Public Health IT Public Health Enabled Electronic Health Records, Decision Support, and Their Role in the Meaningful Use of Healthcare Technology Lecture a This material (Comp13_Unit4a) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC

EHRs, Decision Support, and Meaningful Use of HIT Learning Objectives Discuss the New York City Department of Health and Mental Hygiene partnership with a commercial EHR vendor and how it created a public health-enabled HER (Lecture a) Describe the EHR "meaningful use" movement and how it could transform existing clinical/public health practices (Lecture a) 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a

New York City Public Health Goals 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a Have a regular doctor or other health care provider Be tobacco free Keep your heart healthy Know your HIV status Get help for depression Live free of dependence on alcohol and drugs Get checked for cancer Get the immunizations you need Make your home safe and healthy Have a healthy baby Take Care New York advises that every New Yorker take these 10 steps to lead a healthier life:

Primary Care Information Project (PCIP) The Primary Care Information Project (PCIP) is a bureau of the NYC Department of Health and Mental Hygiene PCIP is also the regional EHR extension center for NYC Since 2005, PCIP has administered the nation’s largest community EHR expansion program 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a

PCIP (cont.) Table 1.1 (Primary Care Information Project, 2010.) 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a PracticesSitesProviders Hospitals CHCs Small Practices Total

ECW/PCIP Partnership eClinicalWorks (ECW): –a CCHIT-certified vendor providing one integrated system for practice management/EHR/billing/PHR 2007 partnership between PCIP and eClinicalWorks to develop public health functionality in response to Department of Health initiative: Take Care New York This experience helped to shape the criteria for meaningful use as envisioned by PCIP’s founder Dr. Farzad Mostashari 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a

Deal for the Providers 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a We give them… ECW software 10 days of onsite training Data migration services Business analyst services Discounted ASP services Onsite technical assistance They are responsible for… Hardware Staff time spent in training Lost revenue Self-tutorial & web-based learning $4000 per FTE for Technical Assistance

Additional Services 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a Contemplation Provider outreach & education Vendor selection Group purchasing discounts Readiness assessments IT consultation Partners for financing & workforce development Implementation Contract accountability Project management Workflow redesign (large practices) Social networking Communication outreach

Additional Services (cont.) 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a Post go live Revenue cycle optimization EMR consulting QI consulting PCMH preparation Privacy & security consulting Work flow redesign (small practices) Patient portal training Interfaces (e.g.,labs, registries) Pilots Meaningful use Quality measures Utilization measures Health Information Exchange Interoperability Patient engagement Biosurveillance

2010 Goals Extend EHRs that support prevention to 2,500 Medicaid providers, over 1.5 million patients Support EHR-enabled providers in a standardized health information exchange Design and implement a pay-for-performance incentive program that supports and recognizes preventive measures Prepare providers to meet “meaningful use” requirements 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a

NYC REACH Extension Center The Extension Center must be capable of providing assistance to all providers in a designated region, but priority shall be given to providers that are primary- care physicians and/or other health care professionals with prescriptive privileges, such as physician assistants and nurse practitioners A few of the primary priorities of NYC REACH are: 1.Assisting providers to adopt an EHR 2.Providing assistance to reach “Meaningful Use” of the EHR 3.Enabling the electronic exchange of health information between EHRs 4.Reporting of quality measures using the EHR 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a

Meaningful Use as a “Launch Pad” The American Recovery and Reinvestment Act (ARRA) provides over $40 billion in health IT incentives to assist and reward providers for achieving “meaningful use” Primary goal of HIT stimulus –Use timely/easily accessible information to improve the delivery and consistency of effective health care Adoption of technology is not enough Five key areas to integrate technology to improve overall health and delivery systems 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a

Meaningful Use Goals 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a 1. Improve quality, safety, efficiency, and reduce health disparities Provide access to comprehensive patient health data for patient’s health care team Use evidence-based order sets and CPOE e-prescribing Apply clinical decision support at the point of care Generate lists of patients who need care and use them to reach out to patients Report to patient registries for quality improvement, public reporting, etc.

Meaningful Use Goals (cont.) 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a 2. Engage patients and families Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health 3. Improve care coordination Exchange meaningful clinical information among professional health care team

Meaningful Use Goals (cont.) 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a 4. Improve population and public health* Submit data (immunization, syndromic surveillance and reportable disease) to public health agencies 5. Ensure adequate privacy and security protection for personal health information Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law Provide transparency of data sharing to patients

Improve population and public health: 2011 Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a

Improve population and public health: 2013 Receive health alerts from public health agencies Provide sufficiently anonymized electronic syndrome surveillance data to public health agencies with capacity to link to personal identifiers Receive immunization histories and recommendations from immunization registries 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a

Improve population and public health: 2015 Dynamic and Ad hoc quality reports Clinical dashboards Use of epidemiologic data Automated real-time surveillance –Adverse events –Near misses –Disease outbreaks –Bioterrorism 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a

EHRs, Decision Support, and Meaningful Use of HIT Summary – Lecture a Significant support was given to providers in New York City by the Health Department to adopt a prevention-oriented EHR capable of sending electronic health data, particularly syndromic surveillance, quality measurement, and immunization histories 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a

EHRs, Decision Support, and Meaningful Use of HIT References – Lecture a References 1.Singh MP. Project Management: Lessons from the Primary Care Information Project. In Medical Informatics. An Executive Primer. Editor Ong K Healthcare Information and Management Systems Society (HIMSS), Chicago Ill. Second Edition Chapter Dr. Farzad Mostashari is currently serving as Deputy National Coordinator for Programs and Policy Mostashari F, Tripathi M, Kendall M. A tale of two large community electronic health record extension projects. Health Aff (Millwood) Mar-Apr;28(2): Primary Care Information Project. Accessed: October 1, 2010 from Charts, Tables, Figures 1.1 Table: DeLeon S, Shih SC. Tracking the delivery of prevention-oriented care among primary care providers who have adopted electronic health records. J Am Med Inform Assoc. (2011), ahead of print. August 19, Image Slide 5: Primary Care Information Project. Accessed: October 1, 2010 from 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture a