Taking the HITECH Ground - Executive War CollegeAccelerated EMR/EHR adoption • Increase in physicians purchasing solutions from vendors • Growing importance of HIEs • Clouds,
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EMR Weaknesses/Complexities:• Accept unsolicited results?• Need an EMR order number, or Patient ID?• EMR’s test and result codes mapped correctly with the lab’s
codes? Is the mapping up-to-date?• “Ask at Order Entry” questions?• Specimen Requirements?• Medical Necessity Verification?• Office-based versus Internet-based?• Images in reports? PDFs?• Support for partials and finals?• Discrete Micro?• Split requisitions?• Payer Plan-driven routing?• Exception handling?• Costs?
In Sections 1848(o)(2)(A) and 1886(n)(3) of the Act, the Congress specified three types of requirements for meaningful use:
(1) Use of certified EHR technology in a meaningful manner (for example, electronic prescribing);
(2) the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and
(3) that, in using certified EHR technology, the provider submits tothe Secretary information on clinical quality measures and such other measures selected by the Secretary.
• Electronic Health Record (EHR) systems will qualify physicians for between $44,000 and $64,000 in Medicare and Medicaid incentive payments under the American Recovery and Reinvestment Act (ARRA).
• Physicians must demonstrate their “meaningful use” of an EHR before they can claim the stimulus incentives, which first become available in 2011. – 25 Stage 1 Objectives (Ambulatory / Eligible Professionals) – $30,000 of the incentives can be earned in the first two years– Incentives disappear after 2016
• Providers can combine functionality from disparate systems with integration (interfaces) to achieve certification
Formulary Checks• Maintain problem list of current and
active diagnoses (ICD-9 / SNOMED CT)
• ePrescribe• Active medication list• Active medication allergy list• Record demographics• Record/Chart Vital Signs• Record smoking status (ages 13+)• Incorporate clinical lab test results
into EHR as structured• Generate list of patients by condition • Report ambulatory quality measures• Send patient reminders for preventive
care• Implement clinical decision support
rules
• Insurance Eligibility• Submit electronic claims • Provide patient with electronic copy of
health info• Provide patients with electronic
access to their health information• Clinical summaries• Exchange key clinical information
amongst providers• Medical reconciliation• Submit electronic data to
immunization registries• Syndromic surveillance data to public
health agencies• Electronic submission of reportable
lab results to public health agencies• Protect electronic health information
Health information exchange (HIE) is defined as the mobilization of healthcare information electronically across organizations within a region, community or hospital system.
HIE provides the capability to electronically move clinical information among disparate healthcare information systems while maintaining the meaning of the information being exchanged.
The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.
HIE is also useful to Public Health authorities to assist in analyses of the health of the population.