HIMSS: Knowledge, Insights and Community November, 2014 H. Stephen Lieber HIMSS President & CEO

Introduce You To HIMSS Mission: Transform health through information technology Services: Education, events, analytics & consulting, media, communities Reach: Operate in 20+ countries Annually reach more than 600,000 professionals

Key IT Relationships Quality IT is a critical component to the creation of a safe environment and quality patient outcomes Value IT produces significant value on a multi- dimensional metrics

The european EMR Adoption Model … in 8 Stages to Highest Quality in Patient Care “Paperless” patient record environment for highest quality of care, data continuity & full HIE Full electronic clinical decision support, and highest medication safety Completely electronic diagnostic image management Electronic order entry with decision support and result reporting Clinical ordering and documentation – especially nursing care A patient-centered electronic data repository Electronic diagnostic and pharmacy department information

EMR Adoption in the UK and Europe ... based on HIMSS European EMR Adoption Model EMRAM Scores, % of Hospitals, Q3/2014 (based on data from latest 24 months, no weighting etc. applied) Stage United Kingdom Europe* Stage 7 0.0% 0.2% Stage 6 1.1% 2.9% Stage 5 57.1% 24.4% Stage 4 3.3% 5.5% Stage 3 3.1% Stage 2 9.9% 29.8% Stage 1 6.6% 12.0% Stage 0 22.0% 22.1% N 91 1,287 Mean 3.6 2.7 * Includes Austria (35), Belgium (1), Denmark (24), Finland (3), France (17), Germany (252), Ireland (1), Italy (400), Netherlands (69), Norway (3), Poland (3), Portugal (18), Slovenia (2), Spain (216), Sweden (1), Switzerland (8), Turkey (143) Source: HIMSS Europe Database, Q3/2014 (data from 10/2012 – 09/2014) Status as of 10/1/2014

Advanced EMR Capabilities and Quality. High Correlation: Advanced EMR Capabilities and Quality. When we look at the shift in the distribution of hospitals in the HIMSS Analytics EMRAM model over the last seven years, we clearly see the impact of the Federal government’s ARRA/HITECH initiative on the HIT adoption behavior of U.S. hospitals.

EMRAM and QUALITY: Hospital Mortality QUESTION 1: What is the association between EMR capabilities and hospital mortality? Paired HIMSS Analytics EMR Adoption Model (EMRAM) scores with Healthgrades’ hospital quality/mortality data. In General… the more advanced the hospital’s EMR capabilities… the more likely the hospital is to have better risk-adjusted mortality rates when treating conditions like Heart Attack, Heart Failure, Stroke, several types of GI surgeries, Pneumonia, Sepsis and Respiratory failure. Utilized three years of Medicare data (2010 – 2012), clustered data by Healthgrades defined service line to create 5 statistical models by service lines, and compared these to same year EMRAM scores Analyzed actual mortality rate, predicted mortality rate, and z-score Predicted and z-score mortality rate score strongly associated with the EMRAM score

US Hospitals with an "A" Leapfrog Hospital Safety Grade by EMRAM Stage Tipping Point

EMRAM and QUALITY: Staff Perceptions QUESTION 2: What is the association between EMR capabilities and staff perceptions of hospital safety? “Bumped” HIMSS Analytics EMR Adoption Model (EMRAM) scores against AHRQ’s Hospital Survey on Patient Safety Culture In General… the more advanced the hospital’s EMR capabilities… the more positive the staff are about their hospital’s “patient safety culture”. Compared most currently available AHRQ dataset (2011) to 2011 EMRAM scores (ensure we have apples to apples comparison) Looked at two AHRQ variables by EMRAM stage: System and Procedure Effectiveness in ensuring patient safety Overall Patient Safety Culture Grade Both variables showed a strong association with the EMRAM score The staff’s perception of the effectiveness of their hospital’s systems and processes in ensuring patient safety increased with advanced EMR capabilities The staff’s self-reported grade of the hospital’s patient safety culture (where A = the best grade; B = second best grade; etc…) improved with advanced EMR capabilities

IT value can be measured on multi-dimensional metrics

HIMSS Value STEPS™ Model The five Value STEPS are: 1) Satisfaction 2) Treatment / Clinical 3) Electronic information and Data 4) Patient safety and Education 5) Savings The HIMSS Value STEPS Model, found on the HIMSS Value Suite page, is an interactive tool designed to demonstrate the subtypes of value and how they relate to the main categories. In this example, the Treatment and Clinical category has three subtypes: Quality of Care, Efficiencies, and Safety. Here we see Quality of Care highlighted and the specific value statements found in that subtype. Reduction in Readmissions is one of those value statements, and in the model, we include several examples of real providers who have realized that value. Each document at the outer edge tells more of the story. The model does not include all 1100 examples we’ve collected, but does show examples for each of the 87 values we’ve identified

HIMSS HIT Value Suite Collection of over 1200 examples of HIT value 900 unique organizations represented Examples identify: Over 80 specific types of value in the HIMSS Value STEPS™ Methods to achieve benefits realization Lessons learned Since starting the project, HIMSS has collected over 1100 examples of providers, patients and other stakeholders realizing a wide variety of benefits As of this date, HIMSS has identified 87 specific types of value that have actually been realized by real providers and their patient population By extension, this means communities and populations are beginning to see positive results from the appropriate use of HIT From this collection, HIMSS has been able to identify the five main categories of value, and how the 87 subtypes are distributed We can also learn how to target value in the early stages of an implementation, how to manage to that goal, and how to measure success As we are all aware, not every implementation goes as planned, and through these examples, we can learn more about what works and what doesn’t

Value Suite is Global The HIMSS Value Suite page also includes a global map that represents a growing number of the examples we’ve identified. As of this date, over 500 examples are seen. Visitors can choose to show only academic medical centers, or critical access hospitals for example. By clicking on the icon, you can see provider name, type and location

Value Suite is Local By clicking on the icon, you can see provider name, type and location

Value Suite Case Studies Liverpool Heart and Chest Hospital NHS Foundation Trust Increased data sharing allows better management of disparate information St. Helens and Knowsley Teaching Hospitals NHS Trust Improved integration with other organizations University Hospital of Wales Continuous availability of patient data to nurse midwives South London and Maudsley NHS Foundation Trust Patients engaged through use of health status diary 1) Currently over 100 European Cases 2) 45 in the UK 3) Here are some examples of what we’re finding in the UK

Steve Lieber (slieber@himss.org) Knowledge, Insights, Networking. Join the HIMSS Community at HIMSS.org. Thank You. Steve Lieber (slieber@himss.org)