How To Improve Health Care Through A Health Care System

Transcription

1 Health Information Technology in the Real World By C. Kerry Stratford, MD

2 Goals for a satisfying practice Do what we are trained to do without distracting hassles Have some independence and freedom in decision-making Have enjoyable relationships with our patients and colleagues Be regarded as competent and caring clinicians Be compensated fairly for our efforts Have the means necessary to accomplish the above

3 Tools for clinical practice Stethoscope, BP cuff, scale, etc. Recording/retrieving mechanism/system: pen/paper, dictation, keyboard, medical assistant Communication methods: Telephone, letters, internet Practice management system for billing/insurance, etc. Trained employees Resources for learning and reference: books, journals, lectures, seminars, consultants

4 Physician have various levels of utilization and adoption My Remarks try to address those With no IT and just starting, to those with Complete or Full integration Ideas on how to get the most benefit from current opportunities HealthInsight Video excerpt from National TEPR show 2005 in SLC

5 HealthInsight Video

6 Workflow Redesign is Critical New tools to do familiar tasks more efficiently New training (i.e., Medical Assistant documentation) New communication methods (i.e., Internet, etc.) Analyze and Review and Improve Quality and Performance

7 Hardware Computer, Tablet PC, Smartphone, IPad, etc. Patient interaction Simplest form, replace pen and paper Network/Server Wireless Internet connection IT specialist

8 Software Notetaking/drawing/photos Journal/Microsoft OneNote EMR lite vs Full-featured, certified EHR Fast, not get in the way, easily customizable and usable Ability to retrieve, reconcile, analyze and report Registries, structured data, report generators Interoperability, CCD, certification (CCHIT) Collaborate with Colleagues and Patients (Facebook) PM: Integrated vs Interfaced Notepad vs Microsoft Word vs Microsoft Exchange/Sharepoint

9 Interfaces: Ic 3 Improving Care through Connectivity and Collaboration Internet Browser Patient Handouts AAFP Mayo Clinic Decision-making emedicine Up to Date MD Consult/MerckMedicus Labs/Imaging Clinical records Pharmacies Public Health/Immunizations Patient Portal chie

10 Incentives More Satisfying Practice Healthcare and Payment reform Even before Obama, Secretary Leavitt about Value and Quality Measures: If you don t, the MBA s will MCMP/PQRI Meaningful Use

11 Meaningful use: The Good, the Bad and the Ugly? What are the Incentives? (The Good!) Medicare: Up to $44,000 per provider, over five years or Medicaid: Up to $63,750 per provider, over six years Penalties after 2015 (the Bad!)

12 How to Earn Incentives? To be eligible for the incentives providers must: 1. Use a certified EHR in a meaningful manner; (i.e., electronic prescribing, etc.) 2. Exchange health information to improve the quality of care (through a health information exchange, like the chie); and 3. Report on quality measures.

13 What is a certified EHR? Certification Programs: CCHIT vs ONC-ATCB The CCHIT Certified 2011 certification programs include a rigorous inspection of integrated EHR functionality, interoperability, and security according to criteria independently developed by the CCHIT's broadly representative, expert work groups using CCHIT's published testing methods. Ambulatory EHR Inpatient EHR Emergency Department EHR Behavioral Health EHR Long Term and Post Acute Care EHR eprescribing

14 What is a certified EHR? Certification Programs: CCHIT vs ONC-ATCB The ONC-ATCB 2011/2012 certification program tests and certifies that Complete EHRs meet all of the 2011/2012 criteria of the criteria approved by the Secretary of Health and Human Services (HHS)

15 CCHIT 2011 Certified in Ambulatory EHR (as of 10/2/2010, some pre-market) ABELMed EHR-EMR/PM 11 Allscripts Professional EHR 9.1 Aprima 2011 Benchmark Systems Benchmark Clinical 2.0 BizMatics Inc PrognoCIS Version 2.0 Compulink Advantage/EHR 10 CureMD EHR Version 10 E-Health Partners, Inc. EHRez 3.5 eclinicalworks Eclipsys Corporation Sunrise Ambulatory Care 2011 Suite 5.5 Epic Systems Corporation EpicCare Ambulatory - Core EMR Summer 2009 Epic Systems Corporation EpicCare Ambulatory - Core EMR Spring 2008

16 CCHIT 2011 Certified in Ambulatory EHR (as of 10/2/2010) cont. GE Healthcare Centricity Practice Solution 9.5 GE Healthcare Centricity Advance 10.1 Glenwood Systems LLC GlaceEMR 4.5 Greenway Medical Technologies, Inc. PrimeSuite 2011 IGI Health, Inc Orbit EMR 7.0 Ingenix CareTracker 7 Integritas, Inc. Agility EHR 10 Intuitive Medical Software UroChartEHR 4.0 IO Practiceware 7.0 KeyMedical Software, Inc. KeyChart ManagementPlus 5 MCS - Medical Communication Systems, Inc. ipatientcare 10.8 MedEvolve LLC MedEvolve EHR 4.0

17 CCHIT 2011 Certified in Ambulatory EHR (as of 10/2/2010) cont. Medical Informatics Engineering WebChart EHR Version 5.1 Medicat, LLC Medicat meridianemr Version 4.2 NeoDeck Software NeoMed EHR 3.0 NexTech Practice NextGen Ambulatory EHR 5.6 Nortec EHR 7.0 Pulse Systems 2011 Pulse Complete EHR 2011 Streamline EHR 10.8 SuccessEHS 5.3 The DocPatientNetwork.com Doctations 2.0 Universal EMR Solutions Physician's Solution 5.0

18 ONC-ATCB 2011/2012 Certified (as of 10/2/2010) ABELMed EHR - EMR / PM 11 Allscripts Professional EHR 9.2 Aprima 2011 athenaclinicals CureMD EHR 10 The DocPatientNetwork.com Doctations 2.0 eclinicalworks Ambulatory - Core EMR Spring 2008 GE Healthcare Centricity Advance 10.1 gloemr 6.0 Intuitive Medical Software UroChart EHR 4.0 MCS - Medical Communication Systems, Inc. ipatientcare 10.8

19 ONC-ATCB 2011/2012 Certified (as of 10/2/2010) Medical Informatics Engineering WebChart EHR 5.1 Meditab Software, Inc. IMS v NeoDeck Software NeoMed EHR 3.0 NextGen Ambulatory EHR 5.6 Nortec EHR 7.0 Pulse Systems 2011 Pulse Complete EHR 2011 Success EHS 6.0 PARADIGM (QRS Inc.) ifa EMR (ifa united i-tech Inc.) ChartLogic EMR (ChartLogic, Inc.)

20 Final Rule: Beauty or the Beast? (the Ugly?) Stage 1 (2011 and 2012) Must meet coreset, but can defer 5 from optional menu set To meet certain objectives/measures, 80% of patients must have records in the certified EHR technology EPs have to report on 20 of 25 MU objectives

21 Meaningful Use: Core Set Objectives EPs 15 Core Objectives (all req.) Computerized physician order entry (CPOE) E-Prescribing (erx) Report ambulatory clinical quality measures to CMS/States Implement one clinical decision support rule Provide patients with an electronic copy of their health information, upon request Provide clinical summaries for patients for each office visit Drug-drug and drug-allergy interaction checks Record demographics

22 Meaningful Use: Core Set Objectives EPs 15 Core Objectives cont. Maintain an up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 years or older Capability to exchange key clinical information among providers of care and patient-authorized entities electronically Protect electronic health information

23 Menu Set Objectives*-10 Menu Objectives (pick 5/10) Eligible ProfessionalsDrug-formulary checks Incorporate clinical lab test results as structured data Generate lists of patients by specific conditions Send reminders to patients per patient preference for preventive/follow up care Provide patients with timely electronic access to their health information Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate Medication reconciliation Summary of care record for each transition of care/referrals Capability to submit electronic data to immunization registries/systems* Capability to provide electronic syndromic surveillance data to public health agencies* *At least 1 public health objective must be selected

24 CQM: Eligible Professionals Core, Alternate Core, and Additional CQM EPs must report on 3 required core CQM, and if the denominator of 1 or more of the required core measures is 0, then EPs are required to report results for up to 3 alternate core measures EPs also must select 3 additional CQM from a set of 38 CQM (other than the core/alternate core measures) In sum, EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures

25 Clinical Quality Measures CQM: Core Set for EPs Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention Adult Weight Screening and Follow-up CQM: Alternate Core Set for EPs Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older Childhood Immunization Status

26 CQM: Additional Set for EP (pick 3) Diabetes: Hemoglobin A1c Poor Control Diabetes: Low Density Lipoprotein (LDL) Management and Control Diabetes: Blood Pressure Management Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) Pneumonia Vaccination Status for Older Adults Breast Cancer Screening Colorectal Cancer Screening Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD

27 CQM: Additional Set for EP cont. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)effective Continuation Phase Treatment Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Asthma Pharmacologic Therapy Asthma Assessment Appropriate Testing for Children with Pharyngitis Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

28 CQM: Additional Set for EP cont. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies Diabetes: Eye Exam Diabetes: Urine Screening Diabetes: Foot Exam Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation

29 CQM: Additional Set for EP cont. Ischemic Vascular Disease (IVD): Blood Pressure Management Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) Prenatal Care: Anti-D Immune Globulin Controlling High Blood Pressure Cervical Cancer Screening Chlamydia Screening for Women Use of Appropriate Medications for Asthma Low Back Pain: Use of Imaging Studies Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control Diabetes: Hemoglobin A1c Control (<8.0%)

30 Resources HealthInsight s Regional Extension Center: Services to be Available Initial readiness assessment: Clinic needs and goals Workflow analysis: Map out and improve current work processes Pinpoint areas to be simplified and streamlined with EHR Assess current EHR system and usage gaps Tailored selection tools: Help narrow vendor choices and facilitate clinic directed vendor demonstrations Vendor check sheets: Help practice assess whether their current vendor is on track to support meaningful use

31 HealthInsight s Regional Extension Center Services cont. Referrals to visit mentor clinics: Site visits to evaluate clinics that have thoroughly implemented EHR systems Contract negotiation tools: Tailored support of contracting needs Project management and implementation: Planning resources Plan development: Address deficiencies and reach meaningful use requirements Privacy and security best practice: Policy and procedures templates Health information exchange: Connection assistance

32 Beacon Community- Salt Lake-Toole Area chie connection: Financial assistance available for a limited time to support connection to the state clinical health information exchange (chie) Meaningful Use Support: Priority assistance from the Regional Extension Center in achieving meaningful use requirements for federal incentives Care Process Redesign: Analysis of and support in improving current processes for managing the care of patients and other chronic illnesses Diabetes Care Coordination: Improved communication between providers

33 Beacon Community- Salt Lake-Toole Area cont. Community-wide Collaboration: Learning and networking opportunities that support clinical process improvement, improve health information flow, and encourage community-wide adoption of best practices Tools and Resources: Access to electronic decision support tools, as well as patient education and selfmanagement resources Quality Data Feedback and Benchmarks: Access to clinical quality improvement data and benchmarks on diabetes measures Beyond Diabetes: Improved connectivity to public health systems Rest of the State will benefit

34 Clinical Health Information Exchange (chie) UHIN website declared Benefits: Access to Clinical Information from Multiple Sources Get information from hospitals, reference labs, the Utah Department of Health, and other clinicians. Electronic Delivery of Reports Order and receive labs and reports electronically from a single system. Access to E-Lite, a baseline EMR at no additional charge If your organization has limited resources for an EMR or only needs a baseline tool, this may solve your needs. Call UHIN for details. Single interface Only one connection needed for multiple resources.

35 Clinical Health Information Exchange (chie) cont. Virtual Health Record: Consolidation of all current medical summary information in one place Via Continuity of Care Document (CCD) Current problem list Current medication list and record of prescribing Current immunization records Current Allergies Recent Labs and Imaging results Recent Clinical notes Hospital H&P, Discharge, Consult notes Office Progress and Consult notes

36 Clinical Health Information Exchange (chie) cont. Real-time query capability for additional information Potential for Bidirectional Integration with your EMR (via CCD) Reconciliation Registry and Quality Reporting Potential for Patient interaction with Personal Health Records (via CCD/CCR)

37 Health IT Blessing or Curse? Rate of information change: You Ain t Seen Nothing Yet. Last year, despite the global recession, the Digital Universe set a record. It grew by 62% to nearly 800,000 petabytes. A petabyte is a million gigabytes. Picture a stack of DVDs reaching from the earth to the moon and back. This year, the Digital Universe will grow almost as fast to 1.2 million petabytes, or 1.2 zettabytes. (There s a word we haven t had to use until now.) This explosive growth means that by 2020, our Digital Universe will be 44 TIMES AS BIG as it was in 2009 (Figure 1). Our stack of DVDs would now reach halfway to Mars.

38 The answer depends on your attitude. I am Happier because I have the information I need when I need it, anytime and anywhere (no more flying blind in decision making and can stay current) I am a better physician and my patients are getting better care I have less busywork, see more patients, get out of the office quicker, and have more time for my patients with small talk or teaching, etc. I am benefiting financially even before payment reform and meaningful use incentives

39 Types of Physicians Those that watch things happen, Those that make things happen, Those that wonder what happened, Add Those that think they already know what is happening, are doing ok and don t need to change, or have time to adapt

40 There is a Learning Curve but as Futurist Eric Hoffer said: In a time of drastic change it is the learners who inherit the future. The learned usually find themselves equipped to live in a world that no longer exists. Lets not be physicians that wake up and find they live in world that no longer exists and wonder what happened Know and Use the available resources!