CPE regulations require online participants take part in online questions

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1 Demonstrating Meaningful Use and Improving ROI of EHRs How to meet Stage 2 requirements and optimize EHRs Administration CPE regulations require online participants take part in online questions Must respond to at least 4 of the 8 questions Questions will appear on your media player Results will be reviewed in the aggregate; no responses will be tracked back to any individual or organization Do not view the presentation in slide show mode polling questions will not appear To ask a question, use the Ask A Question icon on your media player Help Desk: or outside the United States at

2 Today s KPMG Healthcare speakers Mike Beaty, Partner Jerry Howell, Partner Todd Ellis, Director Neha Sachdeva, Manager 3 Today s discussion Meaningful Use Review Stage 2 objectives & measures highlights Outline the top 4 compliance challenges Provide an approach to meet Meaningful Use requirements EHR Optimization Discuss the lifecycle of EHRs Outline the key EHR implementation challenges Provide an approach for EHR optimization Q&A 4 2

3 Meaningful Use Stage 2 Understanding the goals, provisions and requirements of meaningful use Improve healthcare quality, safety, efficiency and reduce health disparities MU Goals Engage patients and families in their healthcare Improve coordination of care among healthcare providers Ensure adequate privacy and security protections for personal health information Improve population and public health programs Certified EHR Provisions To become a meaningful user of EHR technology, it is essential to use the technology itself The technology in use has been tested and certified in accordance with the Office of the National Coordinator for Health Information Technology (ONC) certification program, as having met all applicable certification criteria adopted by the Secretary of Health and Human Services Basic Requirements Eligible ibl hospitals and providers must use certified EHR technology in a meaningful manner, for example: computer provider order entry (CPOE), eprescribing, access to imaging results, record patient family health history, and others Encourage patients use of health information technology Electronically submit clinical quality measures data from at least 3 of the 6 National Quality Strategy domains 6 3

4 A three-stage approach to achieving meaningful use Stage 1 BUILD Stage 2 USE Stage 3* DEMONSTRATE RESULTS Applicable for 2011 and 2012, focuses on capturing and communicating information in a structured format Starts in 2014, expands on Stage 1, and focuses on improving the care of individual patients Expected to start in 2016, expands on Stages 1 and 2, and focuses on driving improved outcomes Collect electronic health information in a coded format Track key clinical conditions Communicate care needs (including provider and patient communication) Facilitate disease and medication management Implement clinical decision support tools Report key quality and public health information Use of HIT to: exchange information with patients and providers promote continuous quality improvement at the point of care Apply more broadly to both the inpatient and outpatient hospital settings Promote improvements in quality, safety, and efficiency Advance decision support for national high-priority conditions Provide patient access to self-management tools Facilitate access to comprehensive patient data Improve population health Potential For Additional Stages *Note: Requirements for Stage 3 are subject to future rulemaking. 7 Stage 2 objectives & measures highlights To demonstrate MU under Stage 2 criteria: EPs must meet 17 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 20 objectives. EHs and CAHs must meet 16 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 19 objectives. Stage 2 objectives expand on Stage 1 requirements and introduce new core and menu objectives: New Core Track medications using electronic Medication Administration Records (emar) Provide patients with ability to view online, download and transmit health information Use secure electronic messaging to communicate with patients (EP only) New Menu Record electronic notes in patient records Access imaging results through certified EHR technology Record patient family health history Identify and report cancer cases to a State cancer registry and specific cases to specialized registry (for EPs only) Generate and transmit permissible discharge prescriptions p electronically (EH and CAHs only) Provide structured electronic lab results to ambulatory providers (EH and CAHs only) Stage 1 Modifications Increased percentage thresholds and requirements as well as transition of several menu objectives to core Removal of exchange of key clinical information and providing patients timely access to health information (EP) Inclusion of drug-drug/drug-allergy checks with clinical decisions support interventions measure Inclusion of drug-formulary checks with eprescribing measure Inclusion of up-to-date problems list, medications list, and medications allergy list with summary of care document measure Inclusion of CQMs as part of definition meaningful EHR user ; starting 2014, electronic submission of CQMs on 3 of 6 national quality strategy domains 8 4

5 Potential business process impacts of MU Stage 2 Complying with Meaningful Use has impacts throughout the care delivery process. Admissions Scheduling Care Delivery Discharge Transfer Direct & Surgical Admit ED Admit Bed Management Physician Discharge Orders Pre Registration ED Observation Nursing Daily Registration C3, C5 Physician & Ancillary C2, M1 Nursing Admissions C5, C6, M2, M5 Order Entry Clinical Documentation Clinical Quality Reporting C3, C4, C5, M3 Order Fulfillment Physician Admissions C5, M3, M5 Patient/Family Education Physician Admissions Orders C1, C5 C8 C10 C6, M2 C5, C7 C1, C5, C10, C11, M4 C3, C5, C8 C10 Complete Outstanding Orders & Documentation Review Discharge Instructions with Patient Information Technology Systems & Interfaces Regulatory Compliance & HIM Processes Provide Patient Discharge Instructions Core Measures Menu Set Measures Clinical Quality Measures Discharge Patient C6, C13, C14, C15, C16, M2, M6 C9, C12 C1, C5, C11 C1: CPOE C2: Demographics C3: Vital Signs C4: Smoking C5: Clinical Decision Support Intervention C6: Incorporate lab test results in EHR C7:List of patients by specific conditions C8: Automatically track medications C9: View, transmit and download info C10: Patient specific education C11: Med Rec C12: Provide summary of care for transition of care or referral C13: Immunization C14: Reportable lab results C15: Syndromic Surveillance C16: Security M1: Advanced directives M2: Incorporate imaging results M3: Record family health history M4: erx for discharge meds M5: enotes M6: Electronic lab results 9 Top 4 challenges to implementation Stage Vendor Management 2 - Change Management/Adoption Understanding vendor readiness as hospitals move from Stage 1 to Stage 2 Establishing a true partnership with all vendors that will have an impact on MU efforts Vendor ability to deliver implementation resources (ability to support parallel MU stages across many clients) Enhanced organizational training and change management processes to help ensure ability to meet attestation requirements Having a strategy and governance structure to transform the organization MU, ICD-10, ACOs should provide opportunities for organizations to reduce costs, increase revenue, and improve patient safety/outcomes WORKING SMARTER 3 - Technical Integration 4 - Process Transformation Transmission/exchange of patient information across entities not associated with parent Sharing information across a secure platform and having controls in place to mitigate risks Requirement to electronically submit CQMs to CMS. Understanding the importance of knowing how information is being processed within the EHR platform and the identification of all source systems data feeds Establishment of process controls to ensure stability and quality of data across the enterprise Development of an ongoing internal auditing process to consistently monitor performance Developing a documentation retention process and protocols to meet the six-year year CMS audit requirement Developing a strategy to engage the patient and proactively share information 10 5

6 Considerations for implementing a Meaningful Use program Is there an awareness that implementing a Meaningful Use Certified EHR system does not automatically qualify the organization for Medicare related incentives for Meaningful Use? Is there a well developed project plan to meet the Meaningful Use requirements? If so, how is the organization performing against the plan? Is there adequate transparency into the status, issues, and progress being made? Have the change management and training requirements been identified that will help lead to adoption of redesigned clinical work flows and care delivery processes needed to achieve MU? Have the challenges of using the existing EHR for achieving Meaningful Use been considered and evaluated? Has there been a shared and balanced effort between internal project resources and vendor provided resources? Is it clear who owns the Meaningful Use program? Have all roles and responsibilities for project activities requiring completion been clearly communicated and monitored throughout the organization? Were MU Stage 2 objectives considered while implementing the requirements for Stage 1? What is the level of confidence that the organization will be able to achieve and sustain compliance with the HIPAA security program, which is also integral to MU? Is your organization prepared to pass a government initiated Meaningful Use audit? Have the appropriate documentation retention processes and protocols been developed and executed? 11 Meaningful Use assessment approach Stage 2 assessment can: Identify existing gaps and remediation options, and the potential impacts associated with the options Provide an estimate of the effort remaining Develop a remediation plan that improves the system s s ability to meet MU Identify and mitigate potential risks Make organizations alert of hurdles and challenges other organizations have faced Improve documentation retention and book of evidence processes to help prepare for potential CMS audits An assessment should focus on the following phases: Initiate assessment Perform GAP Detailed analysis and roadmap Execute roadmap Has an understanding of work completed to date with respect to MU been established? Have potential gaps between existing/ planned capability and requirements related to MU been identified? Has an analysis of each MU Objective and existing capabilities been performed? Are you ready to execute and manage the initiatives that need to occur? 12 6

7 EHR optimization Importance of EHRs The use of standardized electronic health records and the secure exchange of health information will improve health care quality and safety, and reduce healthcare costs by: Making health information available to authorized health care providers wherever and whenever a patient gets care Giving consumers more complete and accurate information to inform decision-making about their own health care Reducing preventable medical errors and avoiding duplication of treatments and procedures Lowering administrative costs and reducing clerical errors Enhancing research by facilitating the collection of standardized data to evaluate promising medical techniques, devices and drugs Reducing the time it takes to bring safe, effective products and practices to the marketplace. 14 7

8 EHR lifecycle and industry trends EHR technology provides the foundation for organizations to not only comply with healthcare regulations trends but also to improve care delivery and population outcomes while reducing cost. Genomic/Biometric Analytics Paper Processes Capabilities Required Faxing of Orders Electronic Claims Submissions Manual Eligibility Checking Paper Processes Electronic Eligibility Checking HIPAA 5010/ ICD-10 Conversion EHR Adoption KPIs MU Compliance Business Process Redesign Change Management Processes Value Based Purchasing Population Health Management HIE/Public Health Interoperability MU Compliance Base EHR Optimization Enhanced Interoperability Physician Documentation Care Management Patient Engagement Processes Base EHR EHR Optimization Implementation EHR Maturity Path ACOs MU Compliance Enhanced EHR Optimization Disease Management Self-Management Tools Patient Health Record Integration New Business Models Errors due to transcription, illegibility, misplaced information Inefficient care coordination Lack of integration between clinicals and financials Base EHR Implementation Patient safety and clinical decision support Baseline integration between clinicals and financials Improved clinical and financial data capture EHR Optimization Improved system integration Reduced A/R, denials and improved charge capture Improved care coordination through electronic sharing of information (interoperability) Increased patient engagement and preventative care Improved public health outcomes: early detection, prevention and management of chronic diseases New Business Models Predictive care modeling and comparative care research Real-time public health surveillance National health information exchange network IT/IS Infrastructure 15 Supporting the core clinical and revenue cycle integration Example: moving towards an accountable care organization Clinical Platform The Ability to Deliver Effective Care Standardize the enterprise; reduce variation Proactively managing care Leveraging evidence-based practices and care guidelines for both preventive and chronic care to achieve the best possible clinical outcomes ACO Risk Tolerance Revenue Cycle Platform The Ability to Deliver Efficient Care Improving costs involves reducing variations in patterns of care including: Spending on drugs Imaging length of stay Readmissions ED utilization Other System Integration 16 8

9 Common EHR implementation challenges 1. Are your EHR adoption rates low and/or unable to achieve: Organizational, internal KPIs or ROIs? External, industry based KPIs or ROIs? 2. Do you know if you have the appropriate controls in place to help mitigate t system or process related risks? 3. Is your EHR optimally built and configured to facilitate your ability to meet regulatory requirements such as Meaningful Use, ICD-10, etc.? 4. Do you know if you re able to capture the necessary data elements within your EHR to perform the sophisticated analytics needed to participate in new business models such as PCMHs and ACOs? 5. Do you have the appropriate data governance and revenue cycle controls in place? 6. Are you meeting pre go-live baselines with respect to charge capture, payment volumes and AR days? 7. Are you observing bottlenecks in the revenue cycle causing delay in claim submission and reimbursement? 8. Do you have the tools and reports necessary to effectively track and manage your accounts receivable? 17 An EHR optimization approach An optimization approach with underlying methodologies to assess an EHR implementation from the planning phase to post-implementation. To appropriately address a clients optimization needs a focused review of industry trends, the organizations strategic goals and how /why the EHR was implemented will be required. An optimization assessment should focus on the following phases: Planning Phase Design Phase Testing Phase Pre and Post Implementation Phase s Improve Patients Experience Improve Outcomes Improve Work Environments Was the project structured appropriately to manage the effort and mitigate change risk? Was the future state design in line with requirements? Were processes optimized? Is the platform functioning as intended and generating information with integrity? Are there post go live opportunities to optimize the platform? Improve Financial Perf. Promote Mission Industry Trends 18 9

10 Q&A Available publications and external webcasts Healthcare Transformation Meeting the challenges of Meaningful Use Stage 2 Tomorrow, November 13 Special WebEx: Information on Insurance Claims Due to Superstorm Sandy For details and to register us-healthcare@kpmg healthcare@kpmg.comcom The KPMG Healthcare Meaningful Use Readiness Stage 1 Overview of the Final Rule and Clarifications to Meaningful Use A Key to Successful EHR Implementation Quality Assurance and Independent Verification and Validation On-Demand Sessions Supporting Healthcare Transformation through Clinical and Business Intelligence: Practical case studies and lessons learned July 2012 Electronic Health Records Implementation: Leading Practices for Achieving Success May 2012 Demonstrating Meaningful Use of EHRs: The top 10 compliance challenges for Stage 1 and what's new with 2 March

11 Contact Information Mike Beaty KPMG LLP 303 Peachtree Street Suite 2000 Atlanta, GA Office: Jerry Howell KPMG LLP 515 Broadway 4th Floor Albany, NY Office: Todd Ellis KPMG LLP 303 Peachtree Street Suite 2000 Atlanta, GA Office: Neha Sachdeva KPMG LLP 303 Peachtree Street Suite 2000 Atlanta, GA Office: The information contained herein is of general nature and is not intended to address the circumstances of any particular individual or entity. Although we endeavor to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should act on such information without appropriate professional advice after a thorough examination of the particular situation KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. The KPMG name, logo and cutting through complexity are registered trademarks or trademarks of KPMG International. 11