Meeting Meaningful Use Core Objectives with Technology-Enabled Patient Engagement

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1 Meeting Meaningful Use Core Objectives with Technology-Enabled Patient Engagement ACPE Annual Meeting April 25, 2014 Chicago, Illinois Presented By: Dennis P.H. Mihale, MD, MBA Copyright 2014 CPT codes, descriptions and material only are Copyright 2012 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in applicable FARS/DFARS restrictions to government use

2 Problem Statement Meaningful Use Stage II has 17 Core Objectives, all of which must be met. You do not get to pick and choose. Some of them seem almost impossible to meet. You are being asked to get someone else (the patient) to do something No matter whose fault it is, the physician will pay the price Mobile computing/technology may provide a priceless tool to improve patient and family engagement and help meet MU II.

3 Learning Objectives Review Meaningful Use Stage II Identify the Most Difficult Terms Understand Impact of Patient Engagement on MU II Understand how technology impacts MU II Determine how to leverage technology for MU II

4 Meaningful Use Stage II Core Use CPOE for meds, labs and radiology orders Electronic Prescriptions Record demographics: language, sex, race, ethnicity, DOB Record Vita Signs Height and Weight (all ages) and Blood Pressure (Age 3 and over) Document BMI (all ages) and Display Growth Charts (Ages 0 to 20) Record smoking status (Ages 13 and over) Use Clinical Decision Support: improve performance (high priority)

5 Meaningful Use Stage II Core Provide patients the ability to view, download and transmit health information within 4 days of availability to physician: Portal 5% must use this ability or send secure message Provide clinical summaries for patients for each office visit Protect Electronic Health Information: Certified EHR/Tech Capabilities Incorporate Clinical Lab-Test Results: Certified EHR Technology Generate Lists of Patients by specific conditions to use: pop. health Quality improvement, reduction of disparities, research or outreach

6 Meaningful Use Send Reminders for preventive/follow up care: Identify which patients and use patient preferred method Certified EHR Technology: identify/provide patient specific education Medication Reconciliation: EP receives patient from another setting/provider Summary record for each transition of care or referral Able to submit electronic data to immunization registries Use Secure Electronic Messaging: communicate with patients

7 Challenging Core Objectives in MU II Provide patients the ability to view, download and transmit health information within 4 days of availability to physician: Portal 5% must use this ability or send secure message Use Secure Electronic Messaging: communicate with patients Send Reminders for preventive/follow up care: Identify which patients and use patient preferred method Medication Reconciliation: EP receives patient from another provider

8 Meaningful Use (MU) Audits Only 13% of physicians say their EHR can support 14 of 17 core Stage II objectives (CDC Report). Healthcare IT News Jan 22, 2014 Meaningful Use is an All or Nothing deal: If one component of the attestation is faulty, the provider must return all of the money. No partial credit. Fierce EMR 10/17/13 If, based on an audit, a provider is found to not be eligible for an EHR incentive payment, the payment will be recouped. CMS.GOV https://questions.cms.gov/faq.php?faqid=7711 (See handout)

9 Meaningful Use (MU) Audits CMS Recoups All Meaningful Use Money From Providers if Audits Turn Up Errors: AIS Health (from Health Business Daily) 9/16/13 It appears hospitals and physicians will have to give back their entire Meaningful Use incentive payment if CMS auditors find any errors. So far, more clients than not are having audit findings and owing money EHR continually updates system: no proof patient received info at DC You get no credit for getting 90%. You owe all the money back. FierceEMR, 10/1/13 It is not the 1% or 2% reduction in payment that scares me Dennis P.H. Mihale, MD

10 RFI for Meaningful Use (MU) Audits EHR Meaningful Use Incentive Payment Program Audits Apr 10, 2014 Solicitation Number: HHSM G THIS NOTICE IS FOR INFORMATION PURPOSES ONLY This work (HITECH Audit Support) is being done as a modification to an existing contract, GS-23F-0133M/ HHSM G that was awarded to FIGLIOZZI AND COMPANY. This contract was competitively awarded on April 16, 2012

11 RFI for Meaningful Use (MU) Audits The Office of the National Coordinator for Health Information Technology (ONC), along with CMS, has identified criteria to define meaningful use of EHR s. Early stages: users attest that they are meaningful users of EHRs Upon attestation, eligible to receive an incentive payment CMS Office of Financial is responsible for auditing components of the HITECH program Oversees the audit process and the contractor Monitoring control process to ensure users are in compliance with regulations eligible to participate in the program. CMS will evaluate the evidence in order to make a final determination of each meaningful EHR user s eligibility.

12 Mobile Health Computing Exchange of information to and from provider before, during, and after the point of care Patient activities between visits can be reported as they happen Helps identify missing diagnosis and also helps identify co-morbidities

13 Mobile Computing Smartphone app use (not including browser use) exceeded PC use for the first time in January 2014 (CNN Money, Feb 2014) Smartphones are widely used by all age groups and income levels (Pew Research Internet Project, January 2014) 58% of American adults have a smart phone Yes, Medicaid and Medicare members use smart phones and tablets, too: 47% with household incomes <30K/year 44% high school grad or less Race/Ethnicity: White: 53% African-American: 59% Hispanic: 61%

14 Mobile Computing Overview Mobile computing enables all healthcare stakeholders to actively interact with patients, their family, and caregivers on an easy to manage and understand, structured, costefficient, and patient-centric platform. Mobile computing improves physician care management, increases member interaction with their own healthcare without being intrusive, and helps health plans better understand utilization, care spend, provider & patient interaction, and overall care protocols.

15 Patient/Family Engagement Through Mobile Patient and family engagement is the most important asset in health care (IOM: Partnering with Patients, 2/25/13 Workshop) Families and caregivers have access to mobile applications even when away from the patient Wearable and mobile integrations capture contemporaneous data usually not available to the provider Outcomes increased when provider has access to the data between visits Patient satisfaction is increased with access to data between visits Mobile is the new way to take notes and provide helpful information at the visit/point of care

16 Challenging Core Objectives in MU II Provide patients the ability to view, download and transmit health information within 4 days of availability to physician: Portal 5% must use this ability or send secure message Use Secure Electronic Messaging: communicate with patients Send Reminders for preventive/follow up care: Identify which patients and use patient preferred method Medication Reconciliation: EP receives patient from another provider

17 View, Download and Transmit 5% must use this ability or send secure message How do you get patients to come to portal and retrieve data? Do it at the office (point of care) as they checkout Send s with links back to your portal Send alerts (texts) to the patients phone Let them schedule visits on line via their phone For every test, lab or study alert: come to secure portal Allow third parties, approved by the patient, to do it

18 Secure Electronic Messaging Do it at the office (point of care) as they checkout Send secure s with links back to your portal Send alerts (texts) to the patient s phone For every test, lab or study alert: come to secure portal Send reminders for appointment

19 Send Reminders for Care Use patient preferred method What if preferred method is mobile? Paper is easy and is not much harder? Mobile means texts, security and messaging. There are trustworthy vendors to help Build interface from EHR to Mobile Platform (solution) Meet MU Core Objective AND Make Patients Happy

20 Medication Reconciliation EP receives patient from another provider Let s ask the patient to help! Why not ask the family to help? What is the patient really taking? What have they stopped taking? What are they taking that neither doctor prescribed?

21 APPENDIX Interactive Session

22 View, Download and Transmit Do you have a portal that is secure and accessible? Getting patients to visit portal to retrieve data? Hmmm. Do it at the office (point of care) as they checkout Boarding Pass Movie Tickets, Grocery and Retail Store Online Banking and Property and Casualty Insurance We are so far behind the rest of the universe Do you send s with links back to your portal?

23 View, Download and Transmit Can you send alerts (texts) to the patients phone? Can they schedule visits on line via their phone? Yes = Victory. Why? For every test/lab/study alert: come to secure portal Allow third parties, approved by the patient, to do it 5% must use this ability or send secure message

24 Secure Electronic Messaging Do you have secure messaging? Can you message at the office (POC) as they checkout? What about secure s with links back to your portal? Can you send alerts (texts) to the patient s phone Send reminders for appointment

25 Send Reminders for Care Easy Right? Wait What is this Use patient preferred method? What if preferred method is mobile? Paper is easy and is not much harder? Mobile means texts, security and messaging. There are trustworthy vendors to help Build interface from EHR to Mobile Platform (solution) Meet MU Core Objective AND Make Patients Happy

26 Medication Reconciliation Physician receives patient from another provider Be honest: What do we really get from other docs? What are we reconciling? Actual meds vs. what is in the record Do we ask the patient to help? Do we ask the family to help? What is the patient really taking? What have they stopped taking? What are they taking that no one prescribed?

27 Meeting Meaningful Use Core Objectives with Technology Enabled Patient Engagement Presented By: Dennis P.H. Mihale, MD, MBA (813) Copyright 2014 CPT codes, descriptions and material only are Copyright 2012 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in applicable FARS/DFARS restrictions to government use

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