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EHR
Moving Forward Toward Implementation andg p
Meeting Meaningful Use
October 2010
10/27/2010 1CGN & Associates Confidential
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
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
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
Housekeeping 
Have a question during the webinar? 
PollingPolling
Replay
10/27/2010 5CGN & Associates Confidential
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
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
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
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
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
Why start now? – Operational Benefits
Patient
Security Interoperability
Patient 
Outcomes
Operational Benefits
10/27/2010 CGN & Associates Confidential 11
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
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)
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
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
For more information
Nancy Draper
CGN & Associates  ndraper@cgn.net
309-472-4473
10/27/2010 CGN & Associates Confidential 16
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
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
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
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
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
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
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
STRAC – Successful Security for EHR
10/27/2010 CGN & Associates Confidential 24
STRAC Strategy – Start with Existing Infrastructure
Existing  cards used for securing emergency rooms 
(Physical Access Control ‐ PAC)
10/27/2010 25CGN & Associates Confidential
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
STRAC  Policy ‐ Tiers
10/27/2010 27CGN & Associates Confidential
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
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
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
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
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
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
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
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
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
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
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
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
• 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
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
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
Transformation to EHR
Questions
Answers
10/27/2010 43CGN & Associates Confidential
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

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