Coherent Connections: Wiring the Patient Centered Medical Home in a Meaningful Way August 18, 2009

2. Coherent Connections:Wiring the Patient Centered Medical Home in a Meaningful WayAugust 18, 2009 David C. Kibbe, MD, MBA, Senior Advisor, American Academy of Family Physicians, and Chair, ASTM International E31Technical Committee and Principal, The Kibbe Group Dennis Saver, MD <need info>

3. The Health IT Landscape • “Meaningful Use” Defined • EHR Certification Who will certify, and when?

4. Meaningful Use: Meaningful Connections • Identifieshealth IT as a “critical platform” of the PCMH. • (Re) Conceptualizes health IT as an e-platform and set of tools. • Health IT functional priorities to support a PCMH. • Critical capabilities to engage consumers with health IT. • Explores the current use of health IT by primary care physicians.

5. Cross Walk: HIT for PCMH withMeaningful Use Objectives CeHIA Meaningful Connections Report: Capabilities HIT Policy Committee Recommendations: Priorities • Ability to collect, store, manage and transmit health data • Ability to communicate and exchange care planning • Ability to report quality and performance measures • Ability to engage decision support and evidence-based systems • Ability to inform and educate patients online • Improve quality, safety, and efficiency, and reduce health disparities • Engage patients and families • Improve care coordination • Improve population and public health • Ensure privacy and security protections for personal health information "Health Outcomes Policy Priorities" from the HIT Policy Committee

6. Defining Meaningful Use 2011 Objective: “Improve quality, safety, efficiency, and reduce health disparities.” . “Ability of providers and practices to engage in decision support for evidence-based treatments and tests.” • Eligible Providers: • - Implement drug-drug, drug-allergy, drug-formulary checks. • Maintain up-to-date problem list of current and active diagnoses based on ICD-9 or • SNOMED. • - Generate and transmit permissible prescriptions electronically (eRx). • Maintain active medication list and active medication allergy list. • Record demographics: preferred language, insurance type, gender, race, ethnicity. • - Record advance directives. • - Record vital signs: height, weight, blood pressure, calculate and display BMI. • - Record smoking status. • - Incorporate lab-test results into EHR as structured data. • Generate lists of patients by specific conditions to use for quality improvement, • reduction of disparities, and outreach. • - Report ambulatory quality measures to CMS • - Send patient reminders, per patient preference for prev/follow-up care. • - Implement one clinical decision rule relevant to specialty or high clinical priority. • - Document a progress note for each encounter. • - Check insurance eligibility electronically from public and private payers, where possible. • - Submit claims electronically to public and private payers.

7. Defining Meaningful Use 2011 Objective: “Improve quality, safety, efficiency, and reduce health disparities.” . “Ability of providers and practices to engage in decision support for evidence-based treatments and tests.” • 2011 Measures: • - Report quality measures to CMS including: • - % diabetics with A1c under control.; % hypertensive patients with BP under • control; % of patients with LDL under control; % of smokers offered smoking • cessation counseling; % of patients with recorded BMI; % eligible surgical • patients who receive VTE prophylaxis; % of orders (for meds, lab tests, • procedures, radiology, and referrals) entered directly by physicians through • CPOE. • - Use of high-risk medications (Re: Beers criteria) in the elderly. • - % of patients over 50 with annual colorectal cancer screenings. • - % of females over 50 receiving annual mammogram. • - % of patients who received flu vaccine. • - % lab results incorporated into EHR in coded format. • - Stratify reports by gender, insurance. type, primary language, race, ethnicity. • % of all meds entered into EHR as generic, when generic options exist in the • relevant drug class. • % of orders for high-cost imaging services with specific structured indications • recorded. • - % claims submitted electronically to all payers. • - % patient encounters

8. Defining Meaningful Use 2011 Objective: “Engage patients and families.” . “Ability of consumers and patients to be informed and literate about their health and medical conditions and appropriately self-manage with monitoring and coaching from providers.” • Eligible Providers: • Provide patients with an electronic copy of their health • information (including lab results, problem list, medication • lists, allergies) upon request. • Provide patients with timely electronic access to their health • information (including lab results, problem list, medication • lists, allergies). • - Provide access to specific educational resources. • Provide clinical summaries for patients with each • encounter. • 2011 Measures: • -% of all patients with access to personal health information • electronically. • % of all patients with access to patient-specific educational • resources. • % of encounters for which clinical summaries were • provided..

9. Defining Meaningful Use 2011 Objective: “Improve care coordination.” . “Ability of providers, patients and other members of the care team to communicate.” • Eligible Providers: • Capability to exchange key clinical information (e.g., • problem list, medication list, allergies, test results) among • providers of care and patients’ authorized entities • electronically. [per HIE workgroup] • Perform medication reconciliation at relevant encounters • and each transition of care. • 2011 Measures: • - Report 30-day readmission rate. • % of encounters where med reconciliation was • performed. • Implemented ability to exchange health information • with external clinical entity (specifically labs, care • summary, and medication lists). • % of transitions in care for which summary care • record is shared (e.g. electronic, paper, e-Fax).

10. Defining Meaningful Use 2011 Objective: “Improve population and public health.” . “Ability to collect, store, measure and report on the processes and outcomes of individual and population performance and quality of care.” • Eligible Providers: • 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. • 2011 Measures: • -Report up-to-date status for childhood • immunizations. • % reportable lab results submitted • electronically.

11. Defining Meaningful Use 2011 Objective: “Ensure privacy and security protections for personal health information.” . “Ability to collect, store, manage and exchange relevant personal health information” • Eligible Providers: • - Compliance with HIPAA Privacy and Security Rules. • Compliance with fair data sharing practices set forth • in the Nationwide Privacy and Security Framework • 2011 Measures: • Full compliance with HIPAA Privacy and • Security Rules. • Conduct or update a security risk assessment • and implement security updates as necessary.

12. Cross-Walk: MU Requirements andCertifiable EHR Technology Components • Access eligibility and submit claims online. • Generate and refill ePrescriptions. -Meds Decision Support, e.g. drug-drug, etc. • Maintain active patient data, structured format. -Demographics, Problems, Medications -Allergies, Vital Signs, Immunizations -Advance directives, Lab results, Smoking hx • Generate progress note at each visit. • Generate lists of patients by condition. • Generate reports per CMS measures. • Implement at least one CDS rule. • Enable pts. to view/receive copy of summary data. • Enable pts. to access education, coaching. • Enable exchange of summary health data. • Generate reports for public health and surveillance. • Comply with all HIPAA privacy and security rules. • Practice management/billing, w/ online eligibility. • ePrescribing with alerts and reminders. • Office-based Registry application -Report generator either locally or as web service remotely -Care plans based on guidelines • Documentation module • Patient web portal/PHR, with secure messaging and CCR-compliant viewing, downloading, and patient education/engagement capability. • Internet access to secure web server; local hospital, regional, national. • HIPAA privacy officer and program.

14. Clinical Groupware = Modular, mobile, and modestly-priced platforms and software applications for physicians’ practices and hospitals that meet ONC/NIST certification criteria for meaningful use, security, and interoperability

15. Dennis Saver, MD“Boots on the Ground” A view from a practicing physician

16. Questions and Comments? Dennis Saver, MD David C. Kibbe, MD MBA The Kibbe Group LLC email: kibbedavid@mac.com telephone: 913. 205. 7968 home office: 594 D Woodbury Road Fearrington Post Pittsboro, NC 27312