Meaningful Use. A Success Story, The Rest of the Story and Our Way Forward

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1 Meaningful Use A Success Story, The Rest of the Story and Our Way Forward Michael H. Zaroukian, MD, PhD, FACP, FHIMSS CMIO and Professor of Medicine - Michigan State University Medical Director, Clinical Informatics and Care Transformation - Sparrow Health System About MSU HealthTeam Multi-specialty faculty group practice >40 clinics; 12 facilities 135,000 active patients Medical (2) and nursing schools >1,000 users ( concurrent) 210 attending physicians, 179 residents, 200+ students 24 PA / NP providers >300 other health care professionals (RN, LPN, HCA/MA) >200 front office, managers, IT staff, billers, etc. 1

2 Our 2002 Baseline Our 2004 Goal Our Overarching Goals EMR Use that Transforms Care (Clinical and Informatics Leadership) An EMR that is Used (Organizational Leadership) An EMR that Works (Information Technology Leadership) 4 2

3 Our Tools Secure Messaging Billing Interface Patient Portal Clinical Messaging Online Questionnaires Interfaces: Registration/Scheduling Lab, pathology, radiology ECG, PFT Transcription Wireless tablet PCs Disease Management Clinical Decision Support Reports: Reportable Dx Cost-benefit; ROI Quality P4P 5 Our Path: Crawl-Walk-Jog-Run Full office visit charting, CDM STOP paper chart pulls CDS, performance reporting Basic visits, procedures Immunizations, injections Computers inside exam rooms Basic data entry and exchange Problems, meds, allergies Prescribing and printing Computers outside exam rooms Navigate, view, sign 6 3

4 Our Attitude: Strive to Arrive Innovators Early adopters Early majority Late majority Laggards - Strivers Arrivers IT optimists System changers IT realists $$$ Viewers Basic users IT pessimists Categories from: Miller RH, Sim I, Newman J: CHCF, 2003; Our Adoption Barometer 32 Annual IM paper records chart pull charge savings = $87,

5 Our Costs & Savings Our EMR Return on Investment Break-even Point 16.5 months Zaroukian MH, Sierra A. J Healthc Inf Manag, 2006;20:

6 So...How d it Go For the Rest of the Practice? Early Successes Many tools in place for advanced use Some adopted rapidly, focused on appropriate use Strong $ ROI for some Enabled innovative care Open access appointments Visible fairness appointments PCMH-like practice even before PCMH available Early Challenges Some didn t adopt at all Some passive, some active Some only crawled-walked Clinical leaders not made accountable for EMR use Under-resourcing of measurement/reporting Valuable assets implemented but not fully rolled out / in use Technology challenges 11 Subsequent Progress Ongoing Challenges Success Factors New CIO improved HIT Strategies, track record Revised governance Expectations, policies Direction, prioritization Push to update systems Infrastructure improvements EMR upgrades PM upgrades HITECH, health reform laws MU incentives Prospects for payment reform Continued Challenges EMR team work to do vs. staff, resources to do it Training environment, tools, processes, evaluation No formal EMR super-users Limited focus on workflow redesign Slow rollout of patient portal, disease registry Delayed implementation of electronic orders, advanced CDS 12 6

7 So, What are You Doing About it? Within the EMR preparing for MU qualified EMR version upgrade PM integration with EMR Performance reports EMR Dashboard At the edges third party integrations erx go live (10/2010) Finish patient portal, disease registry rollouts Getting Pt instructions, Handouts to portal Electronic orders interface What Else We are Doing About it Beyond Our EMR Change Management Technology Third party documentation, CDS, reporting tool upgrade Online learning modules Learning management system (LMS) Clinical Content Workgroups Linking to our RHIO ( EHR interoperability for our main systems People User retraining for MU and continuous performance improvement Formalizing our super-user program Processes Using process improvement tools (esp. IHI, Clinical Microsystems) Leveraging super-users for workflow process redesign 7

8 Super-Users: The Importance of Help At the Elbow Why EMR Super-users are Important Enhance achievement of organization s quality goals Facilitate EMR system implementation, usability, user acceptance, communications, training, user support and accountability Needed to optimize the EMR system Important to EMR support and maintenance Decrease implementation and optimization costs 8

9 Why EMR Super-users are Important Support new users Implement new features and functionalities Improve EMR user productivity Provide day to day on-site support for other users Enable EMR project team to focus on implementing other sites, coordinate EMR updates, resolve reported issues The Cost of NOT Having Super-users Historical Lower, slower adoption (diffusion) Suboptimal use (infusion) Persistent paper, dictation Workflow inefficiencies Lower receipts Re-implementations Building forms that were never used Delayed optimizations, upgrades Future Higher risk of failure to qualify for $5M in MU incentive payments Fewer $ for needed change Fewer data to prove, improve quality & value Less ready to participate in new payment models (ACO) CMS payments (1-5%) 9

10 A Resolution to our Board Endorse the principles, concepts and approaches to establishing a HT EMR superuser program as outlined in the document EMR Super user Program Assign departmental or clinic business owners to recruit, assign and ensure the engagement and effectiveness of its local EMR super-user(s) Task CISC to oversee EMR Super user Program development and periodically report on its effectiveness. Training for Meaningful Use Connecting to Purpose Why we are doing this, really? Defining Success MU payments, quality goals, payment reform readiness Curriculum and Competencies Training and Assessment Environment Physical, virtual Leading and Managing Change 10

11 The main thing is to keep the main thing the main thing. Stephen Covey Objective Measure (structured data) 1. Record patient demographics > 50% of unique patients 2. Record VS, chart changes (Ht, Wt, BP, BMI, growth charts) >50% age >2 years of age or older (Ht, Wt, BP) 3. UTD problem list >80% of patients 1+ entry 4. Active medication list >80% of patients 1+ entry 5. Med allergy list >80% of patients 1+ entry 6. Smoking status >50% of patients 13+ years of 7. EPs - clinical summary each OV Hosp e-copy of D/C instructions on request 8. Patients get e-copy of their health info on request >50% of all OVs <3 b-days >50% of patients D/C from IP or ED who request e-copy get it >50% of requesting patients get e- copy by 3 b-days 11

12 The main things Objective Measure (structured data) 9. erx - permissible Rx (EPs only) >40% e-transmitted (certified EHR) 10. CPOE for medication orders >30% of patients w/ 1+ med in list have 1+ entered via CPOE 11. Implement interaction checks (drug Functionality enabled for entire drug/allergy) reporting period 12. Implement capability to e-exchange Perform at least one test key clin info (providers, pt-auth entities) 13. Implement one clinical decision support 1 CDS rule implemented rule, ability to track compliance 14. Implement systems to protect Security risk analysis, security privacy,security of patient data in EHR updates PRN, correct deficiencies 15. Report clinical quality measures to 2011: attestation, aggregate CMS or states numerator and denominator 2012: e-submit measures Oh, and one more thing OK, at least 5 more things) Objective Measure 1. Implement drug formulary checks Implemented & access to 1+ int/ext drug formulary (entire period) 2. Structured lab test results in EHRs >40% of numerical or pos/neg results in as structured data EHR as structured data 3. Generate lists of patients by Generate 1+ list(s) of patients with a specific conditions specific condition 4. Use EHR-T to identify/provide ptspecific education resources PRN education resources >10% of patients provided pt-specific 5. Perform MED REC between care MED REC >50% of transitions settings 6. Provide summary of care record for Summary of care record >50% of patient referrals or transitions transitions or referrals 7. Submit e-immunization data to 1+ test of data submission, follow-up registries submission (if registries can accept) 8. Submit e-syndromic surveillance 1+ test of data submission and follow-up data to public health agencies submission (if PH agencies can accept) 12

13 at least 5 more things Objective 9H. Record advance directives for patients age H Submit of electronic data on. reportable laboratory results to public health agencies Measure >50% of patients 65+ have indication of advance directive status recorded 1+ test of data submission and follow-up submission (where PH agencies can accept) 9E. Send reminders to patients (per patient preference) for preventive and follow-up care 10E. Provide patients with timely e- access to their health information (lab results, problem list, med lists, med allergies) H = Hospital E = Eligible Professional >20% of patients 65 or 5 are sent appropriate reminders >10% of patients provided e-access to info within 4 days of being updated in the EHR Comments and Questions 13

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