, in this sample, completing this step. In addition, these six Stage 7 hospitals also implemented necessary updates and correctly identified security deficiencies as part of their risk management process. Several important requirements must be followed to ensure the protection of patient health information and achieve meaningful use, and conducting a security risk analysis is one of the key stipulations in the risk management process for eligible hospitals and providers.

Electronic Medical Record Adoption Model (EMRAM) scores and bed size correlate to readiness to meet Stage 1 of meaningful use. Hospitals with a higher rank on the EMRAM and larger by bed size, tended to have higher adoption rates for many meaningful use criteria, and thus, a higher level of sophistication, resulting in an increased capability to meet Stage 1 of meaningful use.

Academic medical centers adopt IT at a more advanced rate than other hospitals. As noted in the report, “for the most part, on a measure-by-measure basis, academic medical centers had a greater likelihood than other hospitals to have the capability to meet meaningful use criteria.” This correlation supports previous HIMSS Analytics research that identified certain market sectors adopting IT at a more advanced rate, and with higher average EMRAM scores than their counterparts.

As for overall readiness to meet Stage 1 of meaningful use, the study found:

• Ten percent of the 778 hospitals are ready. They can meet all 14 core items and at least five of the 10 menu items identified in the survey.
• Another 31 percent of the hospitals should be prepared to meet Stage 1 of meaningful use shortly and are classified as most likely, since they can meet between 10 and 13 of the core items outlined in the meaningful use requirements AND can meet a minimum of three menu items.
• Just over 53 percent are classified as not likely with nine or fewer core measures (with any number of menu items).
• The final six percent of hospitals did not report that they have the capability to now meet any core or menu measures.

Summary of Core and Menu Measures	Count	Percent
Ready	78	10.03%
Most Likely	241	30.98%
Not Likely	416	53.47%
No Progress Reported	43	5.53%
Total Number of Hospitals	778	100.00%

Table Summary 1

“We also learned that it will be important to encourage health IT adoption in the mountain region of the country, as hospitals in these areas are slower to embrace health IT, and therefore, may not be ready to meet the Stage 1 meaningful use criteria.” Hoyt explained HIMSS Analytics used the US Census designation to define the regions in its report; the mountain region includes Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah and Wyoming. He also noted that the $11.9 million the U.S. Department of Health and Human Services made available in September 2011 will help support the adoption of health IT and EHR adoption for non-urban and smaller facilities.

“Summary of Meaningful Use Readiness” is the first in a HIMSS Analytics quarterly series that will evaluate the readiness of U.S. hospitals to qualify for EHR incentive payments. The next quarterly report on meaningful use readiness will be released in December 2011. Contact Amy Bergau at amy.bergau@himssanalytics.org for information on purchasing the September 2011 report or to be added to a mailing list for quarterly report updates.

About HIMSS Analytics
HIMSS Analytics is a wholly owned not-for-profit subsidiary of the Healthcare Information and Management Systems Society (HIMSS) – a nonprofit driving the change toward a smarter, more efficient healthcare system through the adoption of health IT. The company collects and analyzes healthcare data related to IT processes and environments, products, IS department composition and costs, IS department management metrics, healthcare trends and purchase-related decisions. HIMSS Analytics delivers high quality data and analytical expertise to healthcare delivery organizations, healthcare IT companies, state governments, financial companies, pharmaceutical companies, and consulting firms. Visit www.himssanalytics.org/ for more information.

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For more information, contact:
Joyce Lofstrom/HIMSS
312-915-9237
jlofstrom@himss.org

KT McGraw/HIMSS
617-779-1822
himss@shiftcomm.com

 

Today, Vice President Biden announced the winners of the Apps Against Abuse challenge – a nationwide competition launched in July 2011 with HHS Secretary Sebelius that challenged software developers to create an innovative application that provides young adults with tools to help prevent youth dating violence and assault.

Please join U.S. Chief Technology Officer Aneesh Chopra, White House Advisor on Domestic Violence Lynn Rosenthal, and HHS Chief Technology Officer Todd Park today, Tuesday, November 1 at 3:00 PM EDT for a conference call to celebrate the WINNING APPLICATIONS and to discuss the broader open innovation movement we are building as innovators continue to step up to the plate to help us solve some of the biggest challenges facing America today. Feel free to forward and share this information within your networks.

WHAT: Apps Against Abuse – Tech and Innovation Call

WHEN: Tuesday, November 1st, 3:00 PM EDT

HOW: (800) 288-9626 TITLE: White House Apps Against Abuse Call