National HIT Initiatives & Changing Landscape of Medical Technology

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1 . National HIT Initiatives & Changing Landscape of Medical Technology Dominic H. Mack MD,MBA Executive Medical Director GA-HITREC Deputy Director National Center for Primary Care Morehouse School of Medicine

2 US Health Disparities & Preventable Diseases Diabetes In 2006, about 65,700 nontraumatic lower-limb amputations More than 60% of nontraumatic lower-limb amputations 285 million people internationally 2

3 EHR A medical tool that connects, shares knowledge, and supports best practices for patient care 3

4 HITECH: Catalyst for Transformation Pre A system plagued by inefficiencies EHR Incentive Program and 62 Regional Extension Centers Widespread adoption & meaningful use of EHRs 4

5 Office of the National Coordinator (ONC) Big Picture Goal Paper-Based Practice Support Network REC-Provider Partnership Fully Functional EHR Regional Extension Center Community College Workforce Communities of Practice Health Information Technology Research Center (HITRC) Education and Outreach Workforce Vendor Relations Implementation Workflow Redesign Functional Interoperability Privacy and Security Meaningful Use Population Health Health Care Efficiency Patient Health Outcomes 5

6 Office of Provider Adoption Support (OPAS) Goal: Assist All Providers to Achieve Meaningful Use of EHR Systems Regional Extension Centers (RECs) Provider Provider Adoption Adoption Services Services Meaningful Use Community College Consortium Health Information Technology Research Center (HITRC) 6

7 62 RECs Cover 100% of the USA Goal: 100,000 priority primary care providers achieve meaningful use (MU) by 2012 Not-for-profit organizations Experts in EHR adoption Provide on-the-ground technical assistance Extensive stakeholder partnerships Focused on achieving MU 7

8 United Purpose, Local Approaches Each REC has a: Defined service area Specific number of providers to assist National perspective with local expertise Approach differs by REC: Local/regional centers (RECs within an REC) Hospital partnerships Payer partnerships REC Locations 8

9 REC Focus: Priority Primary Care Providers While RECs are encouraged to work with all providers, they will initially focus on Priority Settings : Individual/small group primary care practices (<10 PCPs) Public Hospitals and CAHs Community Health Centers and Rural Health Clinics Other settings that serve medically underserved populations 9

10 GA-HITREC (GA HIT Regional Extension Center) Statewide Statistics PCPs: 15,563 Priority PCP: 8040 Target Numbers; 5220 providers 56 CAHs & Rural Hospitals Georgia Population: 9,965,744 Total patients served (projected): : 2.8 million

11 Comprehensive Support throughout the Entire EHR Implementation Process 1 Plan 2 Transition 3 Implement 4 Operate & Maintain Readiness assessment Practice workflow redesign EHR implementation Achieve meaningful use EHR system selection HIT education & training Partnering with state & local HIEs Prepare for future pay for performance Primary goal: Give providers as much support as possible 11

12 Meaningful Use & Provider Incentive Program Copyright 2010 All Rights Reserved. 12

13 Thank You!

14 Meaningful Use & Provider Incentive Program Copyright 2010 All Rights Reserved. 14

15 II. Meaningful Use Established Payments Issue Medicare incentive payments to eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) that are meaningful users of certified EHR technology. Issue Medicaid incentive payments to eligible professionals and hospitals for efforts to adopt, implement, or upgrade certified EHR technology Copyright 2010 All Rights Reserved

16 III. Meaningful Use Objectives: 1. Use of certified EHR in a meaningful manner (e.g., e-prescribing) 2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care 3. Use of certified EHR technology to submit clinical quality measures(cqm) and other such measures selected by the Secretary

17 MU Criteria- Stage 1 25 total objectives/measures for EPs and 24 for EH Core set =15 for EPs and 14 for EHs Menu set = 10 (choose 5 out of the 10) If exclusion applies EP or EH may not have to meet objective Three core quality measures in 2011 and 2012: blood-pressure level, tobacco status and adult weight screening and follow-up, or alternates if these do not apply EPs, EHs, and CAHs are required to submit aggregate clinical quality measure numerator, denominator, and exclusion data to CMS or the States by attestation EPs and CAHs must electronically submit clinical quality measures selected by CMS directly to CMS (or the States) through certified EHR technology Copyright 2010 All Rights Reserved. 17

18 Medicaid Eligible Providers Eligible Professionals (EPs) Physicians (Peds have special eligibility & payment rules) Nurse Practitioners (NPs) Certified Nurse-Midwives (CNMs) Dentists Physician Assistants (FQHC or RHC that is directed by a PA) Eligible Hospitals Acute Care Hospitals Children s Hospitals Copyright 2010 All Rights Reserved. 18

19 Medicare Eligible Providers Eligible Professionals (EPs) Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Podiatric Medicine Doctor of Optometry Chiropractor Eligible Hospitals Acute Care Hospitals Critical Access Hospitals (CAHs) Copyright 2010 All Rights Reserved. 19

20 Medicare Calendar Year First Calendar Year in which the EP Receives an Incentive Payment & Later 2011 $18, $12,000 $18, $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12, $2,000 $4,000 $8,000 8,000 $ $2000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0 Copyright 2010 All Rights Reserved. 20

21 Medicaid First Calendar Year in which the EP Receives an Incentive Payment Calendar Year $21, $8,500 $21, $8,500 $8,500 $21, $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8, $8,500 $8, $8,500 Total $63,75 0 Copyright 2010 All Rights Reserved. $63,750 $63,750 $63,750 $63,750 $63,750 21

22 HHS overall objective is to ensure that providers make use of, and patients have access to, clinically relevant electronic information, not just existence of technology 3 stages of meaningful use For HHS These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth Advanced clinical processes Improved outcomes Data capture and sharing Phased in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement. Connecting for Health, Markle Foundation Achieving the Health IT Objectives of the American Recovery and Reinvestment Act April 2009

23 EHR Implementation Remains Limited Among Physicians A 2008 national survey of 2,758 physicians found positive effects of EHR systems on quality of care and satisfaction DesRoches, C., et al, Electronic Health Records in Ambulatory Care - A National Survey of Physicians New England Journal of Medicine, ;359: (http://www.nejm.org/doi/pdf/ /nejmsa )

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33 EHR Adoption Challenges Financial Technical Organization Change Expense of system Uncertainty around ROI Provider and staff productivity Uncertainty about financial incentives Concerns about technically supporting a system Lack of necessary computer skills Finding the right EHR to suit practice needs ( usability ) Having the right IT staff in place Possibility of information overload Disruption of workflow and productivity Privacy and security concerns Maintaining patient centeredness and satisfaction 33 Copyright 2010 All Rights Reserved. 33

34 Implementation vs. Adoption 34

35 EHR Adoption Leadership Quality Improvement Metrics Training 35

36 Providers Report Positive Influence of EHRs on their Practices DesRoches, C., et al, Electronic Health Records in Ambulatory Care A National Survey of Physicians New England Journal of Medicine, 2008;359: (http://www.nejm.org/doi/pdf/ /nejmsa ) 36 Copyright 2010 All Rights Reserved. 36

37 Positive Net Financial Returns with Benefits Increasing as More Features Used Net benefit from using an EMR for a 5 year period was $86,400 per provider Wange, S., et al. (2003) A Cost Benefit Analysis of Electronic Medical Records in Primary Care. The American Journal of Medicine. V.114, April 37 Copyright 2010 All Rights Reserved. 37

38 NEJM ; Sept 1, 2011; EHR and Quality of Diabetes : EHR Care is better: Nearly 51% of patients in practices met endorsed standards. After accounting for differences in patient characteristics, EHR patients still received 35% more of the care standards. EHR Outcomes are better: Nearly 44 % of patients met at least four of five outcome standards EHR Improvement is faster: EHR practices had annual improvements in care that were 10% greater and improvements in outcomes were 4% greater than those of paper-based practices EHR benefits Everyone: Patients showed better results regardless of insurance status, 38

39 Practice-based Care Team Practice Management The Family Medicine Model and the TransforMED Approach Practice Organization Great Outcomes Health Information Technology Health Information Technology Care Management Quality and Safety Quality Measures Patient Experience Access to Care and Information Continuity of Care Services Practice Services 39

40 Example ICD-9 to ICD-10 changes More than just a crosswalk ICD-9 ICD-10 14,000 Diagnosis Codes 4,000 Procedure Codes 68,000 Diagnosis Codes 87,000 Procedure Codes Angioplasty (procedure codes) 1 code Angioplasty (procedure codes) 854 different codes 047K047 Specifying body part, approach and device Pressure Ulcer Codes (diagnosis codes) 7 codes Show location, but not depth Pressure Ulcer Codes (diagnosis codes) 125 different codes L Specific location, depth, severity, occurrence No equivalent ICD 9 Code -Indicated through notes and other methods Y71.3 Surgical instruments, materials and cardiovascular devices associated with adverse incidents Autopsy 89.8 No ICD 10 code Confidential property of Unitedhealth Group. Do not distribute or reproduce without express permission of Unitedhealth Group. 40

41 HIPAA 5010 Overview The Centers for Medicare & Medicaid Services (CMS) mandates that all physicians/hospitals and payers exchange key business transactional data using the HIPAA 5010 format via Electronic Data Exchange (EDI) by 1/1/2012. Transition from HIPAA 4010 to HIPAA 5010 Adds functionality to the enrollment, eligibility, inquiry, claim, claim inquiry, remittance, referral/authorization and premium payment transactions Eliminates redundancy and ambiguity in the usage of transaction standards Clarifies NPI instructions and provide a structure for better usage Establishes a platform for the adoption of International Classification of Diseases, 10th Edition (ICD- 10) codes Reduces reliance on trading partner Companion Guides for Electronic Data Interchange (EDI) transactions Calls for HIPAA 5010 Trading Partner Testing by January 1, 2011 and adoption by January 1, 2012 Opportunities Drive the administrative simplification and transparency agenda Consistent use of transaction sets Consistent communication and testing approach with trading partners including UnitedHealthcare Consistent data and data context across all health plans easing complexity for practice management systems and Confidential vendors property of Unitedhealth Reduce variation and cost of infrastructure Group. Do not and distribute support or of reproduce EDI transactions across the industry without express permission of 41 Unitedhealth Group.Confidential property of UnitedHealth Group. Do not distribute d ih i i f

42 Building an Interconnected, Patient- Centric Care System Health Information Exchange Copyright 2010 All Rights Reserved. 42

43 For More Information Visit the ONC Web site: 43

44 Thank You Dominic H. Mack MD,MBA Executive Medical Director GA-HITREC Deputy Director National Center for Primary Care Morehouse School of Medicine Visit the GA-HITREC Portal: Call GA-HITREC toll free: GA-HITREC:

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