Building a Curriculum for Nursing Informatics
and QSEN – A National Policy Perspective
Judy Murphy, RN, FACMI, FHIMSS, FAAN
Deputy National Coordinator for Programs & Policy
Office of the National Coordinator for Health IT
Department of Health & Human Services
Washington DC
QSEN Workshop
10.02.2012, 1:30-2:30pm
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Opportunities & Challenges
An Update from the ONC
• The Time is Now for Health IT
• Health IT as the Means, not the End
• Meaningful Use Stage 1 Attestation Update
• HITECH Program Updates
• Putting the “I” in Health IT Campaign
• Consumer eHealth
• Challenges and Prizes program
• Meaningful Use of Meaningful Use
• Feet on the Ground and Eye on the Prize
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A Bit of History …
• President Bush’s goal in 2004
“… an Electronic Health Record for
every American by the year 2014. By
computerizing health records, we can
avoid dangerous medical mistakes,
reduce costs, and improve care.”
- State of the Union address,
Jan. 20, 2004
• Executive order established the Office of the National
Coordinator for Health Information Technology (ONCHIT)
as part of the Dept of Health & Human Services (HHS)
– Dr. David Brailer appointed the first National Coordinator
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The Time is Now …
• President Obama’s goal in 2009
“To lower health care cost, cut medical
errors, and improve care, we’ll
computerize the nation’s health records
in five years, saving billions of dollars in
health care costs and countless lives.”
- First Weekly Address
Jan. 24, 2009
• February 17, 2009 – the American Reinvestment and
Recovery Act (ARRA – Stimulus Bill) is signed into law
– HITECH component of ARRA provides an incentive program to
stimulate the adoption and use of HIT, especially EHR’s
– Dr. David Bluementhal appointed the new National Coordinator
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The national focus on HIT continues …
PPACA Mar 2010
(Patient Protection &
Affordable Care Act)
IOM
Future of Nursing Report
Oct 2010
PCAST Report
Dec 2010
(President’s Council of
Advisors on Science
& Technology)
“There is no aspect of our profession that will be
untouched by the informatics revolution in
progress.”
- Angela McBride, Distinguished Professor and University Dean
Emeritus Indiana University School of Nursing
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HIT as the means, not the end
Dr. David Blumenthal, previous National
Coordinator of HIT, emphasizes
“HIT is the means, but not the end. Getting
an EHR up and running in health care is not
the main objective behind the incentives
provided by the federal government under
ARRA. Improving health is. Promoting
health care reform is.”
- At the National HIPAA Summit
in Washington, D.C.
on September 16, 2009
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Modernizing health care
Dr. Farzad Mostashari, current National
Coordinator of HIT, emphasizes
“The goal of implementing health IT is to
provide care that is safer, improves the
quality of care, creates greater efficiency,
and is more coordinated and patientcentered. Technology can help lead the
nation to a place where we can "prevent a
million heart attacks and strokes in the next
five years, where we can reduce hospital
acquired conditions by 40% over the next
three years, [and] reduce readmissions by
20% over the next three years.“
- At the HIMSS Conference
on February 28, 2012
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A Remarkable Journey
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Progress of Eligible Professionals
Toward EHR Incentive Payments
Source: CMS EHR
Incentive Program Data
as of 7/31/2012
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Progress of Eligible Hospitals
Toward EHR Incentive Payments
Note: Totals reflect the
number of unique hospitals
that have received
payments from Medicare or
Medicaid.
Source: CMS EHR
Incentive Program Data
as of 7/31/2012
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Meaningful Use – All Payments
as of July 31, 2012 ($ in Millions)
$900
Payments to All Eligible Professionals and Hospitals Under the Medicare or Medicaid
EHR Incentive Programs
$8,000
$836
Cumulative Total
$6,597
Source: CMS EHR
Incentive Program Data
as of 7/31/2012
$700
$659
$619
$607
$600
$563
$7,000
$6,000
$619
$583
$5,000
$500
$428
$387
$400
$4,000
$384
$3,000
$276
$300
$236
$2,000
$200
$116
$109
$80
$100
$22
$0
$16
$26
Cumulative Amount Paid (Millions)
Amount Paid per Month (Millions)
$800
$1,000
$31
$0
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HITECH Framework for MU of EHRs
Taken from: Blumenthal, D.
“Launching HITECH,” posted by
the NEJM on 12-30-2009.
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Update on ONC Initiatives
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Regional Extension Centers - 62 to support physician adoption
Health Information Exchange - 56 state programs
•
•
Standards & Certification interoperability specifications
Privacy and Security
Beacon Communities – 17 demonstration projects of EHR value
SHARP Research Projects – 4 HIT adoption breakthrough advances
•
•
•
•
Security – University of Illinois at Urbana
Patient-Centered Cognitive Support – University of Texas
Application & Network Design - Harvard
Secondary Use of EHR Data – Mayo Clinic
Workforce Training Programs to support HIT education
•
•
•
University Based Programs – 9 universities Consumer eHealth
Community College Consortiums – 5 regions
Curriculum Development & Competency Exam
Consumer eHealth
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Health IT Resource Center
Work with REC
community and shares
knowledge
Work with external
communities and shares
knowledge
Tools
Beacon
HIE
CCC
REC
SHARP
Resources
Communities
of Practice
(CoPs)
National Learning Consortium
HealthIT.gov
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State HIE Program
and “health information exchange” (the verb)
FOCUS ON INTEROPERABILITY in Stage 2 Meaningful Use
Give providers viable options to meet the expanded Stage 2 MU
exchange requirements
• E-prescribing
• Transition of Care summary exchange:
• Create & transmit from EHR
• Receive & incorporate into EHR
• Lab tests & results from inpatient to outpatient
• Public health reporting – transmission to:
• Immunization Registries
• Public Health Agencies for syndromic surveillance
• Public health Agencies for reportable lab results
• Cancer Registries
• Patient View, Download and Transmit to 3rd Party
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17 Beacon Communities
Western NY Clinical
Information Exchange
Buffalo, NY
Inland Northwest Health
Services
Spokane, WA
Mayo Center Clinic
Rochester, MN
Southeastern Michigan
Health Association
Detroit, MI
Indiana HIE
Rhode Island Quality Institute
Providence, RI
Geisinger Clinic
Danville, PA
Indianapolis, IN
HealthInsight
Salt Lake City, UT
HealthBridge
Cincinnati, OH
Rocky Mountain HMO
Grand Junction, CO
The Regents of the
University of California
San Diego, CA
Eastern Maine Healthcare
Systems
Brewer, ME
Southern Piedmont
Community Care Plan
Concord, NC
Community Services
Council of Tulsa
Tulsa, OK
University of Hawaii at
Hilo
Delta Health Alliance
Stoneville, MS
Louisiana Public Health Institute
New Orleans, LA
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Beacon Community Aims
17 communities each funded ~$12-15M over 3 yrs to…
• Build and strengthen the health IT infrastructure and exchange
capability - positioning each community to pursue a new level of
sustainable health care quality and efficiency over the coming years.
• Improve cost, quality, and population health - translating
investments in health IT in the short run to measureable
improvements in the 3-part aim.
• Innovative - accelerating evidence generation for new approaches in
care delivery, performance measurement, and technology integration.
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Community College Workforce Training
Enrollment and Graduation
as of July 2012
7,000
6,000
Total Students Enrolled or
Completed: 19,831
Attrition Rate: 21.9%
5,000
4,000
2,963
951
874
3,000
2,000
3,828
1,000
583
3,324
1,979
2,712
2,617
South
(20 Colleges)
Northeast
(22 Colleges)
0
Northwest
(8 Colleges)
Southwest
(13 Colleges )
Midwest
(17 Colleges)
Successfully Completed*
Actively Enrolled
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University-Based Workforce Training
Enrollment and Graduation
400
350
Total Students Enrolled or
Completed: 1,577
Percent of Goal: 94%
300
225
250
200
150
77
103
165
93
100
50
0
117
Columbia
148
65
29
Duke
64
88
73
62
58
67
Johns
Hopkins
OHSU
99
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19
George
Washington
Indiana
Graduated
Enrolled
Texas State
Colorado
Minnesota
Target
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HealthIT.gov website (for providers)
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HealthIT.gov website (for patients)
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HealthIT.gov website (for informaticians)
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Putting the “I” in Health IT Campaign
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ePatient Dave
Cancer Survivor and Proud Father
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Nikolai “Koyla” Kirienko
Crohn’s Disease Patient and Trailblazer
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Consumer eHealth Pledge Program
www.healthit.gov/pledge
Over 400 organizations have Pledged to provide access to personal
health information for 1/3 of Americans…
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Consumer Involvement is critical
LINK: http://youtu.be/QCc6QgYUFEM
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Investing in Innovation (i2)
• ONC’s Challenges and Prizes program spurring privatesector innovation and engaging developers to address
health problems that touch every person in America:
 Care Transitions
 Cancer Research
 Heart Disease
 Population Health
 Sexual Abuse
 Disabilities
• Over 100 new applications developed
• Winners have received $195,000 in prizes
• Over 25 new challenges planned
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Million Hearts – Provider Goals
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Consumer Challenge
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Consumer Video Challenge Winner
Dr Funky's Blood Pressure Management Rx
http://bloodpressure.challenge.gov/submissions/7498-dr-funky-s-bloodpressure-management-rx
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Our National Quality Strategy Aims
Better Health
for the
Population
Better Care
for
Individuals
Lower Cost
Through
Improvement
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Health IT:
Helping to Drive the 3-Part Aim
Better healthcare
Improving patients’ experience of care within the Institute of
Medicine’s 6 domains of quality: Safety, Effectiveness, PatientCenteredness, Timeliness, Efficiency, and Equity.
Better health
Keeping patients well so they can do what they want to do.
Increasing the overall health of populations: address behavioral
risk factors; focus on preventive care.
Reduced costs
Lowering the total cost of care while improving quality, resulting
in reduced monthly expenditures for Medicare, Medicaid, and
CHIP beneficiaries.
$
Health Information Technology
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Vision for the Future
• Measures Drive Improvement
– Real-time
– Local ownership with benchmarking
– Linked to decision support and patient dashboards
• Measures Drive Value-Based Purchasing
– Reliable
– Accurate
– Outcomes-based
• Measures Inform Consumers
– Meaningful
– Transparent
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Quality Measurement Enabled by Health IT
• Released July 2012
• Contains a catalog of over 70
activities related to health IT and
quality measurement
• Describes possibilities for the next
generation of quality measurement
• Illustrates challenges facing
advancement
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Meaningful Use as a Building Block
Transform
health care
Improved
population health
Access to
information
Enhanced access
and continuity
Data utilized to
improve delivery
and outcomes
Data utilized to
improve delivery
and outcomes
Patient self
management
Patient engaged,
community
resources
Care coordination
Care coordination
Patient centered
care coordination
Patient informed
Evidenced based
medicine
Team based care,
case management
Basic EHR
functionality,
structured data
Structured data
utilized
Registries for
disease
management
Registries to
manage patient
populations
Privacy & security
protections
Privacy & security
protections
Privacy & security
protections
Privacy & security
protections
Stage 2 MU
PCMH
3-Part Aim
ACO’s
“Stage 3 MU”
Utilize technology
Stage 1 MU
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Best Care at Lower Cost
The Path to Continuously Learning
Health Care in America
September 2012
The Result?
The U.S. health care system today
The Vision
Continuous Learning, Best Care, Lower Cost
10 Recommendations
Foundational elements
1. The digital infrastructure – Improve the capacity to capture clinical, delivery
process, and financial data for better care, system improvement, and creating new
knowledge.
2. The data utility – Streamline and revise research regulations to improve care,
promote the capture of clinical data, and generate knowledge.
Care improvement targets
3.
4.
5.
6.
7.
Clinical decision support
Patient-centered care
Community links
Care continuity
Optimized operations
Supportive policy environment
8. Financial incentives.
9. Performance transparency
10.Broad leadership
Resources
• Browse the ONC website at: HealthIT.gov
click the Facebook “Like” button to add us to your network
• Contact us at: onc.request@hhs.gov
• Subscribe, watch, and share:
@ONC_HealthIT
http://www.youtube.com/user/HHSONC
Health IT and Electronic Health Records
http://www.scribd.com/HealthIT/
http://www.flickr.com/photos/healthit
Health IT Buzz Blog
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Resources
iom.edu/bestcare
http://healthit.ahrq.gov/HealthITEnabledQualityMeasurement/Snapshot.pdf
http://www.ncqa.org/Portals/0/Public%20Policy/PCMH_MU_Graphic_062012.pdf
cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms
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Thank you!
For more information, contact:
judy.murphy@hhs.gov
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