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EHR: Moving Forward Toward Implementation & Meeting Meaningful Use

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CGN recently offered an educational webinar on EHR and Meaningful Use for healthcare professionals. If you are interested in attending a future session, please email us at contactus@cgn.net.

CGN recently offered an educational webinar on EHR and Meaningful Use for healthcare professionals. If you are interested in attending a future session, please email us at contactus@cgn.net.

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  • 1. EHR Moving Forward Toward Implementation andg p Meeting Meaningful Use October 2010 10/27/2010 1CGN & Associates Confidential
  • 2. Central Illinois ACHE Chapter Welcome Anne Dierker C l Illi i ACHE Ch P idCentral Illinois ACHE Chapter ‐ President 10/27/2010 2CGN & Associates Confidential
  • 3. Welcome Our ObjectiveOur Objective “Di C id ti 1 2 3 “Discuss Considerations  for Transformation to an  EHR and the Critical 4 EHR and the Critical  Security Aspects Relative  to HITECH Meaningful  Use” 10/27/2010 3CGN & Associates Confidential
  • 4. Introductions – Our Panel Dennis Glavin PMP Senior Manager CGN & Associates Eric Epley PMP, Senior Manager, CGN & Associates Executive Director, Southwest Texas Regional Advisory p y Brent Terry , g y Council for Trauma – STRAC Program Manager, Southwest Texas Regional Advisory y Mark Bidlake g g , g y Council for Trauma – STRAC Associate Partner CGN & Associates ‐ ModeratorAssociate Partner, CGN & Associates  ‐ Moderator 10/27/2010 4CGN & Associates Confidential
  • 5. Housekeeping  Have a question during the webinar?  PollingPolling Replay 10/27/2010 5CGN & Associates Confidential
  • 6. Agenda 1. Overview and Highlights of EHR and  Meaningful UseMeaningful Use 2. Considerations – What Do You Need in  an EHR system?an EHR system? 3. Security – Critical and Comprehensive 4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 6CGN & Associates Confidential
  • 7. Agenda 1. Overview and Highlights of EHR and  Meaningful UseMeaningful Use 2. Considerations – What Do You Need in  an EHR system?an EHR system? 3. Security – Critical and Comprehensive 4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 7CGN & Associates Confidential
  • 8. Why Start Now? – The Incentive Structure • Incentive formula = ($2 Million + Discharge Payment) x Medicare Share x Payout  PercentagePercentage • Discharge Payment = (# of Discharges less than 23,000 – 1149) x 200 • Medicare Share = (# Part A and C inpatient days / (total inpatient days x % of  h i h )noncharity charges) • Medicare Incentives will be paid out for four years or through Reporting Year 2016,  whichever is earlier.  Payouts will also grow smaller over the four‐year span.  So: For Implementations in 2011‐2013, four‐year payout percentages are 100%,  75%, 50%, 25% 2014 Implementations will pay out for three years starting at 75%p p y y g 2015 Implementations will pay out for two years starting at 50% Post – 2015 Implementations get NO Payout 10/27/2010 8CGN & Associates Confidential
  • 9. The Incentives Structure ‐ Example For a hospital with: • 2,000 total discharges a year,  • 7 000 Medicare A and C Inpatient Days Medicare Share = 7,000 / (21,000 x .87) = 7,000 / 18,270 = .38 Discharge Payment = (2,000 – 1,149)x200 =  851 x 200 = $170,200 2011 Payment = (2,000,000 + 170,200) x .38 x 1 =  $824,676 2012 Payment = (2 000 000 + 170 200) x 38 x 75 = $618 5077,000 Medicare A and C Inpatient Days, • 21,000 total Inpatient Days,  • 87 % in noncharity charges. 2012 Payment = (2,000,000 + 170,200) x .38 x .75 = $618,507 2013 Payment = (2,000,000 + 170,200) x .38 x .5 = $412,338 2014 Payment = (2,000,000 + 170,200) x .38 x .25 = $206,189 TOTAL INCENTIVE = $2,061,690 $412,338 $206,189 $2,061,690 $2,000,000 $824,676 $618,507 $1,000,000 $1,500,000 mount to be paid $0 $500,000 Am 10/27/2010 9CGN & Associates Confidential 2011 2012 2013 2014 Total Incentive Year of Payment
  • 10. Why start now? ‐ Penalties Penalties begin in 2015: ¾ of market basket¾ of market basket  reduced by 33.33 % 2015 2016 ¾ of market basket  d d b 66 66 %reduced by 66.66 % 2017  and beyond ¾ of market  basket  reduced  by  100%and beyond 10/27/2010 CGN & Associates Confidential 10
  • 11. Why start now? – Operational Benefits Patient Security Interoperability Patient  Outcomes Operational Benefits 10/27/2010 CGN & Associates Confidential 11
  • 12. Agenda 1. Overview and Highlights of EHR and  Meaningful UseMeaningful Use 2. Considerations – What Do You Need in  an EHR system?an EHR system? 3. Security – Critical and Comprehensive 4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 12CGN & Associates Confidential
  • 13. The Good News – Stage One focus is clear As of 28 July, 2010, Stage 1 Objectives for Compliance of  Meaningful Use for Hospitals have beeng p REDUCED SIMPLIFIED BENCHMARKED The Result is: 14 Mandatory Objectives 5 Elective Objectives (from a list of 10) 10/27/2010 13CGN & Associates Confidential 5 Elective Objectives (from a list of 10)
  • 14. Fourteen Core Objectives – By Category Accuracy Security Interoperability • Record Demographics • Implement One Clinical  Decision Support Rule  Relevant to Specialty or  • Computerized Physician  Order Entry (CPOE) • Provide Patients with a  Copy of Discharge  • Report Clinical Quality  Measures to CMS/States • Exchange Key Clinical  Information among  High Clinical Priority • Maintain Active  Medication List • Maintain Updated  Instructions Upon  Discharge/Upon Request • Provide Patients with an  Electronic Copy of Health  I f i R Providers of Care and  Patient‐Authorized Entities  Electronically Problem List of Current &  Active Diagnoses • Maintain Active  Medication Allergy List Information upon Request • Protect Electronic  Information • Implement Drug Allergy  Checks • Record and Chart Changes  in Vital Signs d k f• Record Smoking Status for  Patients 13 and Older 10/27/2010 14CGN & Associates Confidential
  • 15. Menu of Elective Objectives – By Category Accuracy Security Interoperability • Drug Formulary Checks • Incorporate Clinical Lab  Results as Structured Data G Li f P i • Provide Patients with  Timely electronic access to  records • Submit electronic data to  immunization  registries/systems • Summary of care record• Generate Lists of Patients  by Specific Condition • Record Advance Directives  for Patients 65 or Older U tifi d EHR • Summary of care record  for each transition of care • Provide electronic  syndromic surveillance  data to public health• Use certified EHR  Technology to identify  patient‐specific education  resources and provide to  patient as appropriate data to public health  agencies patient as appropriate • Medication reconciliation 10/27/2010 15CGN & Associates Confidential
  • 16. For more information Nancy Draper CGN & Associates  ndraper@cgn.net 309-472-4473 10/27/2010 CGN & Associates Confidential 16
  • 17. The long range goals are still taking shape As of 28 July, 2010, the Stage 2 and 3 Objectives are not yet clear Expected 2013 Objectives Patient/Provider  Secure Messaging Generate and  i l i Expected 2015  Objectives Transmit Electronic  Prescriptions Report to External       Di R i t iObjectives Real‐Time Patient         Access to Records Medical Device Disease Registries Upload Data from  Home Monitoring  DevicesMedical Device  Interoperability Access Comprehensive  Patient Data from All Devices Patient Data from All  Available Sources 10/27/2010 17CGN & Associates Confidential
  • 18. Agenda 1. Overview and Highlights of EHR and  Meaningful UseMeaningful Use 2. Considerations – What Do You Need in  an EHR system?an EHR system? 3. Security – Critical and Comprehensive 4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 18CGN & Associates Confidential
  • 19. Security – Why You Should be Concerned  After 2011, multiple parties (other than employees) will  potentially have access to your systems In return YOU will have access to systems you could not  previously access 10/27/2010 19CGN & Associates Confidential
  • 20. Authentication Options Method User  Familiarity Expense Subject to  Compromise Ease of  Unauthorized Use Degree of  RepudiationFamiliarity Compromise Unauthorized Use Repudiation Password High Very Low High Very High High T k I t di t I t di t Hi h V Hi h Hi hToken  (Key Fob) Intermediate Intermediate High Very High High Token  (Smartcard) Intermediate High High Very High High (Smartcard) Biometric Low High Very Low Very Low Very Low Two‐Factor Low Intermediate Very Low Very Low Very Low 10/27/2010 CGN & Associates Confidential 20
  • 21. Authentication Recommendation Smartcards with “two factor authentication” offer “best‐in‐class” for  user securityuser security – Large Storage Capacity on the Chip – Can be configured to require both pin code AND biometric  confirmation – Strong Encryption on the Chipg yp p – Precedent for Use in high – security environments • Department of Defense • State, Local, and Tribal Emergency Responders • E‐Prescription for Controlled Substances 10/27/2010 CGN & Associates Confidential 21
  • 22. Agenda 1. Overview and Highlights of EHR and  Meaningful UseMeaningful Use 2. Considerations – What Do You Need in  an EHR system?an EHR system? 3. Security – Critical and Comprehensive 4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 22CGN & Associates Confidential
  • 23. STRAC ‐ About Us Trauma Coordination for 22 countries in  Southwest Texas (includes San Antonio)Southwest Texas (includes San Antonio) 10/27/2010 23CGN & Associates Confidential
  • 24. STRAC – Successful Security for EHR 10/27/2010 CGN & Associates Confidential 24
  • 25. STRAC Strategy – Start with Existing Infrastructure Existing  cards used for securing emergency rooms  (Physical Access Control ‐ PAC) 10/27/2010 25CGN & Associates Confidential
  • 26. STRAC Strategy – Multi use Useful every day – loss prevention  EHR Access Parking LotParking Lot Doctors Lounge Hospital after hours access Joint Commission Requirements 10/27/2010 26CGN & Associates Confidential
  • 27. STRAC  Policy ‐ Tiers 10/27/2010 27CGN & Associates Confidential
  • 28. STRAC Policy   ‐ Communication for Buy‐in Brochure and FAQ  document widely  distributed Project update sent  through BCMS blast‐fax  when delays encountered Project leadership attended  Med Exec committees 10/27/2010 28CGN & Associates Confidential
  • 29. STRAC  Technical – One Card New Phase 2 Card: • FIPS201 Standard introduced • Added computer access control capabilities • Backward compatible with Version 1 capabilities 10/27/2010 29CGN & Associates Confidential Backward compatible with Version 1 capabilities  • Changed business process for enrollment
  • 30. STRAC Technical ‐ Computer Access Emergency Room computers fitted with card reader forEmergency Room computers fitted with card reader for  computer access control Single PIN to access all 15 applications used in the ER Efficiency gains  Success led to rollout in other ERsSuccess led to rollout in other ERs 10/27/2010 30CGN & Associates Confidential
  • 31. STRAC Logistics ‐ Enrollment • All ph sician cards are Gold cards ith• All physician cards are Gold cards with  computer access capabilities • Enrollment tour:   2300+ physicians  enrolled in less than 6 weeks • IT / Physician Services Directors /  Security Directors participate in y p p issuance plan development 10/27/2010 31CGN & Associates Confidential
  • 32. STRAC ‐ Lessons Learned Everyday use very importanty y y p Communication important Build on small successes ‐ avoid big bang theory of project Multiple organization and department participation in  planning is very important 10/27/2010 32CGN & Associates Confidential
  • 33. Agenda 1. Overview and Highlights of EHR and  Meaningful UseMeaningful Use 2. Considerations – What Do You Need in  an EHR system?an EHR system? 3. Security – Critical and Comprehensive 4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 33CGN & Associates Confidential
  • 34. Your Journey, and Managing the Change Process  The three most fundamental questions Wh ? Wh i ?Where are we? Where are we going? How are we going to get there? 10/27/2010 34CGN & Associates Confidential
  • 35. How are we going to get there? And how is our organization experiencing the journey? It depends on the leadership we provide,  and on how well we manage the change processand on how well we manage the change process 10/27/2010 35CGN & Associates Confidential
  • 36. Leaders keep the vision clear and in focus Some aspects of “the blue dot” are certain Healthcare will transform itself using technology Interoperability the norm Cli i l d ti l t d di tiClinical and operational standardization  Changed processes, practices, roles, structure, relationships, culture, rewards Greater transparency, accountability, and performance‐based compensationp y, y, p p Dramatic improvements in patient safety, care, productivity, health outcomes Costs will be significantly reduced, to a globally competitive level  This is certainly not about replacing paper files with electronic files  Shared information will accelerate shared knowledge & learning    10/27/2010 36CGN & Associates Confidential
  • 37. Principles of organizational change provide direction 1. How problems and goals are framed has significant impact on outcomes EMR  or EHR or EHMS or Healthcare Transformation Compliance or Continuous Innovation in Care 1. How problems and goals are framed has significant impact on outcomes 2. Elements are interdependent; change requires a holistic approach.   Compliance or Continuous Innovation in Care 3. People are not by nature averse to change, but do tend to strongly resist change  imposed upon them.  People support what they help to create. 4. Leaders are an important part of the system, and change involves them too.  5. Effective organizational change management greatly increases the likelihood of g g g g y successful change efforts 10/27/2010 37CGN & Associates Confidential
  • 38. Executive  alignment & active support is essential  Full C‐ suite interest, active support &  commitment is needed to: build a shared visionbuild a shared vision shape the strategy for moving forward in  face of unknowns & turbulence    instill a sense of urgencyinstill  a sense of urgency from the core of a powerful coalition for  change identify and address organizationalidentify and address organizational  readiness issues provide necessary resources and support, remove roadblocksremove roadblocks The first task of executive management is to frame the goal as a long range  enterprise one, rather than an IT project 10/27/2010 38CGN & Associates Confidential
  • 39. Program/project management provides structure An effective program management unit: Key Issues • Getting buy‐in of IT practitioners Provides a governance process that  guides the entire journey Enables a single view of the Getting buy in of IT practitioners • Ensuring executive support through  the multi‐year journey  • Cultural impediments (reactive, silos)Enables  a single view of  the  corporate portfolio Drives improved quality and velocity  of project execution and delivery of   Cultural impediments (reactive, silos) • Stepping up the pace  • Balancing quick wins with big picture • S i i i i ibusiness outcomes. Becomes a Center of Excellence for  PM, BA  OCM disciplines: • Sustaining ongoing communications • Adoption of common processes, tools  and standard metrics (esp in multi‐site)  • I d h (d 1) Provides Executive Information and  Reporting structure and Dashboards • Integrated change management (day 1) • Continuous improvement post go‐live 10/27/2010 39CGN & Associates Confidential
  • 40. • Job specific skills Involvement, communications, training enables systemic change • Job‐specific skills • Applications, tools, process/ work flow training • Org integration, relationship changes  • Continuous improvement & reinforcement • Cross‐functional design teams  High g • Process & workflow  design • Job role , org, other changes • Systems development  • Pilots , hands‐on trials, refinemt Acceptance oductivity • Clear future state picture   • See around the corner • Individual impacts & change process;  taking ownership • Build critical mass & momentum Level of  and Pro • Convey Mgmt Expectations • Overall Vision & Goals • Imperatives for change   • How staff can  engage • WIIFMWIIFM  Low Project/Change Timeline 10/27/2010 40CGN & Associates Confidential
  • 41. Agenda 1. Overview and Highlights of EHR and  Meaningful UseMeaningful Use 2. Considerations – What Do You Need in  an EHR system?an EHR system? 3. Security – Critical and Comprehensive 4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story 5. Navigating the Meaningful Use Journey 6. Q&A 10/27/2010 41CGN & Associates Confidential
  • 42. Agenda 1. Overview and Highlights of EHR and  Meaningful UseMeaningful Use 2. Considerations – What Do You Need in  an EHR system?an EHR system? 3. Security – Critical and Comprehensive 4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story 5. Cultural and Organizational  TransformationTransformation 6. Q & A 10/27/2010 42CGN & Associates Confidential
  • 43. Transformation to EHR Questions Answers 10/27/2010 43CGN & Associates Confidential
  • 44. Thank you! Contact Information: Mark Bidlake,  Associate Partner CGN & Associates Two Mid America Plaza, Suite 915 Oakbrook Terrace, IL Eric Epley, Executive Director  STRAC – Southwest Texas Regional Advisory Council for Trauma 7500 Hwy. 90 West AT&T Building, Suite 200, 630/368‐7810  ext:5002 mbidlake@cgn.net g, San Antonio, TX  78227 210/822‐3888  eric@strac.org  CGN & Associates Confidential10/27/2010 44