Advancing the Implementation of Electronic Records in Athletic Training

Transcription

1 Advancing the Implementation of Electronic Records in Athletic Training Amy Brugge, EdD, ATR, ATC 2016 GLATA Annual Meeting & Symposium March 12, 2016

2 Presenter Conflict of Interest No Conflict The views expressed in these slides & today s discussion are mine I am not employed by, nor am I a representative of any electronic records vendor My views may not be the same as the views of my institution or my colleagues Use discretion when using the provided information when making decision in your own professional practice

3 Outcomes Compare/contrast advantages & disadvantages of various electronic record solutions Define interoperability & health information exchange Summarize implications of the HITECH Act and its subcomponents as related to athletic training Detail the federal government s EHR certification process & explore use the HealthIT.gov product listing

4 Outcomes Formulate appropriate questions for EHR vendors Identify improvements for patient care & efficiency via certified EHR technologies & HIE Discuss how EHRs can increase use of PROMs in clinical practice Consider how EHR documentation will serve as data sets for future outcomes research in AT

5 Professional Expectations BOC Professional Standard #7 All services are documented in writing by the Athletic Trainer and are part of the patient s permanent records. The Athletic Trainer accepts responsibility for recording details of the patient s health status. 1 AT Education Competencies 2 HA 9-12, HA 28, CIP 9 State & Federal Law HIPAA/FERPA DHS & DOE Guide HITECH Act of 2009 Minn. Stat. 62J.495

6 Branches Unbound by Wendy Wahl Grand Rapids Art Museum, Michigan Search & Retrieve Patient Data?

7 Triple Aim of Health Care Institute for Health Care Improvement Triple Aim Initiative 7 1) Improve patient experience of care 2) Improve population health 3) Reduce per capita cost Clinical information systems & health information technology are central to this pursuit

8 Health Information Technology for Economic & Clinical Health (HITECH) ACT of 2009 A component of the American Recovery & Reinvestment (ARRA) Act of 2009 Designed to encourage healthcare organizations to adopt & implement EHR technology to improve care & efficiency Created incentive programs through CMS via Meaningful Use attestation with certified EHR technology

9 Key Definitions Electronic Medical Records (EMRs) Limited in use to ONE healthcare organization Electronic Health Records (EHRs) Meets certification process for interoperability standards for information exchange ACROSS healthcare organizations Personal Health Records (PHRs) Meets certification process for interoperability standards for HIE, can draw information from multiple sources, & is consumer controlled

10 Patient Portals Key Definitions Means for allowing secure patient access to his/her health information electronically Health Information Exchange (HIE) Movement of patient data across organizations or the center that facilitates this process Both a verb and a noun Clinical Decision Support (CDS) Provides staff with knowledge & patient-specific information at appropriate times to enhance the health care delivered

11 Moving from Data to Wisdom in Health Care Data Discrete & without context Information Description added that provides some insight Knowledge Has a mental structure & is refined to be useful through connected relationships Wisdom = decisions & actions Integrated knowledge that creates the capacity to decide, act, or project for similar circumstances Wisdom Knowledge Information Data

12 HITECH Act of President Bush creates the Office of the National Coordinator (ONC) for Health IT in DHS via an executive order Declares the Decade of Health Information Technology 2009 HITECH Act 4 was enacted, creating nearly $30 billion for federal incentive programs for certified EHR adoption and meaningful use Intent was to offset upfront cost of EHR adoption/implementation Also funded 62 Regional Extension Centers to support adoption & meaningful use Established national EHR certification program to ensure interoperability 2015 & Beyond Program moves from incentive payments to penalties

13 Interoperability Ability to transmit health information electronically in a secure fashion across certified EHRs Key to unlocking greater data analytics to improve quality care, outcomes research, & efficiency Moves users from data towards knowledge/wisdom Lacking interoperability = health information segmented into disparate pieces Central to true HIE... Are we committed to this?

14 Certified EHR Technology Oversight through the Office of the National Coordinator (ONC) for Health IT Three approved accrediting bodies that test products to determine compliance Require the capacity to meet all Meaningful Use measures & be interoperable Operational since 2012 & provides a public Certified Health IT Product List (CHPL) 8 Searchable by product name, vendor, or CHPL ID

15 No penalties just discontinuation of incentive availability CMS Incentive Programs 9 Medicare Incentive Program Nationwide federal program For eligible professionals (EPs) & hospitals No min # of Medicare patients required Must demonstrate meaningful use according to national standards in first yr Up to $44k incentive over 5 yrs for EP & $2 million max for hospitals Must initiate participation by 2014 Penalties beginning in 2015 Medicaid Incentive Program Done by states voluntary For eligible professionals (EPs) & hospitals Annual requirement of 30% of providers pop. must be Medicaid Must adopt, implement, or upgrade certified EHR tech in 1 st yr States can require more rigorous MU standards Max $63,750 incentive payment for EPs over 6 yrs/$2 million max for hospitals

16 What about Athletic Trainers? 2005 CMS Ruling...

17 Meaningful Use Three primary components 10 Use of certified EHR in a meaningful manner Use of certified EHR tech for electronic exchange of health info Use of certified EHR tech to submit quality/outcome measures Standards released in 3 stages between 2011 and 2015 Includes both Core & Menu Objectives for EPs/hospitals Process for compliance termed attestation The ONC sets the standards & CMS provides financially incentive (or penalty)

18 MU Stage 2 EP Core Objectives 11 CPOE for meds, labs, & imaging E-Prescribing Records patient demographics Record & chart vitals Record smoking status (>12 y.o.) CDS for certain health conditions Clinical summaries for office visits Pt. can view, download, & transmit within 4 business days Enhanced security measures Lab tests/results as structured data Preventative care reminders Patient-specific education resources Medication reconciliation Summaries for transition of care Submit to immunization registries Use secure electronic messaging with patients

19 MU Stage 2 EP Menu Objectives 11 Capable of submitting surveillance data to public health agencies Electronic notes with searchable text Imaging & corresponding report(s) accessible in EHR Record family health history as structured data Identify & report cancer cases to public health registries Report other special clinical cases to public health registries

20 Looking to Relax More?

21 Selecting Certified EHR Technology 1. Is it listed on the CHPL? 2. Capable of HIE in my state/ region? 3. Capable of MU attestation? 4. HIPAA compliant? 5. PHR/Patient Portal? 6. Cloud-based? Mobile compatible? 7. Use LOINC, SNOMED CT, CVX, RxNorm, UML, & HL7 in addition to ICD & CPT codes? 8. Use DICOM for imaging? 9. Natural Language Processing? 10. Cost?

22 Implementation Considerations College/University Health Services Collaboration with school nurses Outreach ATs Independent Contractors Step-wise transition? Consult with a Health Information Management (HIM) professional You as the referral provider

23 Data Collection? Image from:

24 Improving Care Delivery & Quality Patient Safety Clinical Decision Support HIE with other Providers & Healthcare Organizations Patient Satisfaction Surveys = Demonstrating Value of ATs

25 Evidence-Based Practice

26 Patient-Related Outcomes Measures Ease of implementation with certified EHR technology at the point-of-care Availability of immediate data analysis Secure messaging for patient follow-ups Provider evaluation via satisfaction surveys Exchange of de-identified data sets 12

27 At a crossroads Vision for the Future Focus on health care Enhance our data capture & analytics Demonstrate our value Image from

28 Failure to Launch? Our patient care will exist outside of the health care information network We remain unrecognizable to other providers We will be locked out of third-party reimbursement Adoption across profession will vary by work setting 13 There will not be data to demonstrate our value Research will remain confined to lab settings

29 Developing a Road Map Collaboration with HIM professionals Align with certified EHR vendors Implementation in professional practice Embedded in our education

30 Image courtesy of Praisaeng at FreeDigitalPhotos.net EHRs at all Points of Care Image courtesy of Joe Cygan Image courtesy of Marin at FreeDigitalPhotos.net

31 Contact Information Amy Brugge, EdD, ATR, ATC

32 References 1. Board of Certification, Inc. BOC standards of professional practice; Commission on Accreditation of Athletic Training. The athletic training educational competencies, 5 th ed.; U.S. Department of Health and Human Services, & U.S. Department of Education. Joint guidance on the application of the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to student health records; 2008.: 4. HITECH Act of 2009, Pub. L. No Minn Stat 62J Wahl, W. Branches unbound [art exhibit]. Grand Rapids, MI: Grand Rapids Art Museum. 7. Institute for Health Care Improvement. IHI triple aim initiative; Office of the National Coordinator for Health Information Technology. Certified health IT product list; Wagner KA, Wickham Lee F, Glaser JP. Health Care Information Systems: A Practical Approach for Health Care Management, 3 rd ed. San Francisco, CA: Jossey-Bass; 2013; Office of the National Coordinator for Health Information Technology. Meaningful use definition and objectives; Centers for Medicare and Medicaid. Eligible professional meaningful use core and menu measures; Sauers EL, McLeod TC, Bay RC. Practice-based research networks, part I: clinical laboratories to generate and translate research findings into effective patient care. J Athl Train. 2012;47: Brugge, AM. Athletic training students academic preparation in healthcare documentation [dissertation]. Minneapolis, MN: University of Minnesota; 2015.