Transcript Health Information Technology
FQHC in Western NC Four Comprehensive School-Based Health Centers – over 2,000 students served with 9,430 encounters for nursing, medical, dental, behavioral health, & nutrition services Serve over 16,000 total patients annually with over 70,000 encounters for primary care, dental, behavioral health, nutrition, migrant outreach services, and school health Joint Commission accredited for ambulatory care/slated for PCMH recognition in early 2013
Vetted five different, certified vendors – took more than 6 months to coordinate site visits & demonstration Key stakeholders involved in process, but providers and clinical staff made final choice on the EMR GE Centricity v9.0 chosen in 2010; completed upgrade to v10.0 in 08/12
After selection, created an EMR implementation team that consisted of provider staff, billing staff, administration, support staff, IT staff and senior administration Equipment review to ensure wireless capabilities and ordering of laptops/tablets; inventory and tagging of all equipment; creation of “responsibility forms” for staff signing out tablets Assigned a project manager (internal staff) to help guide the project (previous experience with software) – other duties were minimized to ensure adequate time was given to project Clinical Project Manager assigned from software company
Implemented in phases: › › › › › Phase 1: Six months before go-live, began using registration process and billing systems (October 2010) Phase 2: Determined which patient records should be scanned into system (any patient with a visit in the last 3 years) and hired outside company to scan records into system (October 2011-February 2011) Phase 3: First “go-live” with family practice and school-based health centers (February 2011) Phase 4: Lessons learned from Phase 3, used for roll out of next phase: Behavioral Health and Pediatrics Phase 5: Dental go-live
Clinical Champion on staff essential – SBHC staff provider took this role (double win!) Make decisions based on consensus and find a middle ground for items After implementation, project manager could not get away from software management (staff looked to this person as an expert) Ongoing support and number of staff involved to maintain EMR can add additional FTE to organizational budget ($$$)
SBHC data management specialist is a “super user” on the practice management side Provider “champion” for EMR is an SBHC provider Ability to view records across organization – if student seen in night clinic after hours, provider has access to SBHC records Integrated record – all services in one Easier reporting/management of data Faster turn around for supervising physician to sign documents and review records for clinical supervision protocols
Meaningful use is using certified electronic health record (EHR) technology to:
› Improve quality, safety, efficiency, and reduce health disparities › › › Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of patient health information
Ultimately, it is hoped that the meaningful use compliance will result in:
› Better clinical outcomes › › Improved population health outcomes Increased transparency and efficiency › › Empowered individuals More robust research data on health systems
Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.
The three stages of Meaningful Use are designed to support eligible professionals and hospitals with implementing and using EHRs in a meaningful way to help improve the quality and safety of the nation’s healthcare system. Stage 1 of the EHR Incentive program began in 2011, with Stages II and III to be established by future CMS rules.
The Meaningful Use criteria, objectives and measures will evolve in three stages over the next five years:
Stage 1 2011-2012 Data Capture and Sharing Stage 1 Focus:
Electronically capturing health information in a standardized format
Stage 2 2013 Advanced Clinical Processes Stage 2 Focus:
More rigorous health information exchange (HIE)
Stage 3 2015 Improved Outcomes Stage 3 Focus:
Improving quality, safety, and efficiency, leading to improved health outcomes Using that information to track key clinical conditions Communicating that information for care coordination processes Initiating the reporting of clinical quality measures and public health information Using information to engage patients and their families in their care Increased requirements for e-prescribing and incorporating lab results Electronic transmission of patient care summaries across multiple settings More patient-controlled data Decision support for national high-priority conditions Patient access to self management tools Access to comprehensive patient data through patient-centered HIE Improving population health
An important objective set forth in the Meaningful Use Stage 1 final rule is that eligible professionals and hospitals who participate in the program must be able to record, store, and report clinical quality measures (CQM). In the Meaningful Use Stage 1 final rule, CMS defines CQM as the “processes, experience, and/or outcomes of patient care, observations or treatment that relate to one or more quality aims for health care such as effective, safe, efficient, patient-centered, equitable, and timely care.”
Who is an “eligible professional”?
› Physicians › › › › Pediatricians Dentists Optometrists Nurse Practitioners Physician Assistant (must be in an FQHC/RHC led by a Physician Assistant) › Can be part-time or full-time providers Must meet criteria for patient volume, depending on if attesting to Medicare or Medicaid For FQHCs, patient volume for Medicaid also includes uninsured
Meaningful use criteria for eligible professionals
15 core objectives 5 out of 10 from menu set objectives
(1) Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. (2) Implement drug-drug and drug-allergy interaction checks (3) Maintain an up-to-date problem list of current and active diagnoses. (4) Generate and transmit permissible prescriptions electronically (eRx). (5) Maintain active medication list. (6) Maintain active medication allergy list. (7) Record all of the following demographics: (A) Preferred language. (B) Gender. (C) Race. (D) Ethnicity. (E) Date of birth. (8) Record and chart changes in the following vital signs: (A) Height. (B) Weight. (C) Blood pressure. (D) Calculate and display body mass index (BMI). (E) Plot and display growth charts for children 2–20 years, including BMI.
(9) Record smoking status for patients 13 years old or older. (10) Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States. (11) Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. (12) Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request. (13) Provide clinical summaries for patients for each office visit. (14) Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. (15) Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.
(1) Implement drug formulary checks. (2) Incorporate clinical lab-test results into EHR as structured data. (3) Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. (4) Send patient reminders per patient preference for preventive/follow-up care. (5) Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. (6) Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. (7) The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. (8) The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. (9) Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. (THROUGH EXCLUSION, NCIR CANNOT OFFER THIS RIGHT NOW) (10) Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.
Must meet two years of Stage 1 criteria before moving to Stage 2 in the third year In the first year of participation, providers must demonstrate meaningful use for a 90-day EHR reporting period; in subsequent years, providers will demonstrate meaningful use for a full year EHR reporting period For 2014 only: All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month EHR reporting period. CMS is permitting this one-time three-month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems.
Stage 2 retains this core and menu structure for meaningful use objectives. Although some Stage 1 objectives were either combined or eliminated, most of the Stage 1 objectives are now core objectives under the Stage 2 criteria. For many of these Stage 2 objectives, the threshold that providers must meet for the objective has been raised.
› To demonstrate meaningful use under Stage 2 criteria—
EPs must meet 17 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 20 core objectives.
Stage 2 also replaces the previous Stage 1 objectives to
provide electronic copies of health information or discharge instructions
and provide timely access to health information with objectives that allow patients to access their health information online. Stage 2 criteria place
an emphasis on health information exchange
between providers to improve care coordination for patients. New Stage 2 measures for several objectives
require patients to use health information technology
in order for providers to achieve meaningful use.
Choose a MU-certified EHR system – essential to Stage 1 Determine eligible professionals Create MU performance improvement team (PI team) to determine additional objectives to be measured/tracked – making sure to meet attestation requirements › MU PI Team combined staff from EHR implementation team (provider champion) › MU PI Team reviewed needed forms edits and other revisions in EHR needed to track discrete data Use of local Regional Extension Center/AHEC representative to assist with step-by-step process in selecting additional measures & reviewing EMR capabilities Internal MU reports are completed weekly and shared with provider staff to promote immediate improvement in process to capture needed data
Choosing a MU certified EMR from the beginning is essential It will take a lot longer to implement than you realize › Changes to forms › Edits to information in the EMR Important to have a provider champion who can work with clinical staff to implement needed changes and be “on the floor” to answer questions as they arise When recruiting providers, must be aware of which program(s) they have attested to and for which years Must strategically look ahead to next wave of technology – especially patient portals – and budget accordingly to meet needs
There are many requirements that you must meet for both PCMH and MU PCMH/MU Crosswalk Implementing Meaningful Use will actually help in achieving PCMH It all begins with EMR implementation
Formulary Checks Lab Data in EMR Pt lists by condition Pt reminders Pt e-access to info Pt ed resources Medication Reconciliation x Care Summary @Transition x x x x x x x x x x x x x x x
Submit to Imm. Registry Pub Health Surveillance CPOE for med orders x Drug-drug/drug allergy cks x Problem list x x x E-Prescribe Active Med list Allergy List Demographics x x x x x x x x x x x x x
Ht/Wt/BP/BMI Smoking status Report to CMS Clinical Decision Support Standing Orders x Pts get info x Clin summaries of encounter x Exchange info btw providers x Protect info x x x x x x x x x x x