# Presentation: 921357

## The CPR Landscape:Current Status and Pressing Needs

- Paul C. Tang, MD*Northwestern Memorial Hospital*

## Outline

- Progress Report on the Computer-based Patient Record Since the 1991 IOM Report
- Users and Uses of CPR
- Remaining Impediments
- Role for NCVHS

## CPR DefinitionIOM

- A CPR is an electronic patient record that provides:
- complete and accurate data
- alerts
- reminders
- clinical decision support
- links to medical knowledge
- other aids

## Institute of Medicine ReportFirst Edition, 1991

- Adopt CPR as the standard for all records related to patient care
- Establish public/private CPRI to focus national agenda
- Provide public/private support for CPR research, development, and demonstration
- CPRI: Promulgate national standards for data and security

## CPRI: Review laws and regulations to facilitate implementation of CPRs
Share costs of CPRs among all users of data
Enhance educational programs on CPRs

- Share costs of CPRs among all users of data
- Enhance educational programs on CPRs

- Institute of Medicine Report*First Edition, 1991*

## National Priorities in Health CareChange in Business Landscape

- Cut costs
- Capitate
- PCP as gatekeeper
- Generate quality reports
- Regulate managed care
- Audit billing practices

## NCQA WarningIf You Don’t Have an Information System...

- “Given the magnitude of the U.S. health care enterprise, the need for excellent health plan information systems for a variety of reasons is clear — and yet we do not have them. More often than not, information systems are a barrier to the efficient, effective use of data to measure quality, improve care and service, manage finances, and support clinical research.”

## “Health plans, purchasers, and providers must make a sustained investment of personnel, time and resources.”
“New sets of performance measures will assume that health plans have established the levels of automation described in this report.”

- “New sets of performance measures will *assume* that health plans have established the levels of automation described in this report.”

- NCQA To Providers and Plans:*Get One!*

## National Priority for DataData Driven Decisions

- Mandates
- Cut costs
- Capitate
- PCP gatekeeper
- Report quality
- Billing compliance

- Data-Enabled
- Manage costs
- Manage disease
- Manage demand
- Measure and improve
- By-product of care

## Enabling TechnologiesChange in Technology Landscape

- One world: Internet connectivity
- Negroponte: 1 B users by 2000
- “One” interface (viewer)
- Many computers
- Multiple platforms (H/W, OS)
- Legacy systems

## Status of CPRDevelopment and Implementation

- Status of CPR*Development and Implementation*

## Users
Physicians
Nurses
Patients

- Physicians
- Nurses
- Patients

- Functions
- Access complete, integrated data
- Provide confidentiality and security
- Ubiquitous access
- Decision support
- Patient education

- Users and CPR Functions*Example Primary Users and Functions*

## Users
Clinical management
Administrative management
Clinical researchers
Health services researchers

- Clinical management
- Administrative management
- Clinical researchers
- Health services researchers

- Functions
- Ability to aggregate data
- Maintenance of confidentiality
- Generate data as by-product of care
- Produce reports

- Users and CPR Functions*Example Secondary Users and Functions*

## IOM RecommendationsMid-Decade Follow Up

- Adopt CPR
- Establish public/pvt CPRI
- Public/private funding of research and development
- Share costs of CPRs among users of data

- Still a goal; early adopters implementing
- CPRI established, largely privately funded
- Industry: `99’ CPR vendors at ‘98 HIMSS; Public: NLM, AHCPR, NIST, DoD, VA
- Still largely borne by users of CPR

## CPRI Mandates from IOMPromulgate National Standards

- 1996 National Summit on Health Information Solutions
- Collaborative effort (AHIMA, AMIA, CHIM, CHIME, HIMSS, MLA)
- Over 80 healthcare senior executive stakeholders
- Consensus on:
- Universal Health Identifier
- Confidentiality and Security Laws and Policies
- Terminology Conferences to promote convergence of terminology standards

## Proposed Standards Acceleration Project
CPRI neutral forum, coordination
Full-time efforts to developing standards, esp. terminology
GCPR Project
Complementary government project and national standards development

- CPRI neutral forum, coordination
- Full-time efforts to developing standards, esp. terminology
- GCPR Project
- Complementary government project and national standards development

- CPRI Mandates from IOM*Promulgate National Standards, cont*

## CPRI Guidelines on security and confidentiality
Establishing Information Security Policies
Information Security Education Programs
Managing Information Security Programs
Sample Confidentiality Agreements
Glossary of Terms
Security Features for CPR Systems
Electronic Signature Policies
URL: www.cpri.org

- Establishing Information Security Policies
- Information Security Education Programs
- Managing Information Security Programs
- Sample Confidentiality Agreements
- Glossary of Terms
- Security Features for CPR Systems
- Electronic Signature Policies
- URL: www.cpri.org

- CPRI Mandates from IOM*Promote Enabling Policies and Laws*

## CPRI HIPAA Implementation Conference
April 27-28, 1998
CPRI General Meetings
e.g., July 9, 1998 on Evaluating CPRs
CPRI Davies Award Program for Excellence in CPR Implementation
July 10, 1998
CPRI Terminology Conference II
Winter 98

- April 27-28, 1998
- CPRI General Meetings
- e.g., July 9, 1998 on Evaluating CPRs
- CPRI Davies Award Program for Excellence in CPR Implementation
- July 10, 1998
- CPRI Terminology Conference II
- Winter 98

- CPRI Educational Programs*Enhancing Education on CPRs*

## Pressing NeedsDevelop CPRs and Demonstrate Results

- Evolve products through use and continual enhancement
- Evaluate CPRs to understand and quantify benefits and costs
- Communicate results and best practices
- CPRI Davies Award Symposium
- Conferences and media

## Pressing NeedsInfrastructure

- Standards
- Universal health identifier
- Clinical terminology
- Policies and Laws
- Confidentiality and security
- Cost sharing models
- Leadership and Strategic Planning
- Business needs for information
- High capital costs

## Recommendations for NCVHSAdvancing Progress Towards CPRs

- Standards
- UHI: Conduct hearings, recommend solution
- Clinical terminology and data model: Define problem, recommend public funding to achieve results by 2001
- Policies
- Confidentiality: Keep legislative process on track
- Data and cost sharing: Propose recommendations to HHS for incentives and cost sharing