Powerpoint lawrence m. preston

Lawrence M. Preston, MBA, FHFMA

Professional Medical Consultants, Inc.April 18, 2012

AIIM and ARMA

Background• 19 years in hospital management-California,

Hawaii and Nevada• 20 years in healthcare consulting-based in LV• Primary focus-Physician Practice

Management• Own Primary Care Practice in Mexico• Starting IPA in Nevada• Application in for ACO in Nevada• Board of Directors-ACHE and HFMA Nevada

2Professional Medical Consultants, Inc.

Meaningful Use-Phase ICore Measurements -15 criteria must be met

Menu Set – choose 5 of 10 criteria

Must meet 100% of each or no incentive payment

Payment for Medicare is up to $44,000 over 5 years ($63,750 for Medicaid over 6 years)



Core Measurements1. E-prescribing at least 40% of all RX2. At least 30% of patient seen must have a

medication entered into system 3. EMR software must have drug to drug

interaction/allergy alert4. At least 80% of patients seen must have an

active medication list


Core Measurements-continued5. At least 80% of patients seen must have up

to date diagnosis6. At least 80% of patients seen must have an

active allergy list7. At least 50% of patients seen must have

smoking status and history documented8. Need to implement one clinical decision

support rule


Core Measurements-continued9. Need at least 50% of patients seen to have

documented the following questions:a. Preferred languageb. Genderc. Raced. Ethnicity (Hispanic or Non-Hispanic)e. Date of Birth


Core Measurements-Continued10.Need at least 50% of patients to have seen

the following vitals signs recorded:a. Heightb. Weightc. Blood Pressured. BMI (calculated by Height & Weight)e. Plot and display growth charts for children

ages 2-20


Core Measurements-continued11.Need to report ambulatory clinical quality

measures to CMS (Medicare)12.Need to provide at least 50% of patients

with an electronic copy of their health information within 3 business days-when requested

13.Need to provide at least 50% of patients seen a clinical summary of their visit within 3 business days from the date seen


Core Measurements-continued14.Need to perform at least one test of

electronically exchanging clinical information with another provider

15.Need to have a security risk analysis conducted

Meet each and everyone one of the above criteria to pass this section (no exceptions)


Menu Set Measurements1. Implement drug formulary check2. Have a least 40 % of lab results reported

into system3. Need to generate a least one list of patients

by specific condition (i.e.-Diabetes)4. Need at least 10% of patients to be able to

obtain their medical information within three business days


Menu Set Measurements5. Need at least 20% of patients 65 and older

to be sent a reminder for preventative or follow up care

6. Need at least 10% of patients seen be given patient specific education resources that are generated from the EMR system

7. Need to update at least 50% of patients seen medication list when seen by another doctor


Menu Set Measurements8. Need to send a referral, summary of care

and any other pertinent information on at least 50% of patients being referred out

9. Need to perform at least on test of sending electronic immunization records to an immunization registry

10.Need to perform at least one test of sending electronic syndromic surveillance data to a public health agency


Meaningful Use• Must meet all 15 Core at 100%

• Must meet 5 of the 10 Menu set

• Miss any of the above-no incentive payment

• Check your software to make sure it can do the above and that it has been approved by CMS standards board-now your ready to go


How to ImplementAsk for help from your vendor

Don’t get to complicated

KISS

Physician buy in—largest and most difficult


How to order a Rx through the EHR

Pull Chart Go to Assessment and Plan Choose existing medication from patient’s medication list

For new medication go to search, then change Data Source to Medications, enter dosage, frequency, quantity and refills

Press Output Choose Pharmacy Enter Password Press OK Sign Off Enter Password Change Encounter Type to Prescription Only Press OK


How to add an addendum to EHR chart

Double click on the office visit that needs the addendum (located on the face sheet in the upper R hand corner)

Click on pencil (located in the L upper corner)Click on what section you want to add

information to (hover your mouse over the pictures, A+P, vitals, etc)

Type the information into the box provided.Click OK


EHR Implementation Schedule

Week 1: All staff (including physicians) needs to start using messaging system.

Example: Front desk staff can send message to MA that a patient keeps calling and leaving messages for them, and haven’t received a call back yet.


EHR Implementation ScheduleWeek 2: Physicians need to start reviewing

all lab results through system and message to their MA’s anything needed. No labs should be printed unless needed.

MA’s need to start entering all medications and allergies of the morning patients into the system. MA’s also need to enter entire social history, medications, allergies, medical problems of all new patients.



Week 3: Physicians need to start with 4 patients daily doing only the review of systems in the system.

MA’s need to start entering all medical problems of the morning patients into the system. (They continue adding medications/allergies)



Week 4: Physicians start with 4 patients daily doing physical exam and review of systems in the system.

MA’s need to start entering all vital signs and chief complaints of morning patients into the system. (They continue adding medical problems and medications/allergies)



Week 5: Physicians start with 4 patients daily doing entire patient (review of systems, physical exam, assessment and plan) they will do all new patients and then select others from there. The MA’s will also do their part for these patients.



Week 6: No new patient charts will be made from this point on. They all need to be done in the EHR.

MA’s will need to start sending faxes to the physician to review. Only print out Rx refill requests that will need to continue to be done through the e-prescribe in the EHR.



Week 7: Physicians will continue to increase the number of patients done in the EHR by one in the morning and one in afternoon each week. (So, 3 in the am, 3 in the pm x 1 wk, and then 4 in am, 4 in pm, etc)


Examples of weekly reportsRun weekly reports and compare to previous

week—look for progress and regress

Set goal of what to accomplish-by doctor

These are individual attestations-don’t slow down to the slowest participant


Meaningful Use Status Update 08-04-2011

Dr AA: the following measures not meeting threshold:

Core 9-Smoking Status: currently listed 4%. Needs to be >50%

Core 13 - Clinical summaries: currently listed as 0%. Needs to be >50% (missing report)

Core – Clinical Information Exchange: need to submit 1 test data as a CCR/CCD record to another provider of care.

Menu set – Patient Reminders. Need >20% (missing report)

Menu set – Patient Education. Need >10%. (missing report) 26Professional Medical Consultants, Inc.

Meaningful Use Status Update 08-04-2011Dr BB: the following measures not meeting

threshold:Core 3 – eRX: currently listed 30%. Needs to be >50% Core 7 – Allergy list: currently listed 46.6%. Needs to

be >80% Core 13 – clinical Summary: currently listed 0%. Need

>50% (missing report)Core – Clinical Information Exchange: need to submit 1

test data as a CCR/CCD record to another provider of care.

Menu set – Patient Reminders. Need >20% (missing report)

Menu Set – Patient Education. Need >10%. (missing report)


Meaningful Use Status Update 08-04-2011

Dr CC: the following measures not meeting threshold:Core 7 – Allergy list: currently listed 37.3%. Need >80%Core 9 – Smoking status: currently listed 43.4%. Need to be

>50% Core 13 – clinical Summary: currently listed 0%. Need

>50% (missing report)Core – Clinical Information Exchange: need to submit 1 test

data as a CCR/CCD record to another provider of care.Menu set – Patient Reminders. Need >20% (missing

report)Menu Set – Patient Education. Need >10% (missing

report)


Lessons learnedDon’t slow downFocus on daily and weekly reportingFocus on positive changesCompliment staff-not just physiciansHold your EMR vendor accountableDon’t give in-fight for your goal and timetablePrepare for M U 2-started January 1, 2012


SummaryDon’t be afraid to call your competitorsCall other vendors for inputListen to 3-4 webinars a weekAsk your vendor to provide constant updatesHold frequent meetings with key staffDon’t stop asking your staff how can I helpIf you get frustrated-tackle another issue


Questions-???Thank you very much---

You can always call me at

702 598-0600

Larry Preston




Powerpoint lawrence m. preston

Health & Medicine

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