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Making “Enhanced Use” of Health Information Engelberg Center for Health Care Reform May 14, 2010

Making “Enhanced Use” of Health Information Mark McClellan, MD PhD Director Engelberg Center for Health Care Reform May 14, 2010

Needed Information to Improve Care: Byproduct of Electronic Information for Health Care Research Variables Medical Record Entry Age, Sex, Race/Ethnicity 65 YO White male Smoking status Smoker Health coverage FFS Medicare + PDP Diagnoses Type 2 diabetes Medications Avandia Primary Prevention Flu shot Care Coordination Referral: Eye Exam Secondary Prevention Foot inspection & sensitivity tests Diagnostic test results A1c: 7.5% LDL: 100 Vitals Blood Pressure: 140/89 BMI: 25% Other health outcomes ER admission for hypoglycemia Preventable adverse events 3

Data-Sharing to Support Better Decisions Data on care experience, health status, race, etc. Electronic Feedback: data exchange, Data Exchange patient lists, decision support, alerts, etc. Integrated Health Care Health Info Delivery Plans Mgmt. Exchange Systems 4

Recent Legislative Support for Enhanced Information on Health Care Quality Safety & Health Comparative Surveillance Effectiveness • Center for Medicare • Grants to support • Patient-Centered PPACA and Medicaid Innovation electronic public health Outcomes Research • ACO Shared Savings surveillance Institute (2010) • National Oral Health Program Surveillance System • “meaningful use” • HIT Policy Committee to • Funding to develop data ARRA • data standards and consider national infrastructure for CER certification infrastructure needs for • Federal Coordinating requirements drug safety and Council for CER • Beacon biosurveillance • SHARP • Sentinel active post- FDAAA market drug surveillance system using electronic healthcare information 5

Data-Sharing to Support Better Decisions Data on care experience, health status, race, etc. Electronic Feedback: data exchange, Data Exchange patient lists, decision support, alerts, etc. Integrated Health Care Health Info Delivery Plans Mgmt. Exchange Systems 6

Data Sharing to Support Better Decisions … And for Measuring and Improving Quality Data on care Performance information experience, health for informed selection of status, race, etc. providers Electronic Feedback: data exchange, Data Exchange patient lists, decision support, alerts, etc. Integrated Health Care Health Info Delivery Plans Mgt. Exchange Incentives for Systems improvement; benchmarks Numerators: Provider Performance Numerator Denominator Rates; s Denominator Patient Privacy Protected Consistent Performance Measures 7

Performance Measurement at Varying Levels of Summarization Denominator Numerator MU Enhanced Uses Type 2 Diabetics A1c <7.0% 40 20 50% 75% 40 30 Practice 50% County 33% 60 20 75% State 66% 140 70 20,000 15,000 County 150,000 100,000 State 8

Examples of Enhanced Uses of Health Information Question : Research Variables Is Avandia confounders Age, Sex, Race/Ethnicity associated with Smoking status increased risk of heart attack? Health coverage cost data Question : Diagnoses condition data How does my physician’s Medications performance Primary Prevention Utilization/Process compare to others Care Coordination data in my area, in Secondary Prevention keeping A1c levels below 7.0% A1c test results among patients Lipid test results with Type 2 Blood pressure Health outcome diabetes? BMI data ER/Hospital admissions Hypo/hyperglycemia 9

Data Sharing to Support Better Decisions … And for Measuring and Improving Quality Data on care Performance information experience, health for informed selection of status, race, etc. providers Electronic Feedback: data exchange, Data Exchange patient lists, decision support, alerts, etc. Integrated Health Care Health Info Delivery Plans Mgt. Exchange Incentives for Systems improvement; benchmarks Numerators: Provider Performance Numerator Denominator Rates; s Denominator Patient Privacy Protected Consistent Performance Measures 10

Data Sharing to Support Better Decisions … And for Public Health Surveillance Data on care Better information on experience, health risks of medical products status, race, etc. Electronic Feedback: data exchange, Data Exchange patient lists, decision support, alerts, etc. Integrated Health Care Health Info Delivery Plans Mgt. Exchange Systems Better information on patient risks Numerators: Adverse Event Rates; Numerator Denominator Patient Privacy Protected s Denominator Medical Product Safety Signals 11

Data Sharing to Support Better Decisions … And for Comparative Effectiveness Evidence Data on care Improved information for experience, health treatment decisions status, race, etc. Electronic Feedback: data exchange, Data Exchange patient lists, decision support, alerts, etc. Integrated Health Care Health Info Delivery Plans Mgt. Exchange Improved Systems information for treatment decisions Numerators: Outcome Rates for Patient Numerator Denominator Groups “Randomized” to s Denominator Different Treatments Comparative Effectiveness Evidence 12

Distributed Health Information hospitals physicians claims EHRs registries pharmacies clinical labs 13 PHRs PHR

Reinforcing Financial Support High-Value Capacity to Generate Support for Applying = + Health Care Knowledge that is Knowledge System Actionable • HIT Meaningful Use • Quality Reporting Programs – Payments for Reporting – E-Prescribing • Provider Payment Reform for Increased Value – Bundled payments, medical homes, other provider payment reforms through Innovation Center – Accountable Care Organizations • Research and evaluation grants, other public and private funding for comparative effectiveness research and post-market surveillance 14

Getting There from Here: Improving Clinical Data Systems Quality Comparative Safety Measurement Effectiveness Surveillance and Reporting Research Appropriate testing # of A1c tests Administrative for patients using ------- ordered high-risk medications Data Episode-based resource Medications Administrative use linked to quality prescribed when measures for comm on + Specific % Type 2 diabetics contraindicated by medical and common Additional with A1c < 7.0% allergy list surgical conditions Clinical Data Preventable hospital Quality of life and functional A1c value + daily Electronic & admissions due to outcomes for common blood glucose adverse drug event Personal conditions (e.g. AMI, hip deviations replacement, diabetes) Health Records 15

Key Challenges & Policy Questions High-Value Capacity to Generate Support for Applying = + Health Care Knowledge that is Knowledge System Actionable Timely Relevant Valid Mechanisms for Priorities for Data Critical Mass of Data Sharing Collection & Summary Standardization Measures Network Access Alignment between Sufficient Clinical Privacy and Patient & Population and Statistical Security Health Accuracy and Mechanisms for Reliability of summarizing data Measures for reuse 16

Making “Enhanced Use” of Health Information Engelberg Center for Health Care Reform May 14, 2010