Chapter 1: The National Health Information Technology Landscape

2003: Medicare Modernization Act

- Expanded the program to include prescription drugs and mandated the use of electronic prescribing (e-prescribing) among health plans providing prescription drug coverage to Medicare beneficiaries.

MIIPS: Merit-Based Incentive Payment System

- Providers will receive payments based on performance MIPS Performance Category: 1. Quality (50%) 2. Advancing Care Information (25%) 3. Clinical Practice Improvement Activities (15%) 4. Resource Use (10%)

1996: Health Insurance Portability and Accountability Act (HIPAA)

- Signed by Bill Clinton - Makes health insurance more affordable and accessible - Simplified administrative processes - Protected the security and confidentiality of personal health information

Interoperability Barriers

1. Governance and alignment of agendas among disparate organizations 2. Not Technology 3. Health Information Blocking

Interoperability Organizations

1. HL7 2. FHIR 3. Sequoia Project 4. Commonwell Health Alliance

"Triple Aims" for the US Health Care delivery System

1. Improve the patient experience of care 2. Improve the health of populations 3. Reduce per capita cost of health care (IHI, n.d.)

Chapter 1 Summary

1990's: The Call for HIT IOM HIPAA 2000 - 2010: The Arrival of HIT HITECH Act 2010 - Present: Health Care Reform and the Growth of HIT ACA MACRA Value-based & alternative payment programs Interoperability

2000-2010: The Arrival of Hit

2000: IOM publish a report estimating 44,000 - 98,000 patients die each year because of medical errors 2003: Medicare Modernization Act was passed - Expanded the program to include prescription drugs and mandated the use of electronic prescribing (e-prescribing) among health plans providing prescription drug coverage to Medicare beneficiaries. 2004: Office of the National Coordinator for Health Information Technology (ONC) - Charged the office with providing "leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care" 2009: Health Information Technology for Economic and Clinical Health (HITECH) Act - Legislatively mandated it to provide leadership and oversight of the national efforts to support the adoption of Electronic health records (EHRs) and Health information Exchange (HIE)

2010 - Present: Health Care Reform and the Growth of HIT

2010: President Obama signed the Patient Protection and Affordable Care Act (PPACA), known as the Affordable Care Act (ACA) 2015: Medicare Access and CHIP Reauthorization Act (MACRA) - Value-based payment methods - Alternative payment methods

Commonwell Health Alliance

A consortium of HIT vendors and organizations who are committed to achieving interoperability

Bundled Payments

Aim to incentivize providers to improve coordination, promote teamwork, and lower costs; Payers compensate providers with a single payment for an episode of care

2004: Office of the National Coordinator for Technology (ONC)

Charged the office with providing "leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care"

Error of Omission

Ex: Failing to prescribe a medication from which the patient would likely have benefited.

Sequoia Project

Focused on legal and policy barriers associated with nationwide interoperability

HL7

Focused on technical standards for health information exchange HL7 Fast Healthcare Interoperability Resources (FHIR): standards introduced in 2012 and are under development

Biggest barrier to Health Information Exchange

Health Information Blocking

1990's: The call for HIT

Health Information Technology

2009: Health Information Technology for Economic and Clinical Health (HITECH) Act

Legislatively mandated it to provide leadership and oversight of the national efforts to support the adoption of Electronic health records (EHRs) and Health information Exchange (HIE)

Accountable Care Organizations (ACO)

Networks of providers that share responsibility for coordinating care and meeting health care quality and cost metrics for a defined patient population

Health Information Blocking

Occurs when persons or entities knowingly or unreasonably interfere with the exchange or use of electronic health information

1991: Institute of Medicine (IOM)

Published a report on the problems with paper-based medical records and called for computer-based patient records(CPR)

Patient Centered Medical Homes (PCMH)

Rooted in private sector; in 2007, four physician societies published a statement of principles emphasizing physician-led coordination of care

Interoperability

The ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user