David Groves HealthBridge Executive Director, Tri-State Regional Extension Center
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1 David Groves HealthBridge Executive Director, Tri-State Regional Extension Center CSOHIMSS 2009 Slide 1 May 8 th, 2009
2 HITECH / ARRA Health Information Technology for Economic and Clinical Health Act (HITECH), Provisions of the American Recovery and Reinvestment Act of 2009 (ARRA) Vision Enable significant and measurable improvements in population health through a transformed health care delivery system. HIT Policy Committee Goals Improve quality, safety, and efficiency Engage patients and their families Improve care coordination Improve population and public health Ensure privacy and security protections CSOHIMSS 2009 Slide 2 May 8 th, 2009
3 CMS Final Rule Published July 13, 2010 Contains final definition of Meaningful Use 3-stage approach 25 stage 1 requirements for eligible providers (EP s) Core and Menu groups Stage 2 & 3 requirements to be determined Specifies the following: Process for participation by EP s Eligibility requirements for professionals and hospitals Reporting methodology and timeframes Payment periods Payment calculations/procedures for Medicare & Medicaid Medicare penalties for failing to meaningfully use certified EHR CSOHIMSS 2009 Slide 3 May 8 th, 2009
4 CMS Final Rule Stage * 1. Capturing health information in a coded format 2. Using the information to track key clinical conditions 3. Communicating captured information for care coordination purposes 4. Reporting of clinical quality measures and public health information Capture information. Stage * 1. Disease management, clinical decision support 2. Medication management 3. Support for patient access to their health information 4. Transitions in care 5. Quality measurement 6. Research 7. Bi-directional communication with public health agencies Report information Stage 3 TBD* 1. Achieving improvements in quality, safety and efficiency 2. Focusing on decision support for national high priority conditions 3. Patient access to selfmanagement tools 4. Access to comprehensive patient data 5. Improving population health outcomes Leverage information to improve outcomes *Indicates payment year in which each Stage is first introduced. Actual compliance timeframe depends on an EP s first payment year. CSOHIMSS 2009 Slide 4 May 8 th, 2009
5 15 Stage 1 Core Measures Policy Priority Improving quality, safety, efficiency and reducing health disparities Core Set Stage 1 Objectives Use CPOE for medication orders Implement drug-drug & drug-allergy checks Generate and transmit permissible prescriptions electronically (erx) Record selected demographics (preferred language, gender, race, ethnicity, date of birth) Measure 30%+ of patients Functionally enabled 40%+ of eligible prescriptions 50%+ of patients Maintain an up-to-date problem list of current and active diagnoses Maintain active medication list 80%+ of patients 80%+ of patients CSOHIMSS 2009 Slide 5 May 8 th, 2009
6 15 Stage 1 Core Measures Policy Priority Stage 1 Objectives Maintain active medication allergy list Measure 80%+ of patients Improving quality, safety, efficiency and reducing health disparities (cont.) Record and chart changes in selected vital signs (height, weight, BP, BMI, growth charts (2-20 yrs.) 50%+ of patients Record smoking status for patients 13 years old or older 50%+ of patients Implement one clinical decision support rule along with the ability to track compliance that rule Report ambulatory quality measures to CMS or the States 1 rule Aggregate numerator/ denominator CSOHIMSS 2009 Slide 6 May 8 th, 2009
7 15 Stage 1 Core Measures Policy Priority Stage 1 Objectives Measure Engage patients and families in their healthcare Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and medication allergies) upon request, within 3 days of request Provide clinical summaries to patients for each office visit within 3 days of visit 50%+ of all patients who request 50%+ of all office visits Improve Care Coordination Ensure adequate security and privacy provisions for personal health information Capability to exchange key clinical information (for example problem list, medication lists, medication allergies, diagnostic test results) among providers of care and patient authorized entities electronically Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities. 1 test of capability Conduct or review a security risk analysis CSOHIMSS 2009 Slide 7 May 8 th, 2009
8 10 Stage Menu Measures Policy Priority Improving quality, safety, efficiency and reducing health disparities Menu Set Stage 1 Objectives Implement drug formulary checks Incorporate clinical lab test results into certified EHR technology as structured data Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach Send reminders to patients 65 years or older of 5 years or younger per patient preference for preventive/ follow up care Measure Functionality enabled 40%+ of all clinical lab tests ordered At least 1 report of patients with condition 20%+ of patients CSOHIMSS 2009 Slide 8 May 8 th, 2009
9 10 Stage Menu Measures Policy Priority Engage patients and families in their healthcare Improve Care Coordination Stage 1 Objectives Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate Measure 10%+ of patients 10%+ of patients CSOHIMSS 2009 Slide 9 May 8 th, 2009
10 10 Stage Menu Measures Policy Priority Stage 1 Objectives Measure Improve care coordination Improve population health Perform Medication Reconciliation when the EP or eligible hospital receives a patient from another setting of care or provider of care Provide summary of care record for each transition of a patient to another setting of care or provider of care or referral to another provider of care Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice 50%+ of care transitions to EP 50%+ of care transitions from EP At least 1 test At least 1 test CSOHIMSS 2009 Slide 10 May 8 th, 2009
11 There is Help Regional Extension Center Program WHAT IS IT? New federal program funded by ARRA and aligned with CMS incentive program for EHR adoption GOAL: Help eligible professionals Implement EHR technology achieve meaningful use and qualify for incentives REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. CSOHIMSS 2009 Slide 11 May 8 th, 2009
12 Tri-State REC Service Area State Ohio (11 coun(es) Kentucky (37 coun(es) Indiana (19 coun(es) CSOHIMSS 2009 Slide 12 May 8 th, 2009
13 Tri-State REC Service Area State Ohio (11 coun(es) Kentucky (37 coun(es) Indiana (19 coun(es) NEK Y RHIO CSOHIMSS 2009 Slide 13 May 8 th, 2009
14 Tri-State REC Goals 1,740 Priority Primary Care Providers (PPCPs) to Meaningful Use Support 24 Rural and Critical Access Hospitals in EHR adoption and meaningful use CSOHIMSS 2009 Slide 14 May 8 th, 2009
15 Tri-State REC Activities Program Kick-off Physician Recruitment Capacity development Staff Hiring Subcontracting EHR Vendor Evaluation/Selection Methodology Development Direct Assistance CSOHIMSS 2009 Slide 15 May 8 th, 2009
16 Basic REC Services Education Services on Technology and Meaningful Use Project Planning and Management Group Purchased EHRs and Technology Solutions Implementation Support Quality Reporting Support Integration with a local or state HIE CSOHIMSS 2009 Slide 16 May 8 th, 2009
17 Why Engage the REC for Help Access to federally subsidized help Proven Processes Shortened Timeframes for completion Reduced Risk Lower total out of pocket cost CSOHIMSS 2009 Slide 17 May 8 th, 2009
18 Following a Roadmap to Meaningful Use STAGE 1 Assessment STAGE 2 Planning STAGE 3 Selection STAGE 4 Implementation STAGE 5 HIE Integration STAGE 6 Meaningful Use CSOHIMSS 2009 Slide 18 May 8 th, 2009
19 Planning a Roadmap to Meaningful Use STAGE 1 Assessment STAGE 2 Planning STAGE 3 Selection STAGE 4 Implementation STAGE 5 HIE Integration STAGE 6 Meaningful Use Practice Readiness Assessment Current State Assessment Operational Technology Facility and Infrastructure Workflow Assessment Computer Skills Assessment CSOHIMSS 2009 Slide 19 May 8 th, 2009
20 Planning a Roadmap to Meaningful Use STAGE 1 Assessment STAGE 2 Planning STAGE 3 Selection STAGE 4 Implementation STAGE 5 HIE Integration STAGE 6 Meaningful Use Practice Goals Meaningful Use Gap Analysis and Objectives (menu selection) EHR and Practice Management Software Strategy Future State Description CSOHIMSS 2009 Slide 20 May 8 th, 2009
21 Planning a Roadmap to Meaningful Use STAGE 1 Assessment STAGE 2 Planning STAGE 3 Selection STAGE 4 Implementation STAGE 5 HIE Integration STAGE 6 Meaningful Use Vendor Evaluation Methodology Vendor RFP Vendor Proposal Demonstrations Evaluation and Selection Negotiation CSOHIMSS 2009 Slide 21 May 8 th, 2009
22 Planning a Roadmap to Meaningful Use STAGE 1 Assessment STAGE 2 Planning STAGE 3 Selection STAGE 4 Implementation STAGE 5 HIE Integration STAGE 6 Meaningful Use Product Installation Workflow redesign Training Acceptance Testing Pre-load of Data Manual Automated Go-Live CSOHIMSS 2009 Slide 22 May 8 th, 2009
23 Planning a Roadmap to Meaningful Use STAGE 1 Assessment STAGE 2 Planning STAGE 3 Selection STAGE 4 Implementation STAGE 5 HIE Integration STAGE 6 Meaningful Use Laboratory Results Other clinical results Care Summary Immunization Registry Syndromic Surveillance CSOHIMSS 2009 Slide 23 May 8 th, 2009
24 Planning a Roadmap to Meaningful Use STAGE 1 Assessment STAGE 2 Planning STAGE 3 Selection STAGE 4 Implementation STAGE 5 HIE Integration STAGE 6 Meaningful Use Quality Reporting Security Risk Analysis MU Requirements Measured Interoperability Tests Attestations CSOHIMSS 2009 Slide 24 May 8 th, 2009
25 Lessons Learned Physician recruitment effort is more costly and time consuming than anyone planned Communications and outreach is difficult Six months after ARRA the level of understanding of MU remains low Some skepticism is surely felt among physicians Inertia is not entirely overcome by the incentive payment promise Practices with EHRs in place seem most eager to work with their REC EHR selection process reveals a few clear leaders and a large group of good solutions in the next tier Vendor work forces are stretched and companies are generally looking for collaborative relationships with RECs even if not selected as preferred. Interoperability through an HIE is valued by providers and vendors CSOHIMSS 2009 Slide 25 May 8 th, 2009
26 Q & A CSOHIMSS 2009 Slide 26 May 8 th, 2009
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