Webinar: Information Technology: How to achieve interoperability across the continuum of care

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http://www.modernhealthcare.com/article/20140507/INFO/305079925/

About the Webinar

For most healthcare providers, clinical interoperability remains more of a goal than a reality. This year, the feds are ratcheting up the pressure on providers to incorporate information exchange as part of their daily clinical workflows. To do it, they've built several interoperability requirements into the Stage 2 meaningful use criteria of the electronic health record incentive payment program. We'll explore how to leverage meaningful use interoperability as a basis to improve clinical communications between affiliated and non-affiliated providers, increase patient satisfaction and ramp up for the future with value-based, consumer-focused care.

Join us for this one-hour webinar to learn:
- The basic requirements for interoperability in the Stage 2 meaningful use criteria
- Strategies for implementing a compliant data collection and reporting program
- Pitfalls to avoid and data interpretation issues that need to be addressed

Panelists:

Dr. Clifford Martin
Chief Medical Officer
St. Joseph Physician Network

Dr. Richard Schrieber
Chief Medical Information Officer
Holy Spirit Hospital

Erica Galvez
Interoperability and Exchange Portfolio Manager
Office of the National Coordinator for Health IT

Moderator:

Joseph Con
Health Information Technology Reporter
Modern Healthcare

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Webinar: Information Technology: How to achieve interoperability across the continuum of care

  1. 1. Welcome... Today’s topic Health IT: How to Achieve Interoperability Across the Continuum of Care During today’s discussion, feel free to submit questions at any time by using the questions box. A follow-up e-mail will be sent to all attendees with links to the presentation materials online. Dr. Richard Schreiber Chief medical information officer, Holy Spirit Hospital, Camp Hill, Pa. Dr. Clifford Martin Chief medical officer, St. Joseph Physician Network, Mishawaka, Ind. Erica Galvez Interoperability and exchange portfolio manager, Office of the National Coordinator for Health IT
  2. 2. HousekeepingHousekeeping 1. Viewer Window 2. Control Panel
  3. 3. Joseph Conn Reporter, Modern Healthcare Now speaking... Please use the questions box on your webinar dashboard to submit comments to our moderator
  4. 4. Erica Galvez Interoperability and exchange portfolio manager, Office of the National Coordinator for Health IT Now speaking... Please use the questions box on your webinar dashboard to submit comments to our moderator
  5. 5. Meaningful Use & Certification Relationship for Transitions of Care • When looked across both Stages 1 & 2, the ToC objective includes 3 measures: • Measure #1: requires that a provider send a summary care record for more than 50% of transitions of care and referrals (Stage 1 and 2) • Measure #2 requires that a provider electronically transmit a summary care record for more than 10% of transitions of care and referrals using CEHRT or eHealth Exchange participant (Stage 2) • Measure #3 requires at least one summary care record electronically transmitted to recipient with different EHR vendor or to CMS test EHR (Stage 2) Meaningful Use 2014 Edition Certification • Two 2014 Edition EHR certification criteria • 170.314(b)(1) : Transitions of care— receive, display, and incorporate transition of care/referral summaries. • 170.314(b)(2) : Transitions of care— create and transmit transition of care/referral summaries.
  6. 6. Feature Focus: ToC Measure(2) • The eligible provider, eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10% of such transitions and referrals either: • (a) electronically transmitted using CEHRT to a recipient; or • (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network. ToC Measure #2 170.314(b)(2) • Transitions of care—create and transmit transition of care/referral summaries. • (i) Enable a user to electronically create a transition of care/referral summary formatted according to the Consolidated CDA with, at a minimum, the data specified by CMS for meaningful use. • (ii) Enable a user to electronically transmit CCDA in accordance with: • “Direct” (required) • “Direct” +XDR/XDM (optional, not alternative) • SOAP + XDR/XDM (optional, not alternative) 1 2
  7. 7. Patient Electronic Access to Health Info EPs and EHs: View, Download, Transmit Measure 1: • More than 50% patients are provided timely online access to their health information Measure 2: • More than 5% of patients must access their health information online EPs: Secure Messaging Measure 1: • A secure message was sent using the electronic messaging function of CEHRT by more than 5% of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.
  8. 8. Patient Electronic Access to Health Info VDT objective VDT and secure messaging objective Secure messaging objective Measures Does the EP/EH need to use CEHRT to send initial information to patient? Does the patient need to receive/view/downl oad information using CEHRT? Does the patient need to use CEHRT to transmit information? Does the EP need to use CEHRT to receive information from patient? VDT measure 1: 50% of unique patients provided timely online access to their health information No Yes N/A N/A VDT measure 2: 5% of unique patients view, download or transmit their health information to a 3rd party No Yes They may, but are not required to N/A Secure messaging measure 1: 5% of unique patients send a secure message to the EP N/A N/A They may, but are not required to Yes
  9. 9. Dr. Richard Schreiber Chief medical information officer, Holy Spirit Hospital, Camp Hill, Pa. Now speaking... Please use the questions box on your webinar dashboard to submit comments to our moderator
  10. 10. Meaningful Use 2 and Interoperability • Definitely stresses importance of interoperability • Patient Portal replaces “electronic copy of discharge information” • Settles on C-CDA (Consolidated clinical document architecture) • Requires sending C-CDA to another vendor, but only once
  11. 11. Meaningful Use 2 and Interoperability, cont. •Direct Messaging (DM) –NOT an interoperable requirement –very hard to achieve interoperability with DM • Outside of EMR • No clear way to add data to EMR •Submit labs from EH’s to EP’s –Nice, but actually done via interfacing, not true interoperability –Why not more emphasis on HIE? • especially for those on different EMRs?
  12. 12. Transfer of Care Documents Most difficult interoperability requirement of MU 2 • HISPs don’t talk to HISPs (lack connectivity) • Dismally low adoption of direct addresses • Offset of the reporting periods –EHs: Federal Fiscal Year (attest Oct 1) –EPs: Calendar year (attest by Jan 1) • EPs have not caught up with EHs • Puts EHs at disadvantage With thanks to Michael Zaroukian, Colin Banas, Matthew Shafiroff
  13. 13. AMA Letter to CMMS and ONC “JASON2 report funded by the Agency for Healthcare Research and Quality concisely described the current state of interoperability, finding “[a]t present, large-scale interoperability amounts to little more than replacing fax machines with the electronic delivery of page-formatted medical records.”3 If we are to move away from this approach, the certification process must be keenly focused on achieving true interoperability that is deployed in a fashion that requires minimal user intervention. We believe ONC should focus less on what specific data points are exchanged, and more on identifying and coordinating the standards needed to exchange information.” • Lack of interoperability standards still impedes progress 1http://www.ihealthbeat.org/~/media/Files/2014/PDFs/CMS%20ONC%20Letter%20Stage%203. ashx 2named for the Greek hero 3JASON, A Robust Health Data Infrastructure, November 2013 http://www.healthit.gov/sites/default/files/ptp13-700hhs_white.pdf
  14. 14. Meaningful Use Stage 3 • Nothing about improved care: disappointing • Pharmacy benefit/Surescripts/similar pharmacy fill data companies • To improve med rec we need better “source of truth” of home med list. –We already pay for eRx via Surescripts, and they possess fill data; there is no requirement that they share this data that in a sense we have already paid for
  15. 15. Meaningful Use Stage 3 • No pressure on insurance companies to support HIE – They benefit the most financially from reductions in wasteful duplication and better ability to keep patients out of the hospital1 • Metric for medication reconciliation still 50% – Is it ok to let ½ our patients leave the hospital with poor med lists? – HITPC declined to • Strengthen the metric • Demand that pharmaceutical intermediaries share their data (cited lack of authority in the law) 1Vest JR, et al. Association between use of a health information exchange system and hospital admissions. Appl Clin Inform 2014;5(1):219-231.
  16. 16. What are the current limitations? • Lack of nationwide HIE • Unclear and non-harmonized regulations regarding send/receive messaging for Direct Messages vs HIE • Many vendors have certified EHRs which in fact do not conform to MU requirements – They can send, but can they • Receive at all? • Record upon receipt by intended recipient and generate a report?
  17. 17. What are the current limitations? • Multiple portals confuse patients • Requirements for meaningful use with multiple dependencies all to be achieved simultaneously— impossible – Need milestones first, then meaningful use goals – We are the first MU 2 certified EHR that is trying to connect to an HIE that has been in Pennsylvania the longest—why is it so hard? • Ability to attach, forward, and consolidate data so patients can access one portal, in absence of centralized HIE
  18. 18. Where do we go from here? • FHIR: Fast Healthcare Interoperable Resource • JASON recommends: – Public APIs (application program interfaces) – “Interoperability issues can be resolved only by establishing a comprehensive, transparent, and overarching software architecture for health information.” –Open software architecture –Common mark up language (it alone will not support semantic interoperability—also need APIs) A Robust Health Data Infrastructure. JASON. The MITRE Corporation. http://healthit.gov/sites/default/files/ptp13-700hhs_white.pdf
  19. 19. Dr. Clifford Martin Chief medical officer, St. Joseph Physician Network, Mishawaka, Ind. Now speaking... Please use the questions box on your webinar dashboard to submit comments to our moderator
  20. 20. Saint Joseph Physician Network • Division of Saint Joseph Regional Medical Center- South Bend, IN. • Member of CHE-Trinity Health • Comprised of 72 physicians and 18 Non-Physician Providers • 65% Primary Care Providers & 35% Specialty Providers •43 providers eligible for Meaningful Use 2
  21. 21. Key Components & Partners in our MU 2 Success •Use of Cerner EMR and NextGen practice management software • Strong community Health Information Exchange (HIE) Michiana Health Information Network (MHIN) • Community laboratory service provider with widespread use in area • Experience leadership in HIE and our organization with implementation of a project of this scope
  22. 22. Most Recent Components Installed • Preventive Care / Health Maintenance Modules • Patient Specific Education for Exit Care • Establishing Continuity of Care Documents • Community Patient Portal •Strategies to Engage Patients in use of Portal
  23. 23. Most Significant Challenges to Success • Certification of Medical Assistants • Rapid implementation of required software changes/bundles • Increased need to utilize data in discrete fields • Lab test and Radiology procedure terminology • Processing Speed interruptions
  24. 24. Today’s panelists... Health IT: How to Achieve Interoperability Across the Continuum of Care During today’s discussion, feel free to submit questions at any time by using the questions box. Joseph Conn Reporter, Modern Healthcare Dr. Clifford Martin Chief medical officer, St. Joseph Physician Network, Mishawaka, Ind. Erica Galvez Interoperability and exchange portfolio manager, Office of the National Coordinator for Health IT Dr. Richard Schreiber Chief medical information officer, Holy Spirit Hospital, Camp Hill, Pa. TODAY’S MODERATOR
  25. 25. Thank you... ... for attending today’s editorial webinar on achieving interoperability across the care continuum. We also thank our panelists, Erica Galvez, interoperability and exchange portfolio manager, Office of the National Coordinator for Health IT; Dr. Clifford Martin, chief medical officer, St. Joseph Physician Network, Mishawaka, Ind.; and Dr. Richard Schreiber, chief medical information officer, Holy Spirit Hospital, Camp Hill, Pa. Expect a follow-up e-mail within two weeks. For more information, send an e-mail to webinars@modernhealthcare.com For more information about additional editorial webinars this year, please visit modernhealthcare.com/webinars

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