ehr what are you really gaining

EHR – What Are You Really Gaining? : 

EHR – What Are You Really Gaining? Donna Weinstock October 20, 2010

OFFICE MANAGEMENT SOLUTIONThe art of unifying people, process and strategyDonna Weinstock(847) 205-9797donna@officemanagementsolution.com : 

OFFICE MANAGEMENT SOLUTIONThe art of unifying people, process and strategyDonna Weinstock(847) 205-9797donna@officemanagementsolution.com

Objectives : 

Discuss the pros and cons of EHR Define Meaningful Use; The Final Rule Identify ways to start the process of EHR Objectives

Thinking About an EHR? : 

What will you gain What will your patients gain What will it cost Do you qualify for stimulus money Is it as overwhelming as you thought Will it allow you to keep pace with technology Thinking About an EHR?

For Those Not on EHR : 

How your work flow will be affected by EHR Which EHR system will work best with your specialty Long term value on an EHR The amount of customization a practice will need with an EHR Can the EHR be customized to meet your needs For Those Not on EHR

Return on Investment : 

Return on Investment (ROI) for your practice Improved quality care Better documentation More efficiency Workflow adaptability Higher and quicker reimbursement which translates to improved accounts Return on Investment

It Is Not So Easy : 

Overwhelming at first look Lot of work Don’t really know what you need or want Getting the right IT support Lost revenue during implementation Costly It Is Not So Easy

Challenges : 

Establishing effective workflows Capturing the data Developing processes Insuring privacy Implementing exchange of Health Information (HI) Measuring clinical quality measures Getting physicians involved and trained Challenges

From Then Till Now : 

ARRA (American Recovery and Reinvestment Act) signed in February 2009 by President Barack Obama NPRM (Notice of Proposed Rule Making) period closed on March 15, 2010 CMS received over 2,000 comments The Final Rule on display July 13,2010 From Then Till Now

The Road : 

17 months from signature to The Final Rule Over 2,000 comments Hundreds of hours were spent by volunteers of the Policy and Standards Committee Significant efforts by several organizations ONC (Office of the National Coordinator) CMS (Center for Medicare and Medicaid) OMB (Office of Management and budget) Other federal agencies The Road

Other Acronyms : 

CCHIT - Certification Commission for Health Information Technology (private, not for profit organization since 2004) MU – Meaningful Use EP – Eligible Professional CAH – Eligible Hospital/Critical Access Hospital HITECH – Health Information Technology CQM – Clinical Quality Measure A/I/U – Adopt, implement, or upgrade CMS – Center for Medicare and Medicaid Services CPOE – Computerized Physician Order Entry eRx – E-Prescribing HHS – U.S. Department of Health and Human Services HIT – Health Information Technology PECOS – Provider Enrollment, Chain, and Ownership System PQRI – Medicare physician Quality Reporting Initiative Other Acronyms

Meaningful Use : 

Use of a certified EHR in a meaningful manner Use of a certified EHR technology for electronic exchange of health information to improve quality of healthcare The use of a certified EHR technology to submit clinical quality and other measures Meaningful Use

What Has Changed? : 

Greater flexibility to meet and report certain objectives for Meaningful Use – it is no longer all or nothing There are lower metrics for EHR use in most or many instances Reduced number of clinical quality measures CAH (Clinical Access Hospitals) are now eligible for Medicaid incentives What Has Changed?

What Makes The Final Rule Friendlier? : 

EHR Functional Measures 15 metrics are in the Core Set which are required of everyone 10 metrics are in the Menu Set of which providers must pick 5 Recognition of “metric irrelevance – 2 metrics were removed and 2 were added Thresholds are generally lower (in some cases went from 80% to 30%) Removal of revenue cycle management metrics Addition of two metrics related to patient education materials and advance directives What Makes The Final Rule Friendlier?

More Reasons MU is Friendlier : 

Significant reduction in the number of clinical quality measures – went from 90 down to 44 Three core measures which are required of everyone Choice of three measures chosen from a subset, as most appropriate given the EP’s specialty No longer specialty-oriented More Reasons MU is Friendlier

Clarifications : 

Metrics are now based on actions with patients tracked in EHR which virtually eliminates administrative work around reporting States are allowed to tailor Stage 1 requirements for Medicaid incentives re: public health objectives and data registries – but nothing else Clarifications of ambiguities Registration for the ambulatory incentives will begin in January 2011 (different from hospitals) Clarifications

What Has Not Been Addressed? : 

Information about applying for grants HIPPA changes Office of the National Coordinator (ONC) Final Rule, Health Information Technology (HIT) Initial Set of Standards and Certification Criteria for EHR Technology Establishment of the Certification Programs for HIT requirements and procedures for becoming a certifying body What Has Not Been Addressed?

MU Core Objectives For EPs : 

CPOE (Computerized Physician Order Entry ) E-Prescribing (eRx) Report ambulatory clinical quality measures to CMS/States Implement one clinical decision support rule Provide patients with an electronic copy of their health information, upon request Provide clinical summaries for patients for each office visit Drug-drug and drug-allergy interaction checks Record demographics MU Core Objectives For EPs

MU Objectives for EPs (continued) : 

Maintain an up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 and older Capability to exchange key clinical information among providers of care and patient-authorized entities electronically Protect electronic health information MU Objectives for EPs (continued)

MU Menu Set For EPs : 

Drug-formulary checks Incorporate clinical lab test results as structured data Generate lists of patients by specific conditions Send reminders to patients per patient preference for preventative/follow up care Provide patients with timely electronic access to their health information MU Menu Set For EPs

Menu Set For EPs (continued) : 

Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate Medication reconciliation Summary of care record for each transition of care/referrals Capability to submit electronic data to immunization registries/systems Capability to provide electronic syndromic surveillance data to public health agencies Menu Set For EPs (continued)

Are you still with me? : 

Are you still with me?

3 Stages : 

Stage 1 Improve quality, safety, efficiency and to reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information 2011 and 2012 3 Stages

Stage 1 (continued) : 

To meet certain objectives/measures 80% of patients must have records in the certified EHR technology EPs have to report on 20 of the 25 MU Objectives Eligible hospitals have to report on 19 of 24 MU objectives Reporting period is 90 days for the first year Must be in the same calendar year Must start proving by October 1 of the first year Stage 1 (continued)

Stage 2 : 

Stage 2 Future stages to expand on stage 1 Stage 1 menu set will be transitioned into core set for stage 2 Will reevaluate measures – possibly set higher thresholds Will include greater emphasis on health information exchange across institutional boundaries 2013 Stage 2

MU Denominators : 

2 Types of percentage-based measures are included to address the burden of demonstrating MU Denominator is all patients seen or admitted during the EHR reporting period. This means all patients whether or not their records are kept using certified EHR technology Denominator is actions or subsets of patients seen or admitted during the EHR reporting period. The denominator only includes patients, or actions taken on behalf of those patients whose records are kept using a certified EHR technology MU Denominators

Stage 3 : 

Focuses on Outcomes Improved public health and robust patient-centered health information exchange Stage 3

Who Is Eligible? : 

Medicare Fee-For-Service (FFS) Medicare Advantage (MA) Medicaid Who Is Eligible?

Medicare Eligible EPs : 

Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Podiatric Medicine Doctor of Optometry Chiropractor Medicare Eligible EPs

Medicare Advantage EPs : 

MA Eligible Professionals Must furnish on average at least 20 hours/week of patient care services and be employed by the qualifying MA organization Must be employed by, or be a partner of, an entity that through contract with the qualifying MA organization furnishes at least 80% of the entity’s Medicare patient care services to enrollees of the qualifying MA organization MA Affiliated Eligible Hospitals Will be paid under the Medicare Fee-for-service EHR incentive program Medicare Advantage EPs

Medicaid Eligible EPs : 

Physicians Nurse Practitioners (NPs) Certified Nurse-Midwives (CNMs) Dentists Physician Assistants (PAs) working in a Federally Qualified Health Center (FQHC) or rural health clinic RHC) that is so led by a PA Medicaid Eligible EPs

When Is Stimulus Money Available? : 

A practice can begin to prove MU on January 1, 2011 Attestation for Medicare EHR incentive programs begin April 2011 First money is due (or so we are told) May 2011 To be eligible for 2011 money, a practice must register by February 29, 2012 When Is Stimulus Money Available?

Incentive Payments For Medicare EPs : 

Incentive Payments For Medicare EPs

Additional Incentive Payments For Medicare EPs Practicing in HPSAs* First Calendar Year (CY) for which the EP Receives and Incentive Payment : 

Additional Incentive Payments For Medicare EPs Practicing in HPSAs* First Calendar Year (CY) for which the EP Receives and Incentive Payment

Incentive Payments For Medicaid Eps* First Calendar Year (CY) for which the EP Receives an Incentive Payment : 

Incentive Payments For Medicaid Eps* First Calendar Year (CY) for which the EP Receives an Incentive Payment

Medicare and Medicaid EHR Program Differences : 

Medicare and Medicaid EHR Program Differences

Slide 37: 

Is Final Really Final?

Getting Started : 

Evaluate the practice needs Talk to other physicians in your specialty Select EHR systems to review Getting Started

Choosing An EHR : 

Deciding on an EHR How well it will function for your practice Features Certification Negotiate a contract Implementation timeline Support Training Upgrades Hardware Choosing An EHR

Does It Meet Your Needs : 

Perform a workflow analysis Scheduling Check-in Medical Records, scanning Clinical Telephone triage Prescriptions and refills Labs, Diagnostics, Surgeries Check-out Transcription, letters, follow-ups Billing, collection Patient portals Does It Meet Your Needs

Other Considerations : 

Get a timeline and implementation plan Consider your learning curve Data conversion Going live Hire a consultant to guide you through the process Hire a qualified IT company Consider borrowing options Getting up to speed quickly Other Considerations

Your Second EHR : 

Your choice may be limited by what you have now Map how your current data goes into the new system Define the scope of the data being converted Identify data that is being included and excluded Get a warranty for the conversion Verify that all data came over to new system Consider how you transfer and preserve data How will the data integrate to the new system How will data be reported Your Second EHR

EHR Conversions : 

Keep your old system available for a period of time Access to old records Be willing to convert some data after the implementation Physicians must verify and approve the converted data EHR Conversions

You need to preserve the integrity of the patient’s medical record : 

You need to preserve the integrity of the patient’s medical record

What Are You Gaining? : 

What Are You Gaining?

Improved : 

Quality of care Receivables More accurate coding and billing Workflow Documentation Clinical processes and outcomes Ability to share patient information Reduced medical errors Improved

More Positives : 

Access to patient information from remote locations Meet legal and regulatory standards More efficient and effective informational infrastructure Multi-media clinical references Diseases Conditions Procedures More Positives

Slide 48: 

Are you ready to go to EHR?

Thank You : 

Thank You

Slide 50: 

Donna is a business and health care consultant. She is a licensed Nursing Home Administrator and has spent more than 30 years in the healthcare industry. As an office manager, she has improved processes, staff development and recognizes the value of an efficiently run practice. She is also a speaker, trainer and writer on practice management topics.www.officemanagementsolution.com (847) 205-9797