Preparing for Meaningful Use: An Approach to Foundational Measure Selection and Metric Adherence"

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Preparing for Meaningful Use: An Approach to Foundational Measure Selection and Metric Adherence" ACP Webinar October 25, 2010 Peter Basch, MD, FACP Medical Director, Ambulatory EHR and Health IT Policy, MedStar Health Senior Fellow in Health IT Policy, Center for American Progress VisiDng Scholar, Engelberg Center for Health Care Reform, Brookings InsDtuDon

Review of Meaningful Use" Part of the HITECH Act within the American Recovery and Reinvestment Act of 2009 (the Stimulus Bill ) Provides ~$30B between 2011 2016 to incentive physicians and hospitals to adopt and meaningfully use EHRs Provides for Medicare penalties (starting in 2015) for physicians / hospitals that are not meaningful users of EHR technology

Incentives / Penalties MC" 5

Incentive Medicaid " 6

Purpose of Meaningful Use" National Health Priorities Improving quality, safety, efficiency, and reducing disparities Engaging patients / families in their healthcare Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information Other Policy Goals / Considerations Robust health IT is a prerequisite of any high functioning healthcare system Have > tipping point of MDs / hospitals using robust IT in the provision of healthcare by ~2015 Reduce or eliminate the #1 barrier to MD EHR adoption Opportunity to influence development and use of EHRs and other health IT 7

What Meaningful Use Says to Me" Meaningful use of health IT is the law of the land Using health IT to improve care is an emerging expectation of patients, employers, payers Opportunity for us to take advantage of federal bonus to recoup upfront costs (and avoid future penalties) Opportunity for MDs to assume leadership in how health IT can improve care (or to assume reluctant followship and let others dictate what comes next) 8

Two Approaches to Core Measures" Literal / Incremental Crawl / Walk / Jog / Run Plan to satisfy metric Objective / Goal Oriented Develop clear picture of desired end-state Assess technology / end-user readiness Move iteratively (or with quantum leaps) towards that goal 9

Meaningful Use Core Measures" 10

Example of Goals Focused Approach" Substitute clinical data for claims data for quality reporting / reminders Improve quality for preventive and chronic care measures Use patients at the point-ofcare whenever to validate their own problems, meds, allergies We need to have problems, medications, and allergies list Complete Up-to-date Understandable by patients We can readily create and make use of a pre-visit form for some / all patients We can readily create a post-visit summary We trust our reminders and internal reporting strategy 11

Meaningful Use Core Measures" 12

Aiming for 100% Accurate / Complete Problems / Meds / Allergies for 100% of Patients" 13

Meaningful Use Core Measures" 14

Making it Easy to Create Clinical Summaries" 15

Meaningful Use Core Measures" 16

Using CDS to Improve Collection % for VS and Smoking Status" 17

Meaningful Use Core Measures" 18

Getting eprescribing % Over the Threshold of 40%" Using reporting Run a report to establish baseline Run regular (monthly) reports to show progress Share reports for individuals / groups to stimulate action Other Barriers to eprescribing System UTD list of pharmacies / PBMs Default setting = erx Pharmacy Process to identify preferred pharmacies that are not yet connected Contacting pharmacies to get them connected Patient Encouraging use eprescribe and print backup Rx 19

Meaningful Use Core Measures" 20

MU Menu Set" 21

MU Menu Set" 22

MU Menu Set" 23

MU Menu Set" 24

Providing On-Demand Access to New Lab Results w/in 4d" Patient portal approach Aggressive marketing to providers and patients Takes time and effort to get patients on-board Decision point Providers have to review labs before they are made available to the patient portal Need to make sure that providers are reviewing labs in a timely fashion Labs (at least most of them) are made to the patient portal simultaneous with their entry into the EMR May generate an increase in patient queries as to meaning of their labs for them 25

MU Menu Set" 26

Using Point-of-Care CDS to Address Quality Care Opportunities" 27

Correlation Between Use of Pointof-Care CDS and Quality Metrics" 28

MU Alignment with Other Payers" 29

Bottom Line" Meaningful Use as a way of pushing significant incentives and penalties is the law of the land It is expected to dramatically accelerate EHR adoption and optimal use over the next 4+ years It is also expected to be just the first step in a fundamental change to how providers and hospitals are paid for care Those that are meaningful users will not just reap benefits and avoid penalties they will be prepared for success with PCMHs, ACOs, and other payment reforms 30

Questions???" 31