Stimulus Plan

1. Stimulus Plan Nancy Koenig President Merge Fusion

2. Now Is the Time to Act... • Level Set HITECH Act and it’s Implications • Movements underway • Electronic Ordering with Decision Support • Radiology Market Response to Meaningful Use • CCHIT Certification • What to Expect

3. HITECH Act: What’s at Stake? • Over $30B of direct adoption incentives for “meaningful use” of certified EHRs. • Specifically,$17.7B in Medicare incentives and $12.4 in Medicaid incentives. • Over $2B for infrastructure, health information exchange (HIE) and clinical research funding • Decrease in Reimbursements in 2015 Source: Title VIII Health Information Technology Act 2009

4. Definition of an EHR...Who Can Disagree? • Patient demographics, medical history, problem lists • Capacity to provide decision support, physician order entry, capture/query info related to health quality • Exchange health info with and integrate info from other systems Source: Title VIII Health Information Technology Act 2009

5. However, Devil is in the Meaningful Use Details • Facilitated by the Office of the National Coordinator (ONC) The only mention of Radiology is: [Reduce] inappropriate use of imaging by 2013 Source: Title VIII Health Information Technology Act 2009

6. “We don't currently have a [Radiology subspecialty] program nor is it on our immediate development roadmap. However, if ONC and CMS include this capability in upcoming decisions relative to standards, certification criteria and meaningful use, it is likely that it will be developed as an optional add-on or a module in our Ambulatory or Inpatient programs at some time in the future.” ...as well as the CCHIT Certification Criteria Ambulatory EHR

7. May 2009: Outlook Not Good • RIS/PACS investments are not eligible for stimulus monies • Inpatient or multi-specialty group imaging gain reimbursement advantage through funding • Costly system re-implementation and practice optimization lost • ….Meanwhile reimbursements dropping due to increased utilization requirements

8. ...Meanwhile, the eOrdering Coalition is Formed • Primary goal • To promote computerized physician order entry with decision support as an alternative to RBMs • Members • American College of Radiology • Center for Diagnostic Imaging • GE Healthcare • Merge Healthcare • Nuance Communications • Medicalis

9. ...and it’s spinoff: The Provider Roundtable • Chaired by Merge; Merge users taking active role • Working closely with ACR • Objective: Make the definition of Meaningful Use Meaningful

10. Our Grassroots Movement is Taking Hold... • Healthcare Reform Bills DO NOT include a requirement for RBMs • CMS is proposing a demo of electronic ordering with decision support tools • Provider Roundtable completed a DRAFT meaningful use matrix for Radiology • ONC invited ACR and eOrdering coalition to a private audience to discuss Meaningful Use

11. Recent CCHIT movement opens the door to RIS/PACS... • Added a ‘modular’ option in September to accommodate mixed EHR environments • Does not require full EHR Certification on all criteria • Unclear what this means for attaining grant monies Source: CCHIT Townhall September, 2009

12. Take Advantage of the Momentum • Sign onto the Provider Roundtable • Read the Meaningful Use Matrix; give your input • Recruit your colleagues and your industry affiliations to get on board • Lobby your congressional representatives • Schedule a site visit to demonstrate your adoption of ‘EHR’, how it improves efficiency and patient care

13. Merge is Taking a Leadership Position • Early participant in the eOrdering Coalition • Chairing the Provider Roundtable • Demo eOrdering and automated decision support at RSNA • Pursuing CCHIT certification

14. Learn More • http://www.imagingeconomics.com/listenup/regulatory_watch/20090629.asp • http://www.healthcarefinancenews.com/news/coalition-aims-cut-billions-waste-imaging-tests

15. Thank You For Questions and to Get Involved, please see Nancy

16. Electronic Decision Support, How it Works • Provide immediate access to evidence-based clinical guidance in the ordering of imaging • E-ordering avoids problems associated with RBMS • Variations in service performance and standards • Time and cost involved in obtaining authorization • Ability to create an electronic record of the interaction • Can analyze the data for quality improvement purposes • Is consistent with HIT goals, interoperability and interconnectivity

17. Electronic Decision Support (continued) • How it can be incorporated into proposed legislation mandating RBMs for Part B ordering physicians: • Ordering physicians allowed to elect the option of consulting a decision support guidance tool in lieu of a RBM • Can be done by embedding the tool in their electronic medical records (EMR) or, for smaller providers, by accessing the tool by phone or e-portal through another entity that offers the service • Medicare Administrative Contractors (MACs), or CMS, would contract with electronic decision support providers for the provision of services to ordering physicians to determine the payment arrangement

18. State Initiatives – Electronic Decision Support • Massachusetts General Hospital • Minnesota • Washington State

19. Massachusetts General Hospital

20. State Initiatives • Minnesota • Not legislatively originated • Began with the Institute for Clinical Systems Improvement (ICSI) which is funded by health plans and run primarily by metropolitan hospitals • Demonstration will address how to provide decision support services to all providers including those in rural and underserved areas at the time of ordering • CMS is reviewing these efforts as it begins implementation of its demo authorized under Section 135(b) of MIPPA which directs CMS to evaluate the use of electronic decision support at the time Medicare Part B imaging services are ordered

21. State Initiatives • Washington State • Legislatively mandated through HB 2105 • Applies to advanced diagnostic imaging services (ADIS) – MRI, CT, PET, cardiac nuclear medicine services • Establishes a work group to analyze and identify evidence-based practice guidelines applicable to ADIS and any decision support tools • By July 1, identify practice guidelines and decision support tools to be implemented by all state purchased health programs • By September 1, all state health care programs shall implement evidence-based best practice guidelines and decision support tools

22. Questions • Ariel Gonzalez, Esq., MA, agonzalez@acr.org; (703) 715-3488 • Liz Quam, lquam@cdirad.com; (952) 525-6308 • Hugh Zettel, hubertzettel@med.ge.com; (262) 544-3848 • Mike Fisher, mike.fisher@medicalis.com; (519) 579-5454 x223 • Nancy Koenig, nkoenig@merge.com; (414) 977-4264 • Scott Cowsill, scott.cowsill@nuance.com; (248) 4137856