THE EMR EXPRESS WHAT IS MEANINGFUL USE AND WHY MEANINGFUL USE INTERIM RULES SUMMARY DOES EVERYONE KEEP TALKING ABOUT IT?

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1 INCONCERTCARE EMR AND PMS MONTHLY NEWSLETTER VOLUME 2, ISSUE 3 APRIL/MAY 2010 WHAT IS MEANINGFUL USE AND WHY DOES EVERYONE KEEP TALKING ABOUT IT? This issue is devoted to the incentive payments available through the Centers for Medicare and Medicaid (CMS) for primary care providers who meaningfully use health information technology (HIT). Health center providers will likely be eligible under the Medicaid incentives and there are significant expectations for utilizing and reporting data from the HIT employed. Although the rules are not yet finalized, the INCC team thought it would be helpful to provide some background information on meaningful use for health center staff. INSIDE THIS ISSUE: ELIGIBILITY FOR MEANINGFUL USE 2 MEANINGFUL USE INTERIM RULES SUMMARY Information on the following pages is based on a review of the interim rules for meaningful use that the CMS issued earlier this year. A lengthier version of this summary was developed by Dr. Bery Engebretsen, but for purposes of this newsletter, has been further streamlined. Please note that final rules for meaningful use have not yet been established so all information in this summary should be considered to be a draft. Funding for meaningful use will begin in 2011, however, states have the option of beginning in 2010, if their plan is in place and they are ready. Iowa was the first state to get their implementation plan approved; Nebraska has not yet submitted their plan. Sites that have already implemented or are in the process of implementing an electronic health record (EHR) are still eligible for the funding. The last year one can start the process is FUNDING FOR MEANINGFUL USE MEANINGFUL USE CLINICAL MEASURES REC IN NEBRASKA REC IN IOWA COMMUNICA- TION STRATEGIES

2 PAGE 2 ELIGIBILITY Eligibility to participate in meaningful use is by eligible provider (EP), not site. EPs include physicians, PAs, CNMs, NPs, and dentists (thus it will be important that Dentrix be certified, but there is virtually no discussion of dentists in the interim rules). To be an EP requires that 30% of the EP s encounters over any continuous 90 day period within the most recent calendar year prior to reporting be Medicaid/SCHIP or needy if working in an FQHC or Rural Health Clinic (RHC). Needy includes uncompensated care or patients on a sliding fee scale. It does not include bad debt (see Table 26). The EP must also have at least 50% of their encounters at the FQHC/RHC for six months. Thus part-time practitioners are eligible if they see over half of their patients at the FQHC. The Quad City example says that practitioners practicing in more than one state must sign up with one or the other state Medicaid program. Since states are reimbursed 100% for the payments to EPs, this should not be an issue. TABLE 26: Qualifying Patient Volume Threshold for Medicaid EHR Incentive Program Entity Minimum 90-day Medicaid Patient Volume Threshold Physicians 30% Pediatricians 20% Dentists 30% Certified nurse midwives 30% Physician assistants when 30% practicing at an FQHC/RHC led by a physician assistant Nurse practitioner 30% Acute care hospital 10% Children s hospital Or the Medicaid EP practices predominantly in an FQHC or RHC 30% needy individual patient volume threshold FUNDING The payment amounts for Medicaid to EPs as it stands now is: 85% of $25,000 of eligible costs in the first year and 85% of $10,000 in each of the next five years, for a total of $63,750 per EP over six years. The total amount is less for the Medicare incentive. Siouxland Community Health Center UPDATE Things are progressing well at Siouxland with the practice management implementation. We have initiated work with Dentrix and i2itracks on the interfaces/linkages and are not anticipating any problems though it appears Siouxland will have have some pre-work to clean up data for the demographic conversion and the interfaces. Siouxland has moved through kick off and administration set up, and has super user training scheduled in mid June. All indications are that Siouxland will be able to keep with their scheduled July 2 go live for practice management.

3 VOLUME 2, ISSUE 3 PAGE 3 MEANINGFUL USE In whatever year a site (or, more correctly, an EP) begins to request funding, the requirement is only to show that they are adopting, implementing, or upgrading a certified EHR. This will be by attestation, but the state Medicaid program has the responsibility to verify this and all subsequent requirements. Eligible costs include staffing, training, maintenance, and workflow redesign. But in the second year and on, there will be progressively more meaningful use criteria, including quality indicators, to meet. CMS has issued draft criteria for Phase 1, which are subject to change but include the following noteworthy items: Demographic data must include the patient s preferred language. A clinical progress note is not a requirement, as CMS feels it has little to do with quality. Medication reconciliation will be required. Patients must have electronic access to their visit summary within 96 hours, if desired, via portal, personal health record, or onto a CD or other USB access. Security is not a big part of this as CMS has indicated that HIPPA already covers these issues. Quality reporting will be an increasingly important part of meaningful use. Table 4 (below) lists four measures, as it now stands, that all EPs will be required to report on, beginning in There will be additional measures to report on, by specialty, with primary care being considered a specialty. There is a table that lists the potential measures for primary care, but it is lengthy and available upon request from Deb Kazmerzak It is not exactly clear how many items sites will have to report on at this point in time. There are no measures for oral health, unless sites are to choose from primary care measures like tobacco cessation or a blood pressure measurement. There is an 80% compliance requested for all of the measures. TABLE 4: Measure Group: Core for All EPs, Medicare or Medicaid Measure Number Clinical Quality Measure Title PQRI 114 Title: Preventive Care and Screening: Inquiry Regarding Tobacco Use NQF 0028 NQF 0013 Title: Blood Pressure Measurement NQF 0022 Title: Drugs to be Avoided in the Elderly Patients who receive at least one drug to be avoided Patients who receive at least two different drugs to be avoided

4 PAGE 4 REGIONAL EXTENSION CENTERS IN NEBRASKA AND IOWA Regional Extension Centers were established as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act. The purpose of the HIT Regional Centers is to assist providers in adopting, implementing, and achieving meaningful use with their electronic health record (EHR)/HIT system. INCC has agreements with the organizations designated as Regional Extension Centers (HITREC) in both states. NEBRASKA CIMRO of Nebraska, the Medicare Quality Improvement Organization for the state of Nebraska, was awarded a four year cooperative agreement grant from The Office of the National Coordinator for Health Information Technology (ONCHIT) to establish Wide River TEC to assist Nebraska health care providers with implementing and using EHRs. Wide River TEC will offer technical assistance, guidance, and information on best practices to support and accelerate health care providers efforts to become meaningful users of EHRs, as well as the ability to exchange health information with other providers and agencies. Services offered by Wide River TEC are available to all providers, including those who already have an EHR in place and those that do not. Priority will be given to Nebraska practitioners providing primary care in individual and small group practices, Critical Access Hospitals (CAHs), Rural Health Clinics, Federally Qualified Health Centers (FQHCs) and other settings that serve uninsured, underinsured and medically underserved populations. Technical assistance and support will focus on the following areas: Select and purchase EHR software EHR implementation and project management support Practice and workflow redesign Functional interoperability and health information exchange assessment and guidance Privacy and security best practices EHR optimization and meaningful use Individual provider education and training will be conducted through onsite visits and individualized technical assistance. A team approach will be utilized, with highly trained nursing informatics and technical specialists providing technical assistance. Building on the strong e-health infrastructure that exists in Nebraska, Wide River will help advance the emerging e- health infrastructure. How to Contact Wide River TEC: Phone: Fax: Website:

5 VOLUME 2, ISSUE 3 PAGE 5 IOWA IFMC was designated as Iowa s Health Information Technology Regional Extension Center (HITREC) with operations beginning March 31, IFMC, in partnership with InConcertCare, Inc., will provide 1,200 priority providers (33% of Iowa s primary care practitioners) with direct assistance during the first two years of the program. This includes technical assistance in vendor selection, group purchasing, implementation, project management, practice workflow redesign, interoperability, health information exchange, privacy, and security best practices. The Regional Center will also provide education and outreach, support for local workforce development and assessment of progress toward meaningful use. The Regional Center will assist providers with or without EHRs in achieving meaningful use. Customized services will be available to providers at all stages of the EHR adoption process, i.e. readiness assessment, EHR selection, implementation, and optimization. How to Contact IFMC: Phone: (Susan Harr) or Website: How to Contact INConcertCare: Phone: (Deb) or (Kyle) or Clinical Content Standardization UPDATE Deb Kazmerzak, Kyle Haindfield and Bery Engebretsen are staffing the clinical content development effort which is well underway. A series of additional meetings, all via conference call, have been scheduled through July. Health Center clinicians have really stepped up to take on various content areas thanks to all of you for your hard work! TO LEARN MORE CONSIDER ATTENDING THE MEANINGFUL USE WORKSHOP The Iowa Collaborative Safety Net Provider Network, along with INConcertCare, the Iowa/Nebraska Primary Care Association, Iowa Medicaid Enterprise, and the IFMC, is offering a workshop for safety net providers interested in gaining a better understand of meaningful use of health information technology. The workshop will focus on sharing information about meaningful use criteria, how meaningful use aligns with the patient-centered medical home concept, and resources available in Iowa to assist practices with meeting meaningful use, including the IFMC s Regional Extension Center and Iowa Medicaid Enterprise. Iowa s safety net providers are the target audience, including, but not limited to, Community Health Centers, Critical Access Hospitals, Family Planning Agencies, and Rural Health Clinics. More information about this event, including learning objectives for the workshop and registration information, will be available soon. The event will be free to attend and lunch will be provided. The event will be held Friday, June 11, 2010 from 10:00 a.m. to 3:00 p.m. at the Foxboro Conference Center in Johnston, Iowa.

6 PAGE Hickman Rd. Suite 103 Urbandale, Iowa Phone: Fax: V ISIT US ONLIN E AT: WWW. IANEPCA. COM Communication Strategies - Are YOU Talking? During the last HIT Steering Committee meeting, Network staff asked for feedback from the centers about communications. Following are some great ways in which some of the the centers are communicating internally about the PMS and EMR implementations. If you have thoughts about how to improve communications for the project, please contact Deb Kazmerzak at or Primary Health Care is communicating with their Board every month and provides the same information to all of the staff each month. The implementation is also a standing agenda item during the provider meetings. The EMR Express is sent out to all of the managers as well. Community Health Center of Fort Dodge noted that the implementation is discussed during all staff meetings. The newsletters are put in the break room and are also mentioned during the staff meetings. The senior staff will also be having bi-weekly or monthly meetings, which will provide another opportunity to discuss the implementations. River Hills Community Health Center has several teams that are meeting, including the overall implementation team, as well as practice management and clinical content teams. Siouxland Community Health Center s clinical leadership meets with each of the departments and also shares information with their Board on a regular basis. The Peoples Community Health Clinic team meets every other week. Peoples has also created a special address and voic for staff to ask questions about the process. An Intranet system has also been set up that communicates with staff about key issues in order to encourage people to start using the Intranet on a regular basis. Copies of the newsletter are provided to each staff person on a monthly basis. The Crescent Community Health Center team meets on a weekly basis as a way to keep everyone engaged. Updates to the Board occur on a monthly basis. All of management is involved and the team is trying to involve all of the front line staff too.

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