Health Information Technology and YOU!Health Information Technology and YOU!The Role of AAP ChaptersThe Role of AAP Chapters

in Supporting Member Practicesin Supporting Member Practices

District IV and IX6/23/2012

Joseph H Schneider, MD

Objectives

• Provide an overview of Meaningful Use (MU)

• Detail the role of AAP Health Information Technology Leadership in supporting chapters with adoption and use of health information technology (HIT)

• Provide ideas for Chapter activities

ARRA Legislation

• Passed on February, 2009

• Stage 1 Meaningful Use criteria released in July 2010

• Stage 2 Meaningful Use Notice of Proposed Rule Making released February 2012

Final Rule expected Summer 2012

Start Dates: October 2013/January 2014

HITECH Meaningful Use Framework

MU & EHR Adoption in Pediatrics

• Over $2B in Medicaid EHR Incentive payments made between 1/11 - 3/12 (Office of the National Coordinator, 2012).

• 2009: ~25% of pediatricians using an EMR (AAP Periodic Survey of Fellows, 2009 ; 2012 being fielded this fall).

• 2012: Over 50% of physicians using EHRs system

• ~16% of physicians working with Regional Extension Centers are pediatricians (Office of the National Coordinator, 2012).

MU Objectives

• Improve quality, safety, efficiency

• Reduction in health disparities

• Improve care coordination

• Ensure privacy and security of personal health information

• Improve population health and interact with public health programs

Key Differences in MU Stages

• Multiple Stage 1 objectives would be combined into more unified Stage 2 objectives Changes to seven objectives Elimination of two objectives

• CQMs would be aligned with existing quality programs (e.g. PQRS, NCQA, CHIPRA)

• CQM reporting would be part of the definition of “meaningful EHR user” instead of as a separate meaningful use objective

• Children in CHIP programs in States with Medicaid expansion (7) or combined Medicaid/CHIP programs (26 states) now count towards patient volume thresholds.

• The expansion of the current definition of "encounter" to also include any service rendered on any one day to an individual "enrolled" in a Medicaid program

AAP Advocacy

How is the AAP supporting How is the AAP supporting chapters with chapters with

HIT implementation?HIT implementation?

HIT Leadership Entities

• Child Health Informatics Center Serves as the AAP “home” for HIT initiatives

Directed by Christoph U. Lehmann, MD, FAAP (founding Medical Director)

Governed by an 7-person Project Advisory Committee (Chaired by Stephen Downs, MD MS FAAP)

• Council on Clinical Information Technology

Comprised of 500 members with special interest and training in applying HIT to pediatrics

11-member executive committee

Key Resources and Education

• Resources on EHR Adoption and Use www.aap.org/chic

•State Pages•Meaningful Use Resources•EMR Review Site (aapcocit.org/emr)

• Collaboration with the Office of the National Coordinator and Regional Extension Centers

Top 10 by Count

# AverageEncounterPRO 34 4.62Office Practicum 30 4.7NextGen EMR 13 2.46Amazing Charts 11 4.09eClinicalWorks 10 3.5Allscripts (formerly Misys) 7 2.57Centricity EMR (formerly Logician) 7 2.57Epic Ambulatory 7 4.43MEDENT EMR System 7 3.71Allscripts Enterprise 5 2.6Allscripts Professional 5 4e-MDs 5 4.6Noteworthy 5 4.2

Key Resources and Education

• 2012 NCE Educational ProgramsCOCIT H-ProgramThe Pediatric Office of TodayHIT Networking ForumHIT related general sessions

• Meaningful Use

• Pediatric Specific EHR Functionality EHR Vendor Consortium Regional Extension Centers (RECs)

• AAP Resources: Immunization Information Systems Toolkit Child Health Informatics Advocacy Brief HIT and Medical Home Fact Sheet

Advocacy

Vendor Consortium

• Investigate ways to partner with the vendor community to distribute AAP knowledge and expertise in an electronic format that can be linked to, or embedded within and EHR

• Includes 11 vendors• Areas for Collaboration

Advocacy around common pediatric forms Decision Support Based on Evidence Informed Guidelines ‐ Standardized pediatric vocabulary Improved implementation of Bright Futures Advancing the Medical Home and the development of patient facing

technologies to collect data Standardization of growth and specialty growth charts

How can AAP Chapters Support How can AAP Chapters Support Member Practices Member Practices

with HIT implementation?with HIT implementation?

AAP Chapters Can:

• Educate and spread learnings to chapter members

Recognize member successes (and lessons learned!)

Identify the needs of your members regarding HIT education & plan around those needs

• Encourage participation in Academy HIT initiatives & groups

• Encourage Advocacy at the Chapter member level

• Connecticut, Hawaii, Indiana, and Pennsylvania were awarded $4,000 to:

Provide education to help chapter members adopt/implement electronic health records.

Engage their regional extension centers (REC) and sharing of strategies for how members can access REC services.

Share pediatric specific success stories and challenges about EHR adoption.

Chapter Educational Grants

Chapter Educational Grants• ConnecticutConnecticut

Meaningful Use, incentive money, CT & pediatric specific EHR implementation, security of EMRs, Hall of Experts

• HawaiiHawaii Adoption of EHR for the solo practitioner

• IndianaIndiana Implementing Meaningful Use and EHRs in pediatric

practices with a specific focus on MU Stage 2• PennsylvaniaPennsylvania

Pediatric-specific support for EHR adoption and effective use

Considerations for AAP Chapters

• Develop an HIT committee or appoint a chapter champion

• Interact with your local Regional Extension Center (REC) or Health Information Exchange (HIE)

• Work with Immunization Information Systems at the state level to ensure optimal product development

Thank you !!

Appendix SlidesAppendix Slides

MU Stage 1 Objectives

• 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

• Increased expectations for health information exchange

• Greater use for e-Rx, incorporation of structured laboratory results, and exchange of patient care summaries across unaffiliated physicians, settings, and EHR systems

• Encourage the use of health IT for continuous quality improvement at the point of care

• Focus on patient engagement

NPRM for MU Stage 2 Objectives

Appendix: Implications for Pediatricians

• Record smoking status for patients 13 years old or older (core objective #5)

• Provide clinical summaries for patients for each office visit (core objective #7)

• Provide patients with the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP (core objective #12)

.

Appendix: States with Separate Child Health Plans

AlabamaArizonaColoradoConnecticutGeorgiaKansasMississippiNew YorkNevada

OregonPennsylvaniaUtahVermontWashingtonWest VirginiaWyoming Texas

Source: www.medicaid.gov