this is Health Information management question (HIMT) 1.Discuss the differences
ID: 3679498 • Letter: T
Question
this is Health Information management question (HIMT)
1.Discuss the differences between EHRs in ambulatory and acute care settings. Address infrastructure, data presentation and use, and CPOE vs. e-prescribing. (Approximate length: 350-400 words) 2.Discuss the CMS incentives for quality and e-prescribing. Other than the monetary incentives being provided by CMS, what other reasons are there for participating in these incentive programs? Some sources to answer this question are the following: (a) Overview of the Medicare 2013 E-Prescribing Incentive Program http://www.acponline.org/running_practice/technology/eprescribing/medicare_2013_eprescribing_incentive.htm (b) Electronic Prescribing Incentive Program http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/index.html The first source describes the 2013 ePrescribing Incentive program in detail. The second source discusses EPrescribing and indicates that the EPrescribing incentives are now rolled into demonstrating meaningful use with EHR technology. (Approximate length: 250-300 words).
Explanation / Answer
Health information technology (HIT) has the potential to improve the quality of care while enhancing cost efficiency. To reduce the risks faced by providers considering implementation, it is necessary to develop an understanding of the costs and benefits of HIT investment. A deeper understanding of the business case and cost/benefit accrual is also important to policy makers who wish to influence HIT investment decisions. Although a number of studies have focused on the business case for HIT investments, the emphasis has generally been on the acute and ambulatory care settings.
The Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the Department of Health and Human Services (HHS) recently engaged Booz Allen Hamilton (Booz Allen) to help design a study to assess the business case for HIT in post acute care (PAC) and long-term care (LTC) settings. The purpose of this effort is to inform providers, payors, policy makers and others regarding the costs and benefits (financial and non-financial) of HIT in the PAC/LTC environment.
In developing study approaches Booz Allen reviewed the relevant published literature, conducted stakeholder interviews, and received input from a Technical Expert Panel (TEP). Candidate approaches included prospective and retrospective study designs with or without an ASPE funded implementation. These options were presented to the TEP for comments and feedback. The TEP emphasized the need for a cost-effective study that could generate data-driven findings on the business case for HIT in PAC/LTC within a reasonable timeframe (2-3 years).
Based on these findings Booz Allen recommends that ASPE conduct a retrospective study of 10-20 nursing homes (NHs), or home health (HH) agencies, or both. This approach leverages existing HIT applications in PAC/LTC settings and will spare ASPE the considerable costs associated with subsidizing implementations. Employing both quantitative and qualitative methods, this approach places heavy emphasis on the use of administrative and interview data to inform the estimation of costs and benefits. We believe that the proposed study can be completed within 18-36 months.
We believe that our suggested study approach is a cost and time efficient way to address significant gaps in the understanding of HIT costs and benefits in the PAC/LTC settings. Advances in this understanding may have significant impacts on HIT adoption. In addition to the recommended study design to evaluate costs and benefits, Booz Allen also suggests that ASPE consider sponsoring or cosponsoring a separate survey on the prevalence and penetration of HIT applications in the PAC/LTC sector. The findings of such a survey would be complementary to this study and would provide a much needed quantitative baseline assessment of the state of HIT in the PAC/LTC environment.
Health information technology (HIT) is increasingly viewed as a tool that can promote quality and cost-effective care in the U.S.1 Promoting the use of HIT is a major health initiative of the current Administration and HHS. In April 2004, the President established the Office of the National Coordinator for Health Information Technology (ONC) through an Executive Order. The Executive Order and the strategic framework developed by ONC emphasize the need for:
This need to establish evidence on the costs and benefits associated with HIT is driven by the limited number of systematic studies that examine these costs and benefits across care settings. The lack of a robust evidence on HIT costs and benefits is especially conspicuous in the post acute care (PAC) and long-term care (LTC) environment. A deeper, evidence-based understanding of costs and benefits is needed and is essential to inform providers contemplating purchase of HIT systems. In addition, such an understanding can provide useful and reliable information to policy makers, payors, employers, and others who seek to influence HIT adoption.
To promote this understanding, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the Department of Health and Human Services (HHS) engaged Booz Allen Hamilton (Booz Allen) to design an evaluation to assess the business case for HIT in PAC and LTC settings. The purpose of this project is to develop cost-effective robust study design option(s) that can greatly enhance the existing knowledge base on HIT costs and benefits in the PAC/LTC setting.
HIT can be defined as technology used to collect, store, retrieve, and transfer clinical, administrative, and financial health information electronically.32 With respect to administrative activities, HIT refers to the automation of paper and manual functions to enhance efficiency. Administrative HIT applications include claims and remittance systems, eligibility verification, enterprise resource planning, predictive modeling and data mining systems, Smart cards, and websites that support service delivery. Most administrative functions are related to payor reimbursement activities and many of these applications reuse clinical information collected via other applications.
Representative clinical HIT functionalities include clinical data repositories, clinical documentation, computerized physician order entry (CPOE) including electronic prescribing (e-prescribing), decision-support, digital content, electronic health records (EHRs) and personal health records.
Automated data sharing among providers, or interoperability, promises to bring many of the most significant benefits of HIT. Though currently uncommon, it promises to facilitate true patient centered care so that real-time information will be accessible to all providers as patients move through the system. The need for interoperability has strongly influenced the development of data, messaging, and functional standards for EHRs.34
The Health Level Seven (HL7) group has been working for several years on building consensus for EHR levels of functionality. The EHR-System Functional Model is a component of the Electronic Health Record Functional Model Draft Standard for Trial Use (EHR-FM/S DSTU), and is divided into three sections: direct care, supportive, and information infrastructure functions. There are over 125 individual functions in the EHR-FM/S DSTU, many of which may be used to categorize HIT functions needed in PAC and LTC. The Minimum Function Set (MFS) for LTC was balloted(i) by the HL7 EHR Technical Committee at the end of 2004. The EHR Functional Model Draft Standard -- and the MFS for LTC -- provides the framework for an emerging national reference standard for the selection of appropriate categories and functionalities of HIT for consideration in a future business case evaluation. Currently, the MFS is being updated to reflect a more comprehensive list of functions for PAC/LTC settings.
Although studies in a variety of clinical settings have demonstrated the impact of CPOE, the ability of a particular CPOE system to reduce ADEs depends on that systems level of functionality. Gandhi analyzed error rates at two ambulatory care clinics where prescriptions were hand-written and two that used basic computerized prescribing and found no significant difference in errors between the two types of sites.52 He speculated that more advanced capabilities, including dose and frequency checking, could have prevented 95% of the ADEs. Nebeker and colleagues examined errors and ADEs in a Veterans Administration hospital with CPOE.53 The authors identified 483 significant adverse events or 52 ADEs per 100 admissions. Of these, 9% resulted in serious harm and 91% were deemed moderate in severity. Despite the presence of a minimal CPOE system, a majority of ADEs resulted from adverse drug reactions (93%). The authors observed that this CPOE system lacked decision-support for drug selection, dosing, and monitoring and attributed the errors and adverse events to this gap in functionality. The authors suggested that healthcare providers purchasing CPOE systems should consider whether the system addresses the most troublesome aspects of the medication administration process.
2.In late 2008, CMS announced they were creating an incentive program for physicians using e-prescribing for their Medicare patients. Physicians and other eligible professionals who adopt and use qualified e-prescribing systems to transmit prescriptions to pharmacies may earn an incentive payment of 2.0 percent of their total Medicare allowed charges during 2009. This incentive is in addition to a 2.0 percent incentive payment for 2009 for physicians who successfully report measures under the Physician Quality Reporting Initiative (PQRI), and both incentive payments are in addition to the 1.1 percent fee schedule update required by theMedicare Improvements for Patients and Providers Act of 2008 (MIPPA) So, a physician who successfully reports under both the e-prescribing and PQRI initiatives could receive up to a 5.1 percent pay boost for 2009.
For an e-prescribing system to be eligible for the program it can be either a standalone system or one that is part of an EMR, but it must be able to do the following things:
The following resources provide additional information on the CMS e-prescribing initiative:
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