1. Fundamentals of HIT
Lynne VanArsdale
11/4/2011
UC Denver
San Luis Valley Health Information Technology
Symposium, November 4, 2011 1

2. San Luis Valley AHEC Legal Notice
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3. Agenda
• HIT Alphabet soup
– EMR/EHR, MU, PHR, CDSS, CPOE, PHI …
• Coding Standards
• Health information exchange
• Security
• Quality metrics
• Consumer health data
• BI/data warehouse
• Public health reporting
• Medical devices
• Where to find more information
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4. HIT – What is it?
• Congressional Budget Office (CBO) 2008 definition* of Health
Information Technology (HIT): “computer applications for the
practice of medicine,” and includes
• Electronic Medical Record (EMR) = equivalent to paper-based medical
record
• Electronic Health Record (EHR) = computer-accessible, interoperable
resource of clinical and administrative information pertinent to the
health of an individual
–Personal Health Record (PHR) = an EHR controlled by the patient
–Payer-based Health Record (PBHR) = an EHR owned and
administered by the health plan
*The Congress of the United States Congressional Budget Office, “Evidence on the Costs and Benefits of Health Information Technology,” May 2008.
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5. HIT – What is it?
Congressional Budget Office (CBO) definition also includes
• Computerized Physician Order Entry (CPOE) = electronic applications that physicians
use to order medications, diagnostic tests, and ancillary services
• e-Prescribing = electronic transfer of a prescription from the prescribing
physician’s office to the pharmacy
• Clinical Decision Support Systems (CDSS) = assists physicians with decision making
by providing reminders, suggestions and support in diagnosing and treating
diseases and conditions
• Health Information Exchange (HIE) = electronic movement of any and all health-
related data according to an agreed-upon set of interoperability
standards, processes and activities across nonaffiliated organizations in a manner
that protects the privacy and security of that data; and the entity that organizes and
takes responsibility for the process
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6. U.S. Health Information Policy
April 2004 – Presidential Exec Order 13335
• Established ONC to fulfill the vision of developing a nationwide
interoperable health information technology infrastructure that:
• Ensures that appropriate information to guide medical decisions is available at the
time and place of care;
• Improves health care quality, reduces medical errors, and advances the delivery of
appropriate, evidence-based medical care
• Reduces health care costs resulting from inefficiency, medical errors, inappropriate
care, and incomplete information;
• Promotes a more effective marketplace, greater competition, and increased choice
through the wider availability of accurate information on health care
costs, quality, and outcomes;
• Improves the coordination of care and information among
hospitals, laboratories, physician offices, and other ambulatory care providers
through an effective infrastructure for the secure and authorized exchange of
health care information
• Ensures that patients’ individually identifiable health information is secure and
protected.
– ARRA /Economicsigned on(?)
HITECH Stimulus! 1/29/2009 established law to support this order
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7. Perfect Storm
APCD Declining
ANSI 5010 Health
Payment
Reform ACO, PCMH
Bad Rule
Economy
ICD-10 Meaningful Use
CORHIO Stage II
HIPAA
Implementation
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8. ANSI X12 (5010) and ICD-10
Challenges:
- Continuity over time (episodes
of care, quality
metrics, payment issues)
- Converting systems
- Training people
- Billing-focused
Opportunities:
- Better, fuller information
- Enforcement
- Payment accuracy & fraud
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9. Meaningful Use (MU) / EMR
• CMS rule
– Medicare vs. Medicaid
– Physician vs. hospital
– Incentives (now) and penalties (2015 +)
• Stages (I now, II due in 2012, III ?)
• Criteria
– Three tenets:
• Adopt certified electronic health record technology
• Demonstrate core and menu set requirements
• Report on clinical quality measures
• Certification –
– 1. EMR certification; 2. self-certification for MU of certified EMR
• Health care providers must possess all of the meaningful use capabilities, not just those
that they intend to report
– Office of the National Coordinator for Health Information Technology-
Authorized Testing and Certification Body (ONC-ATCB) and CCHIT
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10. 10

11. MU Stage 1, continued…
Copied from http://mycourses.med.harvard.edu/ec_res/nt/26F568D6-E6F3-418A-96B9-497666DEF5C0/MUQuick.pdf
Disclaimer - This chart is not an official federal document and has been created for public use and convenience by Robin Raiford, RN-BC, CPHIMS, FHIMSS. Note for CPOE, Vital Signs, Smoking
Status, Advance Directives, Patient Reminders – the text reflects ”Unique Patients” but they are listed in “Actions” in an EHR in Table 3 which is how it is noted in this document Please refer to The
Official Web Site for the Medicare and Medicaid EHR Incentive Programs for official publications
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12. Some Coding Standards
(putting medicine in terms computers can understand…)
• ANSI X12 5010 (4010, 6020) -- claims
• ICD- (9,10,11) – diags and treatments
• SNOMED – diags and treatments
• HL7 – medical information infrastructure
• NCPDP -- pharma
• CPT – medical services
• LOINC – lab and clinical data
• CCR, CDA (CCD) – patient medical info exchange
• PACS / DICOM – Images
Conformance:
Where are we
really? 12

13. Other types of HIT
1. Medical device output, input (IEEE 1073)
2. Registries
3. Office systems – billing, appointments (PMIS, PMOS,…)
4. Health business reporting systems
5. Public health systems
6. Telehealth, telemedicine
7. Mobile health
8. Intelligence systems
9. New innovations … Todd Park: web apps
(iTriage), social networks, community dashboards, your
ideas…?
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14. More Alphabet soup
– Interoperability
• NwHIN – ONC design for nation-wide HIT infrastructure
– Service-Oriented Architecture (SOA) – enables interoperability
through published “services” that securely allow info access
• CORHIO – Colorado’s Regional Health Info Org
– QHN – HIE for Western Slope; BEACON partner
• HIE – non-governmental health info exchanges – emerging
for ACO’s and other collaboratives (e.g. SAFTInet/DARTnet)
– Quality / cost –based aggregations
• ACO
• PCMH
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15. CORHIO Alphabet Soup
• QHN = Quality Health Network • CCGC = Colorado Clinical Guidelines
• NCHA = Northern Colorado Health Alliance Collaborative (HealthTeamWorks)
• AHRQ = Agency for Healthcare Research and • CIVHC = Center for Improving Value in
Quality Health Care
• PCDP = Point of Care Demonstration Project • CDPHE = Colorado Department of Public
• TCHF = The Colorado Health Foundation Health and Environment
• MRR = Medical Referral Regions • HCPF = Health Care Policy and Financing
• CHI = Colorado Health Institute • CHIP = Children’s Health Insurance Program
• CMHC = Community Mental Health Center • MMIS = Medicaid Mgmt Info Systems
• BHO = Behavioral Health Organization • SMHP = State Medicaid Health IT Plan
• FQHC = Federally Qualified Health Center • MTIA = Medicaid Info Tech Architecture
• COREC = CO Regional Extension Center • NTIA = National Telecommunications and
Information Administration
• CCMCN = Colorado Community Managed Care • CHA = Colorado Hospital Association
Network
• CFMC = Colorado Foundation for Medical Care • CTN = Colorado Telehealth Network
• CCHN = Colorado Community Health Network • CHC = Colorado Community Health Ctrs
• CACHIE = Colorado Associated Community • HRSA = Health Resources and Services
Health Information Exchange Administration
• CHIMA = Colorado chapter of AHIMA • IPA = Independent Practice Association
• CHIMSS = Colorado chapter of HIMSS • GDAB = Government Data Advisory Board
• COPIC = professional liability insurer • PAHCOM = Professional Association of
Health Care Office Management
• CTA = Colorado Technology Assoc. (CSIA) 15

16. CORHIO – Network of Networks
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17. Health Information Security
Protecting personal health information (PHI)
• Legislation Health insurance
Privacy standard
Security standard
– HIPAA (1996) Reduce fraud/abuse Employer ID
Security and privacy National Provider ID (NPI)
– HITECH Interoperability X12
Part of ARRA, 2009
$20B for HIT projects Penalties $100 - $1.5M
BA obligations per violation, plus up
• **Practice** Security breach notification
Enforcement
to 10 years in prison
Indiv. rights – notice of uses
People Indiv right to EHR info request use restriction
view/copy/ammend
– Information Infrastructure confidential communic.
– Physical Infrastructure accounting of disclosures
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18. Quality Metrics
• Federal / Regulatory / Standards
– CAQH Core – Standards for claims/payment
– AHRQ – quality metrics and research
– NCQA (HEDIS) – health care performance metrics, benchmarks, “seal”
– JCAHO – accreditation of health care providers
• Funding Institutions
– Commonwealth Fund, RWJF, TCHF
• Report cards, NQF, LeapFrog, other independents
• Community efforts
– Colorado Business Group on Health
– Colorado Associated Community Health Information Exchange
(CACHIE)
• Promotes the use of information technology to support quality reporting and
improvement
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19. Health Information BI / Data Warehouse
• Online Transaction Processing (OLTP) vs. Online
Analytical Processing (OLAP)
• Data warehouse forms the foundation of
Clinical Decision Support Systems (CDSS) and
closed loop Computerized Physician Order Public Health School Health
data data
Entry (CPOE) Research Non-profit org
data
• Business intelligence plays a role in improving data
performance (KPI’s)
Local Census
• Medical data mining data data
(epidemiology/surveillance, drug
Insurance State
analysis, diagnosis, interventions) data data
• ACO, PCMH – multitude of data from many
sources need to be integrated
• Operational data store; Data mart; Extract-
Transform-Load (ETL)
• Federated data warehouse; virtual data
warehouse; network of networks
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20. Consumer Health
• PHRs
– Stand alone, tethered, networked
• “got an app for that”
– DSS – iTriage (simple DSS with referral), WebMD
– Treatment compliance
• Social Networks
– Communities
– Provider - patient
• Online data on provider quality and performance
– Healthgrades, Consumerhealthratings.org, HCAHPS, Press
Ganey, Angie’s list,
• Online wellness programs
– Mostly employer-centric – many, many out there
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21. Public Health Reporting Vision
Health
Information Genetic Disorders
Exchange Vital Statistics
Provider 1 • Service oriented
Communicable Diseases
HL7 architecture
• Computer
Provider 2 Immunization
CDA2 networking
Environmental
Health
• Tiered
Provider 3 architectures
Injury Control
X12 • Storage
Provider 4
School Health management
Chronic Care • Data
management
Biosurveilance,
NCPDP Preparedness • Process
management
Women & Children
Provider X Public Health Laboratory
IHE
Quality Improvement
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This diagram was created by Dr. Art Davidson for an HIT class at UC Denver.

22. Medical Devices
• IEEE 1073 – “Medical Information Bus”
– Based on OSI 7-layer model
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23. More Information
• http://www.cbo.gov/publications/collections/health.cfm
• Presidential Executive Order 13335: http://edocket.access.gpo.gov/2004/pdf/04-10024.pdf
• http://www.healthit.gov/ , Office of the National Coordinator:
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204
• www.CORHIO.org; http://www.cotelehealth.com/ ; www.nwhin.org
• www.x12.org; www.wedi.org; www.himss.org ; http://www.cms.gov/ICD10/; http://www.ihtsdo.org/
(SNOMED); www.hl7.org; www.ncpdp.org; http://www.ama-assn.org/ama/pub/physician-
resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page; www.loinc.org;
http://medical.nema.org/ (DICOM);
• Quality:
http://www.ahrq.gov, http://www.qualityindicators.ahrq.gov, http://www.caqh.org, http://www.ncqa
.org, http://www.jointcommission.org/, http://www.qualityforum.org, http://www.commonwealthfu
nd.org, http://www.rwjf.org/
• Consumer Health: http://www.hcahpsonline.org , www.healthgrades.com, www.pressganey.com,
• HIMSS LinkedIn Group discussion on “Top Ten reasons why EMR/EHR implementations are failing” –
over 2200 comments
• ANSI/IEEE 1073: Medical Information Bus (MIB) Health Informatics Journal June 1998 4: 72-83
• SAFTInet
http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/GIM/education/
ContinuingEducation/Documents/4-19-2011_Schilling.pdf
• Data warehouse: http://www.hdwa.org/ , http://datawarehouse.hrsa.gov/, http://health.data.gov
• XML: http://www.w3schools.com/xml/default.asp
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