Qual-IT - February-March 2007 | Archived

The eHealth Initiative (eHI) is a national organization dedicated to quality improvement through widespread use of both HIT and HIE—health information exchange.  Because the lack of incentives is a major barrier to HIT and HIE adoption, in 2005 eHI convened a national multi-stakeholder leadership group to develop principles for such incentives.

These principles have now been embodied in a new eHI report, RFI^eHI: An Employer’s Guide to Healthcare Quality Improvement, which spells out criteria that could be included in employers’ requests to health plans for information, to document how contracting health plans are measuring and supporting HIT use as part of an overall strategy to measure and improve health care quality.  This eHI tool can be used alone, but has also been included as a component of the broader “eValue8” request for information developed by the National Business Coalition on Health.

In 2006, Department of Health and Human Services (HHS) Secretary Michael Leavitt launched a national campaign to coordinate employer and health plan initiatives to advance quality through the use of HIT.  Secretary Leavitt articulated the broad goal of ensuring that consumers have access to information about quality and costs.  Achieving this goal requires health plans and employers to collaborate on four “cornerstones” of a value-driven health care system: “connect the system” through provider adoption of standards-based HIT and HIE; measure and report health care quality; measure and report health care cost; and coordinate incentives to ensure that the highest quality care is purchased and delivered.  To lead by example, an executive order issued last August directed all federal agencies and programs—e.g., the Veterans Administration, Federal Employees Health Benefits Plan, and Medicare—to adopt and utilize these principles. 

To further bolster employers’ adoption of these policies, a coalition of business groups has now issued Value Driven Health Care: A Purchaser Guide.  The publication describes the HHS initiative, provides model contract templates that could be used to evaluate specific health plan policies, and lists organizations that are supporting national and regional quality improvement efforts. 

HHS is also fostering community-based efforts to advance these measures.  In January, Secretary Leavitt designated the Puget Sound Health Alliance, based in Seattle, as the first “Community Leader for Value Driven Health Care.”  Employers are expected to play a major role in these community efforts: the Puget Sound initiative was spearheaded by King County Executive Ron Sims in response to growing concerns about quality and cost trends in the county’s employee benefits program.  Major private employers, such as Boeing, Microsoft, and Starbucks, are also involved. 

In New York, the New York Business Group on Health has been a leading proponent of quality assessment and reporting, specifically supporting employer use of the Leapfrog Group hospital survey (see below) and the eValue8 health plan request for information.  This month, the Business Group announced that more than a dozen leading New York employers, along with several local health plans and associations, had signed on to the standards advanced by HHS and the President.  With support from the Business Group and the Business Council of New York State, large-scale commitment by employers could greatly expand coordinated implementation of standards and incentives that will promote HIT adoption and use throughout the health care system in New York.

On a different front, The Leapfrog Group has developed a new self-assessment tool for hospitals.  Officially launched in November 2000, the Group was founded by a coalition of employers and health care stakeholders to advance patient safety measures and decrease preventable deaths in hospitals.  One of the key items measured in Leapfrog’s hospital quality and safety survey was use of computerized physician order entry (CPOE).  Closer examination of this measure by Leapfrog and HIT experts has made it clear that CPOE functions and use vary widely, based on different vendor offerings and their actual implementation by hospitals.  Simply having CPOE is not sufficient, Leapfrog concluded; the system must provide explicit alerts about medication errors to change health care professionals’ behavior.

Working with First Consulting Group, Leapfrog has now developed a self-assessment tool that will determine whether hospital and ambulatory care facility CPOE systems incorporate adequate decision support and other functions to reduce prescribing errors.  (First Consulting Group presented an overview of the assessment tool during a recent Agency for Healthcare Research and Quality Webcast.)  At a minimum, Leapfrog’s standards require CPOE systems to detect and report back to clinicians at least 50 percent of avoidable, potentially harmful medication errors.  Provider results from this assessment will be included in Leapfrog’s future public reports.

Bailit Health Purchasing LLC.  2007.  Value Driven Health Care: A Purchaser Guide.  Available online at www.leapfroggroup.org/media/file/Purchaser_Guide_Final2-07-07.pdf

eHealth Initiative.  2006.  RFI^eHI: An Employer’s Guide to Healthcare Quality Improvement Through Support of Health Plan Incentives for Adoption and Use of Health Information Technology.  Available online (registration required) at www.ehealthinitiative.org.

eHealth Initiative.  2005. Parallel Pathways for Quality Healthcare.  Available online at

www.ehealthinitiative.org/assets/documents/ParallelPathway5-25-052PM.doc). 

First Consulting Group.  2007.  Leapfrog Computerized Physician Order Entry (CPOE) and Electronic Health Record (EHR) Evaluation Tools: Project Overview and Discussion.  Available online at  http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_3882_219414_0_0_18/AHRQ%20Webcast%20011207.pdf
  

Leapfrog Group.  Further information about the Group’s initiatives and tools is available online at www.leapfroggroup.org/home.

New York Business Group on Health.  Further information about the Group’s work is available online at www.nybgh.org.

Puget Sound Health Alliance.  Further information about the Alliance’s work is available online at www.pugetsoundhealthalliance.org.

U.S. Department of Health and Human Services.  Value Driven Health Care Initiative.  www.hhs.gov/transparency.