Electronic Medical Records and Meaningful Use
- 1. Electronic Medical Records and Meaningful Use 2011 PACAH Annual Conference Seven Spring Mountain Resort Thursday October 27, 2011 Electronic Medical Records and Meaningful Use William “Buddy” Gillespie Director Healthcare Solutions Distributed Systems Services
- 2. William ‘Buddy’ Gillespie Mr. Gillespie is currently the Director of Healthcare Solutions for Distributed Systems Services (DSS) a PA based corporation which provides a broad portfolio of technology solutions that drive business value including a world-class tier III data center and professional services for Collaboration, Virtualization, and Networking. His responsibilities include direct consulting with clients, assessing and improving healthcare solution offerings, helping drive the DSS brand into the healthcare community, and initiating relationships with hospitals and practices for future business development. Mr. Gillespie is the former (retired) Vice President, Chief Technology Officer and CIO Emeritus at WellSpan Health, an integrated delivery system based in York, Pennsylvania. WellSpan has been named a Top 100 Most Wired and a Top 25 Best Connected health system six-years running. Gillespie joined WellSpan Health in 1996 after serving as vice president of information services at Allegheny General Hospital in Pittsburgh. He has been active in healthcare informatics for more than 25 years in both the development and implementation of technology solutions. He also serves on the PAeHI Board where he is Chair of the Health Information Exchange Committee. Mr. Gillespie can be contacted at: [email protected]
- 3. Electronic Medical Records and Meaningful Use • Since the HITECH Act was passed as part of the ARRA in February 2009, healthcare providers have been on a fast track to implement the Electronic Medical Record and achieve Stage I Meaningful Use.
- 4. Electronic Medical Records and Meaningful Use • In the wake of this activity hospitals and physicians have been faced with the daunting task to not only acquire and implement the EMR technology but also change the existing clinical process.
- 5. Electronic Medical Records and Meaningful Use • The presentation will reflect on the definition of the EMR/Meaningful Use: –What is it? –Who qualifies? –What are the incentives? –What do hospitals and physicians need to do to qualify?
- 6. Electronic Medical Records and Meaningful Use What Progress Has Been Made and What Challenges Lie Ahead With the Advent of Stage II & III and Healthcare Reform?
- 8. Healthcare Spending • The Centers for Medicare and Medicaid services estimate that nearly 18% of Medicare patients are re-hospitalized within 30 days of discharge and that 13% of all admissions costing $12 billion dollars are potentially avoidable Evidence on the Costs and Benefits of Health Information Technology. Congressional Budget Office
- 9. HIT Drivers Homecare • Home Health Care • Telemedicine • Remote Patient Monitoring • Fiber Mobile Devices/ Wireless Access • iPAD • Other Slate Devices • Smart Phones • Security • BIOMED Devices- Integration with Electronic Health Record Homecare Restructure of Medical Records Department • Health Information • Management • Reporting Relationship • Patient Portal ETL & Analytics • Cloud Hosting • ONC – MU Templates • Data Warehouse Meaningful use •Three Stages •Physician Adoption •Regional Extension Centers HIPPA 5010 • 2012
- 10. HIT Drivers Clinical Documentation and CPOE • Multiple vendors with semi- mature to mature products • Still only small percent adoption by hospital physicians • A couple of well-publicized failures/difficult starts • Studies of ROI and safety benefits are mixed • Doc’s don’t want to be data entry clerks, slowed down or continually warned about the obvious • e-prescribing gaining steam • Part of Meaningful Use! Quality measures • Six-Sigma • Clinical Decision Support • Analytics HITECH Privacy & Security • Fraud/abuse litigation increase • Breaches on the rise • OCR website list of breaches • Breach Notification • Cost • Insurance • Single Sign-on – Account Provisioning • Encryption • Portable devices • USB devices
- 11. HIT Drivers Medical Home • Smart Medical Devices Accountable Care Organizations (ACOs) • Rules Published • Reduced Revenue • Cost pressure from downward revenue trend • First 3-years during start up • Collaboration • HIE Role • Competition vs. cooperation between providers • Hospital • Physician • Coordinated services and Patient Experience • Patient role/provider-patient relationship Mergers & Acquisitions • Vendors • Technical • ISPs • Payers into clinical and HIE market • Providers • Hospitals • Physicians • Payers • Payers buying HIE vendors Other • Disease management • Evidence-based medicine • Personalized medicine • Genetic testing • Value-based Reimbursement • Individual insurance growth • Medicare payment cuts • Medicaid expansion
- 12. Hospitals Physician Practices Clinics Patients Electronic Medical Record Enterprise Person Identifier One System – One Patient – One Record Right Patient – Right Record
- 13. EMR Investment • 2009: $2 billion • 2015: $3.8 billion • 2020: $ ?
- 15. What is Meaningful Use? Three Primary Components: • Use of a Certified EMR in a Meaningful Manner • Use of Certified EMR Technology for Electronic Exchange of Health Information to Improve Quality of Healthcare (HIE) • Use of Certified EMR Technology to Submit Clinical Quality and Other Measures (Analytics)
- 16. HIT Policy Committee - MU Goals – Improve quality, safety, efficiency, and reduce health disparities – Engage Patients and Families – Improve Care Coordination – Ensure adequate privacy and security protections for personal health information – Improve Population and Public Health
- 17. Purpose of Meaningful Use • Improve Quality, Safety, and Efficiency of Patient Care • Engage Patients and Families • Improve Care Coordination & Patient Experience • Ensure Privacy and Security Protection for Personal Health Information (PHI) • Improve Population Health
- 18. Building Blocks to Better Outcomes Source: HIT Policy Committee meeting, June 8, 2011
- 19. HITECH - MU Timeline
- 20. MU Stage I Requirements • What are the requirements for Stage 1 of Meaningful Use (2011 and 2012)? – Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals as well as Clinical Quality Measures • For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met. – There are 15 required core objectives. – The remaining 5 objectives may be selected from the list of 10 menu set objectives.
- 21. MU Stage I Requirements • Stage 1 Requirements: – Computerized physician Order Entry (CPOE) – Patient visit summaries – One Health Information Exchange Transaction – ePrescribing – Drug-Drug interaction checks – Maintain active Med List • List of patient Med allergies, – diagnoses, demographics, vital signs, smoking status – Electronic copy of records to patients – HIPAA Compliance – Submit quality reports/analytics to CMS – Implement one Decision Support rule
- 22. MU Critical Success Factors • Continuously keep an eye on your Stage I plans and metrics and tweak workflow and process as necessary to remain not only compliant but so it becomes almost seamless • While CPOE in Stage 1 is limited to Medication orders and ties in with several other objectives (Meds Reconciliation, Medication Lists) it will expand. Do CPOE the right way (ensure your compendiums or orders catalogs are physician friendly etc) so your Providers are ready to enter all orders
- 23. MU Critical Success Factors • Stay in close contact with your vendor and make sure they certify against Stage II as soon as possible, regardless of your plans to attest to Stage I • Become engaged in your state HIE and REC programs. Participating will eventually become a MU objective and early engagement ensures you have a voice and are ready
- 24. MU Challenges • Inter-Professional, Collaborative Patient- Centered Care • Workflow & Hand-Off Issues • Effective Use of Technology • Change Management • Evidence-Based Care • Quality Improvement Programs • Adoption of Technology
- 25. HIMSS EMR Adoption Model Hospitals continue to move up the HIMSS Analytics EMR Adoption Model
- 26. Meaningful Use Incentives for Hospitals • $2,000,000 base payment plus –$200/Medicare discharge –Year 2 - 4 drop from 75% to 50% to 25% of Year 1 • 4 Year cap of $11,000,000
- 27. Meaningful Use Incentives for MDs • 2011 - $18k • 2012 - $18k • 2013 - $15k • 2014 - $12k • 2015 - $ 2k –Total $65k • 2016 - Owe Penalties
- 28. MU Stage I Payout • Paid out September 2011: –$652,000,000 –99,000 Registered
- 29. MU Stage II • Stage II Requirements: –Align Meaningful Use (MU) objectives with National Quality Strategy priorities –Ensure MU lays adequate HIT infrastructure to achieve delivery system changes required for Affordable Care Act (ACA) reforms –Ensure technical and implementation feasibility –Encourage and reward early adopters
- 31. Health Information Exchange • Community/Local • IDN/Regional • Statewide
- 32. The 50,000 Foot View of a HIE Infrastructure Health Care Provider or Population Health User Requests Data from the HIE. If Authorized, Patient Data Viewed on HIE Website Portal or in Provider’s Certified Electronic Health Record Product. HIE Procured Application and Hosted Services Hospital Pharmacy Benefit Manager Medicaid Payer System Department of Health State Level Systems Payer System RHIE Lab Diagnostic Imaging Health System Many Touch Points Supply Procured Application with Patient Data 1. Security and Privacy 2. User Provisioning 3. Enterprise Master Patient Index 4. Record Locator Service 5. Data Display, Usage, and Interoperability Internet Based Access 24 x 7 x 365 Availability Security and Privacy Backup and Recovery Hardware and Software Customer Service Supported by Interfaces and Data Usage and Reciprocal Sharing Agreements National Health Information Network
- 33. PA eHealth Collaborative – Governor Corbett issued Executive Order 2011-04 on July 27, 2011 establishing PA eHealth Collaborative • Executive Council • Advisory Committee • PA eHealth Collaborative Office
- 34. PA eHealth Collaborative • March, 2011 Operational Plan approved by ONC with limited access to implementation funds pending reengagement of stakeholders and development of a detailed plan. • Funding Available = $17,140,446 – Match Requirements: – 10% 2/1/2011 - 1/31/2012 – 14% from 2/1/2012 – 1/31/2013 – 33% from 2/1/2013 – 2/7/2014 – Private sector contributions and in-kind services can be used to help with match. • Revised strategic and operational plans, endorsed by stakeholders, need to be developed by January, 2012. • Governance model needs to be established by July 1, 2012
- 35. PA eHealth Collaborative – Per ONC-HIE-Program Information Notice (PIN)-001 • Must enable point to point exchanges in 2011 (Direct Project) • Must address: – Gaps in use of e-prescribing by pharmacies – Gaps in the ability of independent labs to send structured lab results electronically – Gaps in provider ability to electronically share patient care summaries across unaffiliated organizations.
- 36. PA eHealth Collaborative – Re-launched project with a stakeholder planning session on July 26 and 27, 2011 • 134 individuals participated representing many sectors of the healthcare industry and consumers • Compiled information from our planning session • Received positive feedback on re-launch efforts; particularly level of information provided, degree of stakeholder engagement and commitment to transparency • Organized 5 working committees and began work
- 37. What is the Direct Project? – What is the Direct Project? • The Direct Project is an open government initiative started by the Department of Health and Human Services’ Office of the National Coordinator (ONC) for Health Information Technology. • The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.
- 38. What is the Direct Project? – In simple layman’s terms: • A Direct Project implementation encompasses packaging message content, securing it, and transporting it from one location to another; basically, in a form of “secure email.” • The Direct Project focuses on the technical standards and services necessary to securely push content from a sender to a receiver and not on the actual content exchanged. • The Direct Project seeks to benefit patients and providers by improving the transport of health information, making it faster, more secure, and less expensive. • The Direct Project seeks to facilitate “direct” communication patterns with an eye toward approaching more advanced levels of interoperability than simple paper can provide. • The Direct Project itself will not enable health information exchange (HIE) services.
- 39. Summary • Meaningful Use has a long road ahead with many challenges including EHR adoption, competing projects, sustaining technology and costs. • HIT Infrastructure is expanding and will be difficult to sustain. • HIT Drivers come in many forms – including mobile devices, meaningful use, HIE and shifts to the cloud. • Each driver has specific technology needs making it difficult to focus and strategize.
- 40. Thank youThank you Questions & Discussion Electronic Medical Records and Meaningful Use
- 41. Contact Information For additional information, please feel free to contact: • William “Buddy” Gillespie [email protected] (717) 891-0550