Transcript It’s Right
What is the Meaning of
“Meaningful Use” of EHR
PMI
January 21, 2010
Scarborough, ME
Presentation Overview
Introduction to HealthInfoNet and The Maine
Approach to Health Information Exchange
Organizing a Complex Inter-Organization Project
Setting The Stage for ARRA and HITEH
“Meaningful Use” and All That Jazz
Moving Forward to Realize the Vision
Information known
but not shared
Contraindicated
Therapy
Unnecessary duplication
Of service
Health Clinic
Laboratory
Lab
Reference
Reference
Consumer
Pharmacy
Hospital
Physician Office
HealthInfoNet
Free Standing Diagnostic Center
Connecting the Information SilosBridging The Information Handoffs
HealthInfoNet
What Is HealthInfoNet
501(c)(3) Tax Exempt Public-Private
Partnership
Stake Holder Organization Involving
Consumers, Providers, Payers, Business
and Government
An Organization Focused on Supporting
Collaboration and Innovation
The Mission of HealthInfoNet
Develop, promote and sustain an integrated, secure and reliable regional
information network dedicated to delivering authorized, rapid access to personspecific healthcare data across points of care that will support
• Improved patient safety
• Enhanced quality of clinical care
• Increased clinical and administrative efficiency
• Reduced duplication of services
• Enhanced identification of threats to public health
• Expanded consumers access to their own
personal health care information
Primary Functions of The Health
Exchange
Person-Centric Clinical Content
Aggregation Across Points of Care
Delivery
Data Standardization
Workflow Integration
Workflow Optimization
24-Month Demonstration Phase
Participating Organizations
Central Maine HealthCare
Eastern Maine Healthcare
Systems
Franklin Memorial Hospital
MaineGeneral Health
MaineHealth
Martin’s Point Health
Care
Maine CDC
Status of 24-Month Statewide HIE
Demonstration Phase
Impact of 6 Provider Organizations Participating
52%
of annual inpatient discharges
50% of annual Emergency Department visits
42% of annual ambulatory visits
Engagement with Maine Center for Disease
Control and Prevention (Maine CDC)
Automated
laboratory reporting to support mandated
disease reporting
Reporting targeted for 30 of 72 mandated diseases
24 Month Demonstration Phase
Scope
Release 1, (Month 8) featuring:
Patient Identifier and Demographics
Encounter History
Laboratory Results
Radiology Reports
Patient Consent Management
Release 2, (month 12) featuring :
Adverse Reactions/Allergies
Medication History
Diagnosis/Conditions/Problems
Dictated/Transcribed Documents
Parameter-based Launch
The Demonstration Phase
Exchange Technical Model
Current Exchange Volume &
Activity Statistics as of 01-19-10
Total Lives In Master Person Index- 648,938
Total Out of State Lives in MPI- 31,483
Total Individuals Opted Out- 4,520 (<0.7%)
Total Individuals With Registration Events in
Two or More Participating Organizations80,024 (12.15%)
Current Number of Registered Users- 689
Foundation of Organizing A Complex
Collaborative Community Project
Vision
Governance
Founding Principles/Mission
Goals
Valuation
The Project Management Challenges
Confronting HealthInfoNet
Large Number of Unaligned Project
Participants
Geographic Spread
Competing Organization Priorities and
Practices x 7
Blending Project Management Methodologies
Stakeholder Inter-Organization Politics
Building the Infrastructure to Support A
Complex Collaborative Community
Project
Developing a Modified/Collaborative
Project Methodology
Defining a Virtual, Shared Work Space
Maintaining a Strategy for InterOrganization Prioritization Management
and Change Control
Redefining the Concept of “Enterprise”
Setting The Stage for ARRA/HITECH
As The Health Reform Game Changer
An Interesting Approach to Stimulus
Funding is Incentive for Change Not A Blank
Check to Pay For Investment
Focus on Transforming the Information
Technology of Health Care is Really The
Foundation for Transforming Health Care
Its About Comparative Measurement And
Performance Reporting- Stupid
Current ARRA HIT Funding Opportunities
State
HIE
Coop
Applicant/
Fiscal Agent
State
Medicaid
Incentives
Regional
Extension
Center
Beacons
Curriculum
Development
Centers
Medicaid
Non-profit
Community
Inst. of
Higher Ed.
$10M-$20M
$1.82M
Community
College
Consortia
C.C.
Consortia
SHARP
Program
Universitybased Competency
Exam
Training
University/R
University
esearch
Institution
Inst. of
Higher Ed.
Award
Range
$4-40 M
85% net
allowable
costs
Proposal
Due Date
10-16-09
TBD
1-29-10
2-1-10
1-14-10
Funding
Award Date
1-15-10
1-2011
3-31-10
3-2010
3-18-10
3-15-10
Distribution
Quarterly
2010-2014
TBD
2011-2016
Quarterly
2010-2014
TBD
2010-2012
TBD
2010-2012
TBD
2010-2012
Mechanism
Coop
Agreement
Incentive
Payments
Coop
Agreement
Coop
Agreement
Coop
Agreement
Coop
Agreement
Coop
Agreement
Primary
Focus
HIE
Capacity
Meaningful
Use
HIT
Adoption
Quality and
Value
Demonstration
Academic
Program
Creation
Breakthrough Academic Competency
Program
Advances
Test Dev.
Creation
$1M-$30M
Curriculum
Develop.
$6.2M$21.15M
1-22-10
Up to $4M
$6 million
1-25-10
1-25-10
1-25-10
3-15-10
3-18-10
3-18-10
$10M-$18M
TBD
TBD
2010-2014 2010-2013
Grant
TBD
2010-2012
Coop
Agreement
Red: State Government Applicant / Fiscal Agent
Green: Non-governmental Applicant / Fiscal Agent
16
“Meaningful Use”- Noun, Verb or
Expletive
Sets the Bar for Demonstrating “Optimum”
Use of EMR
To Be Defined Over Three Phases- Phase
One Rules Issued on 12-30-09
Each Phase will “Raise the Bar” for
Minimum Standards
Does “Meaningful Use” = “Meaningful
Outcome”
“Meaningful Use” Rules For Providers25 Keys to CMS Incentive Payments
1.
2.
3.
4.
CPOE is used for at least 80% of all orders
Medication interaction checks (drug-drug, drug-allergy, drugformulary) functionality must be enabled.
Maintain an up-to-date problem list for 80% of patients seen
1. Include current and active diagnoses
2. Based on ICD-9-CM or SNOMED
Use e-prescribing (eRx) for at least 75% of prescriptions.
“Meaningful Use” Rules For Providers25 Keys to CMS Incentive Payments
5.
6.
7.
8.
Maintain an active medication list for at least 80% of patients.
Maintain an active medication allergy list for at least 80% of
patients.
Record demographics information (as structured data) for at
least 80% of patients.
Record and chart changes in vital signs for at least 80% of
patients age 2 and over.
Blood Pressure
BMI
Growth Chart (for children age 2 to 20)
“Meaningful Use” Rules For Providers25 Keys to CMS Incentive Payments
9.
10.
11.
12.
Record smoking status for at least 80% of patients 13 years
old or older
Incorporate clinical lab-test results into EHR as structured
data for at least 50% of all clinical lab results ordered.
Generate lists of patients by specific conditions to use for
quality improvement, reduction of disparities, research, and
outreach (at least one report must be generated listing
patients with a specific condition).
Report ambulatory quality measures to CMS or the States
(can be manually submitted in 2011, and must be
electronically submitted in 2012).
“Meaningful Use” Rules For Providers25 Keys to CMS Incentive Payments
13.
14.
15.
16.
Send patient reminders for preventive/ follow-up care for at
least 50% of patients age 50 and over.
Implement five clinical decision support rules relevant to
specific clinical quality metrics
13. Must be relevant to specialty or high clinical priority,
including ordering of diagnostic tests
14. Must have the ability to track compliance with these rules
Electronic insurance eligibility checking (from public and
private payers) for at least 80% of patients.
Electronic claims submission (to public and private payers)
for at least 80% of claims.
“Meaningful Use” Rules For Providers25 Keys to CMS Incentive Payments
17.
18.
19.
20.
Provide patients with an electronic copy of their health
information within 48 hours (including diagnostic test results,
problem list, medication lists, and allergies) for at least 80%
of patients requesting electronic copies.
Provide patients with electronic access to their health
information (including lab results, problem list, medication
lists, allergies) for at least 10% of patients.
Provide clinical summaries to patients for at least 80% of all
office visits.
Demonstrate the capability to electronically exchange clinical
information (problem list, medication list, allergies, diagnostic
test results, etc.) by performing at least one test of
transmission.
“Meaningful Use” Rules For Providers25 Keys to CMS Incentive Payments
21.
22.
23.
Perform medication reconciliation at relevant encounters and
each transition of care for at least 80% of relevant
encounters.
Provide a summary care record for each transition of care
and referral for at least 80% of transitions and referrals.
Demonstrate the capability to submit electronic data to
immunization registries and actual submission where
required and accepted, by performing at least one test of
transmission to immunization registries.
“Meaningful Use” Rules For Providers25 Keys to CMS Incentive Payments
24.
25.
Demonstrate the capability to provide electronic syndromic
surveillance data to public health agencies and actual
transmission according to applicable law and practice, by
performing at least one test of transmission to public health
agencies.
Protect & ensure the security of electronic health information
by implementing appropriate technical capabilities, and
conducting a security risk analysis, and implementing
security updates as necessary.
“Meaningful Use” for Hospitals22 Requirements for CMS Incentive Payments
1.
2.
3.
4.
5.
CPOE is used for at least 10% of all orders
Medication interaction checks (drug-drug, drug-allergy, drugformulary) functionality must be enabled.
Maintain an up-to-date problem list for 80% of patients
admitted
Include current and active diagnoses
Based on ICD-9-CM or SNOMED
Maintain an active medication list for at least 80% of patients
admitted.
Maintain an active medication allergy list for at least 80% of
patients admitted.
“Meaningful Use” for Hospitals22 Requirements for CMS Incentive Payments
6.
7.
8.
9.
Record demographics information (as structured data) for at
least 80% of patients admitted.
Record and chart changes in vital signs for at least 80% of
patients admitted age 2 and over.
Blood Pressure
BMI
Growth Chart (for children age 2 to 20)
Record smoking status for at least 80% of patients admitted
13 years old or older.
Incorporate clinical lab-test results into EHR as structured
data for at least 50% of all clinical lab results ordered.
“Meaningful Use” for Hospitals22 Requirements for CMS Incentive Payments
10.
11.
12.
Generate lists of patients by specific conditions to use for
quality improvement, reduction of disparities, research, and
outreach (at least one report must be generated listing
patients with a specific condition).
Report hospital quality measures to CMS or the States (can
be manually submitted in 2011, and must be electronically
submitted in 2012).
Implement five clinical decision support rules relevant to
specific clinical quality metrics
Must be relevant to specialty or high clinical priority,
including ordering of diagnostic tests
Must have the ability to track compliance with these rules
“Meaningful Use” for Hospitals22 Requirements for CMS Incentive Payments
13.
14.
15.
Electronic insurance eligibility checking (from public and
private payers) for at least 80% of patients admitted.
Electronic claims submission (to public and private payers)
for at least 80% of claims.
Provide patients with an electronic copy of their health
information within 48 hours (including diagnostic test results,
problem list, medication lists, and allergies) for at least 80%
of patients requesting electronic copies.
“Meaningful Use” for Hospitals22 Requirements for CMS Incentive Payments
16.
17.
18.
19.
Provide patients with an electronic copy of their discharge
instructions and procedures at the time of discharge, for at
least 80% of patients requesting electronic copies.
Demonstrate the capability to electronically exchange clinical
information (discharge summary, procedures, problem list,
medication list, allergies, diagnostic test results, etc.) by
performing at least one test of transmission.
Perform medication reconciliation at relevant encounters and
each transition of care for at least 80% of relevant
encounters.
Provide a summary care record for each transition of care
and referral for at least 80% of transitions and referrals.
“Meaningful Use” for Hospitals22 Requirements for CMS Incentive Payments
20.
21.
Demonstrate the capability to submit electronic data to
immunization registries and actual submission where
required and accepted, by performing at least one test of
transmission to immunization registries.
Demonstrate the capability to provide electronic submission
of reportable lab results to public health agencies, and actual
submission where it can be received, by performing at least
one test of transmission to public health agencies.
“Meaningful Use” for Hospitals22 Requirements for CMS Incentive Payments
22.
Demonstrate the capability to provide electronic syndromic
surveillance data to public health agencies and actual
transmission according to applicable law and practice, by
performing at least one test of transmission to public health
agencies.
Protect & ensure the security of electronic health
information by implementing appropriate technical
capabilities, and conducting a security risk analysis, and
implementing security updates as necessary.
REC Core and Direct Services
Core Services
Practice HIT Stage
Assessment
Vendor Selection and Group
Purchase
Outreach and Education
National Learning Consortium
Functional Interoperability HIE
Privacy and Security Practices
Quality Measurement,
Reporting, and Improvement
Local Workforce Development
Direct Services
Practice Workflow Redesign
EMR Implementation
HIE Interface Support
eRx Implementation Support
“Meaningful Use” Compliance
REC Services Divided into 2 Programs
1. Support providers with NO EMR
2. Support providers with EMR
32
REC Performance Milestones
Milestones
• Signed contracts with financial commitments by priority
primary-care providers.
• Number of priority primary-care providers that are actively
using an EHR, including active use of electronic prescribing.
• Utilization of EHRs and promoting features essential for
meaningful use.
• Helping priority primary-care providers to understand, and
implement technology and process changes needed to
attain, and demonstrate attainment of, meaningful use
requirements
33
Proposed MEREC Structure
Core Services (HIN and Partners)
• Provider Education and
Outreach
• Project Management
• Workforce Integration
• National Learning Consortium
• Functional Interoperability
• Privacy and Security
• Group purchasing
• Quality Improvement
Unaffiliated
Practices (Retail
Marketplace)
• Private Practices
• Small-Med
Groups
• Independent
Clinics / Hospitals
HealthInfoNet
(Prime Contractor)
MEREC
Controller
Office
REC
Contracts
Direct Services
• Practice Workflow
Redesign
• EMR Implementation
• HIE Interface Support
• eRx Implementation
Support
• Meaningful Use
Compliance
Direct Brokerage for REC Direct
Services
• Request for Proposal (RFP)
Process for all Direct REC
Services
• Vendor Neutral Contracting
Processes
• Builds off Wholesale and Retail
Marketplace Needs
Affiliated Practices
(Wholesale Marketplace)
•Eastern Maine
•Maine General
•Central Maine
•Maine Health
•Maine PCA
•Others
34
Proposed MEREC Technical
Assistance Program
35
Some Closing Thoughts on
ARRA/HITEC
At $42 Billion and Five Years It Is Too Little Money and
Too Little Time– But What An Opportunity?
Are The Incentives Large Enough To Drive Meaningful
Adoption?
Is The HIT Work Force Available to Make This Happen
or Can It Be Grown Fast Enough To Make It Happen?
Meaningful Use is About Process, Meaningful Change Is
Quite Another Matter
Mixed Messages-Mixed Results What Happened to The
Patient as the Central Objective?