1. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Presentation by: Cora Butler, JD, RN, CHC

2. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Overview: ARRA, HITECH, & Meaningful Use of EHR Background Incentives available under HITECH Act to eligible professionals who adopt certified electronic health records. Identify the process that practices will need to follow to become meaningful users of electronic health records. Identify the services that the Missouri HIT Assistance Center will provide to assist eligible providers become meaningful users of EHR. Distinguish between the steps practices currently using paper records need to take to become meaningful users of EHR from practices that have already implemented some form of EHR. Describe the ways in which the use of HIT supports evolving health care delivery system models focused on coordinating care and community care models such as Medical Homes and Accountable Care Organizations.

3. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" American Recovery and Reinvestment Act (“ARRA”) Amends the Social Security Act by establishing incentive payments to promote adoption and “meaningful use” of interoperable health information technology and qualified electronic health records (“EHRs”). What is the HITECH Act? The Health Information Technology for Economic and Clinical Health Act (HITECH), enacted as part of the 2009 American Recovery and Reinvestment Act (ARRA), provides guidelines for the adoption, implementation and “meaningful use” of EHRs by the nation’s health care providers.

4. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Four goals that advance the use of health information technology (HIT): Standards that allow for the nationwide electronic exchange and use of health information to improve quality and coordination of care. Incentives paid through Medicare and Medicaid to encourage the use of HIT to electronically exchange patients‘ health information. Improvements in quality of care, care coordination, and reductions in medical errors and duplicative care. Strengthening Federal privacy and security laws to protect PHI from misuse as the health care sector increases use of HIT.

5. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Stages of Meaningful Use: Stage I: Capture & Share Data Tracking key clinical conditions & communicating outcomes for care coordination Implementing clinical decision support tools to facilitate disease & medical management Reporting outcomes of public health purposes Stage II: Advanced Care Processes Decision Support Expand exchange of information Encourage use of health IT to enhance computerized provider order entry Transition in care Electronic transmission of diagnostic test results Research Stage III: Improved Outcomes Promotes improvements to quality and safety Clinical decision support with patient access & involvement Improve population health data.

6. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" How Will This Be Accomplished? The HITECH Act has set aside a pool of funds to subsidize, incentivize and facilitate the conversion to EHR systems by medical providers. The Act establishes a nationwide network of assistance centers (RECs) to help health care providers and group practices convert to and operate EHR systems that are federally compliant. The Act also sets forth significant penalties and monetary sanctions for those providers who do not achieve the “meaningful use” by 2015.

7. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Why Should Physicians Care? Adoption of EHRs by healthcare providers is a critical first step in enhancing the quality and value of healthcare in the U.S. CMS has designated specific benchmarks and timelines under “meaningful use” in terms of improving the quality, safety, and efficiency of care. By meeting the HITECH criteria for “meaningful use,” physicians and other providers can qualify for up to $44,000 from Medicare and/or $63,750 from Medicaid to offset their EHR purchase costs.

8. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" “Show me the money!”

9. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" The Medicare EHR Incentive Program Incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology begin in 2011. Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. An additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HSPA) exists. To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012.

10. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" The Medicare EHR Incentive Program EHR Reporting Periods- First payment year: any continuous 90-day period within the payment year in which an EP/EH successfully demonstrates meaningful use of certified EHR technology. After first payment year: the entire year. For implementation in 2015 and later, Medicare EPs, EHs, and CAHs that do not successfully demonstrate MU will have a payment adjustment in their Medicare reimbursement.

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12. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Medicare (Other points of note) An EP will receive 75% of the total “allowed charges” (amount paid under the PFS), up to the capped amount for the year. To get the full $18,000 in CY 2011, the MD must receive at least $24,000 compensation from the Medicare fee schedule Payment limits are 10% higher for an EP who predominantly furnishes services in a designated HPSA No minimum patient volume required.

13. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" The Medicaid EHR Incentive Program Incentive payments will be awarded to EPs, EHs, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation. Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program. Eligible hospital incentive payments begin as early as 2011, depending on when the state begins its program. The last year a Medicaid eligible hospital may begin the program is 2016. Hospital payments are based on a number of factors, beginning with a $2 million base payment.

14. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" The Medicaid EHR Incentive Program: In the first Payment Year, Medicaid providers can receive incentive payment for adopting, implementing or upgrading EHRs. Providers do not have to meet the same Stage 1 meaningful use criteria as Medicare providers are required to meet for reimbursement.

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16. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" How will providers navigate this winding road to Meaningful Use?

17. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" The first step towards eligibility in any payment year is registration with the Centers for Medicare and Medicaid Services (CMS) or the State of Missouri. For the 2011 calendar year, CMS registration will open in January 2011. The deadline for registering for the 2011 incentive payment is February 29, 2012. Registration for the Missouri Medicaid EHR Incentive Program is not yet available. Check back at http://www.dss.mo.gov/mhd/ehr EPs who qualify for both the Medicare and the Medicaid incentives can choose only one program when they register. Prior to 2015, an EP is allowed to switch to the other program one time, provided that the EP has already received at least one EHR incentive payment.

18. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Eight Steps to Becoming a Meaningful User 1. Form EHR payment program committee. 2. Assemble resources and educational material about the HITECH Act for committee members’ background reading and review. Evaluate and understand the guidelines published by CMS, focusing on the 25 “core” and “menu” objectives and measures. (15 core, which are required, & 5 additional menu objectives to choose from.) Divide criteria into: Implemented system capable, but not implemented system not capable.

19. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Eight Steps to Becoming a Meaningful User (cont.) 5. Establish milestones with key implementation goals for meaningful use compliance. 6. One-by-one, with involvement of key stakeholders, begin steps to implement “system capable, but not implemented.” 7. Assign responsibility to commence internal and external discussions, with vendors and stakeholders, regarding the expansion of system capabilities. 8. Establish, in writing, specific timeframes and action plans to meet, review, and update monthly to identify progress based on the goal of compliance.

20. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Regional Extension Centers Established to assist clinicians (physicians, physician assistants, and nurse practitioners) furnishing primary-care services. Emphasis on individual and small group practices (fewer than 10 clinicians with prescriptive privileges). Clinicians in such practices deliver the majority of primary care services, but have the lowest rates of adoption of EHR systems, and the least access to resources to implement. Additional focus assisting critical access hospitals, community health centers, and other settings that predominantly serve uninsured, underinsured, and medically underserved populations.

21. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Who is an Eligible Professional (EP) under the Medicare EHR Incentive Program? Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Podiatry Doctor of Optometry Chiropractor

22. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Who is an Eligible Professional under the Medicaid EHR Incentive Program? Physicians (primarily MDs or DOs) Nurse practitioner Certified nurse-midwife Dentist Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

23. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" The MO HIT Assistance Center guides providers as they navigate the winding road to Meaningful Use.

24. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Missouri HIT Assistance Center: A “one-stop” resource and support center to be used by Missouri health care providers in the planning, selection, design, implementation, and “meaningful use” of EHR systems. Provides consultation, technical assistance, and a platform of supportive services to health care providers and their staffs as they implement EHR systems. The goal is to accelerate provider adoption of EHR systems and help providers achieve “meaningful use”.

25. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Missouri HIT Assistance Center: The range of services and what providers can expect from partnering with the Missouri HIT Assistance Center include: Practice Assessment & Vendor Selection Group Purchasing for Technology Products & EHR Software Workflow Assessment & Redesign Education & Training Privacy & Security Best Pratices Project Management Services “Go Live” Status Consumer Protections Meaningful Use Assistance

26. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Practice Assessment and Vendor Selection: The Missouri HIT Assistance Center assists and consults with participating providers in assessing their EHR needs and in the selection of an appropriate and affordable vendor.

27. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" PRACTICE MANAGEMENT AND FUTURE EHR INFORMATION: 1. Does the practice have an electronic Practice Management System (PMS) used for scheduling and billing? Vendor______________________ Product______________________ Version #_______________ 2. Are you planning to keep your current Practice Management System, or do you plan to change? ___Change PMS to same vendor as EHR ___Implement same EHR vendor as PMS ___Keep PMS, Not Sure about EHR ___Not sure of either 3. Does anyone in your office have experiences using an EHR system Name and position)?________________________________________________________________________________

28. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" QUALITY IMPROVEMENT INITIATIVES: Does the practice currently participate in any Quality initiatives? a. ___PQRI Incentive Program. Which Providers?____________________ b. ___Electronic-Prescribing incentive program. Which providers?__________________ c. ___Chronic Disease or Preventive Care Reporting/Use of a chronic disease registry d. ___Mail/call patients to remind them of due/overdue chronic or preventive care (i.e., not just appointment reminders)? e. ___Standard treatment plans/orders for certain conditions (i.e., preventive care, diabetes, etc.)? f. ___HEDIS Reporting for health plan(s). Which health plans_______________________________________ g. ___CMS Demonstration Project. Identify______________________________ i. ___Other Quality Initiatives________________________________

29. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Group Purchasing for Technology Products & EHR Software: Created to leverage the purchasing power of a group of businesses to obtain discounts from vendors based on their collective buying power. Provides assistance with the RFP (Request for Proposal) process. Guarantees the selected vendor delivers promised services. Protection of the physicians “Bill of Rights” Certification Completion of Milestones Staff Requirements

30. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Workflow Assessment and Redesign: Support to providers and their approved EHR vendors to maintain ongoing EHR workflow assessment and redesign. Guidance in moving the practice toward “meaningful use” by achieving: Implementation and troubleshooting of EHR systems Consistent documentation of essential clinical information Electronic administrative transactions Prescribing Laboratory ordering, tracking results, & the sharing of key data across practice settings Providing patient access to their health care information, public health reporting Assuring the privacy and security of legally protected health care information.

31. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Education and Training: Provide insight on the selection and implementation of EHR technology and systems with the goal of optimizing the quality and value of health care delivery and achieving “meaningful use”, The Missouri HIT Assistance Center will provide and furnish educational materials and conduct training workshops for its participating providers and their support staff.

32. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Privacy and Security Best Practices: Services include education, consultation and technical assistance for the following: Compliance with applicable federal and state laws, rules and regulations Implementation and maintenance of physical network security, access controls, disaster recovery, encryption and storage by backup media and systems Staff training in privacy and security policy, practice and protocols Assuring the privacy and security of all medical information share and exchange media and related issues and services.

33. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Privacy and Security Evaluations: §164.502§164.514 Develop "minimum necessary" policies for: - Uses- Routine disclosures- Non-routine disclosures- Limit request to minimum necessary- Ability to rely on request for minimum necessary §164.504 Develop polices for business associate (BA) relationships and amend business associate contracts or agreements:- Obtain satisfactory assurances in contract- Document sanctions for non-compliance

34. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Project Management Services: Ongoing project management support throughout the implementation process. Such services can include: Individualized coaching, consultation and troubleshooting Assessing and achieving a health care practice’s “readiness” for EHR conversion Identifying and remediating “gaps” in an EHR system infrastructure that impede smooth data flow and delivery Configuring EHR software to meet a particular practice’s needs Providing software training for a practice’s staff Monitoring adherence to project timelines for the achievement of “meaningful use” status.

35. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" “Go Live” Status: A practice reaches “go live” status when health information collection, storage, and exchange system is up and operational. Assistance will be provided to obtain optimal efficiencies from the EHR systems and in ensuring that health care services are delivered in an organized and professional manner. The provider must use the EHR system to improve the quality of health care delivery and to adequately record those facts to qualify for receipt of the incentive payments.

36. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" “Meaningful Use” Status: The ultimate goal for a participating provider is the achievement of “meaningful use”. The criteria are based on the EHR system’s ability to do the following electronically and automatically: Use of CPOE for medication orders Conduct drug-interaction and allergy checks Record patient demographic data List current diagnoses for each patient Maintain patient medication lists Record and chart changes in vital signs Record “smoking” statuses for patients,

37. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" “Meaningful Use” Status Implement clinical decision protocols Report ambulatory quality measures to appropriate government agencies Provide patients with electronic copies of requested health information Electronically exchange and share clinical data among patient-authorized medical providers and other authorized entities Protect the privacy and security of health information and data Order and track laboratory tests and results Implement drug-formulary checks Generate patient lists by specific health conditions for quality improvement purposes

38. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Meeting “Meaningful Use” Status The MO HIT Assistance Center offers website access and support resources for: Updated sections for education and training Practice assessment Workflow redesign Implementation services Meaningful use reporting Portals and links to regional and national health information technology consortiums

39. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" EHR – New User? So Where and How Do You Start? The process of making the transition from paper records to electronic records must be given special consideration: First, you must devote time and effort toward evaluating the available systems and selecting one that meets the needs and budget of the practice. Next is the re-design of the practice’s workflow to coincide with the new technology. Then a detailed analysis of the practice work flow pre-and post-EHR implementation is needed. Gain an understanding of what each employee currently does, and what that employee will do post-implementation.

40. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" EHR – New User? So Where and How Do You Start? Once the practice is up and running providers must understand and comply with the rules set forth by HHS & CMS to qualify for incentive payments. The HITECH act recommends utilizing the RECs as consultants for selecting, adopting, and “meaningfully using” EHRs. Certified EHR technology assures users that their EHR system/module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria.

41. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Current EHR Users Seeking Meaningful Use - A Path Just for You MO HIT Assistance Center's experience in HIT & expertise in meaningful can pinpoint exactly what stands between you and meaningful use. Standardize processes and analyze reports to ensure the integrity of the data input and output, and ensure reports all meet meaningful use standards. Enable providers to maximize their EHR systems, avoid errors, and most importantly, improve health care quality and patient outcomes.

42. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Current EHR Users Seeking Meaningful Use MO HIT Assistance Center Helps Providers: Identify meaningful use barriers Identify solutions to barriers Standardize EHR processes Analyze reports to ensure data/output/report integrity Get the most of your EHR system Keep abreast of privacy & security best practices Develop EHR interoperability & health information exchange Get health information technology education and training

43. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" What’s the Future Hold? Seeing the forest through the trees!

44. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Goals of HER Implementation The goal is not just for providers to purchase and install health IT, but to make improvements in health and health care through use of health IT. This means: Increasing health care quality and safety Reducing disparities Engaging patients Improving efficiency and coordination of care.

45. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" EHR & Telehealth Benefits Telehealth makes substantial contributions in all of these areas by, providing mechanisms to share scarce resources increasing access to specialty services in rural areas, enabling remote monitoring of patients in their homes facilitating individuals’ access to clinicians who are remote from the patients and avoiding costly and unnecessary hospital admissions.

46. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Telehealth; Elements of eHealth include: Video consultation services make specialty services available to rural and other underserved areas improving health care quality and reducing disparities while also increasing convenience for patients. Nearly 50 million people living in rural areas face challenges accessing needed health care today. Home monitoring Remotely monitor a patients’ health—weight, blood pressure and other vital measures—in patients’ and providers’ hands improving chronic care management and patient engagement. Early detection of problems made possible with real time information, but not imaginable through office visits at six-month intervals avoid unneeded hospitalizations for patients with heart failure and other chronic conditions. Secure sharing and remote readingof patient information such as radiographic images on high speed channels can improve care coordination and reduce the risk of medical errors.

47. "Patient Care in an eWorld: Meaningful Use with Minimum Pain" Adoption and use of Electronic Health Records (EHRs) on a national level is becoming a reality. There can be little doubt that EHRs improve health care decision making, maximize patient outcomes and greatly eases the sharing and exchange of health care information among health care providers. Similar to the concept of meaningful use, what many of the new payment approaches share is a move away from fee-for-service payment towards a more outcome-oriented approach. This allows for adoption and use of technologies and care delivery approaches that are proven to work in improving care, engaging patients and reducing unnecessary spending

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