meaningful use of ehr in a pcmh lurio

8/8/2019 Meaningful Use of EHR in a PCMH Lurio

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10/5/2010 Joseph Lurio, MD. Institute for Family Health, [email protected] 1


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Joseph Lurio, M.D., F.A.A.F.P.

Chief Medical Information OfficerInstitute for Family Health


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The Institute for Family Health15 Community Health Centers

5 Bronx, 4 Manhattan,6 Mid-Hudson Valley

8 homeless healthcare sites2 School based health programs3 Dental centers3 Community Mental Health Centers2 Free Clinics

225,000 primary care visits70,000 patients

10/5/2010 3 Joseph Lurio, MD. Institute for Family Health, [email protected]


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E lectronic Health Record

Fully Installed December 2002



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W hy MeaningfulUse?

y Meta-Analysis Showssignificantimprovements inhealthcare providerperformance



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Effects of Computerized Clinical Decision SupportSystems on Practitioner Performance and PatientOutcomes. JAMA, 2005;293:1223-1238

CDSS Type NumberStudies

NumberDemonstratingImprovement

% StudiesDemonstratingImprovement

Diagnostic 10 4 40%

Reminder 21 16 76%

DiseaseManagement

37 23 62%

Drug Dose /Interaction

29 19 66%



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Federal Health InformationTechnology for Economic andClinical Health Act (HIT ECH)

y $ 27 billion over10 years

y Per ClinicianPayments

y

$ 63,750 (Medicaid)y $ 44,000 (Medicare)



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Meaningful Use For HITECH Certification?

Core Objectives (must satisfy all)y Structured Data:

y Patient Demographicsy Vital Signsy Med Allergies

y Problem Listy Med Listy Smoking Statusy Clinical/Discharge

Summaries for patientsy Electronic Copies of

Records for Patients

y ePrescribingy CPOE for medsy

Drug-Drug/Allergy Interaction Checingy Health Information

Exchangey

Clinical Decision Support(at least 1)y Data Security y Quality Measure Reporting

www.nejm .org/doi/pdf/10.1056/ NEJM p100611410/5/2010 10 Joseph Lurio, MD. Institute forFamily Health,


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Meaningful Use For HITECH Certification?

M enu Objectives (5 out of 10 )y Formulary Checksy Clinical Lab Results as

structured datay Patient Lists by

Condition (for Outreach,QI, Research, etc.)

y Patient SpecificEducation

y MedicationReconciliation

y Summary of Care Recordfor Patient

referral/transfery Advance Directivesy Electronic Data

Submission of

Reportable Diseasey Patient

Reminders/Notificationsy Patient Portal

www.nejm .org/doi/pdf/10.1056/ NEJM p100611410/5/2010 11

Joseph Lurio, MD. Institute for Family Health,

[email protected]


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W hy Patient Centered Medical

Home?y Improvements in:

y Quality of carey Patient experience andaccessy Work environmenty Reimbursement from

key payors (in somestates if recognized)

y Reductions in:y Costs related to

preventable, duplicativeandy Unnecessary carey ER visits/Inpatient stays

Deborah Johnson Ingram, CHCANYS & PCDC, July 2010http://www.chcanys.org/clientuploads/2010_pdfs/2-PCMH-Deep-Dive_DJI.pdf



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Patient Centered Medical HomeIncentives

y CMS/NYS reviewingthe potential rewardstructure

y Per visit payment of

$ 16.75y Per member per

month as high as $ 6



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NY State PCMH Incentive Paymenty For claims coded with

E&M and/or PreventiveMedicine codes

y For fee-for-service claimsy $ 5.50 for Level 1y $ 11.25 for Level 2y $

16.75 for Level 3

y For Medicaid Managed Care& Family Health Plus claimsy Plans receive $ 2/ $ 4/ $ 6

PMPM for Levels 1/2/3y Payments must go to recog-

nized practices; cannot beretained by Plans or rolledover to subsequent year

y Plans will provide details onpayout methody Payments for Level 1 will end

after December 2012Deborah Johnson Ingram, CHCANYS & PCDC, July 2010http://www.chcanys.org/clientuploads/2010_pdfs/2-PCMH-Deep-Dive_DJI.pdf

14 Joseph Lurio, MD. Institute for Family Health, [email protected]


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Overlap of Requirements =69%

NCQA PatientCenteredMedicalHome

HITECHMeaningful

Use



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W hat is Meaningful Use?



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W hat is N OT Meaningful Use?



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How it should look..



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Meaningful Use of ElectronicHealth Records in a NCQA Level 3 Patient Centered

Medical Home



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Decision support10/5/2010 20 Joseph Lurio, MD. Institute for Family Health, [email protected]


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Ex ample SmartSet10/5/2010 21 Joseph Lurio, MD. Institute for Family Health, [email protected]


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Allergy/Drug interaction Check



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eRx



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Patient Specific Education Materials



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Structured Lab Data



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Structured Lab Data manipulated



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Patient Portal



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Medline Plus



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Diabetes Smartset



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Patient Specific Goals



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Identify Barriers to Goal Implementation



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Patient Instructions Printed in After Visit Summary (AVS)



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Patient Lists by Condition



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Syndromic Surveillence

Marlena Plagianos, NYC DOHMH10/5/2010 36 Joseph Lurio, MD. Institute for Family Health,

[email protected]


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Preventive Care Results



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Colorectal Cancer Screening Results

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