How To Use Ehr For Health Care
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1 Increase Patient Impact Via Electronic Health Records (EHR) October 1, 2014 Mukesh Mehta, DPh, MBA, RPh Vice President, Clinical & Regulatory Solutions Dale Cooke, PhillyCooke Consulting
2 On the Menu Introduction Market Drivers Electronic Health Record (EHR) Adoption Federal Meaningful Use (MU) Requirements Patients Portals and MU2 Patient Education/Reminders Requirements Options for Fulfilling MU2 Patient Education/Reminders Requirements Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 22
3 On the Menu Introduction Market Drivers Electronic Health Record (EHR) Adoption Federal Meaningful Use (MU) Requirements Patients Portals and MU2 Patient Education/Reminders Requirements Options for Fulfilling MU2 Patient Education/Reminders Requirements Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 33
4 ARRA and HITECH Act On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) and Health Information Technology for Economic and Clinical Health (HITECH) Act Over $60 billion in incentives and grant money to stimulate healthcare information technology (HIT) adoption First time state-based Medicaid programs and Departments of Health became major purchaser of HIT This act seeks to bolster health IT to improve the delivery of healthcare in the United States With various provisions and regulations, the Act provides financial assistance, tools, and resources to HCPs to allow for implementation and utilization of EHR Pay-for-performance (P4P) programs and other quality initiatives Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 44
5 Drivers of EHR Adoption by U.S. Providers Physician s EHR Choice: 1. Eligible professionals can be paid up to $44,000 over 5 years through Medicare and up to $63,750 over 6 years through Medicaid to adopt EHR demonstrate meaningful use Additional dollars from health plans and cost savings 2. Refuse these incentives, don t adopt EHR and suffer CMS penalties Mounting costs for quality reporting in paper Challenges in recruiting MDs or selling practice Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 55
6 On the Menu Introduction Market Drivers Electronic Health Record (EHR) Adoption Federal Meaningful Use (MU) Requirements Patients Portals and MU2 Patient Education/Reminders Requirements Options for Fulfilling MU2 Patient Education/Reminders Requirements Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 66
7 Adoption of EHR Systems by Office-Based Physicians Rapid rate of adoption projected due to Meaningful Use (MU) incentives and penalties Adoption of EHRs increases with the size of the physician practice as the costs can be spread out over a larger group of people Those under age 50, 64% were adopters, while about 50% of those over age 50 were adopters Source: CDC/NCHS, National Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey, EHR Survey, NCHS Data Brief, January 2014 Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 77
8 Electronic Prescribing Use With 73% of office-based physicians actively e-prescribing, more than one billion prescriptions were routed electronically in 2013, a 32% increase in volume over 2012 and almost double the total in 2011 Internists were the leaders by Specialty Practice with 96% e-prescribing in 2013 erx Routing (in million) 1250 [CELLRANGE] % by Specialty [CELLRANGE] 750 [CELLRANGE] 500 [CELLRANGE] 250[CELLRANGE] erx Renewals New erx IM FP Endo Card Ped Specialty Source: Surescripts: The National Progress Report, 2013 Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 88
![[CELLRANGE] 500 [CELLRANGE] 250[CELLRANGE] erx Renewals New erx 80 60 40 20 85 81 80 78 0 2009 2010 2011 2012 2013 0 IM FP Endo Card Ped Specialty Source: Surescripts: The National Progress Report,](/docs-images/44/1819081/images/page_8.jpg "2013 Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential - 2012 PDR Network, LLC. All Rights Reserved. \"PDR\" and \"Physicians' Desk Reference\" are registered trademarks of PDR Network, LLC 88")
9 EHRs = The Physician s New Desktop Patient Communications Regulatory/Risk/REMS Event Reporting/FDA Clinical Trials Patient Assistance Clinical Reference MD Communications Labeling Registries Rx and Claims Prescribers Prescribers Prescribers Prescribers Prescribers Prescribers Prescribers Prescribers Prescribers Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 99
10 On the Menu Introduction Market Drivers Electronic Health Record (EHR) Adoption Federal Meaningful Use (MU) Requirements Patients Portals and MU2 Patient Education/Reminders Requirements Options for Fulfilling MU2 Patient Education/Reminders Requirements Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 10 10
11 Confidential Meaningful Use: Core Set Objectives (for Eligible Professionals) Computerized physician order entry (CPOE) e-prescribing (erx) Report ambulatory clinical quality measures to CMS/States Implement one clinical decision support rule Provide patients with an electronic copy of their health information, upon request Provide clinical summaries for patients for each office visit Drug-drug and drug-allergy interaction checks Record demographics Maintain an 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 Capability to exchange key clinical information among providers of care and patient-authorized entities electronically Protect electronic health information Send reminders to patients per patient preference for preventive/follow up care Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 11 11
12 Patient Portals are Now a Top Provider Priority Greenway-funded research performed by the College of Healthcare Information Management Executives (CHIME) fall 2012 Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 12 12
13 Patient Demand for Online Provider Communication Technology Beyond the Exam Room: How Digital Media is Helping Doctors Deliver t he Highest Level of Care Televox National Survey October 2012 Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 13 13
14 On the Menu Introduction Market Drivers Electronic Health Record (EHR) Adoption Federal Meaningful Use (MU) Requirements Patients Portals and MU2 Patient Education/Reminders Requirements Options for Fulfilling MU2 Patient Education/Reminders Requirements Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 14 14
15 EHR Patient Education: Reality Check 1. All providers must deliver patient education via EHRs: providers have no time to write or review patient education materials providers do not want to fund patient education materials providers will be responsible for the information sent to patients 2. EHRs will select patient education materials for providers: EHRs currently select clinical sources for their EHRs downstream EHRs will allow greater options for patient education but choices will be limited in the near-term 3. Drugs may be better targets for patient education vs. diagnosis: drugs change more frequently than diagnosis drugs require patient activity (Rx fill, refill, follow-up lab, etc.) drug education can be automated with links to eprescribing drug education can include links to patient financial assistance and other supportive services Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 15 15
16 Drug Monograph Patient Information Pill Images / pronunciation Links to additional information How Infobutton Works 1) Infobutton icon appears adjacent to drug or disease name 2) Provider clicks on Infobutton bringing up Patient Education 3) Provider selects print or Patient Portal for delivery to patient Overdose Information/ Contacts Print Portal Infobutton-only patient education means substantial additional repetitive work for busy providers! Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 16 16
17 EHRs and Patient Communication: Optimal Approach The ideal approach to fulfilling the MU2 patient education requirement should be 1. Free: add no new costs for Providers or EHRs 2. Trusted: come from a source that Providers know and trust 3. Infobutton-Enabled: fulfill ONC requirements 4. Integrated into Provider Workflow and Automated: minimize or eliminate work and clicks for Providers 5. Comprehensive: cover most common drugs or diseases 6. Current and Regularly Updated: for patient safety and provider liability Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 17 17
18 Customization and Context are Key for Patient Success Technology Beyond the Exam Room: How Digital Media is Helping Doctors Deliver t he Highest Level of Care Televox National Survey October 2012 Confidential 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 18 18
19 EHR and Patient Portal: Take Homes EHR adoption has passed 70% and represents the new provider workflow 1. Those interested in engaging providers need to include an EHR strategy 2. Increasingly EHRs allow provider AND patient engagement Confidential Patient Portals in EHRs: 1. Are a functional requirement of EHR Meaningful Use 2 2. Require thoughtful execution and use to optimize ROI 3. Move the provider-patient relationship from episodic to ongoing 4. Can provide clear value to the provider including improved: administrative and billing efficiency liability reduction patient satisfaction and retention 5. Can contribute to improved population health and cost reductions focused on wellness and adherence 2014 PDR Network, LLC. All Rights Reserved. Confidential PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 19 19
20 HIPAA Covered Entities Are you a 1.Healthcare provider? 2.Healthcare clearinghouse? 3.Health plan? or are you a business associate of a covered entity? Simplification/HIPAAGenInfo/Downloads/CoveredEntitycharts.pdf 20
21 Can the message stand alone? Is everything on label? Is use of product name OK? Is the approved PI attached/accessible? Is risk information in the body of the message or segregated? Have you taken account of the message delivery system? 21
22 Questions? Dale Cooke PhillyCooke on Twitter PhillyCooke.com
23 Speaker Bio: Dale Cooke Dale Cooke is the owner of PhillyCooke Consulting, which provides advice and training to companies about developing compliant promotional materials for FDA-regulated products. Dale has worked with more than 30 pharmaceutical and medical device clients around the world. His insights have been featured in the Wall Street Journal s Health blog, The Pink Sheet, MedAdNews, PharmExec, and others. Dale is an active member of the Regulatory Affairs Professionals Society (RAPS), Drug Information Association (DIA), Food and Drug Law Institute (FDLI), and the Alliance for a Stronger FDA. He also serves on the faculty of the University of California San Francisco s American Course in Drug Development and Regulatory Sciences program. Dale is the author of Effective Review and Approval of Digital Promotional Tactics, which is part of FDLI s primer series. He is regularly invited to speak at industry conferences on topics including FDA enforcement trends, best practices for review processes, global review practices, and life sciences use of social media. Previously, Dale served as the head of Regulatory for Digitas Health LifeBrands, which is part of the Publicis Healthcare Communications Group. Dale earned his B.A. in Philosophy from Southern Methodist University, an M.A. in Analytical Philosophy from the University of Arizona, and studied Epidemiology and Biostatistics at Drexel University s School of Public Health and Healthcare Compliance at Seton Hall University s School of Law. 23
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