Southern Nevada Medical Industry Coalition

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William Holt
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1 Southern Nevada Medical Industry Coalition EHR Workshop Definitions, Certifications, Mandates Presented by Bill Carns, CMPE, CHBME

2 Who is Bill? President of PracticeMax Founder of ASPenLink Board Member of HBMA Chairman of the Technology Committee Board Member of MVFP Board Member of StatClinix

3 Definitions

4 Definitions PHR (Patient/Personal Health Record) Created, owned, and maintained by individual patients, families, and other providers. Considered part of the legal health record, if so defined by the organization and if used to: Provide patient care Review patient data Document observations, actions, or instructions (including tracking records) Variety of forms and formats (no single sponsorship model has emerged) Shared data record EHR extensions Provider-sponsored Communication vehicles between patient and provider reminders for immunizations or flu shots, appointment scheduling, Rx refills, monitoring tools for disease management, and collection of patient data Common data elements include Demographics, general medical information, allergies & drug sensitivities, conditions, hospitalizations, surgeries, medications, immunizations, tests

tracking records) Variety of forms and formats (no single sponsorship model has emerged) Shared data record EHR extensions Provider-sponsored Communication vehicles between patient and provider

5 Definitions (cont d)

6 Definitions (cont d) Medical Record, Health Record, or Chart Roles Support caregiver decisions Support revenue sought from third-party payers Document history and care Systematic documentation of a patient s medical history Health status (sickness and wellness) Observations Measurements Services provided/received Response to treatment and prognosis Formats Paper-based Hybrid (combination of paper and electronic) Full electronic or digital state

history Health status (sickness and wellness) Observations Measurements Services provided/received Response to

7 Definitions (cont d) EMR A medical record in digital format Implies full electronic or digital state Some experts say EMR is a discrete local record

8 Definitions (cont d) EMR A medical record in digital format Implies full electronic or digital state Some experts say EMR is a discrete local record EHR In general usage EMR & EHR are synonymous Some experts say EHR is a global concept that spans ALL records of doctor offices, labs, treatment facilities, insurance companies and any other part of our healthcare system

are synonymous Some experts say EHR is a global concept that spans ALL records of doctor

9 Definitions (cont d) Interoperability Ability of different HIT systems/applications to Communicate Exchange data accurately, effectively, consistently Use the information exchanged

10 Definitions (cont d) Interoperability Ability of different HIT systems/applications to Communicate Exchange data accurately, effectively, consistently Use the information exchanged

11 Definitions (cont d)

12 Definitions (cont d) Regional Health Information Orgs (RHIOs) A coalition that unites healthcare stakeholders, in a defined geographic area, and governs the health information exchange [HIE] according to nationally recognized standards Types Centralized (Data repository) Federated (Record Locator Service) Hybrid

health information exchange [HIE] according to nationally recognized standards

13 Definitions (cont d) Healthcare Data Warehouses a large-scale central database loaded with information from multiple operating databases, for easy end-user access consolidates inaccessible, disparate data for transformation into usable information

operating databases, for easy end-user access consolidates

14 Definitions (cont d) Healthcare Data Warehouses a large-scale central database loaded with information from multiple operating databases, for easy end-user access consolidates inaccessible, disparate data for transformation into usable information Portal Point of access for information from diverse sources, in a unified way

access consolidates inaccessible, disparate data for transformation into usable

15 Definitions (cont d) Health Level Seven (HL7) All-volunteer, not-for-profit organization Involved in development of international healthcare standards Framework for exchange, integration, sharing and retrieval of electronic health information

international healthcare standards Framework for exchange,

16 Definitions (cont d)

17 Definitions (cont d) Health Insurance Portability and Accountability Act (HIPAA) 1996 Title I Protects insurance coverage for workers and families when they change or lose jobs Title II Applies to Covered Entities Created programs to control fraud and abuse Created Administrative Simplification rules Privacy Rule (initially effective / ) Transactions and Code Sets Rule (compliance ) Security Rule (compliance due / ) Unique Indentifiers Rule (NPI due / ) Enforcement Rule (effective )

Administrative Simplification rules Privacy Rule (initially effective 4-14-2003 / 4-14-2004) Transactions and Code Sets Rule (compliance

18 Definitions (cont d) HIT Transparency (Federal programs) Executive order signed Aug 06 Price and quality transparency Interoperability standards apply to all EHR systems after Jan 07 51% of FEHB plans (90% of enrollees) have some type of PHR 18% are member populated 14% are claims populated 13% are EHR/EMR populated 6 % are view only <5% of plan members have accessed their PHR (as of Sept 07)

plans (90% of enrollees) have some type of PHR 18% are member populated 14% are claims populated

19 Definitions (cont d) HRA (Health Risk Appraisal) a computer-based health-promotion tool, consisting of a questionnaire, a formula for estimating health risks (e.g., premature death), an advice database, and a means to generate reports a guide in promoting health & treating illness used in worksite wellness programs, communitybased health programs, and health care settings

20 CCHIT Certification

21 CCHIT Certification What is the Certification Commission for Healthcare Information Technology (CCHIT)? private, non-profit organization certifies EHRs against requirements Functionality Interoperability Security Ambulatory EHRs certified Roughly 100 EHRs using 2006 criteria Roughly 46 EHRs using 2007 criteria 10 EHRs using 2008 criteria Total certified equal roughly 35% of EHRs 90 public or private initiatives = $800m New 09 HIE certification

22 CCHIT Certification (cont d)

23 CCHIT Certification (cont d) Every criterion must be met to achieve certification 116 criteria in criteria in criteria in 2008 (changes focused on ability to exchange patient information with other systems, notably a patient summary)

24 CCHIT Certification (cont d) Every criterion must be met to achieve certification 116 criteria in criteria in criteria in 2008 (changes focused on ability to exchange patient information with other systems, notably a patient summary) Excluded criterion Ease-of-use Financial viability of EHR software vendor Quality of customer support offered by the vendor Requirements of medical specialties (excluding cardiology and pediatrics in 2008)

25 Governmental Mandates

26 Governmental Mandates e-prescribing bonus on Medicare pmts 2.0% bonus in 2009 & 2010 ($3-4k ave) 1.0% bonus in 2011 & % bonus in 2013

27 Governmental Mandates e-prescribing bonus on Medicare pmts 2.0% bonus in 2009 & 2010 ($3-4k ave) 1.0% bonus in 2011 & % bonus in 2013 non- e-prescribing penalty 1.0% penalty in % penalty in % penalty thereafter

28 Governmental Mandates

29 Governmental Mandates President Bush, in April of 2004, issued an executive order mandating computerized health records by Congress then passed HIPAA, which gives the President s edict the legal support of Federal law.

30 Governmental Mandates President Bush, in April of 2004, issued an executive order mandating computerized health records by Congress then passed HIPAA, which gives the President s edict the legal support of Federal law. Adoption holds great potential for transforming healthcare Ensures citizens have access to high quality, safe and efficient healthcare at every point of service. Enables clinical information and medical knowledge information availability as care decisions are made. Decreases healthcare costs for citizens, employers, payers and the states.

31 Governmental Mandates (cont d) Representative Jon Porter of Nevada announced on that he plans to introduce legislation to mandate the creation of an EHR for every person covered by the Federal Employees Health Benefits (FEHB) Program. Porter heads the House Government Reform Committee s Federal Workforce and Agency Organization Subcommittee. FEHB covers about 4 million current and retired federal employees. The bill would phase in the EHR requirement, beginning with records of claims paid by participating insurance companies. Other components, such as the PHR and a provider-based record, would be phased in accordingly.

32 Contact Information Bill Carns, CPME, CHBME

Federal Employees Health Benefits Program Report on Health Information Technology (HIT) and Transparency. September 2007

Federal Employees Health Benefits Program Report on Health Information Technology (HIT) and Transparency Executive Summary September 2007 This report is based on information collected from health participating