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meaningful use stage 2 patient engagement

meaningful use stage 2 patient engagement
success ehs

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    Stage2mu part2-ptengagementtochie-121005114900-phpapp02 Stage2mu part2-ptengagementtochie-121005114900-phpapp02 Presentation Transcript

    • Meaningful Use Stage 2 (Part 2) – Patient Engagement, HIE and TOC Adele Allison National Director of Government Affairs October 25, 2012
    • Stage 2 MU – Infrastructure Wave Health IT Considerations 888.879.7302 • www.SuccessEHS.com
    • 4 Marks of Meaningful Use Adopt and Use CEHRT Move DATA 888.879.7302 • www.SuccessEHS.com Capture DATA Report DATA
    • 4 Marks of Meaningful Use Core: Core: Core: Menu: Menu: Core: Clinical eCopy Clinical Protect Rx Patient Patient eRx Decision of Summary Reminders Formulary Education Alerts PHI Lists Support Record Adopt and Use CEHRT Core: Core: Menu: Core: Core: Core: Rx Smoking DemoRx Problem Rx Vitals Rx List Allergy graphics Status Reconcile CPOE List List Capture DATA Core: Menu: Menu: Test of Patient TOC Lab Exchange eAccess Summary Results Menu: Menu: Core: Syndromic Immun. CQMs Surveillance Move DATA Report DATA 888.879.7302 • www.SuccessEHS.com Registry Data
    • Core: 4 MarksClinical Meaningful Use of Core: Menu: Menu: Core: Core: Core: Protect 5 CDS Secure eRx and Electronic Patient CPOE Messaging Summary and Rx PHI Formulary (Rx, Lab and Notes w/ Reminders (Electronic & Lists (Encryption) Radiology) Alerts Patients Paper Avail.) Adopt and Use Core: CEHRT Patient Menu: TOC Family Reconcile Smoking DemoLab Vitals Health graphics Status Rx Results History Capture DATA Menu: Core: CQMs: View, Production eSummary Download, Imaging of Care Transfer Results Record Info Menu: Production Production Electronic Production Specialized Cancer Immun. eSyndromic Reporting Registry Surveillance Reporting (EHR Direct Reporting Preferred) Move DATA Report DATA 888.879.7302 • www.SuccessEHS.com
    • 4 Marks of Meaningful Use • Cultural Shift Adopt and Use CEHRT Move DATA 888.879.7302 • www.SuccessEHS.com o Change is hard → “We’ve always done it this way.” o Leadership and Professionalism Capture • Redesign will create DATA temporary Chaos • Address techno-challenged users o Scribes o Focused training o Super-users Report • Celebrate your success! DATA
    • 4 Marks of Meaningful Use • Workflows must be consistent • 3 Data-entry Types 1. Narrative Text 2. Structured Data 3. Object-oriented, Codified Data Adopt and • Apply the 5-Rights Use CEHRT 1. Right Information 2. 3. 4. 5. Right Person Capturing Right Data Format Right Technology Channel Right Time in Workflow 888.879.7302 • www.SuccessEHS.com Capture DATA
    • 4 Marks of Meaningful Use • Define your Use Cases o o o o Referral Management ED/Hospitalization Notification Emergency – “Break-the-Glass” New/Unknown Patient • Use Cases → 2 Clear Goals o ↑ Quality Capture o ↓ Costs Move DATA 888.879.7302 • www.SuccessEHS.com DATA • Interface vs. HIE • Health Information Exchange o Sustainability Model o Emerging Technology
    • 4 Marks of Meaningful Use • Clinical Data Reporting is Crucial! o Drive Reimbursement Reform under ACA (E.g. VBM) o Physician Compare Website • CQMs to be electronically Move submitted by CY2014 DATA • Medicare Data → PQRS o Claims-based o Registry-based o EHR Direct • Medicaid Data → Ind. State o Process and Timelines o Interface or HIE 888.879.7302 • www.SuccessEHS.com Report DATA
    • MU2 Health IT Implementation List CEHRT Extensions CEHRT Standard Offerings • CPOE • eRx, Rx History and Formulary (E.g., Surescripts / RxHub) • Rx Database • Master Patient Index • Evidence-based Guidelines • Patient Administration • Advanced Patient Portal • Detailed Vitals • Patient Education • Smoking Status • HIE → Direct / Exchange • Population Health Mgmt. • Bidirectional Lab Interface / HIE • Thin-Client Operations • Immunization Interface / HIE • Data Encryption Technology • PACS Interface / HIE • Internet Enabled Technology • • Structured Knowledge Base Public Health, Cancer and/or Specialty Registry Interface / HIE • Documentation Tools • Hosting / Emergency Backup 888.879.7302 • www.SuccessEHS.com
    • Stage 2 MU – Infrastructure Wave Health IT Considerations 888.879.7302 • www.SuccessEHS.com
    • Plugging into the Matrix • • Americans are plug into the Matrix more than ever 88% Age 18+ have a cell phone (77% of Rural Residents) • 67% Texting → Dominates, especially with Teens 75% of all Teens text o Teens average 60 texts per day o Girls text more than boys at 100 / day compared to 50 / day o Black teens text average of 80 / day o 57% have a Laptop • 19% have a Tablet Computer • 19% Own and e-book Reader 52% Adult Americans use phones while watching TV • • 888.879.7302 • www.SuccessEHS.com
    • Plugging into the Matrix • Who: 76% Internet Use in U.S. → Ubiquitous and Pervasive o o • What: Internet Usage o o o o o • 4.7% Dial-up 63.5% Broadband 62% Social Networkers 55% Share Photos 26% Comment / Blog 15% Personal Website 12% Tweet Elderly: 53% of Age 65+ use Internet / Email 39% have Broadband o Only 34% of Age 75+ have Internet o 888.879.7302 • www.SuccessEHS.com
    • Plugging into the Matrix • • The Matrix has impacted Patients and Health Care 61% Age 18+ get Health Information Online o • 88% of Caregivers look online for health info 19% Source Provider Rankings / Reviews o o 5% Post Them CMS → Physician Compare www.medicare.gov/find-a-doctor/providersearch.aspx • 18% Source Hospital Reviews o o • • 4% Post Them CMS Hospital Compare www.hospitalcompare.hhs.gov 14% of Patient sign-up for alerts 7% have health apps on handhelds 888.879.7302 • www.SuccessEHS.com
    • Patient Engagement Principles • • Requires real change by both Providers and Patients 2 Golden Rules of Patient Engagement 1. Patient Experience best measure of patient engagement, and 2. Solicit Patient / Family Involvement in how the practice should work for them. • • Research → Better Experience = Better Outcome Patient Involvement → Advisory Councils, Focus Groups, Input = Patient-designed Care Process 888.879.7302 • www.SuccessEHS.com
    • Plugging into the Matrix Area of Family, Friends, Both Equally Is Patient Decision-making Affected? Yes! Professional Advice Sought view of diet, exercise, Patients Fellow stress mgmt. • 49% Influences Accurate Diagnosis 91% 5% 2% • 38% Affected decision about seeing a doctor Rx Information 85% 9% 3% • 38% Altered Alternative Treatment way of coping with Chronic Condition / Pain 63% 24% 5% • Specialist Recommendation 62% 27% 6% Hospital Recommendation 62% 27% 6% Illness Emotional Support 30% 59% 5% Quick Remedy for Health Issues 41% 51% 4% 888.879.7302 • www.SuccessEHS.com
    • Fed. Programs & Patient Engagement • Behavioral Economics requires an Engaged Patient o o • • • Effects of social, cognitive, emotion factors on patient decision-making E.g., Airport McDonalds Story Transition from Episodic Care to Long-Term Healing and Wellness Research → Patient Engagement ↑ Quality and ↓ Costs 4 Federal Initiatives with Patient Engagement Regulations o o o o Meaningful Use Stage 2 - 7 Measures Accountable Care Organizations – 7 Measures NCQA Patient-Centered Medical Home – 66 Factors Value-based Purchasing – CAPHS 888.879.7302 • www.SuccessEHS.com
    • Proposed Stage 2 Core Measures Fed. Objective Programs & Measure Patient Engagement Threshold Exclusions No. Implement CDS to improve on high-priority condition: 1.5 CDS interventions for 5 or more CQMs during entire reporting period; and 2.Enable drug-drug and drug-allergy checks for entire reporting period. For each office visit to patients within 24 hours, which includes up-to-date lists of problems, medications and Rx allergies (paper and electronic must be avail. to pt.) 5 Rules and Rx alerting by attestation None 1 Implement Clinical Decision Support and Track Compliance 2 Provide Patients with Clinical Summaries 3 Use EHR for Patient-Specific Education Resources Provide patient-specific education resources to all patients 10% (Unchanged but EP has no office visit during EHR reporting made Core and “if appropriate removed) period 4 Generate Lists of Patients by Condition 1 List with a Specific Condition for use in quality improvement, reduction of disparities, research or outreach By attestation (Made Core) 5 Use of secured messaging with Patients 50% (Unchanged) Send secured messages to patients seen during reporting period 10% 1. 6 7 Patients can view online, download and transfer Timely Electronic Access to Health info within 4 days of being available to EP, subject to Information 2. EPs discretion to withhold certain info Send Reminders to Patients 888.879.7302 • www.SuccessEHS.com Preventative and follow-up care for all patients based on clinically relevant info for anyone with an OV in past 24 months 50% of all pts., and 10% of pts. access 10% (↓ from 20%, all patients and Made Core) EP has no office visit during EHR reporting period None EP has no office visit during EHR reporting period EP has no orders / • creates info required >50% visit in county • with >50% with 4Mbps broadband avail. EP has no office visit in previous 24 months
    • ACOs and Patient Engagement • 33 Quality Performance Measures • 7 Patient / Caregiver Experience Measure Getting Timely Care, Appointments and Information How Well Your Doctors Communicate Patients’ Rating of Doctor Access to Specialists Health Promotion and Education Shared Decision-Making Health Promotion and Education Method of Data Submission Survey Survey Survey Survey Survey Survey Survey • Final Rule requires CMS qualified Survey Vendor by 2014 • HITPC Preliminary Stage 3 Draft (Aug → Final Recommendations expected in Nov) o o o Patients Option to submit data online → 10% submit Medical Histories Patient education in non-English languages 10% of Patients ability to update and correct information online 888.879.7302 • www.SuccessEHS.com
    • PCMH and Patient Engagement NCQA PCMH 2011 Standard and Element Points • • • 20 4 4 2 2 2 2 4 17 3 4 o 4 5 17 o 4 3 o 4 3 3 9 6 3 18 6 6 6 20 4 4 4 3 3 2 PCMH Standard 1: Enhance Access and Continuity Element A: Access during office hours Element B: Access after hours Element C: Electronic Access Element D: Continuity Element E: Medical Home Responsibilities Element F: Culturally & Linguistically Appropriate Services (CLAS) Element G: Practice Organization PCMH Standard 2: Identify and Manage Patient Populations Element A: Patient Information Element B: Clinical Data Element C: Comprehensive Health Assessment Element D: Using Data for Population Management PCMH Standard 3: Plan and Manage Care Element A: Implement evidence-based guidelines Element B: Identify High-Risk Patients Element C: Manage Care Element D: Management Medications  Element E: Electronic Prescribing PCMH Standard 4: Provide Self-Care and Community Support  Element A: Self-Care Process Element B: Referrals to Community Resources  PCMH Standard 5: Track and Coordinate Care Element A: Test Tracking and Follow-up  Element B: Referral Tracking and Follow-up Element C: Coordinate with Facilities / Care Transitions PCMH Standard 6: Measure and Improve Performance  Element A: Measures of performance Element B: Patient / Family feedback  Element C: Implements Continuous Quality Improvement Element D: Demonstrates Continuous Quality Improvement Element E: Performance Reporting Element F: Report Data Externally Number of Factors 34 4 5 6 3 4 4 8 35 12 9 10 4 23 3 2 7 5 6 10 6 4 25 10 7 8 22 4 4 4 4 3 3 Affordable Care Act mentions Medical Home 15 Times ACA references Patient-Centeredness 36 Times NCQA now offers a new Distinction in Patient Experience nt r k tie wo Pa e Optional with PCMH Recognition ct Component of Quality of Care” re Fram “Consumer Experience is Critical Di tont Uses CAHPS PCMH Survey access: 66 me rs Access e acto Information g ga F n Communication E Coordination of Care Comprehensiveness Self-Management Support and Shared Decision-Making 100 888.879.7302 • www.SuccessEHS.com 149 Must Pass? Yes No No No No No No No No No Yes No No Yes No No Yes No No Yes No No No Yes No No No 6
    • VBP & Patient Engagement • • • • • • • • Hospitals subject to CMS payment adjustments based on patient experience Starts October 1, 2012 Evaluated / Scored on performance improvements over baseline Patient Experience measured by HCAHPS scores Hospital staff undergoing patient satisfaction, customer service and communication training Results published on Hospital Compare website ACA has Physician VBM program starting in 2015 based on 2013 performance Physician Compare website now in place to show performance metrics - first publishing (limited) in CY2013 888.879.7302 • www.SuccessEHS.com
    • Communication Shift • Patient Portals have existed since 1990 o o • Patient Engagement was transactional – Financial Focus 56M accessed records through Patient Portal (Oct 2011) Paradigm shift in the way health information disseminated Pull Information Model Push Information Model 888.879.7302 • www.SuccessEHS.com
    • Patient Portal a MUST • • • Patient Engagement requires a Willing Patient Patient Portals → Contagious and Effective Tools Hub of the Patient, Family, Provider and Staff Communication o o o • Web-based Secure communication channel with clinicians Facilitates appointments and Rx renewal Implementation Considerations o o o o o o Incorporated on Practice or stand-alone website? Separate license cost (3rd party product)? Integration requirements? Browser compatibility (E.g. Microsoft Explorer, Mozilla Firefox) Setup, configuration and training Patient Password management 888.879.7302 • www.SuccessEHS.com
    • Stage 2 MU – Infrastructure Wave Health IT Considerations 888.879.7302 • www.SuccessEHS.com
    • Health Information Exchange (HIE) What is interoperability? Transferring of data accurately from one healthcare venue to another. Who has ever used an ATM? Why is Interoperability so hard to achieve in Healthcare? 888.879.7302 • www.SuccessEHS.com
    • ATM Banking vs. Healthcare ATM Bank to Bank Healthcare Nursing Home Individual Physicians Public Health Authorities Labs Pharmacies ClinicsStudent Health Center Hospitals Payers Dentists Behavioral HealthDiagnostic Center Location Account # Balance Withdraw Amount 888.879.7302 • www.SuccessEHS.com Payer Info Patient Demographics Images Medications Allergies Vitals Discharge Summaries Immunizations Lab Results Mental Health Family History Social History Procedures Consult Reports
    • Interoperability Challenges Challenges causing Healthcare Interoperability to be so hard to achieve. Variability of Applications (standards) Funding Processes and Document Types Semantics and Complex Vocabulary Privacy and Security Free text vs. Discrete Information / Data 888.879.7302 • www.SuccessEHS.com
    • HIE Success Factors • • Early efforts → Some succeeded, some failed Today → Same success factors apply Success Factors Shared Vision with stakeholders Incremental Approach o o Limited initial goals Build on pilots Uninterrupted physician workflow Internet Technology Strong commitment to Medical Informatics 888.879.7302 • www.SuccessEHS.com
    • HIE Guiding Principles Guiding Principles 888.879.7302 • www.SuccessEHS.com 1. Improve Patient Care 2. Increase Operational Efficiency to lower clinic costs
    • Use Cases and Transport Options Examples HIE Options Alerting PCP to ED Visit Direct Transitions of Care Exchange/XDS Referral Management Custom HL7 messages Query for Documents 888.879.7302 • www.SuccessEHS.com
    • Direct Example → Referral Management Consult Referral Jane Doe HISP HISP Arrhythmia Dr. Smith (Internist) 888.879.7302 • www.SuccessEHS.com Consult Report Dr. Heart (Cardiologist)
    • Exchange/XDS Example → Car Accident CCD published Dr. Smith (Rural Health) 888.879.7302 • www.SuccessEHS.com HIE HIE CCD Request John Doe CCD Response Emergency Urban Center
    • Custom HL7 Custom HL7 Established pre-IHE Standards → Long-Established HIEs DO NOT use IHE Industry Standards Custom Development Required Impacts Cost and Speed of Roll-Out Not Meaningful Use Eligible Typically, evaluated on Case-by-Case Basis 888.879.7302 • www.SuccessEHS.com
    • Stage 2 MU – Infrastructure Wave Health IT Considerations 888.879.7302 • www.SuccessEHS.com
    • What is a “Transition of Care?” • • Movement of patients from one provider or setting to another Occurs at multiple levels o Within Settings   o Primary care  Specialty care ICU  Ward Discharge Between Settings    o Referral Hospital  Sub-acute facility Ambulatory clinic  Senior center Hospital  Home Across health states   Curative care  Palliative care/Hospice Personal residence  Assisted living 888.879.7302 • www.SuccessEHS.com (c) Eric A. Coleman, MD, MPH ALF / SNF
    • TOC Potential Issues ICU Home PCP Specialty Pharmacy Case Mgr. Care Giver Inpatient Medication Reconciliation? In-Patient SNF ALF Patient Personal Medicine List? Coordinated Care Plan? 888.879.7302 • www.SuccessEHS.com Care Plan? Medication Reconciliation? Personal Medicine List? Outpatient Discharge Plan? Patient ER • • • • • • Discharge Plan? Medication Reconciliation? Personal Medicine List?
    • TOC and Outcomes • • Problem: 75% of PCPs → No info about a patient’s hospitalization post-discharge = Readmissions Ineffective Transitions → Poor Outcomes and Increased Costs 1:5 Seniors (2.6M) readmitted within 30 days of discharge o 2011 Poor Transitions → $25-45 Billion in wasteful spending o • Hospitalization Care Gaps o o o o o o o o Discharge Rx Reconciliation Lack of Understanding of Discharge Plan of Care Non-compliance or Untimely Post-discharge Plan of Care No appointments with a PCP Logistics (E.g. Transportation) PCP unawareness of hospitalization Lack, delay or inadequate communication with downstream provider Lack or inadequate communication with home care provider (includes family) 888.879.7302 • www.SuccessEHS.com
    • MU2 and TOC / Referrals – 3 Tasks • 1 Core Measure / 1 Task → Rx Reconciliation during TOC - 50% • 1 Core Measure / 2 Tasks → Summary of Care Record for TOC/Referrals o 50% of TOCs / Referrals - AND o 10% electronically transmitted • Summary of Care Record Core Hospital/CAH measure, as well • CMS Alignment → Critical to ACO Performance Gains o 10% Improvement in DM Measures = 1% Reduction in Costs o Conclusion: Care Coordination focus a “Must” for sustainable ACO performance o 6 ACO Performance measures link to care coordination • TOC / Referral success will rely upon HIE 888.879.7302 • www.SuccessEHS.com
    • MU2 and TOC / Referrals – CEHRT Inbound TOC / Referral CEHRT Must • • Display in HumanReadable Format • Accept CCD, CCR and/or CCDA • Incorporate Rx, Allergies and Problems • Transport Vehicle: Direct • 888.879.7302 • www.SuccessEHS.com Receive Information Will CEHRT help match correct patient?
    • MU2 and TOC / Referrals – CEHRT Outbound TOC / Referral CEHRT Must • Create the Order • Create CCDA (Contains elements for Inbound TOC requirements) • Provider Directory (Standard Not Defined in Regulation) • • Send CCDA • 888.879.7302 • www.SuccessEHS.com Connect to HISP Possible Receipt of Record Confirmation
    • Stage 2 MU – Infrastructure Wave Tips for Success Health IT Considerations 888.879.7302 • www.SuccessEHS.com
    • 5 Tips for Success – Patient Engagement • • Tip 1: Measure Patient Satisfaction Pre- and Post-Project Tip 2: Involve the Provider(s) o o • Tip 3: Address Cultural-Change Challenges o o o • They must drive the medical responses They are going to get mad with some survey results “One more thing I have to do!” “Our patients will never go online” Creates a mutual interdependence between Providers and Patients Tip 4: Add a “filter” and Map the Workflow o o o Make the workflow someone’s job (Think “Care Team”) Get Providers into a routine (E.g. See patients, answer emails / flags, cycle again) Perhaps schedule time on the Provider’s calendar 888.879.7302 • www.SuccessEHS.com
    • 5 Tips for Success – Patient Engagement • Tip 5: Promote, Promote, Promote! o o o o o o o o Refine the Message → Faster way to get lab results, refills, etc.; No more Phone-Tag! Strategically place Brochures (E.g., Ck-in / Ck-out, Waiting Room) Add information on appt. reminder cards → “Use our online scheduling!” Remind patients of ability to request refills online when they call for refills Computer in waiting room to assist patients in registering, completing paperwork, etc. Replace “on-hold” music with introduction to patient portal Add-on announcements with all statements, newsletters and ePublications Improve organizational branding 888.879.7302 • www.SuccessEHS.com
    • 5 Tips for Success – HIE and TOC • Tip 1: Define your Use Cases o o • Does it improve quality? Does it decrease costs? Tip 2: Involve the Stakeholders o o • Tip 3: Understand your HIE Market o o o • Hospital Specialty Providers Statewide / Local Market Progress and Barriers HISP Providers for Direct Exchange for more advance Query / Retrieve HIE Tip 4: Allow ample bandwidth to plan and implement o o Data-Sharing Agreements, SOW Understand related Costs 888.879.7302 • www.SuccessEHS.com
    • 6 Health IT Tips – Your IT Vendor • Tip 1: Meaningful Use, PQRS and Other Dashboards? o Metrics / Analytics by Provider o Facilitates quick numerators/denominators for MU attestation o Clinic analytics with drill-through details • Tip 2: Patient Portal Inherent with System? o Should be part of Core Offering o Avoids Additional vendor and integration considerations • Tip 3: Single database solution for PM and EHR • Tip 4: EHR Direct PQRS • Tip 5: More than just first call support o Initiative Toolkits (E.g. MU, PCMH, PQRS) o Consulting Support with domain experts • Tip 6: Ongoing Client Educational Offerings 888.879.7302 • www.SuccessEHS.com
    • Added to The BRIEF or Questions: adelea@successehs.com Follow me on Twitter: www.twitter.com/Adele_Allison 888.879.7302 • www.SuccessEHS.com