Translating Technology Adoption into Meaningful Use in Private Physician Practices (How to Drive Clinical Value from EMRs) Dr.

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1 Translating Technology Adoption into Meaningful Use in Private Physician Practices (How to Drive Clinical Value from EMRs) Dr. Alan Brookstone Founder & CEO June 16, 2011

2 Background Family physician Founded CanadianEMRin 2004 and AmericanEHRPartners in 2010 Local, regional, national and international experience in EMR adoption and use, policy and strategy development Written numerous articles and hosted podcasts and webinars on healthcare technology in Canada, US and abroad

3 Practices with Advanced Electronic Health Information Capacity Percent reporting at least 9 of 14 clinical IT functions* * Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access test results, Rx alerts, clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with test results, preventive/follow-up care reminders; and computerized list of patients by diagnosis, medications, due for tests or preventive care. Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 3

4 Adoption of Technology by GPs (International)

5 Canada vs. United States MU Programs United States Canada Scope National Provincial Structure Highly structured Variable (e.g. AFSP -Alternative Specialist Funding Program BC) Time Frame To be determined Legislation HITECH Act of 2009 Nil in 2011 EMR Certification ONC ATCB Certification (Authorized Testing and Certification Body) Provincial Certification. Intent to build into future specifications Reporting Attestation then Electronic Attestation then Electronic Leverage Incentives Up to $44K for Medicare, Up to $63.5K for Medicaid. Reimbursement penalties begin in 2015 Incentives Linkage to EMR programs. Pay for Performance in some provinces. E.g. CDM Incentive program in BC

6 Introduction Meaningful Use Defined in the US as part of the HITECH Act of 2009 Demonstrate use of certified EMR technology in a meaningful manner Demonstrate that certified EMR technology is connected in a manner that provides for electronic exchange of health information to improve quality Use of certified EMR technology to submit information on clinical quality measures to HHS as specified by HHS Canada Beginning to see the concept of Meaningful Use incorporated into existing EMR programs (Ontario and BC)

7 What is Meaningful Use of Health IT? US - Focus on capabilities of EMR systems: To collect, store, manage and exchange relevant health information To facilitate care team communications in the processes of care delivery and management To collect, store, measure and report on the processes and outcomes of individual and population performance and quality of care To allow providers to engage in decision support for evidence-based treatments and tests To allow patients/consumers to be informed and increasingly literate about their health and medical conditions To provide HIT support for patients, caregivers and family

8 The Stages of Meaningful Use 3 stages each progressively more difficult Specific measure for Stage 2 & Stage 3 not currently defined Stage 1 Meaningful Use Requirements Core Set has 15 measures need to meet all Menu Set has 10 measures of which 5 have to be met At least 1 of the measures needs to be: Test of reporting to an immunization registry Test of reporting to a public health agency for syndromic surveillance

9 Achieving Meaningful Use Type System dependent Eligible provider dependent Patientdependent Visit dependent Activity dependent Request dependent Example Drug-drug allergy check Compliance with Clinical Decision Support rule Smoking status Clinical summaries E-Prescribing Electronic copy of information Source American College of Physicians 9

10 Quality Measure Reporting Requirements 2011 Eligible Professionals seeking to demonstrate Meaningful Use are required to submit aggregate CQM numerator, denominator and exclusion data to CMS or to the States by ATTESTATION Can report on any 90-day consecutive period (within a single calendar year Stage 1, Year 1) 2012 (or 2013) Eligible Professionals are required to ELECTRONICALLYsubmit aggregate CQM numerator, denominator and exclusion data to CMS or to the States

11 How Meaningful Use in US is Applied in Practice Use the EMR (and staff) for the following 6 things: 1. Create problem lists 2. Enter allergies 3. Keep track of vaccinations and preventive care 4. Collect basic demographic data (date of birth, gender, race, ethnicity, and preferred language) 5. Check height, weight and blood pressure 6. E-prescribing

12 Enabling the Ability to Satisfy 8 Core Set and 3 Menu Set Measures: Core Set: Computerized Physician Order Entry; Drug-drug/Drugallergy interactions; Maintain up-to-date problem list; E- prescribing; Active medication list; Active allergy list; Recording of demographics; Record/chart vital signs. Menu Set: Drug-formulary check (at least 1); Generate list of patients with a specific condition; Send reminders for preventive/follow-up care.

13 HITECH Act (Medicare Provisions) Provides financial incentives for adoption of health IT ($44,000 per physician over 5 years) Introduced concept of Meaningful Use Decreasing incentives if start after 2012 Must begin by 2014 to receive any payment Reimbursement Penalty begins 2015 HITECH = Health Information Technology for Economic and Clinical Health Act

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15 How Much are the Medicare Incentives?

16 Bending the Curve Towards Transformed Health Achieving Meaningful Use of Health Data Advanced clinical processes clinical decision support Population Management Data Exchange Improved outcomes & reduced costs Data capture and sharing Source American College of Physicians

17 EMR Use for Basic and Complex Prescribing Tasks

18 HHS Hearings on Meaningful Use Stage 1 May 2011 The Meaningful Use program has motivated our small practice affiliates to install EMR systems. Surely this was the intended effect. However, the gold-rush mentality amongst the small practice groups is problematic as they generally have a very unsophisticated understanding of the Meaningful Use objectives and the potential hurdles involved to achieve them. Dr. Adam Cheriff, CMIO for the Weill Cornell Physician Organization

19 HHS Hearings on Meaningful Use Stage 1 May 2011 As I look at the landscape of small group private practices especially primary care practices, I remain very concerned for those who are just beginning to select and implement an EMR. With the current time table for MU Stage 1 and its now 20 month deadline to obtain the initial and largest amount of MU money, I seriously doubt that many of these small practices will be successful. Dr. Jacqueline Fincher, Managing Partner, McDuffie Medical Associates Thomson, GA

20 EMR Progress in Canada All provincial EMR programs are currently stalled at +/-50% adoption The middle and late majority are a significant challenge Programs are focused on adoption and EMR maturity models Current metrics are primarily subjective and experiential Ontario is establishing a 6 level EMR Maturity Model BC is developing a 5 level EMR Maturity Model for specialists Ontario is not linked to incentives, BC has incentives but both limited discrete metrics

21 Obstacles to Achieving Meaningful Use in Canada Lack of standards-based EMR systems to achieve data interoperability Provincial vs. national EMR certification programs Setting bar too high on functional requirements and too low on clinical improvements and outcomes Key components still missing E-Referral & E-Prescribing Incentives and levers focused on the purchase and use IT Lack of national strategy, metrics and benchmarks

22 Solutions to Achieving Meaningful Use in Canada Re-evaluate the Canadian EMR strategy Are we heading in the right direction? Recognize we are dealing with an ecosystem of GPs & Specialists Establish national interoperable standards for EMRs E-Referral E-Prescribing Align Meaningful Use objectives with provincial clinical programs Establish a set of metrics apply across Canada and start reporting a national scorecard

23 I don't know the key to success, but the key to failure is trying to please everybody. Bill Cosby

24 Q&A