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HIT-REC ServicesGold Vs. SilverWhich is Right for Me?

May 18, 2011

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Presenters:

Cathey Halsten – EHR Advisor

Michelle Brunsen – Quality Improvement Advisor

IFMC Health Information Technology REC

Regional Extension Centers

Regional Extension Centers will assist providers seeking to adopt & become meaningful users of HIT. - ARRA 2009

“Health IT is the means, not the end.”

David Blumenthal, M.D., M.P.P.National Coordinator for HIT

Regional Extension Center Program

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National goal: 100,000 primary care providers adopt health IT and achieve meaningful use by 2012 to improve patient care and safety

IFMC HIT Regional Extension Center

Heavily subsidized to work with primarycare physicians through Feb. 2014 Mission

– To work with 1,200 PCPs to become certified users by 2014

Goal– Help providers adopt and meaningfully use certified EHR technology– Help providers qualify for meaningful use incentive

payments Our Success

– Is measured by how many providers become meaningful users of certified EHR technologyMiller, R.H, et al (2004) “Physicians’ Use of Electronic Medical Records: Barriers And Solutions”. Health Affairs

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Initial Focus: Small Practices and CAHs

Physicians, PAs, NPs• Prescriptive privileges

Family Practice, Internal Med, Peds, OB/GYN in:• Individual and small group practices (10 or fewer

professionals)• Critical Access & Rural Hospitals• Community Health Centers & Rural Health Clinics• Uninsured and underserved populations

With or without an EHR6

Discuss services of Iowa’s RegionalREC

Extension Center

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THE TRUSTED HEALTH IT ADVISOR

Two scopes of services

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Gold Silver

Side by Side Comparison - Summary

Silver• 1 onsite per Milestone or

virtual hours• Email/phone access to

assigned POC• EHR Toolkit/CD

Gold• Max - 30 onsite hours• IFMC HITREC POC• EHR Toolkit/CD• Meaningful Use

Guidebook/CD• Security & Privacy Risk

Assessment Tool

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EHR Toolkit

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EHR

Toolkit

Sample of Tools Provided

Cost Per ProviderSilver

Milestone 1 - $0Milestone 2 - $0Milestone 3 - $0

Gold

Milestone 1 - $510*Milestone 2 - $410*Milestone 3 - $305*

12• One time fee

Add-ons to Silver

Security Risk Assessment

Meaningful Use Guidebook

Solo - $2502-5 Providers - $5005-10 Providers - $750

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Security Risk Assessment

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Meaningful Use Guidebook

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Add-ons to Silver

Security Risk Assessment

Meaningful Use Guidebook

Solo - $2502-5 Providers - $5005-10 Providers - $750

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Available REC Services Vendor Selection

– Selected vendor list Technical Assistance

– Meaningful use gap analysis Implementation

– Field staff support Education/Outreach

– Web site/FAQ– Webinars/face to face events

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Available REC Services• Practice & Workflow Redesign

– On-site Assessments• Health Information Exchange

– Connection and advice• Privacy & Security

– Security Risk Assessment• Consultative Resources

– Provide national resources– Best practices

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We can help you choose a vendor

Iowa REC:• Advocates for the provider

• Works with any EHR chosen by our clients• Has no financial interest in products• Does not purchase or install EHRs

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Registration

We can also help you register and complete attestation for meaningful use!

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Webinars

Ongoing Free Educational Webinars • Library of previously recorded webinars

All webinars provided at 12 noon

Register at www.IowaHITREC.org

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Available REC Services-EHR UsersAlready have an EHR?

• Focus on achieving all aspects of meaningful use• Assist with Registration and Attestation

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Can I switch services?

• As you move from milestone to milestone you can switch to gold or silver

• Your needs may change• Your advisor can give you details

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REC Timeline

In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0004/01. IA-HITREC-12/10-177

Receive Financial $$$

Design/Redesign Workflow

Sign up with the REC

Assessment & Planning

EHR SelectionPurchase EHRTraining & Go-Live Prep

Implementation & EHR Usage

Evaluation & Improvement

Achieve Meaningful Use

Quality Reporting & e-RxImproving Patient Care

REC Expanded Services

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Technical Assistance Packages•EHR Assessment & Planning•EHR Selection & Implementation (includes quality reporting & e-Rx)

•Evaluation & Improvement (meaningful use)

IFMC now offersServices for “grant ineligible” providers

Sign up with the Regional Extension Center!

You will be assigned an Advisor

It’s FREE! No risk to your clinic

Start services when YOU are ready

Cathey Halsten: chalsten@ifmc.orgwww.IowaHITREC.org

Email: IowaHITREC@ifmc.org800-373-2964

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Information and Resources

Meaningful Use Stages 2 & 3

HIT Policy Committee’s Proposed Recommendations for Eligible Professionals

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Background Information - HITPC

• As a federal advisory group, the Health Information Technology Policy Committee:• Advises U.S. Department of Health and Human Services at

ONC on federal HIT policy issues, including how to define Meaningful Use

• 1/12/11 – HITPC published its proposed Stage 2 and 3 Meaningful Use recommendations for public comment

• A 45 day public comment period ended February 25, 2011 on proposed objectives

• 3Q11: Final HITPC recommendations on Stage 2 Meaningful Use expected

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Points to Remember

• These are PROPOSED recommendations that are applied to Eligible Professionals

• Objectives that apply to Eligible Hospitals ONLY are not included here

• Stage 2 is a stepping stone to Stage 3, so Stage 3 is included for context purposes

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Core 1 - CPOE

• Stage 1 – Medication Orders – 30%• Stage 2 – Medication Orders and 1 lab or radiology – 60%• Stage 3 – Medication Orders and 1 lab or radiology – 80%

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Core 2 – Drug-Drug and Drug-Allergy Checks

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• Stage 1 – Enable Drug-Drug and Drug-Allergy Checks• Stage 2 – Employ checks on appropriate evidence-

based interactions• Stage 3 – Add drug age, drug dose, drug lab and drug

condition checking

Core 3 – eRx

• Stage 1 – Generate and transmit permissible prescriptions – 40%

• Stage 2 – 50%• Stage 3 – 80%

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Core 4 – Problem List

• Stage 1 – Maintain Problem List – 80%• Stage 2 – 80%• Stage 3 – 80% of problem lists are up-to-date

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Core 5 – Active Medication List

• Stage 1 – Maintain active medication list – 80%• Stage 2 – 80%• Stage 3 – 80% of medication lists are up-to-date

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Core 6 – Active Medication Allergy List

• Stage 1 – Maintain active medication allergy list – 80%• Stage 2 – 80%• Stage 3 – 80% of medication allergy lists are up-to-date

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Core 7 – Demographics

(Preferred Language, Gender, Race, Ethnicity and Date of Birth)

• Stage 1 – 50%• Stage 2 – 80% and can use them to produce

stratified quality reports• Stage 3 – 90% have demographics recorded

(including IOM categories)

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Core 8 – Vital Signs

(Ht, Wt, BP, calculate and display BMI, plot/display growth charts for children 2-20, including BMI)

• Stage 1 – 50%• Stage 2 – 80%• Stage 3 – 80%

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Core 9 – Smoking Status

(Age 13 and older using structured data)

• Stage 1 – 50%• Stage 2 – 80%• Stage 3 – 90%

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Core 10 – Report Clinical Quality Measures

• Measures reported to CMS or Iowa electronically• Stage 1 - 3 Core or Alternate Core and 3 Additional

Clinical Quality Measures (choose from 38 Measures)• Stage 2 & 3 – Handled by Quality Measures Workgroup

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Core 11 – Clinical Decision Support Rule

• Stage 1 – Implement 1 rule • Stages 2 & 3 – Use CDS to improve performance on

high-priority health conditions. Establish attributes for purposes of certification: • Authenticated• Credibility• Patient-context sensitive• Invokes relevant knowledge• Timely• Efficient workflow• Integrated with EHR• Presented to appropriate party who can take action

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Core 12 – Patient Health information

• Provide patients with an electronic copy of their health information (diagnostic test, problem list, medication list, allergies, discharge summary and procedures)

• Stage 1 –Upon request within 3 business days – 50%• Stage 2 – 50%• Stage 3 – 90%

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Core 14 – Clinical Summaries to Patients

• Provide clinical summaries to patients at each office visit

• Stage 1 – 50% of ALL office visits within 3 business days

• Stages 2 & 3 – Allow patients to view or download within 24 hours of encounter data in readable and structured form• Follow up tests linked to encounter included in future

summaries within 4 days of becoming available

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Core 15 – Exchange Key Clinical Information

• Exchange key clinical information electronically among providers of care

• Stage 1 – Perform test• Stage 2 – Connect to at least 3 external providers

in “primary referral network” or establish bidirectional connection to at least 1 information exchange

• Stage 3 – Connect to at least 30% of providers in “primary referral network” or connect to at least 1 information exchange

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Core 16 – Protect Electronic Health Information

• Protect electronic health information created or maintained by an EHR

• Stage 1 – Protect through implementation of appropriate technical capabilities

• Stages 2 & 3 – Additional privacy and security objectives are under consideration by the HIT Policy Committee’s Privacy and Security Tiger Team

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Menu 1 – Drug-Formulary Check

• Stage 1 – Implement check• Stage 2 – Move to core• Stage 3 – 80% of orders are checked against relevant

formularies

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Menu 2 – Advance Directive

• Stage 1 – For hospitals only.• Stage 2 – Includes EPs. 50% of patients >=65 years have

recorded in their EHR the result of an advance directive discussion and the directive itself if it exists

• Stage 3 – 90% of patients >=65 years have recorded in their EHR the result of an advance directive discussion and the directive itself if it exists

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Menu 3 – Incorporate Lab Results into EHR

• Incorporate clinical lab test results into an EHR as structured data

• Stage 1 – 40%• Stage 2 – Move to core• Stage 3 – 90% and reconcile with structured lab orders,

when available

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Menu 4 – Generate Lists of Patients by Condition

• Generate lists of patients by specific conditions for quality improvement, reduction of disparities and outreach

• Stage 1 – Generate lists by specific conditions• Stage 2 – Move to core• Stage 3 – Use the lists to manage patients for high-priority

health conditions

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Menu 5 – Reminders to Patients

• Stage 1 – 20%; For use in preventive/follow up care• Stage 2 – Move to core• Stage 3 – 20% of patients who prefer to receive reminders

electronically receive preventive or follow-up reminders

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Menu 6 – Electronic access to health information• Provide patients with timely electronic access to their

health information – include lab results, problem lists, medication lists and medication allergies

• Stage 1 – For use in preventive/follow up care within 4 business days of information becoming available

• Stage 2 – 20% of patients use a web-based portal to access their information at least once

• Stage 3 – 30% of patients use a web-based portal to access their information at least once

• Exclusions: Patients without ability to access the Internet

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Menu 7 – Identify and Provide Patient Education

• Identify and Provide patient specific education resources• Stage 1 – 10%• Stage 2 – 10%• Stage 3 – 20% and offer the resources online in the

common primary languages

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Menu 8 – Perform Medication Reconciliation

• Perform medication reconciliation at relevant encounters and transitions of care

• Stage 1 – 50%• Stage 2 – Move to core; raise threshold to 80%• Stage 3 – 90%

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Menu 9 – Provide Summary of Care Record

• Provide summary of care record for relevant transitions of care and referrals

• Stage 1 – 50%• Stage 2 – Move to core• Stage 3 – 80%

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Menu 10 – Data to Immunization Registry

• Submit electronic data to immunization registry or Immunization Information Systems (IIS)

• Stage 1 – Capability to submit and actual submission in accordance with applicable law and practice

• Stage 2 – Mandatory test and some of immunizations to be submitted on an ongoing basis to IIS

• Stage 3 – Providers to review their IIS records via their EHR

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Menu 12 – Syndromic Surveillance Data

• Provide electronic syndromic surveillance data to public health agencies

• Stage 1 – Capability to provide data and actual transmission according to applicable law and practice

• Stage 2 – Move to core• Stage 3 – Mandatory test and submit if accepted

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NEW 1 – Visits Have Electronic EP Note

• Visits have at least one electronic EP note (scanned, narrative, structured, etc.)

• Stage 2 – 30% of visits • Stage 3 – 90% of visits

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NEW 2 – Patient Preferences for Communication

• Patient preferences for communication medium recorded• Stage 2 – 20%• Stage 3 – 80%

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NEW 3 – Care Team Members Available in EHR

• Care team members (including primary care provider) available in EHR

• Stage 2 – 10%• Stage 3 – 50%; make list available via electronic exchange

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NEW 4 – Longitudinal Care Plan for Patients

• Longitudinal care plan for patients with high-priority health conditions

• Stage 2 – Record for 20% of those patients• Stage 3 – Longitudinal care plan available for electronic

exchange for 50% of those patients

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NEW 5 – Online Secure Patient Messaging

• Stages 2 & 3 – Must be in use

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Stage 3 – Proposed Recommendations

• Offer electronic self-management tools to patients with high priority health conditions

• EHRs have capability to exchange data with PHRs using standards-based health data exchange

• Patients offered capability to report experience of care measures online

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Stage 3 – Proposed Recommendations Continued

• Offer capability to upload and incorporate patient-generated data into EHRs and clinician workflow• Electronically collected patient survey data• Biometric home monitoring data• Patient suggestions of corrections to errors in the record

• Public Health Button for EP: • Mandatory test and submit if accepted• Submit notifiable conditions using a reportable public health

submission button• EHR can receive and present public health alerts or follow-up

requests• Patient-generated data submitted to public health agencies

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Contact Us

Your Meaningful Use Expert Resource!

In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0004/01. IA-HITREC-05/11-267

Michelle BrunsenQuality Improvement Advisor

mbrunsen@ifmc.org(515) 453-8180

Cathey HalstenEHR Advisor

chalsten@ifmc.org(515) 440-8284