HI-FIVE (Health Informatics For Innovation, Value & Enrichment) Training is a 12-hour online course designed by Columbia University in 2016, with sponsorship from the Office of the National Coordinator for Health Information Technology (ONC). The training is role-based and uses case scenarios. Also, it has additional, optional modules on other topics of interest or relevance. Although we suggest to complete the course within a month's timeframe, the course is self-paced and so you can start and finish the course at anytime during a month's time period. No additional hardware or software are required for this course. Our nation’s healthcare system is changing at a rapid pace. Transformative health care delivery programs depend heavily on health information technology to improve and coordinate care, maintain patient registries, support patient engagement, develop and sustain data infrastructure necessary for multi-payer value-based payment, and enable analytical capacities to inform decision making and streamline reporting. The accelerated pace of change from new and expanding technology will continue to be a challenge for preparing a skilled workforce so taking this training will help you to stay current in the dynamic landscape of health care. This course is one of three related courses in the HI-FIVE training program, which has topics on population health, care coordination and interoperability, value-based care, healthcare data analytics, and patient-centered care. Each of the three courses is designed from a different perspective based on various healthcare roles. This first course is from a clinical perspective, geared towards physicians, nurse practitioners, physician assistants, nurses, clinical executives and managers, medical assistants, and other clinical support roles. However, we encourage anyone working in healthcare, health IT, public health, and population health to participate in any of the three trainings. If you would like to obtain continuing medical education (CME) or continuing nursing education (CNE) credits, you will need to have eligible credentials, complete the entire course, and complete the evaluation survey at the end. The HI-FIVE team verifies after each month that these requirements have been met and then a separate certificate (fee may apply) is distributed to you from our accreditation office. Please allow time for processing. If you have any further questions about continuing education, please see our website at www.hi-fivetraining.org. Accreditation Statement The College of Physicians and Surgeons of Columbia University is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. AMA Credit Designation Statement The College of Physcians and Surgeons designates this enduring material for 12.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The planning committee members are: Rita Kukafka, DrPH, MA, FACMI; Bruce Forman, MD; Gil Kuperman, MD, PhD; Virginia Lorenzi, MS, CPHIMS, FHL7, and Victoria Tiase, MSN, BN. None of the members of the committee, who planned this CME Activity, have any relevant financial relationships to disclose. The release date is 2/1/17 and the expiration date is 1/31/18. This activity is eligible for 12 continuing nursing education (CNE) credits. Columbia University School of Nursing, Continuing Nursing Education Program is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Exchange of Health Information: Introduction
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来自 Columbia University 的课程
HI-FIVE: Health Informatics For Innovation, Value & Enrichment (Clinical Perspective)
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Columbia University
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从本节课中
Role-Based Content (OPTIONAL) - Physicians / Nurse Practitioners / Physician Assistants / Clinical Executives / Clinical Managers / Public Health Professionals
This module is optional, but has additional topics that you may be interested based on your role. We encourage you to explore any of these topics and there are also quizzes to test your learning.
与讲师见面
Rita KukafkaAssociate Professor
Biomedical Informatics
Welcome to Care Coordination and
Interoperable Health IT Systems Exchange of Health Information.
This is lecture a.
This will be an introduction to health information exchange.
The learning objectives for the exchange of health information exchange unit
are number one, To list the quality problems in healthcare that health
information exchange is intended to remediate.
Two, describe the nature of health information exchange technology assets
that health information exchange is designed to interconnect.
Number three, explain the motivations, capabilities and
challenges of health information exchange organizations.
Number four, explain the motivations, capabilities and challenges of using
Meaningful Use and Direct to advance health information exchange.
And number five, describe the future directions for
health information exchange.
What are the reasons that we need health information exchange?
Health care data may be needed in a place other than where it was generated,
because patients get care in multiple locations.
Today, the movement of health care records is accomplished via the US mail,
fax machines or having patients carry their records between providers or
by other means.
Now electronic health information exchange
would allow the data to be available where it is needed, automatically and
electronically not just where it was produced.
There are several scenarios in which health information exchange could play
a role in improving healthcare.
One example is when a patient moves, perhaps between cities that the physician
in the new city could automatically receive the patient's electronic health
data from the physician who is caring for the patient in the previous city.
Another example of health information exchange is a referral situation.
For example, if a primary care provider refers a patient to a cardiologist,
the primary care provider would automatically
be able to send the relevant data to the cardiologist.
In addition, the primary care provider ideally would know if this specialist has
seeing the patient.
And if the specialist, the cardiologist see the patient, the relevant information
from that specialist visit would be available to the primary care provider.
So, that is another example of how health information exchange can improve
healthcare.
Another example is that patients would be able to have access to their records,
perhaps through patient portals or personal health records.
Another example of a scenario in which health information exchange could play
a role in improving healthcare is in a transitions of care scenario.
For example, if a patient is discharged from the hospital to a non-acute setting
like a skilled nursing facility.
Ideally in those situations,
the non-acute organization would know what happened in the acute setting.
What actions are to be taken in the non acute setting?
And who to call in the acute care setting, if there are questions about either what
happened or what is supposed to be done for the patient?
Another example in which health information exchange would could be
valuable is that healthcare members would know who the other team members are.
If a diabetic patient is being cared for by a primary care provider,
an endocrinologist, a cardiologist,
then each of the physicians would know who the other physicians are.
Also, care team members would know if a care manager is assigned to the patient
and who that care manager is and
they would also know if the patient is seeing a specialist.
And if so, who is that specialist?
When they are scheduled to see that specialist and why?
Another scenario for health information exchange is being able to send data
automatically from healthcare provider organizations to public health
organizations, so that surveillance can be done on health trends in the community.
And another scenario in which health information exchange could play a role
is if a patient comes to the emergency room,
the emergency room physician could have a summary of the patients record from all
the providers that the patient has been seeing.
And if the patient says, I had an imagining study done at another facility
some time ago, the emergency physician would be able to use health information
exchange capabilities to see the results of that imaging study and
fold that information into the patients care.
So, these are some of the examples of the scenarios in which
health information exchange could play a role in supporting healthcare processes.
Why do we want health information exchange?
Over the last several years, there have been increasing concerns about the quality
and costs of healthcare and the potential role that health information technology
could play as part of the solution to these concerns.
In the year 2000, the Institute of Medicine published a report on
the quality of healthcare in the United States, titled Crossing the Quality Chasm.
And in that report,
several problems in healthcare related to quality were identified.
Some of the observations of this report were that quote,
quality problems are extensive and serious that healthcare quality problems could be
classified underused, overused or misused and that large numbers of
Americans are harmed as a result of these problems in healthcare quality, unquote.
Additional observations in the Institute of Medicine report or that,
quote, current approaches to quality improvement are inadequate, unquote.
One constraint to quality improvement that was identified at the time is the lack of
adequate information infrastructure to support quality measurement and
quality improvement.
A 2003 study done by the RAND Corporation that was published by
the New England Journal of Medicine about the quality of care,
collected the data on 7,000 patients in 12 different metropolitan areas.
This study was done via medical record review,
as well as a telephone survey of the patients involved.
The study looked at the quality indicators in 30 different conditions,
as well as for preventive care with a total of 439 indicators of quality.
The findings in that study were that patients received recommended care
only 55% of the time.
In other words, only in 55% of the instances did the patients actually
receive recommended care.
This was a measure that showed compliance with care quality
guidelines happens only about only half the time.
One of the observations of one of the studies's authors was that improvement of
healthcare couldn't be done with the current approach, but
rather a new approach to quality improvement would be needed.
In addition to serious concerns about the quality of healthcare in
the United States,
the costs of healthcare have been increasing steadily over several decades.
This graph shows that the percentage of all goods and services that are devoted to
healthcare has increased from 1965 to 2013 from about 5.5% of
the gross domestic product to up over 17% of the gross domestic product.
So, the portion of the economy that has been devoted to healthcare is increasing
steadily and rapidly at the same time that there are serious concerns about
the quality of healthcare that is being delivered.
As some researchers examine the possible ways to address the quality
gaps in healthcare,
there were several ideas promoted as being good ways to create improvements.
One is that organizations need to be innovative.
Meaning that they need to think of the different ways to tackle these quality
problems.
Number two, that there needs to be effective professional training and
continuing education to ensure that quality care is being delivered.
Number three, the evidence-based in healthcare needs to be increased.
Meaning that we need to understand better what constitutes and
what will lead to high quality care.
Number four, we need to ensure that when evidence is present that it is being
applied consistently and that we're following best practices.
Number five, there should be alignment of reimbursement with quality goals.
And lastly, we should be implementing appropriate information
technology including electronic health records to support the quality goals.
One observation of this is that information systems and
electronic health records are part of the solution to improving quality, but
they're not the entire solution.
They're part of a broader program, as we try to improve health care quality.
In November 2001, the National Center for Vital and
Health Statistics produced a report titled a strategy for
building the national health information infrastructure.
The report looked at healthcare from three dimensions or perspectives.
They looked at the perspective of healthcare providers.
They looked at it from the perspective of patients and consumers of healthcare, and
they also looked at it from the population or public health perspective, and
what would be needed to improve care along each of those dimensions.
What the National Center for Vital and Health Statistics recommended was that
there was to be a comprehensive system that provides information,
so that providers, patients and public health workers are all able to
make sound decisions about health, healthcare and healthcare policy.
This electronic information infrastructure should be developed with leadership from
the United States Department of Health and Human Services.
Additionally, in the mid-2000s, the idea that there needed to be interconnected
health information infrastructure begin to get broad support across public settings,
private settings and governmental settings.
In particular, then President George W Bush in his State of the Union address
in 2004 remarked that quote, by computerizing health records,
we can avoid dangerous medical mistakes, reduce costs and improve care, unquote.
This really lifted the general principle of an electronic health
information infrastructure to a national policy level.
At the same time in 2004 on President George W Bush's website,
it was indicated that he quote, outlined a plan that would ensure that most Americans
would have electronic health records within the next ten years, unquote.
In the mid-2000s, data were assembled to understand what would be required
to create an electronic health information infrastructure in the United States.
The data showed that there were approximately 5,000 hospitals,
about 500,000 office-based physicians, 15,000 nursing homes and
12,000 home health agencies, 250,000 labs and 5,700 imaging centers.
About 67,000 pharmacies, about half of which were in large chain pharmacies and
healthcare payers and insurance companies.
About 75% of hospitals had basic information technology capabilities,
such as electronic laboratory result to lookup in place.
About 10% of office-based physicians had some kind of an electronic health
record in place at that time.
There were about 15,000 nursing homes and 12,000 home health agencies.
All of which had very low rates of adoption of information technology.
There were 250,000 labs and 5,700 imaging centers.
These generally had information technology in place, but those systems were not
connected to other systems of care or broader information networks.
There were about 67,000 pharmacies,
about half of which were in large chain pharmacies.
The chain pharmacies were automated,
but their information systems were not connected to broader networks.
Smaller pharmacies were not yet automated.
Healthcare payers and insurances companies were automated, but
not connected to broader information networks.
An expert panel was convened to estimate the size of the financial investment
that would be necessary to create,
a model of an achievable national health information network was created.
The relevant providers, functionalities, interoperability needs, goals,
current state, gaps between current state and an ideal status and
the necessary funding to address the gaps all were identified.
The result of that analysis was that quote,
to achieve a national health information network would cost
$156 billion in capital investment over a five-year period and
$48 billion in annual operating costs, unquote.
This seemed like a large amount of money and
it certainly is a large amount of money.
But in the discussion section of the study, the authors noted that quote,
$156 billion is equivalent to only 2% of annual healthcare spending for
five years, unquote.
So compared to the total cost of healthcare,
this may not be exorbitant as it first seems.
Moving forward from the mid-2000s, there were two different approaches that were
taken to achieve interconnected infrastructure.
One was activities to interconnect hospitals or
other large provider organizations.
The reason for focusing on these kinds of organizations is that these large
providers take care of hundreds of thousands of patients and they hold many
data types, such as laboratory tests, radiology reports, medication data, etc.
By connecting a small number of these large providers,
there could be substantial progress made in creating
an interconnected health information infrastructure.
The other approach to advancing an interconnected information infrastructure
for healthcare was to try to increase the prevalence of electronic health
records in physicians's offices.
The observation here was that quality and cost could be improved if physicians
had and used electronic health records, but there really was no motivation for
physicians to do so and there were costs involved.
This gap would need to be addressed and this strategy started in 2009.
Why were there these two different approaches?
The strategy for interconnecting hospitals and large providers which really
began in 2005 aimed to make the most of what was already in place.
These large healthcare providers which had some information system capabilities and
that by interconnecting those,
there would be advancement of an interconnected infrastructure.
The idea here was to give responsibilities to states and
other regions rather than the federal government taking a lead role.
This was more a distributed approach and
this would help to address local variability across regions, and states.
In terms of getting electronic health records into physician owned offices,
the strategy began in 2009 and was really part of the American Recovery and
Reinvestment Act known as ARRA.
And within ARRA, there was $30 billion set aside to create incentives for
providers to adopt electronic health records.
This concludes lecture a of health information exchange.
The summary of this lecture is that number one, we need health information exchange,
because patients get care in multiple locations.
Number two,
there are many scenarios in which health information exchange may be helpful.
Number three, there are quality problems in healthcare
that health information exchange can help to address.
Number four, there are many different kinds of health information systems
that need to be connected.
And number five, in the mid-2000s,
there were two strategies that emerged to advance health information exchange.
