Post on 29-Nov-2014
description
Employing the Phases of Electronic
Health Records (EHR)
The Journey from Paper to EHR
Introductions
Val
Migliore,
MBA
Karin
Eichler,
RN
Erik
Riffel,
Exec
Kent
Crosier,
VP
• Unity Health
System
• Regional Extension
Center / MCMS
•Xerox Corporation
• Certified Black
Belt, Lean Six
Sigma
• MGMA Member
• Genesee Valley
OB/GYN, PC:
• Regional Extension
Center / MCMS
•Genesee Hospital
• MGMA Member
• Tri-Delta Resources
• Virtual CIO
• NYeC approved IT
Vendor
• MGMA Member
• Tri-Delta Resources
• MediTech Disaster
Recovery
• NYeC approved IT
Vendor
• MGMA Member
Introductions
Introduce
Yourself• Your Name
• Practice Name
• Practice Specialty
• Your Role
• Expectation
Kent
Crosier
Goals & Objectives
1. Introductions
2. Benefits – What’s In it for Me?
3. What’s the Hold Up?
4. What EHR Is and Is Not
5. Understanding What it Takes
6. Planning
7. Achieving Meaningful Use
8. CMS Incentives
Where are you with EHR Currently?
1No PMSNo EHR
2 PMS Only
3 Implemented
EHR – not certified yet
Audience
Assessment
Rate your practice:
4 Implemented
EHR – certified
5 Fully
Implemented EHR
Achieved MU
MU
Incentive $
Patient
Quality
Productivity
and
Performance
Benefits
What’s the Hold Up?
What’s the Hold Up?
Common EHR Myths
What it is not
You will no longer need to store records.
You will be able to eliminate staff.
Broken processes will be fixed by an EHR.
You will no longer need to reconcile
charts.
You will never search for paper
charts again.
Loose reports will no longer be
a problem.
Reasonable Expectations of an EHR
What it is
Guaranteed1 Possible1 Debatable1
• Legibility of notes
• Accessibility of charts
• No more lost patient
records - EMR
• Multiple users access
to charts
• Disaster Recovery
• E-Prescribing
• Drug-to-drug & allergy
interactions
• Remote chart access
• EHR Stimulus $
• Transcription
cost savings
• Space savings
• Paper savings
• Automated lab &
XRAY results
• Clinical Decision
Support
• Improved patient
communications
• Increased
efficiency
• Quality of care
• Improved
workflow
• Improved coding
accuracy &
charge capture
• Better patient
services
• Time savings
1 “Selecting the Right EMR” e-Book by John Lynn @ http://www.emrandhipaa.com/emr-selection-book/
Understanding What it Takes:
Building a House
Achieve Meaningful Use
Assess SelectPlanImplement
Optimize
Assess
• Buy-In
• Assess readiness
• Identify benefits
• Set goals
• Determine migration path
• Develop budget & business case forEHR & IT
• Current network assessment
Plan
• Identify physician champion
• Establish teams
• Workflow assessment
• Identify opportunities for improvement.
• Establish measurements
• Establish chart conversion strategy
• IT Infrastructure
• Connection to RHIO, Labs, HIE
• Develop project plans & timelines
• Communication Plan
Select
• Understand requirements for practice’s workflow
• Specify desired functions
• Review the field of EHR / IT vendors
• Perform due diligence (to narrow field)
• RFP
• Demo & site visits, reference checks
• Contract negotiations, pricing, terms legal review, financing
Implement & Optimize
• Implement rollout strategy
• Document new workflows and processes
• Implement chart & data conversions
• Manage installation of hardware & IT infrastructure
• TRAIN TRAIN TRAIN
• Rehearse GO-LIVE
• COMMUNICATE COMMUNICATE!!!
Framework…
Practice
EHR VendorIT
It Takes a Village…..
RHIO’s
Labs
HIE’s
Medical
Society
AMA
MGMA
Your Peers
Universities
Colleges
REC’s
NYeC
CMS
HIMSS
SME’s
Consultants
Critical Success Factors
From Zero to Meaningful Use and Beyond!
The HIT Extension Center Experience
Paul Kleeberg, MD FAAFP, FHIMSS
Clinical Director, REACH
HIMSS11 Orlando, Florida
February 21st, 2011,
Critical Success Factors
Critical Success Factors
By Shahid N. Shah
The Healthcare IT Guy
www.netspective.com
From Zero to Meaningful Use and Beyond!
The HIT Extension Center Experience
Paul Kleeberg, MD FAAFP, FHIMSS
Clinical Director, REACH
HIMSS11 Orlando, Florida
February 21st, 2011,
Critical Success Factors
MEANINGFUL USE
HHS
Vision
• Reforming the health care system
• Improving health care quality
• Improving health care efficiency
• Improving patient safety
Path
Defined
• Certification Criteria Determined
• CMS Publishes Final Rule July 2010
• Incentive Programs Established
MU Prep Checklist for Stage 1 (Medicare)
1. Register CMS
2. Certified EHR
3. Implement 15 Core
Objectives
4. Implement 5 of the 10 Menu Set Objectives
5. Declare 90 Day Reporting
Period6. Attestation
Medicare vs. Medicaid
Meaningful Use Criteria: Core
MU Objective MU Measure* Reporting Method Exclusion?
Core Set Objectives for EPs: Must Meet All 15 Measures
C1 Use CPOE for medication orders CPOE is used for more than 30 percent of unique patients EHR TabulatesAny EP who writes fewer than 100 prescriptions during the EHR reporting period.
C2Implement drug-drug and drug-allergy interactions checks The EP has enabled this functionality in EHR Attestation None
C3Maintain an up-to-date problem list of current and active diagnoses
More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have at least one entry or an indication that no problems are known for the patient recorded as structured data. EHR Tabulates None
C4Generate and transmit permissible prescriptions electronically (eRx)
More than 40 percent (adjusted or unadjusted for patient preference) of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology EHR Tabulates
Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
C5 Maintain active medication list
More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data EHR Tabulates None
C6 Maintain active medication allergy list.
More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data EHR Tabulates None
C7Record demographics: Preferred language, gender, race, ethnicity, and date of birth
For more than 50% of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data EHR Tabulates None
C8Record and chart changes in vital signs: Height, Weight, BP, BMI and growth charts for ages 2-20
For more than 50% of all unique patients age 2 and over seen by the EP or admitted to eligible hospital, height, weight and blood pressure are recorded as structured data
Count of Patients in EHR
Any EP who either see no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice.
Meaningful Use Criteria: Core
C9Record smoking status for patients 13 years old or older
More than 50 percent of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospital have smoking status recorded
Count of Patients in EHR Any EP who sees no patients 13 years or older.
C10Report ambulatory clinical quality measures to CMS or in the case of Medicaid to the States
Core CQMs - EPs must report on 3 required core CQMs, 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 also select 3 additional CQMs from a set of 38 CQMs (excluding the core/alternate core measures). It is acceptable to have a '0' denominator provided the EP does not have an applicable population. EHR Tabulates None
C11
Implement 1 clinical decision support rule relevent to specialty or high clinical priority along with the ability to track compliance to that rule
Implement one clinical decision support rule related to efficiency or a clinical quality measure relevant to the EP or eligible hospital Attestation None
C12
Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request
More than 50 percent of all patients who request an electronic copy of their health information are provided it within 3 business days EHR Tabulates
Any EP that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period.
C13Provide clinical summaries for patients for each office visit.
Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days
Count of Patients in EHR
Any EP who has no office visits during the EHR reporting period.
C14
Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically
Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information. Attestation None
C15
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities
Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary Attestation None
Meaningful Use Criteria: Menu
Menu Set Objectives for EPs: Must Choose and Meet 5 of the 10 from the Menu, one of the five must be related to improving public health *p
M1 Implement drug-formulary checks AttestationAny EP who writes fewer than 100 prescriptions during the EHR reporting period.
M2Incorporate clinical lab-test results into EHR as structured data
More than 40% of all clinical lab testsresults ordered by the EP or by anauthorized provider fo whose resultsare in a positive/negative or numericalformat are incorporated in certified EHRtechnology
Count of Patients in EHR
An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period.
M3
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, or outreach
Generate at least one report listing patients of the EP or eligible hospital with a specific condition. Attestation None
M4Send reminders to patients per patient preference for preventive/ follow up care
More than 20 percent of all unique patients 65 years or older who were identified by certified EHR technology as needing a reminder during the EHR reporting period were sent the appropriate reminder
Count of Patients in EHR
An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology.
M5
Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP.
More than 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information subject to the EP’s discretion to withhold certain information. EHR Tabulates
Any EP that neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR 170.304(g)) during the EHR reporting period.
M6
Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate
More than 10 percent of all unique patients seen during the EHR reporting period are provided patient-specific education resources EHR Tabulates None
M7Perform medication reconciliation at relevant encounters and each transition of care.
Perform medication reconciliation for more than 50 percent of transitions of care.
Count of Patients in EHR
An EP who was not the recipient of any transitions of care during the EHR reporting period.
M8Provide summary care record for each transition of care and referral.
Provide summary of care record for more than 50 percent of transitions of care and referrals
Count of Patients in EHR
An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.
M9 *p
Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission according to applicable law and practice.
Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries. Attestation
An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.
M10 *p
Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.
Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically). Attestation
An EP who does not collect any reportable syndromicinformation on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.
Medicare Incentive Payment
Tip: To determine your potential Medicare incentive payment – review 2010 1099(s)
Medicaid Incentive Payment
Services
• Strategic Planning
• Readiness Assessment
• Office Workflows: Clinical & Administrative Process Improvement
• EHR Implementation Project Management
• Meaningful Use & Attestation Readiness and Preparedness
Practice Preparedness
• EHR Vendor Selection
• Vendor Pricing & Contract Negotiations
• Collaboration with IT
Vendor Coordination
Resources
Source Location
CMS http://www.cms.gov/EHRIncentivePrograms/
CMS FAQ’s http://www.cms.gov/EHRIncentivePrograms/Downloads/FA
QsRemediatedandRevised.pdf
HIPAA Security http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsum
mary.html
HIMSS http://www.cms.gov/EHRIncentivePrograms/
AMA http://www.ama-assn.org/ama/pub/physician-
resources/health-information-technology.page
NYeC http://www.nyehealth.org/rec/
MGMA http://www.mgma.com/ & http://www.nymgma.com/
EMR & HIPAA Blog http://www.emrandhipaa.com/emr-selection-book/
Linkedin Join Groups: HIMSS, HIT Works, MU Answers