Friday, June 17th, 2011 - 7:41
Friday, June 17, 2011 - 07:35
There are numerous IT challenges embedded within the ongoing process of health reform. The blog sits down for a Q and A with a UMD researcher intimately involved with these challenges.
The University of Maryland has embarked on a number of initiatives to address the many tough questions involved with the development and implementation of health information technology (HIT). HIT is crucial to the success of health reform and longer term efforts to improve the quality of health care and reduce its cost.
The Center for Health Information and Decision Systems (CHIDS) is “an academic research center with collaboration from industry and government affiliates, and is designed to research, analyze and recommend solutions to challenges surrounding the introduction and integration of information and decision technologies into the health care system.” CHIDS was founded in 2005 and has built an expansive research portfolio including but not limited to studies of Health Information Exchange (HIE), Electronic Health Records (EHRs), Consumer Health Informatics, Health 2.0 and the Impact of HIT. CHIDS is part the Department of Operations and Information Technology (DO&IT) at the Robert H. Smith School of Business; the pool of talent, knowledge and expertise in DO&IT is acknowledged by several publications as a Top-5 performer in research production worldwide.
The University of Maryland Center of Excellence in Health Information Technology Research (COEHITR) is “an interdisciplinary initiative with a mission to accelerate health promotion and health care transformation through the research, design, development and integration of health information and decision technologies.” The Center has four main programmatic areas: Thought Leadership in Health IT (Workshops, seminars, conferences; Policymaking and program support at federal and state level); Engagement with Entrepreneurs and Organizations for technology co-development and strategic partnerships; Faculty Research and Pilot Programs to stimulate trans-disciplinary research and collaboration with health delivery organizations; and, Education and Training to provide university programs, executive education and extension programs. The University of Maryland, between its College Park and Baltimore campuses, has a wealth of research capabilities and resources that have collectively come together in this effort. The initiative is being co-led by CHIDS and the School of Public Health along with a broad steering committee representing all academic partners and an external advisory board.
Kenyon Crowley, associate director at CHIDS and program director at the COEHITR, sat down with the “Making Health Care Reform Work” Blog to discuss the progress of HIT and some of the specific research projects that CHIDS is working on. Crowley said the initiatives are typically focused at the intersection of policy, strategy and technology, and use rigorous research methods to understand the factors that influence the adoption, use and value realization of HIT.
MSPPHealthBlog: What areas of HIT are progressing well so far?
Crowley: The Electronic Health Record (EHR) adoption pace has increased significantly since the passage of the HITECH Act, which was part of the American Recovery and Reinvestment Act of 2009. EHRs will serve as one of the core platforms to enable the vision of an interconnected health ecosystem that promotes quality, safety, efficiency and better management of costs. There has also been momentum for the creation of health information exchanges, with each state having one to several initiatives enabling the secure sharing of patient health information across different care environments to enable a more coordinated health system.
There is widespread recognition and appreciation for the role that health IT will play in healthcare transformation, which has spurred investment and is facilitating intensive work nationwide for implementing and making the best use from HIT to improve quality, safety, efficiency, and deliver a wide range of benefits. This has created a vibrant environment for mergers, acquisitions and other ventures for health IT firms and entrepreneurs. A lot of folks get credit for this, but the Office of National Coordinator for Health IT (ONC) in cooperation with their federal partners gets kudos for executing on a number of programs such as Meaningful Use, SHARP, Regional Extension Centers (RECs), Beacon Programs, State Cooperative Grants, DIRECT & CONNECT that are furthering the momentum.
We are making good progress as a state due to the work of many groups including the Maryland Health Care Commission, the Governor’s office and CRISP among others. CRISP (Chesapeake Information System for our Patients), which serves as the statewide HIE and the Regional Extension Center, has all hospitals set to be connected to the HIE within about a year, and the REC has just recently met the goal of subscribing 1,000 providers for assistance in EHR implementation. There is a vibrant HIT community in Maryland and an active HIMSS (Health Information Management Systems Society) chapter.
MSPPHealthBlog: What are some of the ongoing challenges in HIT?
Crowley: While EHR adoption is progressing, many challenges persist regarding the achievement of “Meaningful Use.” Meaningful use is three stages of rules that detail the things an EHR user must do with their EHR to qualify for federal incentives, such as prescribe a percentage of prescriptions electronically or share information electronically with other clinicians. Hospital CIO’s who manage a large portfolio of technologies are having difficulty in both understanding exactly what will be required of them in future stages of meaningful use and how to get there. The problem is accentuated for small and rural hospitals which may have fewer resources to meet these developing new requirements. Another challenge involves making EHRs usable for physicians – currently there is wide variation on how effective, efficient and satisfying EHRs are and clinicians don’t have a good mechanism for understanding and comparing different EHR options.
There are a number of challenges regarding the formation of Health Information Exchanges (HIE), which will enable different health providers to seamlessly share patient information with one another. One of the key challenges is developing an operating model to deliver the services the community values and is willing to pay for in order to sustain ongoing operations and innovation once the grant funding runs out. While there are a handful of sustainable HIEs nationwide, the vast majority are still searching for a viable model to carry them forward. There are a number of folks who have been leading sustainable and successful HIEs like HealthBridge in Ohio and Michiana Health Information Network in Indiana. In Tulsa, a Beacon community grant is essentially creating an HIE application cloud.
Another challenge involves the lack of data liquidity in the healthcare system. Even as different electronic networks and systems proliferate, there are many challenges in making the data accessible and usable in different contexts and across platforms. If we can disaggregate the data from the application layer, it should improve data liquidity and reduce the costs associated with integrating disparate systems and improve care coordination.
On the policy side, there are important questions yet to be answered on how we create appropriate structures and reimbursement mechanisms for the accountable care organization (ACO) and patient centered medical home (PCMH), respectively. HIT is a key enabler of these models, but designing payment mechanisms that adequately address the risks, costs, and patient-level factors to make these models work is not well understood. These multi-disciplinary questions underlie the importance of efforts such as CHIDS and the Center of Excellence in Health IT Research. The University of Maryland, State of Maryland, CMS and many others are analyzing these fundamental questions which will have a major impact across the healthcare system including on the bottom line.
MSPPHealthBlog: What are some of the research programs being conducted at CHIDS?
The research being undertaken by CHIDS includes a number of programs that seek to address the challenges and meaningful use of HIT. A few examples include:
1. CHIDS is working with the Maryland Health Care Commission, CRISP (Maryland’s statewide HIE), Audacious Inquiry and others on a project to improve care transitions between long-term care and acute care facilities as part of an ONC HIE Challenge Grant. The project will use direct integration of clinical summary documentation into EHRs using the HIE, as well as a portal-based delivery model. The project also features providing information on advanced directives via the HIE. CHIDS is the evaluation partner and will be conducting research to understand the barriers and constraints that may impede the successful adoption and uptake of HIE services and will assess the intervention from a multi-dimensional perspective, including health care outcomes, process measures that are predictors of healthcare outcomes, organizational drivers of adoption and use, social factors, and technical factors.
2. CHIDS is working with Westat and others, under contract with the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare and Medicaid Services (CMS), on a project entitled Development of a Model Electronic Health Record Format for Children. The Children’s Health Insurance Program Reauthorization Act (CHIPRA) directs the Secretary of Health and Human Services to undertake the development of a model electronic health record Format for children enrolled in Medicaid and CHIP programs. The goal is to develop a model electronic health record (EHR) Format designed to meet the needs of providers who treat children.
3. CHIDS along with our UMD partners in the Human-Computer Interaction Lab (HCIL), is working with Westat, Duke and the American Academy of Family Physicians (AAFP) under contract to the Agency of Healthcare and Research Quality (AHRQ) to develop, test and disseminate a toolkit that will be used to evaluate the usability of EHRs in primary care settings. The goal of this effort is to educate clinicians and vendors on effective and efficient EHR designs that support patient safety and a satisfying clinician experience. A product of running the toolkit may be a usability report.
4. CHIDS is working with the Air Force Medical Service on a pilot implementation of a personal health record and patient-provider secure messaging technology within a clinical context. Research will determine whether the arrangement influences attitudinal measures and clinical outcomes. This program is a component of the AFMS patient centered medical home initiative. CHIDS is also working with the AFMS on applied informatics activities. The AFMS has ongoing work to collect relevant Military Health System (MHS) clinical data into a Health Services Data Warehouse (HSDW), which contains significant breadth and depth of data (9 million beneficiaries), and because it contains both direct care and purchased care data in the same repository, it represents a unique dataset that is of enormous potential value to clinical research. Together, we are analyzing key issues relating to operationalizing a large scale data sharing project to be made available for academic researchers.
We also have ongoing research streams aimed at understanding the role of “health 2.0” in influencing care coordination, outcomes, and business drivers for health care organizations; quantifying the impact/ROI of HIT, and programs relating to the design of consumer health informatics, and we work in cooperation with companies of large and small to drive innovation, strategy and product development.
Thank you for the opportunity to share some of what we are doing at the University of Maryland to accelerate health care transformation. It’s a wonderfully exciting time to be part of the health IT community and it’s thrilling to work with such smart, passionate, and provocative researchers and partners in the pursuit of a more patient-centric health system that yields improved quality, safety and efficiency, as well as increased clinician and patient satisfaction.
