PR’s Journey TowardsElectronic Health

Records Adoption & Meaningful Use

PR’s Journey TowardsElectronic Health

Records Adoption & Meaningful Use

PRESENTATION TO PR HIT SUMMITPRESENTATION TO PR HIT SUMMITAntonio FernandezAntonio Fernandez

Regional Extension Center for PR and USVIRegional Extension Center for PR and USVI

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HITECH: How the Pieces Fit Together

Medicare and Medicaid EHR Incentive Programs

Health IT Practice Research

Improved Individual & Population HealthOutcomes

IncreasedTransparency & Efficiency

ImprovedAbility to Study &Improve Care Delivery

ADOPTIONADOPTION

EXCHANGEEXCHANGE

State Grants forHealth Information Exchange

Medicaid Administrative Funding for HIE

Standards & Certification Framework

Privacy & Security Framework

Regional Extension Centers

Medicaid EHR Program 1st Year Incentive

Workforce Training

MEANINGFUL USEMEANINGFUL USE

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Program Timeline

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EHR ADOPTION PROGRESS IN PR

• Physicians who have selected a Certified EHR 3,900• Installations in Physician Practices 2,512• Meaningful Users 325• Dentists in Process of Adoption 197• FQHC’s in EHR Adoption Process 49• Hospitals Having Attested under Medicaid AIU 21• Number of eRx’s during Month of May 451,110• Pharmacies Dispensing e-Rx’s in May 1,012• Active E-Prescribers during month of May 1,854

Physician Adoption by Health Region

Hospitals Attesting under AIU Hospitals Attesting under AIU for 2012 Medicaid Incentivesfor 2012 Medicaid Incentives

FQHC’s in Process of Certified HER AdoptionFQHC’s in Process of Certified HER Adoption

Puerto Rico Monthly ePrescriptions

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Stage 1Data capture and

sharing

Stage 1Data capture and

sharing

Stage 2Advanced clinical

processes

Stage 2Advanced clinical

processes

Stage 3Improved outcomes

Stage 3Improved outcomes

Ascending Meaningful Use Stages

For more information on meaningful use of EHRs, visit: http://www.cms.gov/EHRIncentivePrograms/35_Meaningful_Use.asp

Better clinical outcomes Improved population health outcomes Increased transparency and efficiency Empowered individuals More robust research data on health

system

Improved quality of

patient care

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Meaningful Use: Changes from Stage 1 to Stage 2

Eligible Professionals15 core objectives

5 of 10 menu objectives20 total objectives

Eligible Professionals17 core objectives

3 of 6 menu objectives20 total objectives

Eligible Hospitals & CAHs

14 core objectives5 of 10 menu objectives19 total objectives

Eligible Hospitals & CAHs

16 core objectives3 of 6 menu objectives19 total objectives

Stage 2Stage 2Stage 1Stage 1

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EPs must meet all 17 core objectives:Core Objective Measure

1. CPOEUse CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology

2. E-Rx E-Rx for more than 50%

3. Demographics Record demographics for more than 80%

4. Vital Signs Record vital signs for more than 80%

5. Smoking Status Record smoking status for more than 80%

6. InterventionsImplement 5 clinical decision support interventions + drug/drug and drug/allergy

7. Labs Incorporate lab results for more than 55%

8. Patient List Generate patient list by specific condition

9. Preventive Reminders

Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years

Stage 2 EP Core Objectives

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EPs must meet all 17 core objectives:Core Objective Measure

10. Patient AccessProvide online access to health information for more than 50% with more than 5% actually accessing

11. Visit SummariesProvide office visit summaries for more than 50% of office visits

12. Education Resources

Use EHR to identify and provide education resources more than 10%

13. Secure MessagesMore than 5% of patients send secure messages to their EP

14. Rx ReconciliationMedication reconciliation at more than 50% of transitions of care

15. Summary of Care

Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR

16. Immunizations Successful ongoing transmission of immunization data

17. Security AnalysisConduct or review security analysis and incorporate in risk management process

Stage 2 EP Core Objectives

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EPs must select 3 out of the 6:

Menu Objective Measure

1. Imaging ResultsMore than 10% of imaging results are accessible through Certified EHR Technology

2. Family History Record family health history for more than 20%

3. Syndromic Surveillance

Successful ongoing transmission of syndromic surveillance data

4. CancerSuccessful ongoing transmission of cancer case information

5. Specialized RegistrySuccessful ongoing transmission of data to a specialized registry

6. Progress NotesEnter an electronic progress note for more than 30% of unique patients

Stage 2 EP Menu Objectives

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Eligible hospitals must meet all 16 core objectives:Core Objective Measure

1. CPOEUse CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology

2. Demographics Record demographics for more than 80%

3. Vital Signs Record vital signs for more than 80%

4. Smoking Status Record smoking status for more than 80%

5. InterventionsImplement 5 clinical decision support interventions + drug/drug and drug/allergy

6. Labs Incorporate lab results for more than 55%

7. Patient List Generate patient list by specific condition

8. eMAReMAR is implemented and used for more than 10% of medication orders

Stage 2 Hospital Core Objectives

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Eligible hospitals must meet all 16 core objectives:Core Objective Measure

9. Patient AccessProvide online access to health information for more than 50% with more than 5% actually accessing

10. Education ResourcesUse EHR to identify and provide education resources more than 10%

11. Rx ReconciliationMedication reconciliation at more than 50% of transitions of care

12. Summary of Care

Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR

13. Immunizations Successful ongoing transmission of immunization data

14. LabsSuccessful ongoing submission of reportable laboratory results

15. Syndromic Surveillance

Successful ongoing submission of electronic syndromic surveillance data

16. Security AnalysisConduct or review security analysis and incorporate in risk management process

Stage 2 Hospital Core Objectives

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Eligible Hospitals must select 3 out of the 6:

Menu Objective Measure

1. Progress NotesEnter an electronic progress note for more than 30% of unique patients

2. E-RxMore than 10% electronic prescribing (eRx) of discharge medication orders

3. Imaging ResultsMore than 10% of imaging results are accessible through Certified EHR Technology

4. Family History Record family health history for more than 20%

5. Advanced DirectivesRecord advanced directives for more than 50% of patients 65 years or older

6. LabsProvide structured electronic lab results to EPs for more than 20%

Stage 2 Hospital Menu Objectives

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• Stage 2 focuses on actual use cases of electronic information exchange:

• Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals.

• The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals.

• At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR.

Closer Look at Stage 2: Electronic Exchange

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Changes to Stage 1: E-Copy & Online Access

Current Stage 1 Objective

Objective= Objective=

Provide patients with e-copy of

health information upon

request

Provide electronic access to health

information

Provide patients with e-copy of

health information upon

request

Provide electronic access to health

information

New Stage 1 Objective

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Objective= Objective=

Provide patients the ability to view online,

download and transmit their

health information

Provide patients the ability to view online,

download and transmit their

health information

• The measure of the new objective is 50% of patients are provided access to their information; there is no requirement that 5% of patients do access their information for Stage 1.

• The change in objective takes effect in 2014 to coincide with the 2014 certification and standards criteria

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• Patient engagement – engagement is an important focus of Stage 2.

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• EXCULSIONS – CMS is introducing exclusions based on broadband availability in the provider’s county.

Requirements for Patient Action:•More than 5% of patients must send secure messages to their EP•More than 5% of patients must access their health information online

Closer Look at Stage 2: Patient Engagement

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CQM Selection and HHS Priorities

•All providers must select CQMs from at least 3 of the 6 HHS National Quality Strategy domains:

Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness

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• CMS’s commitment to alignment includes finalizing the same CQMs used in multiple quality reporting programs for reporting beginning in 2014

• Other programs include Hospital IQR Program, PQRS, CHIPRA, and Medicare SSP and Pioneer ACOs, and Patient-Centered Medical Homes

Hospital Inpatient Quality

Reporting Program

Hospital Inpatient Quality

Reporting Program

Physician Quality

Reporting System

Physician Quality

Reporting System

Children’s Health

Insurance Program

Reauthorization Act

Children’s Health

Insurance Program

Reauthorization Act

Medicare Shared Savings

Program and Pioneer ACOs

Medicare Shared Savings

Program and Pioneer ACOs

Aligning CQMs Across Programs

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Patient-Centered Medical Homes

• Model for care provided by physician practices that seeks to strengthen the physician-patient relationship and replaces episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship.

• It is a Model of care where each patient has an ongoing relationship with a personal physician who leads a team that takes collective responsibility for patient care. The physician-led care team is responsible for providing all the patient’s health care needs and, when needed, arranges for appropriate care with other qualified physicians .

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Patient-Centered Medical Home

• Six MUST PASS elements are considered essential to the patient-centered medical home, and are required for practices at all recognition levels by NCQA. Practices must achieve a score of 50% or higher on must-pass elements:

• 1.PCMH 1, Element A: Access During Office Hours • 2.PCMH 2, Element D: Use Data for Population Management • 3.PCMH 3, Element C: Care Management • 4.PCMH 4, Element A: Support Self-Care Process • 5.PCMH 5, Element B: Referral Tracking and Follow-Up • 6.PCMH 6, Element C: Implement Continuous Quality Improvement

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Patient-Centered Medical Home

• PCMH 1: Access and Continuity

• PCMH 2: Identify and Manage Patient Populations

• PCMH 3: Plan and Manage Care

• PCMH 4: Self- Management Support

• PCMH 5: Track and Coordinate Care

• PCMH 6: Performance Measurement and Quality Improvement

Meaningful Use Criteria

• Improving quality, safety, efficiency, and reducing health disparities

• Engage patients and families in their health care

• Improve care coordination • Ensure adequate privacy and security

protections for personal health information

• Improve population and public health

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REC 2.0 Scope of Services• Medicaid/Medicare EHR Incentive Program Eligible Provider Registration &

Attestation Support• Outreach to Other Eligible Providers (Hospitals, Physicians Specialists &

Dentists)• Meaningful Use Education and Provider Support• Privacy & Security Education & Risk Assessment• Direct Messaging/Health Information Exchange• ADT (Admissions/Discharge/Transfer) Care Transitions Coordination• Accountable Care Organizations, Patient-Centered Medical Homes &

Transformation Project Support• Meaningful User Groups/Communities of Practice• HIT Education, Training, and Workforce Development• Healthcare Analytics

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AREAS OF OPPORTUNITY• Specialized EHR Needs for Key specialty areas: Psychiatric/Behavioral Health Care Pediatric/Children’s HealthCare Correctional Health Care• Strategies for Consumer Engagement & Mobile Health

Applications for Consumers, Patients and Families• Population Health Management• Privacy & Security Education, Risk Assessment & Management• Designing Integrated Models of Care which could be adapted

to Serving Underserved Populations outside of Puerto Rico

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• CMS Stage 2 Webpage:

• http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

Links to the Federal Register

Tipsheets:

– Stage 2 Overview

– 2014 Clinical Quality Measures

– Payment Adjustments & Hardship Exceptions (EPs & Hospitals)

– Stage 1 Changes

– Stage 1 vs. Stage 2 Tables (EPs & Hospitals)

Stage 2 Resources

RECPR.ORG/BLOG

Other LinksU.S. Department of Health & Human Services

http://www.hhs.gov

Welcome to the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)https://pecos.cms.hhs.gov

National Plan & Enumeration Systemhttps://nppes.cms.hhs.gov/NPPES/LoginPage.do?userType=PROVIDER

Puerto Rico Immunization Registryhttps://prir.salud.gov.pr/PRIRPRD/portalInfoManager.do

Puerto Rico Health Informatio Network (PRHIN)https://www.prhin.net

Mi Saludhttp://www.salud.gov.pr/Pages/default.aspx

Contact Information

Antonio Fernandezafernandez@psm.edu

Regional Extension Center (REC)Ponce School of Medicine & Health Sciences