Welcome to another Health IT Advisors’ slidecast on EHR for medical practices. Today I’m going to speak about the latest information on meaningful use of EHR technology. On June 16th the Meaningful Use Workgroup of the Health IT Policy committee presented their recommendations on quantifying meaningful use.The slides presented come directly from the Workgroup’s presentation. They provide an excellentroadmap for funding qualification.We will focus on the criteria a medical practice should use to select an EHR vendor.My name is Michael Duffy and I’m a principal of Health IT Advisors.
Meaningful use of EHR technology is required for medical practices to qualify for the Stimulus Bill funds.This presentation lays out the features that practices should require their EHR vendor to support.
This workgroup is responsible for the ongoing definition of meaningful use which is a requirement for medical practices to qualify for Stimulus Bill funds.
The workgroup has segmented by 2 year increments it’s review of meaningful use. This approachallows for the ramping up of EHR technology in medical practices and makes qualification forStimulus Bill funds within the reach of all medical practices.For the years 2011 and 2012 the focus will be on creating, capturing and sharing patient medical information.Beginning in 2013 the definition of meaningful use will evolve into EHR solutions being required tohandle advanced care process and decision support.In 2015 the workgroup envisions EHR functionality providing improved outcomes for patients.The focus of the group initially is 2011 and 2012 and is the focus of this presentation.
For 2011 the workgroup broke down requirements in 5 areas:The improvement of quality , safety and efficiency.Providing more transparency to the patient in their care.Care coordination between multiple providers.The use of EHR in public health concerns.Privacy and security of EHR data.In each of the 5 areas the workgroup looked at the objectives and the measures. Medical practices shouldfocus on ensuring their EHR solutions addresses the measures.
There are 4 objectives for improving the quality, safety and efficiency of care:Capture date in coded format (problem, medication, vital signs and basic information.Note the progress between encounters.Use computerize physician order entry including electronic prescribing.Use EHR to organize and manage your patient population.
These are the requirements for quality,safety and efficiency.I’m not going to repeat these, but it’s important to note these and ensure that the EHR solution youare considering provides these features.……….give time to read.
One of the objectives of the EHR provisions in the stimulus bill is to encourage the use of EHRby the patient population.EHR solutions should have a patient portal that allows a patient to manage the appropriate partsof their own EHR.This self service capability can be valuable to both the patient and the provider.
Minimum percentage haven’t been spelled out, but if your EHR solution can provide a patient portalthen the “engaging patient” meaningful use measurements should be easily achieved.
Improving care coordination meaningful use is a trickier subject.Exchanging data between different EHR solutions can be problematic. Be sure to receivean understanding from your EHR vendor how their solution interoperates with others. A question toask is “What data interoperability standard does your solution adhere to?” A Health Information Exchange is a data hub where data is transferred between providers. Your EHRvendor should have the ability to communicate with an HIE. These are sometimes called Regional Health Information Organaizations or RHIO.
These are the measures that are required for meaningful use in 2011 and 2012.The key measure is the ability to share patient data outside of your practice.
Improving and monitoring public health is an important by product of EHR.The same interoperability standard we discussed earlier under Care Coordination will be usedfor public health reporting.
Electronically reporting Immunization and lab are the measures of meaningful use for Public Health.
HIPAA stands for Health Insurance Portablitiy and Accountability Act. Under HIPAA there is a PrivacyRule that governs the use and disclosure of health information held by "covered entities”. Medical practices are a covered entity.It is legally required that a practice protect the privacy of patient information contained in an EHR.There are penalties for non-compliance of the Privacy Rule.
When selecting an EHR vendor it is critical that you have an understanding of how your patients data isprotected in the system.There are two types of EHR system architectures.The first is a hosted solution in which the patient’s information is stored at the vendors site and the internet is used to connect your office to the data removes much of the risk to the practice of HIPAA compliance.The second, is an on premise model in which the EHR system stores patient data on a server in your office. This model has a higher risk of HIPAA compliance. When considering an EHR solution one should weight the pros and cons of a hosted vs on-premisemodel.
The Meaningful Use workgroup has laid out a roadmap of the requirements an EHR solution needs address to qualify for Stimulus Bill funding.Meaningful use will evolve every 2 years to incrementally achieve the goal of improving our nation’s health care.Medical practices should select an EHR vendor who can deliver the 2011 measures today and one that hasa record of ongoing certifications and upgrades.For more information go to www.hitadvisors.com.
EHR Meaningful Use ONC Policy Commitee June 16 2009
Meaningful Use Requirements for Medical Practices<br />Health IT Advisors<br />www.hitadvisors.com<br />Michael Duffy<br />1<br />
Co-Chairs:<br />Paul Tang, Palo Alto Medical Foundation<br />Farzad Mostashari, New York City Health Department<br />Members:<br />David Bates, Brigham & Women’s Hospital<br />Christine Bechtel, National Partnership for Women & Families<br />Neil Calman, The Institute for Family Health<br />Art Davidson, Denver Public Health Department<br />David Lansky, Pacific Business Group on Health<br />Deven McGraw, Center for Democracy & Technology<br />Latanya Sweeney, Carnegie Mellon University<br />Charlene Underwood, Siemens<br />ONC Lead:<br />John Glaser<br />2<br />Meaningful Use Workgroup Members<br />
Broad Charge<br />Make recommendations to the HIT Policy Committee regarding the process for defining and revising meaningful use and national goals, proposed new meaningful use definitions and national goals and standards and policy priorities to support meaningful use and national goals.<br />3<br />Meaningful Use Workgroup Charges<br />
HIT-Enabled Health ReformAchieving Meaningful Use<br />2009<br />2011<br />2013<br />2015<br />HIT-Enabled Health Reform<br />Meaningful Use Criteria<br />HITECH Policies<br />2011 Meaningful Use Criteria (Capture/share data)<br />2013 Meaningful Use Criteria<br />(Advanced care processes with decision support)<br />2015 Meaningful Use Criteria (Improved Outcomes)<br />4<br />
Draft: Meaningful Use criteria (focused on 2011)<br />5<br />
Improve Quality, Safety, Efficiency2011 Objectives<br />Capture data in coded format<br />Maintain current problem list<br />Maintain active medication list<br />Maintain active medication allergy list<br />Record vital signs (height, weight, blood pressure)<br />Incorporate lab/test results into EHR<br />Document key patient characteristics (race, ethnicity, gender, insurance type, primary language)<br />Document progress note for each encounter (outpatient only)<br />Use CPOE for all order types<br />Use electronic prescribing for permissible Rx<br />Implement drug-drug, drug-allergy, drug-formulary checks<br />Manage populations<br />Generate list of patients by specific conditions (outpatient only)<br />Send patient reminders per patient preference<br />6<br />
Improve Quality, Safety, Efficiency2011 Measures<br />% Labs incorporated into EHR in coded format<br />% CPOE orders entered directly by physician<br />Report quality measures using HIT-enabled quality measures (HIT-QM)<br />% Diabetics with A1c under control<br />% Hypertensives with BP under control<br />% LDL under control<br />% Smokers offered smoking cessation counseling<br />% Patients with recorded BMI<br />% Colorectal screening for 50+<br />% Mammograms for women 50+<br />% Current pneumovax status<br />% Annual flu vaccination<br />% Aspirin prophylaxis for patients at risk for cardiac event<br />% Surgical patients receiving VTE prophylaxis<br />Avoidance of high risk medications in elderly<br />Quality reports stratified by race, ethnicity, gender, insurance type<br />7<br />
Engage Patients and Families2011 Objectives<br />Provide patients with electronic copy of- or electronic access to- clinical information per patient preference <br />Includes labs, problem list, medication list, allergies<br />Provide access to patient-specific educational resources<br />Provide clinical summaries for patients for each encounter<br />8<br />
Engage Patients and Families2011 Measures<br />% Patients with electronic access to personal health information<br />% Patients with access to patient-specific educational resources<br />% Encounters where clinical summary provided<br />9<br />
Improve Care Coordination2011 Objectives<br />Exchange key clinical information among providers of care<br />Perform medication reconciliation at relevant encounters<br />10<br />
Improve Care Coordination2011 Measures<br />% Encounters where medication reconciliation performed<br />Implemented ability to exchange health information with external clinical entities<br />Problems, labs, medication lists, care summaries<br />% Transitions in care where summary care record is shared (in 2011, could use any modality)<br />11<br />
Improve Population and Public Health2011 Objectives<br />Submit electronic data to immunization registries where required and can be accepted<br />Submit electronic reportable lab results to public health agencies<br />Submit electronic syndrome surveillance data to public health agencies according to applicable law and practice<br />12<br />
Improve Population and Public Health2011 Measures<br />Report up-to-date status of childhood immunizations<br />% Reportable lab results submitted electronically<br />13<br />
Ensure Privacy and Security Protections2011 Objectives<br />Compliance with HIPAA Rules and state laws<br />Compliance with fair data sharing practices set forth in the National Privacy and Security Framework<br />14<br />
Ensure Privacy and Security Protections2011 Measures<br />Full compliance with HIPAA<br />Entity under investigation for HIPAA violation cannot achieve meaningful use until entity is cleared<br />Conduct or update a security risk assessment and implement security updates as necessary<br />15<br />
Summary<br />Proposed Meaningful Use criteria for 2011 is achievable by today’s EHR solutions.<br />Have a clear understanding of the requirements and the vendors features to meet the requirements.<br />For educational webinar and seminars on selecting an EHR solution for your practice go to www.hitadvisors.com.<br />