HIT AND HIE IN THE STATE HIT AND HIE IN THE STATE OF MICHIGANOF MICHIGAN

Meghan Sifuentes Vanderstelt

HIT ManagerMichigan Department of Community Health

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DEPARTMENT OF COMMUNITY HEALTH2013 STRATEGIC PRIORITIES

MISSIONMDCH will protect, preserve, and promote the health and safety of the people of Michigan with particular attention to providing for the needs of vulnerable and under-served populations.

VISIONImproving the experience of care, improving the health of populations, and reducing per capita costs of health care.

STRATEGIC PRIORITIESImprove Population HealthTransform the System of CareReform the Health Care SystemTransform the Department of Community Health 

THE SIM OPPORTUNITY(State Innovation Model)

•Collaborating to create meaningful system change in order to

Improve CareImprove Health Outcomes

Reduce Costs

•Create a State Healthcare Innovation Plan (SHIP)• Funding to bring together a broad base of stakeholders to plan

an innovative, multi-payer and multi-sector health care delivery system transformation

•Testing and implementation funding anticipated

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Center for Medicare and Medicaid Innovation- CMS

State Innovation Model (SIM) &The State Healthcare Innovation Plan

(SHIP)

• Major deliverable – done by September

• SIM Advisory Committee asked to provide input:• Consider Michigan’s health system, payment models,

performance metrics “as is” and “to be”• Develop a roadmap for health system transformation

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Michigan’s Plan• Multi-payer, multi-stakeholder, multi-system approach to develop and

test comprehensive system reform• Invest in a lifetime of good health for people and communities

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Innovations being tested• MiPCT• Value Partnerships• Care Bridge• Health Information Exchange• Trailblazers• Community Linkages• Strengthen Public Health Infrastructure for Improved

Health Outcomes• Maternal and Child Health Initiatives• MI Healthcare Workforce Planning Team

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The Health Information Technology Commission

(HITC)

The Health Information Technology Commission is created within the department to facilitate and promote the design,

implementation, operation, and maintenance of an interoperable health care information infrastructure in this

state.

HIT Commission Public Act 137-2006

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HITC Job Description• Develop and maintain a strategic plan to guide implementation

of an interoperable health information technology system • Perform activities within HIT scope as directed by MDCH and

DTMB• ID strategies to improve ability to monitor health status

• Provide recommendations on policy to achieve HIT adoption• ID critical issues that affect private/public adoption

• Technical• Scientific• Economic• Governance• Other

• Increase public’s understanding of HIT• Promote effective and efficient communication among health

care providers:• Hospital, physicians, payers, employers, pharmacies, labs, and other

health care entities

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2013 HITC ObjectivesObjective: To recommend and advise the Michigan Department of Community Health on Policy decisions, business and technical needs, and general oversight for the following HIT activities

essential to the State of Michigan HIT and HIE landscape during 2013.

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Role of HIT and HIE Stakeholders

• Identify new and emerging best practices

• Provide input for evolving policy framework

• Collaborate and identify potential crossover opportunities

• Coordinate and further advance HIT and HIE in Michigan

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Vision beyond HIT and HIE

• Research • Quality improvement• Inspire confidence and trust in health IT• Empower the consumer to be more actively involved in their health care

• Improve population health

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Roadmap For Reforming The Healthcare System

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Michigan Medicaid EHR Michigan Medicaid EHR Incentive Program UpdateIncentive Program UpdateJune 5, 2013June 5, 2013

Jason Werner, MDCHJason Werner, MDCH

Program Summary

This ARRA funded program provides financial incentives (100% Federal) to eligible Medicaid professionals and hospitals to meaningfully use (MU) a certified EHR technology.

Program administration (90% Federal) is the responsibility of DCH.

Eligible Professionals:(Non-hospital based with at least 30% Medicaid volume)• Physicians/Pediatricians (20%)• Optometrists• Dentists• Certified Nurse Mid-wives• Nurse Practitioners• Physician Assistants (PA) practicing in a PA-led FQHC or

Rural Health ClinicHospitals:• Acute care -- at least 10% Medicaid volume• Children’s hospitals• Critical access hospitals

Who Is Eligible to Receive the Medicaid Incentive Payments?

Certified EHR Technology

Office of National Coordinator (ONC) maintains the list of complete EHRs and EHR modules that have been tested and certified. There are now 6 certifying bodies and over 3,000 certified products.Certified = Capable of meeting Meaningful Use (MU).

Meaningful Use Timeline

  Meaningful Use Stage

1st year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

2011 AIU 1 1 2 2 3 TBD TBD TBD TBD TBD

2012   AIU 1 1 2 2 3 TBD TBD TBD TBD

2013     AIU 1 1 2 2 3 TBD TBD TBD

2014       AIU 1 1 2 2 3 TBD TBD

2015         AIU 1 1 2 2 3 TBD

2016           AIU 1 1 2 2 3

Stage 1 vs. Stage 2

*Regardless of the stage of MU, all providers will complete this number of CQMs in 2014

Stage I

15 Core 5 of 10 Menu 6 of 44 CQM’s

Total of 26 Objectives

Stage II

17 Core 3 of 6 Menu *9 of 64 CQM’s

Total of 29 Objectives

Effective 4/20/2012 Effective 1/1/2014

Core Objectives Comparison

Core Objective Stage 1 Stage 2

1 CPOE Use CPOE for >30% of medications

Use CPOE for > 60% of medications, 30% of laboratory and 30% of radiology

2 e-Rx e-Rx for >40% e-Rx for >50%

3 Demographics Record demographics for >50%

Record demographics for >80%

4 Vital Signs Record vital signs for >50% Record vital signs for >80%

5 Smoking Status Record smoking status for >50%

Record smoking status for >80%

6 CDS Interventions Implement 1 clinical decision support rule. Drug/drug and drug/allergy is separate Core Objective in Stage 1

Implement 5 clinical decision support interventions and drug/drug and drug/allergy

7 Labs Menu Objective in Stage 1; Incorporate lab results for >40%

Incorporate lab results for >55%

8 Patient List Menu Objective in Stage 1; Must generate one report

Generate patient list by specific condition

Core Objectives Comparison

Core Objective Stage 1 Stage 2

9 Preventive Measures

Menu Objective in Stage 1; Reminders for follow up care for >20% of patients ≤ 5 or ≥ 65 years of age

Reminders for follow up care for >10% of patients with two or more office visits in the last 2 years

10 Patient Access Menu Objective in Stage 1; Provide online access to health information for >10% within 4 business days of EHR update

Provide online access to health information for >50% with >5% actually accessing

11 Visit Summaries Provide summaries for >50% of office visits within 3 business days

Provide summaries for >50% of office visits within 1 business day

12 Education Resources

Menu Objective in Stage 1; Provide education resources for >10% of all unique patients

Provide education resources for >10% of all unique patients

13 Secure Messages New for Stage 2 More than 5% of patients send secure messages to their EP

Core Objectives Comparison

Core Objective Stage 1 Stage 2

14 Medication Reconciliation

Menu Objective in Stage 1; Medication Reconciliation for >50% of transitions of care

Medication Reconciliation for >50% of transitions of care

15 Summary of Care

Menu Objective in Stage 1; Provide documents for >50% of transitions of care/referrals

Provide documents for >50% of transitions of care/referrals with 10% sent electronically. At least one is sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR

16 Immunizations Menu Objective in Stage 1; Perform one successful test transmission of immunization data

Successful ongoing transmission of immunization data

17 Security Analysis

Conduct or review security analysis and incorporate in risk management process

Conduct or review security analysis and incorporate in risk management process

Stage 2 – EPs must select 3 our of 6 Menu

Menu Objective Stage 1 Stage 2

1 Imaging Results New for Stage 2 More than 20% of imaging results are accessible through CEHRT

2 Family History New for Stage 2 Record Family History for >20%

3 Syndromic Surveillance

Successful ongoing transmission of syndromic surveillance data

Successful ongoing transmission of syndromic surveillance data

4 Cancer New for Stage 2 Successful ongoing transmission of cancer case information

5 Specialized Registry New for Stage 2 Successful ongoing transmission of data to specialized registry

6 Progress Notes New for Stage 2 Enter an electronic progress note for >30% of unique patients

CQMs in 2014 and Beyond

CQM Changes in 2014

Provider Prior to 2014 2014 and Beyond*

EPs Complete 6 out of 44

•3 Core or 3 Alternate core•3 Additional CQMs

Complete 9 out of 64

Choose at least 1 measure from 3 of 6 NQS domains

*Regardless of the stage of MU, all providers will complete this number of CQMs in 2014

Auditing

MDCH is responsible for the auditing function including Meaningful Use (MU)To help with the audit function related to MU Public Health testing, MDCH has created a MU repository

What is this MU Repository?

Tool used by the Michigan Department of Community Health (MDCH) to track providers in the State of Michigan that wish to meet electronic public health reporting meaningful use requirements.

Medicare?

CMS is running a similar program for Medicare providers.Professionals can only claim one incentive program (either Medicaid or Medicare).Very similar eligibility criteria.10,991 Medicare providers have registered with 8,121 having received a payment.

Incentive Payment for Eligible Professionals

First Calendar Year in which the EP receives an Incentive Payment

Calendar Year

CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016

2011 $21,250

2012 $8,500 $21,250

2013 $8,500 $8,500 $21,250

2014 $8,500 $8,500 $8,500 $21,250

2015 $8,500 $8,500 $8,500 $8,500 $21,250

2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250

2017 $8,500 $8,500 $8,500 $8,500 $8,500

2018 $8,500 $8,500 $8,500 $8,500

2019 $8,500 $8,500 $8,500

2020 $8,500 $8,500

2021 $8,500

Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

Incentive Payment for Eligible Hospitals

Payments are formula driven and will vary per hospital.Most hospitals will receive between $1-$3 million.Payments are made over 3 years at a 50%, 40%, 10% ratio.MDCH will utilize cost report data in deriving the incentive amount.

Registrations/Payments

As of 5/29/2013

  Registered

Paid Under

AIU

Paid Under

MUTotal

PaymentsDollars Paid (In Millions)

EP 3,756 2,516 431 2,947 $55.6

EH 117 93 50 143 $108.6

Totals 3,873 2,609 481 3,090 $164.2

What the rest of 2013 holds?

Launching Stage II of MUGetting Registration System ReadyGetting Public Health Registries ReadyGetting MU Repository Ready (MSSS, Cancer, CDR)

Increasing MU Adoption RatesElectronic Clinical Quality Reporting

www.MichiganHealthIT.org

Questions?