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GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
GhA Ceo Webinar 12 2009 Final
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GhA Ceo Webinar 12 2009 Final


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Presentation on preparing for Meaningful Use of EHRs.

Presentation on preparing for Meaningful Use of EHRs.

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  • Quality measures are actually quite complicated and include:Inclusion criteria - define what patients to include in the population for this condition.Exclusion criteria - define which patients should be excluded from this particular measureOutcome - is what tells us if the recommended care happened—e.g. did the patient receive beta-blocker within 24 hr of arrival at the hospital?Most of the data elements for complex quality measures like core measures are for exclusion criteria. This is the price we pay for clinical appropriateness. In the case of this measure………Note that there are a number of different sources to check for this information. Also there are more sources than data elements because some have multiple possible sources.
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    • 1. Helping Georgia Hospitals Prepare for Meaningful Use and Improved Quality
      Kent Giles, MPPMEric Bartholet
      December 9, 2009
    • 2. Agenda
      Welcome and Introductions
      Review Meaningful Use Requirements
      Review “where we are” in GHA Facilities
      Keys to Success
    • 3. Introductions
      Kent Giles, MPPM, Partner, CSC Healthcare
      25 years of Hospital Administration, Physician Practice, Payor and Consulting
      GHA Account Partner and Advisor to C-Level Executives across the SE US
      Subject Matter expertise in strategy, planning, IT and Margin/Operations Improvement
      Eric Bartholet, Partner, CSC Healthcare
      IT Strategy & Planning
      Over 25 years working with healthcare systems
      Subject Matter Expertise in It Strategy, Systems Implementation and Architecture
    • 4. Adoption of Clinical IT in Hospitals is Low and Even Lower Among Physicians
      Transforming the health system will require hospitals and physicians to dramatically increase their use of HIT
      The latest data from HIMSS Analytics suggests that just over 40 percent of hospitals have basic clinical (nursing) documentation but less than2 percent have physician documentation(HIMSS Analytics, 2009)
      The level of current EMR adoption will be a major factor in how much investment will be necessary to satisfy the Meaningful Use requirements
    • 5. EHR Meaningful Use Timetable
      Meaningful Use and HIT-Enabled Health Reform Targets
      The “meaningful use” criteria to be phased in, with the criteria building from year to year.
      HIT-Enabled Health Reform
      Capture & Share Data
      Advanced Care Processes with Clinical Decision Support
      Improved Outcomes
      Source: Meaningful Use Work Group Presentation at the HIT Policy Committee Meeting on June 16, 2009
    • 6. EHR Meaningful Use Timetable
      Example of Estimated Incentive Payment Schedule
      • Payments are made over four years
      • 7. Payments start based on when you achieve the Meaningful Use requirements
      • 8. Compression of incentive payments begins if you don’t achieve Meaningful Use by 2013
      • 9. Penalties begin in 2015 and are perpetual
    • EHR Meaningful Use Requirements Summary
      This is a case study from a CSC assessment. The following charts are intended to identify areas where effort and investment may be required:
      Well positioned to meet Meaningful Use criteria
      Effort may be required
      There is no active project to meet the requirements
    • 10. EHR Meaningful Use Requirements Summary
    • 11. EHR Meaningful Use Requirements Summary
    • 12. What CEO’s Want to Know
      Meaningful Use
      Can my application vendor make my hospital ARRA compliant?
      Can we just accept the penalties and not achieve meaningful use?
      Isn’t this an issue that I should delegate to my CIO?
      4. How do we achieve MU and keep our medical staff and clinicians happy?
      What is the financial impact on my organization?
      What are the major CEO risks that I face?
    • 13. HITECH Framework
      HITECH Scorecard: Results Of 17 GHA Hospitals
      Overall readiness can be determined by totaling the scores of all the categories, 80 is “likely to achieve MU”. To have a good probability of readiness, a hospital needs to score 80 percent or better in a given category.
      Dimensions of Healthcare Delivery
    • 14. MU is an operational and clinical issue rather than an IT issue.
      Clinical Documentation and Quality Reporting
      1. INCLUSION
      3. EXCLUSION
      2. OUTCOME
      • Principal dx of AMI-6
      • 15. HF on arrival/within 24 hr
      • 16. Shock on arrival/within 24 hr
      • 17. Bradycardia day of/before disc
      • 18. Heart transplant during stay
      • 19. LVAD during hospital stay
      • 20. Patient has pacemaker
      • 21. 2nd or 3rd degree block on ECG
      • 22. Allergy to beta blocker
      • 23. Other contraindication to beta blocker
      • 24. Arrival date/time
      • 25. Beta blocker administered (date/time)
      • 26. Birth date
      • 27. Admission date
      • 28. Discharge date
      • 29. Transfer from hospital/ED
      • 30. Transfer out soon after arr.
      • 31. Receiving CMO only
      • 32. Involved in clinical trial
      • 33. Discharged to hospice
      • 34. Expired
      • 35. Left against medical advice
      Acute myocardial infarction (AMI) patients without beta-blocker contraindications who received a beta blocker within 24 hr after hospital arrival
      (4 data elements)
      (6 data elements
      (7 data elements)
      RNDOCUMENTATION(1 data element)
      (8 data elements)
      (3 data elements)
    • 36. Achieving “Meaningful Use” with Accelerated Project PlanOrganizations who address clinical change management and provide disciplined implementation management achieve sustainable results.
      Success = Right Product x Right Implementation x Right Clinical Adoption
      Short Term Success (Good, Bad)
      Milestones Met
      Low Customer Satisfaction
      Organizational Readiness is Low
      Project Success with Long Term Sustainability (Good, Good)
      • Milestones Met
      • 37. High level of user satisfaction
      • 38. Expectations are fulfilled
      • 39. MU Achieved
      Implementation Management
      Strong Commitment with Limited Success (Bad, Good)
      • Users are committed to ideas/excited
      • 40. Project milestones not met
      • 41. Expectations unfulfilled
      • 42. MU achievement unlikely
      Limited Success (Bad, Bad)
      • Milestones not Met
      • 43. No Project Rigor
      • 44. Low User Satisfaction
      • 45. Non-achievement
      Clinical Change Management
    • 46. ARRA Costs vs. Incentives (350 bed facility w. limited CIS)
      ARRA costs (capital vs operating)
      Capital: $ 2.75 million
      License and Installation – $1,550,000
      Project Management - $450,000
      Training - $150,000
      Clinical Adoption - $450,000
      Order Sets (250), Reports (50), Interfaces - $150,000
      Operating: $3.24 million / year
      Hosting and Application Management - $850,000/year
      Help Desk - $90,000
      Additional FTEs in IT, Departments- $1,500,000/year
      Back Up and Recovery - $ 800,000
      ARRA Revenues
      Incentive Payments of $6,200,000
      Impact Analysis
      Initial need to fund $2,750,000 with cash or financing
      Additional Operating Budget of $3.24 million / ongoing
      $3,670,000 in annual penalties if MU not achieved
    • 47. Recommendations for Hospitals and Participating Providers
      Educate - Your Leadership
      Understand the regulations, rewards, risks and costs. Proforma incentives and ongoing deductions.
      Form - Steering Committee Chaired by a C-Level Executive (CEO preferred)
      MU is a major impact on clinical, business office, IT and medical staff
      Include key clinical, IT, operational and financial leaders (Big Team)
      Maximize quality improvement, patient safety and cost reduction opportunities
      Reduce the number of initiatives across the Hospital to provide focus on MU
      Assess - Current State Assessment w. Road Map (GHA offers one)
      Determine where you are currently using HITECH Framework
      Develop overall timelines, major milestones, operational and capital budget
      Develop measures and accountabilities with responsible parties
      Implement – CIS and Revise Clinical Processes and Work Flow
      System Selection based upon criteria not vendor demos
      Build a detailed project plan with PMO
      Be honest about your internal capabilities and needs
      Engage partners (application vendor (s), consulting resources, internal hires)
      Focus on clinical adoption and implementation in a combined methodology with PMO
      Focus on best practices and maximize opportunities for improvement
      Improve – Improve Performance
      Receive Stimulus Dollars
      Constant improvement of quality, service and process improvement / cost reduction
    • 48. Elements of Meaningful Use of EHRs
      Meaningful Use
    • 49. Q & A
    • 50. Questions or Comments?Thank you!
      Kent Giles, MPPM