Focus on Logistic Concerns In Physician Practices

By: Jitesh Chawla, MD

Chief Medical Information Officer

Patagonia Health, Inc.

SATISFYING MEANINGFUL

USE REQUIREMENTS

IMPORTANCE OF THIS DISCUSSIONFacilitators to Broad Adoption of Health IT

TOPICS TO COVER

1 Quick recap of MU

2. Common Concerns regards to achieving MU objectives

3. Solutions to these Concerns

4. Where MU fits into regular care

5. Why change is difficult

WHERE MEANINGFUL USE CAME FROM AND

WHY THE FEDS CARE ABOUT THIS

Social Security Act

ARRA (stimulus bill)

HITECH

Coordination of Care

Safety, Quality and Efficiency

Patient Engagement

Health Status of Populations

Privacy and SecurityFive Key Goals in the US

Healthcare System

(Hersh, 2010)

HOW DOES THIS INCENTIVE PROGRAM WORK?

• Usage of the electronic health record

• Certification through accreditation bodies

• Compliance tracked through CMS

• Money given through EHR incentive program

HOW MUCH MONEY CAN I GET?

(source: CMS)

• Under Medicare: Maximum of $42,000

• Under Medicare in areas of shortage: Maximum of $4,400

• Under Medicaid: Maximum of $63,750

AM I ELIGIBLE? (SOURCE: CMS)

MedicareDoctor of Optometry,

Doctor of Podiatry,

Chiropractor

MedicaidNurse Practitioners,

Certified Midwives,

Physician Assistants

in FQHC or RAC

Doctor of Medicine

Doctor of Osteopathy

Doctor of Dentistry

or Dental Surgery

WHO ARE THE KEY PLAYERS AND HOW AM I

AFFECTED?

EHR Implementation

ATCBs

RECs CMS

STAGES OF MEANINGFUL USE(SOURCE: CMS)

Stage 1

• Data Capture and Sharing

• 2011-2013

Stage 2

• Advanced Clinical Processes

• 2013-2015

Stage 3

• Improved Quality Measure Reporting

• 2015 and Beyond

ACHIEVING THE OBJECTIVESCommon Concerns Include:

Cost of EHR (NEJM, 2009) or MU implementation

1. Cuts other costs 2. Plans starting to reimburse for using EHR

Hampering proper workflow (CSC, 2009)

1. EHRs organize

a. Partitioned chart b. Codified data

2. Improves efficiency

a. Allows multiple users b. Decision Support

c. Documentation at point of care d. Smart text

ACHIEVING THE OBJECTIVES

Not enough staff

1. Auto populated data

2. Provider main user

Too complicated (HIMSS, 2010)

1. Data prompting

2. Help screens / IT support

3. MU compliant EHR

CASE EXAMPLE: CORE OBJECTIVE 12

(PAPER BASED VS. EHR)

Task or Constraint Paper Based Using EHR

Gathering information Multiple charts, staff time Click of a button

Compiling information Staff time, prone to error Click of a button

3 day time limit Interrupts work flow Not an issue

Need HIPPA consent Consent form passed

around

At point of care

Objective: Provide Patients with electronic copy of their

health information upon request

HOW MUCH EXTRA WORK IS IT, REALLY?

(SOURCE: CMS)

Objective # Task Most Doing already

8 Record Demographics X

10 Maintain Active Medication List X

11 Maintain Active Allergy List X

12 Record Vital Signs X

Objective # Benefit to you Additional investment

2 E-prescribing Less Rx errors iPad, PDA, EHR module

9 Record Smoking

status

Represents

quality

2 minutes

6 Provide clinical

summaries to

patient

Happy patient Few clicks of a button

ACHIEVING AN OBJECTIVE/MEASURE:

SUGGESTED SOLUTION

Quality Measure

Diabetic patients from 18 to 75 years old with high levels of hemoglobin A1c

Patients more than 50 years old who received a flu vaccine

Patients older than 18 with diagnosis of diabetic retinopathy with documentation or

absence of macular edema

Issues:

Where do I get all this information?

Who gathers the information?

How do I incorporate this into workflow?

Lab report screen, Immunization

Screen, Document notes screen

Provider – no need for staff help

Little to no change-at point of care

IS MU PART OF ROUTINE CARE?

Scenario Task Staff

Responsible

MU Criteria

Last A1c 3 months ago. Fasting 140s, PP 250.

Here for routine check and ER F/U

Record A1cs Lab Tech Additional

Quality

Got new lipid medication as LDL was >100, not

on ASA, d/c metformin

New dx of post MI and started on beta blocker

Update

Medication List

Provider/

Nurse

Core

Objective 5

Patient has rapidly rising creatinine but needs

ACEI due to CHF most MI. Needs to help to

decide if should use ACEI and, if yes, what dose

to start with

Use Clinical

Decision Support

Provider Core

Objective

12

“The EHR should not duplicate (often

inefficient) paper‐based workflow but

instead be implemented to achieve new

efficiencies as well as quality

and safety of care” (Kilo)

SUMMARY

1. Utilizing EHRs can help, not hinder your practice

2. Achieving MU is not difficult if you leverage the EHR’s

capabilities

3. Time to start is now, money is on the line

4. Help is available, just call

DON’T FEAR CHANGE, JUST CHANGE!

QUESTIONS ?• Jitesh Chawla, MD

Chief Medical Information Officer

jitesh@patagoniahealth.com

• Abhi Muthiyan

Chief Technology Officer

abhi@patagoniahealth.com

APPENDIX: ADDITIONAL PAYMENT FOR

MEDICARE EPS IN HEALTHCARE SHORTAGE

AREAS

Year 2011 2012 2013 2014 2015

2011 1,800 - - - -

2012 1,200 1,800 - - -

2013 800 1,200 1,500 - -

2014 400 800 1,200 1,200 -

2015 200 400 800 800 0

2016 - 200 400 400 0

Total 4,400 4,400 3,900 2,400 0

(Source: CMS)

APPENDIX: HOW MUCH MONEY CAN I GET?

Year 2011 2012 2013 2014 2015 2016

2011 21,250 - - - -

2012 8,500 21,250 - - -

2013 8,500 8,500 21,250 - -

2014 8,500 8,500 8,500 21,250 -

2015 8,500 8,500 8,500 8,500 21,250

2016 8,500 8,500 8,500 8,500 21,250

2017 8,500 8,500 8,500 8,500 8,500

2018 8,500 8,500 8,500 8,500

2019 8,500 8,500 8,500

2020 8,500 8,500

2021 8,500

Total 63,750 63,750 63,750 63,750 63,750 63,750

Under Medicaid: (Source: CMS)

Federal EHR

Certification

Requirements

APPENDIX: HOW DO I GET STARTED?

• Information Needed:

• 1. Name of the Eligible Provider

• 2. National Provider Identifier (NPI)

• 3. Business address and business phone

• 4. Taxpayer Identification Number (TIN) to which the provider would like the

• incentive payment made to

• 5. Medicare or Medicaid program selection (may only switch once after

• receiving an incentive payment before 2015) for EPs

• 6. For Medicaid providers, selecting which state want to file under.

HOW DO I GET STARTED?

3. Register for EHR

Incentive program

1. Enroll in

CMS payment

programs

2. Enroll in PECOS