Coordination of the Physician Coordination of the Physician Office and Hospital EHROffice and Hospital EHR

Bill French, VP eHealth StrategiesBill French, VP eHealth Strategies

Wisconsin Office of Rural Health HIT Wisconsin Office of Rural Health HIT Implementation WorkshopImplementation Workshop

Stevens Point, WIStevens Point, WI

August 24, 2007August 24, 2007

Today’s ObjectivesToday’s Objectives

Explore methods for sharing information between Explore methods for sharing information between the hospital and physician office electronic health the hospital and physician office electronic health recordrecordWhich is really a small part of the discussion of Which is really a small part of the discussion of Continuity of Care (COC)Continuity of Care (COC)Review Wisconsin and National initiatives Review Wisconsin and National initiatives addressing COCaddressing COC

MetaStar is:MetaStar is:An independent, not-for-profit organizationAn independent, not-for-profit organization

Mission: to effect positive change in the Mission: to effect positive change in the quality, efficiency and effectiveness of health quality, efficiency and effectiveness of health care care

Contract with Centers for Medicare & Contract with Centers for Medicare & Medicaid Services (CMS) as the Medicare Medicaid Services (CMS) as the Medicare Quality Improvement Organization (QIO)Quality Improvement Organization (QIO)

for Wisconsinfor Wisconsin

The Doctor’s Office Quality The Doctor’s Office Quality – Information Technology Project (DOQ-IT)– Information Technology Project (DOQ-IT)

DOQ-IT project promotes the adoption of DOQ-IT project promotes the adoption of EHRs in physician offices. EHRs in physician offices. Assist physician offices who already have Assist physician offices who already have EHRs with disease/population management EHRs with disease/population management and internal or external reportingand internal or external reportingFREE service to office practicesFREE service to office practicesMetaStar does not endorse any specific MetaStar does not endorse any specific vendor or servicesvendor or services

Wisconsin DOQ-IT ProjectWisconsin DOQ-IT Project

DOQ-IT IPG

revised 9/06

MetaStar is currently working with approximately 40 clinics ranging in size from one to 70 physicians

DOQ-IT RoadmapDOQ-IT Roadmap

Planning an EHR

Select ing an EHR

Implement ing an EHR

Improving with an EHR

Organization View Webcasts

#1 --What is an EHR? #2 --Organizing your Efforts

Host MetaStar Planning Visit

Goal Setting View Webcasts

#3 --Process Mapping #4 --Leadership and

Successful Change

Host MetaStar Goal Setting Visit

Requirements Specifications View Webcast

#5—Business Case and ROI

Participate in 1-day workshop: EHR Planning

Documentation Complete a commu nication plan

Complete process mapping

Request additional MetaStar support, as needed: Onsite visits, Conference Calls and/or E- mails

Move to Selecting

an EHR Module

Selection Criteria View Webcasts

#6 – Vendor Selection I #7 – Vendor Selection II #8 – Interoperability

Participate in 1 -day workshop:

Preparing for Selection

Due Diligence Complete an RFP Complete due diligence on 3 -5

vendors

Host a MetaStar Selection V isit

Select a vendor of c hoice

Contracting

View W ebcast #9 – Contract Coaching

Contact with vendor of choice Coordinate a conference call

with clinic, vendor and MetaStar

Request additional MetaStar support, as needed: Onsite visits, Conference Calls and/or E -mails

Move to Implementing an EHR Module

Implementation Plan View Webcast s

#10 -- Hardware #11 – Implementation

Strategy #12--Communicating with

Patients

Participate in 1 -day workshop: Implementation Planning

Functional

View Webcast s #13 – Forms and Templates #14 – Chart Conversion

System Build

View Webcast s #15 – Guidelines #16 – Security #17 – Test Planning

Host a MetaStar Planning Visit

Install View Webcast

#18 –Issues Management & Change Control

Go-live date

Request additional MetaStar support, as needed: Onsite visits , Conference Calls and/or E-mails

Move to Impr oving an EHR Module

Evaluation View Webcast

#19 – Benefits Realization & Utilization

Complete evaluation plan

Quality Measures and Reporting

View Webcast #24 – Reporting &

Benchmarking #25 – Using EHR data for

quality

Submit data to CMS Warehouse (optio nal)

Improvement Planning

View Webcast #20 – Improvement 101 #21 – Strategies to improve

with an EHR #22 – ePrescribing in the

physician office #23 -- Integrating EHR

systems & Patient Portals

Participate in 1 -day workshop:

Improvement with an EHR Comp lete an improvement plan

Host a MetaStar Improvement

Planning Visit Request additional MetaStar support, as needed: Onsite visits, Conference Calls and/or E -mails

Hospital IT-Related ProjectsHospital IT-Related Projects

Computer Provider Order Entry (CPOE)Computer Provider Order Entry (CPOE)

Patient Centered Bar Code TechnologyPatient Centered Bar Code Technology

Telemedicine/telehealthTelemedicine/telehealth

Other MetaStar Hospital ProjectsOther MetaStar Hospital Projects

Reporting of Quality MeasuresReporting of Quality Measures

Improvement on Appropriate Care Improvement on Appropriate Care MeasuresMeasures

Surgical Care Improvement ProjectSurgical Care Improvement Project

Rural Organizational Safety CultureRural Organizational Safety Culture

Hospital Payment Monitoring ProgramHospital Payment Monitoring Program

Other MetaStar EHR-Related ActivitiesOther MetaStar EHR-Related Activities

Board position on the Wisconsin Health Board position on the Wisconsin Health Information ExchangeInformation Exchange

Governor’s eHealth and Patient Safety Governor’s eHealth and Patient Safety Board work groupsBoard work groups

Other ProjectsOther Projects

Culture in MedicineCulture in Medicine

Quality improvement project for Medicare Quality improvement project for Medicare drug benefitdrug benefit

Beneficiary protectionBeneficiary protection

Commercial ServicesCommercial Services

HEDIS AuditorHEDIS Auditor

Completed an environmental scan of EMRs Completed an environmental scan of EMRs in Wisconsin hospitals and physician in Wisconsin hospitals and physician practices for the Governor’s eHealth and practices for the Governor’s eHealth and Patient Safety BoardPatient Safety Board

MetaStar’s Web SiteMetaStar’s Web Site

DOQ-IT and Hospital EHR tools available .DOQ-IT and Hospital EHR tools available .

www.metastar.comwww.metastar.com

Hospital & Physician Office HER - One Path Hospital & Physician Office HER - One Path to Continuity of Care (COC)to Continuity of Care (COC)

Why are we concerned with COC?Why are we concerned with COC?

Quality of care - patient safetyQuality of care - patient safety

Efficiency of careEfficiency of care

Patient satisfactionPatient satisfaction

Market shareMarket share

COC and Quality of Care COC and Quality of Care

Extrapolation of national estimates to SE Extrapolation of national estimates to SE WisconsinWisconsin

400 people die for lack of recommended 400 people die for lack of recommended carecare

55% of patients fail to receive 55% of patients fail to receive recommended evidence-based carerecommended evidence-based care

COC and Efficiency of CareCOC and Efficiency of Care

Missed prevention opportunities cost $7M Missed prevention opportunities cost $7M in hospital bills, $80.5M in lost work daysin hospital bills, $80.5M in lost work days

Wisconsin clinicians and staff in outpatient Wisconsin clinicians and staff in outpatient clinics spend up to 25% of their time clinics spend up to 25% of their time searching for information needed to care for searching for information needed to care for patients – estimated to be $668 in SE patients – estimated to be $668 in SE WisconsinWisconsin

Patient SatisfactionPatient Satisfaction

Patients do not like to repeat informationPatients do not like to repeat information

Patients will change providers that lack the Patients will change providers that lack the technology for the patient to communicate technology for the patient to communicate with all of their providerswith all of their providers

Market ShareMarket Share

Physicians will not continue to refer Physicians will not continue to refer patients to hospitals and providers who do patients to hospitals and providers who do not keep the referral physician informednot keep the referral physician informed

What Does the Hospital EHR Need from the What Does the Hospital EHR Need from the Physician Office EHR?Physician Office EHR?

Why the patient is being referred to the Why the patient is being referred to the hospitalhospital

Admission for medical and/or surgical Admission for medical and/or surgical therapy?therapy?

Period of observation?Period of observation?

Diagnostic tests?Diagnostic tests?

What Clinical Information Does the Hospital What Clinical Information Does the Hospital EHR Need from the Physician Office EHR? EHR Need from the Physician Office EHR?

Test results and findings indicating the need Test results and findings indicating the need for hospital servicesfor hospital services

Admitting orders Admitting orders

Medication status to include drug allergiesMedication status to include drug allergies

Patient and family medical historyPatient and family medical history

What Does the Physician Office EHR Need What Does the Physician Office EHR Need from the Hospital EHR?from the Hospital EHR?

When the patient needs to be seen next?When the patient needs to be seen next?

What follow-up care is required?What follow-up care is required?

Medication status when discharged?Medication status when discharged?

Lab Results?Lab Results?

How May COC Be Achieved?How May COC Be Achieved?

Health Systems with integrated EHRs Health Systems with integrated EHRs across all providersacross all providers

Local initiates to share health informationLocal initiates to share health information

National initiatives to further National initiatives to further interoperability interoperability

Health Systems with Integrated EHRs Health Systems with Integrated EHRs

Small number of large providers will realize Small number of large providers will realize this level of functionalitythis level of functionality

Large number of small physician practices, Large number of small physician practices, community and rural hospitals will not be community and rural hospitals will not be able to obtain this level of functionalityable to obtain this level of functionality

MetaStar ExperienceMetaStar Experience

Integration is often a reason to select a Integration is often a reason to select a productproduct

Lab interfacing is much easierLab interfacing is much easier

Buy-in can be difficult if the hospital Buy-in can be difficult if the hospital doesn’t include provider in selectingdoesn’t include provider in selecting

Workflow needs to be addressed in both Workflow needs to be addressed in both settingssettings

MetaStar Experience MetaStar Experience

The flow between settings should be The flow between settings should be mappedmapped

Need to have both hospital and clinic Need to have both hospital and clinic representation on the implementation teamrepresentation on the implementation team

Clinical implementation is typically more Clinical implementation is typically more difficultdifficult

Functionality vs. integration debateFunctionality vs. integration debate

National Initiatives to Achieve COCNational Initiatives to Achieve COC

American National Standards Institute American National Standards Institute (ANSI) (ANSI)

Health Level 7 (HL7) Health Level 7 (HL7)

American Society for Testing and Materials American Society for Testing and Materials (ASTM)(ASTM)

National Initiatives to Achieve CCR (Cont)National Initiatives to Achieve CCR (Cont)

CCHIT Ambulatory Interoperability 2007 CCHIT Ambulatory Interoperability 2007 Final CriteriaFinal Criteria

Regional Health Information Organizations Regional Health Information Organizations (RHIOs)(RHIOs)

American National Standards Institute (ANSI)American National Standards Institute (ANSI)

(ANSI) coordinates the development and (ANSI) coordinates the development and use of voluntary consensus standards in the use of voluntary consensus standards in the United States and represents the needs and United States and represents the needs and views of U.S. stakeholders in views of U.S. stakeholders in standardization forums around the globestandardization forums around the globe

Approves many HL 7 standards Approves many HL 7 standards

Health Level 7Health Level 7

Standards for electronic interchange of Standards for electronic interchange of clinical, financial, and administrative clinical, financial, and administrative information among information among healthhealth care-oriented care-oriented computer systems; e.g. hospital information computer systems; e.g. hospital information systems, clinical laboratory systems systems, clinical laboratory systems

Collaborated with ASTM to develop the Collaborated with ASTM to develop the Continuity of Care Document (CCD)Continuity of Care Document (CCD)

CCDCCD

CCD is a “melding” of HL 7’s Clinical CCD is a “melding” of HL 7’s Clinical Document Architecture (CDA) and the Document Architecture (CDA) and the Continuity of Care Record (CCR) Continuity of Care Record (CCR) developed by ASTM developed by ASTM

The final (CCD) will describe how to The final (CCD) will describe how to implement the CCR dataset with the implement the CCR dataset with the standard architecture for clinical records standard architecture for clinical records developed by HL7 developed by HL7

American Society for Testing and Materials American Society for Testing and Materials (ASTM) (CCR)(ASTM) (CCR)

CCR developed jointly by ASTM International, CCR developed jointly by ASTM International, the Massachusetts Medical Society, the Health the Massachusetts Medical Society, the Health Information Management and Systems Society, Information Management and Systems Society, the American Academy of Family Physicians and the American Academy of Family Physicians and the American Academy of Pediatrics to improve the American Academy of Pediatrics to improve continuity of care, to reduce medical errors, and to continuity of care, to reduce medical errors, and to assure a minimum standard of health information assure a minimum standard of health information transportability when a patient is referred or transportability when a patient is referred or transferred to, or is otherwise seen by another transferred to, or is otherwise seen by another provider.provider.

CCR Basic Patient InformationCCR Basic Patient Information

Header InformationHeader InformationPatient’s, provider and insurance Patient’s, provider and insurance informationinformationPatients health status - allergies, Patients health status - allergies, medications, vital signs, diagnoses, recent medications, vital signs, diagnoses, recent proceduresproceduresRecent care providedRecent care providedReason for referral or transferReason for referral or transfer

Patient, Provider and Insurance Information-Patient, Provider and Insurance Information-HeaderHeader

Header,Header, or or Document Identifying Document Identifying InformationInformation , contains required information , contains required information about the referring or "from" clinician, as about the referring or "from" clinician, as well as information about the referral or well as information about the referral or "to" provider, and document date. It also "to" provider, and document date. It also addresses the purpose for creating the addresses the purpose for creating the document and reason for referral. document and reason for referral.

Patient, Provider and Insurance Information Patient, Provider and Insurance Information (Cont)(Cont)

Patient Identifying InformationPatient Identifying Information : This section includes the : This section includes the required information to identify and distinguish the patient required information to identify and distinguish the patient throughout the referral process, transitioning to and from throughout the referral process, transitioning to and from hospital, clinic, physician office, or home environments hospital, clinic, physician office, or home environments (any care setting). (Note: The CCR is not based on a (any care setting). (Note: The CCR is not based on a centralized system or a national patient identifier. Rather, it centralized system or a national patient identifier. Rather, it is based on a federated or distributed identification system is based on a federated or distributed identification system that links various providers and contains the minimal set of that links various providers and contains the minimal set of identifying information that could be used by any record identifying information that could be used by any record system [paper or electronic] to assign the individual their system [paper or electronic] to assign the individual their own identifier.) Additional information in this section own identifier.) Additional information in this section includes support contacts and advanced directives. includes support contacts and advanced directives.

Patient, Provider and Insurance Information Patient, Provider and Insurance Information (cont.)(cont.)

Patient's Insurance andPatient's Insurance and Financial Information.Financial Information. The individual's Medicare or commercial The individual's Medicare or commercial insurance information. Data elements include insurance information. Data elements include Insurance Company Name, Subscriber's Name, Insurance Company Name, Subscriber's Name, Subscriber's Date of Birth, Subscriber's Member Subscriber's Date of Birth, Subscriber's Member ID, and Other Insurance Information. These are ID, and Other Insurance Information. These are the minimal data elements from which eligibility the minimal data elements from which eligibility for insurance coverage may be determined.for insurance coverage may be determined.

Patients Health Status - diagnosesPatients Health Status - diagnoses

Health Status of the PatientHealth Status of the Patient : Diagnoses, : Diagnoses, Problems, and Conditions are preferably ranked Problems, and Conditions are preferably ranked by order of importance or in reverse chronological by order of importance or in reverse chronological order. They are described in plain English and by order. They are described in plain English and by code, according to the selected coding system. code, according to the selected coding system. Also included are date of onset, date of most Also included are date of onset, date of most recent resolution, status, patient awareness of recent resolution, status, patient awareness of condition, family history, social history, and a condition, family history, social history, and a source field. source field.

Patients health status - allergies, medications, Patients health status - allergies, medications, (Cont)(Cont)

Adverse Reactions/Alerts lists allergies by agent Adverse Reactions/Alerts lists allergies by agent and symptom with optional fields for source and and symptom with optional fields for source and date of last reaction, as well as other pertinent date of last reaction, as well as other pertinent alerts about the patient. alerts about the patient.

Current Medications are listed by brand name, Current Medications are listed by brand name, generic name (optional), code system, code, start generic name (optional), code system, code, start date, dose, schedule, refills, prescriber, status, and date, dose, schedule, refills, prescriber, status, and a comments field. a comments field.

Patient Health Status - ImmunizationsPatient Health Status - Immunizations

Immunizations documentation includes Immunizations documentation includes information about each disease against information about each disease against which immunization was given, the date the which immunization was given, the date the immunization was received, and (optional) immunization was received, and (optional) dose strength, unit and route of dose strength, unit and route of administration as well as manufacturer and administration as well as manufacturer and lot #. lot #.

Patient Health Status- Vital SignsPatient Health Status- Vital Signs

Vital Signs documentation includes height, Vital Signs documentation includes height, weight, blood pressure, temperature, weight, blood pressure, temperature, respiratory rate, date vital signs were respiratory rate, date vital signs were recorded, pulse oximetry, and optional peak recorded, pulse oximetry, and optional peak expiratory flow rate (PEFR), as well as head expiratory flow rate (PEFR), as well as head circumference (for Pediatrics). circumference (for Pediatrics).

Patient Health Status- Laboratory ResultsPatient Health Status- Laboratory Results

Laboratory Results documentation includes Laboratory Results documentation includes blood sugar, urine protein, creatinine, blood sugar, urine protein, creatinine, sodium, potassium, hemoglobin, sodium, potassium, hemoglobin, hematocrit, WBC, and the date the sample hematocrit, WBC, and the date the sample was taken. was taken.

Patient Health Status- ProceduresPatient Health Status- Procedures

Procedures/Assessments documentation Procedures/Assessments documentation includes descriptions of procedures, code includes descriptions of procedures, code system, procedure code, procedure date and system, procedure code, procedure date and time, location, result and performed by time, location, result and performed by whom. Also included here are assessments, whom. Also included here are assessments, such as mental health assessment, such as mental health assessment, functional assessment. functional assessment.

Patient Health Status- ExtensionPatient Health Status- Extension

The The Health StatusHealth Status section may be amplified section may be amplified in the optional “extension” for medical in the optional “extension” for medical specialty-specific information. For instance, specialty-specific information. For instance, pediatric providers may want to include a pediatric providers may want to include a growth chart in the CCR.growth chart in the CCR.

Recent Care ProvidedRecent Care Provided

Care DocumentationCare Documentation: Includes detail on the : Includes detail on the patient-clinician encounter history, such as patient-clinician encounter history, such as the dates and times of recent and pertinent the dates and times of recent and pertinent visits and the purposes of the visits and visits and the purposes of the visits and names of clinicians or providers. This names of clinicians or providers. This documentation section may be significantly documentation section may be significantly expanded in the optional “extensions .” expanded in the optional “extensions .”

Reason for Referral or TransferReason for Referral or Transfer

Care Plan RecommendationCare Plan Recommendation: The Care Plan : The Care Plan is a free text entry section that includes is a free text entry section that includes planned or scheduled tests, procedures, or planned or scheduled tests, procedures, or regimens of care regimens of care

Extensions of the Six Major Sections Extensions of the Six Major Sections

EnterpriseEnterprise and Institution-specific Informationand Institution-specific Information particularly particularly regarding discharge or transfer, e.g., hospital to nursing regarding discharge or transfer, e.g., hospital to nursing and rehabilitation facilities or to home care agencies, and and rehabilitation facilities or to home care agencies, and vice versa. vice versa. Minimum data sets oriented toward Medical SpecialtiesMinimum data sets oriented toward Medical Specialties , , e.g., Pediatrics, Surgery, OB-GYN, Cardiology, e.g., Pediatrics, Surgery, OB-GYN, Cardiology, Orthopedics, etc. Orthopedics, etc. Disease ManagementDisease Management will accommodate recording specific will accommodate recording specific disease management information, measures or guidelines, disease management information, measures or guidelines, e.g., diabetes, congestive heart failure, asthma, etc. This e.g., diabetes, congestive heart failure, asthma, etc. This extension may be utilized by health plans, pharmaceutical extension may be utilized by health plans, pharmaceutical companies, patient advocacy groups, and others interested companies, patient advocacy groups, and others interested in promoting “best practices” in promoting “best practices”

Extensions of the Six Major Sections (Cont)Extensions of the Six Major Sections (Cont)

An extension for An extension for Patient-entered, Personal Health Patient-entered, Personal Health RecordRecord use, e.g., for complementary and use, e.g., for complementary and alternative medicine care documentation or other alternative medicine care documentation or other patient considerations such as private or sensitive patient considerations such as private or sensitive health information a patient may be reluctant to health information a patient may be reluctant to share with certain practitioners or spouses. share with certain practitioners or spouses.

An extension for more comprehensive An extension for more comprehensive Payer-Payer-specific Informationspecific Information and possibly claims and possibly claims attachments. attachments.

CCR GoalCCR Goal

Enable the next provider to easily access the Enable the next provider to easily access the information at the beginning of a first information at the beginning of a first encounter and easily update the information encounter and easily update the information when the patient goes on to another when the patient goes on to another provider to support the provider to support the safety, quality and safety, quality and continuity of care.continuity of care.

CCR Format CCR Format

XML standard documentXML standard document

Machine and human readableMachine and human readable

Displayed or printed through use of web Displayed or printed through use of web browser, PDF reader and word processorbrowser, PDF reader and word processor

Developing the ability to forward and Developing the ability to forward and receive this XML document will be useful receive this XML document will be useful when integration of EHR is not presentwhen integration of EHR is not present

CCR is Not anCCR is Not an

EHREHR : Although the CCR is meant to address the need for : Although the CCR is meant to address the need for continuity of care from one provider or practitioner to any continuity of care from one provider or practitioner to any other practitioner, it is not designed to be a mini EHR. Lab other practitioner, it is not designed to be a mini EHR. Lab and x-ray and other testing results are included only to the and x-ray and other testing results are included only to the extent the provider completing the document finds them extent the provider completing the document finds them relevant.  It does not list symptoms as its primary relevant.  It does not list symptoms as its primary function.  Rather it lists diagnoses and the “Reason for function.  Rather it lists diagnoses and the “Reason for Referral” to the next provider or diagnostician.  The Referral” to the next provider or diagnostician.  The “Reason for Referral” may include problems or symptoms “Reason for Referral” may include problems or symptoms but not in the manner in which a traditional EHR uses but not in the manner in which a traditional EHR uses them as the starting point for a documentation of the them as the starting point for a documentation of the SOAP-type note. Nor does it include a chronology of SOAP-type note. Nor does it include a chronology of events, in the fashion expected in an EHR events, in the fashion expected in an EHR

CCR is Not aCCR is Not a

Progress NoteProgress Note : Completion of the CCR should not be : Completion of the CCR should not be thought of as mandatory after every visit to a primary care thought of as mandatory after every visit to a primary care physician (PCP) or specialist or other clinician who is physician (PCP) or specialist or other clinician who is delivering care to the patient.  Thus, it is not replacing a delivering care to the patient.  Thus, it is not replacing a progress note used in the traditional record. However, if progress note used in the traditional record. However, if the clinician is planning to refer the patient to another the clinician is planning to refer the patient to another provider, then the CCR should be updated and prepared provider, then the CCR should be updated and prepared specifically for the next anticipated provider and specifically for the next anticipated provider and customized to assist at the next “point of care”.  Any customized to assist at the next “point of care”.  Any relevant information for the next provider should be added relevant information for the next provider should be added to the CCR, just prior to the referral, if feasible. to the CCR, just prior to the referral, if feasible.

CCR is Not aCCR is Not a

Discharge SummaryDischarge Summary : The CCR differs from the Discharge : The CCR differs from the Discharge Summary mainly in that the CCR is much more concise, Summary mainly in that the CCR is much more concise, involves less narrative or free text, and emphasizes the involves less narrative or free text, and emphasizes the brief care plan for the next steps to assist the patient to brief care plan for the next steps to assist the patient to recover or be rehabilitated following the most recent recover or be rehabilitated following the most recent episode of illness/care.  The CCR highlights or spells out episode of illness/care.  The CCR highlights or spells out the next appointments and follow-up visits and instructions the next appointments and follow-up visits and instructions to assist the Visiting Nurse or other next caregiver to assist the Visiting Nurse or other next caregiver regarding expectations of the follow-up encounter from the regarding expectations of the follow-up encounter from the perspective of the clinician completing the form perspective of the clinician completing the form

CCR is Not aCCR is Not a

Consultation NoteConsultation Note : The CCR is not : The CCR is not intended to replace the initial consultant's intended to replace the initial consultant's note to the referring physician. There is, note to the referring physician. There is, however, a potential for the CCR to be used however, a potential for the CCR to be used in lieu of the consultant's note back to the in lieu of the consultant's note back to the referring PCP after the second visit, referring PCP after the second visit, provided the lengthier summary of findings provided the lengthier summary of findings and plan of care were documented after the and plan of care were documented after the first visit and sent to the original provider first visit and sent to the original provider

Medical Records Institute (MRI) Medical Records Institute (MRI) Supports CCRSupports CCR

The Medical Records Institute Inc invites healthcare practitioners, provider institutions, The Medical Records Institute Inc invites healthcare practitioners, provider institutions, payers, managed care organizations, and others to submit their application for MRI ’s payers, managed care organizations, and others to submit their application for MRI ’s prestigious Continuity of Care Awards 2007. prestigious Continuity of Care Awards 2007. For the purpose of this Awards program, a Continuity of Care application is the adoption For the purpose of this Awards program, a Continuity of Care application is the adoption and utilization by a healthcare entity (e.g., solo practitioner, RHIO, provider institution, and utilization by a healthcare entity (e.g., solo practitioner, RHIO, provider institution, physician practice, employer, payer) of the Continuity of Care Record (CCR) data set physician practice, employer, payer) of the Continuity of Care Record (CCR) data set detailed in the ASTM Continuity of Care Record Standard Specification 1 for the direct detailed in the ASTM Continuity of Care Record Standard Specification 1 for the direct purpose of giving clinicians access to relevant current and past patient information in purpose of giving clinicians access to relevant current and past patient information in order that they may make informed healthcare assessments and treatment decisions. order that they may make informed healthcare assessments and treatment decisions. Such applications seek to reduce wasteful duplication, improve patient safety, and Such applications seek to reduce wasteful duplication, improve patient safety, and enhance quality of care.enhance quality of care.Adoption of the CCR data set may be through implementation of the ASTM E31 CCR Adoption of the CCR data set may be through implementation of the ASTM E31 CCR and/or through integration of its data set into HL7 ’s Continuity of Care Document and/or through integration of its data set into HL7 ’s Continuity of Care Document (CCD). Utilization of the CCR data set must include import and export of the data set (CCD). Utilization of the CCR data set must include import and export of the data set to/from other healthcare entities and/or patients for the purpose of supporting delivery of to/from other healthcare entities and/or patients for the purpose of supporting delivery of healthcare. (Note: Recognizing that not every provider entity may have implemented healthcare. (Note: Recognizing that not every provider entity may have implemented everything addressed in the CCR data set, submissions will be accepted for partial everything addressed in the CCR data set, submissions will be accepted for partial implementations as well.)implementations as well.)MRI awarded the winner a $3000 prize during the 2007 TEPR meeting in DallasMRI awarded the winner a $3000 prize during the 2007 TEPR meeting in Dallas

CCHIT LinkCCHIT Link

http://www.cchit.org/files/Ambulatory_Domahttp://www.cchit.org/files/Ambulatory_Domain/Ambulatory_INTEROPERABILITY_2007in/Ambulatory_INTEROPERABILITY_2007_Proposed_Final_Criteria_14Feb07.pdf_Proposed_Final_Criteria_14Feb07.pdf

http://www.cchit.org/files/Inpatient_Domain/Ihttp://www.cchit.org/files/Inpatient_Domain/Inpatient_Interoperability_2007_Draft_Criterianpatient_Interoperability_2007_Draft_Criteria.pdf.pdf

CCHIT CCHIT Ambulatory Interoperability CCHIT CCHIT Ambulatory Interoperability 2007 Final Criteria2007 Final Criteria

Implement HL-7 ASTM CCD and ASTM Implement HL-7 ASTM CCD and ASTM CCRCCR

IA-3.10 Access and view a medication IA-3.10 Access and view a medication history from a PHRhistory from a PHR

IA-5.09 Send data to PHRIA-5.09 Send data to PHR

CCHIT Ambulatory Interoperability 2007 CCHIT Ambulatory Interoperability 2007 Final Criteria (Cont)Final Criteria (Cont)

IA-5.10 Receive data from PHR and import IA-5.10 Receive data from PHR and import to EHRto EHR

IA 5.11 Receive registration summary from IA 5.11 Receive registration summary from patient and import into EHR patient and import into EHR

Regional Health Information Organizations Regional Health Information Organizations (RHIOs)(RHIOs)

A RHIO is a group of organizations with a A RHIO is a group of organizations with a business stake in improving the quality, business stake in improving the quality, safety and efficiency of healthcare safety and efficiency of healthcare delivery.  RHIOs are the building blocks of delivery.  RHIOs are the building blocks of the proposed National Health Information the proposed National Health Information Network (NHIN). To build a national Network (NHIN). To build a national network of interoperable health records, the network of interoperable health records, the effort must first develop at the local and effort must first develop at the local and state levels.  state levels. 

A Wisconsin RHIOA Wisconsin RHIO

The Wisconsin Health Information Exchange (WHIE) The Wisconsin Health Information Exchange (WHIE) is a project that is the first step in establishing a multi-is a project that is the first step in establishing a multi-purpose health information exchange system in purpose health information exchange system in southeastern Wisconsin to improve the quality and southeastern Wisconsin to improve the quality and efficiency of health care efficiency of health care National Institute of Medical Informationics (NIMI) is National Institute of Medical Informationics (NIMI) is registered in Wisconsin as a non-profit 501C3 registered in Wisconsin as a non-profit 501C3 corporation and serves as the non-profit organizational corporation and serves as the non-profit organizational entity that is creating WHIE entity that is creating WHIE

A Wisconsin RHIO (Cont)A Wisconsin RHIO (Cont)

Providers may join the WHIEProviders may join the WHIE

Membership will enable access to clinical Membership will enable access to clinical information required to achieve COC information required to achieve COC

Questions?Questions?

Contact InformationContact Information

MetaStar, Inc.MetaStar, Inc.2909 Landmark Place2909 Landmark PlaceMadison, WI 53713Madison, WI 53713

Phone number Phone number 608 441-8246608 441-8246

www.metastar.comwww.metastar.combfrench@metastar.combfrench@metastar.com

This material was prepared by MetaStar, the Medicare Quality Improvement Organization for Wisconsin, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.  8SOW-WI-INP-07-65