INCORPORATING ELECTRONIC MEDICAL RECORDS IN SBHC s

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1 masbhc MARYLAND ASSEMBLY ON SCHOOL-BASED HEALTH CARE Annual Spring Conference INCORPORATING ELECTRONIC MEDICAL RECORDS IN SBHC s PRESENTED BY: Christine Perkey, RN, CMPE Senior Consultant Consulting and Practice Management Services

RECORDS IN SBHC s PRESENTED BY: Christine Perkey, RN,

2 Maryland s SBHC SBHC s may use outdated and unsupported Electronic Medical Records software such as Clinical Fusion SBHC s may not have or utilize an Electronic Health Records/Practice Management System SBHC s may not fully understand the features and functionality of a viable Electronic Health Records System SBHC s may not understand how to select or transition to a viable an Electronic Health Records/Practice Management System SBHC s may lack the ability to efficiently bill for services due to the lack or the limitations of their current Electronic Health Records/Practice Management System software. 2

Records System SBHC s may not understand how to select or transition to a viable an Electronic Health Records/Practice Management System SBHC s may lack

3 EHR/EMR Electronic Health Record/ Electronic Medical Record SBHC s transition to a EHR/PMS PMS Practice Management System EHR/PMS features necessary for School-Based Health Centers Clearinghouse electronic data interchange 3

Management System EHR/PMS features necessary for

4 Electronic Health Records (EHR) EHR is a digital version of a patient s paper chart, is real-time, patient-centered records that make information available instantly and securely to authorized users. 4

5 Basic EHR Features Record and maintain patient demographic information Encounter documentation: Clinical, social and family history Allergies Patient visit Medication management Orders and results management Immunization management Treatment plans Laboratory and test results Radiology images 5

Patient visit Medication management Orders and results management

6 Basic EHR Features (continued ) Provider/patient schedules Charge and code capture Reporting Automate and manage workflows to improve efficiency Allow access to evidence-based tools that providers can use to make decisions about a patient s care Shared health information with other health care providers and organizations Transcription system Encrypted 6

evidence-based tools that providers can use to make decisions about a patient s care

7 Basic EHR Features (continued ) Direct internet access Referral authorization requests & approvals/denials Electronic payer connectivity Tables / flow sheets Graphics Free-hand drawing Stored images Annotations to images Custom Views Views customizable by user 7

connectivity Tables / flow sheets Graphics Free-hand drawing

8 SBHC Essential EHR Features Patient pre-registration - SBHC enrollment process Well Child/Preventative Exam Templates Sick Visit Templates Growth Charts Ability to import educational information, e.g. VIS sheets & Bright Futures Ability to scan documents, insurance cards, etc. Immunization tracking, inventory and ability to interface with state immunization registry 8

9 SBHC Essential EHR Features (continued) Ability to Electronically share data with: Primary Care Provider (PCP) Patient s Medicaid Managed Care Organizations (MCO s) - as is required by COMAR regulations Laboratories Medical imaging facilities Pharmacies - ability to e-prescribe Specialists and emergency facilities 9

(MCO s) - as is required by COMAR regulations Laboratories Medical imaging

10 SBHC Essential EHR Features (continued) Evidence-based action plans, e.g. Asthma Action Plans Weight-based Dose Calculators School, sports, camp, and immunization forms Consent Management Confidential Documents - Adolescent assessments Patient Portal Bilingual patient reminders and recalls 10

and immunization forms Consent Management Confidential Documents -

11 Certified EHR Ensures that the EHR technology offers the necessary technological capability, functionality, and security to help them achieve meaningful use. Eligible health care providers must use certified EHR technology to qualify for incentive payments. There are more than 500 certified Complete EHRs or EHR Modules 11

Eligible health care providers must use certified EHR technology to qualify for

12 Certified EHR Technology In order to capture and share patient data efficiently, providers need an EHR that stores data in a structured format. Structured data allows patient information to be easily retrieved and transferred, and it allows the provider to use the EHR in ways that can aid patient care. Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have established standards and other criteria for structured data that EHRs must use in order to qualify for this incentive program. 1 To learn which EHR systems and modules are certified for the Medicare and Medicaid EHR Incentive Programs, visit the Certified Health IT Product List (CHPL) on the ONC website: Certified EHR Technology, Centers for Medicare and Medicaid Services, Guidance/Legislation/EHRIncentivePrograms/Certification.html (October 17, 2013) 12

Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have established standards and other criteria for structured data

13 Meaningful Use Use of EHRs in a way that positively affect patient care. 13

14 Meaningful Use Meaningful use refers to the use of certified EHR technologies by health care providers in ways that measurably improve health care quality and efficiency. The ultimate goal is to bring about health care that is: Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of patient health information 14

The ultimate goal is to bring about health care that is: Improve quality, safety, efficiency, and reduce

15 EHR Sample Screen Shots 15

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17 Patient Identifiers Document Name 17

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21 Patient Name and ID 21

22 Practice Management System (PMS) Is software used to organize a practice s administrative functions Perform billing functions Reporting 22

23 Interfaced PMS and EHR Two Different Software Applications with an Interface to Exchange Data PMS EHR EHR/PMS Fully Integrated EHR and PMS Single Software Application 23

24 PMS Features Stores and maintains patient demographic data Permits pre-registration of patient data SBHC enrollment process Appointment scheduling Insurance eligibility and benefit verification Patient financial responsibility determination Maintenance and storage of insurance files and data Maintenance of CPT and ICD codes 24

25 PMS Features (continued) Billing Functions: Charge capture and reconciliation Electronic and paper claims processing Accounts receivable management Electronic and paper patient statements Administrative reports 25

26 Clearinghouse 26

27 Clearinghouse electronically transmits data back to the PMS PMS Data electronically sent to Clearinghouse Payers electronically transmit data back to the Clearinghouse Clearinghouse sends data electronically to the payers 27

28 Clearinghouse Functions Electronic Claims: Processes and transmits electronic claims to payers Electronic Eligibility Verification: Verify insurance eligibility and provide benefit information Electronic Remittance Advise (ERA): Ability send electronic remits from a payer to the PM system Claim Status Reports: Ability to check the status of claims Rejection Analysis: Have error codes displayed in plain English Online Access: Edit and correct claims 24/7 online Print Paper Claims: When necessary Electronic Patient Statements: Affordability - When you take into consideration the cost of purchasing forms, printing, envelopes, and postage; a clearinghouse ends up costing about the same as processing paper statements, except you have many added benefits. 28

29 Electronic Eligibility Verification 29

30 Questions to Ask a EHR/PMS Vendor 1. How long has your company been a CCHIT certified EHR vender? 2. Is your system a fully integrated EHR and PMS system? 3. Is your system utilized in any SBHC s? Do you have any local references? 4. How is the product licensed and what does that license provide? 5. Is your product sold as a complete package or can modules be purchased separately? 6. Is your system operated on the cloud or server? 30

31 Questions to Ask a EHR/PMS Vendor (continued) 7. Can your product interface with: a) My current EHR/PMS? b) The state immunization registry? c) Labs, e-prescribing or imaging systems? Do these interfaces currently exist? If not what is the cost to create an interface? 8. Can more than one person work in the same chart? 9. What is included in the price? Software Hardware Training Technical Support Maintenance Upgrades Implementation Off-site back-up Licenses 31

32 What You Can Do NOW Create a Work Plan: Create categories Assign tasks Put the plan into action Work as a team Meet regularly to monitor progress Modify and update the work-plan as it evolves 32

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34 The Importance of Documentation The basic principles for documentation of services provided are: If it is not documented, it did not happen. If it cannot be understood, it did not happen. If it cannot be read, it did not happen. If it did not happen, it should not have been paid. If it was paid, the money should be paid back. 34

35 Questions and Answers 35

36 Resources AMA information and guidelines for EHR and PMS s: EHR certification information: 36

37 Christine Perkey, RN, CMPE Senior Consultant Consulting and Practice Management Services Member of National and Maryland MGMA Montgomery County SBHC Billing Pilot Program EHR and PMS system evaluation, implementation assistance and for medical practices, health departments and community-based clinics. Create, implement and streamline work flow processes for clinics and medical practices Project Director for the CDC/DHMH Immunization Billing Project for the Maryland Local Health Departments. Train staff and assist in creating operational and clinical policies and procedures. Create and present webinars for DHMH, the Texas Sustainability and Capacity Building Network and University of Maryland and private practices and clinics on practice and clinic operations, medical billing, coding, documentation, electronic medical records and practice management systems. Assist medical practices and clinics transition from paper charts to electronic medical records. Provide advice, support and training to providers and staff on medical billing issues and third party reimbursement. 37

Practice Management & Electronic Health Record Systems: School-Based Health Center Requirements & Configuration Considerations.

Practice Management & Electronic Health Record Systems: School-Based Health Center Requirements & Configuration Considerations May 23, 2012 Introduction In today s rapidly changing health care environment,