Certification and Meaningful Use of Electronic Health Records what. care leaders must know

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1 Certification and Meaningful Use of Electronic Health Records what hospice and home care leaders must know OBJECTIVES Define meaningful use requirements of electronic health records Explain certification of electronic health records and Recovery Act funding Make decisions about electronic medical records and opportunities to achieve meaningful use. 1

2 Health Care IT and EHR This is an exciting time in the adoption and use of electronic health records (EHR) Government initiatives exceed any in the past for encouragement of adoption Meaningful use is being defined for 2011 and into the future with specific goals and adoption schedules to be published Certification i of EHR is growing and will continue to expand with new certifying bodies proposed Health IT Foundation Health IT is a cornerstone of the future of Healthcare Improve Quality & Care Coordination Timely access to patient health information Patient Safety IOM Report ~ Up to 98,000 Americans die each year from medical errors Patient Satisfaction Reduce duplicative paperwork, increase access, education & accountability Improve Billing & Collections 15-minute increments, auto-calculations, time-tracking, etc.. Clinical Research Participate with no workflow disruption with provider & patient revenue Reduce Waste, Fraud & Abuse Estimated $70B-$200B+ annually in fraud; $600B-$850B annually overall 2

3 Stimulus Act Language Certification American Recovery and Reinvestment Act of 2009 (ARRA) passed February 2009 Medicare and Medicaid incentives are for adoption and meaningful use of certified EHR technology Why certified EHR technology? Standards-compliance and interoperability of technology adopted Security and protection of privacy of personal health information Ensure ability to support meaningful use, and ultimately achieve health outcome policy priorities and care goals identified by HHS/ONC Reduce potential for fraud and abuse within the incentive programs HIT Stimulus Funds Overview Over $30B (and up to $45B) of direct adoption incentives for meaningful use of certified EHRs. Specifically, $20B in Medicare incentives and $14B in Medicaid incentives $2B for ONC, NIST & HIE Infrastructure $2.5B for distance learning, telemedicine and broadband program account loan guarantees and grants $1.5B to HRSA for grants for construction, renovation, and equipment for health centers $1.1B 1B to AHRQ for clinical research funding $500M to Social Security Administration Conservative CBO estimates show that ARRA funding will save over $15B in government spending throughout the health sector through improved quality and care coordination, reductions in medical errors and duplicative care. 3

4 Meaningful Use Defined An eligible professional (EP) and an eligible hospital shall be considered a meaningful EHR user for an EHR reporting period for a payment year if they meet the following three requirements: Use certified EHR in a meaningful manner eprescribing/ CPOE Utilize certified EHR technology that is connected in a manner that provides for the electronic exchange of health information to improve the quality of healthcare such as promoting care coordination Submit information on clinical quality measures and other measures in a form and manner specified by the Secretary How this affects hospice and home care Currently no stimulus funds for hospice or home care or many other providers Watch for the final rules defining meaningful use as MU is likely l to become required even without stimulus funding Watch for future criteria for certification of hospice EHR probably in 2013 or later Prepare for use of EHRs and many changes over the coming gyears Expand use of EHRs over time and move toward interoperability with other providers 4

5 Meaningful Use Goals Improve quality, safety, efficiency and reduce health disparities Engage patients and families Improve care coordination Ensure adequate privacy and security protections for personal health information Improve population and public health Meaningful Use Considerations Balance competing considerations of proposing a definition that best ensures reform of healthcare and improved healthcare quality Encourage widespread EHR adoption Avoid imposing excessive or unnecessary burdens on healthcare providers, while simultaneously acknowledging the short time-frame available Promote healthcare & technology innovation Establish more extensive criteria over time stages 1-3 as a beginning 5

6 Meaningful Use WG Stage 2/3 Multiple Work Streams to Consider ONC Ongoing HITPC/ MU WG June 8, 2011 MU Stage 2 CMS Sept./Oct Security/ Privacy Fall 2011 August 3, 2011 Quality Measures Sept./Oct Patient Safety HIE / Interoperability What are all these acronyms Office of National Coordinator for health information technology (ONC): mmunity/healthit_hhs_gov home/1204 The ONC has various advisory committees and there is a health IT policy committee which is a Federal Advisory Committee with several workgroups 6

7 HIT POLICY WORKGROUPS Meaningful Use (MU) Certification/Adoption Information Exchange (HIE) Nationwide Health Information Network (NHIN) Strategic Plan Privacy & Security Policy Enrollment Governance Quality Measures 25 Meaningful Use Stage 1 Objectives for Eligible Professionals CPOE for 80% of all orders D D, D A & D Formulary checks Maintain problem list erx for 75% of permissible scripts Active medication list Active Maintain per Submit claims to Encounter medication condition patient payers medication allergy list lists resolution Record patient demographics Record and chart changes in vitals Record smoking status Capture labs as EHR data Report quality measures to CMS Send patient reminders Launch/track clinical decision support rules Check patient eligibility via payers Provide patient health status on request Provide access to patient records Provide clinical summaries per visit Exchange data among providers Care summaries for referral Data to immunization registries Surveillance data to public agencies Secure data protection 7

8 Medicare & Medicaid Incentives Stage I ~ Electronic capture of health information in a coded format; tracking key clinical conditions and communicating outcomes for care coordinating; implementing clinical decision support tools to facilitate disease and medication management; and reporting outcomes for public health purposes. Stage II ~ Expands on stage I. Encourages the use of health IT to enhance computerized provider order entry; transitions in care; electronic transmission of diagnostic test results; and, research. Currently Stage II requirements are being delayed Introduction to CCHIT Introduction to CCHIT and EHR Certification 8

9 CCHIT in Brief Certification Commission for Health Information Technology (CCHIT) Mission: accelerate the adoption of robust, interoperable health h IT by creating an efficient, credible certification process Status: independent, nonprofit 501(c)3 organization Developed certification criteria and inspection processes under contract with DHHS/ONC, Federally recognized certifying body since 2006 (Stark safe harbor, Medicare EHR demo, State ehealth programs, private sector pay-for-performance programs) CCHIT ORGANIZATION 9

10 Certification of EHRs used in LTPAC Description of the Domain The Advisory Task Force recommended that the Commission adopt Long Term and Post Acute Care (LTPAC) as the term to describe the collection of care settings for which EHR technology certification programs are to be developed. 10

11 LTPAC EHR Technology Certification Recommendations and Priorities Home Care Hospice Other Home & Community Based Care Adult Day Care Assisted Living Nursing Facilities Inpatient Rehab Facility Long Term Care Hospital Other Institutional Providers Private Duty Care Management Certified Home Health Home Hospice Personal Care Skilled Nursing Facility Intermediate Care Facility Allied Health *Rehab *Mental Health *Nutrition *Social Services Home Infusion Inpatient Hospice Mental Health Nursing Facility Mental Retardation/ Developmentally Disabled Facility Home Medical Equipment 2010 Slide 21 April 23, 2010 Future Settings for EHR Certification The following care settings are recommended as possible future areas for LTPAC EHR technology certification: Adult Day Care Assisted Living Facilities and other Personal Care Homes Home Hospice Home Medical Equipment services Independent Retirement Communities Non-Medicare Home Health Care (e.g. private duty) Standalone Inpatient Hospice (if not already licensed as one of the priority settings) 11

12 Attributes for Consideration Advance directives (dropped from HHS rules) Allergies and alerts Capture, query and report compliance with health care quality measures Clinical decision support Family and social History Functional status Medication lists including medication reconciliation during transition of care Provider order management, including medications including administration instructions and non-medication treatments Setting-specific assessments as required for reimbursement (e.g., Minimum Data Set for SNFs/NFs) How to Optimize your EHR Assure you are meeting the requirements as they are finalized Set goals for use of EHR in your organization Remember your EHR must be Meaningfully Used at the point-of-care The EHR is easily customizable & flexible to your workflow But keep in mind too much customization can create benchmarking difficulty 12

13 How to Optimize your EHR Seek a Trusted Advisor & Partner Ensure you partner with a company that is expert in EHR meaningful use, certification & standards Track record of being proactive in the evolution of healthcare EHR Certification, Standards Development & Interoperability Assign a Meaningful Use Leader in your Facility Understand how it effects you How to Optimize your EHR Health IT is a Cornerstone of the Future of Healthcare Improve Quality and Care Coordination Patient Safety Patient Satisfaction Improve Billing and Collections Clinical Research Reduce Waste, Fraud and Abuse 13

14 How to Optimize your EHR Promote Operational Performance through Health Information Improve Quality and Care Coordination Concurrent access to patient health information Concurrent benchmark capacities leading to timely QAPI response Coordination with health providers Promote Patient Safety IOM Reports up to 98,000 Americans die each year from medical errors How to Optimize your EHR Patient Satisfaction Promotes data collection for Patient satisfaction benchmarks Data may become the voice for our industry to demonstrate outcomes Improve Billing and Collections Regulatory changes, 15 minute increments, auto-calculations, etc. Promotes coordination of clinical documents and billing office functions Concurrent financial benchmarks 14

15 How to Optimize your EHR Clinical Research Promotes data collection for clinical research projects related to both clinical i l and financial outcomes. Reduce Waste, Fraud and Abuse Focus on effective efficiencies and through the use of Health IT How to Optimize your EHR Optimizing EHR provides benefits to your Organization Improve operational performance through the use of dashboards and process improvement Promote collaboration of Clinical, Finance and Operations through Benchmarking Strive for and celebrate successful outcomes 15

16 Additional Resources Government & HHS Stimulus Sites Link to CMS Health IT Website EHR Association Statements on Health IT s.asp Presenters and Contact Information Teresa R. Craig, CEO Suncoast Solutions U.S. Highway 19 N Suite 450 Clearwater, FL Phone: tcraig@sncoast.com 16

17 Presenters and Contact Information Christie Franklin, RN, BA, CHCE President/CEO Bristol Hospice, LLC 255 East 400 South, Ste. 200 Salt Lake City, UT Phone: