PR’s Journey Towards Electronic Health Records Adoption & Meaningful Use PRESENTATION TO PR HIT SUMMIT PRESENTATION TO PR HIT SUMMIT Antonio Fernandez Antonio Fernandez Regional Extension Center for PR and USVI Regional Extension Center for PR and USVI
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PR’s Journey Towards Electronic Health Records Adoption & Meaningful Use
PR’s Journey Towards Electronic Health Records Adoption & Meaningful Use. PRESENTATION TO PR HIT SUMMIT Antonio Fernandez Regional Extension Center for PR and USVI. ADOPTION. MEANINGFUL USE. Health IT Practice Research. Regional Extension Centers Medicaid EHR Program 1 st Year Incentive - PowerPoint PPT Presentation
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PR’s Journey TowardsElectronic Health
Records Adoption & Meaningful Use
PR’s Journey TowardsElectronic Health
Records Adoption & Meaningful Use
PRESENTATION TO PR HIT SUMMITPRESENTATION TO PR HIT SUMMITAntonio FernandezAntonio Fernandez
Regional Extension Center for PR and USVIRegional Extension Center for PR and USVI
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HITECH: How the Pieces Fit Together
Medicare and Medicaid EHR Incentive Programs
Health IT Practice Research
Improved Individual & Population HealthOutcomes
IncreasedTransparency & Efficiency
ImprovedAbility to Study &Improve Care Delivery
ADOPTIONADOPTION
EXCHANGEEXCHANGE
State Grants forHealth Information Exchange
Medicaid Administrative Funding for HIE
Standards & Certification Framework
Privacy & Security Framework
Regional Extension Centers
Medicaid EHR Program 1st Year Incentive
Workforce Training
MEANINGFUL USEMEANINGFUL USE
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Program Timeline
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EHR ADOPTION PROGRESS IN PR
• Physicians who have selected a Certified EHR 3,900• Installations in Physician Practices 2,512• Meaningful Users 325• Dentists in Process of Adoption 197• FQHC’s in EHR Adoption Process 49• Hospitals Having Attested under Medicaid AIU 21• Number of eRx’s during Month of May 451,110• Pharmacies Dispensing e-Rx’s in May 1,012• Active E-Prescribers during month of May 1,854
Physician Adoption by Health Region
Hospitals Attesting under AIU Hospitals Attesting under AIU for 2012 Medicaid Incentivesfor 2012 Medicaid Incentives
FQHC’s in Process of Certified HER AdoptionFQHC’s in Process of Certified HER Adoption
Puerto Rico Monthly ePrescriptions
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Stage 1Data capture and
sharing
Stage 1Data capture and
sharing
Stage 2Advanced clinical
processes
Stage 2Advanced clinical
processes
Stage 3Improved outcomes
Stage 3Improved outcomes
Ascending Meaningful Use Stages
For more information on meaningful use of EHRs, visit: http://www.cms.gov/EHRIncentivePrograms/35_Meaningful_Use.asp
Better clinical outcomes Improved population health outcomes Increased transparency and efficiency Empowered individuals More robust research data on health
system
Improved quality of
patient care
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Meaningful Use: Changes from Stage 1 to Stage 2
Eligible Professionals15 core objectives
5 of 10 menu objectives20 total objectives
Eligible Professionals17 core objectives
3 of 6 menu objectives20 total objectives
Eligible Hospitals & CAHs
14 core objectives5 of 10 menu objectives19 total objectives
Eligible Hospitals & CAHs
16 core objectives3 of 6 menu objectives19 total objectives
Stage 2Stage 2Stage 1Stage 1
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EPs must meet all 17 core objectives:Core Objective Measure
1. CPOEUse CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology
2. E-Rx E-Rx for more than 50%
3. Demographics Record demographics for more than 80%
4. Vital Signs Record vital signs for more than 80%
5. Smoking Status Record smoking status for more than 80%
6. InterventionsImplement 5 clinical decision support interventions + drug/drug and drug/allergy
7. Labs Incorporate lab results for more than 55%
8. Patient List Generate patient list by specific condition
9. Preventive Reminders
Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years
Stage 2 EP Core Objectives
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EPs must meet all 17 core objectives:Core Objective Measure
10. Patient AccessProvide online access to health information for more than 50% with more than 5% actually accessing
11. Visit SummariesProvide office visit summaries for more than 50% of office visits
12. Education Resources
Use EHR to identify and provide education resources more than 10%
13. Secure MessagesMore than 5% of patients send secure messages to their EP
14. Rx ReconciliationMedication reconciliation at more than 50% of transitions of care
15. Summary of Care
Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR
16. Immunizations Successful ongoing transmission of immunization data
17. Security AnalysisConduct or review security analysis and incorporate in risk management process
Stage 2 EP Core Objectives
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EPs must select 3 out of the 6:
Menu Objective Measure
1. Imaging ResultsMore than 10% of imaging results are accessible through Certified EHR Technology
2. Family History Record family health history for more than 20%
3. Syndromic Surveillance
Successful ongoing transmission of syndromic surveillance data
4. CancerSuccessful ongoing transmission of cancer case information
5. Specialized RegistrySuccessful ongoing transmission of data to a specialized registry
6. Progress NotesEnter an electronic progress note for more than 30% of unique patients
Stage 2 EP Menu Objectives
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Eligible hospitals must meet all 16 core objectives:Core Objective Measure
1. CPOEUse CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology
2. Demographics Record demographics for more than 80%
3. Vital Signs Record vital signs for more than 80%
4. Smoking Status Record smoking status for more than 80%
5. InterventionsImplement 5 clinical decision support interventions + drug/drug and drug/allergy
6. Labs Incorporate lab results for more than 55%
7. Patient List Generate patient list by specific condition
8. eMAReMAR is implemented and used for more than 10% of medication orders
Stage 2 Hospital Core Objectives
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Eligible hospitals must meet all 16 core objectives:Core Objective Measure
9. Patient AccessProvide online access to health information for more than 50% with more than 5% actually accessing
10. Education ResourcesUse EHR to identify and provide education resources more than 10%
11. Rx ReconciliationMedication reconciliation at more than 50% of transitions of care
12. Summary of Care
Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR
13. Immunizations Successful ongoing transmission of immunization data
14. LabsSuccessful ongoing submission of reportable laboratory results
15. Syndromic Surveillance
Successful ongoing submission of electronic syndromic surveillance data
16. Security AnalysisConduct or review security analysis and incorporate in risk management process
Stage 2 Hospital Core Objectives
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Eligible Hospitals must select 3 out of the 6:
Menu Objective Measure
1. Progress NotesEnter an electronic progress note for more than 30% of unique patients
2. E-RxMore than 10% electronic prescribing (eRx) of discharge medication orders
3. Imaging ResultsMore than 10% of imaging results are accessible through Certified EHR Technology
4. Family History Record family health history for more than 20%
5. Advanced DirectivesRecord advanced directives for more than 50% of patients 65 years or older
6. LabsProvide structured electronic lab results to EPs for more than 20%
Stage 2 Hospital Menu Objectives
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• Stage 2 focuses on actual use cases of electronic information exchange:
• Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals.
• The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals.
• At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR.
Closer Look at Stage 2: Electronic Exchange
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Changes to Stage 1: E-Copy & Online Access
Current Stage 1 Objective
Objective= Objective=
Provide patients with e-copy of
health information upon
request
Provide electronic access to health
information
Provide patients with e-copy of
health information upon
request
Provide electronic access to health
information
New Stage 1 Objective
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Objective= Objective=
Provide patients the ability to view online,
download and transmit their
health information
Provide patients the ability to view online,
download and transmit their
health information
• The measure of the new objective is 50% of patients are provided access to their information; there is no requirement that 5% of patients do access their information for Stage 1.
• The change in objective takes effect in 2014 to coincide with the 2014 certification and standards criteria
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• Patient engagement – engagement is an important focus of Stage 2.
•
• EXCULSIONS – CMS is introducing exclusions based on broadband availability in the provider’s county.
Requirements for Patient Action:•More than 5% of patients must send secure messages to their EP•More than 5% of patients must access their health information online
Closer Look at Stage 2: Patient Engagement
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CQM Selection and HHS Priorities
•All providers must select CQMs from at least 3 of the 6 HHS National Quality Strategy domains:
Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness
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• CMS’s commitment to alignment includes finalizing the same CQMs used in multiple quality reporting programs for reporting beginning in 2014
• Other programs include Hospital IQR Program, PQRS, CHIPRA, and Medicare SSP and Pioneer ACOs, and Patient-Centered Medical Homes
Hospital Inpatient Quality
Reporting Program
Hospital Inpatient Quality
Reporting Program
Physician Quality
Reporting System
Physician Quality
Reporting System
Children’s Health
Insurance Program
Reauthorization Act
Children’s Health
Insurance Program
Reauthorization Act
Medicare Shared Savings
Program and Pioneer ACOs
Medicare Shared Savings
Program and Pioneer ACOs
Aligning CQMs Across Programs
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Patient-Centered Medical Homes
• Model for care provided by physician practices that seeks to strengthen the physician-patient relationship and replaces episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship.
• It is a Model of care where each patient has an ongoing relationship with a personal physician who leads a team that takes collective responsibility for patient care. The physician-led care team is responsible for providing all the patient’s health care needs and, when needed, arranges for appropriate care with other qualified physicians .
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Patient-Centered Medical Home
• Six MUST PASS elements are considered essential to the patient-centered medical home, and are required for practices at all recognition levels by NCQA. Practices must achieve a score of 50% or higher on must-pass elements:
• 1.PCMH 1, Element A: Access During Office Hours • 2.PCMH 2, Element D: Use Data for Population Management • 3.PCMH 3, Element C: Care Management • 4.PCMH 4, Element A: Support Self-Care Process • 5.PCMH 5, Element B: Referral Tracking and Follow-Up • 6.PCMH 6, Element C: Implement Continuous Quality Improvement
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Patient-Centered Medical Home
• PCMH 1: Access and Continuity
• PCMH 2: Identify and Manage Patient Populations
• PCMH 3: Plan and Manage Care
• PCMH 4: Self- Management Support
• PCMH 5: Track and Coordinate Care
• PCMH 6: Performance Measurement and Quality Improvement
Meaningful Use Criteria
• Improving quality, safety, efficiency, and reducing health disparities
• Engage patients and families in their health care
• Improve care coordination • Ensure adequate privacy and security
protections for personal health information
• Improve population and public health
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REC 2.0 Scope of Services• Medicaid/Medicare EHR Incentive Program Eligible Provider Registration &
Attestation Support• Outreach to Other Eligible Providers (Hospitals, Physicians Specialists &
Dentists)• Meaningful Use Education and Provider Support• Privacy & Security Education & Risk Assessment• Direct Messaging/Health Information Exchange• ADT (Admissions/Discharge/Transfer) Care Transitions Coordination• Accountable Care Organizations, Patient-Centered Medical Homes &
Transformation Project Support• Meaningful User Groups/Communities of Practice• HIT Education, Training, and Workforce Development• Healthcare Analytics
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AREAS OF OPPORTUNITY• Specialized EHR Needs for Key specialty areas: Psychiatric/Behavioral Health Care Pediatric/Children’s HealthCare Correctional Health Care• Strategies for Consumer Engagement & Mobile Health
Applications for Consumers, Patients and Families• Population Health Management• Privacy & Security Education, Risk Assessment & Management• Designing Integrated Models of Care which could be adapted
to Serving Underserved Populations outside of Puerto Rico