HIE/HIO Organizations Supporting Meaningful Use (MU) Stage 2 Goals Pam Matthews, RN, MBA, FHIMSS, CPHIMS Senior Director HIMSS Didi Davis, President, Serendipity Health, LLC East TN Regional HIMSS Conference Tuesday, January 14, 2014
Intersection of HITECH and HIE Meaningful Use Stage 2 and future stage criteria is anticipated to include rigorous expectations for health information exchange including: Data capture in electronic format Electronic data exchange capabilities - transmission and receipt Structure data formats Centers for Medicare & Medicaid Services (CMS)* states that any provider receiving an EHR incentive payment for either the Medicare or Medicaid EHR Incentive Program may be subject to an audit. Providers may have only 2 weeks to collect and submit audit documentation Providers can be audited up to six years following attestation Recommended best practices is to keep audit-ready files available for each year that providers attest for an EHR Incentive payment * http://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/registrationandattestation.html 2
Intersection of HITECH and HIE http://www.himss.org/files/himssorg/content/files/mu2_hie_matrix_final.pdf 3
Survey Survey Purpose: HIMSS conducted a survey to report if local/regional/private HIE/HIOs are offering Meaningful Use related services to their stakeholders. HIE/HIOs should be prepared to support their participating stakeholders for auditreadiness if selected for an audit. Targeted Audience for Survey: HIE/HIO Organizations Methodology: An online survey tool was used for data collection Survey results are self reported with no additional follow-up of participants Survey participants are confidential 4
Demographics Participation: n-profit HIE/HIO Organizations 23 Total Participants Geographic Region: Distributed across the 10 regions designated by CMS 8% 8% 8% 13% 8% 13% 4% 4% 17% 17% 8 State-Designated Entities (SDEs) 65% 35% 5
Computerized Provider Order Entry (CPOE) Use CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. If order goes beyond organizational boundaries, then Enterprise HIE is implied and could be involved. Does your HIE provide services or a gateway to facilitate orders / results delivery? 48% 52% 6
Demographics Recording EP Record the following demographics: preferred language, sex, race, ethnicity, date of birth. EH/CAH Record the following demographics: preferred language, sex, race, ethnicity, date of birth, date and preliminary cause of death in the event of mortality in the EH or CAH. Does your HIE MPI or empi act as a Patient Cross Reference Manager to maintain a global community ID? 26% 74% 7
Clinical Decision Support Rules Use clinical decision support to improve performance on high-priority health conditions. Does your HIE facilitate population health management best practices by providing clinical decision support rules systems? 91% 9% 8
Lab-Test Results (CEHRT) Incorporate clinical lab-test results into Certified EHR Technology as structured data. Lab results are ideally electronically incorporated into the EHR via a structured format and shared within an organization, and ultimately across both public and private HIE organizations. Other Responses: Independent labs & imaging centers Regional based labs Unaffiliated hospitals Nursing homes Other diagnostic facilities 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Who does your HIE currently receive feeds from? 0% 13% 83% 70% 22% 22% 9
Patient Reminders [EP Only] Use clinically relevant information to identify patients who should receive reminders for preventive / follow-up care and send these patients the reminder, per patient preference. Does your HIE provide this publish/subscribe functionality for care coordination? 78% 22% 10
Patient Access [EP/ Only] Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP. EH/CAH only: Provide patients the ability to view online, download, and transmit information about a hospital admission. Does your HIE organization offer this service? 32% 68% 11
Secure Messaging [EP Only] Use secure, electronic messaging to communicate with patients on relevant health information. Does your HIE offer Direct HISP services for secure messaging between providers and patients? 41% 59% 12
Summary Care Record The EP, EH or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary of care record for each transition of care or referral. Does your HIE provide a summary of care record on behalf of your connected stakeholders for transitions of care or referrals? 30% 70% 13
Immunization Registries Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. Does your HIE transport Immunization Registry information to your state department of health on behalf of your connected stakeholders? 41% 59% 14
Lab Test Reporting [EH / CAH Only] Capability to submit electronic reportable laboratory results to public health agencies, except where prohibited, and in accordance with applicable law and practice. Does your HIE transport Electronic Lab Test Result reporting information to your state department of health on behalf of your connected stakeholders? 52% 48% 15
Syndromic Surveillance [EH / CAH Only] Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice. Does your HIE transport Syndromic Surveillance information to your state department of health on behalf of your connected stakeholders? 70% 30% 16
Cancer Registry [EP Only] Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. Does your HIE transport Cancer Registry information to your state department of health on behalf of your connected stakeholders? 87% 13% 17
Data Protection Protect electronic health information created or maintained by Certified EHR Technology through the implementation of appropriate technical capabilities. Has your HIE organization reviewed or conducted a security risk analysis? 13% 87% 18
Advance Directives [EH / CAH Only] Record whether a patient 65 years or older has an advance directive. Does your HIE organization facilitate access to advance directives for a community? 78% 22% 19
Imaging Results Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through Certified EHR Technology. 78% Does your HIE organization facilitate access to imaging results for a community? 22% 20
Lab Results (Ambulatory) Provide structured electronic lab results to ambulatory providers. Does your HIE organization normalize lab data with LOINC or an alternative? 43% 57% 21
HIMSS ANALYTICS EMRAM SCORES Prepared for Tennessee HIMSS Chapter HIMSS Analytics has devised the EMR Adoption Model, an 8-step process that allows you to track progress against healthcare organizations across the country and view all scores in the HIMSS Analytics Database. Once a provider obtains their EMRAM score, they can: Begin to meet application requirements and become operational stage by stage, working toward the final level, Stage 7 Compare your progress with other organizations, and also across departments within your organization Align IT initiatives with your overall business strategy and shape strategy for future IT investments
Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 2011 Q4 2012 1.2% 1.9% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 5.2% 8.2% Closed loop medication administration 8.4% 14.0% CPOE, Clinical Decision Support (clinical protocols) 13.2% 14.2% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed 44.9% 12.4% 5.7% 38.3% 10.7% 4.3% All Three Ancillaries t Installed 10.1% 8.4% Data from HIMSS Analytics Database 2012 HIMSS Analytics N = 5,281 N = 5,458
2013 Q2 2013 Q3 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 2.1% 2.2% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS 10.0% 11.1% Closed loop medication administration 18.7% 20.9% CPOE, Clinical Decision Support (clinical protocols) 14.6% 15.1% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed 34.5% 9.0% 3.8% 31.9% 8.4% 3.5% All Three Ancillaries t Installed 7.2% 6.9% Data from HIMSS Analytics Database 2012 HIMSS Analytics N = 5439 N = 5437
HIMSS Analytics EMRAM SCORES Tennessee EMR Adoption Model SM (EMRAM) Average Median Min Max Entire HIMSS Analytics Database 3.8921 3.5800 0.0000 7.0710 East South Central Region (N=459) 3.5137 3.4220 0.0000 6.0710 Alabama (N=102) 3.5583 3.4710 0.0000 6.0630 Arkansas (N=87) 3.3351 3.3500 0.0000 6.0710 Georgia (N=156) 3.8829 3.5050 0.0000 7.0310 Kentucky (N=109) 3.7372 3.3630 0.0000 6.0710 Mississippi (N=102) 3.2645 3.4180 0.0000 6.0710 Missouri (N=137) 4.2951 4.2070 0.0000 7.0630 rth Carolina (N=124) 4.1721 3.5340 0.0100 6.0710 Tennessee (N=146) 3.4898 3.4100 0.0000 6.0710 Virginia (N=91) 4.8167 5.1340 0.0000 7.0710 East South Central Region includes Alabama, Kentucky, Mississippi, and Tennessee. HIMSS Analytics Database Fourth Quarter 2012 25
EMRAM home page: http://www.himssanalytics.org/e mram/index.aspx Stage 7 Hospitals (state data is located here): http://www.himssanalytics.org/em ram/scoretrends.aspx
Thank You Q & A Pam Matthews, RN, MBA, FHIMSS, CPHIMS Senior Director HIMSS pmatthews@himss.org Office: 706-838-0583 // Cell: 706-424-3471 Twitter: @pvmatthews 27
Resources HIMSS Ambulatory HIE Toolkit http://www.himss.org/library/health-information-exchange/ambulatory-hie/toolkit HIMSS Enterprise HIE Toolkit http://www.himss.org/library/health-information-exchange/enterprise-hie/toolkit HIMSS State HIT Dashboard http://apps.himss.org/statedashboard// HIMSS Membership http://www.himss.org/membership/ HIMSS Analytics EMRAM http://www.himssanalytics.org/emram/aemram.aspx HIE Symposium at HIMSS14 http://www.himssconference.org/education/eventslisttopic.aspx?metadataid=125 28