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Electronic Health Records Statewide Review – Overview and Outcomes

Kim Salamone, Ph.D.Vice President, Health Information Technology

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Health Services Advisory Group

Quality Improvement Organization for Arizona, California, and Florida

Arizona Regional Extension Center (REC)

Dedicated to improving quality of care delivery and health outcomes through information, education, and assistance

Partners with physicians, health plans, nursing homes, hospitals

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Agenda Introductions Quality Improvement Organizations (QIOs) National Strategy for Quality Improvement HSAG’s Meaningful Use Overview to date Proposed Rule Changes 2014 Changes to Stage 1 MU Physician Quality Reporting System Barriers What to do now to prepare Q&A

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QIOs Historically, Medicare Beneficiary

Complaints (Sections 1152-1154 of the Social Security Act)

Largest federal program dedicated to improving health quality at the community level

QIOs in every state and territory CMS relies on QIOs to improve the quality

of health care for all Medicare beneficiaries

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QIOs (cont’d)

Serve as the “boots-on-the-ground” professionals working to bring about change at the local level to help achieve national goals

Convene, organize, and motivate providers and serve as change agents

Current QIO initiatives run August 2011–July 2014

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National Strategy for Quality Improvement in Healthcare

Better Care Reduce harm caused by poor-quality care.Increase patient engagement.Improve communication and care coordination.

Better Health for Populations Promote prevention and treatment of leading causes of mortality, starting with cardiovascular disease.Affordable Care Make quality care more affordable by developing and spreading new healthcare delivery models.

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Landscape is changing Healthcare industry is changing

– Public reporting of quality measures– More for less– Pay based on value

Increasing pressure on EHRs to assist in these changes

EHRs are not the magic bullet, but can be a significant instrument of change– Workflow changes– Technical issues

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EHRs for improving quality What needs to be in place for reporting? What information do you need out of your

system?– Administrative

• How many pharmaceutical samples were given out?• Which patient reminder letters need to be printed and

mailed? Or signed up for a patient portal?– Clinical

• Which patients are on ‘X’ drug, which has just been recalled?• How many patients between the ages of 50 and 79 were

screened for Colorectal cancer?• Which patients with diabetes have an HbA1C greater than 9?

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EHRs for improving business Once you have your reporting figured out:

– Know the measures – Know WHAT the variables are– Know WHERE the variables are

• Do templates need to be ‘tweaked’• Careful of the upgrades

Examine the workflow changes that may be needed (especially in documentation)

Develop policies and procedures around the documentation of the measures

Pay 4 Performance, ACA, PCMH

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HSAG’s MU Overview HSAG has worked with 341 practices/1,500 EPs• 12 Critical Access Hospitals• 4 “Other” Underserved• 1 Practice Consortium• 315 Private Practices 1-10 providers• 1 Public Hospital • 1 Rural Hospital • 16 FQHCs

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HSAG’s MU Overview: Community Health Centers

The Arizona Alliance for Community Health Centers list 19 health centers + 1 Look-Alike

Of the 20 total, HSAG is working with 17 – 15 have at least one provider that has attained MU– Assisted 353 providers reach MU

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HSAG’s MU Overview: Outside of the CHCs, HSAG has worked with

324 practices Assisted 689 providers attain MU at 281

practices reach MU– 43 of the 324 practices have no MU

providers

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HSAG Has Helped 1042 Providers Reach MU

Non-CHC Providers - 689CHC Providers - 353

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MU Timeline

EPs – Report on calendar year (January 1 – December 31)EHs – Report on Federal Fiscal Year (October 1 – September 30)*Reporting period in 2014 is 90 days (Medicare Calendar Quarter)

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Proposed Rule Changes

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2014 Changes to Stage 1 Cannot exclude the public health reporting

measure– Must meet and report on at least one

All measures must be submitted electronically for Medicare EPs– Beyond their first year – Two ways: PQRS or CMS Portal– If Medicare EPs didn’t report in 2013 for PQRS

there will be a payment adjustment in 2015

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2014 Changes to Stage 1 Must have a 2014 MU certified system

– Beyond the first year of demonstrating MU– Report 90 days instead of full year– Medicare, calendar quarter– Medicaid, unknown if calendar quarter– Allows up to 9 months to upgrade to a certified

EHR technology to the 2014 edition Must have a patient portal Providers who have met Stage 1 for two or

three years must meet Stage 2 criteria

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Stage 2 MU Overview Comparison from Stage 1 to Stage 2

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Changes to CQMs Reporting

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Stage 2 CQM Objectives Changes: 9 vs. 6, Aligned with National Quality Strategy

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Physician Quality Reporting System Tax Relief and Healthcare Act (TRHCA) Division B,

Title I, Section 101 provides statutory authority for PQRI– Originally PVRP (Physician Voluntary Reporting

Program) 2006• Claims only

– Physician Quality Reporting Initiative 2007• Claims, Registry by 2009

– Physician Quality Reporting System 2010• Claims, Registry, and EHR • GPRO

– Must have IACS account

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Physician Quality Reporting System EPs include MDs, DOs, DDSs, PAs, NPs, therapists,

etc. 2012–2014 incentives are at 0.5 percent Medicare payment reduction of 1.5 percent in

2015 2 percent in 2016 onward for not satisfactorily

reporting quality data 2015 Value-based modifier in groups over 10 2016 Value-based modifier in all practices

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CMS PQRS EHR – it’s a new day CMS embracing technical standards

– Meaningful Use– HL7’s Quality Reporting Document Architecture

(QRDA)– Patient level data, de-identified– ‘Physician Compare’

‘Qualified EHRs’ Barriers

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Barriers to Rural Health Monetary

– Patient Portal – 2014 certified EHR

Patient Engagement– Medicaid– Medicare

EHR vendors releasing 2014

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What to do now to prepare

EHR System Readiness Work Flow Changes Staff Training

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Overcoming Barriers: 2014 Editions What is the cost for the upgrade? Does your vendor have a 2014 certified

version?– Currently this is not an exhaustive list, many outpatient

EHRs are currently not 2014 certified– http://www.healthit.gov/buzz-blog/meaningful-use/certifi

ed-ehr-health-it-products-list-available/

Training on upgraded version? Workflow redesign to capture new measures? PQRS?

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Overcoming Barriers: Patient Engagement

Patient engagement– Patient Portal does not have to be through your EHR, it

does; however, have to meet certain requirements.– Explore different options and find the one that best fits

your needs.– Explore if it can interface with your EHR.– Explore using an HIO. – Discuss the portal with your patients, encourage them

to login, view their record, and send a message to the provider confirming they are able to access.

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Overcoming Barriers: Patient Broadband Access

You may be eligible for an exclusion

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Prepare Now for Stage 2

Vendor Coordination – Is your system certified for Stage 2?– When will you get upgraded?– Will your vendor train on new functionality and

reporting?

Certification Link: http://oncchpl.force.com/ehrcert?q=CHPL

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Prepare Now for Stage 2

Infrastructure Planning – Training and Testing Stage 2 Functionality in Test

Environment– Coordination of Interfaces (Labs, Radiology,

Outpatient sites, etc.)– Patient Portal

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Prepare Now for Stage 2 Workflow Review

– Assess existing workflow (as-is) and create Stage 2 workflows (to-be)

Project Management Planning – Create Stage 2 implementation schedule to cover

upgrades, training, workflow redesign, monitoring of Stage 2 achievement and attestation

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Stage 2 Resources

CMS Stage 2 Webpage: http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Stage_2.html

Tip sheets Available: – Stage 2 Overview – 2014 Clinical Quality Measures – Payment Adjustments & Hardship Exceptions (EPs & Hospitals) – Stage 1 Changes – Stage 1 vs. Stage 2 Tables (EPs & Hospitals)

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Discussion Where are you regarding Stage 1? What are your challenges moving on to

Stage 2? What does your EHR vendor say for 2014

certification? Have you started preparing for Stage 2?

– What is working?– What isn’t working?

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Stage 2 Resources CMS Stage 2 Web page (Tip Sheets are available):

http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Stage_2.html

Patient Engagement Fact Sheet http://www.healthit.gov/sites/default/files/key_considerations_for_health_information_organizations_vdt.pdf

Certified HIT Product List http://oncchpl.force.com/ehrcert?q=chpl

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Additional Questions?

Kim Harris-Salamone, PhD, MPAVice President, Health Information Technology

Health Services Advisory GroupKSalamone@hsag.com