1 HEALTH INFORMATION AND TECHNOLOGY & TRANSITIONS OF CARE Robert Hunter, DO, FACOEP, FACOFP AOA Health Policy Fellow OMED 2011 Orlando, FL November 1 st,2011
2 Acknowledgments Ohio Osteopathic Association Health Policy Fellowship Executive Director AOAMI Ohio ACOFP AOA MY FAMILY
4 Background ARRA included over $20 billion for (HIT). The cost of implementing EMR. Quality care for patients. Meaningful use criteria ever changing. Distribution of funds.
5 Background Significant in primary care. Hospitals also can qualify for millions. Eligible professionals stand to get up to $44,00 under Medicare and $63,750 under Medicaid. Security and privacy a concern for patients. Establishment of Regional Extension Centers (REC).
6 Benefits PCP manage information. EMR can help with better accessibility. EMR can help speed work flow. Lessen time spent on paperwork. Obtaining data.
7 Benefits Staff will have quicker access. Improvement of communication with patient. Improve revenue. Improve patient safety. Escribing and legible prescriptions
8 Benefits Data collection for research. Evaluate practice habits. Easier use of evidence based medicine. Reduction in need of staff. Lessen storage of medical records
9 Barriers Few US doctors or hospitals have EMR s. Cost is a significant barrier. Meaningful use criteria difficult to understand. Multiple EMR companies to choose from. Older physicians looking at retirement.
10 Barriers Loans for EMR. Life expectancy of EMR. Meaningful use changing before EMR companies can update systems. Economic recession. Bills for physician loans/grants pending.
11 Rationale Penalties for not participating. Patient safety. Quality of care. Access to information. Incentives for meeting MU.
12 Considerations The financial benefits of EMR. Doctors may see only 11 cents of every dollar saved through the use of EMR. Five to six years for EMR to recoup its cost. Which EMR? Life expectancy of EMR.
13 Additional Considerations Blue Cross/Blue Shield of Massachusetts. Unrealistic investment. Incentive payments are offered after physicians purchase an EMR system.
14 Considerations/ Incentives The first phase. Track key clinical conditions and for coordination of care. Implementing clinical decision support tools. Reporting clinical quality measures and public health information.
15 Considerations/ Incentives Payments are determined by October of the following year. Reporting is through attestation. Payment is delayed at least a year after proving compliance. Some studies show only 30% of EP will qualify today.
16 Objectives and Aims Incentives/MU need to be simplified. Access to grants and government loans. Government control of EMR companies. Integration of information. Timeline for incentives/mu.
17 Meaningful Use Essentials for EMR meaningful use Getting started Focus of the future Final regulations released 27 billion in bonus Medicare payments
18 Core Set: All 15 Required Meaningful Use Objective 1. Record patient demographics 2. Record VS, chart changes (Ht, Wt, BP, BMI, growth charts) 2011 Measure (structured data) >50% of unique patients >50% age>2years of age or older (Ht, Wt, BP) 3. UTD problem list 4. Active medication list 5. Med allergy list 6. Smoking status 7. Eps-clinical summary each OV 8. Patients get e-copy of their health info on request >80% of patients 1+entry >80% of patients 1+entry >80% of patients 1+entry >50% of patients age 13+ years >50% of all OVS <3 business days >50% of requesting patients get e- Copy by 3 business days
19 Core Set: All 15 Required Meaning Use Objective 9. erx - permissible Rx (Eps only) 10. CPOE for medication orders 11. Implement interaction checks (drug-drug/allergy) 12.Implement capability to e- exchange key clinical info (info (providers, pt-auth entities) 13.Implement one clinical decision support rule, ability to track compliance 2011 Measure (structured data) >40% e-transmitted (certified EHR) >30% of patients w/ 1+med in list have 1+ entered via CPOE Functionality enabled for entire reporting period Perform at least one test 1 CDS RULE implemented
20 Core Set: All 15 Required Meaning Use Objective 14. Implement systems to protect privacy, security of patient data EHR 15. Report clinical quality measures to CMS or states 2011 Measure (structured data) Security risk analysis, security updates PRN, correct deficiencies 2011: attestation, aggregate Numerator and denominator 2012: e-submit measures
21 Menu Set: 5 of 10 Required Meaningful Use Objective 1. Implement drug formulary check 2. Structured lab test results in EHRs as structured data 3. Generate lists of patients by specific conditions 4. Use HER to identify/provide ptspecific education resources PRN 5. Perform MED REC between care settings 2011 Measure Implemented & access to 1+ int/ext drug formulary (entire period) >40% of numerical or pos/neg results in HER as structured data Generate 1+ list(s) of patients with a specific condition >10% of patents provided pt-specific education resources MED REC >50% of transitions
22 Brief Description: Menu Set (5/10) Meaningful Use Objective 2011 Measure 6. Provide summary of care record for referrals or transitions 7. Submit e-immunization data to registries 8. Submit e-syndromic surveillance 9. Send reminders to patients (per patient preference) for preventive and follow-up care
23 Brief Description: Menu Set (5/10) Meaningful Use Objective 10. Provide patients with timely e- access to their health information (lab results, problem list, med lists, med allergies) 2011 Measure >10% of patients provided e-access to info within 4 days of being updated in EHR Blumefield, D.(August 4, 2010), Meaningful Use it s Implications for Your Practice [American EHR] Retrieved August 16, 2010, from
24 Adopt, Install & Implement EMR Data Capture & Sharing Advanced Clinical Processes Improved Patient Outcomes 2013
25 Meaningful Users Meaningful User Money to reward investment for healthcare change Demonstrative support and improvement in quality and value measures Preparation and eligibility for new payment models Non-Meaningful User No incentives, no rewards Payments decreased to 1-5% Decreased data, poorer quality and value Decreased preparedness to participate in new payment models
26 Meaningful Use The meaningful use criteria need to be revised. The AOA and AMA proposed revisions to a CMS rule on meaningful use. HHS received approximately 2,000 letters on proposed rule. CMS decreased number of requirements.
27 Payment Reform Based on quality measures. Payment for coordination of care, prevention, early detection, chronic disease management and medical homes. Shared responsibility Bundling. Optimization of resources. Healthcare organizations held accountable for quality.
28 Payment Reform Quality Incentives Costs Penalties
29 Suggestions Eliminate the objectives that don t directly apply to the EMR. Decrease the number of quality measure reporting requirements. Allow physicians to pick only three clinically relevant measures. Time period for reporting needs extended.
30 Additional Factors The factor most frequently cited as a facilitator of EMR adoption is financial incentives. Congress needs to ensure that continued. Small Business Health Information Technology Financing Act H.R. 3014
31 Already have EMR Ensure that your EMR qualified for meaningful use. Make use of utilizing it in a meaningful way. Engage positively within your practice EMR leadership and meaningful use by all.
32 Physicians Without EMR Do not wait to implement system. Make a plan Do not wait. Go alone? Ask for assistance, receive help from those with experience and resources.
33 Conclusion Shifting the rewards of the current health care market. Physicians need access to private lenders/grants through guarantees. MU needs changed. Reporting period needs lengthened.
34 The J-curve example of physician adoption
35 Office of National Coordinator(ONC) formed Standard and Interoperability Framework This was launched on January 7 th 2011 Goal was interoperability challenges critical critical to meet meaningful use objectives Transitions of Care and Lab Interface are the 2 main work groups
36 There are many subdivisions There have been 2 F2F meetings in DC Open to volunteers Meetings are teleconference and vary Initial results have been presented to HIT Standards Committee
37 I have been a member of several committees on behalf of AOAMI You can join on the wiki page The meeting are ongoing I am looking at joining the Long Term Care group
38 Questions Thank you for time and attention Enjoy the rest of OMED and Mickey!
39 HUNTER FAMILY HALLOWEEN
40 References Association, American Medical (2010, March 15). AMA Comments on CMS Proposed Rule on Meaningful Use Of EHR Blumefield, D.(August 4, 2010), Meaningful Use it s Implications for Your Practice [American EHR] Retrieved August 16, 2010, from DesRoches, C., Campbell, E., Rao, S., Donelan, K., Ferris, T., & Jha, A. (2008). Electronic Health Records in Ambulatory Care-A National Survey of Physicians. The New England Journal of Medicine, Dolan, P. (2008, March 10). Insurer finds EMRs won't pay off for its doctors. Retrieved May 1, 2010, from American Medical News: Ebell, M, Frame, P. (2001). What can technology do to, and for, family medicine? Family Medicine,
41 References Shaw, G. (2010, July 13), Winners and Losers in HHS Final Meaningful Use Rule. Health Leaders. Retrieved August 8, Simmons, J. (2010, July 13). Meaningful Use Final Rule Released by HHL. Health Leaders. Retrieved August 8, 2010: Rule-Release Society, H. I. (2010, January 8). "The Basics" Frequently Asked Questions on Meaningful Use and the American Recovery & Reinvestment Act of Retrieved May 1, 2010, from HIMSS: