An EHR isn’t Enough: Information Exchange for Meaningful Use

1. An EHR isn’t Enough: Information Exchange for Meaningful Use June 18, 2010 Marty Larson

2. Agenda • Health Information Exchange • Meaningful Use Objectives • Conclusion

3. HIE • Data Sendors • Hospitals • Laboratories • Imaging Centers • Other providers

4. Data Receivers • Providers • EMR • Paper • Hybrid • Public Health • Clinics • Other Hospitals • Other HIEs

5. Health Information Exchange Data Senders Hospitals Labs Radiology Other HIE Pharmacies CMS Other States Public Health Patients Other HIE’s Data Receivers Totally Paper Practices Practice Electronic Inbox Interface Interface Community Approved EMR’s Other Practice EMR’s Paper Records Paper Records

6. Meaningful Use Objectives • Use CPOE • Implement drug-drug, drug-allergy, drug- formulary checks • Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT® • Generate and transmit permissible prescriptions electronically • Maintain active medication list. • Maintain active medication allergy list • Record demographics. • Record and chart changes in vital signs. • Record smoking status for patients 13 years old or older • Incorporate clinical lab-test results into EHR as structured data. • Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. • Report ambulatory quality measures to CMS or the States. • Send reminders to patients per patient preference for preventive/ follow-up care • Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules • Check insurance eligibility electronically from public and private payers • Submit claims electronically to public and private payers. • Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request • Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) • Provide clinical summaries to patients for each office visit. • Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. • Perform medication reconciliation at relevant encounters and each transition of care. • Provide summary care record for each transition of care and referral. • Capability to submit electronic data to immunization registries and actual submission where required and accepted. • Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice. • Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.

7. Meaningful Use Objectives • Use CPOE

8. Health Information Exchange CPOE Data Senders Hospitals Labs Radiology Other HIE Pharmacies CMS Public Health Patients Other HIE’s Data Receivers Totally Paper Practices Practice Electronic Inbox Interface Interface Community Approved EMR’s Other Practice EMR’s Paper Records Paper Records

9. Meaningful Use Objectives • Use CPOE • Generate and transmit permissible prescriptions electronically

10. Health Information Exchange E-Prescribing Data Senders Hospitals Labs Radiology Other HIE Pharmacies CMS Public Health Patients Other HIE’s Data Receivers Totally Paper Practices Practice Electronic Inbox Interface Interface Community Approved EMR’s Other Practice EMR’s Paper Records Paper Records

11. Meaningful Use Objectives • Use CPOE • Generate and transmit permissible prescriptions electronically • Incorporate clinical lab-test results into EHR as structured data.

12. Health Information Exchange Structured Lab Results Data Senders Hospitals Labs Radiology Other HIE Pharmacies CMS Public Health Patients Other HIE’s Data Receivers Totally Paper Practices Practice Electronic Inbox Interface Interface Community Approved EMR’s Other Practice EMR’s Paper Records Paper Records

13. Meaningful Use Objectives • Use CPOE • Generate and transmit permissible prescriptions electronically • Incorporate clinical lab-test results into EHR as structured data. • Report ambulatory quality measures to CMS or the States.

14. Health Information Exchange PQRI Data Senders Hospitals Labs Radiology Other HIE Pharmacies CMS Public Health Patients Other HIE’s Data Receivers Totally Paper Practices Practice Electronic Inbox Interface Interface Community Approved EMR’s Other Practice EMR’s Paper Records Paper Records

15. Meaningful Use Objectives • Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request • Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)

16. Health Information Exchange PHR Data Senders Hospitals Labs Radiology Other HIE Pharmacies CMS Public Health Patients Other HIE’s Data Receivers Totally Paper Practices Practice Electronic Inbox Interface Interface Community Approved EMR’s Other Practice EMR’s Paper Records Paper Records

17. Meaningful Use Objectives • Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.

18. Health Information Exchange Clinical Notes Data Senders Hospitals Labs Radiology Other HIE Pharmacies CMS Public Health Patients Other HIE’s Data Receivers Totally Paper Practices Practice Electronic Inbox Interface Interface Community Approved EMR’s Other Practice EMR’s Paper Records Paper Records

19. Meaningful Use Objectives • Capability to submit electronic data to immunization registries and actual submission where required and accepted. • Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

20. Health Information Exchange Public Health Data Senders Hospitals Labs Radiology Other HIE Public Health Patients Other HIE’s Pharmacies CMS Data Receivers Totally Paper Practices Practice Electronic Inbox Interface Interface Community Approved EMR’s Other Practice EMR’s Paper Records Paper Records

21. Conclusion • An EHR isn’t Enough: Information Exchange for Meaningful Use • 9 Meaningful Use Objectives met by using a Health Information Exchange • Reduction in Cost • Reduction in Hassle • Increased staff Productivity • Questions/Comments