Connect eNews

LEVERAGING TECHNOLOGY— EMPOWERING PHYSICIANS

ISSUE 4, WINTER 2013

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Daniel Wilt, Program Director for the Healthcare IT Regional Extension Center for CRISP, came to the agency with a background in healthcare and more than 15 years of experience with implementing electronic health records (EHRs).

As an enterprise architect at CareFirst BlueCross BlueShield, he worked on the Primary Care Medical Home Pay for Performance and the payer-based Personal Health Record initiatives, helping to define the architecture and technology solutions. He also contributed to the company’s healthcare IT policy and analysis and served as the company’s point for health information exchanges (HIEs) in the Mid-Atlantic

region. Previously he had served as Vice President of Information Technology at Erickson Living, leading the Erickson Health technology initiatives for five years. He oversaw EHR implementation in health-related lines of business, and his team developed a personal health record system that provided secure web-based access to residents’ medical information. As the organization’s HIPAA Security Officer, he implemented controls to ensure the mandated privacy and security of the records.

Wilt’s articles on the use of EHRs in extended care include the co-authored “Crossing Barriers,” in the Journal of Health Information Management, and he is a contributing author to the book Understanding and Designing Your Active Directory Infrastructure. Mr. Wilt holds a bachelor of science degree in business administration from Drexel University’s LeBow College of Business and an executive MBA from Temple University’s Fox School of Business.

We asked Mr. Wilt to tell us more about CRISP and recent developments in Maryland Health Care IT. His answers follow.

Welcome to ZaneNet Connect eNewsWelcome to the online newsletter of our ZaneNet Connect community of healthcare providers and innovators who are leading the initiative to transform patient care through the use of Health Information Technology.

Each issue features the story of a provider who has successfully initiated the meaningful use of electronic health records and qualified for incentive payments. Experiences vary, as do the size and needs of practices, and we can all learn from each other’s experience. In this issue, we share the successful transformation of a multiple-provider practice, the Cullen, Umosella, Cullen and Cullen internal medicine practice.

Looking at Maryland, we applaud the news that the state’s health information exchange has gone live. In a related story, we highlight Daniel Wilt, CRISP’s Program Director, and the agency’s accomplishments and plans. Our federal news concerns another outcome of the Affordable Care Act, the final rule authorizing an enhanced Medicaid pay scale for primary care providers, which is to take effect in January.

We present as our featured product ZaneNet Connect’s own IT Managed Services, and we add another tip to our series on attesting to meaningful use.

We welcome your feedback and your suggestions on how this newsletter can best serve our community.

Maryland Leaders in Healthcare IT: Daniel Wilt

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Success Story: Cullen, Umosella, Cullen, and Cullen

This year, the Cullen, Umosella, Cullen and Cullen internal medicine practice of Oxon Hill and Bethesda successfully implemented a new electronic health record system. All four partners, Collin, Edward, and Dennis Cullen and Charles Umosella, individually attested to meaningful use and received their first incentive payments.

We spoke with Dr. Umosella, who headed the search for the right electronic record system. Their decision to adopt a criterion that the system should be “easy to use” required that he “learn what was in each system.” The partners discussed his recommendations and made their choice. They then committed to the time-consuming task of training to use the system. Wanting to be comfortable with the data, they made up test patients to practice on and made the process work.

The partners made certain decisions about how implementation would proceed. Trying to keep the office schedule unchanged meant not entering

all of a patient’s data into the system at one appointment but putting it in over time, especially during the longer annual checkup appointment.

The practice has a long history in Maryland. The Oxon Hill office was opened in the nineteen fifties by the Cullens’ father. With paper records dating back 10 or 15 or more years, moving that information to electronic records has been particularly challenging.

The partners became aware of MSOs in general and of ZaneNet Connect in particular when they received a letter from ZaneNet explaining the program. Partnering with ZaneNet brought assistance with the transition from paper to electronic records and, later, guidance through the attestation process.

Well into the transition, growing pains are still felt, as the partners adjust to new equipment and must find time to learn to handle challenges. So far, the office workflow has been slower, under the

demands of training and new procedures. However, by early next year, a switch in the Medical Management system, once integrated, will automate records and populate the billing site, even adjusting the E/M codes.

Fortunately, benefits are also becoming visible: At patient visits, all the health data is laid out in the records and need only be updated, and the content is more reliable. Also, providers can access patient records from the hospital or from other sites where the provider may want to work.

The partners are looking forward to this time next year, when they anticipate a smoother, quicker process that will speed up the day. Their advice—do it! Choose that system that works for your practice and you find is easy to use, and do the work.

Dr. Charles Umosella, above; Edward, Collin, and Dennis Cullen, left.

Be sure to check out the online archive of our Success Stories on the ZaneNet Connect website.

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Maryland Health IT NewsMaryland’s Statewide Health Information Exchange Goes LiveOn October 13, Maryland’s REC, the Chesapeake Regional Information System for our Patients (CRISP), announced that Maryland had formally “gone live” with its statewide health information exchange (HIE). The HIE supports the private and secure exchange of health information among physician practices, hospitals, labs, radiology centers, and other healthcare institutions.

“Today’s announcement, while exciting evidence of the hard work of numerous stakeholders, is not an endpoint. Rather it’s the beginning of a process which will give physicians new and more effective tools to provide the best care to their patients,” said David Horrocks, President of CRISP.

At the time of the announcement, participating organizations included Holy Cross, Suburban, and Montgomery General hospitals; Community Radiology and Advanced Radiology (both RadNet partners) and American Radiology Services; and Quest Diagnostics and Laboratory Corporation of America; more were expected to connect soon. Other hospitals, physician practices, and clinics will be coming online before the end of the year, including many of the state’s federally qualified health clinics, which predominantly serve Medicaid, uninsured and other underserved patients. All 48 Maryland hospitals, with a total of 11,175 in-patient beds, have committed to sharing data with the statewide HIE.

The data the HIE is able to exchange will expand as participation grows, from today’s hospital discharge summaries, lab results and radiology results to medical documents that contain more complete medical information, sometimes referred to as continuity of care documents, or CCDs.

“This is a major step in developing an electronic system that protects individual privacy while improving the quality of health care and controlling costs,” said Lt. Governor Anthony G. Brown. “Soon, every Marylander will be able to enjoy the benefits of having their critical medical information delivered with speed and accuracy to the point of care, avoiding medical mistakes especially in case of an emergency.”

SOURCE Chesapeake Regional Information System for our Patients

Progress Continues in Setting up Health Insurance Marketplacesby Kathleen Sebelius, Secretary of Health and Human Services Posted December 10, 2012

Ten months from today, Americans in every state can begin to choose health insurance in new state marketplaces where they will have access to affordable coverage. Many will have never had health insurance, or had been forced to make the decision to go without insurance after losing a job or becoming sick. It is a groundbreaking time for health care in our country.

Today, we’re announcing that six states who applied early have made enough progress setting up their own marketplaces or Exchanges that we are ready to conditionally approve their plans—meaning they are on track to meet all Exchange deadlines. These early applicant, early approval states include: Colorado, Connecticut, Massachusetts, Maryland, Oregon, and Washington. …Today’s approval for these six early states and our continuedeffort to give states the guidance and tools they need to move forward, ensures that starting in October 2013, consumers in all states can begin filling out applications for private health insurance in affordable, quality plans.


Federal Health IT News

As Medicaid programs and providers prepare to cover more patients in 2013, a CMS press release November 1 stated: “Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the final rule implementing the part of the health care law that delivers higher payments to primary care physicians serving Medicaid beneficiaries…The final rule implements the Affordable Care Act’s requirement that Medicaid pay physicians practicing in family medicine, general internal medicine, pediatric medicine, and related subspecialists at Medicare levels in Calendar Years 2013 and 2014. This payment increase goes into effect in January of 2013.”

Nationally, Medicaid’s average payment rate for physician services is now just two-thirds of what Medicare pays. States will receive an additional $11 billion from the federal government during this period to administer the enhanced pay rates. The

Affordable Care Act authorized the temporary pay parity provision, and the increase above current payment levels is fully funded by the federal government.

Physicians who deliver primary care services in the fields of family, general internal or pediatric medicine are eligible, as are subspecialists of these fields. The final rule also states that nurse practitioners and physician assistants would also qualify for the increased rate, provided they are supervised by physicians who are eligible. The Medicaid payment ceiling for children’s vaccine administration also will be raised. The increases will not apply to federally qualified health centers and rural health clinics.

The rule provides information about how CMS and the states will make the increased payments operational. It includes information about the identification of

eligible providers and services and how to meet the statutory requirements for these payments for services provided through managed care. The rule also provides important information on how this policy applies to the Vaccines for Children (VFC) program, which has its own statutory requirements for billing and payment, and updates the administration fees that may be billed under VFC based on medical inflation rates.

Medicaid Pay Raise for Primary Care Physicians

In Stage 1, providers must meet a public health meaningful use menu objective; one is the capability to submit electronic data to immunization registries (Menu Objective 9). One criterion is to test, and if successful, establish a connection from the EHR to the immunization information registry (IIS) in the provider’s jurisdiction (in Maryland, the Department of Health and Mental Hygiene (DHMH)).

The practice will generate an electronic test of Immunization data from its certified EHR according to the HL7 Implementation Guides for Immunization. DHMH can accept HL7 version 2.3.1 or 2.5.1 (see the DHMH site). The test data does not need to succeed in order to meet the Stage 1 public health measure.

To fill out the DHMH MU survey and submit it on the website, required information includes the practice’s name, contact information and NPI and/or CCN. Schedule a date/time to set up and test your connection to DHMH through SFTP or PHINMS. DHMH will assign you a username and password to establish connection, and you can send your test data before or during your 90-day reporting period.

When ready to send your data, label your file with the practice’s abbreviated name and NPI or CCN. For multiple providers using the same EHR system, use the group or practice NPI and send a single test file. DHMH will send you a testing confirmation letter, which will include correcting any errors in your HL7 test data and quality assurance/validation.

The Maryland DHMH sets out the full procedure for immunization reporting on its website, http://mmcp.dhmh.maryland.gov/ehr/SitePages/immunization.aspx.

MEANINGFUL USE

OF THE WEEK

Submitting Electronic Data to Immunization

Registries

TIP


HIPAA Breaches with Paper Records

A Reminder: Paper Medical Records Pose Critical Security IssuesPrivacy and security have always been a concern when housing medical information. In fact, security issues with paper medical records helped drive the move into electronic medical record management. Chances are that a primary care practice now moving from paper to virtual records possesses a considerable store of paper records of patient health information that must be kept confidential. The Health Insurance Portability and Accountability Act (HIPAA) requires healthcare providers to protect medical record privacy, whether the records are in use, in transit, or in storage or are scheduled for disposal.

Paper records can be hard track and to maintain, because of their sheer volume and because the parts of a paper record can be misplaced. When stored, paper records are vulnerable to weather-related concerns like tornadoes and flooding, and in some locations may be accessible by unauthorized persons.

Because paper medical records are frequently copied and faxed, extra copies can be transmitted to the wrong location or be thrown away, compromising the privacy and security of the medical information they contain. When sensitive records must be transported from one location to another, paper records must be carefully tracked and never left in an insecure location.

Failing to plan for the privacy and security of paper records will expose a practice to fines for HIPAA breaches. An appropriate risk management strategy must include provisions that recognize concerns unique to handling paper records.

HIPPA TrainingHIPPA Training. For medical practices, workforce training is essential to assure compliance with the HIPAA Privacy Rule, which establishes national standards to protect individuals’ personal health information. The rule requires safeguards to protect the privacy of this information and limits the uses that may be made of such information without patient authorization.

ZaneNet Connect is now offering HIPPA training for your office and professional staff for a nominal fee. Our training, which can be provided on site or by WebEx, takes from 45 minutes to 1 hour to complete. At the end of the training session, participants will be asked to log onto our Learning Center link, at http://learn.zanenetconnect.com/login/index.php. Here they will be asked to choose a user name and password to sign on to take a test. Each participant who passes the test will be issued a certificate of completion, which will be sent to their individual email addresses.

We plan that in the future this training will be completely web-based. Participants will then be able independently to access and complete the training and receive certification by signing on at a time convenient to them.


Many physicians implementing electronic records look forward to the interoperability offered by the Health Information Exchange. ZaneNet Connect’s Community Provider Connect (CPC) has been developed to link our providers to Maryland’s HIE, bringing them immediate access to all their patients’ current medical records and other services.

With a patient-centered focus that unifies patient records from multiple sources and simplifies the referral process, the exchange contributes to increased staff productivity and revenue. In addition, it supports the retrieval and submission of data that demonstrate Meaningful Use.

A pilot program is now available through ZaneNet Connect for a limited time. Join our pilot program and connect to the HIE at no additional costs for your practice during your first 90 days. As part of the pilot, your initial set-up fee of $2,500 will be waived, as will all monthly fees, during the pilot period. For more information on this offer or to register, call 301-830-7799. View the CPC brochure on our website, www. zanenetconnect.com.

ZaneNet Connect continues to work with the Prince George’s County Health Department to provide technical assistance as the department implements a comprehensive electronic health information system to serve its nine clinics, which provide a broad array of services to patients throughout the county. We congratulate the department’s clinics for reaching “Go-Live” status with their registration systems on December 3 and look forward to their continued success.

Community Provider Connect

Product Highlight:ZaneNet ConnectIT Managed ServicesEffective IT systems should ensure dependability, ease of use and security. To implement and utilize Electronic Health Records successfully, providers must determine how to meet their IT goals. ZaneNet Connect will assess your practice and provide you an optimal IT infrastructure support plan, tailored to the specific needs of your medical practice and the EHR you’ve selected.


1. Please describe CRISP’s role inMaryland healthcare. To this date, has provider adoption of EHR systems met CRISP goals?

CRISP’s mission is to advance the health and wellness of Marylanders by deploying health information technology solutions adopted through cooperation and collaboration. We will enable the Maryland healthcare community to appropriately and securely share data, facilitate and integrate care, create efficiencies, and improve outcomes.

CRISP runs the following programs in the State of Maryland: the Statewide Health Information Exchange, the Regional Extension Center, and the Challenge Grant Program.

A health information exchange (HIE) is the infrastructure that supports the flow of health information between physician practices, hospitals, labs, radiology centers, and other healthcare institutions. An HIE allows delivery of the right health information to the right place at the right time, providing safer, more timely, and efficient patient-centered care. The Maryland Health Care Commission has designated CRISP the entity to build the HIE for the state of Maryland. This work is being funded through Maryland’s unique all-payor system and a federal ARRA grant.

The CRISP Regional Extension Center (REC) is a resource for any Maryland healthcare provider needing assistance in adopting an electronic health record (EHR). The REC has partnered with state-designated Management Services Organizations (MSOs) as the mechanism for achieving widespread adoption and meaningful use of EHRs. CRISP’s goal is to assist 1,000 priority primary care providers across Maryland, particularly those in rural and medically underserved areas, to achieve the meaningful use of EHRs. CRISP was chosen as Maryland’s Regional Extension Center by the Office

of the National Coordinator for Health Information Technology (ONC) on April 6, 2010. CRISP was awarded $6.4 million to assist 1,000 primary care providers to deploy EHRs and achieve meaningful use under Grant #90RC0059/01.

In 2011, the MHCC received funding from the Office of the National Coordinator (ONC) to address transitions of care in long-term care, which is one of the four challenge themes of the HIE Challenge Program. The goal of this project is to leverage Maryland’s operational statewide health information exchange to electronically share critical pieces of clinical information, including information on advance directives where they exist, in near real-time as residents of the state’s long term care (LTC) facilities transition from one care setting to another. The pilot project seeks to deploy new scalable technology among seven pairs of LTC facilities and five geographically proximate hospitals that will enable the exchange of care-transition data.

Under the REC program CRISP has made great progress in meeting our goal of getting 1,000 providers to Milestone 1 “Sign Ups” and Milestone 2 “Go Lives” and is quickly closing in on our goal of 1,000 Meaningful Users, currently at 245. However, we would like to see adoption increase at a faster pace and expect that it will continue to climb each month as the incentives program pays out the Meaningful Use dollars.

2. After the federal incentive programends, what will change? Is there a risk that momentum will slow? What would you like to see happen? What role do you see for Managed Services Organizations at the post-incentive stage? How can providers benefit from using MSOs?

The federal incentives program has three stages and will last for at least 5 years, with each successive stage requiring more to meet the Meaningful Use measure. We are encouraged to see that providers are really

starting to make the effort to go electronic and to recognize the possibilities for the entire healthcare system.

In Maryland we partnered with the MHCC MSO program on purpose because we think that having local organizations like the MSOs to help providers meet the Meaningful Use criteria would be a long-term business model that fills the needs of the providers. We hope that the MSOs will outlive the incentives program and become a key feature in the Maryland market that supports the adoption of HIT in the state. Even when the incentives program is over, there will still be a need to have qualified organizations like MSOs to support providers with HIT technology adoption. We are still just at the beginning of the HIT adoption curve and expect this work to continue as we move from implementation to improving quality.

Providers benefit from using MSOs by knowing that they have local resources to support their practices, people knowledgeable on the federal programs; by utilizing an MSO, they are helped to qualify for the state payer incentives. We also believe that as healthcare reform continues in the country, the MSOs are positioned perfectly to help organizations adapt to the new model.

3. On May 22, Governor O’Malleysigned legislation making Maryland the 13th state to require insurers, nonprofit health service plans, and HMOs to provide coverage for health care services delivered through telemedicine. Please comment on the significance of this legislation and the role that CRISP plays in the marketplace.

We have not played a large role in the telemedicine discussions in the state, but we have helped the MHCC to offer solutions that might be of interest to both providers and insurers.

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301-830-7799 phone301-358-0821 fax

ZaneNet in the CommunityZaneNet Connect joined Dr. Yvette Weir and other local community members and organizations for a 3.5 mile walk this fall as part of Michelle Obama’s Let’s Move initiative to highlight the importance of exercise for the entire family.

4. The O’Malley administration has statedthe strategic policy goal of establishing a “best in the nation” statewide Health Information Exchange. What is the state’s role in implementing the HIE? How do you see the HIE helping the practices we serve?

We are excited to hear about opportunities to work on behalf of the state to make the CRISP HIE a sustainable and successful enterprise. We continue to push forward with our key services and offerings of the Query Portal, Direct Secure Email, and Encounter Notification System. Below are some statistics on how we are proceeding with the adoption of the HIE in the state.

[CRISP’s Query Portal allows participating providers to use the Internet to find patients’ medical information from participating hospitals, labs, radiology centers and other providers.] In the month of October, we had over 7,000 queries and were successful 70% of the time in finding a patient in our system. Users opened just over 1 document per patient found in the month. We have

over 1,400 Opt Outs to date. We have 39 of the hospitals contributing at least one clinical feed (Lab, Radiology, or Transcribed Documents) and have over 27M documents in the system and over 4M patients in the master patient index.

The Encounter Notification System (ENS) has been up and running since August. The service notifies the provider who is subscribed to a patient when the patient is either hospitalized or discharged. We do the notifications through our Direct Secure Email solution. We have over 200,000 patients subscribed, and over 200 notifications happen each day. This service helps to close the loop to the primary care provider that a patient has been admitted to or discharged from the hospital, a notification that does not consistently happen otherwise.

5. The state has undertaken a pilotprogram to establish Health Enterprise Zones (HEZ) to improve healthcare and reduce health disparities in underserved communities. Is there a role for Health IT/EHR technologies in an HEZ?

We are excited to see that Maryland is working to promote the Health Enterprise Zone as a way to address the underserved and disparities in the state. We have had little interaction in the initial stages of this process but support the concept and the support that it provides in helping providers to be able to adopt technology to support their practices.

6. What is your vision for Maryland’shealthcare providers? Are additional programs available or in the works to help providers? Looking 5 years into the future, what do you see in the healthcare landscape in this state?

It is hard to predict what the healthcare landscape will look like in 5 years; however, we are definitely on a track that is moving to more electronic health records. I expect that once we are through with the implementation of the EHR systems and the providers have the ability to focus on Stage 3 Meaningful Use, which should be focused on Quality of Care, we should see an improvement in the information that providers have. We should see a day when information from all the providers is easily shareable across all providers and is impacting the care of the patient in positive ways.

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