CoArtha Technolsolutions IT for Meaningful Use


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  • CoArtha TechnoSolutions , is an end-to-end Healthcare IT, Product Development company. We provide healthcare solutions to Providers/Payers to Automate Practice & Clinical Management, Interoperability HIE and Clinical Labs, Portals & User Experience for customers, Outsourced Product Development for Healthcare ISVs, Remote Infrastructure Management and Revenue Cycle Management solutions for Providers. We offer one of the most cost effective and comprehensive outsourcing solutions to healthcare professionals available.   Keywords: EHR, HIT, HIE, ARRA, HL7, Interoperability, OPD, Healthcare, RCM, Revenue Cycle Management
  • Takeaways from the slide:
  • How to Use this Flow Chart: A Medicaid eligible professional may also be eligible for the Medicare incentive and should follow the path of answering no to the question of Medicaid patient volume to determine Medicare eligibility. An eligible professional who qualifies for both programs may only participate in one program. Eligible Professionals eligible to receive EHR incentive payments under Medicare or Medicaid will maximize their payments by choosing the Medicaid EHR Incentive Program.
  • What are Clinical Quality Measures? Essentially, the measure of the care you’re providing to your patients based on administrative or medical record data Once benchmark data is gathered, analyzing this data will allows government and the industry to identify patterns in diagnosis & treatment related to geography, insurance coverage, race, language and other segmentation Effective, Safe, Timely Care, Patient-Centered Can attest that almost any of the metrics are irrelevant to your practice to remove it from the list and reduce the number of metrics you must report on Can be dummy data but cannot be simulated tests
  • Include approximate timelines Project plan to come up with the people involvement at different stages of implementation Step 1: Build the Case for Change Rapidly builds motivation for EHR adoption in even the most skeptical staff member Addresses the major concerns staff members have about EHR adoption so these concerns don’t derail your project later Overcomes complacency and gets staff members to willingly contribute the extra time, effort and energy needed for a smooth and rapid transition Builds urgency for EHR adoption in practice leaders — partners, physicians, practice managers who may not all appreciate the need for an EHR Step 2: Identify the Guiding Team Identifies the right staff members to take the lead in the practice’s transition to Meaningful Use Effectively delegates project responsibilities, so you can focus on patient care Defines communication and decision-making strategies to avoid the miscommunications and misunderstandings that often delay EHR projects and lead to costly mistakes Step 3: Motivate with Inspiring Goals Defines Meaningful Use objectives for the practice & target dates by which to achieve them Sets specific goals for: Improved practice bottom-line performance Enhanced patient care & satisfaction Reduced administrative burdens and improved quality of practice life Step 4: Promote Staff Collaboration Gets staff members involved in implementation & Meaningful Use. By fully engaging staff members in EHR adoption, you can significantly reduce the costs of your implementation Identifies bottlenecks, inefficiencies and sources of productivity slowdowns that can be reduced or eliminated through effective EHR use Delineates the system configuration, peripherals, interfaces (incoming & outgoing), and EHR components your practice needs to achieve the Meaningful Use objectives defined in Step 3 Identifies potential implementation problems before they can cause real damage Ensures successful workflow design Step 5: Translate Plans into Action Identifies the strategies your practice will use for: Migrating patient data into the EHR Data entry Clinical documentation Managing incoming documents that cannot be directly imported into the EHR Provides a system for maintaining accountability, so staff members and vendor implementation teams do what they need to do, when they need to do it, to keep your EHR transition on track Identifies the specific training each staff member should have to build the proficiency needed for Meaningful Use — saving time and money on unnecessary and repetitive training Step 6: Build Confidence Identifies intermediate objectives that build momentum toward Meaningful Use Provides a tracking mechanism, so all staff members can see the progress of the transition Step 7: Achieve & Sustain Meaningful Use Provides a mechanism to track your practice’s progress to meeting Meaningful Use goals in the areas of: core objectives menu objectives clinical quality measures Assists you and your practice staff with registering and attesting for the incentive payments you are eligible to receive Provides you with updates on Meaningful Use guidelines and requirements, so you don’t have to worry about missing changes in deadlines and reporting requirements
  • - Web-based systems. - ASP with local thin-client: central data center serving multiple hospitals; a combination of onsite and vendor- hosted storage; corporate data centers; local data exported daily to a larger [storage] site; and a remote storage owned by the organization. But for many physicians in small offices, the cost advantages are not enough to overcome concerns regarding the security of their patients’ personal health data when stored off-site. Indeed, this group shows a higher percentage of records stored onsite when compared to hospitals.
  • The Meaningful Use cost has been segregated into the three categories and the above slide depicts the costs for single provider and the benefits to understand the ROI Year-over-Year and Five year total. Product cost Implementation cost Provider cost Salient points: Provider has choice to take Meaningful use either this year by June or next year by June (to provide necessary time to get the process approved) Overall implementation would take about 2 months and following to it there will be 90 day attestation process (no breaks) Provider can bet for break even ROI in a single year of implementation if he/she plans right Scenarios: Doctors with EMR (for & not for MU), Doctors with no EMR – HIE integration, Integrations with Labs Factors affect timelines Solution: Configuration of EHR, EHR finalization, Which HIE to use? Integration Remote / Onsite, Differentiators slide
  • Shivaji Mukthavaram, Technology, Business Expert & PMP Haricharan Juvvadi – Healthcare Expert
  • CoArtha Technolsolutions IT for Meaningful Use

    1. 1. Shivaji Mukthavaram, CEO Email:
    2. 2. <ul><li>Healthcare: Our Domain Focus </li></ul><ul><li>CoArtha Service Offerings </li></ul><ul><li>Offerings Details </li></ul><ul><ul><li>Healthcare IT (HIT) </li></ul></ul><ul><ul><li>Healthcare Portals </li></ul></ul><ul><ul><li>Outsourced Product Development (OPD) </li></ul></ul><ul><ul><li>Remote Infrastructure Management (RIM) </li></ul></ul><ul><li> CoArtha Technosolutions is </li></ul><ul><li> HL7 Organizational Member </li></ul>
    3. 3. <ul><li>Physicians group count (Internal medicine, Family Practice, Pediatrics, OBGYN, Anesthesiology which is covering 52% of the doctors) </li></ul><ul><li>Healthcare source of revenue (FOCUS on Medicare, Medicaid, Private Insurance) </li></ul><ul><li>Physicians density (>240 physician density states with least operational expenses) </li></ul><ul><li>Based on the Insurance coverage across the nation </li></ul><ul><ul><li>Source: US Census Bureau, Service Annual Survey 2007 </li></ul></ul>
    4. 4. <ul><li>Business Entity </li></ul><ul><li>Conceptualized in 2010 </li></ul><ul><li>Execution Bandwidth </li></ul><ul><ul><li>15yrs outsourcing experience </li></ul></ul><ul><ul><li>End2End Business Execution ($20 Mn/year) </li></ul></ul><ul><ul><li>Operations rigor, Real-time visibility & execution transparency a way-of-life </li></ul></ul><ul><ul><li>Unflinching customer orientation </li></ul></ul><ul><li>Team Profile </li></ul><ul><li>Domain experience 2 to 7 yrs </li></ul><ul><li>Managed team sizes (80 to 250) </li></ul><ul><li>Strong results orientation </li></ul><ul><li>Excellent communication skills </li></ul><ul><li>Team size (10 Now, 50 – Dec’11) </li></ul><ul><li>Vision: Geared to Deliver </li></ul><ul><li>Your benefit is our achievement </li></ul><ul><ul><li>IT for Meaningful use </li></ul></ul><ul><ul><li>Reduced Cycle time at a fraction of cost </li></ul></ul><ul><ul><li>Infrastructure Availability & Scalability </li></ul></ul><ul><ul><li>Reduced AR days </li></ul></ul><ul><li>Hard Infrastructure </li></ul><ul><li>Internet bandwidths (2 – 3 Mbps) </li></ul><ul><li>Power back up, Disaster Recovery </li></ul><ul><li>HIPPA standard access privileges </li></ul>
    5. 5. Provider End Customer ISV
    6. 6. Meaningful Use: The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use: 1. The use of a certified EHR in a meaningful manner, such as e-prescribing. 2. The use of certified EHR technology for electronic exchange of health information to improve quality of health care. 3. The use of certified EHR technology to submit clinical quality and other measures.
    7. 8. * Hospital-based professionals excluded from incentives Eligible Providers - Medicare Eligible Providers - Medicaid Eligible Professionals (EPs)* Eligible Professionals (EPs) Doctor of Medicine or Osteopathy Physicians (Pediatricians have special eligibility & payment rules) Doctor of Dental Surgery or Dental Medicine Nurse Practitioners (NPs) Doctor of Podiatric Medicine Certified Nurse-Midwives (CNMs) Doctor of Optometry Dentists Chiropractor Physician Assistants (PAs) who lead a FQHC)or rural health clinic Eligible Hospitals* Eligible Hospitals Acute Care Hospitals Acute Care Hospitals, Critical Access Hospitals Critical Access Hospitals (CAHs) Children’s Hospitals
    8. 12. <ul><li>Two required components under HITECH statute </li></ul><ul><ul><li>EHR Functional (operational) metrics </li></ul></ul><ul><ul><ul><li>15 Core measures (Required of everyone) </li></ul></ul></ul><ul><ul><ul><li>10 Menu Set measures (You choose five that best fit within your practice) </li></ul></ul></ul><ul><ul><li>Clinical Quality Metrics (CQM) </li></ul></ul><ul><ul><ul><li>Eligible professionals must report on 6 total CQMs: </li></ul></ul></ul><ul><ul><ul><ul><li>3 required core measures (substituting alternate core measures where necessary) and 3 additional measures (selected from a set of 38 clinical quality measures). </li></ul></ul></ul></ul><ul><ul><ul><li>Eligible hospitals and CAHs must report on all 15 of their CQMs. </li></ul></ul></ul>Measures of EHR Use: Interoperability Tests Electronic data exchange with provider not in the same organization 1 Test Submission of reportable lab data to PHD* 1 Test Submission of immunization reports to PHD 1 Test Submission of syndromic surveillance to PHD 1 Test
    9. 13. Summary of Stage 1 Meaningful Use Objectives and Measures for Eligible Professionals (July 13, 2010) Core Objectives (All must be satisfied) Functional Requirements Objective / Condition 1. Computerized Physician Order Entry (CPOE) • At least one medication ordered via CPOE for >30 percent of unique patients seen with at least one medication on current medication list 2. Drug-drug, Drug-Allergy Checking • CPOE drug-drug and drug-allergy checking features are enabled 3. Generate and Transmit Electronic Prescriptions • >40 percent of all permissible medication orders (excluding controlled substance orders) are electronically prescribed 4. Maintain up-to-date Problem/Diagnosis List • For >80 percent of unique patients seen (at least one structured entry, ICD-9-CM or SNOMED CT) 5. Maintain Active Medication List • For >80 percent of unique patients seen (at least one structured entry) 6. Maintain Active Medication Allergy List • For >80 percent of unique patients seen (at least one structured entry) 7. Record Vital Signs • For >50 percent of unique patients ≥ 2 years old seen, record and chart changes in vital signs (as structured data): – Height, weight, blood pressure – Calculate and display BMI – Plot and display growth chart, including BMI (patients 2-20 years old) 8. Record Demographics • For >50 percent of unique patients seen, record demographics (as structured data): – Gender – Ethnicity, race (federal guidelines), preferred language – Date of birth 9. Record Smoking Status • For >50 percent of unique patients seen ≥ 13 years old 10.Report Quality Measures to CMS and the States • Report ambulatory quality measures — per data captured and calculated by the EHR — to CMS or the states for specified core and specialty measures – For 2011: attest to accuracy and completeness of aggregate numerator and denominator – For 2012 (and beyond): submit (at least one measure) electronically 11. Implement Clinical Decision Support • Implement one rule (with high clinical priority for or relevant to the specialty of the EP) and track compliance Health Information Exchange (HIE) Requirements Objective / Condition 12. Provide Patients with Clinical Summary of Office Visits • Satisfy more than 50 percent of requests for a clinical summary of an office visit (via Personal Health Record (PHR), portal, other electronic media, or printed output) within 3 business days 13. Provide Patient with Electronic Copies of Health Information • Provide >50 percent of patients who request copies with electronic copies of their health information (lab test results, problem, medication, allergy lists) within 3 business days 14. Implement Capability to Exchange Key Clinical Information • Perform at least one test of the capability of the certified EHR system used by the EP to electronically exchange key clinical information (for example, problem list, med list, allergies, test results) with another EHR (not shared) HITECH Privacy And Security Objective / Condition 15. Implement Systems to Protect Patient Data • Conduct or update a security risk assessment per 45 CFR 164.308 (a)(1) and implement security updates as necessary
    10. 14. Summary of Stage 1 Meaningful Use Objectives and Measures for Eligible Professionals (July 13, 2010) Menu Set Objectives (5 Must Be Satisfied) Functional Requirements Objective / Condition 1. Incorporate Test Results into EHR • Incorporate clinical laboratory test results into EHR as structured data for >40 percent of all clinical lab tests ordered with positive/negative or numeric results 2. Medication Reconciliation • Performed at >50 percent of relevant encounters and transitions of care 3. Drug Formulary Checking • Drug-formulary check functionality is enabled (with access to at least one internal or external formulary for entire period) 4. Generate Patient Lists • Generate at least one list of the EP’s patients with a specific condition to use for quality improvement, reduction of disparities, and/or outreach Health Information Exchange (HIE) Requirements Objective / Condition 5. HIE: Patients • Provide >10 percent of unique patients seen with electronic access (available on-demand at any time) to their health information (lab test results, problem, medication, allergy lists) within 4 business days of the information’s availability to the EP 6. Patient Follow-up/Preventive Care Reminders • Send reminders for preventive/follow-up care (per patient preference) to >20 percent of patients who are ≥65 or <5 years old 7. HIE: External Providers • Provide summary care record (via electronic exchange, secure portal, secure e-mail, CD, USB drive or printed copy) for >50 percent of patient transitions of care and referrals 8. HIE: Immunization Registries • Perform at least one test of the capability to submit electronic data to immunization registries • Actual submission where required and accepted 9. HIE: Syndromic Surveillance Data • Perform at least one test of the capability to provide electronic surveillance data to public health agencies • Actual transmission according to applicable law and practice 10. Identify Patient-Specific Educational Resources • Use EHR technology to identify and provide >10 percent of unique patients seen with patient-specific educational resources
    11. 15. <ul><li>We will work with you throughout the process </li></ul><ul><ul><li>Meaningful use Registration (Provider or 3 rd Party on behalf of Provider) </li></ul></ul><ul><ul><li>Stage 1: 90 day continuous Meaningful use first year </li></ul></ul><ul><ul><ul><li>Use the system at least for a month before the 90 day continuous usage </li></ul></ul></ul><ul><ul><li>Stage 2: 1 year subsequent Meaningful use </li></ul></ul>
    12. 16. <ul><li>What if I already use an EHR? </li></ul><ul><ul><li>Ensure your EHR Vendor guarantees ARRA Certification! </li></ul></ul><ul><ul><li>Assess the Meaningful Use Gap: Criteria vs. Current use </li></ul></ul><ul><ul><li>Utilize ePrescribing functionality </li></ul></ul><ul><ul><li>Be specific—use the data fields—no data, no queries </li></ul></ul><ul><li>What if I’m “in the process”? </li></ul><ul><ul><li>Captain your ship: encourage all to row the same direction </li></ul></ul><ul><ul><li>Current paper records: scan to import into new system </li></ul></ul><ul><ul><li>Inform all third party businesses of your transformation </li></ul></ul><ul><li>Can I stop and restart participation? </li></ul><ul><ul><li>Under Medicare, if you skip a year, you will return to a later payment year </li></ul></ul><ul><ul><ul><li>E.g., skipping second year would mean forfeiting $12,000 </li></ul></ul></ul><ul><ul><li>Under Medicaid, you can pass on a year of proving Meaningful </li></ul></ul><ul><ul><ul><li>Use and return as if you didn’t skip </li></ul></ul></ul><ul><li>Can I reassign incentive payments? </li></ul><ul><ul><li>Yes - to your employer or an entity with which you have a valid employment agreement </li></ul></ul><ul><ul><ul><li>Reassignment to only one entity will be allowed </li></ul></ul></ul><ul><ul><li>Nothing precludes reassignment of only the allowable charges for professional services to the employer/entity but not the incentive payment, or vice versa </li></ul></ul><ul><ul><ul><li>Dependent on the details of the contract </li></ul></ul></ul>
    13. 17. <ul><li>How will they decide if I’m a Hospital-based physician and thus excluded? </li></ul><ul><ul><li>Congress acted in April of this year to clarify that only inpatient activities are excluded from “allowable charges” If you work in a practice closely affiliated with a hospital but deliver outpatient care, you are now eligible However, if you spend time in the hospital or ED, the hospital based definition still matters </li></ul></ul><ul><li>What kind of Flexibility does MU have on the required measures? </li></ul><ul><ul><li>If a core measure cannot be met, attest to an acceptable reason for its “exclusion,” and your total number of required measures is reduced: you do not have to substitute another ! </li></ul></ul><ul><ul><ul><li>Example: What if the majority of your patients live in rural areas with no access to a Pharmacy that accepts eRx – you cannot meet the threshold </li></ul></ul></ul><ul><ul><ul><li>Simply attest to that reason and your number of 20 Stage 1 requirements is now lowered to 19. </li></ul></ul></ul><ul><li>Can I collect HITECH </li></ul><ul><li>incentives & others? </li></ul>
    14. 20. <ul><li>Differentiators </li></ul><ul><ul><li>Focused on healthcare domain only with end-to-end offerings (Healthcare IT, Product Development, Web portals development, RCM, MT, etc.) </li></ul></ul><ul><ul><li>Extensive number of years (more than a decade) in serving the Healthcare providers </li></ul></ul><ul><ul><li>Deep healthcare/application knowledge and bench strength </li></ul></ul><ul><ul><li>Excellent technical resources </li></ul></ul><ul><ul><li>Good exposure in terms of meaningful use </li></ul></ul><ul><ul><li>Last but not least… Economical cost, Global Delivery, Meaningful Use result-based charges (70-30 model) *** Offer applies to HITECH Act Medicare reimbursement payments only </li></ul></ul><ul><li>Benefits of working with our team: </li></ul><ul><ul><li>System Selection - research and recommend the best certified system for your needs </li></ul></ul><ul><ul><li>Overall Strategy - provide you with a road map for attaining Meaningful Use </li></ul></ul><ul><ul><li>Project Planning - establish tasks and reasonable timelines for your Meaningful Use strategies </li></ul></ul><ul><ul><li>Project Management - assurance that targets are met to get you one step closer to your incentive payment </li></ul></ul><ul><ul><ul><li>Development of Gap Analysis - assessing each of the Meaningful Use criteria </li></ul></ul></ul><ul><ul><ul><li>Recommended Action Plan - relative to each relevant Meaningful Use criteria </li></ul></ul></ul><ul><ul><li>Address Technology/Interoperability with other systems and operational practices </li></ul></ul><ul><ul><li>Vendor Management - work as a liason between your organization and your / our vendor of choice </li></ul></ul>
    15. 21. <ul><li>Incentives are based on demonstrating Meaningful Use of the system, which goes beyond the EMR Product implementation </li></ul><ul><ul><li>Capture the Data </li></ul></ul><ul><ul><li>Establish Effective Workflows to Reinforce Data Entry (Including Medication Reconciliation) </li></ul></ul><ul><ul><li>Drive Provider Involvement in Adoption of the EHR </li></ul></ul><ul><ul><li>Computer-Based Provider Order Entry (CPOE) </li></ul></ul><ul><ul><li>Start E-Prescribing — as Soon as Possible </li></ul></ul><ul><ul><li>Develop a Process for Managing Clinical Decision Support (CDS) </li></ul></ul><ul><ul><li>Implement Patient Health Information Exchange Workflows </li></ul></ul><ul><ul><li>Formulate a Provider Health Information Exchange Strategy </li></ul></ul><ul><ul><li>Ensure Privacy and Security Compliance </li></ul></ul><ul><ul><li>Initiate EHR-Based Quality Performance Measurement Support </li></ul></ul><ul><li>Our holistic view (Stage 1 interoperability, Stage 2, HIE, Clinical Decision support, and potential subsequent stages 3 and beyond). </li></ul>
    16. 22. Assessment <ul><li>Practice Assessments: </li></ul><ul><li>Practice Readiness Assessment, Office Staff Survey, Computer Knowledge Evaluation </li></ul><ul><li>2. Hold regular staff meetings and create the project team </li></ul>Planning <ul><li>Review practice data: </li></ul><ul><li>Migrating patient data into the EHR </li></ul><ul><li>Data entry </li></ul><ul><li>Clinical documentation </li></ul><ul><li>Managing incoming documents that cannot be directly imported into the EHR </li></ul><ul><li>2, identify and target improvement opportunities 3. Define EHR implementation goals </li></ul><ul><li>4. Prepare practice for change 5. Utilize project tools and optimize shared learning </li></ul>Selection 1. Understand and renew available EHR solutions, 2. Define EHR system requirements 3. Begin to prepare staff and office for an EHR system 4. Select EHR system, solution and vendor 5. Prepare practice for change 6. Utilize project tools and optimize shared learning Implementation 1. Create EHR system implementation plan and timetable 2. Install and configure hardware 3. Install and configure EHR system 4. Prepare staff and office for EHR 5. Complete pre implementation baseline evaluation 6. Journal experience 7. Go-live with EHR system 8. Utilize project tools and optimize shared learning Perform 1. Conduct post go live reviews of implementation 2. Conduct post go live . EHR staff training 3. Journal experience 4. Complete post-implementation evaluation 5. Utilize project tools and optimize shared learning Attest & Payment 1. Review EHR implementation impact analysis, 2. Utilize EHR to practice evidence based medicine 3. Identify and target additional care management and process improvement opportunities 4. Utilize project tools and optimize shared learning 5. Attestation health check and incentives
    17. 23. <ul><li>EMR solution modules, features, price, support, interoperability, Certification </li></ul><ul><li>Clinical workflow – does software accommodates your practice style? </li></ul><ul><li>Practice to EMR fitment </li></ul><ul><ul><li>Document Templates, Codes, etc. </li></ul></ul><ul><li>Deployment models: </li></ul><ul><ul><li>On-Premise, Web based, Remote server models </li></ul></ul><ul><ul><li>Data storage, User experience, Connectivity, CAPEX </li></ul></ul>
    18. 25. <ul><li>Computer skills survey and training </li></ul><ul><li>Organizational Readiness Assessment </li></ul><ul><li>Meaningful Use training </li></ul><ul><li>Security Risk Analysis </li></ul>
    19. 26. Complete EHR Implementation in < 2 months Costs vs. Payments by the Calendar Year
    20. 27. Service Offering EHR / OPD Portal RIM Web Development C#, ASP.NET, .NET Framework 3.0/3.5, PHP Java, Servlets, Web Services User Experience : AJAX, JavaScript, CSS, HTML, XML, Flash, Action Script, JSON, JQuery Windows & Linux, Nagios, Microsoft Exchange, IIS, SMTP, Netorking, Appache, Tomcat, etc. Databases / Data Migration SQL Server 2005/2008, Oracle 10g/ 11g, MySQL Other Technologies HL7 2.x/3.0, CDA SCRUM Agile Project Management
    21. 28. <ul><li>It is our pleasure to help you!! </li></ul><ul><li>Shivaji Mukthavaram, CEO </li></ul><ul><ul><li>Email: [email_address] </li></ul></ul><ul><li>Haricharan Juvvadi, VP – Operations </li></ul><ul><ul><li>Email: [email_address] </li></ul></ul> CoArtha Technosolutions Pvt. Ltd. Hyderabad, India