Information Technology Compliance, Solutions & Trends

1. Information Technology Compliance, Solutions & Trends ABC Conference Tampa Florida January 2011

2. Mike Mytych Bio • 35 year career in healthcare • 20 years in Consulting with an emphasis on clinical systems and focus on physician adoption of I/T • Clients range from small physician groups to large multi-hospital organizations • Conducted over 200 vendor selections for both hospitals and physicians with over 50 cardiology engagements ranging from small practices to complete heart hospital I/T strategies • Worked with 6 major HIEs including Chicago, Minneapolis, Wisconsin, Washington DC, New York City • Spent 15 years in the vendor community and is former VP of Sales for the physician systems division at Baxter • Adjunct Faculty member at University of Wisconsin Milwaukee Healthcare Informatics Graduate program teaching Healthcare I/T Procurement

3. Disclosure • Provide industry education for CDW, GE and NextGen in partnership with Wakerly Partners and C-Suite Resources • We do not provide competitive analysis or benchmarking to any vendor • Participate on 3 investor advisory company panels for publically traded company assessment and prohibited from disclosing any information that is not included in the public domain.

4. Today’s Objectives • What are the key I/T drivers for today's practice? • Impact of ARRA / HITECH / Healthcare Reform on impact on I/T decisions. • What are the critical EMR/EHRs – CV Requirements? • What will the future look like for the CV Practice ?

5. Audience Survey • EMR Today? • Buying an EMR? • Integrated with Hospital? • Integration Discussions?

6. Today’s Key I/T Drivers

7. I/T Drivers • ARRA / HITECH Meaningful Use Rules • Hospital Integration – Care Coordination • Documenting care that enables quality / performance assessment • Maintaining reimbursement and getting greater operational efficiency

8. Driving Practice I/T Decisions • EHRs and Meeting Meaningful Use • Integration with Hospitals • PM System Decisions • Cardiology PACS • HIPAA Compliance • Regulatory/Quality Measure Compliance • PQRI and eRX Incentives • Device Upgrades & Integration • Preparing for Health Reform and participating in ACOs & Health Information Exchange • Others, ICD10 etc.

9. Decisions - Decisions There is a lot to get done ! • Priorities • Resources • Timing • Timeline • Dependencies

10. Questions We Hear… • With all that is happening around us, what are my best options for a good long term decision regarding I/T? • How can I optimize the use of systems for better patient care and provider satisfaction without losing productivity? • How can I minimize wasteful decisions? • Will the government programs like HITECH be changed substantially in the near future? • Will my integration with a hospital change the way my providers will utilize EHRs? • What is an HIE, is it real and when do I need to participate? • Dozens of others…

11. ARRA – HITECH Compliance Have a Road Map as to How you get there & Operate under the new Rules “I don't like mysteries. They give me a bellyache and I got a beauty right now.” James Kirk

12. Non-compliance Is An Expensive Choice 2011 is the first year for partial qualification for meeting Meaningful Use (Stage 1) 2013 and 2015 will have different rules that build out toward the HITECH objectives (Stage 2 and Stage 3) and the preliminary objectives were released January 2011 Physicians and hospitals must meet government’s definition of meaningful use of Electronic Health Records (EHR) Technology” in order to be paid their bonuses or be prepared to have the penalties kick in in 2015.

13. Refresh - “Meaningful Use” Meaningful use is defined as: • Use of a certified EHR in a meaningful manner (ex: clinical documentation, e-prescribing, etc.) • Use of certified EHR technology for electronic exchange of health information • Use of certified EHR technology to submit clinical quality and other measures. To insure Meaningful Use and to ensure continued adoption and subsequent use of the EHR there are specific rules for demonstration of that use.

14. Reporting Requirements Summary Requirements vary based on whether the applicant is an “eligible professional” or eligible hospital.” • Reporting Period –for any consecutive 90 days for first year; one year subsequently   • For 2011 –Providers required to submit summary quality measure data to CMS or States by attestation • For 2012 –Providers required to electronically submit quality measure data to CMS or States

15. The March Toward Reform • ARRA/HITECH • Meaningful Use 2011 – 2013 – 2015 • Medicare Penalties 2015+ • Data Analytics • Setting the Stage for Healthcare Reform • Increased utilization demand from the uninsured/underinsured • Changes in plans / employer offerings • Bundled payments – reward for quality performance • Quality / outcomes evolution • Medical Home • Development and operation of ACO's • Comparative Effectiveness • Nationwide goal to remove cost from the delivery system while improving quality

16. Data and More Data CV Data No EMR = Not Enough Data Point of Care

17. EHRs and Meaningful Use

18. Leadership Concerns • When should we buy? • Who is the right vendor? • Can they get us to meaningful use? • Do we have time for PM? • Who will help us through all of these changes?

19. Meaningful Use Implications • Physician clinics will have to carefully assess their ability to meet meaningful use by 2011/2012. • Just having an EHR does not mean that a clinic will meet the criteria. • Each physician’s group will need to understand what it will take to have the required interoperability, system interfaces, data standards and timeline requirements. • Physicians may be invited to participate in HIE technologies offered by the Hospitals to assist in complying with Meaningful Use criteria. • Few Physician Clinics have integration or interchange with Imaging systems for movement of diagnostic reporting (PACS, CPACS, RIS).

20. Common Questions from those who already have an EMR? • Is my vendor certified? • What is the current state of implementation and quality of use by my clinicians? (still using dictation?) • What gaps do we have to complete the EHR implementation (eRx & Lab are key) • Are we capturing the required discreet data? • Lab results are discreet and complete? • Interchange capabilities with our referring physicians and hospitals?

21. MU is not just about EHR Unless you are the only practice on an island, no one vendor can enable the physician to meet meaningful use. The stimulus law compels the creation of ways to exchange health information within states and across a nationwide HIT infrastructure… Cardiovascular Patient Records and related discrete data are a primary target of these efforts… http://govhealthit.com/newsitem.aspx?nid=72400

22. MU Compliance • Reporting – QC what you can do and how you are measuring up to the standards • Know how data is generated and by whom • Change behavior to become compliant

23. EHR’s for the CV Practice

24. Vendor Selection Considerations • Vendor Certification • PM Vendor • Hospital Vendor • Vendor Stability • Cost • Performance • Others

25. EHR Vendor Certification • Surescripts LLC  - Arlington, VADate of authorization: December 23, 2010.Scope of authorization: EHR Modules: E-Prescribing, Privacy and Security. • ICSA Labs  - Mechanicsburg, PADate of authorization: December 10, 2010.Scope of authorization: Complete EHR and EHR Modules. • SLI Global Solutions  - Denver, CODate of authorization: December 10, 2010.Scope of authorization: Complete EHR and EHR Modules. • InfoGard Laboratories, Inc. – San Luis Obispo, CADate of authorization: September 24, 2010.Scope of authorization: Complete EHR and EHR Modules. • Certification Commission for Health Information Technology (CCHIT) - Chicago, ILDate of authorization: September 3, 2010.Scope of authorization: Complete EHR and EHR Modules. • Drummond Group, Inc. (DGI) - Austin, TXDate of authorization: September 3, 2010.Scope of authorization: Complete EHR and EHR Modules http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3120

26. Certified Vendors • Currently 193 vendor products are certified • Not all are comprehensive EHRs • Very few offer a comprehensive CV EHR • Make sure your vendors are certified and contractually commit to remaining certified http://onc-chpl.force.com/ehrcert/EHRProductSearch

27. EHR Evaluation Considerations Performance • Depth in Cardiology and Interoperability • Ability to interoperate with others • Patient identity management • Inbound unsolicited data management • Market share in your region • Validation of capability and contractual commitment • Pre-contract integration and interoperability plan

28. EHR Implementation Timeline Vendor Assessment & Selection Contract & Implementation Plan Complete Interfaces for I/O Training Implementation & Go-live Reach Meaningful Use 1 to 3 months 1 to 2 months 2 to 4 months 1 to 3 months 1 to 4 months Total: 6 to 16 months depending on resources, size of group, PM integration and other variables.

29. Summary Physician / EHR requirements • Meeting Cardiology Workflow • Flexibility of design / settings • Interfaces with Devices – Patient ID, Orders, Results • CPACS • PaceArt • Others • Comprehensive “one-stop shopping” for all patient records components from the patient summary screen with individual settings • Integration into clinic workflows • Nursing triage • Physician in-box of new records / results • Ease of mapping to existing records – both paper and electronic, patient identifiers • Ease of validation of data prior to upload into the permanent record from outside systems Key Focal Points • Interoperability - Your Device Integration • Echo, ECG, Stress, Holter, Nuclear, CT, PV, etc. • Specialty Clinics: Limpid, AntiCoag, Device, CHF, etc. • Lab Interfaces - • Quality Data / Measures – how is data collected • Effective Clinical Decision Support – documentation of non-std events • Executive Reporting / ease of use

30. Other Requirements • Mapping to your ACO partners • Management of change to national standards • Health Information Exchange Requirements – Regional, State, Enterprise • Referral coordination for exchange – changes in workflows • Patient / Consumer Compliance Requirements – access to electronic copies of their records • Others

31. Example of ACO I/T Requirements

32. Example - Hospital / Physician Integration • Hospital bias toward enterprise system choices • Lack of granular understanding of practice workflows, requirements • Nomenclature and data integration and normalization between hospitals and physicians • Patient identifiers between hospitals and clinics • Orders being received by hospitals from physician EHRs • Physician use of multiple clinical documentation systems • Hospital portal access and download of data to EHR • Hospital links to office EHR via web • Images • Security issues • Enterprise Data Analytics – common clinical model • E.g. Marshfield Semantic interoperability project

33. Example: Physician EHR Environment Summary HIE Requirements • Documents • Outbound CCD/CCR • Outbound referral request • Outbound referral results (CCD) • Imaging • Links to Hospital PACS from hospital results records • Links to Clinic PACS from hospital devices • Orders / Results – Hospitals • Radiology • Cardiology • Others • Lab Information Systems – reference labs, hospitals etc. • Orders • Results • Status • Pharmacy • Outbound eRx to Retail • Outbound patient record to hospital – active meds • Inbound patient history – CCD • Inbound patient active meds – hospital discharges – medication reconciliation

34. Buying an EHR • Have a plan as to how you will make your decision • Include as many clinicians and operations members as you can • Map all of the your detailed requirements to what the vendor says they can do and make sure they are transferred into the contract • Don’t rush your decision • Speak to as many references as you can • Don’t sign their standard contract

35. Health Information Exchange & Care Coordination

36. No matter what the Hospital relationship… CV practices are going To be asked to be a critical Component of care coordination

37. Data and Information Exchange Clinical Information / Data Care Continuum Point of Care

38. Health Information Exchange (HIE) Definition: HIE refers to the process associated with the electronic movement of health-related data and information among organizations at the community, regional, statewide, or nationwide levels according to agreed standards, protocols, and other criteria.

39. Health Information Exchange (HIE) GROUPPRACTICE Imaging Center LAB OTHER HIE’s HOSPITALS Rx PHYSICIAN Consumer Long Term Care Health Information Exchange Platform Primary Functions: • Secure clinical information sharing • Coordination of care • Support Accountable Care Organizations • Quality and health status reporting • Shared platform State of IL Public Health

40. Cardiovascular HIE Requirement • Cardiovascular groups will be a significant target for health information exchange over the next 2 years with target for implementation by 2013 (Stage 2) • Coordination of care and reduction of duplicate testing are the primary objectives • ED access to CV patient records – Wisconsin Study • CCD exchange • PHR service

41. Physician EHR Environment Summary HIE Requirements • Lab Information Systems – reference labs, hospitals etc. • Orders • Results • Status • Pharmacy • Outbound eRx to Retail • Outbound patient record to hospital – active meds • Inbound patient history – CCD • Inbound patient active meds – hospital discharges – medication reconciliation • Documents • Outbound CCD/CCR • Outbound referral request • Outbound referral results (CCD) • Imaging • Links to Hospital PACS from hospital results records • Links to Clinic PACS from hospital devices • Orders / Results – Hospitals • Radiology • Cardiology • Others

42. ConclusionsDawn of a New Era • EMR - MU – Stage 1, 2 & 3 - CV • Patient Centric Care Coordination Processes • HC Reform Rule Flexibility • ACO Development • Data supports Quality Outcomes • Consumer Focus & Engagement

43. Thanks ! Health Information Consulting, LLC Mike Mytych mmytych@hicllc.com 262-253-9110