Giving Meaning to Meaningful Use: Huntsville Hospital s Perspective

1. Giving Meaning to Meaningful Use:Huntsville Hospital�s Perspective Stage 1: Can We Get There & How? Cheri Jackson GE CUE Virtual Conference

2. Disclaimer

3. Huntsville Hospital Serving the Tennessee Valley since 1895 881 licensed acute care beds Teaching facility for the University of Alabama-Birmingham 650 physicians on staff who are supported by 5,000+ hospital employees, including nearly 2,000 nurses. Centricity Enterprise 6.1

5. Stages of Meaningful Use Stage 1: 2011 1) Capturing health information in coded format; 2) using the information to track key clinical conditions; 3) communicating captured information for care coordination purposes; 4) reporting of quality measures and public health information. Stage 2: 2013 Criteria would likely expand on upon Stage 1 criteria in the areas of disease management, clinical decision support, medication management, support for patient access to health information, transitions in care, quality measures, research, and bi-directional communication with public health agencies. CMS may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings.� Stage 3: 2015 Would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.

6. Just the Facts, Right? What is ARRA? The American Recovery & Reinvestment Act of 2009, signed into law by President Obama in Feb, 2009. Aimed to stimulate the economy through investments in infrastructure, unemployment benefits, transportation, education, healthcare & to assist providers and other entities in adopting and using health IT. What is the Purpose of the LAW? Congress designed the legislation to improve US Healthcare through development of a solid health information infrastructure, while simultaneously stimulating the economy through new investments and job growth. What are the 5 Broad Goals? 1) Improve quality, safety, efficiency, and reduce health disparity; 2) Engage patients & family; 3) Improve care coordination; 4) Ensure adequate privacy and security protections for PHI; 5) Improve population & public health.

7. Acronyms, Acronyms, Acronyms HITECH The health IT sections of the ARRA law go under the acronym HITECH. MU Meaningful Use-use of health IT to further the five broad goals of the ARRA and to further the goal of information exchange among heath professionals. EHR-Electronic health record, and then there is a �certified� EHR (required for MU).

8. What IS Required for MU Two Categories of Requirements for Eligible Hospitals Eligible Hospital Health IT Functionality 14 Core Set Measures 10 Menu Set Measures Clinical Quality Measures 15 Measures ED Stroke VTE Testing Requirements Published by National Institute of Standards and Testing (NIST)- http://healthcare.nist.gov/ 2 Certifying Bodies Identified CCHIT Drummond Group Inc.

9. How to Meet MU with What You Have- Huntsville Hospital�s Perspective HH current plan is to move from GE CE 6.1 to 6.9 to be on Certified MU platform HH will build out all MU capability possible on 6.1 & implement prior to 6.9 upgrade HH will complete portions of build that can only be done in 6.9 when upgrade is delivered and implement at go-live of 6.9

10. Core Set Measures: Where We Are Today CPOE- > 30% of unique patients with at least one medication in their medication list Still Planning- exploring meeting this measure based on pharmacists protocols and modes of modifications to orders in GE CE & implementation of ED CPOE (Wellsoft) Need to upgrade to 6.9 to meet reporting requirements Record & Chart Changes in Vital Signs- For > 50% of all unique patients age 2 and over. GE CE utilizing Flowsheets GE CE implemented Growth Charts Need to upgrade to 6.9 to meet reporting requirements Record Smoking Status for > 50% of unique patients 13 years or older GE CE utilizing Flowforms Need to upgrade to 6.9 to meet reporting requirements

11. Core Set Measures: Where We are Today, cont. Implement drug-drug & drug-allergy interaction check GE CE with SQL Allergy Module Record demographics > 50% of unique patients (preferred language, gender, race, ethnicity, DOB, date & preliminary cause of death) Need version 6.9 upgrade to record Ethnicity GE CE implement charting of preliminary cause of death in flowform Need to upgrade to 6.9 to meet reporting requirements Maintain up-to-date Problem List with at least 1 entry on > 80% of unique patients GE CE- Still planning on how will implement Problem List and who will maintain. Need to upgrade to 6.9 to meet reporting requirements

12. Core Set Measures: Where We are Today, cont. Maintain an active medication list for > 80% of unique patients GE CE Order Profile & Medication Worklist Screens Need a plan for how to document if patient has no active medications- GE suggested Med Order- No Active Medications. Need to upgrade to 6.9 to meet reporting requirements Maintain an active medication allergy list for > 80% of unique patients GE CE utilizing SQL allergy module Need to upgrade to 6.9 to meet reporting requirements Implement one clinical decision support rule with the ability to track compliance with rule GE CE utilizing Blaze Rules Need to upgrade to 6.9 to meet rule tracking requirements

13. Core Set Measures: Where We are Today, cont. Report hospital quality measures to CMS or State Need to make sure all data captured in Certified System & system has electronic reporting capability Need upgrade to 6.9 to accomplish the Quality Measures reporting Provide >50% of all patients with an electronic copy of the health information, upon request HH utilizes SLH and Menon PTR for this currently & provides data from these applications on a CD to patient. Rule requires the systems report percentage of compliance. Discussing with vendors their plans for certification. Provide >50% of all patients with an electronic copy of their discharge instructions, upon request HH would plan to utilize SLH and Menon PTR for this & provide data from these applications on a CD to patient. Rule requires the systems report percentage of compliance. Discussing with vendors their plans for certification. Also utilize Care Notes and need to discuss with vendor MU certification plans.

14. Core Set Measures: Where We are Today, cont. Capability to exchange key clinical information among providers of care and patient authorized entities electronically Potential plan would be to send data from GE CE to one of our community physicians utilizing GE EMR Need upgrade to 6.9 for capabilities Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities HH plans to bring in an outside company to perform an assessment on where we are in meeting this measure

15. Menu Set Measures- Where We are Today Implement drug-formulary checks GE CE utilizing formulary substitutes built in Pharmacy module Record Advance Directives for >50% of unique patients 65years or older GE CE utilizing flowforms Need to upgrade to 6.9 to meet reporting requirements Incorporate >40% of clinical lab-test results into certified EHR as structured data GE CE lab results >40% of positive/negative and numeric are sent in via interface from Sunquest as structured data If LOINC required will need to make changes in Sunquest to incorporate Generate lists of patients by specific condition GE CE Cobol reports Use Certified EHR technology to identify patient-specific education resources and provide to >10% of unique patients Planning- HCS medication discharge instructions Future- review Discharge Instructions that are available as new product in GE CE 6.9

16. Menu Set Measures- Where We are Today Medication reconciliation for >50% of transitions of care in which the patient is admitted to the eligible hospital Complete implementation of HCS on Surgery Units, Pediatrics, and Behavioral Health. Provides a summary of care record for >50% of transitions of care & referrals Need upgrade to GE CE 6.9 to provide CCD or CCR Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice HCS- explore options of meeting based on medication give information & reporting from this system for Stage 1. HH would not be able to meet this measure for Stage 1 with GE CE because we would not be on Enterprise Orders in time to utilize the Immunization Module for this. Capability to submit electronic data on reportable lab results to public health agencies & actual submission in accordance with applicable law and practice Sunquest- exploring options to interface between Sunquest lab system and Public Health Department. Capability to submit electronic syndromic surveillance data to public health agencies & actual submission in accordance with applicable law and practice Sunquest- exploring options to interface between Sunquest lab system and Public Health Department.

17. Quality Measures- Where We are Today Required 2 ED Measures 7 Stroke Measures 6 VTE Measures Current State Some data gathered from Billing information Some data gathered manually from charts Some data submitted electronically, but not via Certified systems Planning Need to implement Problem List in GE CE to capture diagnosis as structured data Need to make sure all data captured in EHR Need to look at Blaze Rules required Need upgrade to GE CE 6.9 to accomplish the Quality Measures reporting

18. Where We Are Today for 2011 Summary of HiTECH Measures- Core Measure Set Met in GE CE 6.1 ( some build may be needed) 1 Measure Met but need MU Version of CE GE for Reporting 6 Measures Planning Phase 4 Measures Need GE CE MU Version to accomplish 3 Measures Menu Measure Set HH would plan on meeting 7 of 10 on menu set 2 still need more research/ could be added to list to meet Providing Summary of Care Record Patient-Specific Education Instructions 1 cannot be met until on Enterprise Orders Immunization Module

19. Where Are We Headed for 2011-2012 Implement Problem List in GE CE CPOE Readiness Assessment & Planning Nursing Optimization Assessment Upgrade to CEUI Upgrade to GE CE 6.9 Implement new Perinatal System Continue to Roll-out HCS for Electronic Medication Reconciliation Potentially Report Lab Data to Health Department via Sunquest Broader incorporation of quality data capture into GE CE 3rd Party HIPAA Privacy & Security Assessment & Follow-up Continue involvement with Professional Associations, Vendors, & Educational Sessions and Government updates Educating the other Departments in the Organization Many, many, many other IT related projects Oh and one more thing- Open a new hospital- Madison, Alabama

20. Just Some of Our Concerns Multiple simultaneous MU related projects in parallel with all other high priority projects Ability for the hospital in general and nursing in particular to be able to absorb all that is happening in the timeframe outlined GE�s ability to deliver a certified version of Centricity Enterprise within our target date The need to follow up stage 1 MU rapidly with the opening of Madison Hospital, while beginning our efforts to acquire stage 2 MU, and accomplish the ICD-10 deadline

21. Q & A ?