electronic medical records and meaningful use

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

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]


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.


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.


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?


Meaningful Use

What Progress Has Been Made and

What Challenges Lie Ahead With the

Advent of Stage II & III and

Healthcare Reform?

Healthcare Spending

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

HIT DriversHomecare

• 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

HIT DriversClinical Documentationand 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

HIT DriversMedical Home• Smart Medical Devices

Accountable CareOrganizations (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

Hospitals

Physician

PracticesClinics

Patients

Electronic Medical Record

Enterprise Person Identifier

One System – One Patient – One Record

Right Patient – Right Record

EMR Investment

• 2009: $2 billion

• 2015: $3.8 billion

• 2020: $ ?

HIMSS Survey-Priorities

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)

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

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

Building Blocks to Better Outcomes

Source: HIT Policy Committee meeting, June 8, 2011

HITECH - MU Timeline

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.

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

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

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

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

HIMSS EMR Adoption Model

Hospitals continue to move up the HIMSS Analytics EMR Adoption Model

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

Meaningful Use Incentives for MDs

• 2011 - $18k

• 2012 - $18k

• 2013 - $15k

• 2014 - $12k

• 2015 - $ 2k

–Total $65k

• 2016 - Owe Penalties

MU Stage I Payout

• Paid out September 2011:

–$652,000,000

–99,000 Registered

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

Health Information Exchange

Health Information Exchange

• Community/Local

• IDN/Regional

• Statewide

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

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


• 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


– 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.


– 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

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.

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.

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.

Thank youThank you

Questions & Discussion


Meaningful Use

Contact Information

For additional information, please feel free to contact:

• William “Buddy” Gillespie

[email protected]

(717) 891-0550