Aami hitech mu impact on the future on HC IT

HITECH and Meaningful Use:

The Impact on the Future of Healthcare Technology

Management

Amy Walker MS, RN, CPHQ, FACHE, NEA-BC

Practice Director Health IT +

Member HIMSS Public Policy Committee

• Relate the components of The HITECH Act and Meaningful Use to health management technology

• Identify whether existing systems meet requirements

• Communicate technology needs and request feedback from end users for a smooth transition

• Implement best practices to move people and systems forward under these new requirements

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What We Will Cover…..

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Clinical Informatics

New Clinical Informatics Initiatives

Healthcare Operations

Information Technology

Communication

Communication

The Foundation

Definitions

• Ecosystem

• Requirement

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Leading from good to great does not mean coming

up with the answers and then motivating everyone

to follow your messianic vision. It means having the

humility to grasp the fact that you do not yet

understand enough to have all of the answers and

then to ask the questions that will lead to the best

possible insights.

(Jim Collins, Good to Great)

What This Presentation Is Not About

The thoughtless application of IT, for slash and burn downsizing, restructuring,

and outsourcing.

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• President Bush’s goal in 2004

• Executive order established the Office of the National Coordinator for Health Information Technology (ONCHIT) as part of the Dept of Health & Human Services (HHS)– Dr. David Brailer appointed the first National Coordinator

A quick trip down memory lane …

“… an Electronic Health Record for every American by the year 2014. By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”

- State of the Union address, Jan. 20, 2004

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HITECH Act? hmm, sounds familiar…

• Signed into law February 2009 as part of ARRA

• Goal– 90% of U.S. physicians and 70% of

hospitals using EHR by 2019

• How?– Provide $19 Billion to doctors and

hospitals through DHS to implement EHR by 2011

ARRA• HITECH Care• Care Coordination• Disease Management• Value-based Purchasing• Bundled Payment• Medical Home

• Comparativeness Effectiveness

• Meaningful Use• Public Reporting and

Accountability• Reward Top Performers• Penalize Bottom

Performers

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ARRA EHR Adoption –Incentive Requirements

• To encourage broad adoption of EHRs, ARRA offers reimbursement to eligible providers/hospitals who meet two requirements:– Acquire a certified EHR product or service

– Demonstrate that the organization or provider are using that product/service “meaningfully”

• ARRA creates HIT Policy and HIT Standards Committees which must recommend:– Criteria for certifying EHR products

– Criteria for demonstrating that an applicant is using the EHR meaningfully

Why are We Here?

• 2011• 2013 • 2015

• Improve quality, safety, efficiency, and reduce health disparities

• Engage patients and families in their health care

• Improve care coordination

• Improve population and public health

• All the while maintaining privacy and security

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HITECH Framework for MU of EHRs

Taken from: Blumenthal, D. “Launching HITECH,” posted by the NEJM on 12-30-2009.

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MU Measures Quality Measures

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VTE - 1 VTE Prophylaxis within 24 hours of arrival

Stroke - 2 Ischemic Stroke - Discharge on Antithrombotics

VTE - 2 VTE Prophylaxis within 24 hours of arrival to ICU

Stroke - 3 Ischemic Stroke - Anticoagulation for A-Fib/Flutter

VTE -3 VTE Diagnosis - Anticoagulation Overlap Therapy

Stroke - 4 Ischemic Stroke - Thrombolytic therapy for patients arriving within 2 hours of symptom onset

VTE -4 VTE - Platelet Monitoring on unfractionated Heparin

Stroke - 5 Ischemic or Hemorrhagic Stroke - Antithrombotic therapy by day 2

VTE - 5 VTE - Discharge Instructions Stroke - 6 Ischemic Stroke - Discharge on Statins

VTE - 6 VTE - Incidence of potentially preventable VTE

Stroke - 8 Ischemic or Hemorrhagic Stroke – Education

ED - 1 ED throughput-arrival to departure for admitted patients

Stroke - 10

Ischemic or Hemorrhagic Stroke - Rehabilitation Assessment

ED – 2 ED throughput - Admit decision time to ED departure time for admitted patients.

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HITECH Incentives for Hospitals – Medicare Example

Four Year CMS Health IT Incentive Payment Scenarios:

2011 2012 2013 2014 2015 2016

2011 $20 $0 $0 $0 $0 $0

2012 $15 $20 $0 $0 $0 $0

2013 $10 $15 $20 $0 $0 $0

2014 $5 $10 $15 $15 $0 $0

2015 $0 $5 $10 $10 $10 $0

2016 $0 $0 $5 $5 $5 $0

2017 $0 $0 $0 $0 $0 $0

$50 $50 $50 $30 $15

Maximum Medicare health IT incentive paymentfor thisyear is:

If the first qualifying year is:

Total of Maximum over 4, 3, or 2 Years' Medicare Health

IT Incentive Payments

Example Numbers(millions)

Penalties begin

100% 100% 100% 60% 30%

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Current State for EMR Adoption in Home Health

• Over 80% use telemonitoring devices – from lo tech to hi tech

• EMR Technology Levels* (2007 survey data)– 43% use EMR systems with following functionality

• Patient demographics 95%• Point of care clinical documentation 29%• Clinical notes 34%• Clinical decision support 23%• Record MD orders 50%

– 31% in process

Resnick, H.E., and Alwan, M. (2010). Use of health information technology in home health and hospice agencies: United States, 2007. Journal of the American Medical Informatics Association 17(4):389-395.

What Does It Mean?

• Increased reliance on IT

• Greater need for informatics professionals

• SWOT analysis should come sooner rather than later

• Suddenly, certifications matters more than ever

• More governance / new regulatory and reimbursement guidelines

Leveraging best practices to move and systems forward

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• Improve quality, cut costs– Accountable Care Organizations

• Larger insurance footprint• Not predetermined• Focus on value• Shift to outpatient care• Data driven problem solving• Refocus on fraud• Growing information technology footprint

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Goals of Healthcare Reform

• Proposed CMO ACO rules published

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• Meaningful Use Stage 2

• Advanced Clinical Process

• Medicare Accountable Care Organizations

• Medicare Value-based Purchasing

• Reduced Medicare Payments for Hospital Readmissions

• Medicare Bundle Payment Pilot

• ICD-10 Conversion

• Meaningful Use Stage 3 Improved Outcomes

• Health Insurance Exchanges (electronic eligibility)

• Reduced Medicare Payments for Hospital acquired Infections (HAI)

• MedicareExpenditures

Capped

• Medicare payment adjustment begins for non meaningful users of IT

Accelerating Health Care Value

“Readiness for change is one of the hardest problems we face”, Paul Tang, HIT Policy Committee vice chair and Palo Alto Medical Foundation vice president and chief medical information officer.

“To realize our vision, we must foster a pervasive culture of innovation”, Douglas D. French, former Ascension Health president and chief executive officer.

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Clinical Informatics

New Clinical Informatics Initiatives

Clinical Operations

Information Technology

Communication

Communication

Health IT Strategic Framework

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Meaningful Healthcare Reform A Journey

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Industrial Strength LEADERSHIP & MANAGEMENT

• Complete an enterprise assessment of the organizational readiness to reform

• Evaluate the present situation, identify recommendations, and best practices to optimize the future state

• Identify obstacles, challenges, sources of issues, and needed changes

• Identify indicators of healthcare reform and changes in order to maximize operational performance

• Create and heavily emphasize an EFFECTIVE & INNOVATIVE change management and communication plan

• Create a practical benefits realization plan

Certified EHR Technology

• Office of the National Coordinator for Health Information Technology has approved two entities as able to review and certify EHRs – Certification Commission for Health Information

Technology (CCHIT) – Drummond Group Inc.

• Unless your current system is homegrown, piecemeal or older, your EHR vendor is likely already pursuing certification

• (and/or trying to sell you a new or upgraded system – which they promise will be certifiable)

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Aurora Health Care HITECH Gap Analysis

Look at each MU Criteria (and Gap) in 3 ways:

1. Technology – do you need software installed?

2. Adoption – do you have the required adoption?

3. Ability to Measure – can you measure?

Use these same categories in theWork Plan for tracking

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Aurora Health Care MU Dashboard

Slide #31

Aurora Health Care Project Tracking Tool

HIPAA

Privacy and Security

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Today’s Privacy and Security EnvironmentCovered Entities

Medical Homes

Medical Homes

Medical Homes

Pharmacy

Laboratories

Medical Log

Physician Portal

Personal Healthcare

Records

Medical Records

Clinical Image Records

Wellness Centers

Outpatient Care

Accountable Care Organizations

Exercise Log

EMR

Social Worker

Emergency

Payer

Primary Care Physician

Patient

Increase in HIPAA Penalties

Under the ARRA:

All such violations of an identical provision in a calendar year

(A) Did Not Know ............................................. $100 $50,000 $1,500,000

(B) Reasonable Cause ..................................... 1,000 50,000 1,500,000

(C) Willful Neglect—Corrected ........................ 10,000 50,000 1,500,000

(C) Willful Neglect—Not Corrected .................. 50,000 1,500,000

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A Sample of Questions for HIPAA-Security Assessment

• What is our single vulnerability from a technology or security point of view?

• How vulnerable are we to attack on confidentiality, integrity, and availability of our data and systems?

• What is the assessment of physical security controls at each of our sites (data center, home office, field offices, and other sites?

• How prepared are our incident response plans?• Have we protected our company in contracts with vendors?• Do we understand what PHI we produce, capture, store,

transport, and destroy?

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Standards and Interoperability

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HITECH Drives US Standards Efforts

• Goal: Transform healthcare through the meaningful use of health data

• Data capture data sharing advanced clinical processes

Improved Outcomes

• Requires organized structuring and effective use of information to support decision making

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Need for Health Data Standards

• Standards are foundational to development, implementation and exchange of EHRs

• Clinicians need ubiquitous access to health information to provide optimal care

• Providers, payers and public health entities must exchange health information between departments, across organizations and agencies

• Consumers need assurance that caregivers have seamless access to correct information

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ONC Standards and Interoperability Framework

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Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

Tools and Services(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

Use Case Developmentand Functional Requirements

Use Case Developmentand Functional Requirements

Standards DevelopmentStandards

Development

Certificationand Testing

Certificationand Testing

Harmonization ofCore Concepts

Harmonization ofCore Concepts

Implementation Specifications

Implementation Specifications

Pilot Demonstration Projects

Pilot Demonstration Projects

Reference Implementation

Reference Implementation

ICD-10

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ICD-10 Compliance Impact

• International Classification of Disease 10th Revision• federally mandated by October 1, 2013 for all providers• more flexible code set expands for new procedures, diagnoses and

technologies• greater specificity translates to improved quality measurements and patient

safety standards

• Impact to include:• Coding Medical Records/Health Information Management• Registration/Scheduling• Encounter Forms/Charge Tickets• Clinical Documentation– Information Systems; including EHR’s …the entire Revenue Cycle

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Home Health

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Home Health Today

3.3 million seniors receiving care on any given day – over 14 million per year*

• Over 10,000 agencies – coverage in every state• Approx 1 million clinicians; multidisciplinary• Most provide specialty programs

– Diabetes, Congestive Failure, COPD, Stroke– Patient centered, self management focus

• Many specialize in geriatrics• Lowest cost/best outcomes in chronic care management for

elderly**

*Medicare Payment Advisory Commission. (2011) http://www.medpac.gov/documents/Mar11_EntireReport.pdf

Literature Shows

• Seniors do better at home for acute care on clinical outcomes, costs, satisfaction

• Transitioning elders from acute to home with teaching for self management and f/u more effective, low readmission rates

• Use of telemonitoring in home for CHF and cardiac patients w/PHR show optimal recovery and self management results.

Aging Demographics

• 7000 Baby Boomers turning 65 yrs every day• 2011 Legislature targeting Medicare and

Medicaid cuts• Current CMS spending and Baby-Boomer

impact vs. national fiscal goal of deficit reductions

• HH positioned to provide highest quality and best outcomes in care delivery for our elder population

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Key Initiatives in ACA(CBO est. 13.5b savings 2011-19 Sec 3021-3027)

• CMI – Center for Medicare and Medicaid Innovation – launched November, 2010

• Hospital at Home – for elderly

• Care Transition Program Pilot

• Readmissions Reduction Program

• Accountable Care Org/Bundling Pilots

Clinical Engineering

The Clinical Engineering Department provides multiple services to ensure that the medical equipment needs for patients and staff are met. We provide services with accuracy and integrity.

– Provide installation, preventive maintenance– Provide mandatory pre-use inspections– Performs investigations– Provides assistance in the disposal of medical equipment – Provides for in-service training and support

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Perhaps Clinical Engineering Might Also Focus On

• Identifying improvement opportunities• Participating in information technology and management

strategy• Optimization in the use of devices• Rounding to ensure feedback and evaluation of device

usage• Expert resource in care coordination: technologies,

equipment and information flow • Expert resource in equipment, process, and information

flow for meaningful use, and • Expert resource for teams defining information technology

management

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It’s Not What We Don’t Know

That Hurts, It’s What We

Know That Ain’t So

Will Rogers (1879-1935)

Planning for Quality the Systems Thinker51

“Systems Thinking is a discipline for seeing wholes, recognizing patterns and interrelationships, and learning

how to structure those

interrelationships in more

effective, efficient ways.”

Senge, P., & Lannon-Kim, C., 1991

Five Dysfunctions of a Team

• Absence of Trust• Fear of Conflict• Lack of Commitment• Avoidance of Accountability• Inattention to Results• Identify the behaviors?• How do you know that these have been

overcome? The Five Dysfunctions of a Team: A Leadership Fable, San Francisco;

Jossey-Bass, 2002

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Lean Incorporated into Our Teams

• People first• Flexibility• Walking the Talk• Our colleagues are assets• Always provide value• Mentor and coach• Bridge organizational boundaries• Adjustments made as work flow indicates• Applies frontline feedback

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Listening Techniques

• Clarify-get more information• Restate-check the meaning• Remain neutral-convey interest• Reflect-help them evaluate their feelings• Summarize-bring the discussion into focus

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Are the skills, knowledge, and experience of the actors well matched with the tasks they are

asked to perform?

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It is only after I have read, identified, and stimulated your needs that I will be able

to energize our discussions while irresistibly presenting my ideas to you.

(Robert Mayer, How to Win Any Negotiation)

Power/Influence is the ability to get people to perceive that a given behavior (or performance) is the best action they can take in the service of their values.

Care Providers

• At risk and accountable• Will prepare for multiple reform outcomes• Forge new partnerships • Reliance on valid performance vs. faulty• Increase in training• Empowered to lead improvement• Decrease in the size of the pie• Increase in reliance in technology• Driven by incentives and penalties

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It Is Not The Strongest Who Survive, Or The Fastest.

It Is The Ones Who Can Change the Quickest.

Charles Darwin

Care Providers Must Simplify Communication

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Communication Balancing Act

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Accountable Care Organizations

A concept that has the potential to revolutionize the way healthcare is delivered, experienced, and paid for in America.– Care coordination– Patient centered using to the full extent all health

care professionals– Respects patient centeredness by respecting patient

choice of provider and shared decision making– Positive patient experience

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Medical Home

Six medical home standards– Enhance access and continuity– Identify and manage patient populations– Plan and manage care– Provide self-care and community support– Track and coordinate care– Measure and improve performance

•E-Visits

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Innovative Systems

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The Vscan by GE, is a new mobile device designed for doctors who are making house calls.

FutureScan 2011: Healthcare Trends and Implications 2011 - 2016Society for Healthcare Strategy and Market Development / Health Administration Press January 2011

Innovative Systems

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AirStrip Technologies, has built its revolutionary AppPoint™ software development platform with a vision of securely sending critical patient information directly from hospital monitoring systems, bedside devices, and electronic health records to a clinician's mobile device.

Further Impact to Information Systems

• Zero tolerance for negative unintended consequences will be identified and resolved

• Increased support to care coordination

• Increased certification criteria based on measurable achievements

• Mathematical and logical models will become the norm to support healthcare reform

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Perhaps Clinical Engineering Might Needs to Focus On

• Identifying improvement opportunities• Participating in Information technology and management

strategy• Optimization in the use of devices• Rounding to ensure feedback and evaluation of device usage• Expert resource in care coordination: technologies,

equipment and information flow • Expert resource in equipment, process, and information flow

for meaningful use

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Perhaps Clinical Engineering Might Needs to Focus On

• Identifying improvement opportunities• Participating in Information technology and management

strategy• Optimization in the use of devices• Rounding to ensure feedback and evaluation of device usage• Expert resource in care coordination: technologies,

equipment and information flow • Expert resource in equipment, process, and information flow

for meaningful use

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Health IT Strategic Framework

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Enterprise Commitment

and Accountability

Organizational Readiness A

Pervasive Culture

• Industrial strength leaders• Industrial strength organizations• Un-ending curiosity and fact finding• Ability to project what-if scenarios• Ability to simplify every process• Ability to act lean• Zero tolerance for waste

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Implement best practices to move people and systems forward under these new requirements

Closing Thought…

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We can build high performance teams that together, determine and implement the requirements for healthcare organizations that operate as innovation engines, transforming people, technology, and processes to advance healthcare reform.

We realize it begins with us.

Thank you!

For more information, please contact:[email protected] or [email protected], 703-283-4678