CLINICAL ROLE IN EHR IMPLEMENTATION AT ICH

1. CLINICAL ROLE INEHRIMPLEMENTATIONAT ICH Presented by: Dianne Paulk, CNO Jim O’Connor, CIO The content and/or presentation of the information with which Irwin County Hospital (ICH) is involved will provide education or improvements in healthcare and will not promote a specific proprietary business interest or a commercial interest. Content for this activity will be well-balanced, evidence-based and unbiased. ICH has not and will not accept any additional payments or reimbursements beyond that which has been agreed upon directly with HomeTown Health in partnership with them to deliver education to their member hospitals. This disclosure is in accordance with the policy of HomeTown Health, LLC relative to education activities when an instructor has proprietary or financial interest in any product, service or material discussed during a presentation, that information will be disclosed in advance of the learning event.

2. “Only 20 percent of doctors and 10 percent of hospitals use even basic electronic health records,” said Kathleen Sebelius, Secretary of Health and Human Services. New York Times, July 2010

3. “We have a list of more than 130 hospitals who have indicated to us they intend to apply to receive Medicare funds for achieving Meaningful Use in 2011.” • CPSI, April 2011

4. Getting Started towards anElectronic Health Record If only it was this easy! 

5. The secret of getting ahead is getting started. The secret to getting started is breaking your complex overwhelming tasks into small manageable tasks and then starting on the first one. Mark Twain

6. Steps We Took… • 1999 CPSI Order Entry (Training) • Jan 1, 2000 (Y2K) Implemented Order Entry • Laboratory • Pharmacy • Pharmacy Clinical Monitoring • Micromedex/Care Notes • Developed Routine (Standing) Order Sets

7. Steps We Took… • 2008 • Point of Care (POC) Decision • Electronic Forms Decision – Unlimited Forms • Training – Mobile and In-house • Review of all Clinical Documentation • Created Flowcharts and Electronic Forms • Routine Order Sets • IT Decisions

8. Steps We Took… • June 1, 2009 – Virtual Chart • Implemented POC and Electronic Forms • Computerized Documentation and/or Use by Clinical and Business Departments • Computerized Medication Reconciliation • Computerized Med/Act (Kardex) • Patient Education Documents • Hard-coded Questions for some patient demographic and clinical information (Smoking Status, Allergies, Advance Directives, Language…)

9. Steps We Took… • 2011 • Chart Link (Virtual Chart for Physicians) • CPOE • Laptops for Physicians (Doctor’s Day) • Training • Attestation Period (July 3 – September 30)

10. Steps in Progress… 2011-2012 • New faster Access Points • CPSI Version 18 • New Diabetic Record • Medication Management (Medication Reconciliation) • e-Sign for Transcribed Reports • Storage of old Records • Improved EHR for ED and OB

11. Who Should be Involved??? • Nursing Managers and Staff (Seek out Nurses with IT Knowledge) • IT (Do you have a Computer Guru with Clinical Knowledge?) • Pharmacy (Willing to spend the time to update Pharmacy Tables)

12. Who Should be Involved??? (Con’t) • HIM (Responsible for maintaining a complete health record. Maintaining the Patient Problem List.) • UR (Documentation affects reimbursement) • Ancillary Departments (Alternate names of exams)

13. Who Should be Involved??? (Con’t) • Physicians (Accomplishment of an EHR is impossible without the commitment and dedication of your Medical Staff.) • CEO/CFO/Governance $$$$$

14. MU CLINICAL OBJECTIVES • Core Objectives • Menu Set Objectives

15. MU Core Objectives… • Core Objective 1 -Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local, and professional guidelines. -More than 30 percent of all unique patients with at least on medication in their medication list

16. MU Core Objectives… • Core Objective 2 -Implement drug-drug and drug-allergy interaction checks. -This measure requires yes/no answer.

17. MU Core Objectives… • Core Objective 3 -Maintain an up-to-date problem list of current and active diagnoses. -More than 80 percent

18. MU Core Objectives… • Core Objective 4 -Maintain active medication list. -More than 80 percent

19. MU Core Objectives… • Core Objective 5 -Maintain active medication allergy list. -More than 80 percent

20. MU Core Objectives… • Core Objective 6 -Record all of the following demographics: (A) Preferred language. (B) Gender. (C) Race. (D) Ethnicity. (E) Date of birth. (F) Date and preliminary cause of death in the event of mortality in the eligible hospital or CAH. -More than 50 percent

21. MU Core Objectives… • Core Objective 7 -Record and chart changes in the following vital signs: (A) Height. (B) Weight. (C) Blood pressure. (D) Calculate and display body mass index (BMI). (E) Plot and display growth charts for children 2–20 years, including BMI. -More than 50 percent of all unique patients age 2 height, weight and blood pressure are recorded as structured data.

22. MU Core Objectives… • Core Objective 8 -Record smoking for patients 13 years old or older. -More than 50 percent of all unique patients 13 years have smoking status recorded as structured data.

23. MU Core Objectives… • Core Objective 9 -Report hospital clinical quality measures to CMS or, in the case of Medicaid eligible hospitals, the State. -Provide aggregate numerator, denominator, and exclusions through attestation as discussed in section III(A)(3) of the final rule.

24. Mu core objectives… • Core Objective 10 -Implement one clinical decision support rule related to a high priority hospital condition along with the ability to track compliance with that rule. -Implement one clinical decisions support rule.

25. MU Core Objectives… • Core Objective 11 -Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures), upon request. -More than 50% of all patients who request an electronic copy of their health information are provided it within 3 business days.

26. MU Core Objectives… • Core Objective 12 -Provide patients with an electronic copy of their discharge instructions at the time of discharge, upon request. -More than 50% of all patients who are discharged and who request an electronic copy of their discharge instructions are provided it.

27. MU Core Objectives… • Core Objective 13 -Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient-authorized entities electronically -Performed at least one test of certified EHR technology’s capability to electronically exchange key clinical information.

28. MU Core Objectives… • Core Objective 14 -Protect electronic health information created or maintained by the certified HER technology through the implementation of appropriate technical capabilities. -Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

29. MU Menu Set Objectives… Menu Set Objective 1 - Implement drug formulary checks. - Yes or no.

30. MU Menu Set Objectives… • Menu Set Objective 2 -Record advance directives for patient 65 years old or older. -More than 50 percent of all patients 65 years or older

31. MU Menu Set Objectives… • Menu Set Objective 3 -Incorporate clinical lab-test results into EHR as structured data. -More than 40 percent of all lab tests ordered whose results are positive/negative or numeric in format

32. MU Menu Set Objectives • Menu Set Objective 4 -Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. -Generate at least one report listing patients with a specific condition. -Yes or no.

33. MU Menu Set Objectives… • Menu Set Objective 5 -Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. -More than 10 percent patients are provided patient-specific education resources.

34. MU Menu Set Objectives… • Menu Set Objective 6 -The eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. -More than 50 percent of transitions of care

35. MU Menu Set Objectives… • Menu Set Objective 7 -The eligible hospital or CAH that transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. -Provide summary of care for more than 50 percent of all transitions of care and referrals

36. MU Menu Set Objectives… • Menu Set Objective 8 -Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. -Yes or no… -Exclusion available (no immunizations or no registry)

37. MU Menu Set Objectives… • Menu Set Objective 9 -Capability to submit electronic data on reportable (as required by State or local law) lab results to public health agencies and actual submission according to applicable law and practice. -Yes or no -Exclusion (if public health can’t receive)

38. MU Menu Set Objectives… • Menu Set Objective 10 -Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. -Yes or no -Exclusion (if public health can’t receive)

39. Pitfalls / Lessons Learned… When it is obvious that the goals cannot be reached, don't adjust the goals, adjust the action steps. Confucius

40. Pitfalls / Lessons Learned… • Select, Involve, and Educate ALL Members of the EHR Team. Information Technology enables the journey towards EHR…People make it work

41. Pitfalls / Lessons Learned… • Research Implementation Strategies Make certain that you are capturing the Meaningful Use numerator/denominator that is best for your facility. For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.

42. Pitfalls / Lessons Learned… • There are two methods for calculating ED admissions for the denominators for measures associated with Stage 1 of Meaningful Use objectives. • Eligible hospitals and CAHs must select one of the methods below for calculating ED admissions to be applied consistently to all denominators for the measures.

43. Pitfalls / Lessons Learned… • Before attesting, eligible hospitals and CAHs will have to indicate which method they used in the calculation of denominators. (1) Observation Services Method (2) All ED Visits Method

44. Pitfalls / Lessons Learned… • Observation Services Method (Should include the following VISITS to the ED): • (ER to Admit Status) Patient enters the ED and is then an Admit to the Inpatient Setting Place of Service (POS) 21. • (ER to Observation Status) Patient enters the ED and then receives Observation Services in either POS 22 or POS 23.

45. Pitfalls / Lessons Learned… • ALL ED Visits Method: (An alternate method for computing admissions to the ED is to include all ED visits (POS 23 only) in the denominator for all measures requiring inclusion of ED admissions.) • All actions taken in the inpatient or emergency departments (POS 21 and 23) of the hospital would count for purposes of determining meaningful use.

46. Pitfalls / Lessons Learned… • Register with Medicare and Medicaid EARLY • NO need to wait until you have completed your attestation period before you register • Registration Password is required • Registration usually completed by CFO

47. CPSI Meaningful Use Roadmap http://cpsinet.com Each facility will need to purchase the following applications in order to meet Meaningful Use: • Interface Management System (IMS) • Hospital Information Management (HIM) • Electronic File Management (EFM) • Laboratory • Pharmacy • Pharmacy Clinical Monitoring • Point of Care (POC) and\or Electronic Forms • Core Measures

48. CPSI Meaningful Use Roadmap (con’t) • ChartLink • CPOE • Medication Management • Micromedex/Care Notes • Medical Practice EMR (MP EMR) – (if desire to apply for Eligible Providers) • Clinical Vocabulary In addition to the above, each facility will also need to do the following: • Convert to Linux Server • Convert to UBL’s (User Based Logins) • Convert Immunizations to standardized CVX codes

49. Final Take Aways… • START NOW!!! Sign up with HomeTown Health, GA HITREC and register with CMS • INVOLVE EVERYONE!!! Focus on your Super Users, Pharmacy, Docs and those that write the checks!!!!! • LOOK FORWARD!!! Stage 1 is just a start. Look at the measures and imagine what you can do now to make Stage 2 and 3 easier rather than re-engineering the process again in a year or less!

50. Questions/comments… Contact information: Dianne Paulk: dpaulk@irwincntyhospital.com Jim O’Connor: joconnor@irwincntyhospital.com https://www.cms.gov/EHRIncentivePrograms/Downloads/Hospital_Attestation_Worksheet.pdf http://cpsinet.com