1. Employing the Phases of Electronic
Health Records (EHR)
The Journey from Paper to EHR
2. Introductions
Val Karin Erik Kent
Migliore, Eichler, Riffel, Crosier,
MBA RN Exec VP
• Unity Health
System • Genesee Valley • Tri-Delta Resources • Tri-Delta Resources
• Regional Extension OB/GYN, PC: • Virtual CIO • MediTech Disaster
Center / MCMS • Regional Extension • NYeC approved IT Recovery
•Xerox Corporation Center / MCMS Vendor • NYeC approved IT
• Certified Black •Genesee Hospital • MGMA Member Vendor
Belt, Lean Six • MGMA Member • MGMA Member
Sigma
• MGMA Member
3. Introductions
Kent
Crosier
Introduce
Yourself
• Your Name
• Practice Name
• Practice Specialty
• Your Role
• Expectation
4. Goals & Objectives
1. Introductions 5. Understanding What it Takes
2. Benefits – What’s In it for Me? 6. Planning
3. What’s the Hold Up? 7. Achieving Meaningful Use
4. What EHR Is and Is Not 8. CMS Incentives
5. Where are you with EHR Currently?
Rate your practice: 1
No PMS
No EHR
5 2
Fully PMS Only
Implemented
EHR Audience
Achieved MU
Assessment
3
Implemented
4 EHR – not
Implemented certified yet
EHR – certified
6. Benefits
MU Patient Productivity
Incentive $ Quality and
Performance
10. Common EHR Myths
What it is not
Broken You will no longer
processes will be You will be able
need to reconcile
fixed by an EHR. to eliminate staff.
charts.
You will never You will no Loose reports
search for paper longer need to will no longer be
charts again. store records. a problem.
11. Reasonable Expectations of an EHR
What it is
Guaranteed1 Possible1 Debatable1
• Legibility of notes • EHR Stimulus $ • Increased
• Accessibility of charts • Transcription efficiency
• No more lost patient cost savings • Quality of care
records - EMR • Space savings • Improved
• Multiple users access • Paper savings workflow
to charts • Automated lab & • Improved coding
• Disaster Recovery XRAY results accuracy &
• E-Prescribing • Clinical Decision charge capture
• Drug-to-drug & allergy Support • Better patient
interactions • Improved patient services
• Remote chart access communications • Time savings
1 “Selecting the Right EMR” e-Book by John Lynn @ http://www.emrandhipaa.com/emr-selection-book/
12. Understanding What it Takes:
Building a House
Achieve Meaningful Use
Implement
Assess Plan Select
Optimize
13. Framework…
Assess Plan
• Buy-In • Identify physician champion
• Assess readiness • Establish teams
• Identify benefits • Workflow assessment
• Set goals • Identify opportunities for improvement.
• Determine migration path • Establish measurements
• Develop budget & business case for • Establish chart conversion strategy
EHR & IT • IT Infrastructure
• Current network assessment • Connection to RHIO, Labs, HIE
• Develop project plans & timelines
• Communication Plan
Select Implement & Optimize
• Understand requirements for • Implement rollout strategy
practice’s workflow • Document new workflows and
• Specify desired functions processes
• Review the field of EHR / IT vendors • Implement chart & data conversions
• Perform due diligence (to narrow field) • Manage installation of hardware & IT
• RFP infrastructure
• Demo & site visits, reference checks • TRAIN TRAIN TRAIN
• Contract negotiations, pricing, terms • Rehearse GO-LIVE
legal review, financing • COMMUNICATE COMMUNICATE!!!
14. It Takes a Village…..
Medical
Society
AMA Your Peers
MGMA
Practice
REC’s CMS
NYeC HIMSS
EHR
IT Vendor
RHIO’s Universities
Labs Colleges
HIE’s
SME’s
Consultants
15. Critical Success Factors
From Zero to Meaningful Use and Beyond!
The HIT Extension Center Experience
Paul Kleeberg, MD FAAFP, FHIMSS
Clinical Director, REACH
HIMSS11 Orlando, Florida
February 21st, 2011,
18. Critical Success Factors
From Zero to Meaningful Use and Beyond!
The HIT Extension Center Experience
Paul Kleeberg, MD FAAFP, FHIMSS
Clinical Director, REACH
HIMSS11 Orlando, Florida
February 21st, 2011,
19.
20. MEANINGFUL USE
• Reforming the health care system
• Improving health care quality
HHS • Improving health care efficiency
Vision • Improving patient safety
• Certification Criteria Determined
• CMS Publishes Final Rule July 2010
Path • Incentive Programs Established
Defined
21. MU Prep Checklist for Stage 1 (Medicare)
1. Register 2. Certified
CMS EHR
3. Implement 4. Implement 5
15 Core of the 10 Menu
Objectives Set Objectives
5. Declare 90
Day Reporting 6. Attestation
Period
23. Meaningful Use Criteria: Core
* Reporting
MU Objective MU Measure Method Exclusion?
Core Set Objectives for EPs: Must
Meet All 15 Measures
Any EP who writes fewer than 100 prescriptions during the
C1 Use CPOE for medication orders CPOE is used for more than 30 percent of unique patients EHR Tabulates EHR reporting period.
Implement drug-drug and drug-allergy interactions
C2 checks The EP has enabled this functionality in EHR Attestation None
More than 80 percent of all unique patients seen by the EP or admitted to the
Maintain an up-to-date problem list of current and eligible hospital have at least one entry or an indication that no problems are
C3 active diagnoses known for the patient recorded as structured data. EHR Tabulates None
More than 40 percent (adjusted or unadjusted for patient preference) of all
Generate and transmit permissible prescriptions permissible prescriptions written by the EP are transmitted electronically using Any EP who writes fewer than 100 prescriptions during the
C4 electronically (eRx) certified EHR technology EHR Tabulates EHR reporting period.
More than 80 percent of all unique patients seen by the EP or admitted to the
eligible hospital have at least one entry (or an indication that the patient is not
C5 Maintain active medication list currently prescribed any medication) recorded as structured data EHR Tabulates None
More than 80 percent of all unique patients seen by the EP or admitted to the
eligible hospital have at least one entry (or an indication that the patient is not
C6 Maintain active medication allergy list. currently prescribed any medication) recorded as structured data EHR Tabulates None
Record demographics: Preferred language, gender, For more than 50% of all unique patients seen by the EP or admitted to the eligible
C7 race, ethnicity, and date of birth hospital have demographics recorded as structured data EHR Tabulates None
Any EP who either see no patients 2 years or older, or who
For more than 50% of all unique patients age 2 and over seen by the EP or admitted believes that all three vital signs of height, weight, and blood
Record and chart changes in vital signs: Height, to eligible hospital, height, weight and blood pressure are recorded as structured Count of pressure of their patients have no relevance to their scope of
C8 Weight, BP, BMI and growth charts for ages 2-20 data Patients in EHR practice.
24. Meaningful Use Criteria: Core
Record smoking status for patients 13 years old or More than 50 percent of all unique patients 13 years old or older seen by the EP Count of
C9 older or admitted to the eligible hospital have smoking status recorded Patients in EHR Any EP who sees no patients 13 years or older.
Core CQMs - EPs must report on 3 required core CQMs, and if the denominator of
1 or more of the required core measures is 0, then EPs are required to report
results for up to 3 alternate core measures. EPs also must also select 3 additional
CQMs from a set of 38 CQMs (excluding the core/alternate core measures). It is
Report ambulatory clinical quality measures to CMS acceptable to have a '0' denominator provided the EP does not have an applicable
C10 or in the case of Medicaid to the States population. EHR Tabulates None
Implement 1 clinical decision support rule relevent to
specialty or high clinical priority along with the ability Implement one clinical decision support rule related to efficiency or a clinical
C11 to track compliance to that rule quality measure relevant to the EP or eligible hospital Attestation None
Provide patients with an electronic copy of their
health information (including diagnostic test results, Any EP that has no requests from patients or their agents for
problem list, medication lists, medication allergies), More than 50 percent of all patients who request an electronic copy of their an electronic copy of patient health information during the
C12 upon request health information are provided it within 3 business days EHR Tabulates EHR reporting period.
Provide clinical summaries for patients for each office Clinical summaries provided to patients for more than 50 percent of all office Count of Any EP who has no office visits during the EHR reporting
C13 visit. visits within 3 business days Patients in EHR period.
Capability to exchange key clinical information (for
example, problem list, medication list, medication
allergies, diagnostic test results), among providers of Performed at least one test of certified EHR technology's capacity to electronically
C14 care and patient authorized entities electronically exchange key clinical information. Attestation None
Protect electronic health information created or
maintained by the certified EHR technology through
the implementation of appropriate technical Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement
C15 capabilities security updates as necessary Attestation None
25. Meaningful Use Criteria: Menu
Menu Set Objectives for EPs: Must Choose
and Meet 5 of the 10 from the Menu, one
of the five must be related to improving
public health *p
Any EP who writes fewer than 100 prescriptions during
M1 Implement drug-formulary checks Attestation the EHR reporting period.
More than 40% of all clinical lab tests
results ordered by the EP or by an
authorized provider fo whose results
are in a positive/negative or numerical Count of An EP who orders no lab tests whose results are either in
Incorporate clinical lab-test results into EHR as format are incorporated in certified EHR Patients in a positive/negative or numeric format during the EHR
M2 structured data technology EHR reporting period.
Generate lists of patients by specific conditions to
use for quality improvement, reduction of Generate at least one report listing patients of the EP or eligible hospital with
M3 disparities, or outreach a specific condition. Attestation None
More than 20 percent of all unique patients 65 years or older who were Count of An EP who has no patients 65 years old or older or 5
Send reminders to patients per patient preference identified by certified EHR technology as needing a reminder during the EHR Patients in years old or younger with records maintained using
M4 for preventive/ follow up care reporting period were sent the appropriate reminder EHR certified EHR technology.
Provide patients with timely electronic access to Any EP that neither orders nor creates lab tests or
their health information (including lab results, information that would be contained in the problem list,
problem list, medication lists, medication More than 10 percent of all unique patients seen by the EP are provided medication list, medication allergy list (or other
allergies) within four business days of the timely electronic access to their health information subject to the EP’s information as listed at 45 CFR 170.304(g)) during the
M5 information being available to the EP. discretion to withhold certain information. EHR Tabulates EHR reporting period.
Use certified EHR technology to identify patient-
specific education resources and provide those More than 10 percent of all unique patients seen during the EHR reporting
M6 resources to the patient if appropriate period are provided patient-specific education resources EHR Tabulates None
Count of
Perform medication reconciliation at relevant Perform medication reconciliation for more than 50 percent of transitions of Patients in An EP who was not the recipient of any transitions of
M7 encounters and each transition of care. care. EHR care during the EHR reporting period.
Count of An EP who neither transfers a patient to another setting
Provide summary care record for each transition Provide summary of care record for more than 50 percent of transitions of Patients in nor refers a patient to another provider during the EHR
M8 of care and referral. care and referrals EHR reporting period.
Capability to submit electronic data to
immunization registries or Immunization An EP who administers no immunizations during the EHR
Information Systems and actual submission Performed at least one test of certified EHR technology’s capacity to submit reporting period or where no immunization registry has
M9 *p according to applicable law and practice. electronic data to immunization registries. Attestation the capacity to receive the information electronically.
An EP who does not collect any reportable syndromic
Capability to provide electronic syndromic Performed at least one test of certified EHR technology’s capacity to provide information on their patients during the EHR reporting
surveillance data to public health agencies and electronic syndromic surveillance data to public health agencies (unless none period or does not submit such information to any
actual transmission according to applicable law of the public health agencies to which an EP or eligible hospital submits such public health agency that has the capacity to receive the
M10 *p and practice. information have the capacity to receive the information electronically). Attestation information electronically.
