Hot Topics : Medical Data Exchange and Health Story Project

1. Hot Topics:Medical Data Exchangeand Health Story Project Susan Lucci, RHIT, CMTNick MahurinRobin Daigh, MBA

2. HIT: The Perfect Storm RAC Audit Outcomes Reporting zpic EMR Selection Meaningful Use ICD10

3. HITECH ActEMR Confusion, Acceleration • The goal of the HITECH initiative is to improve patient care, not to mindlessly adopt health information technology. eRx electronic exchange of PHI  quality measures • Many CCHIT-certified EHRs “are neither user­friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system.”David Blumenthal, MD – Nat’l Coord, ONCHIT • For most physicians in medical practices today, Meaningful Use does not appear to them to be a way to practice smarter -- it appears to be a path to just working harder.David Kibbe, MD

4. Industry Solutions • Health Story ProjectDevelops and promotes HL7 information standards that support the flow of information between narrative documents and electronic medical records. • Medical Data ExchangeThe first nationwide NHIN offering a private, secure, network-based platform for the distribution and sharing of electronic medical records among hospitals, physicians, RHIOs, HIEs, providers

5. At the end of this session you will: Understand the clinical importance of structured narrative notes Be familiar with the goals and document standards of the Health Story Project Explain how the Medical Data Exchange meets requirements for NHIN and MU Recognize how these initiatives are working together to accelerate EMR adoption Session Objectives

6. EMR Use in Physician Practices Source: Texas Medical Association N=370, 4% response rate

7. EMR Use in Physician Practices 3 to 5 minutes / patient = 1 to 2 hours / day= 1 to 3 fewer patients / day Source: Texas Medical Association N=370, 4% response rate

8. Direct Data EMR Entry

9. EMR Templated Note

10. Why Health Story • The physician’s need for fast and easy (30 sec) methods of creating clinical documentation The enterprise need for structured and coded information capture to support meaningful use Computer image courtesy of M*Modal

11. The Easy Choice MRN: 00000 DOS: 11/11/2001 CHIEF COMPLAINT: Fatigue SUBJECTIVE: Patient is a 25 year old woman complaining of feeling frequently fatigues. She reported also occasional dizziness, sleeping difficulties and morning headaches. OBJECTIVE: Recent bout with the flu PHYSICAL EXAMINATION: Vital signs are normal with a blood pressure of 120/80, pulse 62, temperature 98.6 degrees, weight 108 pounds. ASSESSMENT: Although flu symptoms were in remission, patient has not fully recovered yet. PLAN: Place patient on Biaxin for the next two weeks. The patient will call us if there is no improvement, any worsened or new symptoms.

12. Health Story Project healthstory.com

13. Project Members Founding Members Promoters Contributors Aprima Software | Scribe Healthcare Technologies All Type | Arrendale Associates | BayScribe Documentation Services Group | eMTS | Healthline, Inc. | MedEDocs MD-IT | New England Medical Transcription | Phoenix Medcom | Sten-Tel, Inc. . Participants

14. Benefits of Health Story Project

15. Do you know what the most important work done in a hospital is?” asked Babs, the head of human resources at Heimlich Hospital. “Healing sick people?” one of the children asks innocently. “You’re wrong,” Babs growls, silencing the children. “The most important thing we do at the hospital,” she continues without flinching, “is paperwork.” A Cautionary Tale

16. 1.26+ Billion Records Each Year • Majority of notes are dictated and transcribed • 40% are shared with other providers • Vast majority are faxed or mailed (even with EMR) • Must reach small physician offices where 75% of patient visits occur Increase of 200 million visits annually 971 M Physician Office 130 M Hospital Outpatient 124 M Hospital Emergency 35 M Hospital Inpatient Source: National Center for Health Statistics

17. IT Profs: What are the major IT challenges you anticipate in implementing EMR? Source: Healthcare Data Management Survey, Embarcadero Technologies N=111, June 2010

18. IT Profs: What are the major IT challenges you anticipate in implementing EMR? Source: Health Reform: Priorities and Challenges for Health Executives, CSC N=59, July 2010

19. Phys Execs: How easy or difficult will it be to meet meaningful use criteria? 3.72 Provide at least 10% of patientswith electronic access to PHI 3.70 Perform 1+ test of sending syndrome surveillance data to public health 3.63 Perform 1+ test of exchangingPHI with other providers 3.58 Perform at 1+ test of sending immunization data to public health Source: Medical Group Management Association N=439, March 2010

20. Medical Data Exchange icsalabs.com/mdex • Meets all NHIN requirements • Authentication / Certificates • Delivery Protocol • Trust Relationships • Document Standards • Directories • Security

21. What is Standard Today? Specialty Group Primary Care Hospital

22. How is the Exchange Used? Specialty Group Medical Data Exchange Primary Care Hospital

23. How is the Exchange Used? Specialty Group Patient History Preop H&P Operative Report Discharge Summary Primary Care Hospital

24. Benefits of Medical Data Exchange

25. Bottom Line Implications

26. IT Profs: What are the major IT challenges you anticipate in implementing EMR?      Source: Health Reform: Priorities and Challenges for Health Executives, CSC N=59, July 2010

27. Is your transcription vendor set up to deliver CDA documents? If no, when? Is your EMR vendor set up to receive CDA documents? If no, when? Is your transcription vendor a member of the Medical Data Exchange? Your EMR vendor? If no, when? Where to Start? Builds on your existing workflow Productive, not disruptive

28. Capture the patient’s story and the clinician’s rationale(preserve original intent to aid clinical decisionmaking) Make efficient use of physician time(keep doctors from becoming data entry clerks) Preserve face-to-face interactions between physician and patient(physicians can focus on the patient, not the computer screen) Ensure the quality and validity of clinical data going into an EMR(physicians are far from 100% accurate in dictating/ entering data) Promote information sharing in a secure environment(route readable patient notes among providers) Benefit to Providers

29. Hot Topics:Medical Data Exchangeand Health Story Project Susan Lucci, RHIT, CMTNick MahurinRobin Daigh, MBA