CMS ehealth Summit UW Medicine
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1 CMS ehealth Summit UW Medicine David Chou, MD, MS CTO, IT Services, UW Medicine Professor, Lab Medicine, University of Washington Meaningful Use Executive Co-Chair Baltimore, December
2 UW Medicine Health System (Italics Shared IT Infrastructure) Academic institutions University of Washington Medical Center (UWMC) Harborview Medical Center (HMC trauma/public hospital) Seattle Cancer Care Alliance (SCCA cancer center) Outpatient clinics Hospital-based Primary Care network (UW Neighborhood Clinics or UWNC) Affiliated, wholly-owned Community hospitals Northwest Hospital (NWH) Valley Medical Center (VMC) Closely affiliated VA Medical Centers Seattle Children s Hospital Peace Health System
3 Electronic Medical Record Systems Cerner Millennium Powerchart Inpatient UWMC and HMC Ambulatory SCCA Epic EpicCare UWMC, HMC, NWH ambulatory Full implementation planned May 2014 Inpatient and ambulatory VMC Siemens Soarian Inpatient NWH Integration has occurred with academic sites and is in process with community hospitals All hospitals and many providers have received AIU
4 Stage 1 Status Eligible hospitals NWH attested 2012 VMC, HMC, UWMC attested 2013 Eligible providers Rolling attestations since not all clinics are implemented 260 providers attested in providers are attesting in 2013 Remaining providers will attest in 2014
5 Lessons Learned Stage 1 Getting attention of organization takes time MDs did not understand what was needed Money has helped It took time to build the team with the right skills Our systems had a lot of legacy code which needed to be updated (and reconfigured) We had the same trouble spots as everyone else AVS Problem lists Changing workflows In retrospect, Stage 1 was relatively easy
6 Stage 2 Status Eligible hospitals Community hospitals plan to attest in 2014 Academic hospitals plan to attest in 2015 Eligible providers 300 will attest in 2014 (mix of primary care and specialists) Most other academic providers will attest in 2016
7 Lessons Learned Stage 2 Transitions of care Requires community infrastructure and cooperation UW Medicine must redefine organizational strategies, processes and workflows for intakes and referrals Resource conflicts with MU, ICD10, erx, PQRS, etc. Resource scheduling (e.g., public health reporting requires coordination of three vendors and DOH) Required EHR code releases are often late and buggy Implementing required technical and organizational infrastructure in time is challenging Lack of clarity for many activities (e.g., how do we maintain Direct addresses) Skills acquired in Stage 1 are enough, but resources needed are greater
8 Meaningful Use Status Stage 3 Objectives support improved outcomes although will require significant effort to achieve in allowed timeframe More organizational, workflow, and implementation challenges with wider requirements Increased CQMs challenges workflows and change management, especially with need for discrete data MU3 does not consider other organizational needs deferred by MU1/2 (replace obsolete systems, integrate new systems, mergers and acquisitions, etc.) Requirements challenge providing care to the underserved Language requirement in patient portals and AVS Access for elderly and rural communities
9 Key Takeaways MU steps are 2 year cycles, but the implementation requires more than 5 years in Stage 2 and possibly more in Stage 3. Vendor: Specifications / Coding / Testing / Certification / Rollout User: Configuration / Testing / Training / Implementation / Adoption Vendors are still developing Stage 2 functionality MU requirements dictate what ; EHR vendors and users must determine how, a challenging and transformative process Time does not allow for reengineering and hardwiring workflows Multiple and conflicting mandates (e.g., ICD-10, CQM and PQRS) Expected workflows may be inconsistent with specialty care Academic institutions and care teams are inconsistent with the single provider models (e.g., provider communications)
10 CMS ehealth Summit Panel: MU Stage 3 December 6 th 2013 Linda Fischetti RN MS VP Care Delivery Accountable Care Solutions from Aetna
11 Aetna s values drive ACS strategy. apple 2
12 Our Meaningful Use Journey Since MU s start, the healthcare industry has experienced significant changes ACOs Providers now managing risk for a population Care Coordination 3
13 Continuing Movement Towards Accountability Time Past Environment Future Environment EPISODIC COST ACCOUNTABILITY TOTAL COST ACCOUNTABILITY Traditional fee-forservice Pay-forperformance Shared risk/ savings Full risk / bundled payments Each step brings us closer to controlling costs, increasing quality, and improving the patient experience. 4
14 Opportunities to Support Change Encourage Payment and Delivery Innovation and Reward Provider Efficiency Provide incentives for interoperability Improve the financial incentives for ACOs to assume risk. And reward those providers that do share risk. Government Support Opportunity Program Alignment Improve Quality and Accountability Streamline high-value quality measures. Offer flexibility to ACOs in meeting Meaningful Use standards. Extend Stark Anti-Kickback Safe Harbor exceptions to encourage technology sharing and meaningful provider coordination. Health Information Technology Regulatory Certainty & Clarity 5
15 Thank You Linda Fischetti RN MS 6
16 Meaningful Use Stage 3: EHR Vendor Perspectives Shiv Gopalkrishnan, General Manager, Health System Solutions, GE Healthcare IT December 6, 2013
17 Stages 1 and 2: Key learnings EHR incentive program has driven adoption and we are now in an increasingly digital ecosystem with robust EHR functionality, including enhanced interoperability and patient engagement ONC and CMS staff and leaders are engaged and responsive Vendors and providers are focused on MU... but also have other HIT and EHR priorities ICD-10 Accountable and integrated care Usability Other HIT systems Other regulatory requirements and desired features/functions 2 / Meaningful Use /11/2013
18 Stages 1 and 2: Key learnings Complex program: each measure has detailed specifications, spawning many vendor/provider questions and FAQ iterations Timing tight for vendors & providers: reflected in concerns with Stage 2 certified product availability and implementation timing Final rules issued Q3:2012, but critical supplementary materials not final until late Q4:2012, and some needed information unavailable until early 2013, with critical tools being revised throughout 2013 In release planning, key levers are scope, resources, and timing Sources of provider burden and uncertainty include all or nothing scoring, measurement challenges, audit concerns Uncertainty and complexity can undermine program success 3 / Meaningful Use /11/2013
19 High level recommendations Stage 3 should start no sooner than 3 years after Stage 2 start CMS and ONC should provide clear Stage 3 timetable to providers and vendors ASAP: the industry is working on 2016/17 EHR-related planning Customers need to know vendor plans well in advance All required materials - including final CQM specifications and certification test scripts/data - should be available no later than 18 months before the start of Stage 3 Still very tight given development and implementation timing Final Rules only start needed guidance - FACA recommendation and proposed rules are not solid basis to start software development 4 / Meaningful Use /11/2013
20 High level recommendations Stage 3 should focus on helping providers further use robust Stages 1 & 2 capabilities to improve outcomes and reduce costs, emphasizing: Interoperability, Care Coordination, Quality. Do not add many new MU requirements or certification criteria Consider impact of new requirements, including measurement, on (1) usability and (2) development & implementation costs Avoid adding (into MU or certification) emerging functionalities not well-defined or standardized by the market or typically in EHRs, such as advanced population health management tools Market forces will increasingly drive product functionality as providers seek to succeed in VBP and integrated and accountable care 5 / Meaningful Use /11/2013
21 High level recommendations Reconsider all or nothing approach to attestation Consider three-month reporting period for first year of Stage 3 HIT Policy Committee MU measure consolidation promising... but, just put in certification has costs for providers & vendors HITPC s alternate deeming path worth consideration, but should not add to complexity or vendor development burden and must align with realistic assessment of ecqm readiness Continue with progress to align quality measures and reporting across federal and other quality programs 6 / Meaningful Use /11/2013
22 CMS ehealth Summit Stage 3 Meaningful Use Panel Dec. 6, 2013 Robert M. Tennant Senior Policy Advisor MGMA Government Affairs Washington, DC rtennant@mgma.org Copyright Medical Group Management Association (MGMA ). All rights reserved.
23 Medical Group Management Association MGMA is the premier association for professional administrators and leaders of medical group practices MGMA has o o o More than 30,000 national and state members All group sizes, types and medical specialties Where more than 280,000 physicians provide more than 40% of U.S. physician services Copyright Medical Group Management Association (MGMA ). All rights reserved.
24 Lessons Learned-the Good Medical groups are, in general, very supportive of the adoption of EHRs as they have the ability to improve both the clinical and administrative side of the practice Although not covering all the cost of a typical EHR install, the incentive payments are a clear sweetener A significant percentage of EPs have attested under Stage 1 of the MU program MGMA applauds CMS for its provider outreach and education resources and encourages a continuation of these efforts for the second stage of the program and beyond Copyright Medical Group Management Association (MGMA ). All rights reserved.
25 Concerns Challenging current environment for EPs and vendors (HIX, ICD-10, Admin Simp, Payer ID, Privacy, SGR, etc) Redundant requirements (i.e., security risk assessment-already required since 2005) MU criteria weighted toward primary care (i.e., smoking status, referrals, reminders) All or nothing approach All year reporting Copyright Medical Group Management Association (MGMA ). All rights reserved.
26 Concerns Reliance on patient actions and costly technology to meet a measure (i.e., secure messaging, portals) New criteria must not act as a disincentive to participate (i.e., of the $44k total: $38k for Stage 1 $6k for Stages 2/3) Insufficient time for software developers and EPs to move from one stage to another Copyright Medical Group Management Association (MGMA ). All rights reserved.
27 Certified 2011 Complete Ambulatory EHRs Copyright Medical Group Management Association (MGMA ). All rights reserved.
28 Certified 2014 Complete Ambulatory EHRs Copyright Medical Group Management Association (MGMA ). All rights reserved.
29 Suggested Program Modifications-General Allow group MU reporting as is done with PQRS Avoid multiple reporting of the same quality data Permit flexibility in achieving MU (criteria/ time) Avoid measures that require action by 3 rd parties (patients, other care settings) Permit the unforeseen circumstances hardship category to include vendor-related problems No penalties for Stage 1 attesters Copyright Medical Group Management Association (MGMA ). All rights reserved.
30 Suggested Program Modifications-Stage 2 To ease the transition to Stage 2: Extend the reporting period for Stage 2 incentives Extend the reporting period for Stage 1 incentives Conduct a comprehensive vendor survey Build additional flexibility into the Stage 2 reporting requirements Copyright Medical Group Management Association (MGMA ). All rights reserved.
31 Suggested Program Modifications-Stage 3 Fully evaluate Stages 1/2 to before developing Stage 3 requirements Engage patients, don t force them Consider usability criteria instead of additional functionality Expand funding for the RECs and allow them to assist for Stage 2/3 and in other HIT areas Copyright Medical Group Management Association (MGMA ). All rights reserved.
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