Carolyn P. Hartley, MLA President, CEO Physicians EHR, Inc

Carolyn P. Hartley, MLA President, CEO Physicians EHR, Inc

Health Information Management Professional SME to Regional Extension Centers President, CEO: Physicians EHR, Inc 140+ complex to risky EHR installations Workflow, process redesign, compliance, change management Lead, Co Author 20 books published by AMA, ADA, ASCO, AGA. Editor in Chief, Physicians ehealth Report

1. Patient Portals 2. Clinical quality measures 3. HIPAA Risk Assessment / 2014 risks 4. Computerized Provider Order Entry 5. Clinical Decision Support 6. Clinical Lab Results 7. Medication Reconciliation

Clarity of regulations Programs competing for your attention ICD 10, HIPAA Omnibus, ACA, ACOs, MU Stage 2 Volume of information vs. Areas of focus Emerging technology: what to trust, what not to trust Process of information sharing Slowly emerging consumers

What is required for MU Stage 2? (D2) What does CEHRT have to demonstrate? What must a modular certified patient portal demonstrate? What do physicians want in a portal? What the EHR vendor provides What patients need What RECs can do to help physicians

Objective Measure Exclusion? Patient Ability to Electronically View, Download & Transmit Health Information >50% provided timely online access >5% view, download, or transmit to a 3 rd party Yes Clinical Summaries >50% within one business day Yes Patient Specific Education Resources Use Secure Electronic Messaging >10% all unique patients receive patient specific education resources through logic built into the system. >5% unique patients sent a secure electronic message Yes Yes

ONC requires EHRTs to support Direct protocol for Transition of Care (TOC) and Portal Transmit. Very complex and challenging. ONC Certification does NOT address Patient Consent or Provider Look up Just Secure Transmission. Setting up Direct environment will take time. PROVIDER POINT: Discuss with EHR vendor how is your EHR supporting electronic exchange (HISP, no HISP, etc.) and how does that impact your community (e.g. state HIE)? Source: Kyle Meadors, Drummond Group

The portal piece of 2014 Edition (View, Download, Transmit) is significantly more complex. Patients now have the ability to transmit summary records via Direct. What is not tested is policy and IT setup decisions on how to enable patient to exchanges data with other providers/organizations. PROVIDER POINT: While Direct utilizes email, setup is not nearly as simple as emailing someone in Outlook. PROVIDER POINT: Other portals besides the one packaged with your EHR can be used in MU (e.g. community hospital) but must ensure other portal is certified and not breaking possession rule (see ONC FAQ #21 Question [12 10 021 2]). Source: Kyle Meadors, Drummond Group

Test Procedure for 170.304 (i) Exchange Clinical Information and Patient Summary Record 1) Receive and display in human readable format a patient s summary record from other providers Diagnostic tests results, problem list, medication list, medication allergy list 2) Generate and transmit from the EHR in HL7 CCD or ASTM CCR format (at least) Diagnostic test results, problem list, medication list, medication allergy list.

1) Patient Portal must be ONC HIT certified 2) If EP goes this route, EP is responsible for any set up/configuration. 3) EP also must ensure the EHR vendor will play nice with the 3 rd party portal. 4) EHR may be tightly coupled with their portal, may not be practical to have a 2 nd portal option. EHR Vendors want to keep customers and likely to find a way to leverage new portal in sales. Source: Kyle Meadors, Jim Tate

Will the patient portal offered by my EHR vendor meet clinical needs of my patient population? Yes use the portal No select another portal (specialty) Maybe ask for advice Will my EHR become irrelevant? Data outside the EHR; not important to PT/MD Phone calls, texts, emails, MD to MD, MD to PT

STAGE 1: CORE Minimum 6: maybe 9 or 10 2014 All providers, regardless of stage of CQMs report in the same way: EP: 9 out of 64 EH / CAH: 16 out of 29 PLUS: 3 of 6 key health care domains: Patient & family engagement Patient safety Care Coordination Population & Public Health Efficient Use of Healthcare Resources Clinical Processes

Roll out of 2014 MU CEHRT ICD 10 10/1/2014 End to End Testing ICD 10; Vendor updates Changes to clinical documentation, templates

ICD 9: 3 5 characters ICD 10: Seven characters (x indicates blank) Disease Category Etiology (cause) Anatomic Site Manifestation Extension for More Specificity

How are EHR software companies supporting clinical documentation? Standards (SNOMED, LOINC) More space (alpha numeric) Additional drop down menus Customization issues: Speed texts Templates Clinical decision support How are your clients updating their clinical documentation?

SNOMED embedded in CEHRT 2014. Vendors must demonstrate SNOMED in: Smoking Status Family Health History Cancer Registry Clinical Summary SNOMED & LOINC in: Lab Orders, Results Posting Biggest changes: Obstetrics Cardiology Orthopedics

Natural Language Processing (NLP) M*Modal Nuance Communications (Dragon) Wired Informatics (Invenio ) 3M Precyse

HIPAA Risk Assessments Updated Privacy Risks due to specificity in ICD 10 codes Updated Notice of Privacy Practices, made available effective date. Business Associate Agreements / Amendments Updated risk assessments with updated patient rights

Marketing requirements Refill reminder is an exception Restrict disclosure of PHI to health plan if paid for in full. School immunization records w/o authorization Families of deceased can exercise right to protect identity for 50 years after death. GINA Encrypt data at rest, including mobile devices Possible compensation to patients for breach

STAGE 1 CORE Use CPOE for medication orders directly entered by any licensed HC professional (per state, local and professional guidelines). >30% with at least one medication in list; seen by the EP STAGE 2 CORE Use CPOE for medication, lab and radiology orders directly entered by any licensed HC professional. Increased percentages >60% meds >30% lab orders > 30% radiology orders Denominators change in 2014 If seen more than once in reporting period, PT is counted just once. Diagnostic codes must accompany the lab / imaging order ICD 10; ICD 9 codes

STAGE 1 CORE Implement one clinical decision support rule relevant to specialty or high clinical priority; track compliance with that rule. STAGE 2 CORE Implement 5 clinical decision support interventions related to 4 or more clinical quality measures. Drug drug and drug allergy intervention enabled Attestation: Yes/No

Problem List Medication List Medication Allergy List Demographics Lab tests and values Vital Signs Problem List Medication List Medication Allergy List Demographics Lab tests and values Vital signs

Select and Activate Trigger Identify Problem List Medication list Medication allergy list Demographics Lab tests and values/results Vital signs Electronically trigger interventions Identify a user diagnostic and therapeutic reference Diagnostic and therapeutic reference information Configure EHR brings up patient s record with interventions Review Evidence Based CDS Attributes Bibliographic citation, developer, funding source, release Review attributes of at least one drug drug, drug allergy interaction

STAGE 1 MENU Reconcile medications for >50% patients transitioned into the EP s care STAGE 2 CORE Reconcile medications for >50% patients transitioned into the EP s care. Relevant encounter left relevant if EP determines it to be so. Medications reported by PT AND hospital s ATD (in patient)

Include patient in medication reconciliation Workflow redesign Patient Portal Kiosks: Phreesia connects with RxHub/Surescripts for patients to identify on check in. Also connects patient with eligibility. Currently selected by Allscripts, emds, Greenway, Nextgen

STAGE 1 MENU Incorporate clinical lab test results into CEHRT as structured data. > 40% all clinical lab test results are incorporated into CEHRT as structured data. STAGE 2 CORE Incorporate clinical lab test results into CEHRT as structured data. > 55% of all clinical lab tests ordered are incorporated in CERHT as structured data Hot button: ICD 10 will change this significantly, depending on payer contracts

Critical in specialties dependent on lab results to make clinical decisions Urology Oncology Hematology Nephrology Neurology

Update hardware, software 2014 CEHRT Product Rollout ACA: new pts. ICD 10 testing ICD 10 Training Update interfaces for ICD 10 Jan Feb Mar April May June July Aug Sept Oct Nov Dec 2014 Unknown: Vendor readiness for ICD 10 and updates Significant payment delays

1. Patient Portals 2. Clinical quality measures 3. HIPAA Risk Assessment / 2014 risks 4. Computerized Provider Order Entry 5. Clinical Decision Support 6. Clinical Lab Results 7. Medication Reconciliation

Thanks a bunch! Carolyn Hartley Physicians EHR, Inc Carolyn@physiciansehr.com 919 637 0220 www.physiciansehr.com #PhysiciansEHR