Powerpoint lawrence m. preston

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April 18 AIIM Show Las Vegas

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Powerpoint lawrence m. preston

  1. 1. Lawrence M. Preston, MBA, FHFMAProfessional Medical Consultants, Inc. April 18, 2012 AIIM and ARMA
  2. 2. Background• 19 years in hospital management-California, Hawaii and Nevada• 20 years in healthcare consulting-based in LV• Primary focus-Physician Practice Management• Own Primary Care Practice in Mexico• Starting IPA in Nevada• Application in for ACO in Nevada• Board of Directors-ACHE and HFMA Nevada Professional Medical Consultants, Inc. 2
  3. 3. Meaningful Use-Phase I Core Measurements -15 criteria must be met Menu Set – choose 5 of 10 criteria Must meet 100% of each or no incentive payment Payment for Medicare is up to $44,000 over 5 years ($63,750 for Medicaid over 6 years) Professional Medical Consultants, Inc. 3
  4. 4. Professional Medical Consultants, Inc. 4
  5. 5. Core Measurements1. E-prescribing at least 40% of all RX2. At least 30% of patient seen must have a medication entered into system3. EMR software must have drug to drug interaction/allergy alert4. At least 80% of patients seen must have an active medication list Professional Medical Consultants, Inc. 5
  6. 6. Core Measurements-continued1. At least 80% of patients seen must have up to date diagnosis2. At least 80% of patients seen must have an active allergy list3. At least 50% of patients seen must have smoking status and history documented4. Need to implement one clinical decision support rule Professional Medical Consultants, Inc. 6
  7. 7. Core Measurements-continued1. Need at least 50% of patients seen to have documented the following questions: a. Preferred language b. Gender c. Race d. Ethnicity (Hispanic or Non-Hispanic) e. Date of Birth Professional Medical Consultants, Inc. 7
  8. 8. Core Measurements-Continued1. Need at least 50% of patients to have seen the following vitals signs recorded: a. Height b. Weight c. Blood Pressure d. BMI (calculated by Height & Weight) e. Plot and display growth charts for children ages 2-20 Professional Medical Consultants, Inc. 8
  9. 9. Core Measurements-continued1. Need to report ambulatory clinical quality measures to CMS (Medicare)2. Need to provide at least 50% of patients with an electronic copy of their health information within 3 business days-when requested3. Need to provide at least 50% of patients seen a clinical summary of their visit within 3 business days from the date seen Professional Medical Consultants, Inc. 9
  10. 10. Core Measurements-continued1. Need to perform at least one test of electronically exchanging clinical information with another provider2. Need to have a security risk analysis conducted Meet each and everyone one of the above criteria to pass this section (no exceptions) Professional Medical Consultants, Inc. 10
  11. 11. Menu Set Measurementsm Implement drug formulary checko Have a least 40 % of lab results reported into system% Need to generate a least one list of patients by specific condition (i.e.-Diabetes)o Need at least 10% of patients to be able to obtain their medical information within three business days Professional Medical Consultants, Inc. 11
  12. 12. Menu Set Measurementsm Need at least 20% of patients 65 and older to be sent a reminder for preventative or follow up carer Need at least 10% of patients seen be given patient specific education resources that are generated from the EMR systemo Need to update at least 50% of patients seen medication list when seen by another doctor Professional Medical Consultants, Inc. 12
  13. 13. Menu Set Measurementsm Need to send a referral, summary of care and any other pertinent information on at least 50% of patients being referred oute Need to perform at least on test of sending electronic immunization records to an immunization registryi Need to perform at least one test of sending electronic syndromic surveillance data to a public health agency Professional Medical Consultants, Inc. 13
  14. 14. Meaningful Use• Must meet all 15 Core at 100%• Must meet 5 of the 10 Menu set• Miss any of the above-no incentive payment• Check your software to make sure it can do the above and that it has been approved by CMS standards board-now your ready to go Professional Medical Consultants, Inc. 14
  15. 15. How to Implement Ask for help from your vendor Don’t get to complicated KISS Physician buy in—largest and most difficult Professional Medical Consultants, Inc. 15
  16. 16. How to order a Rx through the EHR Pull Chart Go to Assessment and Plan Choose existing medication from patient’s medication list  For new medication go to search, then change Data Source to Medications, enter dosage, frequency, quantity and refills Press Output Choose Pharmacy Enter Password Press OK Sign Off Enter Password Change Encounter Type to Prescription Only Press OK Professional Medical Consultants, Inc. 16
  17. 17. How to add an addendum to EHR chart Double click on the office visit that needs the addendum (located on the face sheet in the upper R hand corner) Click on pencil (located in the L upper corner) Click on what section you want to add information to (hover your mouse over the pictures, A+P, vitals, etc) Type the information into the box provided. Click OK Professional Medical Consultants, Inc. 17
  18. 18. EHR Implementation Schedule Week 1: All staff (including physicians) needs to start using messaging system. Example: Front desk staff can send message to MA that a patient keeps calling and leaving messages for them, and haven’t received a call back yet. Professional Medical Consultants, Inc. 18
  19. 19. EHR Implementation Schedule Week 2: Physicians need to start reviewing all lab results through system and message to their MA’s anything needed. No labs should be printed unless needed. MA’s need to start entering all medications and allergies of the morning patients into the system. MA’s also need to enter entire social history, medications, allergies, medical problems of all new patients. Professional Medical Consultants, Inc. 19
  20. 20. EHR Implementation Schedule Week 3: Physicians need to start with 4 patients daily doing only the review of systems in the system. MA’s need to start entering all medical problems of the morning patients into the system. (They continue adding medications/allergies) Professional Medical Consultants, Inc. 20
  21. 21. EHR Implementation Schedule Week 4: Physicians start with 4 patients daily doing physical exam and review of systems in the system. MA’s need to start entering all vital signs and chief complaints of morning patients into the system. (They continue adding medical problems and medications/allergies) Professional Medical Consultants, Inc. 21
  22. 22. EHR Implementation Schedule Week 5: Physicians start with 4 patients daily doing entire patient (review of systems, physical exam, assessment and plan) they will do all new patients and then select others from there. The MA’s will also do their part for these patients. Professional Medical Consultants, Inc. 22
  23. 23. EHR Implementation Schedule Week 6: No new patient charts will be made from this point on. They all need to be done in the EHR. MA’s will need to start sending faxes to the physician to review. Only print out Rx refill requests that will need to continue to be done through the e- prescribe in the EHR. Professional Medical Consultants, Inc. 23
  24. 24. EHR Implementation Schedule Week 7: Physicians will continue to increase the number of patients done in the EHR by one in the morning and one in afternoon each week. (So, 3 in the am, 3 in the pm x 1 wk, and then 4 in am, 4 in pm, etc) Professional Medical Consultants, Inc. 24
  25. 25. Examples of weekly reports Run weekly reports and compare to previous week— look for progress and regress Set goal of what to accomplish-by doctor These are individual attestations-don’t slow down to the slowest participant Professional Medical Consultants, Inc. 25
  26. 26. Meaningful Use Status Update 08-04-2011 Dr AA: the following measures not meeting threshold: Core 9-Smoking Status: currently listed 4%. Needs to be >50% Core 13 - Clinical summaries: currently listed as 0%. Needs to be >50% (missing report) Core – Clinical Information Exchange: need to submit 1 test data as a CCR/CCD record to another provider of care. Menu set – Patient Reminders. Need >20% (missing report) Menu set – Patient Education. Need >10%. (missing report) Professional Medical Consultants, Inc. 26
  27. 27. Meaningful Use Status Update 08-04-2011 Dr BB: the following measures not meeting threshold: Core 3 – eRX: currently listed 30%. Needs to be >50% Core 7 – Allergy list: currently listed 46.6%. Needs to be >80% Core 13 – clinical Summary: currently listed 0%. Need >50% (missing report) Core – Clinical Information Exchange: need to submit 1 test data as a CCR/CCD record to another provider of care. Menu set – Patient Reminders. Need >20% (missing report) Menu Set – Patient Education. Need >10%. (missing report) Professional Medical Consultants, Inc. 27
  28. 28. Meaningful Use Status Update 08-04-2011 Dr CC: the following measures not meeting threshold: Core 7 – Allergy list: currently listed 37.3%. Need >80% Core 9 – Smoking status: currently listed 43.4%. Need to be >50% Core 13 – clinical Summary: currently listed 0%. Need >50% (missing report) Core – Clinical Information Exchange: need to submit 1 test data as a CCR/CCD record to another provider of care. Menu set – Patient Reminders. Need >20% (missing report) Menu Set – Patient Education. Need >10% (missing report) Professional Medical Consultants, Inc. 28
  29. 29. Lessons learned Don’t slow down Focus on daily and weekly reporting Focus on positive changes Compliment staff-not just physicians Hold your EMR vendor accountable Don’t give in-fight for your goal and timetable Prepare for M U 2-started January 1, 2012 Professional Medical Consultants, Inc. 29
  30. 30. Summary Don’t be afraid to call your competitors Call other vendors for input Listen to 3-4 webinars a week Ask your vendor to provide constant updates Hold frequent meetings with key staff Don’t stop asking your staff how can I help If you get frustrated-tackle another issue Professional Medical Consultants, Inc. 30
  31. 31. Questions-???  Thank you very much---  You can always call me at  702 598-0600  Larry Preston Professional Medical Consultants, Inc. 31
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