Performance Improvement 2007. Objective 5.5: Accelerate the development and use of an electronic health information infrastructure

Summary:

This study explored the federal government's role in the emerging technology of personal health records. The study team interviewed 15 experts in key positions in the federal government and health care and health information technology fields. The team drew from presentations at two hearings on personal health record models. There was general agreement that the federal government should facilitate standards-based approaches to health data collection and exchange and finance and help disseminate findings from a wide range of experiments to find the most successful public health record models. The government could be most effective by avoiding two possible pitfalls: sponsoring a superficial, one-size-fits-all public health record, and allowing many agencies to offer independent pubic health records with little coordination or strategic vision. The real test for public health records would be whether they made it easier for ordinary people to engage more actively in maintaining their own health and health care with better communication, improved safety, enriched knowledge and confidence, and trusted safeguards of their privacy. The study team concluded that the federal government should take a lead role as personal health records evolve in order to help promote this new technology becoming a trusted, widely used tool.

Report Title: Identifying Appropriate Federal Roles in the Development of Electronic Personal Health Records: Results of a Key Informant Process http://odphp.osophs.dhhs.gov/projects/PHRecords/default.htm
Agency Sponsor: OPHS-ODPHP, Office of Disease Prevention and Health Promotion
Federal Contact: Harris, Linda, 240-453-8262
Performer: David Lansky, Susan Kanaan, Josh Lemieux; working under auspices of FACCT, Foundation for Accountability; Portland, OR
PIC ID: 8467

Summary:

This study assessed the value of using data from the Department of Labor's Pension and Welfare Benefits Administration for determining whether employees received employer-provided health care. The study used administrative records from benefit plans filed annually by firms (on IRS Form 5500, that provides information on employee benefit plans, including data on different types of health insurance plans) when merged with individual and employer data from the Census Bureau's Longitudinal Employer Household Dynamics data program. The study explored what proportion of the health benefit plans on file in the Form 5500 data can accurately be linked to specific employers. Further, the study examined how the proportion of firms offering health plans observed in these data coincides with what was observed in other data sources. The study looked at individual workers and whether their employment by firms that had and had not filed health plans was consistent with their self-reporting of access to health benefits as reported in the Current Population Survey and the Survey of Income and Program Participation. Finally, the study examined the types of questions that these data could inform, and identified some descriptive findings on changes in employer health benefits that illustrate what the first steps of such a research agenda might look like.

The study found that while the data are not well-suited to examine the proportion of workers receiving employer-sponsored health care or the proportion of firms offering health care, they could contribute significantly to our understanding of the types of firms that offer health plans, as well as how offers and cost-sharing change over time within specific firms. Several types of research questions could be pursued with the data systems identified. How much of the increases in employer health care costs are passed along to employees? How do such increases affect employee participation in employer-offered health insurance plans? How does turbulence in an economic sector affect the kinds of benefits being offered by businesses in that sector? Do reports by workers accurately reflect changes in employer offerings?

Report Title: Employer Provided Health Insurance: What can be Learned from the 5500 Data? http://aspe.hhs.gov/hsp/05/admin-data-emp-ins/index.htm
Agency Sponsor: ASPE, Office of the Assistant Secretary for Planning and Evaluation
Federal Contact: Hauan, Susan, 202-690-8698
Performer: U.S. Census Bureau; Washington, DC
PIC ID: 8289

Summary:

The study examined what physicians in small practices (nine or fewer members) believe are the elements of electronic medical records (EMRs) that will improve the quality of their health care and provide them with the greatest financial return. The study also sought to identify the most efficient, effective and successful implementation strategies for EMRs in these small practice offices. This, the first part of a two part study, focused on understanding the factors influencing adoption of electronic health records in small practices and developing an explanatory model incorporating these factors. Electronic medical records are viewed as a means to achieve improved health care quality and reduced costs. A number of public and private sector initiatives focus on promoting the adoption of health information technology such as community- and physician-focused initiatives. Despite these initiatives, the adoption of EMRs has been limited. Adoption rates vary widely across care settings; for instance, rates in ambulatory settings range between 15 and 18 percent. With approximately 75 percent of physician practices employing fewer than nine physicians, such low adoption rates among small practices does not bode well for a national goal of achieving broad use of electronic medical records. Low rates of EMR adoption have been attributed to a variety of forces including: misaligned financial incentives, lack of standard system applications, and the high turnover of health information technology vendors. Few studies have examined, at a microeconomic level, the various economic and non-economic factors that promote or deter EMR adoption in small practice settings. The analysis revealed that physicians are motivated to adopt electronic medial records by both financial and non-financial factors. Physicians care about quality and patient safety in addition to their income and leisure.

Report Title: Assessing the Economics of Electronic Medical Record Adoption and Successful Implementation in Physician Small Practice Settings http://aspe.hhs.gov/sp/07/adoption/index.htm
Agency Sponsor: ASPE, Office of the Assistant Secretary for Planning and Evaluation
Federal Contact: Burke-Bebee, Suzie, 202-401-8266
Performer: Moshman Associates, Inc.; Bethesda, MD
PIC ID: 8475

Summary:

This study provided recommendations regarding the use of health information technology content and messaging standards that could be applied to existing and emerging health assessment requirements (such as the assessments that nursing homes, home health agencies, and in-patient rehabilitation facilities are required to complete). Health information technology is expected to improve the quality of health care and patient safety, decrease costs, and increase efficiencies in health care delivery. To facilitate the effective and efficient use of health information technology generally, voluntary consensus standards are gradually being developed and adopted by a wide range of public and private individuals and organizations. To most efficiently support health information exchange and re-use, health information technology solutions must be "interoperable." Interoperability means the ability of different health information technology systems, software, and networks to exchange and reuse data accurately, effectively, securely, and consistently in various settings, including preserving the meaning of the data. Nursing homes, home health agencies, and in-patient rehabilitation providers face challenges in acquiring and implementing such interoperable health information technology solutions. Research has found that the health information technology products used by these providers are not interoperable with electronic health records systems used in other health delivery settings (for example, acute care hospitals and physician practices). Federal requirements for patient assessments are a significant barrier to interoperability. These assessments are not linked with health information technology standards that would support standardized exchange and reuse of assessment content. Federal law and Centers for Medicare and Medicaid Services' regulations require that Medicare and Medicaid certified nursing home providers complete, and electronically submit, patient-specific health and functional assessment information several times during each patient's stay. In nursing homes, the required assessment is the "Minimum Data Set" (MDS). Medicare, and sometimes Medicaid, uses this data to determine provider payments, report on various quality activities, and for other purposes.

The study , conducted in collaboration with the Centers for Medicare and Medicaid Services, examined how to apply health information technology standards to the Minimum Data Set. The study identified possible matches of standardized vocabulary terms and concepts with the Minimum Data Set concepts. The study also represented the Minimum Data Set in a format known as "Logical Observation Identifiers Names and Codes" (LOINC). The use of the LOINC format enables the standardized exchange using health information technology messaging standards of assessment results. The study constructed sample messages using data elements from the Minimum Data Set that had been represented in the LOINC format and linked standardized vocabulary content. The standards identified in this study were endorsed by the Consolidated Health Informatics (CHI) Initiative, one of the electronic government activities under the Office of Management and Budget and recommended for adoption and use by the National Committee for Vital and Health Statistics.

Report Title: Making the Minimum Data Set Compliant with Health Information Technology Standards http://aspe.hhs.gov/daltcp/reports/2006/MDS-HIT.htm
Agency Sponsor: ASPE, Office of the Assistant Secretary for Planning and Evaluation
Federal Contact: Harvell, Jennie, 202-690-6443
Performer: Apelon; Alameda, CA
PIC ID: 8338

Summary:

This study assessed the role of MEDLINE when accessed via wireless handheld computers in real clinical scenarios. MEDLINE is a database of over 15 million references to articles published in more than 5,000 current biomedical journals from the United States and over 80 foreign countries. It is an indexing service for research in medicine and related fields. "MD on Tap" is a software application enabling individuals, using personal digital assistants or smartphones to search and retrieve MEDLINE citations in real time directly through a wireless connection to the Internet. MEDLINE and MD on Tap are sponsored by the National Library of Medicine. For this study medical residents accompanied teams on teaching rounds in intensive care units and general medical wards of teaching hospitals, recording clinical questions in real clinical scenarios and searching MEDLINE for answers. The study found MEDLINE to be useful in answering clinical questions and found that MD on Tap was an effective interface to MEDLINE in clinical settings. The system was easy to use and allowed clinicians to quickly find relevant citations. The study analyzed the search and retrieval results from 363 clinical questions asked by members of clinical teams during 77 daily rounds. Answers to 246 (68%) questions were found in MEDLINE by five physicians during rounds using the handheld devices. Strategies that significantly (at the p<.05 statistical confidence level) facilitated timely retrieval of results included using spell check, and using three to four search terms. Possible improvements identified by the study included expanded automatic topical and evidence-level clustering and providing patient outcome information along with the titles of the retrieved articles.

Report Title: Evaluating MD on Tap and MEDLINE via Handheld Computers as a Resource for Mobile Clinicians. http://aspe.hhs.gov/pic/fullreports/06/8393.htm
Agency Sponsor: NIH, National Institutes of Health
Federal Contact: Hauser, Susan, 301-435-3209
Performer: University Clinical, Education and Research Associates; Honolulu, HI
PIC ID: 8393