Illinois Hospital Association

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April 26, 2007

Integration of Quality and Health Information Technology Update

It is becoming increasingly more apparent at the national level that in order to rapidly improve the processes and outcomes of care and have the capability to capture and report the necessary performance information, hospitals need funding and standards to implement the Electronic Health Record (EHR). Within Illinois and at a national level, there are many activities converging that might help spur EHR development.

Illinois Electronic Health Records (EHR) Task Force
Task Force Report and Recommendations
The Illinois EHR Task Force was created as a result of House Bill 2345 sponsored by Representative Julie Hamos in spring 2005. The EHR Task Force Bill called for the assembling of a Committee made up of a wide variety of stakeholders in health care including hospitals, physicians, nurses, medical records, pharmacists, health plans, consumers, technology experts, Medicare QIO, and federal and state agencies to develop consensus on a plan for implementation of EHRs in an integrated healthcare system. Illinois Department of Public Health staff served as Chair and IHA served as Vice Chair of the Task Force. There were many people outside of the Committee involved in the meetings and discussions.

One of the challenging aspects of the EHR Task Force was to ensure that all providers had the same understanding of EHR and the characteristics of an Electronic Health Record. There are many people that have written on the characteristics and distinguishing factors of an EHR versus computerized, electronic, or automated medical records, including C. Peter Waegemann, CEO of the Medical Records Institute. EHRs are viewed as being very different than just an image of a medical record as they have interoperable capabilities and span across different care settings for patients – they are not just a snap shot in time – but a complete history and perspective on a patient.

The EHR Task Force adopted an EHR systems definition used by the Robert Wood Johnson Foundation and the Office of the National Coordinator of Healthcare Information Technology (ONCHIT): "A repository of information regarding the health of a subject of care, in a form able to be processed by a computer that is stored and transmitted securely and accessible by multiple authorized users using different applications. It has a standardized information model which is independent of an EHR system. Its primary purpose is the support of continuing, efficient and quality integrated health care and it contains information that is retrospective, concurrent and prospective."

After convening several work groups and working to develop consensus for a federated clinical health record, the Illinois EHR Task Force submitted its recommendations and plan for implementation of EHR within Illinois. The plan was submitted as required by December 31, 2006 and is published on IDPH’s web site at http://www.idph.state.il.us/ehrtf/ehrtf_home.htm.

Health Information Security-Privacy Collaboration (HISPC) During the midst of the EHR Task Force deliberations, the Agency for Healthcare Research and Quality (AHRQ) provided grant opportunities to states to identify issues and obstacles in sharing information among covered entities within a state. The purpose was to identify all of the real and perceived barriers and interpretations of state law in information sharing regarding patient care. Specialty providers that receive patients from other states and providers that border states have been struggling with understanding different state rules and provisions for transferring or receiving health information on patients.

The Illinois Foundation for Quality Health Care took the lead on preparing and implementing the grant on behalf of the State of Illinois and the EHR Task Force. The outcome and recommendations of the grant work will be made publicly available and AHRQ, and their vendor RTI, are holding conferences on the findings. AHRQ will be working on consolidating findings and making recommendations to the Department of Health and Human Services on possible obstacles that could be overcome to aid in advancing EHR and health information exchanges. Information on the project can be found at www.rti.org/hispc and within a couple of weeks individual state HISPC reports will appear on this web site.

HB1254 – Development of Illinois Health Information Network (ILHIN)
House Bill 1254 has been introduced by Representative Julie Hamos and calls for the establishment of the public-private partnership organization for the implementation of the recommendations of the EHR Task Force. House Bill 1254 has the support of IHA and has passed in the House unanimously and is now in the Senate. Also, a modified version of the ILHIN bill is included within the Illinois Covered bill.

IHA Board Adopted Regional Health Information Organization (RHIO) Principles
As you many recall, IHA created a RHIO Committee to help guide and assist IHA in developing principles for IHA staff and hospitals to rely upon in engaging in discussions with other stakeholders. The IHA RHIO Committee, chaired by Gary Kaatz, President of Rockford Health System, is comprised of CEOs, CIOs, physicians, planners, and quality directors from IHA member hospitals.

The IHA Board accepted the recommendations of the IHA RHIO Committee and adopted the IHA RHIO Principles document attached.

Quality Encounter Program at Evanston Hospital on EHR
On April 12, Evanston Hospital and Evanston Northwestern Healthcare (ENH) hosted the IHA Quality Encounter program at Evanston Hospital. The focus of the program was on the benefits and value of the integration of quality and electronic health records. Hospital attendees heard from the chief executives, chief nurse executive, chief information officer, physicians, nurses, and trainer on the development and implementation of the EHR. Staff openly shared details about their journey and responded to numerous questions on best practices and lessons learned. The question and answer sessions extended to about an hour and a half until all questions were answered by the Evanston and ENH executives and staff.

Attendees found this program to be very valuable no matter what type of hospital they were from or where they were in the continuum of implementing or planning their hospital EHR. Hospitals heard about the EHR and saw it demoed and were able to identify the value of it as the EHR improves quality and outcomes of care, reduces inefficiencies, improves the financial bottom line, and serves to provide a safe and supportive environment for clinicians and care givers to practice in.

IHA started the Quality Encounter conference series about 3 years ago in an effort to highlight a strategic area or development of hospitals. The conferences are held at the hospital site and hosting hospitals are encouraged to have their CEO, Board members, CMO, CNE, Quality, and other key staff to present and participate. Hospitals are encouraged to bring their board members, executives, physicians, clinicians, and other staff to attend these programs. The presentations, dialogue, and question and answer sessions have always been well received and insightful for attendees.

Federal Focus on EHR and HIT Developments
As many of you are aware, the Department of Health and Human Services initiated a "Value Driven Healthcare Program" earlier this year that focuses on EHR and HIT as well as pricing transparency, quality transparency, and incentive types of payment systems. In the proposed rules for Medicare payment that were recently released, the CMS Value Based Purchasing program proposes incentives for a variety of quality initiatives, including in the near future, EHR and other health information technology advancements, such as electronic prescribing and computerized physician order entry.

Certification Commission for Healthcare Information Technology (CCHIT)
As you may recall, at the urging of ONCHIT, several national organizations came together to establish a mechanism and organization for certifying EHR systems. The organization that was formed was CCHIT and in 2006 released the first set of certified EHR systems for ambulatory settings. The inpatient certified EHR system is scheduled to be released soon but has been delayed several times due to the complexity and depth of hospital inpatient operations and systems.

As a result of the challenges CCHIT has faced in trying to conduct a thorough certification process, CCHIT recently announced a series of organizational changes – including staff expansion and volunteer opportunities. Hospitals are most interested in ensuring their systems are certified as the systems do go through a rigorous review and in the future, DHHS has indicated they will require providers to be utilizing certified EHR vendors for Value Based Purchasing incentive purposes.

Information on CCHIT’s recent developments can be found on their web site at: http://www.cchit.org/about/overview.htm.

Updates on HIPAA Privacy Rule Compliance and Enforcement by Office For Civil Rights (OCR)
DHHS has revised the OCR web site to provide greater insight into HIPAA privacy compliance and enforcement issues. Hospitals should periodically check this web site for new information, case examples, and to research issues on privacy compliance. The new web site can be found at http://www.hhs.gov/ocr/privacy/enforcement/.

IHA will keep you updated on these developments and opportunities to advance quality improvement and EHR implementation in your hospital and community.

Staff Contact: Pat Merryweather: pmerryweather@ihastaff.org