what did i work on in washington?
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What Did I Work on in Washington?. John Glaser April 16, 2010. Transformational Change in Health Care Delivery & Population Health. Electronic Health Records as a Foundation. Technology Adoption. 2012?. TIME. 2004. EHR Adoption in Physician Office Practices. 25. 100. 20. 80. - PowerPoint PPT PresentationTRANSCRIPT
What Did I Work on in Washington?
John Glaser
April 16, 2010
Electronic Health Records as a Foundation
TIMETIME
Transformational Change in Health Care Delivery & Population Health
Technology Adoption
20042004 2012?2012?
100
80
60
40
20
0
9%
50%
Size of Practice
> 50 physicians
Per
cent
age
1 - 3physicians
DesRoches CM et al., N Engl J Med 2008;359:50-60.
25
20
15
10
5
0
4%
13%
Level of EHR Function
Fully Functional
Basic System
Per
cent
age
EHR Adoption in Physician Office Practices
American Recovery and Reinvestment Act (ARRA)
Title XIII $2B to the Office of the
National Coordinator for Health IT to develop the foundation necessary for broad adoption of EHRs
Title IV $23B in Medicare and
Medicaid financial incentives to providers who are Meaningful Users of certified, interoperable EHRs (first payment year FY 2011)
The Core Idea
Adoption
Meaningful Use
Outcomes
Examples of Meaningful Use
Maintain an up-to-date problem list of current and active diagnoses
At least 80% of patients seen or admitted have at least one entry
Record smoking status for patients 13 and older
At least 80% of patients seen or admitted have “smoking status” recorded
Send reminders to patients per patient preference for preventive/follow-up care
Reminders sent to 50% of all patients seen that are over 50 years old
Provide patients with an electronic copy of their health information
At least 80% of patients who request an electronic copy are provided it within 48 hours
Provide summary of care record for each transition of care or referral
Summary provided for at least 80% of all transitions of care or referrals
Capability to provide electronic syndromic surveillance data to public health agencies
Perform at least one test of capacity to provide such data
Providers Must Submit Quality Measures
Physicians -Core quality measures-Smoking status-Blood pressure-Drugs to be avoided by the elderly
-Set of 3-5 specialty-specific measures
Hospitals -Thirty-five measures (currently submitting nine for PQRI)
EHRs Must Support Standards
Problem List (ICD-9-CM or SNOMED)
Patient summary (HL7 CDA R2 CCD)
Lab orders and results (LOINC)
Prescriptions (NCPDP SCRIPT 10.6)
Units of measure (UCUM) Quality reporting (CMS PQRI 2008 Registry XML)
Medication List (RxNorm) Submission to public health agencies (HL7 2.3.1)
FY 11 Privacy and Security Standards Must be Implemented
To Receive Payments and Avoid Penalties Providers Must
Implement applications needed to support meaningful use
Certify their electronic health record Support required data, transaction and
quality measure reporting standards Meet privacy and security standards Achieve meaningful use goals
Status of Strategy
Meaningful Use NPRM has been released and comments are being reviewed
Standards and certification criteria IFR has been released and comments are being reviewed
Certification process NPRM was released in February and comments are being received
To Support the Achievement of Meaningful Use Several Grant Programs have been Developed
Extension centers to provide EHR assistance to: Public or not for profit hospitals or critical access hospitals Federally qualified health centers Entities in rural and other areas that serve uninsured,
underinsured, and medically underserved individuals Individual and small group primary care practices
State health information exchanges (HIE) to: Develop and implement HIE privacy and security requirements Develop interoperability directories and technical services Coordinate with Medicaid and state public health programs Ensure effective HIE governance and accountability
To Support the Achievement of Meaningful Use Several Grant Programs have been Developed
Workforce development grants to: Establish electronic health record curriculum Provide training through community colleges
and universities Develop competency-based exams
Beacon communities Identify 15 communities that will address a
community health concern using interoperable electronic health records
To Support the Achievement of Meaningful Use Several Grant Programs have been Developed
Advanced research centers (SHARP) to fund breakthrough research in:
Security of health information technology Patient-centered cognitive support Healthcare application and network platform
architectures Secondary use of EHR data
Status of Strategy
Grants/contracts have been awarded for: Regional extension centers State health information exchanges Workforce development Research centers
Beacon community grants will be announced shortly
CMS Estimates of the Number of Providers who will be Meaningful Users in 2011
Scenario 2011 2012 2013
Eligible Professionals Low 10% 13% 15%
High 36% 40% 44%
Hospitals Low 30% 35% 46%
High 43% 58% 73%
Baselines considerations (2008):
29% of hospitals have some level of medication CPOE (AHA)
4% of eligible professionals have a full function electronic health record
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