American Academy of Pediatrics...
Transcript of American Academy of Pediatrics...
Meaningful What?
Electronic Medical Record and Health
Information Technology Initiatives:
The New Primary Care Practice
Christoph U Lehmann, MD
Disclosures
Disclosure: Pediatric Informatics
Disclosure: Applied Clinical Informatics
Sources Medicare and Medicaid Programs; Electronic Health Record Incentive Program - Notice
of Proposed Rule Makinghttp://edocket.access.gpo.gov/2010/pdf/E9-31217.pdf
Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology - Interim Final Rulehttp://edocket.access.gpo.gov/2010/pdf/E9-31216.pdf
Diamond L, Bates M. Quality Metrics Requirements for Obtaining Meaningful Use: Developing a Plan for Implementation. HIMSS
Minnesota health: http://www.health.state.mn.us/e-health/hitech/ht052009faqprov.pdf
Koss on Care LLC, Presentation for Medicaid
HIMSS: One stop for all ARRA information www.himss.org/economicstimulus
ONC: http://healthit.hhs.gov
CMS: www.cms.hhs.gov
Tennessee Office of eHealth Initiatives
California Center for Connected Health
Dr. Joseph Schneider, Past-Chair, COCIT
Jennifer Mansour & Beki Marshall, AAP
Acronyms AQA – Ambulatory Care Quality Alliance
ARRA – American Recovery and Reinvestment Act (a.k.a. the ―stimulus bill‖)
CDS – Clinical Decision Support
CPOE – Computerized Provider Order Entry
EH- Eligible Hospital as defined by the CMS EHR Incentive Program
EHR – Electronic Health Record
EP – Eligible Provider as defined by the CMS EHR Incentive Program
HIE – Health Information Exchange
HIT – Health Information Technology
HITECH - Health Information Technology for Economic and Clinical Health Act
HQA – Hospital Quality Alliance
IFR – Interim Final Rule
MU – Meaningful Use
NPRM – Notice of Proposed Rule Making
NQF – National Quality Forum
ONC – The Office of the National Coordinator for Health Information Technology
PHI – Protected Health Information
PI – Process Improvement
PQRI – Physician Quality Reporting Initiative
RHQDAPU – Reporting Hospital Quality Data for Annual Payment Update
HIT at the AAP
1980 2010
1985
Formation of AAP Section on
Computers and Other Technologies
1991
Formation of Task Force
on Medical Informatics
2002
Merger of SCOT
and TFOMI
2006
Merged group renamed Council on
Clinical Information Technology
2009
Establishment of
Child Health
Informatics Center
AAP Council on Clinical Information
Technology (COCIT)
600 members with special interest or training in applyingHIT to pediatrics
11-member Executive Committee
AAP Policy development
Web and educational resources
Six years ago...
10
George W. Bush, April 26,
2004
“…Within 10 years, every American must have a personal electronic medical record.
That's a good goal for the country to achieve.
The federal government has got to take the lead in order to make this happen..”
ARRA Legislation
• Passed & signed Feb 2009
• Anticipated HIT spending
• US $ 45+ Billion
• Stage One ―Meaningful Use‖
criteria July 2010
• STIMULUS BILL
A good Stimulus Bill
Increases confidence by
Promising spending
Promising better employment
Improving infrastructure
While spending as little money as
possible
Keeping the budget in check
Total Federal Health IT Spending (through ONC)
before HITECH:
$300,000,000
Total expected gross outlays through HITECH (up to):
$45,000,000,000
15,000% increase
Historical Look at Spending in Health IT
13
Source: http://www.kighealthcare.com/images/growth_chart.jpg (NextGen)
Meaningful Use 860+ page document for the Final Rule
Only STAGE ONE
15 core requirements
10 menu requirements
Quality Measures not pediatric friendly
Eligibility Challenges 20% Medicaid patient encounters
NEED for Advocacy and Advising Office of the National Coordinator
CMS
NEED for Education of Pediatricians
AAP Child Health Informatics Center
Authorized by AAP Board in October 2009
―Home‖ for health information technology
initiatives within the AAP
Medical Director Chris Lehmann, MD,FAAP ,Johns Hopkins University
Announced April 2010
Mission
HIT Advocacy for Pediatrics Congress, Office of the National Coordinator, CMS
etc.
Education Aid in EHR selection and implementation
Meaningful Use rule interpretation
Resources for pediatricians
Research & Development Influence EHR technology to be Child-Friendly
Collaborate with AAP partners in HIT
Child Health Informatics Center
May – September 2010
Education Chapter meetings
Publications
NCE activities
Resource Warehouse Meaningful Use Summaries
Regional Meaningful Use Resources
EHR evaluation tool
Advisory Board Creation
Collaboration ePros, PPI, COCIT, QuIIN (readiness assessment)
―The meaningful use framework will be about the goals of care, not the technology.”
―The HITECH Act makes clear that the adoption of records is not a sufficient purpose: it is the use of EHRs to achieve health and efficiency goals that matters.”
David Blumenthal, MDNational Coordinator, ONCIT
Meaningful Use
Periodic Survey: Pediatricians Use of EHRs
Basic – 19% (ALL 7 items) Fully functional – 6%(Basic + 11additional functions = ALL 18 items)
Patient demographics Highlights out-of-range lab results
Patient problem lists Clinical notes include medical history, follow-
up notes
Orders for prescriptions Orders for laboratory tests
Ability to view lab results Lab orders sent electronically
Ability to view imaging results Warnings of drug interactions,
contraindications
Patient medication lists Prescriptions sent to pharmacies
Clinical notes Orders for radiology tests
Radiology orders sent electronically
Electronic images returned
Guideline reminders (preventive)
Guideline reminders (chronic)
Improve quality, safety, efficiency and reduce disparities
Engage patients
Improve coordination of care
Ensure privacy and security of PHI
Improve population health and interact with public health programs
Meaningful Use - Objectives
HITECH's Framework for MU of EHRs
Blumenthal D. N Engl J Med. 2010 Feb 4;362(5):382-5.
Regional Extension Centers
$650 million under the HITECH Act
Creation of a network of up to 70 Regional Health Information Technology Extension Centers focusing initially on primary care providers in small
practices
offer advice on which EHR systems to purchase
assist physicians and hospitals in becoming meaningful EHR users.
Other HITECH Initiatives
Development of minimum capabilities that EHRs must meet in order to be "certified."
Certification process (DHHS)
Development of exchange capabilities within and across State jurisdictions ($560 million)
National infrastructure for health information exchange (Nationwide Health Information Network)
HITECH privacy protections under HIPAA
What is MU and who determines it?
There are three base requirements for ―meaningful use‖ identified in the new law, including:
Use of certified EHR technology.
Electronic exchange of health information
Use of EHR in reporting on clinical and other quality measures
Medicare & Medicaid (limited)
Certification Process NPRM
Released
Comments on NPRM
due (60 days)
Final Rule Released
(60 days to draft final
rule)
Final Rule effective (60
days after release)
Federal process to recognize
certification entities
established (60 days
after effective
date)
First certification
entities recognized by federal
government (60 days
after established)
Significant number of products
certified (6 months after first entity
recognized)
Hospitals select
products and establish
contracts (6 month
process)
Vendor places
hospital on schedule (6 month wait
time)
Installation (18 to 24 month
process)
Achieve meaningful use for the first time (90 day
reporting period)
Timeline for Meaningful Use
Mar 2010
May 2010
July 2010
Sep 2010
Nov 2010
Jan 2011
June 2011
July –Dec 2011
Jan –June 2012
July 2012 - Dec 2013
Jan –Mar 2014
Incentive program starts – FY 2011
Amount of incentive drops
for newly eligible hospitals – FY
2014
Penalties begin – FY 2015
FINAL RULE
First Certifications
Certification Process Two Certification Programs
TEMPORARY certification program to test and certify Complete EHRs and/or EHR Modules (until Q1 2012)
Assuring the availability of Certified EHR Technology prior to the date on MU incentives are available
Permanent certification program to replace the temporary certification program
Separate the responsibilities for performing testing and certification
Introduce accreditation requirements
Establish requirements for certification bodies authorized by the National Coordinator related to the surveillance of Certified EHR Technology
Three Certifying Agencies
21 Certified products as of Oct 1, 2010
What health care professionals are
eligible for MU incentives?
Under the HITECH Act, an eligible professional is defined as, ―a physician, as defined in section 1861(r)‖ of the Social Security Act. These professionals include: Physicians
Dentists
Podiatrists
Optometrists
Chiropractors
Under Medicaid also:
Nurse Practitioners (NPs)
Certified Nurse-Midwives (CNMs)
Dentists
Medicare & Medicaid Programs: EHR
Incentive Program
Defines eligible hospitals (EHs) and eligible
professionals (EPs)
Establishes payment years & reporting
periods
Creates 3 Stages of implementation;
Provides details on Stage 1 goals and
requirements— covering 2011 and 2012.
What is required for MU?
Provider
must use the certified EHR as the primary
record of care for patients
reports certain clinical quality measures to
CMS (or the State under Medicaid)
provides certain attestations regarding
EHR use.
How will physicians prove MU?
Demonstration of meaningful use and
information exchange may be satisfied
by:
an attestation
submission of claims with appropriate coding
survey response
reporting of clinical quality measures
Eligibility Under Medicaid Any Provider with a National Provider Identifier
who over a continuous, representative 90-day period in the calendar year prior to reporting
has at least 30% of all patient encounters
is a PEDIATRICAN and has at least 20% of all patient encounters
with Medicaid patients
Eligibility Under Medicaid 2 Any Provider for whom at least 50% of patient
encounters over a 6-month period occur in a Federally-Qualified Health Center (FQHC) or
Rural Health Center (RHC)
with at least 30% of patient encounters from individuals who: Receive medical assistance from Medicaid or CHIP;
Are furnished uncompensated care by the provider;
Are furnished services at no cost or reduced cost according to a sliding-scale determined by the individual’s ability to pay.
One of many emails..“ I'm a pediatrician in a 6 man group in the suburbs of
Chicago…
We were an early adopter of the XYZ EHR, based on the promise of reimbursement. Unfortunately, … with the unrealistic requirements of populations composed of 20% Medicaid …, we would have no chance to participate. … I have been repeatedly assured that provisions will be made for pediatricians to allow us to participate. ….
Right now, I feel as if we have wasted the over $100,000 for the system as well as the countless hours I've put in to the system to make it more usable for us.
I'm hoping you can offer some advice as to our next steps…”
Being a pediatrician has some
advantages:
No penalties for Medicaid participants
Medicare providers will experience penalties
as early as 2015
Implementation may start later
Medicaid Providers
Users of Certified EHR Technology in 2011
Do NOT need to demonstrate – Attestation ONLY!
Earliest Payment:
Register – January 2011
Attest – April 2011
Payment – May 2011
Stage Focus Date
Range
Stage 1 Electronic data capture, track & communicate
key conditions, CDS, quality measure &
public health data reporting
Starting
in 2011
Stage 2 expands on stage 1, covers disease
management dimensions, information
exchange in the most structured format
possible (CPOE and Diagnostic Study
Results like Labs & Rads)
Starting
in 2013
Stage 3 promotes improvements in quality, safety &
efficiency as well as population health,
focuses on CDS for national high priority
conditions & Patient self management tools
Starting
in 2015
MEDICARE Stages Start Dates
First Payment
Year
Payment Year
2011 2012 2013 2014 2015
2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3
2012 Stage 1 Stage 1 Stage 2 Stage 3
2013 Stage 1 Stage 2 Stage 3
2014 Stage 1 Stage 3
2015 Stage 3
1st payment year - EHR reporting period means any continuous 90-day period with meaningful use of certified
EHR technology
2nd payment year and subsequently - EHR reporting period means the entire payment year
Medicaid Providers
Year 1 and 2 – Stage 1 only
Year 3 – MUST meet criteria in effect
If 2012 is Year 1
providers will have to jump to Stage 2 in 2014
providers will have to jump to Stage 3 in 2015
If 2013 is Year 1
providers will have to jump to Stage 3 in 2015
States cannot leverage penalties
Start Date as late as 2016 (Medicare
starts penalties in 2015)
Medicaid Payments
Providers (30% Medicaid volume) up to 85% of ―net average allowable costs‖
related to EHR purchase, updates, training, implementation, and maintenance
Payment capped at $21,250 for payment year 1 and $8.500 for Years 2-6
Pediatricians (Medicaid volume of 20-29%)
Payment capped is $14,167 in Year 1 and $5,667 in Year 2-6
Payment Amount for Medicaid
Professionals
Cap on Net Average Allowable Costs
(HITECH Act)
Up to 85 percent
For Eligible
Professionals
Max Cumulative
Incentive over 6-
years
$25,000 in Year 1 for most professionals $21,250
$63,750$10,000 in Years 2-6 for most professionals $8,500
$16,667 in Year 1 for pediatricians (> 20 percent and
<30% Medicaid patient volume)
$14,167
$42,500
$6,667 in Years 2-6 for pediatricians (> 20
percent and <30% Medicaid patient volume)
$5,667
Nothing in the Act excludes
such payments from taxation or
as tax-free income!
Payments For Medicaid EPs (>30% Patient Volume)
Calendar
YearMedicaid EPs who begin adoption in
2011 2012 2013 2014 2015 2016
2011 $21,250
2012 $8,500 $21,250
2013 $8,500 $8,500 $21,250
2014 $8,500 $8,500 $8,500 $21,250
2015 $8,500 $8,500 $8,500 $8,500 $21,250
2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250
2017 $8,500 $8,500 $8,500 $8,500 $8,500
2018 $8,500 $8,500 $8,500 $8,500
2019 $8,500 $8,500 $8,500
2020 $8,500 $8,500
2021 $8,500
TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750
Payments For Medicaid EPs (>20% and <30% Patient Volume)
Calendar
YearMedicaid EPs who begin adoption in
2011 2012 2013 2014 2015 2016
2011 $14,167
2012 $5,667 $14,167
2013 $5,667 $5,667 $14,167
2014 $5,667 $5,667 $5,667 $14,167
2015 $5,667 $5,667 $5,667 $5,667 $14,167
2016 $5,667 $5,667 $5,667 $5,667 $5,667 $14,167
2017 $5,667 $5,667 $5,667 $5,667 $5,667
2018 $5,667 $5,667 $5,667 $5,667
2019 $5,667 $5,667 $5,667
2020 $5,667 $5,667
2021 $5,667
TOTAL $42,500 $42,500 $42,500 $42,500 $42,500 $42,500
Medicaid Incentive Program
Enrollment
NPI (National Provider Identifier)
Business address and phone
Taxpayer Identification Number
SSN (payment to individual)
EIN (payment to practice)
Decision on participation through Medicare or
Medicaid
If Medicaid – State selected (choose ONE state if
participating in more than on Medicaid program)
Stage 1: Goals for Meaningful Use
Provide access to comprehensive patient health data for patient’s healthcare team.
Use evidence-based order sets and computerized provider order entry (CPOE).
Apply clinical decision support at the point of care.
Generate lists of patients who need care and use them to reach out to those patients.
Report information for quality improvement and public reporting.
Meaningful Use Criteria
Stage 1
Core set (15) Providers must meet ALL criteria in the core set
Menu Set (10) Providers must meet 5 of the menu set
States may modify criteria ONLY related to Public health
Registries
Core Set
1. Use CPOE
Denominator: Unique patients with at least
one medication
Numerator: Number of patients with at least
one medication order in CPOE
Goal: >30%
Core Set
2. Drug-Drug & Drug-Allergy Check
Functionality enabled 100% of the time
3. ePrescribing
Denominator: permissible prescriptions
Numerator: prescriptions transmitted
electronically using the EHR
Goal: >40%
Core Set
4. Record Demographics
Preferred Language, Gender, Race,
Ethnicity, Date of Birth
Denominator: Unique patients
Numerator: Patients with recorded
demographics
Goal: >50%
Core Set
5. Up to date Problem List
6. Active Medication List
7. Active Medication Allergy List
Denominator: Unique patients
Numerator: Patients with 1+ entry
Goal: >80%
Core Set
8. Recording of Vital Signs
Height, weight, blood pressure, body mass
index, growth chart (including BMI)
Denominator: Unique Patients >= 2 years
Numerator: patients with recorded height,
weight, blood pressure as structured data
Goal: >50%
Core Set
9. Recording of Smoking Status
Denominator: Unique Patients >= 13 years
Numerator: patients with recorded smoking
status
Goal: >50%
Core Set
10. Clinical Decision Support
Implement one CDS rule
11. Report Ambulatory Clinical Quality
Measures
2011 – attestation
2012 – electronic submission
Discussed later in detail
Core Set
12. Electronic Copy of Health Information
Diagnostic test results, problem list,
medication list, medication allergy list
Denominator: All unique patients who
requested a copy
Numerator: Patients who received a copy
within 3 business days
Goal: >50%
Core Set
13. Clinical Summary
May include updated medication list, test
results, procedures and instructions
Denominator: All unique patients
Numerator: Patients who received a Clinical
Summary within 3 business days
Goal: >50%
Core Set
14. Capability to exchange key clinical
information
Perform >=1 test of EHR’s capacity to
exchange electronically
15. Protect EHR information
Security risk analysis, implement security,
correct deficits
Menu Set - select 5
1. Implement drug-formulary checks
Functionality enabled and access to 1 or more formularies
2. Incorporate Lab results
>40% of laboratory results are incorporated in EHR
3. Patient List by Condition
Generate >= 1 report of patients with a specific condition
Menu Set - select 5
4. Patient Reminders for Preventive/Follow-Up Care
>20% of patients >=65 years or <=5years received an appropriate reminder
5. Timely Electronic Access
>10% of unique patients are provided electronic access to health information within 4 business days Providers may withhold information
Menu Set - select 5
6. Patient Specific Resources
>10% of unique patients are provided patient specific resources (using EHR technology)
7. Medication Reconciliation
Medication Reconciliation is performed >50% of transitions of care to the provider
8. Summary of Care Document
>50% of transition of care or referrals include a summary of care record
Menu Set - select 5
9. Data Transmission to Immunization
registries/Information Systems
Perform 1 or more tests to test EHR’s capacity to
submit Immunization data
Submit if registry has the ability to accept data
10. Data Transmission of Syndromic Surveillance
Data to Public Health Agencies
Perform 1 or more tests to test EHR’s capacity to
submit Syndromic Surveillance data
Submit if public health agency has the ability to
accept data
Measures
―In order for an EP or an eligible hospital
to demonstrate that it meets these
proposed objectives, we believe a
measure is necessary for each objective‖
MU Measurement
Even though incentives are paid by
Medicare or Medicaid, the requirements
for MU apply to ALL patients.
MU measurements are based on a
percentage of ALL patients
Measure Reporting
Pediatricians required to report
3 ―core‖ measures
3 ―alternate core‖ measures
If the denominator is 0 for any core measure
-> replace with alternate core measures
If the denominator is 0 for all core and
alternate core measures -> report on 3 of the
―additional‖ measures
% of patient visits for patients aged 18 years and older with a
diagnosis of hypertension who have been seen for at least 2 office
visits, with blood pressure (BP) recorded.
% of patients 18 years of age and older who were current smokers
or tobacco users, who were seen by a practitioner during the
measurement year and who received advice to quit smoking or
tobacco use or whose practitioner recommended or discussed
smoking or tobacco use cessation medications, methods or
strategies.
% of patients aged 18 years and older with a calculated BMI in the
past six months or during the current visit documented in the
medical record AND if the most recent BMI is outside parameters,
a follow-up plan is documented.
Core Measures
Recording of BP in Hypertension
Smoking Cessation
Follow-up plan in patients with
abnormal BMI
Alternate Core Measures % of patients 2-17 years of age who had an outpatient visit with a
Primary Care Physician (PCP) or OB/GYN and who had evidence
of BMI percentile documentation, counseling for nutrition and
counseling for physical activity during the measurement year.
% of children 2 years of age who had 4 diphtheria, tetanus and
acellular pertussis (DTaP); 3 polio (IPV), 1 measles, mumps and
rubella (MMR); 2 H influenza type B (HiB); 3 hepatitis B (Hep B); 1
chicken pox (VZV); 4 pneumococcal conjugate (PCV); 2 hepatitis A
(Hep A); 2 or 3 rotavirus (RV); and 2 influenza (flu) vaccines by
their 2nd birthday.
The measure calculates a rate for each vaccine and 9 separate combination
rates.
% of patients aged 50 years and older who received an influenza
immunization during the flu season (September through February).
Recording of BMI, Nutrition &
Exercise counseling
Complete immunization at Age 2
Influenza shot in flu season
Additional Measures % of patients aged 5 through 40 years with a diagnosis of mild, moderate,
or severe persistent asthma who were prescribed either the preferred long-
term control medication (inhaled corticosteroid) or an acceptable
alternative treatment.
% of patients aged 5 through 40 years with a diagnosis of asthma and
who have been seen for at least 2 office visits, who were evaluated during
at least one office visit within 12 months for the frequency (numeric) of
daytime and nocturnal asthma symptoms.
% of children 2-18 years of age, who were diagnosed with pharyngitis,
dispensed an antibiotic and received a group A streptococcus (strep) test
for the episode.
The % of adolescent and adult patients with a new episode of alcohol and
other drug (AOD) dependence who initiate treatment through an inpatient
AOD admission, outpatient visit, intensive outpatient encounter or partial
hospitalization within 14 days of the diagnosis and who initiated treatment
and who had 2 or more additional services with an AOD diagnosis within
30 days of the initiation visit.
Long-term control treatment in
Asthma patients
Evaluation of Asthma symptoms
in Asthma Patients
Strep A test in Patients
prescribed Abx for Pharyngitis
Treatment for new diagnosis of
dependence
Additional Measures % of patients, regardless of age, who gave birth during a 12-month period who were
screened for HIV infection during the first or second prenatal care visit.
% of D (Rh) negative, unsensitized patients, regardless of age, who gave birth during
a 12-month period who received anti-D immune globulin at 26-30 weeks gestation.
% of women 15- 24 years of age who were identified as sexually active and who had
at least one test for chlamydia during the measurement year.
% of patients 5 - 50 years of age who were identified as having persistent asthma and
were appropriately prescribed medication during the measurement year. Report 3 age
stratifications (5- 11 years, 12-50 years, and total).
% of patients 18 - 75 years of age with diabetes (type 1 or type 2) who had
hemoglobin A1c > 9.0%.
% of patients 18-75 years of age with diabetes (type 1 or type 2) who had LDL-C <
100mg/dL).
% of patients 18 - 75 years of age with diabetes (type 1 or type 2) who had blood
pressure <140/90 mmHg.
% of patients aged 18 years and older with a diagnosis of heart failure and left
ventricular systolic dysfunction (LVSD) (LVEF < 40%) who were prescribed ACE
inhibitor or ARB therapy.
HIV screening in pregnancy
Rhogam in Rh neg, unsensitized patients
Chlamydia test in sexually active women
Appropriate medication Rx in persistent Asthma patients
Additional Measures % of patients aged 18 years and older with a diagnosis of coronary artery disease (CAD)
and prior myocardial infarction (MI) that were prescribed beta-blocker therapy.
% of patients 65 years of age and older who have ever received a pneumococcal vaccine.
% of women 40-69 years of age who had a mammogram to screen for breast cancer.
% of adults 50-75 years of age who had appropriate screening for colorectal cancer.
% of patients aged 18 years and older with a diagnosis of CAD who were prescribed oral
antiplatelet therapy.
% of patients aged 18 years and older with a diagnosis of heart failure who also have
LVSD (LVEF < 40%) and who were prescribed betablocker therapy.
The % of patients 18 years of age and older who were diagnosed with a new episode of
major depression, treated with antidepressant medication, and who remained on an
antidepressant medication treatment.
% of patients aged 18 years and older with a diagnosis of primary open angle glaucoma
(POAG) who have been seen for at least 2 office visits who have an optic nerve head
evaluation during one or more office visits within 12 months.
% of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a
dilated macular or fundus exam performed which included documentation of the level of
severity of retinopathy and the presence or absence of macular edema during one or more
office visits within 12 months.
•Meaningful Quality Reporting Measures for Pediatrics
are limited
•Reporting Measures are of limited use to Sub-specialists
•Many measures could have been expanded to include
pediatric patients
Are you hooked yet?
23% Do Not Intend To Pursue Stimulus
Incentives
Source: Texas Medical Association survey, 2009
17% Do Not Plan On An EMR
Source: Texas Medical Association survey, 2009
What’s the Problem With EMRs?
Source: TMA survey, 2009
So – what to do? Certified EHR – talk to your vendor!
National Provider Identifier
Choose Medicaid Program
AAP is monitoring resources for YOU! ONC
RECS
Local & State
Meaningful Use Resources
http://derm.med.jhmi.edu/AAP_MU/
Documentation Challenge
Pediatric EMR Rating:
www.aapcocit.org/emr
EMR Product Comparison
AllScripts (2.7 – 3 reviews) Peak Practice (5 - 1 rev)
e-MDs (4.7 – 3 reviews) MedInformatix (No Ratings)
GE Centricity (3.2 – 5 revs) NextGen (2.3 – 11 revs)
eClinicalWorks (3.7 – 7 revs) Practice Partner (3 – 2 revs)
AHRQ – Model EHR Development
$4.7M – 2 year project – Limited eligible bidders
AAP Subcontract from Westat
Technical Expert Panel
Environmental scan - content experts
Evaluation of existing EHRs
Development of model EHR format
Dissemination of model (QuINN, CAQI, COCIT)
Development of 3 new component/modules
AAP - Model EHR – Informatics Team
Stephen Downs
Williams Adams
Chris Lehmann
Kevin Johnson
Andrew Spooner
Ken Mandl
COCIT - Joe Schneider, Jeannie Marcus
NACHRI - Aileen Sedman, Feliciano Yu
APQ - Joy Kuhl
AAP - Model EHR – HIT Issues EHR Design
Vocabulary Standards
Human Computer Interface
Privacy and Security
Communication Standards
ePrescribing
Medication Safety and Mgmt
Implementation
Ambulatory Care
Inpatient Care
Personal Health Records
Registries
Health Information Exchange
Public and population health
Prenatal Care
Newborn Screening
Growth and Development
Immunizations
Quality Improvement
Clinical Decision Support
AAP - Model EHR – Policy Issues
Confidentiality and adolescent services
Medical Home
Foster care
School and community agencies information
Newborn metabolic and hearing screenings
Quality improvement and measurement
Guidelines integration
Plain language/literacy
CHIC Collaborations
Council on Clinical Information Technology
Federal Affairs Office
AAP Quality Activities Steering Committee on Quality Improvement and Management (SCOQIM)
Partnership for Policy Implementation (PPI)
Chapter Alliance for Quality Improvement (CAQI)
Quality Improvement Innovation Network (QuIIN)
Internal and External Collaborative Activities Alliance for Pediatric Quality (APQ)
CHIC Future Plans
Grant applications
Continued Member Education
Evaluate potential for web services
Contribute to future MU discussion / Advocacy
Evaluate QuIIN members' readiness for MU
AAP Staff
Jennifer Mansour Manager, Health Information Technology Initiatives
Beki Marshall Manager, HIT
Education and Implementation
Vanessa Shorte Program Manager, Child Health Informatics Center
Sunnah Kim, RN, MS, CPNP Director, Division of Practice
Ed Zimmerman, MS Director, Department of Practice
Dan Walters Division of State Governemnt Affairs,
DOCCSA
Bob Hall, JD Assistant Director,
Department of Federal Affairs
Jonathan Klein, MD, MPH Associate Executive Director
Meaningful Use
Thank you!
Christoph U. Lehmann, MD, FAAP
Director, Child Health Informatics Center
American Academy of Pediatrics