EHR for the PCMH A Doctor s Perspective. Medical Home Summit

Transcription

1 EHR for the PCMH A Doctor s Perspective Medical Home Summit Salvatore Volpe MD FAAP FACP CHCQM March 15, 2011

2 Learning Objectives Why I adopted an EHR My experience: what I needed to do to achieve best practices How I benefited from EHR adoption

3 Healthcare Challenges Fractured healthcare delivery system Medicare beneficiaries see 1 14 unique providers annually, On average 6 different providers/yr 1 in 10 tests were ordered on the same patient by more than one physician Patient s multiple healthcare records do not interoperate An unwired healthcare system 90% of the >30B healthcare transactions in the US every year are conducted via mail, fax, or phone Aftermath of a Natural Disaster: Hurricane Katrina Slide taken from presentation Assessing Value/Calculating ROI by Blackford Middleton, MD; HIT Summit Pre-Conference II;

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5 Is This an Efficient Work Setting? Hey Hey Sally! Sally! Where Where is is Mrs. Mrs. Jones Jones x-ray? x-ray? Prescription refill refill request request on on fax fax machine (Right (Right behind behind the the joke joke of of the the day) day) Printer Printer with with results results from from one one lab lab Unsorted results results Unopened mail mail Courier Courier just just dropped off off more more envelopes About About to to ring ring with with stat stat results results Web Web portal portal (from (from one one hospital)

6 Clinical Benefits Reduction in Medication Errors to Illegible Handwriting Ambiguity Removed in Prescribing

7 Benefits of eprescribing a care provider a doctor or nurse practitioner uses a computer system to enter information about prescription medications that a patient needs & electronically transmits that data directly to the pharmacy computer eprescribing can reduce medication errors/injuries provide greater convenience for patients streamline refill processes better manage medication costs help people remember to take their medications properly ehealth Initiative June, 2008

8 Benefits: Enhanced Practice Productivity and Efficiency

9 Examples of Cost Savings Based on 68 Charts per day: 2 physician practice Chart handling/searching: 136 charts managed/day (5 min per); 680 = $35,088/yr New chart creation: 10 min per chart; 100 $12/hr = $5,160/yr Transcription: transcribing, filing, managing: $1,200/mo = $14,400/yr Chart Storage: ex. 10 x 14 $20 per sq ft = $33,600/yr Chart Supplies: charts, encounter forms, progress notes, lab sheets, history forms, problem lists, printing and photo copying = $10,000/yr Estimated Total Annual Savings: $ 98,248

10 Benefits to Patients and Practice Patient safety: drug to drug interactions, drug to allergy interactions; drug to lab alerts; out-of-range lab result notifications; education materials; summary of the visit; PHRs on USB/CD/Paper; on-line capabilities Clinical Decision Support to help treat diseases and track care over time: Diabetes, Coronary Artery, High Blood Pressure/Hypertension; PQRI Voluntary Clinical Reporting Electronic transference of patient encounter data: CMS, PQRI, Registries, Immunizations (identified vs. deidentified data depending on target destination) Office efficiencies: workflow, task assignments, referrals, decrease in lost time and revenue with improved visit super-bill coding; on-line formularies; erx for new and refill prescriptions; eorders send/receive from Labs

11 The Connected Healthcare Community: (ACO?) Patient-centric design Disparate IT systems are unified through a shared information architecture Collaborative Care Model All providers have access to complete, upto-date patient information Diagnostic Labs Pharmacies Hospitals Patients Managed Care Physicians & Staff

12 TWO IMPORTANT STEPS TO EHR ADOPTION SUCCESS Step 1: Get a partner Join the local REC The Regional Extension Center (REC) will be an organization that is a home for various types of resources packaged to facilitate better HIT adoption across the states and nation. Step 2: Engage your entire practice team They are your biggest asset! Experts in the workflows! Clinical, front office and back office need to be engaged in the process Need to have support before during and after implementation In the small office we wear many hats and share many tasks

13 Patient Centered Medical Home The Patient Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth and adults The PCMH is a health care setting that facilitates: partnerships between individual patients, & their personal physicians, and when appropriate, the patient s family partnerships among the physicians involved in the coordination of the patient s care

14 Medical Home Dash Board Sample EHR This is an example of a patient centered medical home dash board. The physician can track out going referrals, preventative medicine guideline actions, patient specific follow-up items.

15 Take home notes EHR Sample EHR Sample EHR

16 Patients as proof readers EHR Sample EHR Sample EHR

17 Sample Medical Summary Screen EHR EHR

18 Office Home Page

19 Patient Portal Reminder EHR EHR

20 Patient Portal Referral List EHR EHR

21 Patient Portal Lab/Diagnostic Reports EHR EHR

22 American Recovery & Reinvestment Act of 2009 Federal Incentives under ARRA Medicaid incentive: up to $64,000 beginning in 2012 with an amount up to $21,500 to be paid in year 1 and the balance paid over the next 5 years; Medicare incentive: up to $44,000 beginning in 2011 (early adopters can receive $18,000) or 2012 ($15,000) with the balance paid over 4 years at $12,000, $8,000, $4,000 and $2,000 ending in 2015 Reimbursement policy is base on meeting meaningful use : using electronic prescribing, ability to produce quality reports, and the ability to electronically exchange patient information

23 Medicare Bonus for eprescribers Doctors who prescribe Medicare Part B drugs electronically next year will be rewarded with additional pay. However, those incentives eventually will run out, and penalties will begin for physicians who stick with paper. Percent of annual Medicare pay: Year Incentive Penalty (Adoption) (Non-Adoption) % None % None % None % 1% % 1.5% Beyond None 2% Source: The Medicare Improvements for Patients and Providers Act of 2008

24 Criteria for Achieving Meaningful Use & PCMH Meaningful Use Improve quality, efficiency and reduce health disparities Engage patients & families Improve care coordination Improve population & public health Ensure privacy & security PCMH Access & communication Patient tracking & registry Care management Patient self-management Electronic prescribing Test tracking Referral tracking Performance reporting & improvement Advanced electronic communications

25 How Do I Demonstrate Meaningful Use? In 2011 providers will attest to the achievement of each Meaningful Use Measure, most likely through a web portal provided by CMS Starting in 2012, CMS and NYS Medicaid will determine Meaningful Use through automated transmissions directly from EHRs Payment will be rolling Norman Regional Health System s Dr. Cynthia Taylor First in Nation to Receive Check for Meaningful Use 01/24/2011, $21,250.00

26 Can the Medical Home Model Improve Patient Care?

27 Lessons Learned PCMH is a good guide for office transformation, but the practice staff has to buy into the concept first Sometimes, the transformation is the easiest part. Proving it is the challenge Care coordination efforts are rarely documented EMRs not yet ready to facilitate capture of that information Hard to get aggregate look (many fields are not queriable/no reports available) How do you prove something was given or printed? Chicken/Egg: Implementation/Wait for Reimbursement

28 Yes, some days are like this

29 As time passes, more days are like this

30 Thank You for Attending Questions?