increase patient impact via electronic health records (ehr) · • downstream ehrs will allow...

Increase Patient Impact Via Electronic Health Records (EHR)

October 1, 2014

Mukesh Mehta, DPh, MBA, RPh Vice President, Clinical & Regulatory Solutions 201.358.7538 | [email protected] Dale Cooke, PhillyCooke Consulting 267.971.8826 | [email protected]

mailto:[email protected]

mailto:[email protected]

Confidential - ©2012 PDR Network, LLC. All Rights Reserved. "PDR" and "Physicians' Desk Reference" are registered trademarks of PDR Network, LLC 2 2 ©2014 PDR Network, LLC. All Rights Reserved. Confidential

• Introduction

• Market Drivers

• Electronic Health Record (EHR) Adoption

• Federal Meaningful Use (MU) Requirements

• Patients Portals and MU2 Patient Education/Reminders Requirements

• Options for Fulfilling MU2 Patient Education/Reminders Requirements

On the Menu


• Introduction

• Market Drivers





On the Menu


• On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) and Health Information Technology for Economic and Clinical Health (HITECH) Act

• Over $60 billion in incentives and grant money to stimulate healthcare information technology (HIT) adoption

• First time state-based Medicaid programs and Departments of Health became major purchaser of HIT

• This act seeks to bolster health IT to improve the delivery of healthcare in the United States

• With various provisions and regulations, the Act provides financial assistance, tools, and resources to HCPs to allow for implementation and utilization of EHR

• Pay-for-performance (P4P) programs and other quality initiatives

ARRA and HITECH Act


Drivers of EHR Adoption by U.S. Providers

Physician’s EHR Choice:

1. Eligible professionals can be paid up to $44,000 over 5 years through Medicare and up to $63,750 over 6 years through Medicaid to adopt EHR demonstrate meaningful use – Additional dollars from health plans and cost savings

2. Refuse these incentives, don’t adopt EHR and suffer CMS penalties – Mounting costs for quality reporting in paper – Challenges in recruiting MDs or selling practice


• Introduction

• Market Drivers





On the Menu


Adoption of EHR Systems by Office-Based Physicians

Source: CDC/NCHS, National Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey , EHR Survey, NCHS Data Brief, January 2014

• Rapid rate of adoption projected due to Meaningful Use (MU) incentives and penalties

• Adoption of EHRs increases with the size of the physician practice as the costs can be spread out over a larger group of people

• Those under age 50, 64% were adopters, while about 50% of those over age 50 were adopters


Electronic Prescribing Use

• With 73% of office-based physicians actively e-prescribing, more than one billion prescriptions were routed electronically in 2013, a 32% increase in volume over 2012 and almost double the total in 2011

• Internists were the leaders by Specialty Practice with 96% e-prescribing in 2013

Source: Surescripts: The National Progress Report, 2013

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

0

250

500

750

1000

1250

2009 2010 2011 2012 2013

eRx Renewals

New eRx

eRx Routing (in million) % by Specialty

Specialty

96 85 81 80 78

0

20

40

60

80

100

IM FP Endo Card Ped


EHRs = The Physician’s New “Desktop”

Regulatory/Risk/REMS

Rx and Claims

Patient Assistance

Clinical Trials Event Reporting/FDA

Registries MD Communications

Prescribers Prescribers Prescribers Prescribers Prescribers Prescribers Prescribers Prescribers Prescribers

Labeling

Patient Communications

Clinical Reference


• Introduction

• Market Drivers





On the Menu


Meaningful Use: Core Set Objectives (for Eligible Professionals)

• Computerized physician order entry (CPOE)

• e-Prescribing (eRx)

• Report ambulatory clinical quality measures to CMS/States

• Implement one clinical decision support rule

• Provide patients with an electronic copy of their health information, upon request

• Provide clinical summaries for patients for each office visit

• Drug-drug and drug-allergy interaction checks

• Record demographics

• Maintain an up-to-date problem list of current and active diagnoses

• Maintain active medication list

• Maintain active medication allergy list

• Record and chart changes in vital signs

• Record smoking status for patients 13 years or older

• Capability to exchange key clinical information among providers of care and patient-authorized entities electronically

• Protect electronic health information

• Send reminders to patients per patient preference for preventive/follow up care

• Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate


Patient Portals are Now a Top Provider Priority

Greenway-funded research performed by the College of Healthcare Information Management Executives (CHIME) fall 2012


Patient Demand for Online Provider Communication

Technology Beyond the Exam Room: How Digital Media is Helping Doctors Deliver t he Highest Level of Care Televox National Survey October 2012


• Introduction

• Market Drivers





On the Menu


EHR Patient Education: Reality Check

1. All providers must deliver patient education via EHRs:

• providers have no time to write or review patient education materials

• providers do not want to fund patient education materials

• providers will be responsible for the information sent to patients

2. EHRs will select patient education materials for providers:

• EHRs currently select clinical sources for their EHRs

• downstream EHRs will allow greater options for patient education but choices will be limited in the near-term

3. Drugs may be better targets for patient education vs. diagnosis:

• drugs change more frequently than diagnosis

• drugs require patient activity (Rx fill, refill, follow-up lab, etc.)

• drug education can be automated with links to ePrescribing

• drug education can include links to patient financial assistance and other supportive services


Drug Monograph

• Patient Information

• Pill Images / pronunciation

• Links to additional information

• Overdose Information/ Contacts

Print Portal

How Infobutton Works

1) Infobutton icon appears adjacent to drug or disease name

2) Provider clicks on Infobutton bringing up Patient Education

3) Provider selects print or Patient Portal for delivery to patient

Infobutton-only patient education means substantial additional repetitive work for busy providers!

http://www.pdr.net/drugpages/productlabeling.aspx?mpcode=76000300



http://www.celebrex.com/offers.aspx


EHRs and Patient Communication: Optimal Approach

The ideal approach to fulfilling the MU2 patient education requirement should be…

1. Free: add no new costs for Providers or EHRs

2. Trusted: come from a source that Providers know and trust

3. Infobutton-Enabled: fulfill ONC requirements

4. Integrated into Provider Workflow and Automated: minimize or

eliminate work and clicks for Providers

5. Comprehensive: cover most common drugs or diseases

6. Current and Regularly Updated: for patient safety and provider liability


Customization and Context are Key for Patient Success

Technology Beyond the Exam Room: How Digital Media is Helping Doctors Deliver t he Highest Level of Care Televox National Survey October 2012


EHR and Patient Portal: Take Homes

EHR adoption has passed 70% and represents the new provider workflow

1. Those interested in engaging providers need to include an EHR strategy

2. Increasingly EHRs allow provider AND patient engagement

Patient Portals in EHRs:

1. Are a functional requirement of EHR Meaningful Use 2

2. Require thoughtful execution and use to optimize ROI

3. Move the provider-patient relationship from episodic to ongoing

4. Can provide clear value to the provider including improved:

• administrative and billing efficiency

• liability reduction

• patient satisfaction and retention

5. Can contribute to improved population health and cost reductions

focused on wellness and adherence

HIPAA Covered Entities

Are you a…

1.Healthcare provider?

2.Healthcare clearinghouse?

3.Health plan?

or are you a business associate of a

covered entity?

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http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-

Simplification/HIPAAGenInfo/Downloads/CoveredEntitycharts.pdf

http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/Downloads/CoveredEntitycharts.pdf










Can the message stand alone?

‣ Is everything on label?

‣ Is use of product name OK?

‣ Is the approved PI attached/accessible?

‣ Is risk information in the body of the message

or segregated?

‣Have you taken account of the message

delivery system?

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Questions? Dale Cooke

PhillyCooke Consulting

[email protected]

@PhillyCooke on Twitter

PhillyCooke.com

www.Scribd.com/Dale_Cooke

www.slideshare.net/PhillyCooke

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http://www.Scribd.com/Dale_Cooke

http://www.slideshare.net/phillycooke

Speaker Bio: Dale Cooke

Dale Cooke is the owner of PhillyCooke Consulting, which provides advice and training to

companies about developing compliant promotional materials for FDA-regulated products. Dale

has worked with more than 30 pharmaceutical and medical device clients around the world. His

insights have been featured in the Wall Street Journal’s Health blog, The Pink Sheet,

MedAdNews, PharmExec, and others. Dale is an active member of the Regulatory Affairs

Professionals Society (RAPS), Drug Information Association (DIA), Food and Drug Law Institute

(FDLI), and the Alliance for a Stronger FDA. He also serves on the faculty of the University of

California San Francisco’s American Course in Drug Development and Regulatory Sciences

program.

Dale is the author of Effective Review and Approval of Digital Promotional Tactics, which is part of

FDLI’s primer series. He is regularly invited to speak at industry conferences on topics including

FDA enforcement trends, best practices for review processes, global review practices, and life

sciences use of social media. Previously, Dale served as the head of Regulatory for Digitas Health

LifeBrands, which is part of the Publicis Healthcare Communications Group.

Dale earned his B.A. in Philosophy from Southern Methodist University, an M.A. in Analytical

Philosophy from the University of Arizona, and studied Epidemiology and Biostatistics at Drexel

University’s School of Public Health and Healthcare Compliance at Seton Hall University’s School

of Law.

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