1. HITECH and Meaningful Use:
The Impact on the Future of Healthcare
Technology Management
Amy Walker MS, RN, CPHQ, FACHE, NEA-BC
CEO OptimizeIT Consulting
Healthcare IT Strategist
Past Member HIMSS Public Policy Committee
2. What We Will Cover…..
• Relate the components of The HITECH Act and
Meaningful Use to health management technology
• Identify whether existing systems meet requirements
• Communicate technology needs and request feedback
from end users for a smooth transition
• Implement best practices to move people and systems
forward under these new requirements
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3. The Foundation
Your EcoSystem
Vision , Mission, and Strategic Goals
Communication
New Clinical Informatics Initiatives
Clinical Informatics
Healthcare Operations
Communication
Information Technology
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4. Leading from good to great does not mean coming
up with the answers and then motivating everyone
to follow your messianic vision. It means having the
humility to grasp the fact that you do not yet
understand enough to have all of the answers and
then to ask the questions that will lead to the best
possible insights.
(Jim Collins, Good to Great)
5. Your mind is like a parachute-
It only works when open
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6. What This Presentation Is
Not About
The thoughtless application of IT, for slash and
burn downsizing, restructuring,
and outsourcing.
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7. A quick trip down memory lane …
• President Bush’s goal in 2004
“… an Electronic Health Record for
every American by the year 2014. By
computerizing health records, we can
avoid dangerous medical mistakes,
reduce costs, and improve care.”
- State of the Union address,
Jan. 20, 2004
• Executive order established the Office of the National
Coordinator for Health Information Technology (ONCHIT)
as part of the Dept of Health & Human Services (HHS)
– Dr. David Brailer appointed the first National Coordinator
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8. HITECH Act? hmm, sounds familiar…
• Signed into law February 2009
as part of ARRA
• Goal
– 90% of U.S. physicians and 70% of
hospitals using EHR by 2019
• How?
– Provide $19 Billion to doctors and
hospitals through DHS to
implement EHR by 2011
9. ARRA
• HITECH Care • Comparativeness
• Care Coordination Effectiveness
• Disease Management • Meaningful Use
• Value-based Purchasing • Public Reporting and
• Bundled Payment Accountability
• Medical Home • Reward Top Performers
• Penalize Bottom
Performers
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10. ARRA EHR Adoption –Incentive Requirements
• To encourage broad adoption of EHRs, ARRA offers
reimbursement to eligible providers/hospitals who meet
two requirements:
– Acquire a certified EHR product or service
– Demonstrate that the organization or provider are using that
product/service “meaningfully”
• ARRA creates HIT Policy and HIT Standards Committees
which must recommend:
– Criteria for certifying EHR products
– Criteria for demonstrating that an applicant is using the EHR
meaningfully
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11. Why are We Here?
• 2011
• 2013
• 2015
• Improve quality, safety, efficiency, and reduce health
disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population and public health
• All the while maintaining privacy and security
12. HITECH Framework for MU of EHRs
Taken from: Blumenthal, D.
“Launching HITECH,” posted
by the NEJM on 12-30-2009.
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13. MU Measures Quality Measures
VTE - 1 VTE Prophylaxis within 24 hours of Stroke - 2 Ischemic Stroke - Discharge on
arrival Antithrombotics
VTE - 2 VTE Prophylaxis within 24 hours of Stroke - 3 Ischemic Stroke - Anticoagulation for
arrival to ICU A-Fib/Flutter
VTE -3 VTE Diagnosis - Anticoagulation Stroke - 4 Ischemic Stroke - Thrombolytic
Overlap Therapy therapy for patients arriving within 2
hours of symptom onset
VTE -4 VTE - Platelet Monitoring on Stroke - 5 Ischemic or Hemorrhagic Stroke -
unfractionated Heparin Antithrombotic therapy by day 2
VTE - 5 VTE - Discharge Instructions Stroke - 6 Ischemic Stroke - Discharge on
Statins
VTE - 6 VTE - Incidence of potentially Stroke - 8 Ischemic or Hemorrhagic Stroke –
preventable VTE Education
ED - 1 ED throughput-arrival to departure Stroke - Ischemic or Hemorrhagic Stroke -
for admitted patients 10 Rehabilitation Assessment
ED – 2 ED throughput - Admit decision time
to ED departure time for admitted
patients.
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15. HITECH Incentives for Hospitals – Medicare
Example
Four Year CMS Health IT Incentive Payment Scenarios:
Example Numbers If the first qualifying year is:
(millions) 2011 2012 2013 2014 2015 2016
2011 $20 $0 $0 $0 $0 $0
Maximum 2012 $15 $20 $0 $0 $0 $0
Medicare
health IT 2013 $10 $15 $20 $0 $0 $0
incentive 2014 $5 $10 $15 $15 $0 $0
payment
for this 2015 $0 $5 $10 $10 $10 $0
year is: 2016 $0 $0 $5 $5 $5 $0
2017 $0 $0 $0 $0 $0 $0
Penalties
Total of Maximum over 4, 3,
begin
or 2 Years' Medicare Health $50 $50 $50 $30 $15
IT Incentive Payments
100% 100% 100% 60% 30%
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16. Current State for EMR Adoption in Home Health
• Over 80% use telemonitoring devices – from lo tech to hi tech
• EMR Technology Levels* (2007 survey data)
– 43% use EMR systems with following functionality
• Patient demographics 95%
• Point of care clinical documentation 29%
• Clinical notes 34%
• Clinical decision support 23%
• Record MD orders 50%
– 31% in process
Resnick, H.E., and Alwan, M. (2010). Use of health information technology in home health and
hospice agencies: United States, 2007. Journal of the American Medical Informatics
Association 17(4):389-395.
17. What Does It Mean?
• Increased reliance on IT
• Greater need for informatics professionals
• SWOT analysis should come sooner rather than later
• Suddenly, certifications matters more than ever
• More governance / new regulatory and reimbursement
guidelines
19. Healthcare
Reform
Patient Care Meaningful
Care
Use of
Providers Advancements Technology
Clinical
Engineering
20.
21. Goals of Healthcare Reform
• Improve quality, cut costs
– Accountable Care Organizations
• Larger insurance footprint
• Not predetermined
• Focus on value
• Shift to outpatient care
• Data driven problem solving
• Refocus on fraud
• Growing information technology footprint
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22. • Medicare • Health
Accountable Insurance
Care Exchanges
Organizations • Medicare (electronic
• Medicare Value- Bundle eligibility)
based Payment • Reduced
• Proposed CMO Purchasing Medicare
• Reduced Pilot Payments for • Medicare
ACO rules • ICD-10
Medicare Hospital Expenditures
published Payments for Conversion acquired Capped
Hospital Infections
Readmissions (HAI)
2011 2012 2013 2014 2015
• Meaningful • Meaningful • Medicare
payment
Use Stage 2 Use Stage 3
adjustment
• Advanced Improved begins for
Clinical Outcomes non
Process meaningful
users of IT
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23. Accelerating Health Care Value
“Readiness for change is one of the hardest
problems we face”, Paul Tang, HIT Policy Committee vice chair and Palo
Alto Medical Foundation vice president and chief medical information officer.
“To realize our vision, we must foster a
pervasive culture of innovation”, Douglas D. French, former
Ascension Health president and chief executive officer.
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24. Your EcoSystem
Vision , Mission, and Strategic Goals
Communication
New Clinical Informatics Initiatives
Clinical Informatics
Clinical Operations
Communication
Information Technology
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25. Health IT Strategic Framework
Transfor- Innovation
mation
Engine
Information
Technology
A learning health system is patient centered and uses information to continuously
improve health and healthcare of individuals and the population
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26. Meaningful Healthcare Reform A Journey
Industrial Strength
LEADERSHIP & MANAGEMENT
• Complete an enterprise assessment of the
organizational readiness to reform
Enterprise • Evaluate the present situation, identify
Clinical & recommendations, and best practices to optimize the
Commitment Operational future state
and Leaders
Accountability • Identify obstacles, challenges, sources of issues, and
needed changes
• Identify indicators of healthcare reform and
changes in order to maximize operational
Communication performance
Transformational
Readiness • Create and heavily emphasize an EFFECTIVE &
INNOVATIVE change management and
communication plan
• Create a practical benefits realization plan
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27. Healthcare
Reform
Patient Care Meaningful
Care
Use of
Providers Advancements Technology
Clinical
Engineering
28. Certified EHR Technology
• Office of the National Coordinator for Health
Information Technology has approved two entities as
able to review and certify EHRs
– Certification Commission for Health Information
Technology (CCHIT)
– Drummond Group Inc.
• Unless your current system is homegrown, piecemeal
or older, your EHR vendor is likely already pursuing
certification
• (and/or trying to sell you a new or upgraded system – which they
promise will be certifiable)
29. Aurora Health Care HITECH Gap Analysis
Look at each MU Criteria (and Gap) in 3 ways:
1. Technology – do you need software installed?
2. Adoption – do you have the required adoption?
3. Ability to Measure – can you measure?
Use these same categories in the
Work Plan for tracking
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33. Today’s Privacy and Security Environment
Covered Entities
Physician
Portal
Medical Homes
Personal
Primary Care Healthcare
Physician Records
Medical Log
Exercise Log
Laboratories
Medical Homes
Accountable Care
Patient
Organizations
EMR Outpatient Care
Medical Homes
Social Worker Wellness Centers
Pharmacy
Medical Records
Emergency
Payer Clinical Image Records
34. Increase in HIPAA Penalties
Under the ARRA:
All such violations of an identical provision in a calendar year
(A) Did Not Know ............................................. $100 $50,000 $1,500,000
(B) Reasonable Cause ..................................... 1,000 50,000 1,500,000
(C) Willful Neglect—Corrected ........................ 10,000 50,000 1,500,000
(C) Willful Neglect—Not Corrected .................. 50,000 1,500,000
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35. A Sample of Questions for HIPAA-Security Assessment
• What is our single vulnerability from a technology or security
point of view?
• How vulnerable are we to attack on confidentiality, integrity,
and availability of our data and systems?
• What is the assessment of physical security controls at each of
our sites (data center, home office, field offices, and other
sites?
• How prepared are our incident response plans?
• Have we protected our company in contracts with vendors?
• Do we understand what PHI we produce, capture, store,
transport, and destroy?
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37. HITECH Drives US Standards Efforts
• Goal: Transform healthcare through the
meaningful use of health data
• Data capture data sharing advanced clinical
processes
Improved Outcomes
• Requires organized structuring and effective use
of information to support decision making
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38. Need for Health Data Standards
• Standards are foundational to development,
implementation and exchange of EHRs
• Clinicians need ubiquitous access to health
information to provide optimal care
• Providers, payers and public health entities must
exchange health information between
departments, across organizations and agencies
• Consumers need assurance that caregivers have
seamless access to correct information
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39. What are Data Standards?
They are standards
having to do with the
structure and content
of health information
Data + Context + Structure Information
Information + Rules + Analysis Knowledge
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40. ONC Standards and Interoperability Framework
Standards Pilot Demonstration
Development Projects
Use Case Development
Harmonization of Implementation Reference Certification
and Functional
Core Concepts Specifications Implementation and Testing
Requirements
Tools and Services
(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)
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42. ICD-10 Compliance Impact
• International Classification of Disease 10th Revision
• federally mandated by October 1, 2013 for all providers
• more flexible code set expands for new procedures, diagnoses and
technologies
• greater specificity translates to improved quality measurements and patient
safety standards
• Impact to include:
• Coding Medical Records/Health Information Management
• Registration/Scheduling
• Encounter Forms/Charge Tickets
• Clinical Documentation
– Information Systems; including EHR’s
…the entire Revenue Cycle
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44. Home Health Today
3.3 million seniors receiving care on any given day – over 14 million
per year*
• Over 10,000 agencies – coverage in every state
• Approx 1 million clinicians; multidisciplinary
• Most provide specialty programs
– Diabetes, Congestive Failure, COPD, Stroke
– Patient centered, self management focus
• Many specialize in geriatrics
• Lowest cost/best outcomes in chronic care management for
elderly**
*Medicare Payment Advisory Commission. (2011)
http://www.medpac.gov/documents/Mar11_EntireReport.pdf
45. Literature Shows
• Seniors do better at home for acute care on clinical
outcomes, costs, satisfaction
• Transitioning elders from acute to home with teaching for self
management and f/u more effective, low readmission rates
• Use of telemonitoring in home for CHF and cardiac patients
w/PHR show optimal recovery and self management results.
46. Aging Demographics
• 7000 Baby Boomers turning 65 yrs every day
• 2011 Legislature targeting Medicare and
Medicaid cuts
• Current CMS spending and Baby-Boomer
impact vs. national fiscal goal of deficit
reductions
• HH positioned to provide highest quality and
best outcomes in care delivery for our elder
population
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47. Key Initiatives in ACA
(CBO est. 13.5b savings 2011-19 Sec 3021-3027)
• CMI – Center for Medicare and Medicaid
Innovation – launched November, 2010
• Hospital at Home – for elderly
• Care Transition Program Pilot
• Readmissions Reduction Program
• Accountable Care Org/Bundling Pilots
48. Healthcare
Reform
Patient Care Meaningful
Care
Use of
Providers Advancements Technology
Clinical
Engineering
49. Clinical Engineering
The Clinical Engineering Department provides multiple services to ensure that
the medical equipment needs for patients and staff are met. We provide
services with accuracy and integrity.
– Provide installation, preventive maintenance
– Provide mandatory pre-use inspections
– Performs investigations
– Provides assistance in the disposal of medical equipment
– Provides for in-service training and support
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50. Perhaps Clinical Engineering Might Also Focus On
• Identifying improvement opportunities
• Participating in information technology and management
strategy
• Optimization in the use of devices
• Rounding to ensure feedback and evaluation of device
usage
• Expert resource in care coordination: technologies,
equipment and information flow
• Expert resource in equipment, process, and information
flow for meaningful use, and
• Expert resource for teams defining information technology
management
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51. It’s Not What We Don’t Know
That Hurts, It’s What We
Know That Isn't So
Will Rogers (1879-1935)
52. “Systems Thinking is a discipline for seeing
wholes, recognizing patterns and
interrelationships, and learning
how to structure those
interrelationships in more
effective, efficient ways.”
Planning for Quality the Systems Thinker
Senge, P., & Lannon-Kim, C., 1991
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53. Five Dysfunctions of a Team
• Absence of Trust
• Fear of Conflict
• Lack of Commitment
• Avoidance of Accountability
• Inattention to Results
• Identify the behaviors?
• How do you know that these have been
overcome? The Five Dysfunctions of a Team: A Leadership Fable, San Francisco;
Jossey-Bass, 2002
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54. Lean Incorporated into Our Teams
• People first
• Flexibility
• Walking the Talk
• Our colleagues are assets
• Always provide value
• Mentor and coach
• Bridge organizational boundaries
• Adjustments made as work flow indicates
• Applies frontline feedback
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55. Listening Techniques
• Clarify-get more information
• Restate-check the meaning
• Remain neutral-convey interest
• Reflect-help them evaluate their feelings
• Summarize-bring the discussion into focus
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56. Are the skills, knowledge, and experience of the
actors well matched with the tasks they are
asked to perform?
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57. It is only after I have read, identified, and
stimulated your needs that I will be able
to energize our discussions while
irresistibly presenting my ideas to you.
(Robert Mayer, How to Win Any Negotiation)
58. Power/Influence is the ability to get people to
perceive that a given behavior (or performance) is the
best action they can take in the service of their values.
59. Healthcare
Reform
Patient Care Meaningful
Care
Use of
Providers Advancements Technology
Clinical
Engineering
60. Care Providers
• At risk and accountable
• Will prepare for multiple reform outcomes
• Forge new partnerships
• Reliance on valid performance vs. faulty
• Increase in training
• Empowered to lead improvement
• Decrease in the size of the pie
• Increase in reliance in technology
• Driven by incentives and penalties
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61. It Is Not The Strongest Who Survive, Or The Fastest.
It Is The Ones Who Can Change the Quickest.
Charles Darwin
62. Care Providers Must Simplify Communication
• Payer to • Patients as
Employee Consumers
• Payer to
Consumer
• Payer to
Employee
Interoper- Meaningful
ability Data
Adherence Decision
Compliance Support
• Provider to • Provider to Provider
Consumer • Specialty to
Specialty
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66. Accountable Care Organizations
A concept that has the potential to revolutionize
the way healthcare is delivered, experienced, and
paid for in America.
– Care coordination
– Patient centered using to the full extent all health care
professionals
– Respects patient centeredness by respecting patient
choice of provider and shared decision making
– Positive patient experience
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67. Medical Home
Six medical home standards
– Enhance access and continuity
– Identify and manage patient populations
– Plan and manage care
– Provide self-care and community support
– Track and coordinate care
– Measure and improve performance
• E-Visits
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68. Innovative Systems
The Vscan by GE, is a new
mobile device designed for
doctors who are making
house calls.
FutureScan 2011: Healthcare Trends and Implications 2011 - 2016
Society for Healthcare Strategy and Market Development / Health Administration Press January 2011
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69. Innovative Systems
AirStrip Technologies, has built its
revolutionary AppPoint™
software development platform
with a vision of securely sending
critical patient information
directly from hospital monitoring
systems, bedside devices, and
electronic health records to a
clinician's mobile device.
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70. Further Impact to Information Systems
• Zero tolerance for negative unintended consequences will be
identified and resolved
• Increased support to care coordination
• Increased certification criteria based on measurable
achievements
• Mathematical and logical models will become the norm to
support healthcare reform
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71. Perhaps Clinical Engineering Might Needs to Focus On
• Identifying improvement opportunities
• Participating in Information technology and management
strategy
• Optimization in the use of devices
• Rounding to ensure feedback and evaluation of device usage
• Expert resource in care coordination: technologies,
equipment and information flow
• Expert resource in equipment, process, and information flow
for meaningful use
71
72. Perhaps Clinical Engineering Might Needs to Focus On
• Identifying improvement opportunities
• Participating in Information technology and management
strategy
• Optimization in the use of devices
• Rounding to ensure feedback and evaluation of device usage
• Expert resource in care coordination: technologies,
equipment and information flow
• Expert resource in equipment, process, and information flow
for meaningful use
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73. Health IT Strategic Framework
Enterprise
Commitment
and
Accountability
Organizational
Transfor-
Readiness A mation
Innovation
Pervasive Engine
Culture
Information
Technology
A learning health system is patient centered and uses information to continuously
improve health and healthcare of individuals and the population
73
74. Implement best practices to move people and systems
forward under these new requirements
• Industrial strength leaders
• Industrial strength organizations
• Un-ending curiosity and fact finding
• Ability to project what-if scenarios
• Ability to simplify every process
• Ability to act lean
• Zero tolerance for waste
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75. Closing Thought…
We can build high performance
t e a m s t h a t t o g e t h e r, d e t e r m i n e a n d
implement the requirements for
healthcare organizations that operate
as innovation engines, transforming
p e o p l e , t e c h n o l o g y, a n d p r o c e s s e s t o
advance healthcare reform.
We realize it begins with us.
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76. Thank you!
For more information, please contact:
awalker@optimizeitconsulting.com or
703-283-4678
