Employing the Phases of Electronic

Health Records (EHR)

The Journey from Paper to EHR

Introductions

Val

Migliore,

MBA

Karin

Eichler,

RN

Erik

Riffel,

Exec

Kent

Crosier,

VP

• Unity Health

System

• Regional Extension

Center / MCMS

•Xerox Corporation

• Certified Black

Belt, Lean Six

Sigma

• MGMA Member

• Genesee Valley

OB/GYN, PC:

• Regional Extension

Center / MCMS

•Genesee Hospital

• MGMA Member

• Tri-Delta Resources

• Virtual CIO

• NYeC approved IT

Vendor

• MGMA Member

• Tri-Delta Resources

• MediTech Disaster

Recovery

• NYeC approved IT

Vendor

• MGMA Member

Introductions

Introduce

Yourself• Your Name

• Practice Name

• Practice Specialty

• Your Role

• Expectation

Kent

Crosier

Goals & Objectives

1. Introductions

2. Benefits – What’s In it for Me?

3. What’s the Hold Up?

4. What EHR Is and Is Not

5. Understanding What it Takes

6. Planning

7. Achieving Meaningful Use

8. CMS Incentives

Where are you with EHR Currently?

1No PMSNo EHR

2 PMS Only

3 Implemented

EHR – not certified yet

Audience

Assessment

Rate your practice:

4 Implemented

EHR – certified

5 Fully

Implemented EHR

Achieved MU

MU

Incentive $

Patient

Quality

Productivity

and

Performance

Benefits

What’s the Hold Up?

What’s the Hold Up?

Common EHR Myths

What it is not

You will no longer need to store records.

You will be able to eliminate staff.

Broken processes will be fixed by an EHR.

You will no longer need to reconcile

charts.

You will never search for paper

charts again.

Loose reports will no longer be

a problem.

Reasonable Expectations of an EHR

What it is

Guaranteed1 Possible1 Debatable1

• Legibility of notes

• Accessibility of charts

• No more lost patient

records - EMR

• Multiple users access

to charts

• Disaster Recovery

• E-Prescribing

• Drug-to-drug & allergy

interactions

• Remote chart access

• EHR Stimulus $

• Transcription

cost savings

• Space savings

• Paper savings

• Automated lab &

XRAY results

• Clinical Decision

Support

• Improved patient

communications

• Increased

efficiency

• Quality of care

• Improved

workflow

• Improved coding

accuracy &

charge capture

• Better patient

services

• Time savings

1 “Selecting the Right EMR” e-Book by John Lynn @ http://www.emrandhipaa.com/emr-selection-book/

Understanding What it Takes:

Building a House

Achieve Meaningful Use

Assess SelectPlanImplement

Optimize

Assess

• Buy-In

• Assess readiness

• Identify benefits

• Set goals

• Determine migration path

• Develop budget & business case forEHR & IT

• Current network assessment

Plan

• Identify physician champion

• Establish teams

• Workflow assessment

• Identify opportunities for improvement.

• Establish measurements

• Establish chart conversion strategy

• IT Infrastructure

• Connection to RHIO, Labs, HIE

• Develop project plans & timelines

• Communication Plan

Select

• Understand requirements for practice’s workflow

• Specify desired functions

• Review the field of EHR / IT vendors

• Perform due diligence (to narrow field)

• RFP

• Demo & site visits, reference checks

• Contract negotiations, pricing, terms legal review, financing

Implement & Optimize

• Implement rollout strategy

• Document new workflows and processes

• Implement chart & data conversions

• Manage installation of hardware & IT infrastructure

• TRAIN TRAIN TRAIN

• Rehearse GO-LIVE

• COMMUNICATE COMMUNICATE!!!

Framework…

Practice

EHR VendorIT

It Takes a Village…..

RHIO’s

Labs

HIE’s

Medical

Society

AMA

MGMA

Your Peers

Universities

Colleges

REC’s

NYeC

CMS

HIMSS

SME’s

Consultants

Critical Success Factors

From Zero to Meaningful Use and Beyond!

The HIT Extension Center Experience

Paul Kleeberg, MD FAAFP, FHIMSS

Clinical Director, REACH

HIMSS11 Orlando, Florida

February 21st, 2011,

Critical Success Factors

Critical Success Factors

By Shahid N. Shah

The Healthcare IT Guy

www.netspective.com

From Zero to Meaningful Use and Beyond!

The HIT Extension Center Experience

Paul Kleeberg, MD FAAFP, FHIMSS

Clinical Director, REACH

HIMSS11 Orlando, Florida

February 21st, 2011,

Critical Success Factors

MEANINGFUL USE

HHS

Vision

• Reforming the health care system

• Improving health care quality

• Improving health care efficiency

• Improving patient safety

Path

Defined

• Certification Criteria Determined

• CMS Publishes Final Rule July 2010

• Incentive Programs Established

MU Prep Checklist for Stage 1 (Medicare)

1. Register CMS

2. Certified EHR

3. Implement 15 Core

Objectives

4. Implement 5 of the 10 Menu Set Objectives

5. Declare 90 Day Reporting

Period6. Attestation

Medicare vs. Medicaid

Meaningful Use Criteria: Core

MU Objective MU Measure* Reporting Method Exclusion?

Core Set Objectives for EPs: Must Meet All 15 Measures

C1 Use CPOE for medication orders CPOE is used for more than 30 percent of unique patients EHR TabulatesAny EP who writes fewer than 100 prescriptions during the EHR reporting period.

C2Implement drug-drug and drug-allergy interactions checks The EP has enabled this functionality in EHR Attestation None

C3Maintain an up-to-date problem list of current and active diagnoses

More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have at least one entry or an indication that no problems are known for the patient recorded as structured data. EHR Tabulates None

C4Generate and transmit permissible prescriptions electronically (eRx)

More than 40 percent (adjusted or unadjusted for patient preference) of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology EHR Tabulates

Any EP who writes fewer than 100 prescriptions during the EHR reporting period.

C5 Maintain active medication list

More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data EHR Tabulates None

C6 Maintain active medication allergy list.

More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data EHR Tabulates None

C7Record demographics: Preferred language, gender, race, ethnicity, and date of birth

For more than 50% of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data EHR Tabulates None

C8Record and chart changes in vital signs: Height, Weight, BP, BMI and growth charts for ages 2-20

For more than 50% of all unique patients age 2 and over seen by the EP or admitted to eligible hospital, height, weight and blood pressure are recorded as structured data

Count of Patients in EHR

Any EP who either see no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice.

Meaningful Use Criteria: Core

C9Record smoking status for patients 13 years old or older

More than 50 percent of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospital have smoking status recorded

Count of Patients in EHR Any EP who sees no patients 13 years or older.

C10Report ambulatory clinical quality measures to CMS or in the case of Medicaid to the States

Core CQMs - EPs must report on 3 required core CQMs, and if the denominator of 1 or more of the required core measures is 0, then EPs are required to report results for up to 3 alternate core measures. EPs also must also select 3 additional CQMs from a set of 38 CQMs (excluding the core/alternate core measures). It is acceptable to have a '0' denominator provided the EP does not have an applicable population. EHR Tabulates None

C11

Implement 1 clinical decision support rule relevent to specialty or high clinical priority along with the ability to track compliance to that rule

Implement one clinical decision support rule related to efficiency or a clinical quality measure relevant to the EP or eligible hospital Attestation None

C12

Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request

More than 50 percent of all patients who request an electronic copy of their health information are provided it within 3 business days EHR Tabulates

Any EP that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period.

C13Provide clinical summaries for patients for each office visit.

Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days

Count of Patients in EHR

Any EP who has no office visits during the EHR reporting period.

C14

Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically

Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information. Attestation None

C15

Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary Attestation None

Meaningful Use Criteria: Menu

Menu Set Objectives for EPs: Must Choose and Meet 5 of the 10 from the Menu, one of the five must be related to improving public health *p

M1 Implement drug-formulary checks AttestationAny EP who writes fewer than 100 prescriptions during the EHR reporting period.

M2Incorporate clinical lab-test results into EHR as structured data

More than 40% of all clinical lab testsresults ordered by the EP or by anauthorized provider fo whose resultsare in a positive/negative or numericalformat are incorporated in certified EHRtechnology

Count of Patients in EHR

An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period.

M3

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, or outreach

Generate at least one report listing patients of the EP or eligible hospital with a specific condition. Attestation None

M4Send reminders to patients per patient preference for preventive/ follow up care

More than 20 percent of all unique patients 65 years or older who were identified by certified EHR technology as needing a reminder during the EHR reporting period were sent the appropriate reminder

Count of Patients in EHR

An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology.

M5

Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP.

More than 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information subject to the EP’s discretion to withhold certain information. EHR Tabulates

Any EP that neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR 170.304(g)) during the EHR reporting period.

M6

Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate

More than 10 percent of all unique patients seen during the EHR reporting period are provided patient-specific education resources EHR Tabulates None

M7Perform medication reconciliation at relevant encounters and each transition of care.

Perform medication reconciliation for more than 50 percent of transitions of care.

Count of Patients in EHR

An EP who was not the recipient of any transitions of care during the EHR reporting period.

M8Provide summary care record for each transition of care and referral.

Provide summary of care record for more than 50 percent of transitions of care and referrals

Count of Patients in EHR

An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.

M9 *p

Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission according to applicable law and practice.

Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries. Attestation

An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.

M10 *p

Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically). Attestation

An EP who does not collect any reportable syndromicinformation on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.

Medicare Incentive Payment

Tip: To determine your potential Medicare incentive payment – review 2010 1099(s)

Medicaid Incentive Payment

Services

• Strategic Planning

• Readiness Assessment

• Office Workflows: Clinical & Administrative Process Improvement

• EHR Implementation Project Management

• Meaningful Use & Attestation Readiness and Preparedness

Practice Preparedness

• EHR Vendor Selection

• Vendor Pricing & Contract Negotiations

• Collaboration with IT

Vendor Coordination

Resources

Source Location

CMS http://www.cms.gov/EHRIncentivePrograms/

CMS FAQ’s http://www.cms.gov/EHRIncentivePrograms/Downloads/FA

QsRemediatedandRevised.pdf

HIPAA Security http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsum

mary.html

HIMSS http://www.cms.gov/EHRIncentivePrograms/

AMA http://www.ama-assn.org/ama/pub/physician-

resources/health-information-technology.page

NYeC http://www.nyehealth.org/rec/

MGMA http://www.mgma.com/ & http://www.nymgma.com/

EMR & HIPAA Blog http://www.emrandhipaa.com/emr-selection-book/

Linkedin Join Groups: HIMSS, HIT Works, MU Answers