Agenda. Topic Industry Today - Quality Measure Reporting Stage 1 Meaningful Use - Overview - Tenet Experience

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1 Achieving Meaningful Use Symposium Eligible Hospital Perspective Stage 1 Learnings, Stage 2 Preparation Liz Johnson, MS, FHIMSS, CPHIMS, RN-BC, VP, Applied Clinical Informatics, Tenet Health DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 2 Agenda Topic Industry Today - Quality Measure Reporting Stage 1 Meaningful Use - Overview - Tenet Experience Stage 2 Meaningful Use - Prepare for the Future, Expand on Stage 1 Components Questions

3 3 The Industry Today

4 4 Quality Reporting Today Merges Quality and Finance Compliance 11%-79% of the time McGlynn EA et al. NEJM 2003; 348: Quality Reporting PQRI HACs MS-DRGs 1999 IOM Report: 44K 98K patients die each year from medical errors 18 types of medical errors account for 2.4 million hospital days and $9.3B in excess charges per year Meaningful Use

5 Does Higher Reimbursement Equal Better Quality? The New York Times, June 2,

6 6 The Cost Conundrum McAllen, TX Lowest household income in country ($12,000/yr) One of most expensive healthcare markets in country ($15,000/enrollee/yr) El Paso, TX 8 miles from McAllen Same demographics Lower Medicare expenditures ($7,504/enrollee/yr) How to reconcile the difference? Pay for quality, not quantity The New Yorker, Atul Gawande, June 1, 2009

7 7 The Rate of HIT Change Used to Be Leisurely

8 8 Regulations Accelerated Change Exponentially X

9 Stage 1 Meaningful Use

10 10 EHR Incentive Program Meaningful Use Detailed Components A hospital must be a meaningful user to receive payment incentives By law, a meaningful user must: Use a certified EHR Exchange health information Report quality measures Staged approach over several years Stage 1 Data Capture & Sharing Final rule published in 2010 Begin data collection in 2011 Stage 2 Advanced Clinical Processes Final rule due July 2012 Begin data collection October 2013 Stage 3 Improve Outcomes Final rule due ~ end of 2013

11 Meaningful Use Stage 1 Measure Breakdown Demonstrate MU The Measures Utilization Measures (24) Clinical Quality Measures (15) * One utilization measure is Report Clinical Quality Measures Core (14)* Menu (10) 11 Percent based - automate numerator, denominator Yes/No Aggregate/ calculate from electronic specs

12 12 EHR Incentive Program Registrations and Payments through 12/11 Medicare/ Medicaid Medicare Medicaid Provider/ Hospital Registered Attested Paid Providers 124,921 15,255 $275 million Hospitals 3002 (includes 2834 Medicare/Medicaid hospitals) 604 (includes 566 Medicare/Medicaid hospitals) $1.1 billion Providers 49,051 15,132 $295 million Hospitals 2909 (includes 2834 Medicare/Medicaid hospitals) 1043 (includes 566 Medicare/Medicaid hospitals) $853 million Total 176,049 30,991 $2.5 billion Monthly stats available at

13 Tenet Experience

14 Tenet Healthcare Corporation One of the Largest Investor-Owned Health Care Delivery Systems in the Nation acute care hospitals in 11 states 90outpatient centers 57,000 employees $9.2 billion net operating revenues (CY 10) 512, 972 admissions (CY 10) 3.9 million outpatient visits (CY 10)

15 Tenet s IMPACT Schedule

16 2012 IMPACT Rollout Schedule 2012 Initiatives CPOE Go Live at 19 hospitals Foundation Systems* at 11 hospitals Cerner OB rollout for 3 hospitals ED pilot and eprescribing kickoff Optimization Program initiated, initial focus 1 st 7 CPOE hospitals 2012 Year End Goals 38 hospitals live on Foundation Systems 26 hospitals live on CPOE 26 hospitals will attest for Meaningful Use Stage 1 16 Key CPOE Live (9) In Flight (33) On the runway (8)

17 17 Meaningful Use Life Cycle Tenet Program Meaningful Use Stage 1 Requirements Provide Users a Certified EHR Enterprise Wide Data Warehouse Meaningful Use Dashboard Monitor & Track Compliance Document & Compliance Evidence Attest to CMS

18 18 Mapping out Meaningful Use Process

19 CMS Tenet s Approach to Electronify Measures Reporting Compliance MU Dashboard Capture Data Data Warehouse Determine Meaningful Use Requirements Capture the right data in the right format enabled by workflow to support Meaningful Use Stages 1-3 and other related initiatives Support Tenet s overall BI Objective Identify Content Sources Develop Processes Workflows Impacted 19 PBAR* Cerner* EDW* Make Design Decisions

20 20 Clinical Business Intelligence -Meaningful Use Dashboard

21 21 The Tenet MU Attestation Process Attestation Scheduled Attestation Evidence Collected or Generated Attestation Acknowledgement and Response Hospital Sponsor Review and Sign-off Review of Evidence Documentation Leadership Review and Sign-Off CMS Attestation

22 Meaningful Use Attestation Documentation 22 Compliance tool that supports the hospital workflows to complete the attestation for submission to Headquarters Reminder tool for start and end times associated with Meaningful Use attestation timelines Central repository for Links to instructions for steps to attestation Attestation responses for each hospital Evidence to illustrate achievement, and provide support in the event of CMS audit Audit tool that time stamps work-flows, responses, authors, and evidence

23 23 Meaningful Use Attestation Evidence Checklist Example

24 24 Meaningful Use Attestation Evidence Checklist Example

25 25 Lessons Learned Engage Entire Team to Keep Process Moving Forward Bigger than you think Make decisions focused towards the horizon Avoid pitfalls Have end users test function and provide feedback prior to release Improve process continuously Don t be reactive keep larger picture in mind Focus on end goal Have program ownership at all operating levels Have shared vision with leadership on clinical and financial goals Ensure open feedback loop Keep clinicians engaged Creative physician training Balance CDS strategy to avoid alert fatigue Include clinicians in review process, and incorporate their suggestions

26 Preparing for Meaningful Use Stage 2

27 27 Stage 2 -Most Significant for Eligible Hospitals CPOE emar eprescribing for discharge meds Patient View and download Physician Notes Summary of Care/Care Plan/CareTeam Clinical Decision Support Clinical Quality Measures Continued adoption 30 to 60% and expansion - rad and lab Integration into EHR, 30% medication orders automatically tracked Generate and transmit 10% of all hospital discharge orders Patient access required Requirement note to be searchable Format still being defined CCD Selection of measure(s) and criteria for demonstration of improvement emeasure still being defined by HITPC Quality Measures Working Group

28 28 Prepare for Future CPOE Developed our plan for 80% epres Software license in place CDS Part of our Standard Implementation emar Part of our Standard Implementation Menu Develop reporting and compliance for all 10 Menu Set measures providing flexibility in choosing 5 for submission Quality Measures Develop reporting capabilities to deliver all 15 electronic specified quality measures

29 29 Prepare for the Future Quality Measures Measured Electronically 90 Days Develop reporting capabilities to deliver all 15 electronic specified quality measures Stroke-5 Antithrombotic Therapy by Day 2 (Ischemic Stroke) Hospital A 100.0% Incorporate specific data elements in the EHR build design for 20 measures proposed for Stage 2 and 3 Ability to drill down to the patient and nursing unit Hospital B Hospital C Hospital D Hospital E Hospital F Hospital G 90.3% 89.5% 84.2% 80.6% 80.0% 68.0% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

30 Prepare for the Future Better Analytics Decision Support, Alerts Clinical Decision Support Rules Blood transfusions IV to PO conversion reminders Restraint monitoring Advanced Directives Vaccine administration VTE therapy Etc Alerts will expand in logic, with more interpretation and proactive interventions, such as. Mrs. Jones creatinine has doubled over last 6 months, from 0.5 to 1.0, consider switching her ACE Inhibitor to an ARB for her hypertension therapy. 30 Today Future

31 31 Prepare for the Future emar - Tools to improve safety: barcode scanners Barcode Scanners New workflow for nurses and pharmacy Allows us to capture near miss information Today Future

32 32 Lessons Learned Maintain corporate support for Meaningful Use Project and New Reimbursement Models Budgets don t end at the end of Stage 1 attestation Plan out projects to continue for at least 6 months beyond Stage 2 attestation Remember there is a Stage 3.proposed rule due for release about 12 to 18 months after Stage 2 is released Collect data for ALL measures during stage 1 Strive to stage 2 thresholds during stage 1 Be prepared to start building additional Quality emeasures when Stage 2 final rule is published in mid-2012

33 Don t let the future be the enemy of now Imagine a world where integrated data Pharmacy Data Safer Care EHR Data Improved Disease Mgmt Improved Satisfaction Medical Device Data Lab Data Better informed Clinicians becomes information that drives patient care 33 Radiology Data

34 Meaningful Use as a Stepping Stone for Home Care Meaningful Care Liz Johnson Community Care Patient Inpt care EHR Implementation Roll out Enterprise Data Warehouse Financial gains (MU, VBP) Time to adjust workflows Improved Efficiency Duplicate tests Data abstraction Chart reviews Length-of-stay etc Ambulatory Care Fully Integrated Data Improved Quality Pressure Ulcers Blood Use Hospital Acquired Conditions Readmissions ADEs 34 Today Value Realized Future

35 35

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