CGN recently offered an educational webinar on EHR and Meaningful Use for healthcare professionals. If you are interested in attending a future session, please email us at contactus@cgn.net.

1. EHR
Moving Forward Toward Implementation andg p
Meeting Meaningful Use
October 2010
10/27/2010 1CGN & Associates Confidential

2. Central Illinois ACHE Chapter Welcome
Anne Dierker
C l Illi i ACHE Ch P idCentral Illinois ACHE Chapter ‐ President
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3. Welcome
Our ObjectiveOur Objective
“Di C id ti
1
2
3
“Discuss Considerations
for Transformation to an
EHR and the Critical
4
EHR and the Critical
Security Aspects Relative
to HITECH Meaningful
Use”
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4. Introductions – Our Panel
Dennis Glavin
PMP Senior Manager CGN & Associates
Eric Epley
PMP, Senior Manager, CGN & Associates
Executive Director, Southwest Texas Regional Advisory p y
Brent Terry
, g y
Council for Trauma – STRAC
Program Manager, Southwest Texas Regional Advisory y
Mark Bidlake
g g , g y
Council for Trauma – STRAC
Associate Partner CGN & Associates ‐ ModeratorAssociate Partner, CGN & Associates ‐ Moderator
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5. Housekeeping
Have a question during the webinar?
PollingPolling
Replay
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6. Agenda
1. Overview and Highlights of EHR and
Meaningful UseMeaningful Use
2. Considerations – What Do You Need in
an EHR system?an EHR system?
3. Security – Critical and Comprehensive
4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story
5. Navigating the Meaningful Use Journey
6. Q & A
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7. Agenda
1. Overview and Highlights of EHR and
Meaningful UseMeaningful Use
2. Considerations – What Do You Need in
an EHR system?an EHR system?
3. Security – Critical and Comprehensive
4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story
5. Navigating the Meaningful Use Journey
6. Q & A
10/27/2010 7CGN & Associates Confidential

8. Why Start Now? – The Incentive Structure
• Incentive formula = ($2 Million + Discharge Payment) x Medicare Share x Payout
PercentagePercentage
• Discharge Payment = (# of Discharges less than 23,000 – 1149) x 200
• Medicare Share = (# Part A and C inpatient days / (total inpatient days x % of
h i h )noncharity charges)
• Medicare Incentives will be paid out for four years or through Reporting Year 2016,
whichever is earlier. Payouts will also grow smaller over the four‐year span. So:
For Implementations in 2011‐2013, four‐year payout percentages are 100%,
75%, 50%, 25%
2014 Implementations will pay out for three years starting at 75%p p y y g
2015 Implementations will pay out for two years starting at 50%
Post – 2015 Implementations get NO Payout
10/27/2010 8CGN & Associates Confidential

9. The Incentives Structure ‐ Example
For a hospital with:
• 2,000 total discharges a year,
• 7 000 Medicare A and C Inpatient Days
Medicare Share = 7,000 / (21,000 x .87) = 7,000 / 18,270 = .38
Discharge Payment = (2,000 – 1,149)x200 = 851 x 200 = $170,200
2011 Payment = (2,000,000 + 170,200) x .38 x 1 = $824,676
2012 Payment = (2 000 000 + 170 200) x 38 x 75 = $618 5077,000 Medicare A and C Inpatient Days,
• 21,000 total Inpatient Days,
• 87 % in noncharity charges.
2012 Payment = (2,000,000 + 170,200) x .38 x .75 = $618,507
2013 Payment = (2,000,000 + 170,200) x .38 x .5 = $412,338
2014 Payment = (2,000,000 + 170,200) x .38 x .25 = $206,189
TOTAL INCENTIVE = $2,061,690
$412,338
$206,189
$2,061,690
$2,000,000
$824,676
$618,507
$1,000,000
$1,500,000
mount to be paid
$0
$500,000
Am
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2011 2012 2013 2014 Total Incentive
Year of Payment

10. Why start now? ‐ Penalties
Penalties begin in 2015:
¾ of market basket¾ of market basket
reduced by 33.33 %
2015
2016
¾ of market basket
d d b 66 66 %reduced by 66.66 %
2017
and beyond
¾ of market
basket
reduced
by
100%and beyond
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11. Why start now? – Operational Benefits
Patient
Security Interoperability
Patient
Outcomes
Operational Benefits
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12. Agenda
1. Overview and Highlights of EHR and
Meaningful UseMeaningful Use
2. Considerations – What Do You Need in
an EHR system?an EHR system?
3. Security – Critical and Comprehensive
4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story
5. Navigating the Meaningful Use Journey
6. Q & A
10/27/2010 12CGN & Associates Confidential

13. The Good News – Stage One focus is clear
As of 28 July, 2010, Stage 1 Objectives for Compliance of
Meaningful Use for Hospitals have beeng p
REDUCED SIMPLIFIED BENCHMARKED
The Result is:
14 Mandatory Objectives
5 Elective Objectives (from a list of 10)
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5 Elective Objectives (from a list of 10)

14. Fourteen Core Objectives – By Category
Accuracy Security Interoperability
• Record Demographics
• Implement One Clinical
Decision Support Rule
Relevant to Specialty or
• Computerized Physician
Order Entry (CPOE)
• Provide Patients with a
Copy of Discharge
• Report Clinical Quality
Measures to CMS/States
• Exchange Key Clinical
Information among
High Clinical Priority
• Maintain Active
Medication List
• Maintain Updated
Instructions Upon
Discharge/Upon Request
• Provide Patients with an
Electronic Copy of Health
I f i R
Providers of Care and
Patient‐Authorized Entities
Electronically
Problem List of Current &
Active Diagnoses
• Maintain Active
Medication Allergy List
Information upon Request
• Protect Electronic
Information
• Implement Drug Allergy
Checks
• Record and Chart Changes
in Vital Signs
d k f• Record Smoking Status for
Patients 13 and Older
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15. Menu of Elective Objectives – By Category
Accuracy Security Interoperability
• Drug Formulary Checks
• Incorporate Clinical Lab
Results as Structured Data
G Li f P i
• Provide Patients with
Timely electronic access to
records
• Submit electronic data to
immunization
registries/systems
• Summary of care record• Generate Lists of Patients
by Specific Condition
• Record Advance Directives
for Patients 65 or Older
U tifi d EHR
• Summary of care record
for each transition of care
• Provide electronic
syndromic surveillance
data to public health• Use certified EHR
Technology to identify
patient‐specific education
resources and provide to
patient as appropriate
data to public health
agencies
patient as appropriate
• Medication reconciliation
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16. For more information
Nancy Draper
CGN & Associates ndraper@cgn.net
309-472-4473
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17. The long range goals are still taking shape
As of 28 July, 2010, the Stage 2 and 3 Objectives are not yet clear
Expected 2013 Objectives
Patient/Provider
Secure Messaging
Generate and
i l i
Expected 2015
Objectives
Transmit Electronic
Prescriptions
Report to External
Di R i t iObjectives
Real‐Time Patient
Access to Records
Medical Device
Disease Registries
Upload Data from
Home Monitoring
DevicesMedical Device
Interoperability
Access Comprehensive
Patient Data from All
Devices
Patient Data from All
Available Sources
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18. Agenda
1. Overview and Highlights of EHR and
Meaningful UseMeaningful Use
2. Considerations – What Do You Need in
an EHR system?an EHR system?
3. Security – Critical and Comprehensive
4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story
5. Navigating the Meaningful Use Journey
6. Q & A
10/27/2010 18CGN & Associates Confidential

19. Security – Why You Should be Concerned
After 2011, multiple parties (other than employees) will
potentially have access to your systems
In return YOU will have access to systems you could not
previously access
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20. Authentication Options
Method
User
Familiarity
Expense
Subject to
Compromise
Ease of
Unauthorized Use
Degree of
RepudiationFamiliarity Compromise Unauthorized Use Repudiation
Password High Very Low High Very High High
T k I t di t I t di t Hi h V Hi h Hi hToken
(Key Fob)
Intermediate Intermediate High Very High High
Token
(Smartcard)
Intermediate High High Very High High
(Smartcard)
Biometric Low High Very Low Very Low Very Low
Two‐Factor Low Intermediate Very Low Very Low Very Low
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21. Authentication Recommendation
Smartcards with “two factor authentication” offer “best‐in‐class” for
user securityuser security
– Large Storage Capacity on the Chip
– Can be configured to require both pin code AND biometric
confirmation
– Strong Encryption on the Chipg yp p
– Precedent for Use in high – security environments
• Department of Defense
• State, Local, and Tribal Emergency Responders
• E‐Prescription for Controlled Substances
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22. Agenda
1. Overview and Highlights of EHR and
Meaningful UseMeaningful Use
2. Considerations – What Do You Need in
an EHR system?an EHR system?
3. Security – Critical and Comprehensive
4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story
5. Navigating the Meaningful Use Journey
6. Q & A
10/27/2010 22CGN & Associates Confidential

23. STRAC ‐ About Us
Trauma Coordination for 22 countries in
Southwest Texas (includes San Antonio)Southwest Texas (includes San Antonio)
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24. STRAC – Successful Security for EHR
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25. STRAC Strategy – Start with Existing Infrastructure
Existing cards used for securing emergency rooms
(Physical Access Control ‐ PAC)
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26. STRAC Strategy – Multi use
Useful every day – loss prevention
EHR Access
Parking LotParking Lot
Doctors Lounge
Hospital after hours access
Joint Commission Requirements
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27. STRAC Policy ‐ Tiers
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28. STRAC Policy ‐ Communication for Buy‐in
Brochure and FAQ
document widely
distributed
Project update sent
through BCMS blast‐fax
when delays encountered
Project leadership attended
Med Exec committees
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29. STRAC Technical – One Card
New Phase 2 Card:
• FIPS201 Standard introduced
• Added computer access control capabilities
• Backward compatible with Version 1 capabilities
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Backward compatible with Version 1 capabilities
• Changed business process for enrollment

30. STRAC Technical ‐ Computer Access
Emergency Room computers fitted with card reader forEmergency Room computers fitted with card reader for
computer access control
Single PIN to access all 15 applications used in the ER
Efficiency gains
Success led to rollout in other ERsSuccess led to rollout in other ERs
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31. STRAC Logistics ‐ Enrollment
• All ph sician cards are Gold cards ith• All physician cards are Gold cards with
computer access capabilities
• Enrollment tour: 2300+ physicians
enrolled in less than 6 weeks
• IT / Physician Services Directors /
Security Directors participate in y p p
issuance plan development
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32. STRAC ‐ Lessons Learned
Everyday use very importanty y y p
Communication important
Build on small successes ‐ avoid big bang theory of project
Multiple organization and department participation in
planning is very important
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33. Agenda
1. Overview and Highlights of EHR and
Meaningful UseMeaningful Use
2. Considerations – What Do You Need in
an EHR system?an EHR system?
3. Security – Critical and Comprehensive
4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story
5. Navigating the Meaningful Use Journey
6. Q & A
10/27/2010 33CGN & Associates Confidential

34. Your Journey, and Managing the Change Process
The three most fundamental questions
Wh ? Wh i ?Where are we? Where are we going?
How are we going to get there?
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35. How are we going to get there?
And how is our organization experiencing the journey?
It depends on the leadership we provide,
and on how well we manage the change processand on how well we manage the change process
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36. Leaders keep the vision clear and in focus
Some aspects of “the blue dot” are certain
Healthcare will transform itself using technology
Interoperability the norm
Cli i l d ti l t d di tiClinical and operational standardization
Changed processes, practices, roles, structure, relationships, culture, rewards
Greater transparency, accountability, and performance‐based compensationp y, y, p p
Dramatic improvements in patient safety, care, productivity, health outcomes
Costs will be significantly reduced, to a globally competitive level
This is certainly not about replacing paper files with electronic files
Shared information will accelerate shared knowledge & learning
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37. Principles of organizational change provide direction
1. How problems and goals are framed has significant impact on outcomes
EMR or EHR or EHMS or Healthcare Transformation
Compliance or Continuous Innovation in Care
1. How problems and goals are framed has significant impact on outcomes
2. Elements are interdependent; change requires a holistic approach.
Compliance or Continuous Innovation in Care
3. People are not by nature averse to change, but do tend to strongly resist change
imposed upon them. People support what they help to create.
4. Leaders are an important part of the system, and change involves them too.
5. Effective organizational change management greatly increases the likelihood of g g g g y
successful change efforts
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38. Executive alignment & active support is essential
Full C‐ suite interest, active support &
commitment is needed to:
build a shared visionbuild a shared vision
shape the strategy for moving forward in
face of unknowns & turbulence
instill a sense of urgencyinstill a sense of urgency
from the core of a powerful coalition for
change
identify and address organizationalidentify and address organizational
readiness issues
provide necessary resources and support,
remove roadblocksremove roadblocks
The first task of executive management is to frame the goal as a long range
enterprise one, rather than an IT project
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39. Program/project management provides structure
An effective program management unit:
Key Issues
• Getting buy‐in of IT practitioners
Provides a governance process that
guides the entire journey
Enables a single view of the
Getting buy in of IT practitioners
• Ensuring executive support through
the multi‐year journey
• Cultural impediments (reactive, silos)Enables a single view of the
corporate portfolio
Drives improved quality and velocity
of project execution and delivery of
Cultural impediments (reactive, silos)
• Stepping up the pace
• Balancing quick wins with big picture
• S i i i i ibusiness outcomes.
Becomes a Center of Excellence for
PM, BA OCM disciplines:
• Sustaining ongoing communications
• Adoption of common processes, tools
and standard metrics (esp in multi‐site)
• I d h (d 1)
Provides Executive Information and
Reporting structure and Dashboards
• Integrated change management (day 1)
• Continuous improvement post go‐live
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40. • Job specific skills
Involvement, communications, training enables systemic change
• Job‐specific skills
• Applications, tools, process/ work flow training
• Org integration, relationship changes
• Continuous improvement & reinforcement
• Cross‐functional design teams
High
g
• Process & workflow design
• Job role , org, other changes
• Systems development
• Pilots , hands‐on trials, refinemt
Acceptance
oductivity
• Clear future state picture
• See around the corner
• Individual impacts & change process;
taking ownership
• Build critical mass & momentum
Level of
and Pro
• Convey Mgmt Expectations
• Overall Vision & Goals
• Imperatives for change
• How staff can engage
• WIIFMWIIFM
Low
Project/Change Timeline
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41. Agenda
1. Overview and Highlights of EHR and
Meaningful UseMeaningful Use
2. Considerations – What Do You Need in
an EHR system?an EHR system?
3. Security – Critical and Comprehensive
4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story
5. Navigating the Meaningful Use Journey
6. Q&A
10/27/2010 41CGN & Associates Confidential

42. Agenda
1. Overview and Highlights of EHR and
Meaningful UseMeaningful Use
2. Considerations – What Do You Need in
an EHR system?an EHR system?
3. Security – Critical and Comprehensive
4 Use Case STRAC Tells Their Stor4. Use Case – STRAC Tells Their Story
5. Cultural and Organizational
TransformationTransformation
6. Q & A
10/27/2010 42CGN & Associates Confidential

43. Transformation to EHR
Questions
Answers
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44. Thank you!
Contact Information:
Mark Bidlake,
Associate Partner
CGN & Associates
Two Mid America Plaza, Suite 915
Oakbrook Terrace, IL
Eric Epley, Executive Director
STRAC – Southwest Texas Regional
Advisory Council for Trauma
7500 Hwy. 90 West
AT&T Building, Suite 200,
630/368‐7810
ext:5002
mbidlake@cgn.net
g,
San Antonio, TX 78227
210/822‐3888
eric@strac.org
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