REC Reported Practice Level Challenges to Achieving Meaningful Use

Office of Provider Adoption SupportDawn Heisey-Grove, MPH

September 10, 2012

Initial Program Goal: 100,000 priority primary care providers achieve meaningful use (MU) by 2014

62 RECs Cover 100% of the USA

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Every REC:• Has a defined service area and specific number of providers• Provides unbiased, practical support

throughout process• Serves as two-way pipeline to federal

and local resources

Approach differs by REC:• Independent operations• Affiliation with QIOs and universities• Partnership with other ONC grantees

(Beacon and HIE)• Variety of hospital and payer partnerships

Public Hospitals (16,994)

Community Health Center (20,834)

Rural Health Clinic (3,618)

Rural Hospital (1,447)

Critical Access Hospital (4,050)

Other Underserved

Setti ng (16,592)

Practice Consortium

(17,591)

Private Practice 1- 10

(46,613)

Breakdown of Providers Working with RECs*

Over 120,000 providers:≈ 42% of all PCPs in US≈ 70% of all rural providers≈ 74% of FQHCs*Not shown: 10,000+ specialists

Who RECs Are Helping

3http://dashboard.healthIT.gov**Data as of 3-12-2012

Who Works with the RECs?

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Family Practice Providers (52,665)

Pediatricians(21361)

Internal Medicine Practitioners

(29,320)

OB-GYNs (14,702)

General Practice Providers (5,579)

Gynecologists (926)

Other Providers

(1,665)

Geriatricians (882)

Adolescent Medicine Providers

(222)

Specialties Working with RECs

**Data as of 3-12-2012

Background

• In November, 2011, RECs were asked to enter site-level challenges in the CRM

• RECs are using the CRM Challenges feature in varying ways– Some are creating a “Challenges” for every site; for those

sites on track, they are creating an “On Track” issue– Others are only creating “Challenges” issues for those

practices that are stuck in the process• 3 RECs are sending data files to OPAS external to the

CRM. Those data are incorporated into these slides.

Challenges Categories

• One field captures the stage of adoption for the practice: are they trying to reach AIU, or MU?

• There are then 5 Challenges Types: Practice Issues, Vendor Issues, Attestation Process problems, problems with MU Measures, and an “On Track” classification

• Within each of the Challenges Types, there are sub-categories. A definition page is available upon request.

Primary and Secondary Challenges Categories

Practice Issues

Workflow adoption

Provider engagement

Training

Vendor selection

Administrative

Financial

Staffing

Vendor Issues

Upgrade

Delays in implementation / installation

Certification

Reports slow / not available

Training / support materials inadequate/not

availableLack of vendor

support

Technical

Inaccurate reports and/or data

Attestation Process Issues

Calculating patient volume

Medicaid program not up yet

Medicaid technical/ administrative

Medicare technical/ administrative

MU Measures

Core CQMs

Alternate Core CQMs

Additional CQMs

Each of the Core / Menu Set measure

Complete list of Challenges categories, including tertiary categories and descriptions of the categories, is available upon request.

Resolved Challenges: Site Level

• Challenges can be resolved with at the site level or provider level

• At the site level, a Challenges would be resolved if:– the REC indicates the issue is “Completed”– a new issue is created to indicate the site is now

on track– An “on track” issue is resolved if a new Challenges

issue is created

Resolved Challenges: Provider Level

• At the provider level, all challenges are resolved if the provider receives an MU payment from CMS.

• Other ways a provider may have a Challenges resolved:– Attestation Process issues are resolved when a payment is

received from CMS– AIU issues are resolved if an AIU payment is received by CMS– Vendor selection issues are resolved if a provider reaches M2 and

the issue was created before the M2 date– All issues except Attestation Process are resolved if a provider

reaches M3– All AIU Vendor Issues when the provider reaches M2, provided

the issue was created before the M2 date

Top Ten Overall Challenge Categories by Number of Providers ImpactedRank Secondary Challenge Category Rank

Last Month

Total Providers Impacted (% resolved)

New reports this month by number of providers (% of total providers with new reports)

1 MU Measures 1 4,556 (12%) 364 (15%)

2 Provider engagement 2 3,853 (12%) 249 (10%)

3 Administrative practice issues 4 3,063 (11%) 510 (21%)

4 Vendor selection 3 2,974 (22%) 72 (3%)

5 Workflow adoption 6 2,081 (10%) 76 (3%)

6 Vendor delays in implementation/ installation 5 1,995 (9%) 157 (6%)

7 Medicaid Program not up yet 7 1,645 (29%) 32 (1%)

8 Practice financial issues 10 1,609 (14%) 244 (10%)

9 Vendor EHR reports slow/ not available 8 1,408 (12%) 66 (3%)

10 Practice staffing issues 13 1,191 (14%) 77 (3%)

Data as of August 5, 2012, pulled from the ONC CRM. A total of 19,237 challenge Issues have been reported by RECs, impacting 54,101 providers. A total of 1,197 challenge Issues were created between July 1 and August 5, 2012, affecting 3,251 providers. 2,942 providers had challenge issues resolved between July 1 and August 5, 2012.

Challenge Activity For The Month

Top Ten New Challenge IssuesSecondary Challenge Category

Number of Providers (% of total providers with new reports)

Administrative practice issues 510 (21%)

MU Measures 364 (15%)

Provider engagement 249 (10%)

Practice financial issues 244 (10%)

Vendor delays in implementation / installation 157 (6%)

Vendor EHR reports slow/ not available 95 (4%)

Staffing 77 (3%)

Workflow adoption 76 (3%)

Medicare technical issues 75 (3%)

Vendor selection 72 (3%)

Top Ten Resolved ChallengesSecondary Challenge Category

Number of Providers (% of total providers impacted by secondary category)

Vendor selection 192 (13%)

MU Measures 159 (11%)

Provider engagement 124 (8%)

Vendor EHR reports slow/ not available 109 (7%)

Administrative practice issues 95 (6%)

Vendor upgrades 76 (5%)

Practice staffing issues 67 (5%)

Vendor delays in implementation / installation 60 (4%)

Medicaid program not up yet 59 (4%)

Workflow adoption 54 (4%)

Data as of August 5, 2012, pulled from the ONC CRM. A total of 1,197 challenge issues were created between July 1 and August 5, 2012, affecting 3,251 providers. 2,942 providers had challenge issues resolved between July 1 and August 5, 2012. The green circle represents the issue with the most movement this month.

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Overall Top Ten MU Measures-Specific Challenges

Rank Meaningful Use MeasureNumber of Providers Impacted

New Reports this month by number of providers impacted

1 Core 13: Clinical Summary 1648 116 (28%)

2 Menu 7: Medication Reconciliation 852 9 (2%)

3 Core 15: Security Review 851 15 (4%)

4 Menu 4: Patient Reminders 820 6 (1%)

5 Menu 8: Summary Care Record 802 7 (2%)

6 Menu 9: Immunization 607 11 (3%)

7 Menu 6: Educational Resources 585 26 (6%)

8 Core 14: Electronic Exchange 513 17 (4%)

9 Core 9: Smoking Status 490 1 (0.2%)

10 Core CQMs 444 7 (2%)

Data as of August 5, 2012, pulled from the ONC CRM. Users may select multiple measure-specific issues as challenges within one report, therefore, these numbers may overestimate the total number of challenge reports for Measure-specific issues. The blue ribbon indicates the top reported issue for the month. The green circle represents the issue with the most movement this month.

Measures to watch:Core 4 (eRx) is #13 overall this month (down from #8) with 21 (5%) new reports.

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7

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Top Ten Newly Reported MU Measures-Specific Challenges: July 1-August 5, 2012

Rank Meaningful Use Measure New Reports this month, by number of providers impacted

Percent of total monthly providers impacted

1 Core 13: Clinical Summary 116 28%

2 Core 9: Smoking Status 62 15%

3 Core 8: Vital Signs 37 9%

4 Menu 6: Educational Resources 26 6%

5 Core 4: eRx 21 5%

6 Core 14: Electronic Exchange 17 4%

7 Core 15: Security Review 15 4%

8 Additional CQMs 12 3%

9 Menu 9: Immunization 11 3%

10 Menu 2: Laboratory Tests 10 2%

Data as of August 5, 2012, pulled from the ONC CRM. Users may select multiple measure-specific issues as challenges within one report, therefore, these numbers may overestimate the total number of challenge reports for Measure-specific issues.

Top Ten Top Ten Challenge Categories for Providers Trying to Reach MURank Secondary Challenge Category Rank

Last Month

Total Providers Impacted (% resolved)

Reports this month (% of total monthly reports)

1 MU Measures-specific issues 1 2,859 (8%) 109 (14%)

2 Provider engagement 2 1,533 (5%) 124 (16%)

3 Practice administrative issues 6 1,133 (3%) 96 (13%)

4 Vendor EHR reports slow/ not available

3 1,064 (5%) 16 (2%)

5 Workflow adoption 4 1,023 (2%) 30 (4%)

6 Upgrade 5 805 (3%) 20 (3%)

7 Vendor delays in implementation/ installation

7 565 (0.4%) 45 (6%)

8 Practice staffing issues 13 538 (1%) 64 (8%)

9 Practice financial issues 9 526 (2%) 8 (1%)

10 Vendor reports and/or data inaccurate

10 523 (1%) 39 (5%)

Data as of August 5, 2012, pulled from the ONC CRM. MU refers to the implementation phase the site is at for their EHR. A total of 11,991 providers have MU challenge Issues. The green circle represents the issue with the most movement this month; the blue ribbon indicates the top reported challenge for the month.

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Top Ten Newly Reported Challenge Categories for Providers Trying to Reach MU: July 1-August 5, 2012

Rank Secondary Challenge Category Rank Last Month

Total Providers Impacted

Percent of total monthly providers impacted

1 Provider engagement 2 124 16%2 MU Measures 1 109 14%3 Administrative practice issues 6 96 13%4 Practice staffing issues 7 64 8%5 Medicare technical issues 17 53 7%6 Vendor delays in implementation/

installation3 45 6%

7 Vendor reports and/or data inaccurate

9 39 5%

8 Practice staff training 4 32 4%9 Workflow adoption 5 30 4%10 Upgrade 15 20 3%

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Data as of August 5, 2012, pulled from the ONC CRM. MU refers to the implementation phase the site is at for their EHR. A total of 2,773 providers have newly reported MU challenge Issues between July 1-August 5, 2012. The green circle represents the issue with the most movement this month.

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Challenge and On Track Reports by Site

12%

8%

79%

Proportion of Sites with Challenge/On Track

Reports

Barrier Issue On Track ReportNo Barrier Issue

Series112000

12500

13000

13500

14000

14500

15000

15500

16000

16500

24211387654321

*

Number of Reports Per Site

Data as of August 5, 2012, pulled from the ONC CRM. 15,983 sites are represented in 19,237 challenge reports. Each site in the CRM may have multiple challenge issues created for it.

*84% of sites have only 1 challenge/on track issue reported.

Overall Monthly Challenge Activity

Nov-11

Dec-11

Jan-12

Feb-12

Mar-

12

Apr-12

May

-12

Jun-12

Jul-1

2

Aug-12

0

1000

2000

3000

4000

5000

6000

7000

8000

ResolvedUpdatedCreated

*

*Data as of August 5, 2012, pulled from the ONC CRM. A total of 19,237 challenge Issues have been reported by RECs.

Proportion of Providers Impacted by Challenge Types as Reported in CRM

Unresolved Challenge Issues

Practice Issues50%

MU Measures14%

Vendor Issues25%

Attestation Process12%

Resolved Challenge Issues

Issue Type Percent Resolved

Attestation Process 29

MU Measures 12.3

Practice Issues 13.7

Vendor Issues 15.9

Data as of August 5, 2012, pulled from the ONC CRM. 43,906 providers have open challenge issues; 33% (14,420) of those are on track. 10,195 providers have resolved issues.

Practice Issue Challenges

Unresolved Practice Issue Challenges

Adminis-trative

15%

Financial10%

Provider En-

gage-ment21%

Staffing8%

Training6%

Vendor Se-lection

31%

Workflow Adop-tion10%

Resolved Practice Issue Challenges by Number of Providers

Nov-11

Dec-1

1

Jan-1

2

Feb-1

2

Mar-

12

Apr-12

May

-12

Jun-1

2Ju

l-12

Aug-12

0

50

100

150

200

250

300

350

400

450

Workflow AdoptionVendor SelectionTrainingStaffingProvider EngagementFinancialAdministrative

Data as of August 5, 2012, pulled from the ONC CRM. A total of 17,015 providers have a practice issue challenges report; 1,425 (8%) do not have a sub-category. 2,337 (14%) providers have practice issues that have been resolved.

Num

ber

of

Pro

vid

ers

Vendor Issue Challenges

Unresolved Vendor Issue Challenges

Certification12%

Delays In Implemen-tation/In-stallation

27%

Inaccurate Reports And/Or Data

11%

Lack Of Support3%

Reports Slow/Not Available

16%

Technical12%

Training/Support

Materials4%

Upgrade15%

Vendor Selection0%

Resolved Vendor Issue Challenges

Nov-11

Dec-11

Jan-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12Jul-1

2

Aug-120

50

100

150

200

250

300

UpgradeTraining/Support ma-terialsTechnicalReports Slow/Not AvailableLack Of SupportInaccurate Reports and/or DataDelays In Implementa-tion/InstallationCertification

Data as of August 5, 2012, pulled from the ONC CRM. A total of 8,737 providers have a vendor issue challenge report ; 825 (9%) do not have a sub-category. 1,385 (16%) providers have resolved vendor issue challenges.

Num

ber

of

Pro

vid

ers

Attestation Process Challenges

Unresolved Attestation Process Issues

Med-icaid Pro-gram

Not Up Yet

34%

No Sub-Type26%

Medicaid19%

Medicare15%

Calculate Patient Volume

6%

Resolved Attestation Process Issues

Nov-11

Jan-1

2

Mar-

12

May

-12

Jul-1

20

50

100

150

200

250

300

MedicareMedicaid Program Not Up YetMedicaidCalculate Patient Volume

Data as of August 5, 2012, pulled from the ONC CRM. A total of 4,878 providers have an attestation process challenge report; 1,230 (25%) do not have a sub-category. 1,419 (29%) providers have a resolved attestation process issue.

Num

ber

of

Pro

vid

ers

Top Five Challenges by Practice Type

Private Practice

Private Practice

1-10 11+

1 MU Measures Practice staffi ng

MU Measures Practice

Administrative Provider

EngagementPractice

financial issues

Vendor delays In

Implementation/Installation

Provider Engagement

Practice administrative

Medicaid program not up

yet

2 Practice Administrative

Practice Administrative

Workflow adoption

Vendor selection

Vendor selection

Provider Engagement

Provider Engagement

MU Measures MU Measures MU Measures

3

Vendor delays In

Implementation/Installation

MU Measures Provider

engagement MU Measures MU Measures

Medicaid program not up

yet

Practice Administrative

Practice financial issues

Vendor technical

Vendor selection

4Medicaid

program not up yet

Practice financial issues

Practice Administrative

Training/support materials

Practice Administrative

MU Measures Medicaid

program not up yet

Practice administrative

Vendor upgrade

Vendor upgrade

5 Medicaid technical issues

Workflow adoption

Vendor delays In

Implementation/Installation

Provider Engagement

Practice financial issues

Medicare technical issues

Vendor selection

Vendor selection

Medicaid calculate

patient volume

Provider Engagement

Rural Health Clinic

Rural Hospital

Specialty Practice Rank CHCs CAHs

Other Underserved Setting

Practice Consortium

Public Hospitals

Data as of August 5 2012, pulled from the ONC CRM. Non-priority hospitals did not report any challenges.

Attestation Process Practice Issue Vendor IssueMU Measures

Top Five MU Measures-Specific Challenges by Practice Type

Rank CHCs CAHs

Other Underserved Setting

Practice Consortium

Private Practice 1-10

Public Hospitals

Rural Hospital

Rural Health Clinic

Specialty Practice

1 Core 15: Security Review

Menu 4: Patient Reminders

Core 13: Clinical Summary

Core 15: Security Review

Core 13: Clinical Summary

Core CQMs Core 8: Vital Signs Core 4: eRx

Core 9: Smoking Status

2 Menu 9: Immunization

Core 13: Clinical Summary

Menu 8: Summary Care Record

Core 13: Clinical Summary

Core 15: Security Review

Core 13: Clinical Summary

Core 9: Smoking Status

Core 13: Clinical Summary

Core 4: eRx

3 Menu 5: Electronic Access

Menu 8: Summary Care Record

Menu 4: Patient Reminders

Core 14: Electronic Exchange

Menu 9: Immunization Core 1: CPOEN/A Core CQMs

Core 13: Clinical Summary

4 Core 4: eRxMenu 7: Medication Reconciliation

Menu 7: Medication Reconciliation

Core 11: Implement CDS

Core 14: Electronic Exchange

Core 9: Smoking Status

N/A Additional CQMs

Core 15: Security Review

5 Core 12: Electronic Copy

Menu 6: Educational Resources

Menu 6: Educational Resources

Core 9: Smoking Status

Core 9: Smoking Status

Core 4: eRx N/ACore 10: Reporting Ambulatory CQMs

Core 5: Active Medication List

Data as of August 5, 2012,pulled from ONC CRM, Private Practices >10 and non-priority hospitals did not report any MU Measures challenges.Users may select multiple measure-specific issues as challenges within one report, therefore, these numbers may overestimate the total number of challenge reports for Measure-specific issues.Green arrows indicate measures with significant upward movement in the rankings.

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5

11

8

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