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1 AHRQ and Health IT Public Health Data Standards Consortium J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality March 17, 2004
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2 Agency for Healthcare Quality and Research (AHRQ) u To improve the quality, safety, efficiency, and effectiveness of health care for all Americans u Lead Federal agency supporting research into improving patient safety and the quality of health care u Funds Research on –Quality measures-- Medical Expenditure Panel Survey –Strategies for quality improvement-- Decision support tools –Information Technology evaluation, tools, and databases u Patient Safety--new initiative in Health Info. Technology u FY 2004 Budget: $304 M
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3 Agenda u Patient Safety u AHRQ’s HIT program u Patient Safety Standards u PHDSC
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4 Patient Safety– a Major, National Problem u Leading to extensive –Deaths –Cost –Added suffering u Recognized in IOM reports and by Congress –To err, Chasm, others –AHRQ mandates –Proposed legislation
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5 What is? u HIT u Value u Patient Safety u Medical Error u Adverse Event
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6 AHRQ’s HIT Program for 2004 u Over $50 million in 2004 funding u Transforming Healthcare Quality through IT –Implementation Grants –Planning Grants –Demonstration Grants –HIT Resource Center –HIT Data Standards
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7 AHRQ Grants Transforming Healthcare Quality u AHRQ Planning Grants –Up to $7M for 35 new grants; $5M to rural and small communities –For HC systems and partners to implement HIT to promote patient safety/quality of care u AHRQ Implementation Grants –Up to $24M for 48 new grants’ $14M for rural and small hospitals –To evaluate the measurable and sustainable effects of HIT on improving PS & QC. –50% cost sharing, Max 20 percent on computer hardware and software u AHRQ Demonstrating the Value Grants –Up to $10M for 20 new grants; practice-based research networks encouraged to apply –To increase the knowledge and understanding of the value of HIT »Clinical, safety, quality, financial, organizational, effectiveness, efficiency u Submit application by April 22, 2004
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8 Patient Safety and Standards u 21 states collect patient safety incident (PSI) data—mostly mandatory, esp. for deaths u Data collections are not uniform or standardized u Coordination is needed to establish trends, baselines, and to learn from the successful efforts of other states
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9 Types of Info Collected u Wrong patient--Wrong site surgery u Incorrect procedure/treatment u Retained foreign bodies u Unexpected deaths u Cardiac arrests u Loss of limb or organ u Impairment of limb or bodily functions u Other serious occurrences – New York State D/Health, 2001
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10 Issues u Mandatory vs Voluntary Reporting –Non-punitive for reporting –Punitive for reporting u Data Quality –Identify low reporters –Focus on event identification methods –Show that better reporting leads to better quality
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11 Issues u Use of the information –Provider advisories –Public reporting –Quality improvement activities –Comparative reporting –Tracking and trending –Provider profiles (need better risk adjusters) –Inform consumers/patients
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12 Where’s the Info Support? u Data/systems are not interoperable –Need metadata –Need scalability –Need identifiers –Need health data standards –Need data information system integration –Need incentives
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13 Patient Safety: Data Standards u Developing a standards framework for reporting patient safety incidents u Developing common terminologies –Vocabularies –Code classifications u Mapping terminologies into SNOMED u Implementing standards in patient safety and quality of care
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14 Patient Safety Standards Needed u Add-ons to claims transactions for reporting PSI’s? –X12N, claims, e.g., low birth-weight babies –X12N, HL7 claims attachments u Special messages for reporting PSI’s –HL7 hospital messages for internal reporting and aggregation –X12N messages for reporting from hospitals to third parties, say, states u Taxonomies for classifying PSI’s for uniformity in data collection and reporting u Free text for capturing special information not codified u Drive improvements in SNOMED and other medical vocabularies
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15 Patient Safety Perspectives u CPOE: Is the Bang worth the Buck? –CPOE costs $5 million+ –What is the value of the harm averted? Sizeable. –Will physicians object to frequent and multiple alerts that reduce productivity? Where’s the incentive? u Would adding nurses improve patient safety more? u Will IT reduce the demands on the interns and residents who work many consecutive hours? –Not a substitute for reducing their excessive hours, but evidence is lacking u Will IT reduce hospital-acquired infections? »Hand washing programs may be most effective here
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16 PHDSC u Who: State health departments, state-wide health data organizations, and others u What: Reduce cost and improve the uniformity of collecting data for special needs for –Population health analyses –Consumer information –Health benefits and payment policies –Patient safety incident reporting
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17 PHDSC u Why: –To coordinate representation at standards meetings –To reduce the cost of this representation –To establish partnerships for common issues, such as patient safety incident data: »Collections, analyses, reporting, and aggregation –To learn of proposed data standards policies and problematic issues faced by similar programs
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18 AHRQ in 2003 u Funded IOM to advise on standards for PS –Report out in November 2003; published soon in 2004 u Funded IOM to develop initial functions for an EHR –Letter report delivered July 31,2003 u Worked with CMS and VA to develop the definition of an EHR as an ANSI standard, beginning with the IOM letter report and moving to HL7: –First ballot, not approved; second ballot out on March 15, 2004 –Responses addressing the negative ballots are being prepared u Maintained support of ANSI HISB for SDO coordination u Started the Patient Safety SIG at HL7 u Joined PHDSC--as a founding member u HHS NHII, Markle Foundation, CAHIT, CHI, NCVHS
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19 AHRQ in 2004 u Working in collaboration with HHS NHII u Patient Safety HIT Grants Program u Patient Safety HIT Standards Program u Continuing work on –HL7 Standard for EHR functions –Patient Safety SIG –Support of PHDSC –Others
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20 PHDSC This is a place where we bring our issues and our ideas. We avoid 50+ solutions for the the same problem. We find commonality and gain productivity. We work together to obtain change.
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21 AHRQ and Health IT Public Health Data Standards Consortium J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality March 17, 2004
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