Amy walker aami_%202011(7)

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Amy walker aami_%202011(7)

  1. 1. HITECH and Meaningful Use: The Impact on the Future of Healthcare Technology Management Amy Walker MS, RN, CPHQ, FACHE, NEA-BC CEO OptimizeIT Consulting Healthcare IT Strategist Past Member HIMSS Public Policy Committee
  2. 2. • Relate the components of The HITECH Act and Meaningful Use to health management technology • Identify whether existing systems meet requirements • Communicate technology needs and request feedback from end users for a smooth transition • Implement best practices to move people and systems forward under these new requirements 2 What We Will Cover…..
  3. 3. Your EcoSystem Vision , Mission, and Strategic Goals 3 Clinical Informatics New Clinical Informatics Initiatives Healthcare Operations Information Technology Communication Communication The Foundation
  4. 4. Leading from good to great does not mean coming up with the answers and then motivating everyone to follow your messianic vision. It means having the humility to grasp the fact that you do not yet understand enough to have all of the answers and then to ask the questions that will lead to the best possible insights. (Jim Collins, Good to Great)
  5. 5. Your mind is like a parachute- It only works when open 5
  6. 6. What This Presentation Is Not About The thoughtless application of IT, for slash and burn downsizing, restructuring, and outsourcing. 6
  7. 7. 7 • President Bush’s goal in 2004 • Executive order established the Office of the National Coordinator for Health Information Technology (ONCHIT) as part of the Dept of Health & Human Services (HHS) – Dr. David Brailer appointed the first National Coordinator A quick trip down memory lane … “… an Electronic Health Record for every American by the year 2014. By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” - State of the Union address, Jan. 20, 2004 7
  8. 8. HITECH Act? hmm, sounds familiar… • Signed into law February 2009 as part of ARRA • Goal – 90% of U.S. physicians and 70% of hospitals using EHR by 2019 • How? – Provide $19 Billion to doctors and hospitals through DHS to implement EHR by 2011
  9. 9. ARRA • HITECH Care • Care Coordination • Disease Management • Value-based Purchasing • Bundled Payment • Medical Home • Comparativeness Effectiveness • Meaningful Use • Public Reporting and Accountability • Reward Top Performers • Penalize Bottom Performers 9
  10. 10. 10 ARRA EHR Adoption –Incentive Requirements • To encourage broad adoption of EHRs, ARRA offers reimbursement to eligible providers/hospitals who meet two requirements: – Acquire a certified EHR product or service – Demonstrate that the organization or provider are using that product/service “meaningfully” • ARRA creates HIT Policy and HIT Standards Committees which must recommend: – Criteria for certifying EHR products – Criteria for demonstrating that an applicant is using the EHR meaningfully
  11. 11. Why are We Here? • 2011 • 2013 • 2015 • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • All the while maintaining privacy and security
  12. 12. 12 HITECH Framework for MU of EHRs Taken from: Blumenthal, D. “Launching HITECH,” posted by the NEJM on 12-30-2009. 12
  13. 13. 13 MU Measures Quality Measures 13 VTE - 1 VTE Prophylaxis within 24 hours of arrival Stroke - 2 Ischemic Stroke - Discharge on Antithrombotics VTE - 2 VTE Prophylaxis within 24 hours of arrival to ICU Stroke - 3 Ischemic Stroke - Anticoagulation for A-Fib/Flutter VTE -3 VTE Diagnosis - Anticoagulation Overlap Therapy Stroke - 4 Ischemic Stroke - Thrombolytic therapy for patients arriving within 2 hours of symptom onset VTE -4 VTE - Platelet Monitoring on unfractionated Heparin Stroke - 5 Ischemic or Hemorrhagic Stroke - Antithrombotic therapy by day 2 VTE - 5 VTE - Discharge Instructions Stroke - 6 Ischemic Stroke - Discharge on Statins VTE - 6 VTE - Incidence of potentially preventable VTE Stroke - 8 Ischemic or Hemorrhagic Stroke – Education ED - 1 ED throughput-arrival to departure for admitted patients Stroke - 10 Ischemic or Hemorrhagic Stroke - Rehabilitation Assessment ED – 2 ED throughput - Admit decision time to ED departure time for admitted patients.
  14. 14. 1 2 3 4 5 6 7 8 9
  15. 15. 15 HITECH Incentives for Hospitals – Medicare Example Four Year CMS Health IT Incentive Payment Scenarios: 2011 2012 2013 2014 2015 2016 2011 $20 $0 $0 $0 $0 $0 2012 $15 $20 $0 $0 $0 $0 2013 $10 $15 $20 $0 $0 $0 2014 $5 $10 $15 $15 $0 $0 2015 $0 $5 $10 $10 $10 $0 2016 $0 $0 $5 $5 $5 $0 2017 $0 $0 $0 $0 $0 $0 $50 $50 $50 $30 $15 Maximum Medicare health IT incentive payment for this year is: If the first qualifying year is: Total of Maximum over 4, 3, or 2 Years' Medicare Health IT Incentive Payments Example Numbers (millions) Penalties begin 100% 100% 100% 60% 30% 15
  16. 16. Current State for EMR Adoption in Home Health • Over 80% use telemonitoring devices – from lo tech to hi tech • EMR Technology Levels* (2007 survey data) – 43% use EMR systems with following functionality • Patient demographics 95% • Point of care clinical documentation 29% • Clinical notes 34% • Clinical decision support 23% • Record MD orders 50% – 31% in process Resnick, H.E., and Alwan, M. (2010). Use of health information technology in home health and hospice agencies: United States, 2007. Journal of the American Medical Informatics Association 17(4):389-395.
  17. 17. What Does It Mean? • Increased reliance on IT • Greater need for informatics professionals • SWOT analysis should come sooner rather than later • Suddenly, certifications matters more than ever • More governance / new regulatory and reimbursement guidelines
  18. 18. Leveraging best practices to move and systems forward 18
  19. 19. Patient Care Advancements Healthcare Reform Meaningful Use of Technology Clinical Engineering Care Providers
  20. 20. • Improve quality, cut costs – Accountable Care Organizations • Larger insurance footprint • Not predetermined • Focus on value • Shift to outpatient care • Data driven problem solving • Refocus on fraud • Growing information technology footprint 21 Goals of Healthcare Reform
  21. 21. • Proposed CMO ACO rules published 2011 2012 2013 2014 2015 22 • Meaningful Use Stage 2 • Advanced Clinical Process • Medicare Accountable Care Organizations • Medicare Value- based Purchasing • Reduced Medicare Payments for Hospital Readmissions • Medicare Bundle Payment Pilot • ICD-10 Conversion • Meaningful Use Stage 3 Improved Outcomes • Health Insurance Exchanges (electronic eligibility) • Reduced Medicare Payments for Hospital acquired Infections (HAI) • Medicare Expenditures Capped • Medicare payment adjustment begins for non meaningful users of IT
  22. 22. Accelerating Health Care Value “Readiness for change is one of the hardest problems we face”, Paul Tang, HIT Policy Committee vice chair and Palo Alto Medical Foundation vice president and chief medical information officer. “To realize our vision, we must foster a pervasive culture of innovation”, Douglas D. French, former Ascension Health president and chief executive officer. 23
  23. 23. Your EcoSystem Vision , Mission, and Strategic Goals 24 Clinical Informatics New Clinical Informatics Initiatives Clinical Operations Information Technology Communication Communication
  24. 24. Health IT Strategic Framework A learning health system is patient centered and uses information to continuously improve health and healthcare of individuals and the population Information Technology Transfor- mation Innovation Engine 25
  25. 25. Meaningful Healthcare Reform A Journey 26 Communication Transformational Readiness Clinical & Operational Leaders Enterprise Commitment and Accountability Industrial Strength LEADERSHIP & MANAGEMENT • Complete an enterprise assessment of the organizational readiness to reform • Evaluate the present situation, identify recommendations, and best practices to optimize the future state • Identify obstacles, challenges, sources of issues, and needed changes • Identify indicators of healthcare reform and changes in order to maximize operational performance • Create and heavily emphasize an EFFECTIVE & INNOVATIVE change management and communication plan • Create a practical benefits realization plan
  26. 26. Patient Care Advancements Healthcare Reform Meaningful Use of Technology Clinical Engineering Care Providers
  27. 27. Certified EHR Technology • Office of the National Coordinator for Health Information Technology has approved two entities as able to review and certify EHRs – Certification Commission for Health Information Technology (CCHIT) – Drummond Group Inc. • Unless your current system is homegrown, piecemeal or older, your EHR vendor is likely already pursuing certification • (and/or trying to sell you a new or upgraded system – which they promise will be certifiable)
  28. 28. 29 Aurora Health Care HITECH Gap Analysis Look at each MU Criteria (and Gap) in 3 ways: 1. Technology – do you need software installed? 2. Adoption – do you have the required adoption? 3. Ability to Measure – can you measure? Use these same categories in the Work Plan for tracking 29
  29. 29. 30Slide #30 Aurora Health Care MU Dashboard
  30. 30. Slide #31 Aurora Health Care Project Tracking Tool
  31. 31. HIPAA Privacy and Security 32
  32. 32. Today’s Privacy and Security Environment Covered Entities Medical Homes Medical Homes Medical Homes Pharmacy Laboratories Medical Log Physician Portal Personal Healthcare Records Medical Records Clinical Image Records Wellness Centers Outpatient Care Accountable Care Organizations Exercise Log EMR Social Worker Emergency Payer Primary Care Physician Patient
  33. 33. Increase in HIPAA Penalties Under the ARRA: All such violations of an identical provision in a calendar year (A) Did Not Know ............................................. $100 $50,000 $1,500,000 (B) Reasonable Cause ..................................... 1,000 50,000 1,500,000 (C) Willful Neglect—Corrected ........................ 10,000 50,000 1,500,000 (C) Willful Neglect—Not Corrected .................. 50,000 1,500,000 34
  34. 34. A Sample of Questions for HIPAA-Security Assessment • What is our single vulnerability from a technology or security point of view? • How vulnerable are we to attack on confidentiality, integrity, and availability of our data and systems? • What is the assessment of physical security controls at each of our sites (data center, home office, field offices, and other sites? • How prepared are our incident response plans? • Have we protected our company in contracts with vendors? • Do we understand what PHI we produce, capture, store, transport, and destroy? 35
  35. 35. Standards and Interoperability 36
  36. 36. HITECH Drives US Standards Efforts • Goal: Transform healthcare through the meaningful use of health data • Data capture data sharing advanced clinical processes Improved Outcomes • Requires organized structuring and effective use of information to support decision making 37
  37. 37. Need for Health Data Standards • Standards are foundational to development, implementation and exchange of EHRs • Clinicians need ubiquitous access to health information to provide optimal care • Providers, payers and public health entities must exchange health information between departments, across organizations and agencies • Consumers need assurance that caregivers have seamless access to correct information 38
  38. 38. What are Data Standards? 39 Data + Context + Structure Information Information + Rules + Analysis Knowledge They are standards having to do with the structure and content of health information
  39. 39. ONC Standards and Interoperability Framework 4 Tools and Services (Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc) Use Case Development and Functional Requirements Standards Development Certification and Testing Harmonization of Core Concepts Implementation Specifications Pilot Demonstration Projects Reference Implementation
  40. 40. ICD-10 41
  41. 41. ICD-10 Compliance Impact • International Classification of Disease 10th Revision • federally mandated by October 1, 2013 for all providers • more flexible code set expands for new procedures, diagnoses and technologies • greater specificity translates to improved quality measurements and patient safety standards • Impact to include: • Coding Medical Records/Health Information Management • Registration/Scheduling • Encounter Forms/Charge Tickets • Clinical Documentation – Information Systems; including EHR’s …the entire Revenue Cycle 42
  42. 42. Home Health 43
  43. 43. Home Health Today 3.3 million seniors receiving care on any given day – over 14 million per year* • Over 10,000 agencies – coverage in every state • Approx 1 million clinicians; multidisciplinary • Most provide specialty programs – Diabetes, Congestive Failure, COPD, Stroke – Patient centered, self management focus • Many specialize in geriatrics • Lowest cost/best outcomes in chronic care management for elderly** *Medicare Payment Advisory Commission. (2011) http://www.medpac.gov/documents/Mar11_EntireReport.pdf
  44. 44. Literature Shows • Seniors do better at home for acute care on clinical outcomes, costs, satisfaction • Transitioning elders from acute to home with teaching for self management and f/u more effective, low readmission rates • Use of telemonitoring in home for CHF and cardiac patients w/PHR show optimal recovery and self management results.
  45. 45. Aging Demographics • 7000 Baby Boomers turning 65 yrs every day • 2011 Legislature targeting Medicare and Medicaid cuts • Current CMS spending and Baby-Boomer impact vs. national fiscal goal of deficit reductions • HH positioned to provide highest quality and best outcomes in care delivery for our elder population 46
  46. 46. Key Initiatives in ACA (CBO est. 13.5b savings 2011-19 Sec 3021-3027) • CMI – Center for Medicare and Medicaid Innovation – launched November, 2010 • Hospital at Home – for elderly • Care Transition Program Pilot • Readmissions Reduction Program • Accountable Care Org/Bundling Pilots
  47. 47. Patient Care Advancements Healthcare Reform Meaningful Use of Technology Clinical Engineering Care Providers
  48. 48. Clinical Engineering The Clinical Engineering Department provides multiple services to ensure that the medical equipment needs for patients and staff are met. We provide services with accuracy and integrity. – Provide installation, preventive maintenance – Provide mandatory pre-use inspections – Performs investigations – Provides assistance in the disposal of medical equipment – Provides for in-service training and support 49
  49. 49. Perhaps Clinical Engineering Might Also Focus On • Identifying improvement opportunities • Participating in information technology and management strategy • Optimization in the use of devices • Rounding to ensure feedback and evaluation of device usage • Expert resource in care coordination: technologies, equipment and information flow • Expert resource in equipment, process, and information flow for meaningful use, and • Expert resource for teams defining information technology management 50
  50. 50. It’s Not What We Don’t Know That Hurts, It’s What We Know That Isn't So Will Rogers (1879-1935)
  51. 51. Planning for Quality the Systems Thinker 52 “Systems Thinking is a discipline for seeing wholes, recognizing patterns and interrelationships, and learning how to structure those interrelationships in more effective, efficient ways.” Senge, P., & Lannon-Kim, C., 1991
  52. 52. Five Dysfunctions of a Team • Absence of Trust • Fear of Conflict • Lack of Commitment • Avoidance of Accountability • Inattention to Results • Identify the behaviors? • How do you know that these have been overcome? The Five Dysfunctions of a Team: A Leadership Fable, San Francisco; Jossey-Bass, 2002 53
  53. 53. Lean Incorporated into Our Teams • People first • Flexibility • Walking the Talk • Our colleagues are assets • Always provide value • Mentor and coach • Bridge organizational boundaries • Adjustments made as work flow indicates • Applies frontline feedback 54
  54. 54. Listening Techniques • Clarify-get more information • Restate-check the meaning • Remain neutral-convey interest • Reflect-help them evaluate their feelings • Summarize-bring the discussion into focus 55
  55. 55. Are the skills, knowledge, and experience of the actors well matched with the tasks they are asked to perform? 56
  56. 56. It is only after I have read, identified, and stimulated your needs that I will be able to energize our discussions while irresistibly presenting my ideas to you. (Robert Mayer, How to Win Any Negotiation)
  57. 57. Power/Influence is the ability to get people to perceive that a given behavior (or performance) is the best action they can take in the service of their values.
  58. 58. Patient Care Advancements Healthcare Reform Meaningful Use of Technology Clinical Engineering Care Providers
  59. 59. Care Providers • At risk and accountable • Will prepare for multiple reform outcomes • Forge new partnerships • Reliance on valid performance vs. faulty • Increase in training • Empowered to lead improvement • Decrease in the size of the pie • Increase in reliance in technology • Driven by incentives and penalties 60
  60. 60. It Is Not The Strongest Who Survive, Or The Fastest. It Is The Ones Who Can Change the Quickest. Charles Darwin
  61. 61. Care Providers Must Simplify Communication •Provider to Provider •Specialty to Specialty •Provider to Consumer •Patients as Consumers •Payer to Employee •Payer to Consumer •Payer to Employee Interoper- ability Meaningful Data Decision Support Adherence Compliance 62
  62. 62. Communication Balancing Act 63 This is What I Asked This is What I Heard
  63. 63. Patient Care Advancements Healthcare Reform Meaningful Use of Technology Clinical Engineering Care Providers
  64. 64. 65
  65. 65. Accountable Care Organizations A concept that has the potential to revolutionize the way healthcare is delivered, experienced, and paid for in America. – Care coordination – Patient centered using to the full extent all health care professionals – Respects patient centeredness by respecting patient choice of provider and shared decision making – Positive patient experience 66
  66. 66. Medical Home Six medical home standards – Enhance access and continuity – Identify and manage patient populations – Plan and manage care – Provide self-care and community support – Track and coordinate care – Measure and improve performance • E-Visits 67
  67. 67. Innovative Systems 68 The Vscan by GE, is a new mobile device designed for doctors who are making house calls. FutureScan 2011: Healthcare Trends and Implications 2011 - 2016 Society for Healthcare Strategy and Market Development / Health Administration Press January 2011
  68. 68. Innovative Systems 69 AirStrip Technologies, has built its revolutionary AppPoint™ software development platform with a vision of securely sending critical patient information directly from hospital monitoring systems, bedside devices, and electronic health records to a clinician's mobile device.
  69. 69. Further Impact to Information Systems • Zero tolerance for negative unintended consequences will be identified and resolved • Increased support to care coordination • Increased certification criteria based on measurable achievements • Mathematical and logical models will become the norm to support healthcare reform 70
  70. 70. Perhaps Clinical Engineering Might Needs to Focus On • Identifying improvement opportunities • Participating in Information technology and management strategy • Optimization in the use of devices • Rounding to ensure feedback and evaluation of device usage • Expert resource in care coordination: technologies, equipment and information flow • Expert resource in equipment, process, and information flow for meaningful use 71
  71. 71. Perhaps Clinical Engineering Might Needs to Focus On • Identifying improvement opportunities • Participating in Information technology and management strategy • Optimization in the use of devices • Rounding to ensure feedback and evaluation of device usage • Expert resource in care coordination: technologies, equipment and information flow • Expert resource in equipment, process, and information flow for meaningful use 72
  72. 72. Health IT Strategic Framework A learning health system is patient centered and uses information to continuously improve health and healthcare of individuals and the population Information Technology Transfor- mation Innovation Engine 73 Enterprise Commitment and Accountability Organizational Readiness A Pervasive Culture
  73. 73. • Industrial strength leaders • Industrial strength organizations • Un-ending curiosity and fact finding • Ability to project what-if scenarios • Ability to simplify every process • Ability to act lean • Zero tolerance for waste 74 Implement best practices to move people and systems forward under these new requirements
  74. 74. Closing Thought… 75 We can build high performance teams that together, determine and implement the requirements for healthcare organizations that operate as innovation engines, transforming people, technology, and processes to advance healthcare reform. We realize it begins with us.
  75. 75. Thank you! For more information, please contact: awalker@optimizeitconsulting.com or 703-283-4678

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