Meaningful Use and Electronic Health Record. May 16, 2012

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1 Meaningful Use and Electronic Health Record May 16, 2012

2 Who is Promedica? 2

3 Who is Promedica? ProMedica is a mission-based, not-for-profit healthcare organization formed in ProMedica has more than 14,300 employees and nearly 1,700 physicians with more than 400 healthcare providers employed by ProMedica Physicians. Our 11 hospitals and more than 306 facilities offer comprehensive diagnostic, medical and surgical specialties in heart and vascular, oncology, orthopaedics, neurology, and women and pediatric services, as well as providing continuing care services and various health plans to meet the community needs through Paramount insurance. ProMedica's mission is to improve health and well-being, with a strong focus on wellness and clinical excellence, as well as innovative, community advocacy programs that address health-related issues such as hunger and obesity.

4 Who Am I? Eric Perron Ambulatory Technology Director Promedica Bachelor s in Business IT and MBA in IT 20 Years in Healthcare mostly with St. Luke s 1 year with Promedica in current role Last 6 years focused on federal legislation that has impact on healthcare through technology.

5 What is Ambulatory IT? Ambulatory vs. Acute Acute Care = typical hospital stay highly acute patients, tends to be episodic in nature Ambulatory Care = everything else driven by the intimate relationship between physician and patient. The fading role of the hospital. Ambulatory IT is focused on gathering the information being collected at the point of care and turning it into a longitudinal patient record. The fastest growing technology sector in healthcare is focused on the ambulatory sector and how to integrate information across the ambulatory and acute care environments.

6 What are we doing? Deploying Electronic Health Records. PERIOD!! Our collective jobs are to figure out how to integrate the information that is gathered at each patient encounter and creating an easy to use, easy to transport, secure patient record. We want patients to be involved in their care and their record keeping Banking Airlines

7 Textbook Definition of E.H.R An electronic health record (EHR) is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations. [1] It is a record in digital format that is theoretically capable of being shared across different health care settings. In some cases this sharing can occur by way of network-connected enterprise-wide information systems and other information networks or exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information. Wickapedia

8 Alphabet Soup Electronic Health Record

9 Quality Incentives: PCMH The Patient-Centered Medical Home theory: patients who are fully engaged in their care with their primary care physician have better outcomes.

10 Shared Clinical Record The Theory: That a large multi-specialty organization like PHS should share clinical data across a longitudinal record to improve quality outcomes.

11 Quality Incentives: ACO The Accountable Care Organization theory: that providers who share in risk and are incentivised to manage patient population should also share in the reward.

12 Quality Incentives: MU Meaningful Use Overarching Goals: Improve quality, safety, efficiency, and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information

13 Major milestones 02/17/09 Obama signs ARRA legislation includes HITECH ACT 07/13/10 Stage 1 Final Rules Published 01/01/11 Stage 1 Registration Portal Opened 05/2011 First payment on incentives began 10/01/12 Last day to qualify for 100% of incentive Stage 2 begins 2015 Stage 3 begins 2016 Penalty phase begins.

14 Two Routes to $$$ for ambulatory Medicare: Up to $44, HPSA = 10% Bonus No Patient minimums No mid-levels Calculation: 75% of submitted Allowable charges by doc, up to cap for the year. First year of program is 2011 or 2012 Penalties for non-compliance 2016 Medicaid: Up to $64, No additional bonuses 30% Medicaid payor mix, 20% for Peds. NP s, NMW s, PA s only if lead provider in a rural health clinic. No calculation based on fees flat payment intended to offset costs of implementation and support of E.H.R. 1 st year of program is any year you start. No penalties.yet.

15 Two Routes to $$$ for hospitals Medicare: Dollars are much larger: $2MM Base + per discharge percentage. There is no maximum theoretically infinite. Runs on Federal Fiscal Year rather than calendar year. All Acute Care Hospitals are eligible including CAH Medicaid: Dollars are easier Medicaid patient mix must be x All Acute Care hospitals with x% Medicaid are eligible Children s Hospitals with x% of Medicaid population. Incentives could run until 2021

16 Medicare Incentive Program

17 Medicaid Incentive Program

18 What you have to do Stage 1 EPs 15 Core Objectives Computerized Physician Order Entry (CPOE) for Medications >30% E-Prescribing (erx) >40% Report Clinical Quality Measures to CMS/States yes/no attestation Implement 1 Clinical Decision support rule yes/no attestation Provide patients with electronic copy of health record, upon request within 3 business days >50% Clinical Summaries provided to patients within 3 business days 50% of all office visits Drug-drug and drug-allergy interaction checks yes/no attestation Record patient demographics >50% Maintain up-to-date problem list >80% Maintain up-to-date active medication list >80% Maintain up-to-date active medication allergy list >80% Record height, weight and blood pressure for patients age 2 and over >50% Record smoking status for patients 13 and older >50% Exchange key clinical information among providers of care and patient-authorized entities electronically yes/no attestation Protect electronic health information. yes/no attestation

19 What you have to do Stage 1 - EPs 10 Menu Objectives (select only 5) Drug-formulary checks yes/no attestation Lab tests results ordered by the EP with +/- or numerical formatted results are incorporated in EHR technology. >40% Generate lists of patients based on specific conditions to use for quality improvement, to reduce disparities, research or outreach yes/no attestation Reminder for preventative/follow up care sent to patients seen by the EP that are >/= to 65 years or </= to 5 years per patient preference. >20% Provide patients electronic access to their health information (lab results, problem lists, med lists, and med allergies) within 4 business days of the information being available to the EP >10% Per Patient Portal Only Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate >10% The EP performs medication reconciliation when the patient is transitioned into the care of the EP. >50% The EP who transitions or refers their patient to another setting or provider of care provides a summary record for transitions of care and referrals >50% of transitioned patients Capability to submit electronic data to immunization registries/systems yes/no attestation Ohio is not ready to accept = exemption at this time Capability to provide electronic syndromic surveillance data to public health agencies. yes/no attestation Ohio is not ready to accept = exemption at this time

20 What you have to do Stage 1 Hospitals Eligible Hospitals 14 Core Objectives CPOE Drug-drug and drug-allergy interaction checks Record demographics Implement one clinical decision support rule Maintain up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 years or older Report hospital clinical quality measures to CMS or States Provide patients with an electronic copy of their health information, upon request Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request Capability to exchange key clinical information among providers of care and patient-authorized entities electronically Protect electronic health information

21 What you have to do Stage 1 Hospitals Eligible Hospitals Menu Set (10 Objectives) Drug-formulary checks Record advanced directives for patients 65 years or older Incorporate clinical lab test results as structured data Generate lists of patients by specific conditions Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate Medication reconciliation Summary of care record for each transition of care/referrals Capability to submit electronic data to immunization registries/systems* Capability to provide electronic submission of reportable lab results to public health agencies* Capability to provide electronic syndromic surveillance data to public health agencies*

22 Stage 2 and beyond Stage 2 rules have been published and are in public comment phase. Future Stages build upon the previous stage. Stage 1 menu set will be transitioned into core set for Stage 2 and so on for Stage 3. As new rulemaking is proposed, will reevaluate measures possibly higher thresholds Will include greater emphasis on health information exchange across institutional boundaries

23 So What s the big deal? Electronic Health Records are at the core of all these new opportunities, but. Proper adoption is sporadic at best. Optimization of the product requires physicians to change their process and workflow.. That s the issue!!

24 Son of What s the Big Deal? Many organizations like Promedica are playing catch-up. Started too late High demand for the same highly sought-after resources. Extraordinarily high cost to implement effectively. Do you spend $50MM to get $25MM? High churn.

25 What s the Big Deal the sequel? HIT Professionals can help drive the change. Education in HIT, RHIA s, RHIT s are extraordinarily important to carrying this process forward. The only thing constant in healthcare today is change.

26 How do we get there?? Should have all eligible providers registered with CMS. Should know where you are in relationship to Medicare vs. Medicaid Your Electronic Health Record system should be in its final stages of implementation. HIT should be working directly with teams to operationalize MU components.(this is the hard part). Attest Sustain

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