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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 and g p Meeting Meaningful Use October 2010 10/27/2010 CGN & Associates Confidential 1
  • 2. Central Illinois ACHE Chapter Welcome Anne Dierker Central Illinois ACHE Chapter ‐ P id C l Illi i ACHE Ch President 10/27/2010 CGN & Associates Confidential 2
  • 3. Welcome 1 Our Objective Our Objective 2 3 4 “Discuss Considerations  “Di C id ti for Transformation to an  EHR and the Critical  EHR and the Critical Security Aspects Relative  to HITECH Meaningful  Use” 10/27/2010 CGN & Associates Confidential 3
  • 4. Introductions – Our Panel Dennis Glavin PMP, Senior Manager, CGN & Associates PMP Senior Manager CGN & Associates Eric Epley p y Executive Director, Southwest Texas Regional Advisory  , g y Council for Trauma – STRAC Brent Terry y Program Manager, Southwest Texas Regional Advisory  g g , g y Council for Trauma – STRAC Mark Bidlake Associate Partner, CGN & Associates  ‐ Associate Partner CGN & Associates ‐ Moderator 10/27/2010 CGN & Associates Confidential 4
  • 5. Housekeeping  Have a question during the webinar?  Polling Replay 10/27/2010 CGN & Associates Confidential 5
  • 6. Agenda 1. Overview and Highlights of EHR and  Meaningful Use Meaningful 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 Story 4 Use Case STRAC Tells Their Stor 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 CGN & Associates Confidential 6
  • 7. Agenda 1. Overview and Highlights of EHR and  Meaningful Use Meaningful 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 Story 4 Use Case STRAC Tells Their Stor 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 CGN & Associates Confidential 7
  • 8. Why Start Now? – The Incentive Structure • Incentive formula = ($2 Million + Discharge Payment) x Medicare Share x Payout  Percentage • Discharge Payment = (# of Discharges less than 23,000 – 1149) x 200 • Medicare Share = (# Part A and C inpatient days / (total inpatient days x % of  noncharity charges) h i h ) • 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 CGN & Associates Confidential 8
  • 9. The Incentives Structure ‐ Example Medicare Share = 7,000 / (21,000 x .87) = 7,000 / 18,270 = .38 For a hospital with: Discharge Payment = (2,000 – 1,149)x200 =  851 x 200 = $170,200 • 2,000 total discharges a year,  2011 Payment = (2,000,000 + 170,200) x .38 x 1 =  $824,676 • 7 000 Medicare A and C Inpatient Days 7,000 Medicare A and C Inpatient Days, 2012 Payment = (2,000,000 + 170,200) x .38 x .75 = $618,507 2012 Payment = (2 000 000 + 170 200) x 38 x 75 = $618 507 • 21,000 total Inpatient Days,  2013 Payment = (2,000,000 + 170,200) x .38 x .5 = $412,338 • 87 % in noncharity charges. 2014 Payment = (2,000,000 + 170,200) x .38 x .25 = $206,189 TOTAL INCENTIVE = $2,061,690 $2,000,000 $2,061,690 $206,189 $412,338 $1,500,000 mount to be paid $618,507 $1,000,000 $824,676 Am $500,000 $0 2011 2012 2013 2014 Total Incentive Year of Payment 10/27/2010 CGN & Associates Confidential 9
  • 10. Why start now? ‐ Penalties Penalties begin in 2015: 2015 ¾ of market basket  ¾ of market basket reduced by 33.33 % ¾ of market basket  2016 reduced by 66.66 % d d b 66 66 % ¾ of market  2017  basket  reduced  by  and beyond and beyond 100% 10/27/2010 CGN & Associates Confidential 10
  • 11. Why start now? – Operational Benefits Patient  Patient Security Interoperability Outcomes Operational Benefits 10/27/2010 CGN & Associates Confidential 11
  • 12. Agenda 1. Overview and Highlights of EHR and  Meaningful Use Meaningful 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 Story 4 Use Case STRAC Tells Their Stor 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 CGN & Associates Confidential 12
  • 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 been g p REDUCED SIMPLIFIED BENCHMARKED The Result is: 14 Mandatory Objectives 5 Elective Objectives (from a list of 10) 5 Elective Objectives (from a list of 10) 10/27/2010 CGN & Associates Confidential 13
  • 14. Fourteen Core Objectives – By Category Accuracy Security Interoperability • Record Demographics • Computerized Physician  • Report Clinical Quality  • Implement One Clinical  Order Entry (CPOE) Measures to CMS/States Decision Support Rule  • Provide Patients with a  • Exchange Key Clinical  Relevant to Specialty or  Copy of Discharge  Information among  High Clinical Priority Instructions Upon  Providers of Care and  • Maintain Active  Discharge/Upon Request Patient‐Authorized Entities  Medication List • Provide Patients with an  Electronically • Maintain Updated  Electronic Copy of Health  Problem List of Current &  I f i R Information upon Request Active Diagnoses • Protect Electronic  • Maintain Active  Information Medication Allergy List • 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 CGN & Associates Confidential 14
  • 15. Menu of Elective Objectives – By Category Accuracy Security Interoperability • Drug Formulary Checks • Provide Patients with  • Submit electronic data to  • Incorporate Clinical Lab  Timely electronic access to  immunization  Results as Structured Data records registries/systems •GGenerate Lists of Patients  Li fP i • Summary of care record Summary of care record  by Specific Condition for each transition of care • Record Advance Directives  • Provide electronic  for Patients 65 or Older syndromic surveillance  •UUse certified EHR  tifi d EHR data to public health  data to public health Technology to identify  agencies patient‐specific education  resources and provide to  patient as appropriate patient as appropriate • Medication reconciliation 10/27/2010 CGN & Associates Confidential 15
  • 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  Transmit Electronic  i l i Prescriptions Expected 2015  Report to External       Objectives Disease Registries Di R iti Real‐Time Patient         Upload Data from  Access to Records Home Monitoring  Medical Device  Medical Device Devices Interoperability Access Comprehensive  Patient Data from All  Patient Data from All Available Sources 10/27/2010 CGN & Associates Confidential 17
  • 18. Agenda 1. Overview and Highlights of EHR and  Meaningful Use Meaningful 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 Story 4 Use Case STRAC Tells Their Stor 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 CGN & Associates Confidential 18
  • 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 CGN & Associates Confidential 19
  • 20. Authentication Options User  Subject to  Ease of  Degree of  Method Expense Familiarity Compromise Unauthorized Use Repudiation Password High Very Low High Very High High Token  T k Intermediate I t di t Intermediate I t di t High Hi h Very High V Hi h High Hi h (Key Fob) Token  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 security user security – Large Storage Capacity on the Chip – Can be configured to require both pin code AND biometric  confirmation – Strong Encryption on the Chip g 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 Use Meaningful 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 Story 4 Use Case STRAC Tells Their Stor 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 CGN & Associates Confidential 22
  • 23. STRAC ‐ About Us Trauma Coordination for 22 countries in  Southwest Texas (includes San Antonio) Southwest Texas (includes San Antonio) 10/27/2010 CGN & Associates Confidential 23
  • 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 CGN & Associates Confidential 25
  • 26. STRAC Strategy – Multi use Useful every day – loss prevention  EHR Access Parking Lot Doctors Lounge Hospital after hours access Joint Commission Requirements 10/27/2010 CGN & Associates Confidential 26
  • 27. STRAC  Policy ‐ Tiers 10/27/2010 CGN & Associates Confidential 27
  • 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 CGN & Associates Confidential 28
  • 29. STRAC  Technical – One Card New Phase 2 Card: • FIPS201 Standard introduced • Added computer access control capabilities • Backward compatible with Version 1 capabilities  Backward compatible with Version 1 capabilities • Changed business process for enrollment 10/27/2010 CGN & Associates Confidential 29
  • 30. STRAC Technical ‐ Computer Access Emergency Room computers fitted with card reader for  Emergency 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 ERs Success led to rollout in other ERs 10/27/2010 CGN & Associates Confidential 30
  • 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 /  y p p Security Directors participate in  issuance plan development 10/27/2010 CGN & Associates Confidential 31
  • 32. STRAC ‐ Lessons Learned Everyday use very important y 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 CGN & Associates Confidential 32
  • 33. Agenda 1. Overview and Highlights of EHR and  Meaningful Use Meaningful 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 Story 4 Use Case STRAC Tells Their Stor 5. Navigating the Meaningful Use Journey 6. Q & A 10/27/2010 CGN & Associates Confidential 33
  • 34. Your Journey, and Managing the Change Process  The three most fundamental questions Where are we? Wh ? Where are we going? Wh i ? How are we going to get there? 10/27/2010 CGN & Associates Confidential 34
  • 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 process and on how well we manage the change process 10/27/2010 CGN & Associates Confidential 35
  • 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 Clinical and operational standardization  Cli i l d ti l t d di ti Changed processes, practices, roles, structure, relationships, culture, rewards Greater transparency, accountability, and performance‐based compensation p y, y, p p Dramatic improvements in patient safety, care, productivity, health outcomes Costs will be significantly reduced, to a globally competitive level  Shared information will accelerate shared knowledge & learning    This is certainly not about replacing paper files with electronic files  10/27/2010 CGN & Associates Confidential 36
  • 37. Principles of organizational change provide direction 1. How problems and goals are framed has significant impact on outcomes How problems and goals are framed has significant impact on outcomes EMR  or EHR or EHMS or Healthcare Transformation 2. Elements are interdependent; change requires a holistic approach.   Compliance or Continuous Innovation in Care 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.  g g g g y 5. Effective organizational change management greatly increases the likelihood of  successful change efforts 10/27/2010 CGN & Associates Confidential 37
  • 38. Executive  alignment & active support is essential  Full C‐ suite interest, active support &  commitment is needed to: build a shared vision build a shared vision shape the strategy for moving forward in  face of unknowns & turbulence    instill  a sense of urgency instill a sense of urgency from the core of a powerful coalition for  change identify and address organizational  identify and address organizational readiness issues provide necessary resources and support, remove roadblocks remove 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 CGN & Associates Confidential 38
  • 39. Program/project management provides structure Key Issues An effective program management unit: • Getting buy in of IT practitioners Getting buy‐in of IT practitioners Provides a governance process that  • Ensuring executive support through  guides the entire journey the multi‐year journey  Enables  a single view of  the  Enables a single view of the • Cultural impediments (reactive, silos) Cultural impediments (reactive, silos) corporate portfolio • Stepping up the pace  Drives improved quality and velocity  • Balancing quick wins with big picture of project execution and delivery of   business outcomes. • Sustaining ongoing communications S i i i i i Becomes a Center of Excellence for  • Adoption of common processes, tools  PM, BA  OCM disciplines: and standard metrics (esp in multi‐site)  • Integrated change management (day 1) I d h (d 1) Provides Executive Information and  Reporting structure and Dashboards • Continuous improvement post go‐live 10/27/2010 CGN & Associates Confidential 39
  • 40. Involvement, communications, training enables systemic change • Job specific skills Job‐specific skills • Applications, tools, process/ work flow training • Org integration, relationship changes  • Continuous improvement & reinforcement High • Cross‐functional design teams  g • Process & workflow  design • Job role , org, other changes • Systems development  • Pilots , hands‐on trials, refinemt Level of Acceptance • Clear future state picture   oductivity • See around the corner • Individual impacts & change process;  taking ownership • Build critical mass & momentum and Pro • Convey Mgmt Expectations • Overall Vision & Goals • Imperatives for change   • How staff can  engage • WIIFM WIIFM  Low Project/Change Timeline 10/27/2010 CGN & Associates Confidential 40
  • 41. Agenda 1. Overview and Highlights of EHR and  Meaningful Use Meaningful 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 Story 4 Use Case STRAC Tells Their Stor 5. Navigating the Meaningful Use Journey 6. Q&A 10/27/2010 CGN & Associates Confidential 41
  • 42. Agenda 1. Overview and Highlights of EHR and  Meaningful Use Meaningful 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 Story 4 Use Case STRAC Tells Their Stor 5. Cultural and Organizational  Transformation 6. Q & A 10/27/2010 CGN & Associates Confidential 42
  • 43. Transformation to EHR Questions Answers 10/27/2010 CGN & Associates Confidential 43
  • 44. Thank you! Contact Information: Mark Bidlake,  Eric Epley, Executive Director  Associate Partner STRAC – Southwest Texas Regional CGN & Associates Advisory Council for Trauma Two Mid America Plaza, Suite 915 7500 Hwy. 90 West , Oakbrook Terrace, IL AT&T Building, Suite 200 g, 630/368‐7810  San Antonio, TX  78227 ext:5002 210/822‐3888  mbidlake@cgn.net eric@strac.org  10/27/2010 CGN & Associates Confidential 44