1. The Role of Health Information Technology Regional Extension Centers in Texas

2. Goal: Use health communication strategies and health information technology (IT) to improve population health outcomes and health care quality, and to achieve health equity. Why Are Health Communication and Health Information Technology Important?  Effective use of communication and technology by health care and public health professionals can bring about an age of patient- and public-centered health information and services. By strategically combining health IT tools and effective health communication processes, there is the potential to:  Improve health care quality and safety.  Increase the efficiency of health care and public health service delivery.  Improve the public health information infrastructure.  Support care in the community and at home.  Facilitate clinical and consumer decision-making.  Build health skills and knowledge. Berkman ND, DeWalt DA, Pignone MP, et al. Literacy and health outcomes: Summary [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2004 Jan. 8 p. (AHRQ publication; no. 04-E007-1); (Evidence report/technology assessment; no. 87). Available from: http://www.ahrq.gov/clinic/epcsums/litsum.htmhttp://www.ahrq.gov/clinic/epcsums/litsum.htm Department of Health and Human Services (US), Office of Disease Prevention and Health Promotion. Health literacy online: A guide to writing and designing easy-to-use health web sites [Internet]. Rockville, MD: Office of Disease Prevention and Health Promotion. Available from: http://www.health.gov/healthliteracyonline/why.htmhttp://www.health.gov/healthliteracyonline/why.htm

3.  The IOM Committee on Improving the Patient Record, formed in 1991/ report in 1997.  This report sought to understand why diffusion of information management technology was lacking in medical record systems  Identified impediments and way to overcome them  Suggested improvements, plans, policies and strategies for the integration and use health IT. Dick RS, Steen EB, Detmer DE. The Computer-Based Patient Record: An Essential Technology for Health Care, Washington, D.C.: National Academy Press; 1997. http://books.nap.edu/books/0309055326/html/index.html http://books.nap.edu/books/0309055326/html/index.html

4. Care Oriented  Rapid retrieval  Contemporary  Accurate  Complete information  Point of care  Knowledge databases  Decision support  Care coordination  Referral/followup  Remote monitoring Evaluation Oriented  Tracking costs and value  Assessing performance  Monitoring populations  Supporting research  Aiding communications Committee on Improving the Patient Record (IOM); 1991,1997Committee on Improving the Patient Record (IOM); 1991,1997

7.  $642 million allocated to establish 62 HIT regional extension centers nationally to assist Priority Primary Care Providers (PPCP’s) with electronic medical record (EMR) adoption and Meaningful Use  A Priority Primary Care Provider (PPCP) is defined as a physician (Internal Medicine, Family Practice, OB/GYN, Pediatrics) and other healthcare professionals (PA, NP, Nurse Midwife, or dentist) with prescribing privileges in the following settings:  Small group practices (10 or less providers)  Providers affiliated with community health centers and rural health clinics  Providers who serve mainly underinsured and medically underserved populations  Public or critical access hospitals  Four awarded in Texas  EMR consulting available for primary care providers

8. Texas Regional Extension Centers Texas Medical Association West Texas Regional Extension Center Texas Tech University HSC $7.1 Million 1,133 providers $35.4 Million North Texas Regional Extension Center DFW Hospital Council $8.4 Million 1,498 providers CentrEast Regional Extension Center Texas A&M HSC $5.2 Million 1,000 providers Gulf Coast Regional Extension Center UT HSC Houston $15.2 Million 2,928 providers

9. Partnering with state and local HIEs EHR system selection Readiness assessment Practice workflow redesign HIT education & training Achieving meaningful use EHR implementation Prepare for future pay for performance PlanTransitionImplementOperate & Maintain 1234 WT-HITREC Strategy: Align with TMF & A&M REC to create standard WT-HITREC Strategy: Partner with Vendors & Implementation partners

10. M1

11. How much am I paying? What am I buying What am I buying? Hosp MD Rx Procs RESULT: Uncoordinated care Antagonistic relationships Hosp MD Rx Procs RESULT: Coordinated care Collaborative relationships PHS

12. 12 Confidential Results Distribution Medication History Eligibility Checking Quality Reporting Disease Management Medication Compliance eRx Electronic Medical Record Electronic Health Record with Consumer Access Public Health Reporting Public Health Surveillance Research Immunization & Disease Registries Clinical Documentation Alerts to Providers Referral Processing VALUE DEGREE OF DIFFICULTY Order Mgmt The ultimate value is achieved as we move from services that enable the exchange of individual health information to those that improve community health information

13. Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.001 % of Patients Receiving Care A significantly higher proportion of patients being treated by physicians with EHRs received care that aligns with accepted treatment standards *

14. A significantly higher proportion of patients being treated by physicians with EHRs obtained better outcomes* * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.005 % of Patients Obtaining Outcome Standards Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article

15. * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.001 % of Patients Receiving Care A significantly higher proportion of patients being treated by physicians with EHRs received care that aligns with accepted treatment standards * Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article

16. % of Patients Obtaining Outcome Standards * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant p<0.002 A significantly higher proportion of patients being treated by physicians with EHRs obtained better outcomes * Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article

17.  Improve patient safety and quality of care through analysis and automation  Easily navigate the EHR vendor marketplace, utilize EHR market analysis, confirm vendor certification  Achieve EHR meaningful use objectives to maximize incentives and minimize financial and administrative burdens  Navigate the incentive process to help secure payment  Utilize EHR’s in a meaningful way so patient information is available when and where it is needed  Access to the collective intelligence of Regional Extension Centers across the country  Prepare for future pay for performance programs

18. Information Definitions Decision Support Collection Systems & Workflow Metrics Population Outcome Stage 1 Stage 2 Stage 3 e-Health Adopt, e-RX, Quality Report or CPOE Population Monitoring, Surveillance, Research Rx Interactions, Compliance, Alerts Clinical Pathways Individual Population Disease Outcomes Management Patient Safety Assurance Care Management Personal Health Public Health Translation

19. Data capture and sharing Advanced clinical processes Improved outcomes Bending the Curve : Achieving Meaningful Use of Health Data “Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.” Modified after: Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009 Meaningful Use Workgroup Presentation : Paul Tang & Farzad Mostashari Better preventive care assessment and public health functions

20. Discussion