Connect eNews Summer 2013

LEVERAGING TECHNOLOGY— EMPOWERING PHYSICIANS

ISSUE 5, Summer 2013

Connect eNews

Pamela Creekmur, who was tapped to head the Prince George’s County Department of Health in July after a year as acting health officer, is tasked with improving the health of county residents. As health officer, Creekmur, a native of Portsmouth, Va., manages a department of more than 550 people as well as multiple clinics spread across the county that provide a variety of health-related services to county residents. She is responsible for a general budget that amounts to about $70 million, including grant funding.

Pamela Creekmur’s professional senior health care management career spans over 20 years in healthcare administration and business operations. Ms. Creekmur

is known as a dynamic group motivator and performance coach with proven accomplishments in the areas of organizational and leadership assessment, recruitment and retention, and bottom line improvement. As the Medical Center Administrator for the Largo Medical Center, she was accountable for the overall management of a large multi-specialty medical center with over 350 employees and physicians. Before coming to the Prince George’s County Health Department as the interim Health Officer, she previously served as a Health Plan Operations Director for the District of Columbia/Suburban Maryland region of Kaiser Permanente serving over 280,000 members. During her tenure with Kaiser Permanente, she gained experience with process improvement, policy setting, budget control, program development, and leadership development.

Ms. Creekmur is a graduate of Howard University, where she earned a Bachelor of Science degree in Nursing. Currently, she is a candidate for a Master’s of Science in Health Care Administration from the University of Maryland University College. She lives in Prince George’s County with her husband of 29 years and a daughter.

Welcome to ZaneNet Connect eNewsOnce again, welcome to the online newsletter of our ZaneNet community of healthcare providers and innovators who are leading the initiative to transform patient care through the use of Health Information Technology.

Each issue features the story of a provider who has successfully initiated the meaningful use of electronic health records and qualified for incentive payments. Experiences vary, as do the size and needs of practices, and we can all learn from each other’s experience.

A recent Washington Post article pointed out that whereas a severely underserved community is defined as having one physician for every 3,500 residents, Prince George’s County offers only one for every 7,000. We are delighted, therefore, to highlight the work of the County’s new Health Department head, Pamela Creekmur, and her agenda for change.

Our federal news alerts us to the effect of the sequestration and updates us on the impact of the incentive program. And with new legislation, Maryland continues to lead in health care reform under the Affordable Care Act.

Be sure to take note of the news from ZaneNet Connect and our other offerings and photos.

We welcome your feedback and any suggestions on how this newsletter can best serve all our community.

Maryland Leaders in Healthcare IT: Pamela Creekmur

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Success Story: Dr. Leonard A. Richardson

Responding to the opportunities opening under the Affordable Care Act, Dr. Leonard A. Richardson has transformed his medical practice. After successfully attesting to meaningful use, he received his first incentive payment in June 2012.

Dr. Richardson is the president of Kingdom Medicine and worked as an Internal Medicine/Critical Care Unit physician at Northwest Hospital in Randallstown, MD. He is also the current president of Monumental City Medical Society in Baltimore, an affiliate of the National Medical Association; president and a founding member of the Maryland Physician’s Group; and current Chief of Aerospace Medicine for the 459th Aerospace Medicine Squadron at Joint Base Andrews.

A graduate of the Howard University College of Medicine, Dr. Richardson also holds a bachelor of science degree from Adelphi University and completed a joint residency training program in Internal Medicine at Michigan State University, Kalamazoo Center for Medical Studies and Howard University Hospital.

After serving with distinction in the United States Air Force, he later served at Andrews Air Force Base with the 459th Aeromedical Staging Squadron, leading a unit that provided supportive and emergency medical care for war casualties.

As Dr. Richardson faced the mandate to implement an ONC/ARRA “Meaningful Use” certified Electronic Health Record (EHR) system and attain Stage 1 reporting, his Kingdom Medicine practice was already fully outfitted with computers, successfully incorporating a Practice Management system and utilizing the DrFirst e-prescribing system. Selection of an electronic health

record system was underway.

Although he had thought ahead of the curve, not all of the practice’s equipment was certified. His challenge was to “marry the systems” already in use in the practice with systems certified for the new requirements. Facing an “incredibly complex process, a daunting path,” required learning new concepts, such as the timelines for registration and attestation. What were the parameters for getting to Meaningful Use? What were these numerators and denominators?

He likens the process to “building an airplane while flying.” Anticipating that nine months to year of workflow would be impacted, Dr. Richardson decided that he needed a credentialed guide--not just for EMR selection but also to understand the process ahead, from beginning to end. He found that assistance with an MSO, ZaneNet Connect.

During the implementation process, colleagues, staff and vendors had to be brought along. He wanted them to see that this new way was “how medicine was meant to be.” With the right people on the bus, the question remained of “how to drive.“ The rules were just being written; it was a cutting-edge problem, risky and time consuming. And the practice remained always responsible for its patient information, which could be audited by insurers and payors, while learning to input that data into the new system. It was stressful.

Eventually, as the process continued, gains were evident. “I’ve noticed that

after nine months you see efficiency gains, comprehensive notes for reimbursements, fewer errors, real-time reporting technologically integrated with HIE, patients come in on time. The practice is more efficient, effective.”

For Dr. Richardson, the greatest payoff has been the increased efficiency throughout the practice. He sees more patients and finds that patient satisfaction is up. The practice receives better reimbursement, prescriptions are more accurate and easier to get, and it is possible to print out graphs, reports and demographic information, with no handwriting needed. He regrets that, to date, the HIE is not integrated with the practice’s electronic health records system.

For the future, Dr. Richardson sees that modern medicine is constantly evolving. “If you stay at the front, additional initiatives will happen. Expect to continue to improve, apply for incentives, have a payor plan and have the documentation.”

As for the changes so far, “I have learned you need patience—a virtue for implementation and Meaningful Use. Be amenable to personnel changes; find the right people. Be committed to seeing it through to the end.” He declares that the trip has been “frustrating, exhaustive, but of tremendous benefit.”

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Maryland Health IT NewsThe Maryland Health Progress Act of 2013The Maryland Health Progress Act (SB 274/HB 228), signed into law by Governor Martin O’Malley in May, is the culmination of a three-year effort to use the tools of the Affordable Care Act to enhance access to quality and affordable health care for residents and small employers in the state. The Health Progress Act enacts the remaining policies necessary for the MHBE to expand Medicaid eligibility and, together with HB 361, which conforms State law to the federal consumer protections and insurance market reforms going into effect next year, ensures that Marylanders will reap the full benefits of health care reform and effective implementation of the Affordable Care Act.

The provisions of the Health Progress Act of 2013 include:

• Medicaid expansion

• Dedicated funding stream to finance the MHBE

• Gradual transition of MHIP enrollees into Exchange coverage

• Flexibility for State reinsurance wrap-around program

• Wrongful insurance act

• SHOP rules for employer premium contributions

• Continuity of care for Marylanders

• Consolidated Services Center employee function• Applicability of insurance article• Plan certification appeals process• MCO/carriers permitted to offer plans through Maryland

Health Connection only• Creation of “Application Counselors” and “Captive

Producers”

Upon the passage of the Act by the Senate and House of Delegates, Lt. Governor Anthony G. Brown stated: “I want to thank the members of the House and Senate for coming together and working closely with our partners in the health insurance industry, health care providers and associations, and community advocates to pass the Maryland Health Progress Act, ensuring that we will be among the first states in the country to bring the full benefits of the Affordable Care Act to individuals, families, and small businesses throughout our state… Each and every member of our communities deserves access to affordable, quality healthcare. And while our work is far from finished, the Maryland Health Progress Act is an important step forward towards achieving that goal.”

Product Highlight:Tablets with Windows 8 Standard ProTablets are increasingly the technology of choice in healthcare offices, as doctors and staff members use tablets to document patient information and gain instant access to patient records, exchange information with other healthcare professionals and hospitals, send prescriptions and billing data, and communicate with patients. Tablets and Tablet/Convertibles tend to be lighter than other portable options with longer battery life. Practitioners can choose from a variety of tablet offerings, each of which has its own advantages and limitations.

ZaneNet Connect is currently recommending the Samsung ATIV Smart PC Pro 700T Tablet/Convertible, a tablet that comes with a hard keyboard and trackpad, two additional USB ports, Windows 8 Pro, dual cameras (for patient photos or Telehealth applications), and a mini-HDMI port capable of driving a second monitor. Note that the less expensive Samsung ATIV Smart PC 500T, the same PC with less RAM and a slower processor, works in the same way except for speed and how well it handles multiple windows.

For running your tablet, we recommend the Windows 8 Standard/Pro operating system. Windows 8 Standard is the equivalent of Windows 7 Home Premium, and the Pro version is the equivalent of Windows 7 Ultimate. Windows 8 Standard and Pro based tablets can run any program their hardware supports, including legacy software currently in use. We recommend Pro for its extra security features and for use by larger practices that use Active Directory Logins to access network resources. The alternative operating system Windows 8 RT will not run any programs not specifically designed for Windows 8 and therefore we do not recommend it. Android and IOS based tablets work with only a limited number of EHRs and also are not recommended.

A variety of tablets offered by the Microsoft store can be viewed at the following link: http://www.microsoftstore.com/store/msusa/en_US/list/ThemeID.33363200/parentCategoryID.62684600/categoryID.62685500.

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Federal Health IT NewsSequestration Hits the EHR Incentive ProgramsSequestration will affect EHR incentive payments under Medicare, but not those issued for Medicaid. According to CMS, incentive payments made through the Medicare Electronic Health Records (EHR) Incentive Program are subject to the mandatory reductions in federal spending known as sequestration, required by the Budget Control Act of 2011.

As required by law, President Obama issued a sequestration order on March 1. Under these mandatory reductions, Medicare EHR incentive payments made to eligible professionals and eligible hospitals will be reduced by 2%. This 2% reduction will be applied to any Medicare EHR incentive payment for a reporting period that ends on or after April 1, 2013. Medicaid EHR incentive payments are exempt from the mandatory reductions.

Incentive Program Issues Progress ReportAs of the end of April, the federal government had paid out $14.6 billion in EHR incentive payments. Out of a pool of 532,000 possible participants, 395,000 eligible providers and hospitals were in “active registration” in the federal Meaningful Use program.

Robert Anthony, deputy director of the HIT Initiative Group at the CMS Office of E-Health Standards and Services, said that CMS is encouraged by the steady increase in Medicaid-eligible providers signing up to participate, with some 13,000 Medicaid meaningful users already in the program. “In April, 3,200 came in and demonstrated meaningful use.” He further noted that CMS is seeing an upward trend of meaningful users in both Medicaid and Medicare who are not in primary care. Currently, 61 percent are in specialty care. Also, according to Anthony:

• Approximately 50 percent of Medicare EPs are meaningful users of EHRs.

• Approximately 63 percent of all Medicaid EPs have received an EHR incentive payment.

• 10 percent of Medicaid EPs are meaningful users.

• More than 55 percent of Medicare and Medicaid EPs have made a financial commitment to an EHR.

As of the end of April, more than 292,000 Medicare and Medicaid eligible providers had received an EHR incentive payment. CMS analysis of data through April showed that 194,080 eligible providers had attested: 193,867 successfully and 213 unsuccessfully.

The Clinical Summary includes basic clinical information regarding the care a practice has provided, such as medications, upcoming appointments, or other instructions and affords better communication around pertinent medical information. It is also good practice for engaging patients in their own care and helping them to remember what happened during the office visit. Done right, the clinical summary may also improve the quality of data in the EHR, because patients and their caregivers can review the information for accuracy and correct errors.

Core Measure 13 is one of the most difficult core measures to accomplish for many providers, because it requires significant workflow adjustments both for entering information into the EHR before the end of the visit and for ensuring that staff can deliver a summary to every patient for each visit. A workflow that allows a provider to finish the initial assessment during the visit, entering only the information necessary to the clinical summary, ensures that the summary is completed in a timely manner and reaches each patient after each visit, either in print or accessible via a web portal for the patient to access. Attention should be paid to formatting the summary so that the patient can understand its contents.

It is recommended that providers view the April 2013 update of the requirements for meeting Core Measure 13 by visiting http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/13_Clinical_Summaries.pdf.

A detailed guide to achieving clinical summaries—workflow, contents, clinical visit, roles of providers and staff, format of report—compiled by the Washington Idaho REC can be found online at http://www.wirecqh.org/upload/AVS-Tech-Guide.pdf.

MEANINGFUL USE

OF THE WEEK

Attesting to Core Measure 13, Clinical Summaries

TIP

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ZNC Specialist Moves OnSushma Gottipati has taken a new position in the Prince George’s County Health Department as a Health Information Adoption Specialist in the Childhood Obesity Reduction Initiative Project (CORI). Sushma joined ZNC in 2012 as an EHR implementation specialist with a clinical background, working with healthcare providers to assess what their practices needed to achieve meaningful use.

While at ZaneNet, Sushma joined the ZNC team that helped the Prince George’s clinics implement an integrated EHR system. She also participated in the Prince George’s “Let’s Move” initiative creating a pilot program to increase both the availability and consumption of fresh food for county residents and awareness of childhood obesity, to promote healthy eating and physical activity, and to create a healthy community.

The CORI Project she has now joined seeks to reduce pediatric obesity in Prince George’s County by implementing a pediatric obesity “wellness plan” tailored to each child and family that incorporates physical activity, via the Parks and Recreation Department; education and school-based wellness via the

school-based clinics system; and health care maintenance via Telehealth. This project is a test case demonstrating a community-based, multi-component model for effecting behavioral and system changes that lead to improved outcomes.

In 2012, Sushma graduated from University of Maryland, College Park with a Masters of Health Administration degree; she also holds a Bachelor of Dental Surgery degree. Sushma sits on the State of Maryland’s HIE Policy Board.

On a daily basis, Sushma will be greatly missed by her coworkers and by the clients she served, but we look forward to future collaboration with her in promoting improved access to healthcare in Maryland, especially in underserved populations.

As part of its community service activities, ZaneNet Connect helped sponsor and participated in the First Annual Golf Classic at Bull Run Golf Club in Haymarket, Virginia, on Thursday, May 17. The event featured eighteen holes of golf, lunch, a putting contest, silent auction, and remarks about Mary’s Center over a seated dinner.

Proceeds of the Golf Classic sustain Mary’s Center’s four medical clinics, offering family literacy classes, health promotion, home visiting, tutoring and counseling for teens. Mary’s Center also operates a senior wellness center and mobile medical unit. In the face of imminent federal and local-level budget cuts, Mary’s Center needs the support of individual donors and local businesses now more than ever.

Top right: Maria Gomez, President and CEO and Doug Kammerer, NBC 4 Washington’s Chief Meteorologist.

ZaneNet Donates, Plays Golf to Benefit Center

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Zane Networks has distinguished itself this year with the unique array of services it offers its clients, its community service activities and its outreach to new partners. In May, Zane Networks was named the Montgomery County Small Business of the Year, in the category of 11 to 50 employees, a category that includes ninety-six percent of the county’s 33,000 small businesses.

At the Small Business Awards Ceremony on May 24 at the Bethesda Marriot Conference Center, over 300 companies joined Montgomery County Executive Isiah Leggett (D), Steve Silverman, director of the county’s Department of Economic Development, and Montgomery County Council president Nancy Navarro in honoring winners in eight award categories.

“This select group of honorees represents the very best Montgomery County has to offer,” said Leggett. “We honor and thank them not just for being here but growing, supporting jobs and thriving here in Montgomery County.” “Small businesses represent the heart of the Montgomery County economy,” said Silverman. “Our Department and the County recognize and truly value the significant contributions this sector makes in supporting our local economy.”

Custom Medical Websites Arrive from ZNCZaneNet Connect is now offering its well-established infrastructure and expertise to assist individual medical practices to create an online “storefront” to showcase their practice. At a reasonable one-time setup cost, ZaneNet will supply HIPAA-compliant websites that are mobile enabled, are integrated with Google Calendar and Google Forms with SEO (search-enabled optimization) and can be customized with your practice’s content, color scheme, logo and pictures. For many years, ZaneNet has built and maintained sites for national health associations, businesses and educational institutions. Call us for more information.

ZaneNet Tapped for Small Business of the Year Award

ZaneNet is serving as a subcontractor to Mary’s Center, a Federally Qualified Health Center that provides health care, family literacy and social services to residents of the DC metropolitan region, on the Capital Clinical Integrated Network (CCIN) project. CCIN, funded by the Center for Medicare and Medicaid Services (CMS), has been awarded a $15 million, three-year grant for the newly created network. The CCIN will unite a group of the District’s Medicaid managed care

organizations (MCOs), community health centers, mental health providers, hospitals, health care associations, and health technology specialists to create an innovative patient care model that will improve healthcare delivery and health outcomes while creating savings in care costs that will be shared among network members. We currently provide health IT consulting services on this important project.

ZaneNet Aids DC Community Health Center

Photo courtesy of Mary’s Center.

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In response to our queries, Ms. Creekmur described her agenda and accomplishments:

1. Last July, when Prince George’s County Executive Rushern L. Baker III announced your confirmation as the new head of the Department of Health, he said that as acting director you had been “working to make sure that healthcare is on the front page of the agenda for Prince George’s County.” Please discuss your agenda and how this mission is going forward.

My agenda is quite simply to transform the Health Department into an agile forward-leaning, competitive, customer-focused and results-oriented health enterprise. In doing so, I have already laid out a very clear, unambiguous and new direction for the Department. To accomplish this I have developed a new organizational structure that aligns with our new vision and direction. We are moving from functioning as silos, with mediocre expectations, and we now promote an aura that embraces a sense of

urgency and excellence. Among the agenda items we are focusing on are:

• The provision of coordinated care utilizing EHR as a tool to assist in this transformation

• Training of the Health Department’s Leadership Team to equip them with the necessary skills to move the Department’s agenda forward

• Revamping the Health Department’s Human Resources Unit to institute state of the art practices in critical areas including employee hiring, staff training, retention and succession planning, as part of the strategy to enhance the workforce

• Aligning programs and initiatives with the critical missions of the Department

• Enhancing the Department’s grant application process to enable us to seek additional funds to implement much-needed initiatives to address the health disparities that exist in the County

2. Maryland is recognized as a leading state in Electronic Health Record adoption and related initiatives, such as the Health Information Exchange and Patient Centered Medical Home programs, that encourage coordinated care. How do you see these initiatives playing out in the Department of Health?

Like the State, the Health Department is committed to ensuring that we are in the forefront when it comes to Health Information Technology. To this end, we are among the first in the state to fully adopt an electronic health record (EHR) system and a Practice Management system. It has been quite a challenge as we attempt to integrate many of the state’s existing stand-alone electronic reporting and patient records systems. Some of these older systems are not compatible with the newer EHR systems. Hence, the challenge still is to be fully electronic and at the time streamline and link these systems into one comprehensive electronic health record system capable of generating needed

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ZaneNet Connect NewsZNC Gateway Melds Practices, State Health Information Exchange

Through our gateway, the Community Provider Connect (CPC), ZaneNet connects individual practices to the State’s CRISP Health Informa-tion Exchange (HIE), enabling providers to receive lab results, radiology reports, and admission and discharge summaries from hospitals directly into their EHR systems. Delivering this information via CRISP’s HIE and the CPC alleviates the need for fax and phone and assures greater accuracy and timeliness. The CPC also helps providers to document their Meaningful Use measures and positions them to comply with Stage 2. For more information, please contact ZaneNet Connect.

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8070 Georgia AvenueSuite 407

Silver Spring, MD 20910www.zanenetconnect.com

301-830-7799 phone301-358-0821 fax

reports required by the multiple programs that exist in the health department.

3. Maryland has undertaken a pilot program for a series of geographically based Health Enterprise Zones (HEZs) in underserved communities. On May 1, Lt. Governor Anthony Brown presented officials from the Prince George’s County Health Department (PGHD) with a ceremonial check for $1,100,000 to fund the new Health Enterprise Zone in Capitol Heights, which will be managed by PGHD in partnership with a coalition of local and community partners. Why was the Department chosen, and what programs will it enable?

One of the primary reasons why the Prince George’s County Health Department was chosen was because it submitted a proposal detailing a very compelling case as to why the 20743 zipcode needed the infusion of resources to provide primary medical services to this medically underserved area. This population of approximately 38,621 individuals does not have a Board-certified primary care physician in the community and only one healthcare center. It is an inner beltway community that shares contiguous borders with Washington, DC. It also has one of the highest disease burdens in the county. At the end of the four-year period, that is, the end of the granting period, the area will have five (5) patient centered medical homes (PCMH), each having at least one full-time board certified physician and at least one other health care provider. The coalition and community based work groups have already been formed and have begun meeting with the Health Department personnel to begin the very important work of community engagement and participation in the Health Enterprise Zone.

4. What other Department of Health programs and/or initiatives would you like to highlight here?

• I would like to share with you two new initiatives in the Health Department. One is the Community Transformation Grant (CTG) Small Communities Program. This initiative was made possible by the receipt of a competitive federal grant to implement policy, environmental, programmatic and infrastructure interventions to promote healthy eating; active living; smoke-free environments and access to quality preventive care for residents of 12 zipcodes in the inner beltway. In collaboration with the Prince George’s County Health Action Coalition, the Health Department will institute a number of activities in the targeted communities to increase the number of smoke-free environments, including multi-family housing units and hospital campuses; increase the number of farmer’s markets; reduce the percentage of obese and overweight residents; promote activities that encourage residents to be active; and increase the number of healthcare systems that support hypertension and diabetes prevention through the use of electronic medical records with patient portals. This program is funded through September 2014.

• The second initiative is the Child Obesity Reduction Initiative (CORI). This initiative embraces the theme ”Be Healthy, Be Fit.” The initiative targets children who are overweight and works with them and their parents to adopt lifestyle changes that will lead to weight loss and improved health status. Individuals participating in this program are those between the ages of 6 and 18 who want to “Be a Part of the Healthy Revolution.” During this program, children will continue with their own pediatrician, and a community health worker, a nurse and a nutritionist will be involved to guide them through the process.

5. How would you advise healthcare providers to optimize the opportunities offered by the Affordable Care Act?

I would encourage healthcare providers to accept the fact that the Act is the law of the land. It presents many opportunities for providers to re-tool their patient care practices and leverage the opportunities this new law offers to increase access to quality health care services. I would also encourage the significant numbers of newly qualified individuals to enroll in the expanded Medicare program.

6. What role do you see for Management Services Organizations (MSOs) in supporting healthcare providers in the future?

I see the role of the MSO as an essential partner to assist providers to navigate the path to successful adoption of electronic health records (EHRs). Among the activities I see for the MSOs are to educate providers on ways to maximize the efficiency and effectiveness of EHR systems and on ways to achieve Meaningful Use and how to maximize the receipt of Federal incentives that are still available to EHR adopters; on the path to connecting the EHR to the HIE; and in understanding and meeting the privacy and security requirements.