Of EHRs and Meaningful Use. Pat Wise, RN, MA, MS FHIMSS COL (USA ret d) VP, Healthcare Information Systems, HIMSS

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1 Of EHRs and Meaningful Use Pat Wise, RN, MA, MS FHIMSS COL (USA ret d) VP, Healthcare Information Systems, HIMSS 1

2 MU: Where We are Today From As of the end of January 31, 2013: >210,000 EPs and >2,400 EHs have received EHR Incentive Program payments. ~56% of all U.S. EHs and CAHs have received an incentive payment for EHR AIU or MU 1 of 5 U.S. EPs have received an incentive payment for EHR AIU or MU >$6.8 billion in EHR Incentive Program payments >$4.7 billion in Medicare EHR Incentive Program payments from May 2011 May

3 CPOE Automation and Plan Analysis 2012 (N=5317) 41% 16% 12% 2% 27% 2011 (N=5339) 38% 17% 11% 3% 30% 2010 (N=5283) 27% 18% 12% 4% 40% 2009 (N=5237) 25% 14% 8% 3% 50% 2008 (N=5168) 24% 14% 6% 3% 53% 2007 (N=5073) 19% 16% 5% 4% 55% Automated Replacement Purchases Contracted - Not Yet Installed Contracted - Installation In Process First Time Purchase Not Automated, No Plans to Purchase Hospitals with replacement purchase are less than 1% each year between 2007 and Source: HIMSS Analytics Database

4 CPOE Automation and Plan Analysis 2012 (N=1174) 32% 14% 10% 4% 39% 2011 (N=1127) 28% 15% 11% 5% 44% 2010 (N=1170) 16% 14% 8% 6% 57% 2009 (N=1172) 12% 8% 5% 4% 71% 2008 (N=1317) 10% 7% 3% 77% 2007 (N=1514) 7% 9% 4% 78% Rural Hospitals Automated Replacement Purchases Contracted - Not Yet Installed Contracted - Installation In Process First Time Purchase Not Automated, No Plans to Purchase Hospitals with replacement purchase are less than 1% each year between 2007 and Source: HIMSS Analytics Database

5 CPOE Automation and Plan Analysis 2012 (N=1330) 33% 16% 10% 4% 36% 2011 (N=1330) 28% 16% 10% 5% 40% 2010 (N=1302) 18% 14% 8% 7% 54% 2009 (N=1291) 12% 9% 5% 4% 69% 2008 (N=1254) 9% 9% 3% 75% 2007 (N=1264) 7% 10% 4% 76% Automated Replacement Purchases Contracted - Not Yet Installed Contracted - Installation In Process First Time Purchase Not Automated, No Plans to Purchase CAH Hospitals Hospitals with replacement purchase are less than 1% each year between 2007 and Source: HIMSS Analytics Database

6 CPOE Installations By Type of Hospital Academic (N=206) 94.66% General Medical & Surgical (N=3185) 72.43% Critial Access (N=1330) 59.55% Other (N=596) 77.01% 2012 % of Hospitals Automated for CPOE Source: HIMSS Analytics Database

7 Data Warehousing/Mining Clinical Automation and Plan Analysis 2012 (N=5317) 2011 (N=5339) 2010 (N=5283) 2009 (N=5237) 2008 (N=5168) 2007 (N=5073) 35% 34% 29% 25% 20% 16% 61% 62% 67% 73% 78% 81% Automated Replacement Purchases Contracted - Not Yet Installed Contracted - Installation In Process First Time Purchase Not Automated, No Plans to Purchase Source: HIMSS Analytics Database

8 Bar Coding for Medication Administration 2012 (N=5317) 32.48% 51.78% 2011 (N=5339) 33.25% 50.01% 2010 (N=5283) 34.93% 44.71% 2009 (N=5237) 32.36% 40.84% 2008 (N=5168) 27.83% 35.16% 2007 (N=5073) 8.22% 2.80% Used Planned Source: HIMSS Analytics Database

9 HIE Adoption 2012 (N=5317) 19.67% 27.72% 2011 (N=5339) 16.54% 22.66% 2010 (N=5283) 16.26% 22.70% 2009 (N=5237) 11.95% 18.31% 2008 (N=5168) 8.32% 14.38% 2007 (N=5073) 6.45% 11.49% Participating Planning to Participate Source: HIMSS Analytics Database

10 Plan Trends: Applications 2007 Top 10 Applications Planned For Purchase Application Number of Hospitals % of 5082 Total Hospitals Radiology PACS % CPOE % emar % Document Management % Nursing Documentation % Clinical Data Repository % Physician Documentation % Order Entry % CDSS % 2012 Top 10 Applications Planned For Purchase Application Number of Hospitals % of 5339 Total Hospitals CPOE % Physician Documentation % emar 136 2,56% Laboratory Information System % Clinical Data Repository % CDSS % Nursing Documentation % Order Entry % Radiology Information System % RIS % Medication Reconciliation Software % Source: HIMSS Analytics Database

11 2007 Final 2012 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP 0.0% 1.2% Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS Closed loop medication administration 0.8% 1.4% 6.2% 9.4% CPOE, Clinical Decision Support (clinical protocols) 2.2% 13.2% Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed 25.1% 37.2% 14.0% 43.9% 12.1% 5.5% All Three Ancillaries Not Installed 19.3% 8.4% Data from HIMSS Analytics Database 2012 HIMSS Analytics N = 5073 N =

12 Ambulatory EMR Adoption Model SM US HIE capable, sharing of data between the EMR and community based EHR, business and clinical intelligence Advanced clinical decision support, proactive care management, structured messaging Personal health record, online tethered patient portal 0.00% 1.20% 0.04% CPOE, Use of structured data for accessibility in EMR and internal and external sharing of data Electronic messaging, computers have replaced the paper chart, clinical documentation and clinical decision support Beginning of a CDR with orders and results, computers may be at point-of-care, access to results from outside facilities Desktop access to clinical information, unstructured data, multiple data sources, intra-office/informal messaging Paper chart based 0.41% 10.92% 34.10% 5.29% 48.04% Data from HIMSS Analytics Database 2012 HIMSS Analytics N = 9,247 12

13 A Few Words about the ONC 2014 Edition Certification Complement to CMS MU Stage 2 FR Rule Capabilities, related standards, implementation specifications that CEHRT will need to include support MU in FY/CY 2014 and beyond Standards & certification criteria seek to enhance Care coordination Patient & family engagement Interoperability Security, safety, and efficacy of CEHRT 13

14 ONC HIT Certification Program Changes flexibility for industry to quickly use newer versions of minimum standard code sets certification transparency and clarity Publicly available certification testing results Apply user-centered design processes, adhere to appropriate quality systems principles Improve data portability for EPs Including migration from one EHR to the next Price transparency Disclosing full cost of CEHRT (complete or module) 14

15 Overview of the Proposed Rule for Stage 2 of Meaningful Use Stage 2 delayed one year ( ) First Payment Year TABLE 2: STAGE OF MEANINGFUL USE CRITERIA BY FIRST PAYMENT YEAR Stage of Meaningful Use TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD

16 Overview of the Proposed Rule for Stage 2 of Meaningful Use Increased structured data capture Increasing relevant HIE at transitions of care Retains objectives measures structure Retains core and menu structure EPs must meet or qualify for an exclusion to 17 core and 3 of 5 menu objectives EHs and CAHs must meet or qualify for an exclusion to 16 core and 2 of 4 menu objectives 16

17 Overview of the Proposed Rule for Stage 2 of Meaningful Use Nearly all Stage 1 core and menu objectives retained for Stage 2 Exchange of key clinical information core objective replaced by transitions of care core objective Provide patients with an e-copy of their health information objective replaced by electronic/online access core objective 17

18 Stage 2 EP Measures That Are Challenging Patients view, download or transmit to a third party their health information A patient choice not under direct EP control Secure messaging initiated by patients A patient choice not under direct EP control Electronically transmit a summary of care record using CEHRT to a recipient with no organizational affiliation and using a different CEHRT vendor than the sender 18

19 Professional Society Feedback to CMS: Some Major Themes Too much, too fast, too soon, too hard Too many double-jumps Menu Core and increased thresholds Dependent on technologies and processes not yet proven and/or widely available Increasing costs of MU compliance with decreasing payments Expecting EPs to use CEHRT functionalities while vendors are developing & certifying them 19

20 Core Objectives Set (Must meet all 16) Stage 2 Hospital Objective Use CPOE for medication, lab and radiology orders Record demographics Record and chart changes in vital signs Record smoking status Use Clinical Decision Support Measure > 60% of such orders created are recorded using CPOE > 80% of unique patients admitted have demographics recorded > 80% of unique patients have blood pressure and height/weight recorded > 80% of unique patients smoking status recorded Implement 5 CDS interventions for 5 or more CQM AND implement drug/drug/allergy checks Notes Stage 1 was 30% Stage 1 was 50% Stage 1 was 50% Patients <3 years excluded from blood pressure measure Stage 1 was 50% Patients 13 years or older Stage 1 was one 20

21 Core Objectives Set Stage 2 Hospital Objective Incorporate lab test results Generate lists of patients by conditions Track medications from order to administration using assistive technologies Provide ability to view online, download and transmit information about admission Measure > 55% of results ordered are incorporated as structured data Generate at least one report of patients with specific condition > 10% of orders are tracked using emar > 50% of patients discharged have information online within 36 hours AND > 10% of patients discharged view, download or transmit info Notes Stage 1 was 40% Results can be either positive/negative or numerical Same New Stage 1 was 10% and Menu Set Requires patient action to meet measure New 21

22 Core Objectives Set Stage 2 Hospital Objective Use EHR technology to identify patient-specific education resources Medication reconciliation performed on patients from other settings or where relevant Summary of care record provided with each patient during transition to another setting or referral Measure > 10% of unique patients provided resources identified by EHR Medication reconciliation performed > 65% of transitions of care where patient is admitted Provide summary of care record for > 65 % of transitions or referrals AND transmits a summary record to a recipient with NO organizational affiliation AND using different EHR technology for > 10% of transfers Notes Stage 1 was Menu Set Stage 1 was 50% Menu Set Stage 1 was 1 test 22

23 Core Objectives Set Stage 2 Hospital Objective Capability to submit to immunization registries Capability to submit reportable lab results to PHA Capability to submit surveillance data to public health agencies Protect information through appropriate technical capabilities Measure Successful ongoing submission of data from CEHRT for entire reporting period Successful ongoing submission of data from CEHRT for entire reporting period Successful ongoing submission of data from CEHRT for entire reporting period Conduct or review a security risk analysis including data at rest Notes Stage 1 was single test; Menu Set Stage 1 was single test; Menu Set Stage 1 was single test; Menu Set Added data at rest 23

24 Menu Objectives (Must meet 2 of 4) Stage 2 Hospital Objective Record whether patients 65 or older have an advance directive Imaging results and information accessible through CEHRT Record patient family health history Use erx to generate and transmit permissible discharge prescriptions Measure > 50% of admitted unique patients 65 or older have an advance directive as structured data > 40% of all scans and tests resulting in an image for patients admitted can be accessed through CEHRT > 20% of unique patients admitted have a structured data entry for one or more firstdegree relatives > 10% of discharge medication orders are compared to at least one formulary and transmitted Notes Stage 1 was advance directive indicator only New New New 24

25 Reporting CQM Quality measures categorized into 6 domains: Clinical Process / Effectiveness Patient Safety Care Coordination Efficient Use of Healthcare Resources Patient & Family Engagement Population & Public Health 25

26 Reporting CQM Beginning FY 2014, hospitals must: Report 24 quality measures Choose from menu of 49 measures Include at least 1 measure from each domain Menu to include current Stage 1 set of 15, plus pediatric, obstetric and cardiac measures Applies to both Stage 1 and Stage 2 26

27 Thank you! Questions?

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