Making Healthcare Meaningful Through Meaningful Use Stage 2

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1 Making Healthcare Meaningful Through Meaningful Use Stage 2 Keith Griffin, MD Chief Medical Information Officer Novant Health Medical Group

2 Novant Health: Making Healthcare Remarkable Not-for-profit, integrated health system that spans communities in the Carolinas, Virginia and Georgia 500 locations including 14 medical centers Over 1,900 providers and over 26,000 employees/physician partners Nationally recognized for quality and safety measures HIMSS Stage 7 Ambulatory Award Completed rollout in two years, three years ahead of schedule

3 Stage 1: Guiding Principles MU dollars to offset EHR cost Pooled together and subtracted from the physician project costs Initial yearly cost of EHR assumed a conservative estimate of MU dollars based on original rollout schedule Physician yearly fee for EHR was set based on this equation Dedicated MU team

4 Stage 2: Providers Financial Incentives Table 1: Incentive Payment Schedule Based on Year of First Payment Calendar First CY which EP received incentives Payment Year and subsequent years 2011 $18, $12,000 $18, $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12, $2,000 $4,000 $8,000 $8, $2,000 $4,000 $4, Total $44,000 $44,000 $39,000 $24, Abbreviations: CY calendar year; EP eligible providers

5 Stage 1: 2013 Final State 2 EPs 0.19% 1,051 EPs 99.8%

6 Stage 1, Stage 2: 2014 Final State

7 Stage 1, Stage 2: 2014 Final State

8 Stage 2 Focus Areas

9 Focus Area 1: Patient Reminders (P215) More than 10 percent of patients who have two or more office visits in the last two years are provided a reminder for preventive or follow-up care. The reminders are communicated to the patient based on their communication preference.

10 Focus Area 1: Patient Reminders (P215) Patient portal adoption = single most important initiative of Meaningful Use Stage 2 Corporate prioritization minimized Novant Health s challenges with this measure

11 Focus Area 1: Patient Reminders (P215) More than 430,000 registered MyNovant users 460, , , , , , , , , , , , , , , , , , ,000 80,000 60,000 40,000 20,000 0 FEB 12JUN 12OCT 12FEB 13JUN 13SEP 13NOV 13DEC 13JAN 14FEB 14MAR 14APR 14MAY 14JUN 14JUL 14AUG 14SEP 14OCT 14NOV 14DEC 14JAN 15FEB 15

12 Leveraging MyNovant to Meet Patient Reminder Measures MyNovant reminder options: Letter announcing flu shot availability at Novant Health clinics Annual reminder letters for preventative care Sent during patient s birth month Both options ensure patients are up-to-date on their health maintenance topics

13 Annual Health Reminder Letter Dear Lauren: In addition to providing remarkable care to help you feel better when you are sick, we also want to help you prevent illness and injury from occurring in the first place. With this in mind, our system indicates that you are due for the following: Influenza Vaccine If you have already had these tests done previously or at another location, or you are unable to have these tests performed, please let us know so we can update your records. We appreciate you teaming with us on this information. If we can assist you in providing these services or scheduling an appointment, please call us at your earliest convenience. Sincerely, Sent on behalf of Dr. Capps

14 Focus Area 2: Direct Patient Messaging (P230) A secure electronic message was sent using the messaging function by more than 5% of unique patients who have active MyNovant accounts during the reporting period.

15 Focus Area 2: Direct Patient Messaging (P230) Biggest organizational concern High threshold to meet Leverage MyNovant strategy In-office signup and sending of test message Activation code on AVS Designated workflow for front office staff and clinical team members Patient follow-up functionality

16

17 Focus Area 3: Transitions of Care (P224) The provider who transitions a patient to another setting of care/another provider of care or refers a patient to another provider of care should provide a summary of care record for each transition or referral.

18 Transitions of Care (P224): Strategy Part A Novant Health s setup sends fax at certain trigger point No change in workflow for providers Part B Novant Health benefited because of relationship with Wake Forest, Cone Health, and UNC Out of provider s control (outside organization has to provide connectivity) Leveraged Care Everywhere Requires two systems working together o Novant Health took initiative to reach out to other systems

19 Transitions of Care (P224): Strategy No new training for referral coordinators (embedded in workflow) Referral evaluations/analysis Manual address entry Extensive outreach to providers Evaluation of qualifying transitions of care EHR Link

20 Transitions of Care (P224): Strategy ehealth exchange First in state to go live Pull information to leverage VA and SSA Working to engage other large health care systems HISP Selected SureScripts as HISP provider Share HISP directories with other organizations Collaboration challenges with largest competing healthcare system

21 Focus Area 4: Specialized Registries (P234) The capability to identify and report specific cases to a specialized registry (other than cancer registry) is established in accordance with applicable law and practice.

22 Focus Area 4: Specialized Registries (P234) 3 of out 6 menu measures met based on EHR workflow for 95% of providers Decided to use specialized registry for other 3 menu measures Beginning in 2015, Novant Health began submitting patient data to specialized registries for those providers using this menu measure Separate evaluation process to decide which registry to use and which vendor to facilitate

23 Stage 2 Tactics

24 Stage 2: Providers Financial Incentives Forgo penalty dependent on specific measures If provider could not control, Novant Health s financial penalty would not apply Government penalties do apply

25 Stage 2: Providers Financial Incentives Table 1: Incentive Payment Schedule Based on Year of First Payment Calendar First CY which EP received incentives Payment Year and subsequent years 2011 $18, $12,000 $18, $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12, $2,000 $4,000 $8,000 $8, $2,000 $4,000 $4, Total $44,000 $44,000 $39,000 $24, Abbreviations: CY calendar year; EP eligible providers

26 Stage 2 Communication Tactics Direct communication with providers and practice managers who were not meetings certain measures Meaningful Use section on SharePoint site

27 National Leader: Patients Who Logged into MyNovant

28 National Leader: E-Visits Submitted

29 National Leader: Medical Advice Requests

30 National Leader: MyChart vs. Telephone Encounters

31 National Leader: Patient Visits with Active MyChart Status

32 2014 Results Stage % Stage 2 97%

33 Lessons Learned Constant moderating Do not rely on HISP Aggressive patient portal adoption Align organizational incentives Communication

34 Future State Priorities Continual focus on engagement with other healthcare systems Stage 2, year 2 (12 months) Educating providers of new requirements Complexity of transitioning providers from one organization to another Novant Health inherits penalty Develop Stage 3 plans

35 Questions? Keith Griffin, MD

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