Transcript Meaningful Use

American e-Health
A guide for Meaningful Use & EMR’s
Topics
• Meaningful Use; Economic Stimulus; EMR
certifications
• Do’s & Don’t’s of going paperless; buying
computers & hardware
• Red flags & warnings during EMR sales
process
• EMR purchase contracts
• Best Practices, Evidence-Based Medicine, &
EMR’s
Meaningful Use
• Definition
• $44,000.00 to $64,000.00 per eligible doctor
• Certifications: 758 certified ambulatory EMR’s,
as of September 14, 2011
• Items tested for EMR’s to achieve certification
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http://www.ama-assn.org/amednews/2011/01/24/bisf0126.htm
http://healthit.hhs.gov
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__oncauthorized_testing_and_certification_bodies/3120
www.HealthIT.gov
American Reinvestment & Recovery
Act of 2009
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Expanding affordable health insurance coverage for all
Reducing costs and increasing value in health care services
Eliminating excessive administrative burdens
Increasing investments in wellness and prevention services
Empowering physicians to improve quality through
evidence-based medicine
• Reforming government insurance programs by providing
adequate physician payments to assure timely access for
patients
• Implementing essential payment and delivery reforms to
optimize health care expenditures, including medical
liability and antitrust reforms
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http://www.ama-assn.org/ama/no-index/news/rhetoric-reality-stimulus-package.page
AMA Interpretation of ARRA
• $19BB to qualifying physicians during the next
5 years who buy & implement qualified HIT
• HHS to develop & update uniform standards
• Incentives through Medicare Part B
• Doctors who don’t adopt EHR by 2015 face
reduction in Medicare
• 10% extra bonus to doctors in rural areas
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http://www.ama-assn.org/resources/doc/washington/arra-hit-provisions.pdf
ARRA Incentives & Reductions
Institute of Medicine (IOM) View
The “American Recovery and Reinvestment Act of 2009” (ARRA) provides a
meaningful, initial down payment on CER (comparative effectiveness
research) that will strengthen the delivery of evidence-based medicine
while preserving physician decision-making autonomy. Title VIII of ARRA
includes a $1.1 billion appropriation to fund additional CER administered
by the Agency for Healthcare Research and Quality (AHRQ), the National
Institutes of Health (NIH), and the Secretary of the Department of Health
& Human Services (HHS). This funding will “be used to conduct or support
research to evaluate and compare clinical outcomes, effectiveness, risk,
and benefits of two or more medical treatments and services that address
a particular medical condition” as specified in the Conference Report
concerning the CER provisions. The corresponding statutory language of
ARRA signifies the preeminence of clinical outcome-based research and
analysis (as opposed to research driven by cost analysis and cost
containment). Also, the Conference Report “recognizes that ‘a one-sizefits-all’ approach to patient treatment is not medically appropriate.”
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Source: CMS Report 5 (A-08)
ONC-Authorized Testing and
Certification Bodies (ATCBs)
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Surescripts LLC - Arlington, VA
Date of authorization: 12/23/2010
Scope of authorization: EHR Modules:
E-Prescribing, Privacy and Security
ICSA Labs - Mechanicsburg, PA
Date of authorization: 12/10/2010
Scope of authorization: Complete
EHR and EHR Modules
SLI Global Solutions - Denver, CO
Date of authorization: 12/10/2010
Scope of authorization: Complete
EHR and EHR Modules
InfoGard Laboratories, Inc. – San Luis
Obispo, CA
Date of authorization: 9/24/2010
Scope of authorization: Complete
EHR and EHR Modules
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Certification Commission for Health
Information Technology (CCHIT) Chicago, IL
Date of authorization: 9/3/2010
Scope of authorization: Complete
EHR and EHR Modules
Drummond Group, Inc. (DGI) - Austin,
TX
Date of authorization: 9/3/2010
Scope of authorization: Complete
EHR and EHR Modules
Ambulatory & Inpatient EMR certification checker:
http://onc-chpl.force.com/ehrcert
Going Paperless for Doctors
Do
• Back up all of your existing
computerized data
• Familiarize yourself with
EXAM PORTIONS of EMR’s
• Learn about Server-Based
systems versus Cloud
Computing
• Develop a realistic goforward strategy
• Consider warranty programs
Don’t
• Scan every piece of paper in
your office
• Buy more than you need
• Be fully swayed by
administrative staff
hesitations
• Fear change
• Fall into “blind leading the
blind” situations
Reputable Vendors (New & Refurb)
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In addition to BestBuy, Dell.com, the Mac
Store, Staples, & other reputable retailers, you
may wish to explore:
www.CompUSA.com
www.MicroCenter.com
www.NewEgg.com
www.TigerDirect.com
Discussions
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Antiviruses
Firewalls
Personal emails, Facebook, etc.
Wi-Fi
HOW HIPAA PLAYS A ROLE IN ALL OF THIS
Understanding Change
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Recredentialling if you change billing software
Suggestions for scanning
e-Lab implementations; to pay, or not to pay?
Staff training & vendor support
Setting provisions for additional administrative
& clinical time; calculating losses
• Adding responsibilities to staff members to
compensate for time loss
Pitfalls
• Infrastructure versus
Internet
• Schedulers
• e-Notes
• Billing
• eRx
• e-Labs
• Who owns your data?
• Big Brother?
• Common sales tricks
• Google your sales rep
• Verify integrity of EMR
company
• Verify solvency of EMR
company (public vs.
private)
• If you’ve been tricked…
• Grant pitfalls
• Don’t spend your
Stimulus $ before you get
it
Contracts
• Understand training, sales & support
contracts, & renewals
• Practice obligations w/r/t hourly rates, travel,
etc.
• In-house versus outsourced training & support
• Implementation schedules
• Small print
• Refund policies
3rd Parties
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Patient portals
eRx
Billing software
and more
Also, should you incur 3rd party IT support?
Anatomy of an EMR
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Scheduler/PM
Communications
Patient Records
Accounting/Billing
Education
eRx
Compliance & Data Pooling (Health
Information Exchange/HIE)
Best Practices & Evidence-Based
Medicine
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Definitions
Creating decision trees
Programming into EMR systems
Helping doctors examine
Helping to bill properly
Following guidelines
Definition of Best Practice
A best practice is a technique or methodology
that, through experience and research, has
proven to reliably lead to a desired result. A
commitment to using the best practices in any
field is a commitment to using all the
knowledge and technology at one's disposal
to ensure success. The term is used frequently
in the fields of health care, government
administration, the education system, and
more.
Definition of Evidence-Based Medicine
• Evidence-based medicine (EBM) or evidence-based practice (EBP)
aims to apply the best available evidence gained from the scientific
method to clinical decision making.[1] It seeks to assess the strength
of evidence of the risks and benefits of treatments (including lack of
treatment) and diagnostic tests.[2] Evidence quality can range from
meta-analyses and systematic reviews of double-blind, placebocontrolled clinical trials at the top end, down to conventional
wisdom at the bottom.
• EBM/EBP recognizes that many aspects of health care depend on
individual factors such as quality- and value-of-life judgments,
which are only partially subject to scientific methods. EBP, however,
seeks to clarify those parts of medical practice that are in principle
subject to scientific methods and to apply these methods to ensure
the best prediction of outcomes in medical treatment, even as
debate continues about which outcomes are desirable.
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http://en.wikipedia.org/wiki/Evidence-based_medicine
US Preventative Services Task Force
• Level I: Evidence obtained from at least one properly designed
randomized controlled trial.
• Level II-1: Evidence obtained from well-designed controlled trials
without randomization.
• Level II-2: Evidence obtained from well-designed cohort or casecontrol analytic studies, preferably from more than one center or
research group.
• Level II-3: Evidence obtained from multiple time series with or
without the intervention. Dramatic results in uncontrolled trials
might also be regarded as this type of evidence.
• Level III: Opinions of respected authorities, based on clinical
experience, descriptive studies, or reports of expert committees.
Categorizations
• Level A: Good scientific evidence suggests that the benefits of the clinical
service substantially outweigh the potential risks. Clinicians should discuss
the service with eligible patients.
• Level B: At least fair scientific evidence suggests that the benefits of the
clinical service outweighs the potential risks. Clinicians should discuss the
service with eligible patients.
• Level C: At least fair scientific evidence suggests that there are benefits
provided by the clinical service, but the balance between benefits and
risks are too close for making general recommendations. Clinicians need
not offer it unless there are individual considerations.
• Level D: At least fair scientific evidence suggests that the risks of the
clinical service outweighs potential benefits. Clinicians should not
routinely offer the service to asymptomatic patients.
• Level I: Scientific evidence is lacking, of poor quality, or conflicting, such
that the risk versus benefit balance cannot be assessed. Clinicians should
help patients understand the uncertainty surrounding the clinical service.
Limitations
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Ethics
Cost
Time
Generalizability
Publication bias
Ghost writers
• Populations, clinical
experience, and
dubious diagnoses
• Illegitimacy of other
types of medical
reports
• Political criticism
• Science Based
Medicine
Additional Explanations
• Clinical algorithms are instructions relating to the
management of clinical issues, which are
organized on the basis of conditional, branching
logic
• Clinical informatics is deals with clinical practice,
and extends into medical billing & database
expert systems
• Clinical pathways are interlinked clinical practice
guidelines which organize, sequence and time the
care given to a typical uncomplicated patient
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Schoenbaum SC (ed.) (1995) Using clinical practice guidelines to evaluate quality of care. V1. US Department of Health & Human
Services, Bethesda, MD).
Evaluating Internet Data
BACKGROUND: The advent of virtually free Internet access has opened large vistas of
health care information to those willing to invest a small amount of time and energy
learning how to perform searches using browser software. Health care providers,
organizations, and professional associations, among many others, publish "best
practices" information for both administrative and clinical audiences, making these
recommendations among the fastest-growing types of health care information
appearing on the World Wide Web. The problem is how to find best practices among
the wealth of resources on the Internet and then how to separate the proverbial wheat
from the chaff. WHO IS SEEKING BEST PRACTICES ON THE INTERNET? Best practice
describes a process or technique whose employment results in improved patient and/or
organizational outcomes. Health care providers, managed care organizations,
administrators, payers, and policy analysts are all interested in improving the quality of
health care and are likely to be customers of best practices informational resources.
HOW TO EVALUATE THE QUALITY OF BEST PRACTICES INFORMATION? Once the
information is available on the Internet, the problem for the searcher shifts from one of
quantity to quality. The best practices information seeker should stop and ask a number
of questions about the quality of information, its sources, and the methods used to
obtain it. CONCLUSION: The "truth" may be out there some-where in cyberspace, but
locating best practices information and evaluating its quality require new skills and
patience and time to practice and develop them to the point of efficiency.
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http://www.ncbi.nlm.nih.gov/pubmed/9476203
Contact Us
American eHealth
Collaborative
Website: www.AeHC.us
• In NYC
– (212) 300-5126
• In Washington, DC
– (202) 486-5548
Email: [email protected]