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Regional Extension Centers, EHRs & Meaningful Use  Dominic H. Mack MD,MBA Project Director GA-HITREC Deputy Director National Center for Primary Care Morehouse School of Medicine [email_address] .
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EHR Implementation Remains Limited Among Physicians DesRoches, C., et al, “Electronic Health Records in Ambulatory Care - A National Survey of Physicians” New England Journal of Medicine, 2008;359:50-60. (http://www.nejm.org/doi/pdf/10.1056/NEJMsa0802005) A 2008 national survey of 2,758 physicians found positive effects of EHR systems on quality of care and satisfaction
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],HIPAA 5010 Overview Confidential property of Unitedhealth Group.  Do not distribute or reproduce without express permission of Unitedhealth Group.Confidential property of UnitedHealth Group.  Do not distribute or reproduce without express permission of UnitedHealth Group.
Example ICD-9 to ICD-10 changes Confidential property of Unitedhealth Group.  Do not distribute or reproduce without express permission of Unitedhealth Group. More than just a crosswalk ICD-9 ICD-10 14,000 Diagnosis Codes 4,000 Procedure Codes 68,000 Diagnosis Codes 87,000 Procedure Codes Angioplasty (procedure codes) 1  code 39.50 Angioplasty (procedure codes) 854  different   codes 047K047 Specifying body part, approach and device Pressure Ulcer Codes (diagnosis codes) 7  codes  707.00-707.99 Show location, but not depth Pressure Ulcer Codes (diagnosis codes) 125  different codes L89.131 Specific location, depth, severity, occurrence ,[object Object],[object Object],[object Object],Y71.3  Surgical instruments, materials and cardiovascular devices associated with adverse incidents Autopsy 89.8 No ICD 10 code
HITECH: Catalyst for Transformation  Pre 2009 2009 2014 A system plagued by inefficiencies EHR Incentive Program and 62 Regional Extension Centers Widespread adoption & meaningful use of EHRs
Office of the National Coordinator (ONC) Big Picture Goal … ,[object Object],[object Object],[object Object],[object Object],Paper-Based Practice Support Network REC-Provider Partnership Fully Functional EHR Education and Outreach • Workforce • Vendor Relations •  Implementation •  Workflow Redesign •  Functional Interoperability •  Privacy and Security •  Meaningful Use Population Health Health Care Efficiency Patient Health Outcomes
O ffice   of  the  N ational   C oordination: Organization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Office of Provider Adoption Support (OPAS) Goal: Assist  All Providers  to Achieve Meaningful Use of EHR Systems Community College Consortium Provider Adoption Services Provider Adoption Services Meaningful Use Regional Extension Centers (RECs)  Health Information Technology Research Center (HITRC)
REC Focus:  Priority Primary Care Providers ,[object Object],[object Object],[object Object],[object Object],[object Object]
62 RECs Cover 100% of the USA ,[object Object],[object Object],[object Object],[object Object],[object Object],Goal: 100,000 priority primary care providers achieve meaningful use (MU) by 2012
GA-HITREC (GA HIT Regional Extension Center) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
National Center for Primary Care, Morehouse School of Medicine Community Oriented Technology Pyramid of Providers
NCPC/MSM Partners GA DCH Office of Health Information Technology and Transparency GA  State Medical Association GA  Academy of Family Physicians GA Partnership for Telehealth Hometown Health GA Institute of Technology Southern Polytechnic GA Association for Primary Health Care GA-HIE Andrew Young School of Policy Studies GA Hospital Association GA State Office of Rural Health CHW GMCF (QIO) CAAP Hispanic Health Coalition of GA GA Technical Institute Kibbe Group, Founding Director of the Center for HIT for the of Family Physicians Morehouse School of Medicine Office of Sponsored Research Administration Kids Health First Pediatric , Independent Practice Association  Statewide Area Health Education Centers Network GA Chapter of the of Pediatrics Medical College of GA Amerigroup Technical College System of GA (TCSG) University System of GA Americhoice WellCare of GA Macon State College
GA-HITREC CRM Lifecycle No Cost  Support for PPCPs EHRs NextGen eClinical Works e-MDs Greenway MIE Target Providers PPCPs Non-PCPCs Specialist ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Copyright 2010 All Rights Reserved.
Comprehensive Support throughout the Entire EHR Implementation Process Readiness assessment EHR system selection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Operate  & Maintain 4 Primary goal: Give providers as much support as possible Plan 1 Transition 2 Implement 3
RECs Cover the Full Range of Services Interoperability & HIE Assist providers in meeting functional interoperability requirements (GA-DCH HITT) Implementation Support Provide EHR project management support Meaningful Use Assist providers on achieving Meaningful Use objectives Practice & Workflow Design Assist practices in improvement of daily operations Privacy & Security Implement best practices to protect patient information Outreach & Education Share best practices to select, implement, and meaningfully use EHRs Vendor Selection Assess practice’s IT needs and help select/ negotiate vendor contracts Workforce Provide EHR training to providers and staff  REC Services
After  EHR Integration Halfpenny’s ITF-Based “Lab Hub” Solution Drives clinical lab test results into EHRs as structured data… provides quality results reporting and meets requirements for Meaningful Use
Meaningful Use  &  Provider Incentive Program © Copyright 2010 All Rights Reserved.
Meaningful Use  &  Provider Incentive Program © Copyright 2010 All Rights Reserved.
[object Object],[object Object],Meaningful Use  Established Payments HITECH Act © Copyright 2010 All Rights Reserved.
Meaningful Use Criteria- Stage 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Copyright 2010 All Rights Reserved.
Meaningful Use Criteria- Stage 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Eligible Providers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Copyright 2010 All Rights Reserved.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Medicaid Eligible Providers © Copyright 2010 All Rights Reserved.
Medicare Eligible Providers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],© Copyright 2010 All Rights Reserved.
Medicare First Calendar Year in which the EP Receives an Incentive Payment Calendar Year 2011 2012 2013 2014 2015 & Later 2011 $18,000 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000 2015 $2,000 $4,000 $8,000 8,000 $0 2016 $2000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0 © Copyright 2010 All Rights Reserved.
Medicaid First Calendar Year in which the EP Receives an Incentive Payment Calendar Year 2011 2012 2013 2014 2015 2016 2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 Total  $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 © Copyright 2010 All Rights Reserved.
Hospital Incentive Calculations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.” For HHS…“These goals can be achieved only through  the effective use of information  to support  better decision-making  and  more effective care processes  that improve health outcomes and reduce cost growth” Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009 HHS’ overall objective is to ensure that providers make use of, and patients have access to, clinically relevant electronic information, not just existence of technology 3 stages of meaningful use
Implementation vs. Adoption
EHR Adoption Training
EHR Adoption Challenges Financial Organization Change ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Technical © Copyright 2010 All Rights Reserved.
EHR “ A medical tool that connects, shares knowledge, and supports best practices for patient care”
Building an Interconnected, Patient-Centric Care System Health Information Exchange © Copyright 2010 All Rights Reserved.
Quality and  Safety Health Information Technology Practice  Management Practice-based  Care Team Practice  Services Continuity of  Care Services Care Management Access to Care and Information The Family Medicine Model and the TransforMED  Approach Great  Outcomes Patient  Experience Quality Measures Health Information Technology Practice Organization
Dominic H. Mack MD,MBA Project Director GA-HITREC Deputy Director National Center for Primary Care Morehouse School of Medicine [email_address] Thank You Visit the GA-HITREC Portal:  www.ga-hitrec.org Call GA-HITREC toll free: 877-658-1990 Email GA-HITREC: [email_address]

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1. keynote dominic mack morehouse school of medicine

  • 1. Regional Extension Centers, EHRs & Meaningful Use Dominic H. Mack MD,MBA Project Director GA-HITREC Deputy Director National Center for Primary Care Morehouse School of Medicine [email_address] .
  • 2.
  • 3. EHR Implementation Remains Limited Among Physicians DesRoches, C., et al, “Electronic Health Records in Ambulatory Care - A National Survey of Physicians” New England Journal of Medicine, 2008;359:50-60. (http://www.nejm.org/doi/pdf/10.1056/NEJMsa0802005) A 2008 national survey of 2,758 physicians found positive effects of EHR systems on quality of care and satisfaction
  • 4.
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  • 7. HITECH: Catalyst for Transformation Pre 2009 2009 2014 A system plagued by inefficiencies EHR Incentive Program and 62 Regional Extension Centers Widespread adoption & meaningful use of EHRs
  • 8.
  • 9.
  • 10. Office of Provider Adoption Support (OPAS) Goal: Assist All Providers to Achieve Meaningful Use of EHR Systems Community College Consortium Provider Adoption Services Provider Adoption Services Meaningful Use Regional Extension Centers (RECs) Health Information Technology Research Center (HITRC)
  • 11.
  • 12.
  • 13.
  • 14. National Center for Primary Care, Morehouse School of Medicine Community Oriented Technology Pyramid of Providers
  • 15. NCPC/MSM Partners GA DCH Office of Health Information Technology and Transparency GA State Medical Association GA Academy of Family Physicians GA Partnership for Telehealth Hometown Health GA Institute of Technology Southern Polytechnic GA Association for Primary Health Care GA-HIE Andrew Young School of Policy Studies GA Hospital Association GA State Office of Rural Health CHW GMCF (QIO) CAAP Hispanic Health Coalition of GA GA Technical Institute Kibbe Group, Founding Director of the Center for HIT for the of Family Physicians Morehouse School of Medicine Office of Sponsored Research Administration Kids Health First Pediatric , Independent Practice Association Statewide Area Health Education Centers Network GA Chapter of the of Pediatrics Medical College of GA Amerigroup Technical College System of GA (TCSG) University System of GA Americhoice WellCare of GA Macon State College
  • 16.
  • 17.
  • 18. RECs Cover the Full Range of Services Interoperability & HIE Assist providers in meeting functional interoperability requirements (GA-DCH HITT) Implementation Support Provide EHR project management support Meaningful Use Assist providers on achieving Meaningful Use objectives Practice & Workflow Design Assist practices in improvement of daily operations Privacy & Security Implement best practices to protect patient information Outreach & Education Share best practices to select, implement, and meaningfully use EHRs Vendor Selection Assess practice’s IT needs and help select/ negotiate vendor contracts Workforce Provide EHR training to providers and staff REC Services
  • 19. After EHR Integration Halfpenny’s ITF-Based “Lab Hub” Solution Drives clinical lab test results into EHRs as structured data… provides quality results reporting and meets requirements for Meaningful Use
  • 20. Meaningful Use & Provider Incentive Program © Copyright 2010 All Rights Reserved.
  • 21. Meaningful Use & Provider Incentive Program © Copyright 2010 All Rights Reserved.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28. Medicare First Calendar Year in which the EP Receives an Incentive Payment Calendar Year 2011 2012 2013 2014 2015 & Later 2011 $18,000 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000 2015 $2,000 $4,000 $8,000 8,000 $0 2016 $2000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0 © Copyright 2010 All Rights Reserved.
  • 29. Medicaid First Calendar Year in which the EP Receives an Incentive Payment Calendar Year 2011 2012 2013 2014 2015 2016 2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 © Copyright 2010 All Rights Reserved.
  • 30.
  • 31. “ Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.” For HHS…“These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth” Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009 HHS’ overall objective is to ensure that providers make use of, and patients have access to, clinically relevant electronic information, not just existence of technology 3 stages of meaningful use
  • 34.
  • 35. EHR “ A medical tool that connects, shares knowledge, and supports best practices for patient care”
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 48. Building an Interconnected, Patient-Centric Care System Health Information Exchange © Copyright 2010 All Rights Reserved.
  • 49. Quality and Safety Health Information Technology Practice Management Practice-based Care Team Practice Services Continuity of Care Services Care Management Access to Care and Information The Family Medicine Model and the TransforMED Approach Great Outcomes Patient Experience Quality Measures Health Information Technology Practice Organization
  • 50. Dominic H. Mack MD,MBA Project Director GA-HITREC Deputy Director National Center for Primary Care Morehouse School of Medicine [email_address] Thank You Visit the GA-HITREC Portal: www.ga-hitrec.org Call GA-HITREC toll free: 877-658-1990 Email GA-HITREC: [email_address]

Editor's Notes

  1. Only 4% percent of physicians reported having an extensive, fully functional electronic records system, and 13% reported having a basic system. Primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use electronic health records. Physicians reported positive effects of these systems on several dimensions of quality of care and high levels of satisfaction. Of the small number of respondents who had a fully functional system, 71% reported that their system was integrated with the electronic system at the hospital where they admit patients, as compared with only 56% of respondents with a basic system (P = 0.006). Among the 83% of respondents who did not have electronic health records, 16% reported that their practice had purchased but not yet implemented such a system at the time of the survey. An additional 26% of respondents said that their practice intended to purchase an electronic-records system within the next 2 years.
  2. The Health Information Technology for Economic and Clinical Health Act, or the “HITECH Act”, was introduced in 2009 as a Government response to incentivize the steadfast adoption of health information technology (HIT) to achieve widespread adoption by 2014. The act represents an historic and unparalleled investment in HIT. “This investment lays the groundwork necessary to pursue the President’s goals related to improved health care quality and efficiency and will help transform the way health care is both practiced and delivered.” Source: http://energycommerce.house.gov/documents/20100727/Blumenthal.Testimony.07.27.2010.pdf
  3. OPAS’ goal is to assist all providers to achieve meaningful use of EHR systems
  4. While REC are encouraged to work with all providers they will initially focus on “Priority Settings” such as: Individual/small group practices focused on primary care (>10 PCPs) Public and Critical Access Hospitals (CAHs) Community Health Centers and Rural Health Clinics Other settings that predominantly serve uninsured, underinsured, and medically underserved populations
  5. Initial Goal: Assist at least 100,000 primary care providers in priority settings in achieving Meaningful Use by 2012 Who makes up REC leadership? MDs, RNs, NPs, PharmD’s HIT professionals Former health care executives
  6. RECs serve as a support center to make EHR implementation easier for providers throughout the entire process, or at any point along the way. RECs provide the following services, and other services to be identified by RECs necessary to assist providers to achieve Meaningful Use. Planning During the initial planning phase, the REC will work side by side a provider to conduct an EHR readiness assessment and develop the EHR project management plan. The REC will assist with: EHR review of your practice EHR vendor selection, identification, evaluation and negotiation Transition The REC lead a practice in transitioning from a paper-based health record environment to an interconnected, patient-centric care system. The REC will assist with: Support around practice and workflow redesign, needs prioritization, functional requirements HIT education, including provider-patient communication on issues related to privacy/security Implementation The REC’s goal is for a provider to achieve effective implementation of a certified EHR product. The REC will assists with: System implementation support, troubleshooting and requirements refinement HIE partnerships and preparations Operate & Maintain The REC will continue to support providers and keep them informed about national developments that may impact their work toward achieving meaningful use of a certified EHR system. The REC will assist with: Achieving meaningful use Maximizing payments, minimizing hassle Preparing for pay for performance measures Continuing to support practice transformation and EHR usability through all stages of meaningful use
  7. The HITECH Act authorized CMS to develop Medicare and Medicaid Incentive programs to incentive eligible providers to adopt medical records and become meaningful users of HIT.
  8. There are several unique challenges facing primary care providers, particularly in small practices or clinics, including: administrative and financial burden of implementing new system; operational, technical and infrastructure limitations; and provider and support staff ability to use a new system. Threat of information overload—both at the transitions of care and between disciplines Need to provide for data-sharing between clinical and public health agencies How to use HIT to improve the delivery of healthcare Addressing different views of ‘meaningful’ for different uses and users of HIT HIT system cost Uncertain ROI Lack of trained staff to support IT implementation. Overwhelming number of products / options Technology is not ready; lack of standards Finding an EHR to meet their needs (usability of EHR) Managing patient privacy and security concerns Disbelief in financial incentives
  9. Under HITECH, several key programs, like the Medicare and Medicaid EHR Incentive Program and the Regional Extension Program, have been established to facilitate adoption of EHRs These investments are designed to work together to: Provide the necessary assistance and technical support to providers Enable coordination and alignment within and among states Establish connectivity to the public health community in case of emergencies Assure that the workforce is properly trained and equipped to be meaningful users of EHRs Together these programs build the foundation for every American to benefit from an EHR as part of a modernized, interconnected and vastly improved system of care Source: http://energycommerce.house.gov/documents/20100727/Blumenthal.Testimony.07.27.2010.pdf
  10. TransforMED is the Academy’s “GO TO” entity for assisting practices implement the PCMH. They have organized their implementation offerings using eight domains that align with the more simplified graphical representation I have just presented to introduce you to the PCMH/Family Medicine model. The Academy will continue to use the PCMH terminology in its advocacy work with outside stakeholders promoting the medical home concept as a national health care reform platform.