Common Sense Nuts & Bolts of a Usable Robust EHR: Pointers & Pitfalls Overview of ONC Planned Efforts
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1 Common Sense Nuts & Bolts of a Usable Robust EHR: Pointers & Pitfalls Overview of ONC Planned Efforts K. J. Lee, MD, FACS k.lee@emr-simplicity.com HIMSS May 1,
2 SGR P4P? Tool EMR/EHR Retail Clinic Telemedicine Tool EMR/EHR Tort Reform Frivolous, Vicarious; Documentation, Decrease Errors, Clinical Guidelines Tool EMR/EHR Meaningful Use Tool EMR/EHR 2
3 3
4 4
5 EMR/EHR The needed tool The silver bullet The lynchpin The cornerstone The data 5
6 As we develop these electronic interfaces, it would be wise to remember why we practice medicine, and to develop devices that are more transparent and do not get between us and our patient. Vondell Clark, M.D. Mooresville, NC 6
7 Quality is achieved when we can concentrate on our patients and not get distracted 7
8 Tank versus Sedan 1. Slow, cumbersome 2. Too tall 3. Poor visibility 4. High gas consumption 5. Costly to buy 6. Has to have a special driver 7. Etc. 8
9 What is your response if a hospital buys a fleet of tanks to the tune of $200 million and insists doctors have to use the tanks instead of your sedans to go to work? 9
10 Healthcare Business Week April 2012 Broadcast 55% have purchased EMRs 29% have reported complete failure Great % use EMR only for erx Only 12% actually use it Failure cost is $50,000 per doctor per year 10
11 Satisfying Conflicting Priorities, Pleasing 2 Masters Patient-Doctor Encounter Formulation of Dx/Rx Plans (workflow) Public health/public policy OR One patient at a time Population health & cost 11
12 Conflict or Complement Meaningful Use Patient Doctor encounter Formulation of Dx/Rx Plans (workflow of the doctor) 12
13 DON T WORRY There is a way to do this We ve to find the ingredients 13
14 MAKE LEMONADE OUT OF LEMONS Increase Quality, while on call, out of the office Anywhere Anytime (24/7) 14
15 Advantages 1. Fulfill Meaningful Use 2. Save office floor space 3. Avoid chasing & filing charts 4. Multiple people can access chart simultaneously 5. Save transcription cost 6. Lower overhead 15
16 More technology is not always better The right technology at the right dose, at the right time, at the right cost 16
17 The world can never be 100% paperless Your practice can never be 100% paperless 17
18 Be Careful of 1. Security 2. Downtime in installation 3. Length of training 4. Decrease patient volume 5. Is it costly? 6. Increase or decrease staff 7. Billing/scheduling Best of Breed 8. Unnecessary disruption 18
19 Explanation & Disclaimer Certified by ONC-ATCB Encrypted, SSL, etc. Real time duplicate server Emergency recapture As diligent as humanly possible But. 19
20 EHR/EMR: Pointers & Pitfalls 1. (a) Local server vs Hosted (b) One office vs multiple offices 2. Redundancy, emergency recapture 3. Hotel model vs Stadium model (Too close, too open, best of both worlds) 4. Interconnectivity vs Interoperability 20
21 EHR/EMR: Pointers & Pitfalls 5. (a) Accurate vs automatic coding (b) Justification of code 6. Smart code 7. Macros vs. Macro Plus 8. Template, cloning 9. How to get the clinical information back? 21
22 The most difficult to record accurately, efficiently, honestly and legibly and/or in a structured manner is the HPI, the Physical & Dx/Rx Plans & not the lab tests, prescriptions, ICD s etc. 22
23 Clinician Workflow 12 steps for the Enabler, the tool, the EHR/EMR 1. Patient ID: name, DOB, SS#, chart #, language, ethnicity, race, gender 2. Meds/allergy to meds 3. Review of Systems (ROS) I, II, III 4. (a) Previous HPI & physical (c.c., H&P) (b) Current HPI & physical (c.c., H&P) Write (ink technology, stored electronically, not on paper, eliminate paper charts) Type Voice recognition Dictate to transcriptionist Macros, Macros plus Customized digital H&P (Decision Tree) 23
24 Our Workflow 12 steps for the Enabler, the tool, the EHR 5. Access to test-reports quickly & intuitively (filing cabinets) 6. e-prescribe, frequently used meds 7. Order & track tests, e.g. MRI, have an In Box 8. Order & track referrals 9. Order & track future surgery 10. Code & code guide 11. Next appointment 12. Referral letter, educational materials, instructions to patients 24
25 Collection of Structured Data by Staff 1. Demographics 2. Medication list 3. Allergy to medication list 4. Capture ICD-9 s 5. Vital signs, Ht, Wt, BMI 6. Smoking history 7. Lab results 8. Family & social history 9. DROS III (all encompassing now & future) to fulfill MU 25
26 DROS I Screen shot 26
27 DROS II Screen shot 27
28 Filing Cabinet Screen shot 28
29 Short scroll versus confusing icon 29
30 Frequently used meds screen shot 30
31 Ordering tests, etc. screen shot 31
32 Search for chart by name, DOB, chart number, social security number Touch screen scroll technology Low cost Minimal installation and training downtime Increase productivity and efficiency and not decrease Staff O/H, space O/H to decrease Ease of use and yet robust for meaningful use; it needs to meet the Conflict of Priorities or Pleasing 2 different masters (concentrate on the patient and Meaningful Use) ONC-ATCB certified 32
33 Enterprise System 1. It is a MAJOR change 2. Has to improve efficiency, quality, decrease cost and increase revenue or at least NOT lose revenue 3. Has to have a champion 4. Has to have buy in by ALL 33
34 Quiz: Where was this taken? 34
35 Technology: A step ahead not a step back Has to have fun and passion Life is too short k.lee@emr-simplicity.com 35
36 Meaningful Use Terminology 1. Clinical Quality Measures (CQM) (a) 3 Core or Alternate Core (b) 3 from a menu of (a) 15 core operational objectives (b) 5 out of 10 non-core operational objectives (called another menu of 10) 36
37 Clinical Quality Measures (CQM) 2011 (can start as late as October?) Report to CMS by ATTESTATION numerator, denominator, dates 2012 Actually submit electronically to CMS 37
38 CQM 3 required core, if denominator for required core is ZERO, then find 3 alternative core measures a. Hypertension: BP (NQF 0013) b. Preventive Care: Tobacco use, intervention (NQF 0028) c. Adult weight screening & FU (NQF 0421, PQRI 128) d. Weight & counsel for children & adolescents (NQF 0024) e. Preventive Care: Flu immunization for 50 & over (NQF 0041) (PQRI 110) f. Childhood immunizations (NQF 0038) 38
39 CQM 3 from 38 CQM in a different list a. Pneumonia vaccination status for older adults b. Appropriate testing for children with pharyngitis c. Smoking & tobacco use monitoring d. Breast cancer screening documentation/reminder/disposition e. Colorectal cancer screening documentation/reminder/disposition 39
40 15 Core Operational Objectives 1. Computerized physician order entry (CPOE) (30%, one meds per patient only, schedule & track) 2. E-Rx (40%) 3. Report clinical quality measures 4. One clinical decision support rule 5. Provide patients with electronic copy of their health record, UPON REQUEST (flash drive, disk, patient portal/print) (50%) 40
41 15 Core Operational Objectives 6. Provide clinical summaries for each office visit (H&P, Rx, test results, Rx plan, educational materials) (50%) 7. Drug-drug, drug-allergy checks 8. Record demographics (name, DOB, language, gender, race, ethnicity) (50%) 9. Current diagnoses (ICD9 etc.) (80%) 10. Active medication list (80%) 41
42 15 Core Operational Objectives 11. Active medication allergy list (80%) 12. Chart V.S. Ht, Wt, BMI (50%) 13. Record tobacco use (after 13 y.o.) (50%) 14. Exchange clinical info with other providers (with patient s approval) 15. Protect electronic health info (HIPAA, screen name, alphanumeric passwords, security levels, encrypted, babysitter password iris scan, fingerprint, catch 22 ) 42
43 Do 5 of 10 Non-core Operational Objectives 1. Drug formulary checks 2. Labs as structured data (40%) 3. List of patients by specific conditions (ICD-9, etc.) 4. Reminders to patients (20%) 5. Provide patients timely electronic access (10%) 43
44 Do 5 of 10 Non-core Operational Objectives 6. Patient educational materials (10%) 7. Medication reconciliation (50%) 8. Summary of care/referral letters (50%) 9. Submit electronic immunization data (one test) 10. Provide surveillance data to public health agencies (one test) 44
45 How Much Are the Incentives? Medicare Incentive Payments Detail Columns = first calendar year EP receives a payment Rows = Amount of payment each year if continue to meet requirements 45
46 How Much Are the Incentives? Health Professional Shortage Area Bonuses for Medicare Incentive Program Columns = first calendar year EP receives a payment Rows = Amount of payment each year if continue to meet requirements 46
47 Medicare Payment Adjustments Payment reduction negative adjustments for EP s that are not meaningful users: 2015 = 1% 2016 = 2% 2017 and beyond = 3% 47
48 Medicare Payments for EPs EPs that meet meaningful use criteria: 90 consecutive days for the reporting period CY11 (one year for 2012). Payment will begin on a calendar year basis, effective January 1, Payments will be issued days from successful attestation for CY11 (as early as May 2011). For CY11, the payment cycle is monthly. However only one single payment per year will be provided. 48
49 Stage 2 Objectives/ Menu Set at a Glance March 25, 2012 Medical Economics Use computerized provider order entry for medication, laboratory, and radiology orders. Generate and transmit prescriptions electronically. Record patient demographics (language, gender, race, ethnicity, date of birth). 49
50 Stage 2 Objectives/ Menu Set at a Glance Record and chart vital signs [height, weight, blood pressure (age 3 and over), body mass index, plot and display growth charts (ages 0-20 years)]. Record smoking status. Use Clinical decision support. Incorporate clinical laboratory results into electronic health record (EHR). 50
51 Stage 2 Objectives/ Menu Set at a Glance Generate lists of patients by specific conditions. Identify patients who should receive reminders. Provide patient access to health information online (within 4 business days). Provide clinical summaries for patients for each office visit. 51
52 Stage 2 Objectives/ Menu Set at a Glance Use EHR to identify education resources for patients. Use secure messaging with patients. Use medication reconciliation. Provide summary of care record for each referral or transition of care. Ensure EHR privacy and security. 52
53 Stage 2 Objectives/ Menu Set at a Glance Menu set (must select and meet three) Access imaging results through EHR. Record patient family histories as structured data. Submit electronic syndromic surveillance data to public health agencies. 53
54 Stage 2 Objectives/ Menu Set at a Glance Menu set (must select and meet three) Report cancer cases to state registries Report non cancer cases to state registries Source: Centers for Medicare and Medicaid Services 54
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