3/9/2011 ELECTRONIC HEALTH RECORDS: A NATIONAL PRIORITY. Mandate for electronic health records is tied to:

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1 To lower health care cost, cut medical errors, And improve care, we ll computerize the nation s health records in five years, saving billions of dollars in health care costs and countless lives. ELECTRONIC HEALTH RECORDS: A NATIONAL PRIORITY Healthcare policy Driving Forces for HIT Mandate for electronic health records is tied to: Transparency Pay for performance Increases in quality = decreases in healthcare cost Economic strain on healthcare industry Uninsured population of 46 million [2004] Aged population growth Expanded Medicaid enrollment under the Accountable Healthcare Act Workforce issues Shortages such as nursing, physicians, PT and Pharmacy 2 EHR for All Americans by 2014, a Promise of the HITECH Act Let the whole word know that the American healthcare system has entered the 21 st century No one in the history of healthcare or any other sector has tried to do something as complicated, as difficult. Double-click David Blumenthal, M.D., to start video M.P.P. National Coordinator for Health Information Technology U.S. Department of Health & Human Services Congress has provided my office with very powerful tools so we are bringing those tools to life in support of your work. HITECH = Health Information Technology Economic and Clinical Health 3 1

2 HITECH: Catalyst for Transformation Paper records HITECH Act EHRs & HIE Pre A system plagued by inefficiencies EHR Incentive Program and 60 Regional Extension Centers Widespread adoption and meaningful use of EHRs 4 The National Goal: Building an Interconnected, Patient-Centric Care System 5 Resulting in Improved Quality, Safety and Efficiency Better Communication and care coordination Safer Treatment via e-prescribing Faster Delivery of information and results More efficient Coding and billing 6 2

3 OVERVIEW OF MEANINGFUL USE The American Recovery and Reinvestment Act (ARRA) authorizes the Centers for Medicare & Medicaid Services (CMS) to offer a financial incentive to physician and hospital providers who demonstrate the meaningful use of an electronic health record (EHR). According to the CMS, a provider uses an EHR meaningfully when he or she: 1) Improves quality, safety, efficiency, and reduce health disparities 2) Engages patients and families 3) Improves care coordination 4) Improves population and public health 5) Ensures adequate privacy and security protections for personal health information 7 Five Pillars of Meaningful Use with Implications to Nursing Practice 1) Improve quality, safety, efficiency, and reduce health disparities Provide access to comprehensive patient health data for patient s health care team Use evidence-based order sets and CPOE Apply clinical decision support at the point of care Generate lists of patients who need care and use them to reach out to patients 2) Engage patients and families Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health 3) Improve care coordination Exchange meaningful clinical information among professional health care team 4) Improve population and public health Submit immunization, syndromic surveillance and reportable disease data to public health agencies 5) Ensure privacy and security protection for personal health information Protect confidential information through operating policies, procedures, and technologies Provide transparency of data sharing to patient 8 THE VISION FOR MEANINGFUL USE: Each stage gets progressively harder to drive toward the ultimate goal 3 Stages of Meaningful Use Stage 2 Stage 3 Improved quality of care Stage 1 9 3

4 HITECH Act: A Carrot and Stick Approach The Stick Eprescribing and quality reporting disincentives currently reduced reimbursement for lack of technology and reporting HITECH Act stipulates disincentives by further reductions in Medicare claims payment for non- EHR users starting in 2015 The Carrot Unprecedented funding opportunity of $17.2 billion for HIT funding Financial incentives for early adoption and meaningful use Medicare: achieve meaningful use Medicaid: adopt, implement or upgrade a certified EHR Incentives Summary MEDICARE MEDICAID Incentives Start Incentives End Incentive Amount Reimbursement Reduced Eligible Providers Hospitals Eligible Providers Hospitals CY 2011 FY CY 2016 (max. 5 years) Up to $44,000 total per provider; based on % Medicare claims FY 2015 (max. 4 years) Varies, depending on % Medicare inpatient bed days. CAHs paid based on EHR costs and % Medicare inpatient bed days 2021 (max. 6 years, must start by 2016) Up to $63,750 total per provider; based on 85% of EHR costs 2021 (max. 6 years, must start by 2016) Varies, depending on % Medicaid inpatient bed days CY 2015 FY 2015 No penalties No penalties Timeline: Achieving Meaningful Use Escalating complexity of HIE/HIT to attain $$ HITECH Policies Meaningful Use Criteria: Capture & Share Data Meaningful Use Criteria: Advanced care processes with decision support Meaningful Use Criteria: Improved outcomes 12 Gutshall, T. (2009) 4

5 HITECH Priority Grants Three levels: 1. Regional Extension Centers 2. State Grants to Promote Health Information Technology 3. Information Technology Professionals in Health Care 13 HITECH Act: 3 Levels of Grants 1. Regional Extension Centers (RECs): ($667 million total for the next 2 years 62 centers.100,000 providers) To establish a collaborative consortium of Health Information Technology Regional Extension Centers (Regional Centers) facilitated by the national Health Information Technology Research Center (HITRC). To offer providers across the nation technical assistance in the selection, acquisition, implementation, and meaningful use of an EHR to improve health care quality and outcomes. Note: Support services only no hard ware, software, or dollars directly to the providers 2. State Grants to Promote Health Information Technology To promote health information exchange (HIE) that will advance mechanisms for information sharing across the health care system. 3. Information Technology Professionals in Health Care (Workforce Program): To fund the training and development of a workforce that will meet short-term HITECH Act programmatic needs. 14 Regional Extension Centers in Texas North Texas Regional Extension Center West Texas Regional Extension Center CentrEast Regional Extension Center Gulf Coast Regional Extension Center 15 5

6 Comprehensive Support throughout the Entire EHR Implementation Process 1 Plan 2 Transition 3 Implement 4 Operate & Maintain Readiness assessment Practice workflow redesign EHR implementation Achieving meaningful use EHR system selection HIT education & training Partnering with state and local HIEs Prepare for future pay for performance 16 Nursing Implications Practitioner who effectively interacts with electronic resources for patient care, rather than relying on memory, gains more complete and timely access to information. Rapid access to databases such as formularies, drug references, and other decision-making support tools, improves the quality of care. Nurses at all levels must be prepared to function in all aspects of HIT: Leadership Development Support Multi-disciplinary Team members Nursing Informatics Specialists 1 7 Clinical Examples of West Texas Nurses in Action John Delaney RN BSN CPHIMS Director, West Texas Health Information Technology Regional Extension Center (WTxHITREC) Tamara Bavousett DNP, RN, C-PNP REC Pediatric Nurse Practitioner Advisory Board Member representing NPs 18 6

7 The Medical Home Model, Chronic Care Model & Health Information Technology 19 Success of Medical Home Model Hinges on Health Information Technology Issue Brief: Medical Home 2.0: The Present, the Future Although organizations initially would have to make significant investments to participate in PCMHs because of fixed technology costs, patient outcomes eventually would improve, which could help offset implementation costs; There are challenges in convincing physicians to adopt health IT, particularly in medical home models that require a willingness to use health IT in diagnostics, treatment planning and routine patient interaction; Some organizations might require assistance with IT purchase and implementation; and An impending shortage of primary care physicians would increase the need and dependence on telemedicine and other electronic doctor visits to bolster the practice of primary care medicine (Merrill, Healthcare IT News, 9/16) Characteristics of the New Model of Family Medicine (2004) "A standardized electronic health record, adapted to the specific needs of family physicians and the patients they serve, will constitute the central nervous system of the New Model practice." American Academy of Family Physicians 21 7

8 NCQA PPC-PCMH* Recognition Nine Standards PPC 1: Access and Communication PPC 2: Patient Tracking and Registry Functions PPC 3: Care Management PPC 4: Patient Self-Management Support PPC 5: Electronic Prescribing PPC 6: Test Tracking PPC 7: Referral Tracking PPC 8: Performance Reporting and Improvement PPC 9: Advanced Electronic Communications *PPC= Physician Practice Connections;PCMH=Patient Centered Medical Home 22 The Chronic Care Model The Chronic Care Model (CCM) is: An integrated framework to guide practice redesign, including: Effective team care and planned interactions Self management support bolstered by more effective use of community resources Integrated decision support Patient registries and other supportive information technology. Coleman, Austin, Brach and Wagner (2009). Chronic Care Model: Evidence on the Chronic Care Model in the new Millennium. Health Affairs 28(1): The IOM Report Indicates Significant implications for Nursing Practice related to HIT The report indicates: Given the nature of patient data collection, nurses will be integral to proper collection of meaningful use data. Shifts in time and place of care have significant implications for nursing suggesting that nursing may be delivered remotely--as EHRs, CPOE systems, lab results, imaging systems, and pharmacies are linked in the exchange networks. HIT will fundamentally change the way nurses plan, deliver, document and review clinical care. HIT will refocus nursing on high touch tasks that these technologies cannot readily or appropriately accomplish HIT will lower cost and improve efficiency, effectiveness and quality of care. Care will be provided in an interoperable digital commons requiring more effective multidisciplinary teams. The Future of Nursing: Leading Change, Advancing Health. IOM, retrieved from the worldwide web, January 1, 2011:

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