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Electronic Health Records Statewide Review – Overview and Outcomes

Electronic Health Records Statewide Review – Overview and Outcomes. Kim Salamone , Ph.D. Vice President, Health Information Technology. Health Services Advisory Group. Quality Improvement Organization for Arizona, California, and Florida Arizona Regional Extension Center (REC)

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Electronic Health Records Statewide Review – Overview and Outcomes

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  1. Electronic Health Records Statewide Review – Overview and Outcomes Kim Salamone, Ph.D. Vice President, Health Information Technology

  2. Health Services Advisory Group • Quality Improvement Organization for Arizona, California, and Florida • Arizona Regional Extension Center (REC) • Dedicated to improving quality of care delivery and health outcomes through information, education, and assistance • Partners with physicians, health plans, nursing homes, hospitals

  3. Agenda • Introductions • Quality Improvement Organizations (QIOs) • National Strategy for Quality Improvement • HSAG’s Meaningful Use Overview to date • Proposed Rule Changes • 2014 Changes to Stage 1 MU • Physician Quality Reporting System • Barriers • What to do now to prepare • Q&A

  4. QIOs • Historically, Medicare Beneficiary Complaints (Sections 1152-1154 of the Social Security Act) • Largest federal program dedicated to improving health quality at the community level • QIOs in every state and territory • CMS relies on QIOs to improve the quality of health care for all Medicare beneficiaries

  5. QIOs (cont’d) • Serve as the “boots-on-the-ground” professionals working to bring about change at the local level to help achieve national goals • Convene, organize, and motivate providers and serve as change agents • Current QIO initiatives run August 2011–July 2014

  6. National Strategy for Quality Improvement in Healthcare

  7. Landscape is changing • Healthcare industry is changing • Public reporting of quality measures • More for less • Pay based on value • Increasing pressure on EHRs to assist in these changes • EHRs are not the magic bullet, but can be a significant instrument of change • Workflow changes • Technical issues

  8. EHRs for improving quality • What needs to be in place for reporting? • What information do you need out of your system? • Administrative • How many pharmaceutical samples were given out? • Which patient reminder letters need to be printed and mailed? Or signed up for a patient portal? • Clinical • Which patients are on ‘X’ drug, which has just been recalled? • How many patients between the ages of 50 and 79 were screened for Colorectal cancer? • Which patients with diabetes have an HbA1C greater than 9?

  9. EHRs for improving business • Once you have your reporting figured out: • Know the measures • Know WHAT the variables are • Know WHERE the variables are • Do templates need to be ‘tweaked’ • Careful of the upgrades • Examine the workflow changes that may be needed (especially in documentation) • Develop policies and procedures around the documentation of the measures • Pay 4 Performance, ACA, PCMH

  10. HSAG’s MU Overview • HSAG has worked with 341 practices/1,500 EPs • 12 Critical Access Hospitals • 4 “Other” Underserved • 1 Practice Consortium • 315 Private Practices 1-10 providers • 1 Public Hospital • 1 Rural Hospital • 16 FQHCs

  11. HSAG’s MU Overview: Community Health Centers • The Arizona Alliance for Community Health Centers list 19 health centers + 1 Look-Alike • Of the 20 total, HSAG is working with 17 • 15 have at least one provider that has attained MU • Assisted 353 providers reach MU

  12. HSAG’s MU Overview: • Outside of the CHCs, HSAG has worked with 324 practices • Assisted 689 providers attain MU at 281 practices reach MU • 43 of the 324 practices have no MU providers

  13. MU Timeline EPs – Report on calendar year (January 1 – December 31) EHs – Report on Federal Fiscal Year (October 1 – September 30) *Reporting period in 2014 is 90 days (Medicare Calendar Quarter)

  14. Proposed Rule Changes

  15. 2014 Changes to Stage 1 • Cannot exclude the public health reporting measure • Must meet and report on at least one • All measures must be submitted electronically for Medicare EPs • Beyond their first year • Two ways: PQRS or CMS Portal • If Medicare EPs didn’t report in 2013 for PQRS there will be a payment adjustment in 2015

  16. 2014 Changes to Stage 1 • Must have a 2014 MU certified system • Beyond the first year of demonstrating MU • Report 90 days instead of full year • Medicare, calendar quarter • Medicaid, unknown if calendar quarter • Allows up to 9 months to upgrade to a certified EHR technology to the 2014 edition • Must have a patient portal • Providers who have met Stage 1 for two or three years must meet Stage 2 criteria

  17. Comparison from Stage 1 to Stage 2 Stage 2 MU Overview

  18. Changes to CQMs Reporting

  19. Stage 2 CQM Objectives • Changes: 9 vs. 6, Aligned with National Quality Strategy

  20. Physician Quality Reporting System • Tax Relief and Healthcare Act (TRHCA) Division B, Title I, Section 101 provides statutory authority for PQRI • Originally PVRP (Physician Voluntary Reporting Program) 2006 • Claims only • Physician Quality Reporting Initiative 2007 • Claims, Registry by 2009 • Physician Quality Reporting System 2010 • Claims, Registry, and EHR • GPRO • Must have IACS account

  21. Physician Quality Reporting System • EPs include MDs, DOs, DDSs, PAs, NPs, therapists, etc. • 2012–2014 incentives are at 0.5 percent • Medicare payment reduction of 1.5 percent in 2015 • 2 percent in 2016 onward for not satisfactorily reporting quality data • 2015 Value-based modifier in groups over 10 • 2016 Value-based modifier in all practices

  22. CMS PQRS EHR – it’s a new day • CMS embracing technical standards • Meaningful Use • HL7’s Quality Reporting Document Architecture (QRDA) • Patient level data, de-identified • ‘Physician Compare’ • ‘Qualified EHRs’ • Barriers

  23. Barriers to Rural Health • Monetary • Patient Portal • 2014 certified EHR • Patient Engagement • Medicaid • Medicare • EHR vendors releasing 2014

  24. What to do now to prepare

  25. Overcoming Barriers: 2014 Editions • What is the cost for the upgrade? • Does your vendor have a 2014 certified version? • Currently this is not an exhaustive list, many outpatient EHRs are currently not 2014 certified • http://www.healthit.gov/buzz-blog/meaningful-use/certified-ehr-health-it-products-list-available/ • Training on upgraded version? • Workflow redesign to capture new measures? • PQRS?

  26. Overcoming Barriers: Patient Engagement • Patient engagement • Patient Portal does not have to be through your EHR, it does; however, have to meet certain requirements. • Explore different options and find the one that best fits your needs. • Explore if it can interface with your EHR. • Explore using an HIO. • Discuss the portal with your patients, encourage them to login, view their record, and send a message to the provider confirming they are able to access.

  27. Overcoming Barriers: Patient Broadband Access • You may be eligible for an exclusion

  28. Prepare Now for Stage 2 • Vendor Coordination • Is your system certified for Stage 2? • When will you get upgraded? • Will your vendor train on new functionality and reporting? • Certification Link:http://oncchpl.force.com/ehrcert?q=CHPL

  29. Prepare Now for Stage 2 • Infrastructure Planning • Training and Testing Stage 2 Functionality in Test Environment • Coordination of Interfaces (Labs, Radiology, Outpatient sites, etc.) • Patient Portal

  30. Prepare Now for Stage 2 • Workflow Review • Assess existing workflow (as-is) and create Stage 2 workflows (to-be) • Project Management Planning • Create Stage 2 implementation schedule to cover upgrades, training, workflow redesign, monitoring of Stage 2 achievement and attestation

  31. Stage 2 Resources • CMS Stage 2 Webpage: http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Stage_2.html • Tip sheets Available: • Stage 2 Overview • 2014 Clinical Quality Measures • Payment Adjustments & Hardship Exceptions (EPs & Hospitals) • Stage 1 Changes • Stage 1 vs. Stage 2 Tables (EPs & Hospitals)

  32. Discussion • Where are you regarding Stage 1? • What are your challenges moving on to Stage 2? • What does your EHR vendor say for 2014 certification? • Have you started preparing for Stage 2? • What is working? • What isn’t working?

  33. Stage 2 Resources • CMS Stage 2 Web page (Tip Sheets are available): http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Stage_2.html • Patient Engagement Fact Sheet http://www.healthit.gov/sites/default/files/key_considerations_for_health_information_organizations_vdt.pdf • Certified HIT Product List http://oncchpl.force.com/ehrcert?q=chpl

  34. Additional Questions? Kim Harris-Salamone, PhD, MPA Vice President, Health Information Technology Health Services Advisory Group KSalamone@hsag.com

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