Electronic Health Records and the ASC. California Ambulatory Surgery Association September 12, 2013

Transcription

1 Electronic Health Records and the ASC California Ambulatory Surgery Association September 12, 2013

2 Office of National Coordinator As both public and private payers take concrete steps to change the incentives for paying providers, health IT can provide the infrastructure and the data analytics necessary to improved care coordination, better quality, and lower costs. ONC Report to Congress June

3 The Landscape - Deloitte 3

4 Session Objectives Definitions, Differences/Similarities and Adoption Models for EMR s and EHR s ASC Functions to Automate with an EHR Interoperability Exchanging Data with External Providers/Entities Considerations in Moving Forward with an EHR 4

5 About AmSurg 243 Centers, 35 States Multi-specialty (56), Gastroenterology (151) and Ophthalmology (36) Divisions Governance and Ownership Information Technology Services 5

6 EMR An electronic medical record (EMR) is a digital version of a paper chart that contains all of a patient s medical history from one location. An EMR is mostly used by providers for diagnosis and treatment. Office of National Coordinator for Health Information Technology Health and Human Services 6

7 EHR All that and more. EHR s focus on the total health of the patient going beyond standard clinical data collected in one location. They are built to share information with other providers. They are designed for use by all individuals involved in the care process including the patient. HealthITBuzz ONC Online Publication 7

8 EHR s in the ASC - Functions Pre-procedure, intra-procedure and postprocedure clinical documentation (anesthesia, nursing and procedure/physician) Able to exchange clinical information with lab, pathology, pharmacies (orders and results) according to standards for data transport and security Able to receive and transmit transitions of care documents according to current standards Allow patients to view, edit and download clinical information contained in the EHR 8

9 EHR s in the ASC No incentives No penalties 50% CEHRT requirement for MU EP s Strategic investments? 9

10 Possible Improved Productivity Effects Of Health Information Technology (IT) On Future National Health Spending, Hillestad R et al. Health Aff 2005;24: by Project HOPE - The People-to-People Health Foundation, Inc.

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12 Possible Improved Productivity Effects Of Health Information Technology (IT) On Future National Health Spending, Hillestad R et al. Health Aff 2005;24: by Project HOPE - The People-to-People Health Foundation, Inc.

13 ARRA and HITECH 2009 Stimulus Bill Game Changer, MU Incentives ($18B) Beyond MU Incentives ($2B) Regional Extension Centers Standards Organizations Security Requirements HIE Infrastructure Workforce Training 13

14 ONC HITECH Framework 14

15 Meaningful Use Current Status Through April 2013, 291,000 EP s had received incentive payments, over 50% of Eligible Providers Over 3,800 Hospitals, representing over 80% of Eligible Hospitals 62 REC s providing services for over 132,000 primary care physicians 15

16 Cumulative Monthly Attestations 16

17 CMS EHR Incentive Progress 17

18 Total Vendor Attestations A total of 521 vendors provided certified solutions. The Top 10 Vendors account for 63% of the total attestations, the Top 20 account for 75%. 18

19 Specialty Attestations Gastroenterology (149) Top 10 59% Orthopedics (163) Top 10 48% Ophthalmology (139) Top 10 53% 19

20 California Attestations 20

21 ASC EMR Adoption Single Practices Of the affiliated practices with EHR implementations, 35 were known to have fully achieved Meaningful Use 21

22 ASC EMR Adoption Multiple Practices Of the affiliated practices with EHR implementations, 24 were known to have fully achieved Meaningful Use in over half of the affiliated practices 22

23 Consideration #1 Understand and discuss affiliated physician practice EHR activity through discovery process. 23

24 WK 2013 Physician Outlook Survey 24

25 Deloitte 2013 Physician Survey 25

28 Barriers to Adoption ONC Report 28

29 Ineligible Providers to EHR Incentives 29

30 Barriers to EMR Adoption? Cost Workflow Disruption Staffing needs to implement Physician Resistance Lack of available products in market 30

31 Consideration #2 Address implementation barriers head on. Establish objectives with performance measures for each objective. 31

32 EHR Adoption Models In 2012, nearly three-quarters of office-based physicians (72%) had adopted any EHR system. Forty percent of physicians have adopted a basic EHR with certain advanced capabilities, more than double the adoption rate in ONC Report to Congress June

33 State EHR Adoption healthit.gov 33

34 Rates of Adoption Hospitals, ASC s and Physician Offices are engaged in various rates of adoption of EHR technology Basic documentation eprescribing MU measures Interfaces to ancillary systems Data exchanges to HIE s How do we measure the rate of adoption? 34

35 ONC Report to Congress 35

36 Stage 0 Stage Description Indicators Paper charts are the only means of storing and accessing clinical information (even if there is an electronic scheduling and billing system) (Q 16, Q 18) Procedure notes and nurses notes are still handwritten and filed within paper chart (Q 16, Q 18) Paper Chart Paper chart based 36

37 Stage 1 Stage Description Indicators Web browser on physician and/or nurse desktops for access to online reference material, lab orders, etc. (Q 15) Procedure notes and/or nurses notes scanned and accessible from multiple computers (Q 16, Q 18) Using computers to access health information Desktop access to clinical information, unstructured data, scanned chart forms, access to lab/pathology orders and results Lab/pathology results scanned and accessible from multiple computers (Q 18) Electronic messaging for informal, unstructured intra-office communication (Q 19) 37

38 Stage 2 Stage Description Indicators Clinical Data Repository, patient information aggregated in one location Beginning of a Clinical Data Repository, accessible via computer workstation, containing history and physical information, perioperative information, procedure documentation, orders, results and treatment plans. Information is aggregated and retrievable by patient identification. Computers have replaced or complimented the paper chart (Q 10, Q 16, Q 18) Consent forms, history and physical, nurses notes, procedure report, orders and results aggregated and available by patient identification (Q 18) Use of web portals to order and retrieve lab/pathology results (Q 15) (encrypted to ensure HIPAA security) is utilized, with attachments, to send/receive information that is stored in the clinical data repository (Q 19) 38

39 Stage 3 Stage Description Indicators Nursing documentation to include pre-operative, post-operative and vitals documentation Electronic nursing documentation at the point of care using structured data; vitals are captured from monitors and entered directly into the medical record; complete electronic patient chart with a combination of electronic nursing documentation and scanned documents. Computers have replaced the paper chart (Q 10, Q 16, Q 18) Vitals are entered manually as discrete data elements from monitors (Q 17) Procedure documentation is available through PDF import or scanned and filed within the chart (Q 18) Utilization of a fax or server to send procedure documentation to external providers (Q 26, Q 27) Secure messaging within the application exists and autogenerated in the form of alerts and tasks (Q 19) Use of reminders for follow-up tasks (Q 20) 39

40 Stage 4 Stage Description Indicators Procedure documentation as discrete data elements, automated orders, vitals documentation integrated with vitals monitors Structured physician procedure documentation (to replace dictation and transcription), captured as discrete data elements at the point of care or immediately after the surgical procedure to facilitate billing, quality reporting and interoperability. Use of computers to document procedure as discrete data elements eliminates the need for procedure dictation and transcription (Q 16) Vitals captured via integration with vitals monitors (Q 17) Order forms generated from computers (medication, lab/pathology) used to fax/scan to providers (Q 22) Results scanned and stored into the computer system, routed to secure inbox, generates task for review (Q 19) Reporting capabilities for quality metrics (Q 23) 40

41 Stage 5 Stage Description Indicators Interoperability, secure messaging Interoperability-enabled workflows built into the system to allow for sending/receiving of unstructured data (lab, pathology, procedure reports) and e-prescribing capabilities. Significant use of tasking and reporting to generate efficiencies, reduce handoffs and enhance clinical quality. Use of CDSS (Clinical Decision Support Tools) during pre-op assessment based on patient history, demographics (Q 24) Ability to generate orders and receive results as discrete data elements (Q 23) Ability to utilize e-prescribing directly to pharmacy provider within the EMR (Q 23) Tasking utilized, routing of results for disposition and signoff (Q 21) Basic clinical alerts, including, but not limited to medication contraindications (Q 24) 41

42 Stage 6 Stage Description Indicators Structured data exchanges in compliance with MU standards, Clinical Decision Support System Evidence-based guidelines incorporated into the electronic medical record, structured clinical data exchange, recall management and follow-up care initiated by functionality provided within the electronic medical record. Use of clinical decision support tools within the EMR for treatment and follow-up activity (Q 23) Ability to utilize third party evidencebased guidelines and/or clinical content to reduce order variation (Q 23) Ability to generate reports for necessary recall and follow-up care activities (Q 23) 42

43 Stage 7 Stage Description Indicators Full HIE capabilities, robust patient engagement capability HIE capable, sharing of data between EMR and community based EHR, advanced business and clinical intelligence, quality measure reporting Summary of Care and Continuity of Care Document (within the HL7 Clinical Document Architecture) produced and exchanged from the EMR to external providers involved in patient care processes (Q 26, Q 27) Advanced analytics and business intelligence tools utilized (Q 25) Ability to provide electronic CCD (Continuity of Care Document) to patients, via secure portal, accompanied by provider messaging capability (Q 23) 43

44 STAGE ZERO Paper Chart STAGE SEVEN Full HIE capabilities, Patient Engagement STAGE ONE Using computers to access health information STAGE SIX Structured data exchanges, utilized of clinical decision support ASC EMR ADOPTION MODEL STAGE TWO Clinical Data Repository STAGE FIVE Interoperability, tasking, reporting to streamline operations STAGE THREE Nursing Documentation STAGE FOUR Procedure Documentation

45 Survey Demographics Total of 165 responses representing 1,575 physicians (average of 9 per response) 99 GI, 41 Multi, 25 Eye 70 single practice centers, 95 multiple practice centers 45

46 ASC EMR Adoption All AmSurg 46

47 ASC EMR Adoption Divisions Gastroenterology Multi Eye 47

48 Consideration #3 Establish adoption milestones with specific performance measures. 48

49 Exchange of Clinical Information Fax Secure Point-to-Point Mail 49

50 EHR s and Interoperability 50

51 Care Coordination Standards 51

52 Transition of Care Standards 52

53 Interoperability MU Stage 2 Consolidated Clinical Document Architecture (C- CDA) Standards for transport secure, encrypted Standards for language SNOMED, LOINC, RxNORM Standards for data elements 53

54 ONC Standards 54

55 Certification and Meaningful Use Certification Vendor certification of ability to send/receive Transitions of Care Meaningful Use MU Stage 2 Summary of Care > 50% Electronically > 10% Different EHR or CMS designated test platform 55

56 Direct Transfer Protocol Direct Project specifies a simple, secure, scalable, standards-based way for participants to send encrypted health information directly to known, trusted recipients over the Internet. Push Technology Secure Human Readable Can Be Incorporated 56

57 CCDA for the ASC Vendor 2014 Certification Plans CCDA Plans Vendor A Inpatient, Ambulatory and ASC Vendor B Ambulatory and ASC Vendor C Ambulatory and ASC Certified 2014 Planned Q Planned Q Vendor D ASC Planned Q Vendor E - ASC Planned Q Transitions of Care Send and Receive (View, Display and Incorporate) Transitions of Care Send and Receive (View, Display and Incorporate) Transitions of Care Send and Receive (View, Display and Incorporate) Transitions of Care Send and Receive (View, Display and Incorporate) Transitions of Care Send and Receive (View, Display and Incorporate) 57

58 Consideration #4 Understand and plan for practice, hospital, HIE and center data exchange plans including CCDA and the Direct Protocol. 58

59 Project Success Factors HIMSS EHR Implementation Success Governance Leadership Communication Testing AHIMA Essential People Skills for EHR Implementation Success Communication Change Management Process Project Management 59

60 Consideration #5 Establish project governance, the project team, ensure appropriate time allocation, develop milestones and celebrate success. 60

61 Summary Common Considerations Understand affiliated physicians Address implementation barriers Establish adoption milestones Plan for data exchange partners Celebrate success 61

62 ONC Report to Congress As both public and private payers take concrete steps to change the incentives for paying providers, health IT can provide the infrastructure and the data analytics necessary to improved care coordination, better quality, and lower costs. ONC Report to Congress June

63 Thanks! Questions and Answers 63