information technology compliance, solutions & trends abc conference tampa florida january 2011
TRANSCRIPT
Information Technology Information Technology Compliance, Solutions & Trends Compliance, Solutions & Trends
ABC ConferenceABC Conference
Tampa FloridaTampa Florida
January 2011January 2011
Health Information Consulting, LLCHealth Information Consulting, LLC
Mike Mytych BioMike Mytych Bio
35 year career in healthcare
20 years in Consulting with an emphasis on clinical systems and focus on physician adoption of I/T
Clients range from small physician groups to large multi-hospital organizations
Conducted over 200 vendor selections for both hospitals and physicians with over 50 cardiology engagements ranging from small practices to complete heart hospital I/T strategies
Worked with 6 major HIEs including Chicago, Minneapolis, Wisconsin, Washington DC, New York City
Spent 15 years in the vendor community and is former VP of Sales for the physician systems division at Baxter
Adjunct Faculty member at University of Wisconsin Milwaukee Healthcare Informatics Graduate program teaching Healthcare I/T Procurement
Health Information Consulting, LLCHealth Information Consulting, LLC
Provide industry education for CDW, GE and NextGen in partnership with Wakerly Partners and C-Suite Resources− We do not provide competitive analysis or benchmarking to any
vendor
Participate on 3 investor advisory company panels for publically traded company assessment and prohibited from disclosing any information that is not included in the public domain.
DisclosureDisclosure
Health Information Consulting, LLCHealth Information Consulting, LLC
What are the key I/T drivers for today's practice?
Impact of ARRA / HITECH / Healthcare Reform on impact on I/T decisions.
What are the critical EMR/EHRs – CV Requirements?
What will the future look like for the CV Practice ?
Today’s ObjectivesToday’s Objectives
Health Information Consulting, LLCHealth Information Consulting, LLC
EMR Today?
Buying an EMR?
Integrated with Hospital?
Integration Discussions?
Audience SurveyAudience Survey
Today’s Key I/T DriversToday’s Key I/T Drivers
Health Information Consulting, LLCHealth Information Consulting, LLC
ARRA / HITECH Meaningful Use Rules
Hospital Integration – Care Coordination
Documenting care that enables quality / performance assessment
Maintaining reimbursement and getting greater operational efficiency
I/T DriversI/T Drivers
Health Information Consulting, LLCHealth Information Consulting, LLC
Driving Practice I/T DecisionsDriving Practice I/T Decisions
EHRs and Meeting Meaningful Use
Integration with Hospitals
PM System Decisions
Cardiology PACS
HIPAA Compliance
Regulatory/Quality Measure Compliance
PQRI and eRX Incentives
Device Upgrades & Integration
Preparing for Health Reform and participating in ACOs & Health Information Exchange
Others, ICD10 etc.
Health Information Consulting, LLCHealth Information Consulting, LLC
Decisions - DecisionsDecisions - Decisions
There is a lot to get done !
Priorities
Resources
Timing
Timeline
Dependencies
Health Information Consulting, LLCHealth Information Consulting, LLC
Questions We Hear…Questions We Hear…
With all that is happening around us, what are my best options for a good long term decision regarding I/T?
How can I optimize the use of systems for better patient care and provider satisfaction without losing productivity?
How can I minimize wasteful decisions?
Will the government programs like HITECH be changed substantially in the near future?
Will my integration with a hospital change the way my providers will utilize EHRs?
What is an HIE, is it real and when do I need to participate?
Dozens of others…
ARRA – HITECH Compliance ARRA – HITECH Compliance Have a Road Map as to How you Have a Road Map as to How you get there & Operate under the get there & Operate under the new Rulesnew Rules
““I don't like mysteries. They give me a I don't like mysteries. They give me a bellyache and I got a beauty right now.” bellyache and I got a beauty right now.” James James KirkKirk
Health Information Consulting, LLCHealth Information Consulting, LLC| 12 |
Non-compliance Is An Expensive ChoiceNon-compliance Is An Expensive Choice
2011 is the first year for partial qualification for meeting Meaningful Use (Stage 1)
2013 and 2015 will have different rules that build out toward the HITECH objectives (Stage 2 and Stage 3) and the preliminary objectives were released January 2011
Physicians and hospitals must meet government’s definition of meaningful use of Electronic Health Records (EHR) Technology” in order to be paid their bonuses or be prepared to have the penalties kick in in 2015.
Health Information Consulting, LLCHealth Information Consulting, LLC
Refresh - “Meaningful Use”Refresh - “Meaningful Use”
| 13 |
Meaningful use is defined as:
Use of a certified EHR in a meaningful manner (ex: clinical documentation, e-prescribing, etc.)
Use of certified EHR technology for electronic exchange of health information
Use of certified EHR technology to submit clinical quality and other measures.
To insure Meaningful Use and to ensure continued adoption and subsequent use of the EHR there are specific rules for demonstration of that use.
Health Information Consulting, LLCHealth Information Consulting, LLC
Reporting Requirements Summary Reporting Requirements Summary
Requirements vary based on whether the applicant is an “eligible professional” or eligible hospital.”
Reporting Period –for any consecutive 90 days for first year; one year subsequently
For 2011 –Providers required to submit summary quality measure data to CMS or States by attestation
For 2012 –Providers required to electronically submit quality measure data to CMS or States
| 14 |
Health Information Consulting, LLCHealth Information Consulting, LLC
ARRA/HITECH− Meaningful Use 2011 – 2013 – 2015− Medicare Penalties 2015+− Data Analytics
Setting the Stage for Healthcare Reform− Increased utilization demand from the uninsured/underinsured− Changes in plans / employer offerings− Bundled payments – reward for quality performance− Quality / outcomes evolution − Medical Home− Development and operation of ACO's − Comparative Effectiveness
Nationwide goal to remove cost from the delivery system while improving quality
The March Toward ReformThe March Toward Reform
Health Information Consulting, LLCHealth Information Consulting, LLC
Data and More DataData and More Data
16
Point of Care
CV Data
EHRs and Meaningful UseEHRs and Meaningful Use
Health Information Consulting, LLCHealth Information Consulting, LLC
• When should we buy?
• Who is the right vendor?
• Can they get us to meaningful use?
• Do we have time for PM?
• Who will help us through all of these changes?
Leadership ConcernsLeadership Concerns
Health Information Consulting, LLCHealth Information Consulting, LLC
Meaningful Use ImplicationsMeaningful Use Implications
• Physician clinics will have to carefully assess their ability to meet meaningful use by 2011/2012.
• Just having an EHR does not mean that a clinic will meet the criteria.
• Each physician’s group will need to understand what it will take to have the required interoperability, system interfaces, data standards and timeline requirements.
• Physicians may be invited to participate in HIE technologies offered by the Hospitals to assist in complying with Meaningful Use criteria.
• Few Physician Clinics have integration or interchange with Imaging systems for movement of diagnostic reporting (PACS, CPACS, RIS).
Health Information Consulting, LLCHealth Information Consulting, LLC
Common Questions from those who Common Questions from those who already have an EMR?already have an EMR?
1. Is my vendor certified?
2. What is the current state of implementation and quality of use by my clinicians? (still using dictation?)
3. What gaps do we have to complete the EHR implementation (eRx & Lab are key)
4. Are we capturing the required discreet data?
5. Lab results are discreet and complete?
6. Interchange capabilities with our referring physicians and hospitals?
Health Information Consulting, LLCHealth Information Consulting, LLC
MU is not just about EHRMU is not just about EHR
Unless you are the only practice on an island, no one vendor can enable the physician to meet meaningful use.
The stimulus law compels the creation of ways to exchange health information within states and across a nationwide HIT infrastructure…
Cardiovascular Patient Records and related discrete data are a primary target of these efforts…
http://govhealthit.com/newsitem.aspx?nid=72400
21
Health Information Consulting, LLCHealth Information Consulting, LLC
Reporting – QC what you can do and how you are measuring up to the standards
Know how data is generated and by whom
Change behavior to become compliant
MU ComplianceMU Compliance
EHR’s for the CV PracticeEHR’s for the CV Practice
Health Information Consulting, LLCHealth Information Consulting, LLC
Vendor Certification
PM Vendor
Hospital Vendor
Vendor Stability
Cost
Performance
Others
Vendor Selection ConsiderationsVendor Selection Considerations
Health Information Consulting, LLCHealth Information Consulting, LLC
Surescripts LLC - Arlington, VADate of authorization: December 23, 2010.Scope of authorization: EHR Modules: E-Prescribing, Privacy and Security.
ICSA Labs - Mechanicsburg, PADate of authorization: December 10, 2010.Scope of authorization: Complete EHR and EHR Modules.
SLI Global Solutions - Denver, CODate of authorization: December 10, 2010.Scope of authorization: Complete EHR and EHR Modules.
InfoGard Laboratories, Inc. – San Luis Obispo, CADate of authorization: September 24, 2010.Scope of authorization: Complete EHR and EHR Modules.
Certification Commission for Health Information Technology (CCHIT) - Chicago, ILDate of authorization: September 3, 2010.Scope of authorization: Complete EHR and EHR Modules.
Drummond Group, Inc. (DGI) - Austin, TXDate of authorization: September 3, 2010.Scope of authorization: Complete EHR and EHR Modules
EHR Vendor CertificationEHR Vendor Certification
http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3120
Health Information Consulting, LLCHealth Information Consulting, LLC
Currently 193 vendor products are certified
Not all are comprehensive EHRs
Very few offer a comprehensive CV EHR
Make sure your vendors are certified and contractually commit to remaining certified
http://onc-chpl.force.com/ehrcert/EHRProductSearch
Certified VendorsCertified Vendors
Health Information Consulting, LLCHealth Information Consulting, LLC
EHR Evaluation Considerations EHR Evaluation Considerations
Performance
• Depth in Cardiology and Interoperability
• Ability to interoperate with others
• Patient identity management
• Inbound unsolicited data management
• Market share in your region
• Validation of capability and contractual commitment
• Pre-contract integration and interoperability plan
Health Information Consulting, LLCHealth Information Consulting, LLC
EHR Implementation TimelineEHR Implementation Timeline
Total: 6 to 16 months depending on resources, size of group, PM integration and other variables.
1 to 3 months 1 to 2 months 2 to 4 months 1 to 3 months 1 to 4 months
Health Information Consulting, LLCHealth Information Consulting, LLC
Summary Physician / EHR requirementsSummary Physician / EHR requirements
Meeting Cardiology Workflow
Flexibility of design / settings
Interfaces with Devices – Patient ID, Orders, Results− CPACS− PaceArt− Others
Comprehensive “one-stop shopping” for all patient records components from the patient summary screen with individual settings
Integration into clinic workflows− Nursing triage− Physician in-box of new records / results
Ease of mapping to existing records – both paper and electronic, patient identifiers
Ease of validation of data prior to upload into the permanent record from outside systems
Key Focal Points
Interoperability - Your Device Integration
− Echo, ECG, Stress, Holter, Nuclear, CT, PV, etc.
Specialty Clinics: Limpid, AntiCoag, Device, CHF, etc.
Lab Interfaces -
Quality Data / Measures – how is data collected
Effective Clinical Decision Support – documentation of non-std events
Executive Reporting / ease of use
29
Health Information Consulting, LLCHealth Information Consulting, LLC
Mapping to your ACO partners
Management of change to national standards
Health Information Exchange Requirements – Regional, State, Enterprise
Referral coordination for exchange – changes in workflows
Patient / Consumer Compliance Requirements – access to electronic copies of their records
Others
Other RequirementsOther Requirements
Health Information Consulting, LLCHealth Information Consulting, LLC
Component Early Developing Sustainable Supporting I/T
Member Engagement
Episode of Care Pre-care intervention Prevention:Lifestyle coaching; Remote monitoring
CRMHRAPatient ID Mgt
Cross Continuum Medical Management
Case Management Care Coordination Disease Management & Health Maintenance
Patient ID MgtProvider DirectoryConsent Mgt.Disease RegistriesEMR
Clinical Information Exchange
Read only access; User request – pull
Push & PullCCD
Dynamic context sharing; Patient access
EMR w/ CCDPatient ID Mgt.Provider DirectoryHIE
Quality Reporting Manual entry into Excel
EHR feed to Quality DB Real time access to data Data dashboardsExecutive reporting
EMR w/ Clinical Documentation Analytical Data Warehouse
Business Intelligence/ Predictive Modeling & Analytics
Patient focused; Episode & encounter focused data; retrospective clinical and financial data
Population based; continuum of care data; predictive health analytics
Social and network data; Behavior based analytics; Real time data analysis
Analytical Data Warehouse – cross continuumClinical DashboardComparative Effectiveness Analytics
ACO Risk & Revenue Management
Cost accounting across the continuum of care; global contracting; member data management
Provider management; allocation of payment
Pool management; disease improvement
RCM for ACOAnalytical Data Warehouse
Example of ACO I/T RequirementsExample of ACO I/T Requirements
Health Information Consulting, LLCHealth Information Consulting, LLC
Hospital bias toward enterprise system choices
Lack of granular understanding of practice workflows, requirements
Nomenclature and data integration and normalization between hospitals and physicians
Patient identifiers between hospitals and clinics
Orders being received by hospitals from physician EHRs
Physician use of multiple clinical documentation systems
Hospital portal access and download of data to EHR
Hospital links to office EHR via web− Images− Security issues
Enterprise Data Analytics – common clinical model − E.g. Marshfield Semantic interoperability project
Example - Hospital / Physician Example - Hospital / Physician Integration Integration
Health Information Consulting, LLCHealth Information Consulting, LLC
Lab Information Systems – reference labs, hospitals etc.− Orders− Results− Status
Pharmacy− Outbound eRx to Retail− Outbound patient record to
hospital – active meds− Inbound patient history –
CCD− Inbound patient active meds –
hospital discharges – medication reconciliation
Documents− Outbound CCD/CCR− Outbound referral request− Outbound referral results
(CCD)
Imaging− Links to Hospital PACS from
hospital results records− Links to Clinic PACS from
hospital devices
Orders / Results – Hospitals− Radiology− Cardiology − Others
Example: Physician EHR Environment Example: Physician EHR Environment Summary HIE RequirementsSummary HIE Requirements
Health Information Consulting, LLCHealth Information Consulting, LLC
Have a plan as to how you will make your decision
Include as many clinicians and operations members as you can
Map all of the your detailed requirements to what the vendor says they can do and make sure they are transferred into the contract
Don’t rush your decision
Speak to as many references as you can
Don’t sign their standard contract
Buying an EHRBuying an EHR
Health Information Exchange Health Information Exchange & & Care CoordinationCare Coordination
Health Information Consulting, LLCHealth Information Consulting, LLC
Health Information Consulting, LLCHealth Information Consulting, LLC
Data and Information Exchange Data and Information Exchange
Point of Care
Clinical Information /
Data
Care Continuum
Health Information Consulting, LLCHealth Information Consulting, LLC
Health Information Exchange (HIE)Health Information Exchange (HIE)
Definition: HIE refers to the process associated with the electronic movement of health-related data and information among organizations at the community, regional, statewide, or nationwide levels according to agreed standards, protocols, and other criteria.
Health Information Consulting, LLCHealth Information Consulting, LLC
Health Information Exchange (HIE) Health Information Exchange (HIE)
Primary Functions:
Health Information
ExchangePlatform
Long TermCare
PHYSICIAN
HOSPITALS
LAB
GROUPPRACTICE
Imaging Center
OTHER HIE’s
Rx
Consumer
• Secure clinical information sharing
• Coordination of care• Support Accountable Care
Organizations• Quality and health status
reporting• Shared platform
State of IL
Public Health
Health Information Consulting, LLCHealth Information Consulting, LLC
Cardiovascular HIE RequirementCardiovascular HIE Requirement
Cardiovascular groups will be a significant target for health information exchange over the next 2 years with target for implementation by 2013 (Stage 2)
Coordination of care and reduction of duplicate testing are the primary objectives
ED access to CV patient records – Wisconsin Study
CCD exchange
PHR service
Health Information Consulting, LLCHealth Information Consulting, LLC
Physician EHR Environment Summary HIE Physician EHR Environment Summary HIE RequirementsRequirements
Lab Information Systems – reference labs, hospitals etc.− Orders− Results− Status
Pharmacy− Outbound eRx to Retail− Outbound patient record to
hospital – active meds− Inbound patient history –
CCD− Inbound patient active meds –
hospital discharges – medication reconciliation
Documents− Outbound CCD/CCR− Outbound referral request− Outbound referral results
(CCD)
Imaging− Links to Hospital PACS from
hospital results records− Links to Clinic PACS from
hospital devices
Orders / Results – Hospitals− Radiology− Cardiology − Others
Health Information Consulting, LLCHealth Information Consulting, LLC
EMR - MU – Stage 1, 2 & 3 - CV
Patient Centric Care Coordination Processes
HC Reform Rule Flexibility
ACO Development
Data supports Quality Outcomes
Consumer Focus & Engagement
ConclusionsConclusionsDawn of a New EraDawn of a New Era
Health Information Consulting, LLCHealth Information Consulting, LLC
Thanks !Thanks !
Health Information Consulting, LLC
Mike Mytych
262-253-9110