SOURCE: eHealth

May 25, 2005 16:32 ET

eHealth Initiative Announces "Parallel Pathways for Quality Healthcare"

Framework for Aligning Incentives With Both Quality and Health Information Technology Goals Announced at Connecting Communities for Better Health Learning Forum

WASHINGTON, DC -- (MARKET WIRE) -- May 25, 2005 -- The eHealth Initiative (eHI) today released Parallel Pathways for Quality Healthcare, a Framework and a set of principles for aligning emerging incentive programs with both quality goals and the health information technology (HIT) infrastructure required to achieve those goals -- both within the physician practice and across regions and communities through health information exchange -- to support higher quality, safer and more effective healthcare. The Parallel Pathways Framework was released today at eHI's Connecting Communities for Better Health Second Annual Learning Forum. The two-day Forum is being co-sponsored with The American Health Quality Association and the Public Health Data Standards Consortium.

Reports from Congress, the Administration, and private sector groups such as the Institute of Medicine, the Leapfrog Group, and Connecting for Health have recognized the value of HIT in addressing many of the quality, safety and efficiency challenges within our healthcare system. At the same time, the development and implementation of incentives or pay-for-performance programs are on the rise.

While there is recognition of the value of information technology usage by providers and the exchange of information across institutions to support a comprehensive view of the patient at the point of care, adoption by providers -- in particular practicing clinicians -- continues to be low, due to a number of reasons, including the lack of standards and the significant changes in work flow required to move towards implementation. Many believe that the largest barrier to HIT adoption pertains to both the lack of capital to purchase such systems, and even more so, prevailing reimbursement methods which reward volume of services as opposed to outcomes or activities (such as usage of clinical applications) that would result in higher quality, safer, more efficient healthcare.

The Framework provides guidance to purchasers, payers, practicing clinicians, and regional or community-based collaborations focused on health information exchange that are seeking to improve the quality, safety, effectiveness and efficiency of healthcare in their markets, through HIT and exchange of healthcare data. The Framework provides staged guidance for aligning incentives with three key areas: quality capabilities, HIT capabilities within the physician practice, and health information exchange capabilities with regions and communities across the U.S.

The Framework is based on recommendations made by eHI's Working Group for Financing and Incentives launched in December 2004 to achieve multi-stakeholder consensus on a set of policies and principles for improving health and healthcare by leveraging HIT through financing and incentives, targeting both physician practices and regional and community-based health information initiatives and organizations. The Working Group is co-chaired by Marianne E. DeFazio, Director, Global Health Benefits, IBM and John Glaser, PhD, Vice President, and Chief Information Officer, Partners HealthCare System.

Additionally, the Framework emphasizes the need for a staged, incremental approach that recognizes the varying stages of evolution in markets across the country. The following summarizes at a high-level the three phases of evolution.

--  In Phase I, foundational capabilities would be developed to support
    quality improvement goals using HIT within physician offices and health
    information exchange across regions and communities. Rewards would
    primarily focus both on reporting of measures that rely on manual chart
    abstraction and claims data and physician usage of standards-based,
    interoperable HIT applications with certain basic functionalities.
--  In Phase II, capabilities for quality improvement would be enhanced
    through the use of more advanced HIT as well as increased clinical
    information flow across the region or community to support care delivery.
    Rewards would focus on the reporting of measures that rely on clinical data
    sources; connectivity of standards-based, interoperable HIT applications to
    clinical data sources to support information needs at the point of care;
    and physician usage of HIT with more advanced functionalities.
--  In Phase III, the supporting infrastructure for quality outcomes will
    have been developed. Rewards would focus on performance against process and
    outcomes measures, while phasing out rewards for HIT.
In coming months, the eHI Working Group on Financing and Incentives will expand upon and accelerate the adoption of the Framework by translating its principles and policies into how-to guides and tool-kits for various stakeholders, and by supporting implementation in a number of regions across the U.S.

"We are at a unique point in time, where public and private sector interests are at an all-time high in two key areas: improving the quality and safety of healthcare and moving forward on a health information technology agenda," said Janet M. Marchibroda, Chief Executive Officer of eHealth Initiative and Foundation. "Approaching these two key issue areas in a siloed manner -- without strong integration across both -- will result in missed opportunities, unintended consequences, and possibly reduced impact in both areas."

By laying out an integrated, incremental strategy which incorporates goals related to quality, safety, and efficiency as well as health information technology and exchange, the principles and policies of the Parallel Pathways for Quality Healthcare Framework offer the foundation for building a healthcare system that is safer, of higher quality, and more effective and efficient.

The eHealth Initiative and its Foundation are independent, non-profit organizations whose missions are the same: to drive improvement in the quality, safety and efficiency of healthcare through information and information technology. For more information on the eHealth Initiative and its Foundation, go to

Attachment A

Parallel Pathways for Quality Healthcare: Principles for Financing and Incentives

1. Any incentive program focused on quality should also include some level of incentive either direct or indirect -- for the health information technology (HIT) infrastructure required to support improvements in quality.

2. Any financing or incentive program implemented by either the public or private sector involving HIT should:

- Result in improvements in quality, safety, efficiency or effectiveness in healthcare.

- Incentivize only those applications and systems that are standards-based to enable interoperability and connectivity.

- Address not only the implementation and usage of HIT applications but also the transmission of data to the point of care, both of which are required to support high quality care delivery.

- Allow for internal quality improvement or external performance reporting as mutually agreed upon by purchasers/payers and providers.

3. Financing and incentive programs should seek to align both the costs and benefits related to HIT and health information exchange.

Source: Parallel Pathways to for Quality Healthcare Recommendations of the eHealth Initiative Foundations Working Group for Financing and Incentives, ©eHealth Initiative, May 2005.

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