April 18 AIIM Show Las Vegas

1. Lawrence M. Preston, MBA, FHFMA
Professional Medical Consultants, Inc.
April 18, 2012
AIIM and ARMA

2. 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
Professional Medical Consultants, Inc. 2

3. Meaningful Use-Phase I
 Core 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)
Professional Medical Consultants, Inc. 3

4. Professional Medical Consultants, Inc. 4

5. Core Measurements
1. E-prescribing at least 40% of all RX
2. At least 30% of patient seen must have a medication
entered into system
3. EMR software must have drug to drug
interaction/allergy alert
4. At least 80% of patients seen must have an active
medication list
Professional Medical Consultants, Inc. 5

6. Core Measurements-continued
1. At least 80% of patients seen must have up to date
diagnosis
2. At least 80% of patients seen must have an active
allergy list
3. At least 50% of patients seen must have smoking
status and history documented
4. Need to implement one clinical decision support
rule
Professional Medical Consultants, Inc. 6

7. Core Measurements-continued
1. Need at least 50% of patients seen to have
documented the following questions:
a. Preferred language
b. Gender
c. Race
d. Ethnicity (Hispanic or Non-Hispanic)
e. Date of Birth
Professional Medical Consultants, Inc. 7

8. Core Measurements-Continued
1. Need at least 50% of patients to have seen the
following vitals signs recorded:
a. Height
b. Weight
c. Blood Pressure
d. BMI (calculated by Height & Weight)
e. Plot and display growth charts for children ages 2-20
Professional Medical Consultants, Inc. 8

9. Core Measurements-continued
1. Need to report ambulatory clinical quality measures
to CMS (Medicare)
2. Need to provide at least 50% of patients with an
electronic copy of their health information within 3
business days-when requested
3. Need to provide at least 50% of patients seen a
clinical summary of their visit within 3 business days
from the date seen
Professional Medical Consultants, Inc. 9

10. Core Measurements-continued
1. Need to perform at least one test of electronically
exchanging clinical information with another
provider
2. Need to have a security risk analysis conducted
Meet each and everyone one of the above
criteria to pass this section (no exceptions)
Professional Medical Consultants, Inc. 10

11. Menu Set Measurements
m Implement drug formulary check
o Have a least 40 % of lab results reported into system
% Need to generate a least one list of patients by
specific condition (i.e.-Diabetes)
o Need at least 10% of patients to be able to obtain
their medical information within three business
days
Professional Medical Consultants, Inc. 11

12. Menu Set Measurements
m Need at least 20% of patients 65 and older to be sent
a reminder for preventative or follow up care
r Need at least 10% of patients seen be given patient
specific education resources that are generated from
the EMR system
o Need to update at least 50% of patients seen
medication list when seen by another doctor
Professional Medical Consultants, Inc. 12

13. Menu Set Measurements
m Need to send a referral, summary of care and any
other pertinent information on at least 50% of
patients being referred out
e Need to perform at least on test of sending
electronic immunization records to an
immunization registry
i Need to perform at least one test of sending
electronic syndromic surveillance data to a public
health agency
Professional Medical Consultants, Inc. 13

14. 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
Professional Medical Consultants, Inc. 14

15. How to Implement
 Ask for help from your vendor
 Don’t get to complicated
 KISS
 Physician buy in—largest and most difficult
Professional Medical Consultants, Inc. 15

16. 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
Professional Medical Consultants, Inc. 16

17. 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
Professional Medical Consultants, Inc. 17

18. 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.
Professional Medical Consultants, Inc. 18

19. EHR Implementation Schedule
 Week 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.
Professional Medical Consultants, Inc. 19

20. EHR Implementation Schedule
 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)
Professional Medical Consultants, Inc. 20

21. EHR Implementation Schedule
 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)
Professional Medical Consultants, Inc. 21

22. EHR Implementation Schedule
 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.
Professional Medical Consultants, Inc. 22

23. EHR Implementation Schedule
 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.
Professional Medical Consultants, Inc. 23

24. EHR Implementation Schedule
 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)
Professional Medical Consultants, Inc. 24

25. Examples of weekly reports
 Run 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
Professional Medical Consultants, Inc. 25

26. 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) Professional Medical Consultants, Inc. 26

27. Meaningful Use Status Update 08-04-2011
 Dr 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)
Professional Medical Consultants, Inc. 27

28. 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)
Professional Medical Consultants, Inc. 28

29. Lessons learned
 Don’t slow down
 Focus on daily and weekly reporting
 Focus on positive changes
 Compliment staff-not just physicians
 Hold your EMR vendor accountable
 Don’t give in-fight for your goal and timetable
 Prepare for M U 2-started January 1, 2012
Professional Medical Consultants, Inc. 29

30. Summary
 Don’t be afraid to call your competitors
 Call other vendors for input
 Listen to 3-4 webinars a week
 Ask your vendor to provide constant updates
 Hold frequent meetings with key staff
 Don’t stop asking your staff how can I help
 If you get frustrated-tackle another issue
Professional Medical Consultants, Inc. 30

31. Questions-???
 Thank you very much---
 You can always call me at
 702 598-0600
 Larry Preston
Professional Medical Consultants, Inc. 31

32. Professional Medical Consultants, Inc. 32

33. Professional Medical Consultants, Inc. 33