MO HIT Assistance Center Rural Hospital presentation

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  • Award Announced: April 6, 2010 Second Funding Cycle – Total of 60 RECs around the country
  • Our Mission is: Serve primary care providers, critical access and rural hospitals: Provide comprehensive support and assistance for any providers seeking to advance readiness, adopt, and become meaningful users of health information technology, with a focus on priority primary care practices and other settings serving uninsured, underinsured, and medically underserved populations; Disseminate best practices and educational materials to accelerate efforts to adopt and utilize health information technology to improve the quality and value of health care; and Establish relationships with partners to leverage and disseminate a broad array of technical assistance services and tools to help priority providers in the selection, implementation, and meaningful use of certified EHRs.
  • 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
  • Missouri Assistance Center is one of a select group of organizations throughout the U.S. designated as having the experience and capacity necessary to assist health care providers with the task of modernizing their practices with certified EHRs. We have been selected by the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator (ONC) for Health Information Technology to serve providers, with a focus on primary care providers, in our community. (optional to specify federal designation) An independent, non-profit organization, providing technical assistance, guidance, and information on best practices to support and accelerate providers’ efforts to become meaningful users of certified EHR technology Offers health care providers a combination of national insight and local expertise on the impact of EHRs in medical practice Part of a national network of 60 regional extension centers with direct, rapid and reliable access to a pipeline of key information on health IT and meaningful EHR use
  • During the initial planning phase, the MO HIT Assistance Center will work side by side with you and your team to conduct an EHR readiness assessment and develop the EHR project management plan. We assist with: EHR review of your practice EHR vendor selection, identification, evaluation and negotiation We will lead you in transitioning from a paper-based health record environment to an interconnected, patient-centric care system. We assist with: Practice workflow redesign Needs prioritization Functional requirements Provider-patient communications Best practices for privacy-security of personal health information Our goal is for you to achieve effective implementation of your certified EHR product. We assist with: System implementation support Hosting Troubleshooting Requirements refinement HIE partnerships and preparations We will continue to support your practice and keep you informed about national developments that may impact you as you work toward achieving meaningful use of your certified EHR system
  • For those providers currently using an EHR we will assist with: Identifying barriers and their solutions so providers can successfully demonstrate meaningful use Maximizing Medicare and Medicaid EHR incentive payments while minimizing hassle Preparing for pay-for-performance Continuing to support practice transformation and EHR usability through all stages of meaningful use
  • MO HIT Assistance Center Rural Hospital presentation

    1. 1. Your Answer to All Things EHR
    2. 2. <ul><li>Federally-designated Regional Extension Center for the State of Missouri </li></ul><ul><li>University of Missouri: </li></ul><ul><ul><li>Department of Health Management and Informatics </li></ul></ul><ul><ul><li>Center for Health Policy </li></ul></ul><ul><ul><li>Department of Family and Community Medicine </li></ul></ul><ul><li>Partners: </li></ul><ul><ul><li>Hospital Industry Data Institute (Small Rural and Critical Access Hospitals) </li></ul></ul><ul><ul><li>Kansas City Quality Improvement Organization </li></ul></ul><ul><ul><li>Missouri Primary Care Association </li></ul></ul><ul><ul><li>Missouri Telehealth Network </li></ul></ul><ul><ul><li>Primaris </li></ul></ul>
    3. 3. <ul><li>Vision: Assist Missouri's health care providers in using electronic health records to improve the access and quality of health services; to reduce inefficiencies and avoidable costs; and to optimize the health outcomes of Missourians </li></ul>
    4. 4. Financial Organization Change <ul><li>Expense of system </li></ul><ul><li>Uncertainty around ROI </li></ul><ul><li>Provider and staff productivity </li></ul><ul><li>Uncertainty about financial incentives </li></ul><ul><li>Disruption of workflow and productivity </li></ul><ul><li>Privacy and security concerns </li></ul><ul><li>Maintaining patient centeredness and satisfaction </li></ul><ul><li>Concerns about technically supporting a system </li></ul><ul><li>Lack of necessary computer skills </li></ul><ul><li>Finding the right EHR to suit practice needs (“usability”) </li></ul><ul><li>Having the right IT staff in place </li></ul><ul><li>Possibility of information overload </li></ul>Technical
    5. 5. <ul><li>Require significant support to carry out proper workflow re-design </li></ul><ul><li>Result can be piecemeal and less effective use of EHR capabilities and fewer financial and quality benefits </li></ul><ul><ul><li>Substantial time spent customizing forms and redesigning workflow </li></ul></ul><ul><ul><li>More time spent with patients leading to longer workdays or fewer patients during the initial period </li></ul></ul><ul><ul><li>Overburdened planning and implementing without additional technical support </li></ul></ul>
    6. 6. <ul><li>MEDICARE </li></ul><ul><li>Doctors of medicine or osteopathy, doctors of dental surgery or dental medicine, doctors of podiatry, doctors of optometry and chiropractors who participate in the physician fee schedule (PFS) </li></ul><ul><li>General rule of thumb, MDs or Osteopaths who bill under Medicare Part B are likely eligible. </li></ul><ul><li>No volume requirement </li></ul><ul><li>MEDICAID </li></ul><ul><li>Doctors of medicine or osteopathy only (in some limited cases optometry </li></ul><ul><li>Nurse practitioners </li></ul><ul><li>Certified nurse-midwifes </li></ul><ul><li>Dentists </li></ul><ul><li>EPs must have 30% Medicaid patient volume to qualify (20% for pediatricians) </li></ul>EPs must choose Medicare or Medicaid Incentives
    7. 7. <ul><li>Professionals who “practice predominantly” in an FQHC or RHC may use “needy individual” volume to meet their 30% threshold </li></ul><ul><ul><li>A professional must have more than 50% of encounters that occurred at an FQHC/RHC over a six-month period </li></ul></ul><ul><li>CMS defines “needy individuals” as patients who: </li></ul><ul><ul><li>Receive medical assistance from Medicaid or the Children’s Health Insurance Program; </li></ul></ul><ul><ul><li>Are furnished uncompensated care by the provider; or </li></ul></ul><ul><ul><li>Are furnished services at either no or reduced cost based on a sliding scale </li></ul></ul>
    8. 8. <ul><li>MEDICARE </li></ul><ul><li>Acute care (or subsection d) hospitals paid under the Medicare Inpatient Prospective Payment System (IPPS) </li></ul><ul><li>Critical Access Hospitals (CAHs) </li></ul><ul><li>MEDICAID </li></ul><ul><li>Acute care hospitals </li></ul><ul><li>Children’s hospitals </li></ul><ul><li>Cancer hospitals </li></ul><ul><li>Critical Access hospitals </li></ul><ul><li>Requires 10% Medicaid patient volume to qualify (except Children’s hospitals) </li></ul>Hospitals qualify for both Medicare and Medicaid incentives
    9. 9. <ul><li>Priority: </li></ul><ul><li>Primary care providers, including physicians (Internal Medicine, Family Practice, OB/GYN, Pediatrics) and other health care professionals (NP, PA) with prescribing privileges in the following settings: </li></ul><ul><ul><li>Small group practices (10 or fewer providers with prescriptive privileges </li></ul></ul><ul><ul><li>Ambulatory clinics connected with a public or critical access hospital </li></ul></ul><ul><ul><li>Community health centers and rural health clinics </li></ul></ul><ul><ul><li>Other ambulatory settings that predominately serve uninsured, underinsured, and medically underserved populations </li></ul></ul><ul><li>55 Critical Access and Rural Hospitals </li></ul>
    10. 10. <ul><li>The Missouri Hospital Association through the Hospital Industry Data Group (HIDI) has the responsibility of working with Critical Access Hospitals to achieve Milestones 1, 2, and 3. Individual providers receive services through the HIT Assistance Center. </li></ul>
    11. 11. <ul><li>Population - 5,874,327 </li></ul><ul><li>Primary Care Providers - 5300 </li></ul><ul><li>Priority PCPs - 2400 </li></ul><ul><li>Priority PCPs Served - 1167 </li></ul><ul><li>Total Providers - 17,946 </li></ul><ul><li>CAH and Rural Hospitals - 55 </li></ul>
    12. 12. <ul><li>Team of experienced, Missouri based Health IT professionals </li></ul><ul><li>Part of a national network designated by HHS to assist providers with modernizing their practices </li></ul><ul><li>Direct, rapid and reliable access to a pipeline of key information on health IT and meaningful EHR use </li></ul><ul><li>For providers who do not have a certified EHR system - We help you choose and implement one in your office </li></ul><ul><li>For providers who already have a system - We help eligible providers meet the Medicare or Medicaid criteria for incentive payments </li></ul>
    13. 13. <ul><li>RHC recruited as pilot site based relationship </li></ul><ul><li>Their desires - support resolving challenges: </li></ul><ul><ul><li>Increase patient throughput </li></ul></ul><ul><ul><li>Resolve IT infrastructure issues </li></ul></ul><ul><ul><li>Reduce no-shows </li></ul></ul><ul><ul><li>Decrease time wasted looking for patient-information </li></ul></ul><ul><ul><li>Increase point of care documentation </li></ul></ul><ul><ul><li>Improve reporting and management of chronic/preventive care </li></ul></ul><ul><ul><li>Command attention from the vendor </li></ul></ul><ul><li>Additional observations: </li></ul><ul><ul><li>Improve staff satisfaction related to EHR use and adoption </li></ul></ul><ul><ul><li>Improve communication between clinicians and staff </li></ul></ul>
    14. 14. <ul><li>Recommendation focusing on three key areas: </li></ul><ul><li>Patient throughput </li></ul><ul><ul><li>Ensure the E H R supports patient flow </li></ul></ul><ul><ul><li>Encourage point of care documentation(at least meaningful use documentation) </li></ul></ul><ul><ul><li>Reduce patient waiting time </li></ul></ul><ul><li>User experience </li></ul><ul><ul><li>Improve system performance – uptime and speed </li></ul></ul><ul><ul><li>Consistency in documentation and work steps </li></ul></ul><ul><ul><li>Arrange training for all E H R Users </li></ul></ul><ul><ul><li>Improve document management and scanning process </li></ul></ul><ul><li>Data reporting </li></ul><ul><ul><li>Enhance management reporting capabilities </li></ul></ul><ul><ul><li>Decrease time spent in data collection activities </li></ul></ul><ul><ul><li>Implement Meaningful Use tracking tool </li></ul></ul>
    15. 15. <ul><li>Top 3 Priorities were determined after consulting with staff and physicians </li></ul><ul><ul><li>Address the issues related to point of care documentation </li></ul></ul><ul><ul><li>Command attention from vendor leadership </li></ul></ul><ul><ul><li>Coordination between IT vendor and practice </li></ul></ul><ul><ul><li>Practice administrator hired </li></ul></ul><ul><ul><li>Training on certified version </li></ul></ul><ul><ul><li>Adopting modified workflow - define process and role </li></ul></ul><ul><ul><li>Conclusion – total value of REC is TBD but one Physician reduced the time of chart completion from two weeks to one day </li></ul></ul>
    16. 16. <ul><li>Continuing Education and Training for ALL Providers </li></ul><ul><li>Vendor Selection and Group Purchasing </li></ul><ul><ul><li>Group Purchasing </li></ul></ul><ul><ul><li>Vendor Selection </li></ul></ul><ul><li>EHR Implementation and Project Management </li></ul><ul><li>Practice Workflow Analysis and Redesign </li></ul><ul><ul><li>Practice Readiness Assessment </li></ul></ul><ul><ul><li>Change Management </li></ul></ul><ul><ul><li>Workflow Re-Design </li></ul></ul><ul><li>Functional Interoperability and HIE </li></ul><ul><ul><li>Resources for Health Information Exchange </li></ul></ul><ul><ul><li>Security Risk Analysis </li></ul></ul><ul><li>Help Providers Achieve “Meaningful Use” </li></ul>
    17. 19. <ul><li>Website: http://ehrhelp.missouri.edu </li></ul><ul><li>MO HealthNet EHR Incentive Program website: http://www.dss.mo.gov/mhd/ehr </li></ul><ul><li>CMS EHR Incentive Program website: https://www.cms.gov/EHRIncentivePrograms </li></ul><ul><li>HIT Assistance Center E-Mail: </li></ul><ul><ul><li>[email_address] </li></ul></ul><ul><li>Phone: </li></ul><ul><ul><li>1-877-882-9933 </li></ul></ul>

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