Electronic Health Record Electronic Medical Record

1. Electronic Health Record Electronic Medical Record Where are We?

2. The Electronic Health Record • What IT IS • Individual focused • Individual specific core data set where elements reside in multiple sources. • Mechanism for sharing health data about an individual Will Gaud

3. The Electronic Health Record • Longitudinal health information about an individual from multiple sources • Support for clinical decision making • Accessible in all points of care in a timely manner • Not a technology issue but a patient care issue Will Gaud

4. The Electronic Health Record • What IT IS NOT • Provider focused • An operational system (operational systems feed data to populate the EHR) • A data collection system • A single physical repository Will Gaud

5. The Electronic Health Record • A Clinical Information System/Electronic Patient Record nor Physician’s Office System/Electronic Medical Record, but they are interrelated. Will Gaud

6. The Electronic Health RecordDefined The aggregate electronic record of health- related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care Source: National Alliance for Health Information Technology (NAHIT)  Will Gaud

7. Global EHR PenetrationPrimary Care Physicians Will Gaud

8. EHR Penetration in U.S. Hospitals • Dismal – survey from 3049 nonfederal acute-care hospitals • 1.5% had a comprehensive EHR • 7.6% had a basic system that lacked decision support, only minimal order capability and only had to be available in one unit of the hospital (to be classified as comprehensive, a system had to be used throughout the facility Will Gaud

9. Barries to Adoption • Complexity of operations • Cost • Hardware • Software • Unavailability of resources • Health Information Technology Will Gaud

10. Technology to the Rescue • Cloud Computing - a general term for anything that involves delivering hosted services over the Internet. • Infrastructure-as-a-Service (IaaS) • Platform-as-a-Service (PaaS) • Software-as-a-Service (SaaS) • Cloud computing can help mitigate much of the cost associated with resources, infrastructure and HIT management Will Gaud

11. The Future Immediate and Beyond • Health Information Exchange (HIE) - the mobilization of healthcare information electronically across organizations within a region or community. Will Gaud

12. The Future Immediate and Beyond • The National Health Information Network - a program under the Office of the National Coordinator for Health Information Technology (ONC), established in 2004 to improve the quality and efficiency of healthcare by establishing a mechanism for nationwide health information exchange Will Gaud

13. What to look for in an EHR • CCHIT Certification • Decision support • Clinical practice guidelines • Actionable alerts • Drug interaction warnings • Flexibility of configuration • Registry / population management with interoperable components Will Gaud

14. What’s out there? • Current EHRs are powerful, but they are not optimized for population management or population based reporting – however, the current HRSA EHR Guidelines/Specification specifically asks vendors to provide this functionality Will Gaud

15. Keeping in mind that … An EHR is an electronic record of patient health information including patient demographics, conditions, medications, vital signs, medical history, immunizations, notes, laboratory data and radiology reports that can generate a complete record of a clinical patient encounter (California Health Care Foundation) Will Gaud

16. … we should avoid • Duplicating data among multiple clinical systems as this • Can be expensive and difficult to manage • Defeats the purpose of the EHR – “longitudinal health information about an individual from multiple sources with support for clinical decision making and accessible from all points of care in a timely manner” Will Gaud

17. Adding flexibility to the EHR • Most products in the marketplace are configurable • Ask the vendor (through your functional specification) to provide, as part of the system, the functionality you desire • Ask also for the ability to introduce ‘user defined/validated data elements’ Will Gaud

18. Adding flexibility … • Full support for third party reporting systems (if one is not already included in the system) • Advice on strategy on how to migrate data from existing systems to the EHR • Methods • Vendors Will Gaud

19. Adding flexibility … • Remember that the objective should be the implementation of a system to hold all patient related demographic and clinical data - migration to it from other systems should happen as quickly as time permits to avoid confusion, additional expense and improving quality of care. • It is all about the ‘whole patient’ Will Gaud

20. Becoming “Meaningful Users” What does this mean? Jayne Bertovich

21. Meaningful Use The ultimate goal is to enable significant and measurable improvements in population health Recommendations, Meaningful Use Workgroup to the Health HIT Policy Committee, June 16, 2009 Jayne Bertovich

22. Meaningful Use The ultimate vision is that all patients are fully engaged in health care, providers have real-time access to all medical information and tools to help ensure the quality and safety of the care produced. • Recommendations, Meaningful Use Workgroup to the Health HIT Policy Committee, June 16, 2009 Jayne Bertovich

23. Do I need to think about MU (Meaningful Use)? Yes! 22 objectives for EHRs by 2011. The objectives call for qualified EHRs to: • Allow patients to access clinical information; • Comply with state and federal privacy, security and data sharing regulations; • Document patient progress and provide clinical summaries; Jayne Bertovich

24. Do I need to think about Meaningful Use (MU)? • Exchange critical information with other care providers; • Implement drug interaction safeguards; • Send patient reminders about follow-up and preventive care; • Submit immunization and laboratory data to relevant public health registries; and • Use computerized physician order entry systems to transmit prescriptions. Jayne Bertovich

25. 2009 2011 2013 2015 HIT-Enabled Health Reform Meaningful Use Criteria HITECH Policies 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes) 25 HIT-Enabled Health ReformAchieving Meaningful Use Paul Tang, ChairGeorge Hripcsak. Co-Chair HHS Policy Committee Jayne Bertovich

26. Meaningful Use MatrixJune 16, 2009 Jayne Bertovich

27. Meaningful Use and ARRA The American Recovery and Reinvestment Act (ARRA) authorizes CMS to provide reimbursement incentive for physicians and hospital providers who are successful in becoming “Meaningful Users” of an electronic health record. Providers who are “Meaningful Users” will be eligible for $44,000 in increased Medicare and Medicaid payments over 5 years. Jayne Bertovich

28. Medicare Provision • Medicare: Incentive payments through Medicare (the federal insurance program for those 65 and older) go to non-hospital based physicians and hospitals paid through prospective payment systems that are “meaningful users” of certified EHR systems. In simple terms, “meaningful use” requires that the EHR be installed and actively used to collect and share patient information and to support improved clinical care. Jayne Bertovich

29. Medicare Provision • Meaningful use criteria for physicians include ePrescribing, electronic reporting of clinical quality data, and that the certified EHR is connected for the electronic exchange of health information. Meaningful use criteria for hospitals are similar to those for physicians but do not include ePrescribing. Jayne Bertovich

30. Medicaid Provision Medicaid: Incentive payments through Medicaid (the federal/state program for low-income individuals) go to non-hospital based providers and hospitals. Providers include not only physicians but also dentists, nurse practitioners, certified nurse midwives, and, under specific circumstances, physician’s assistants. In addition to hospitals, federally qualified health centers (FQHCs) and rural health clinics may receive Medicaid incentives for EHR adoption. Jayne Bertovich

31. Medicaid Provision • To qualify for Medicaid incentives, providers must waive any right to the Medicare EHR incentives. Providers must also demonstrate that a qualifying percentage of their patients are Medicaid beneficiaries (or, in the case of FQHCs, “needy individuals”). For most providers, 30 percent of their patients must be Medicaid beneficiaries. Children’s hospitals qualify if they treat Medicaid patients (with no qualifying percentage). Other acute care hospitals must have 10 percent of total patients as Medicaid beneficiaries. Jayne Bertovich

32. Other ARRA HIT Funding • The legislation also allocates $2 billion in discretionary funding to the Health and Human Services Secretary, to be distributed through a mix of grants and loans • Specific allocations are determined within the legislation: • $20 million to the National Institute of Standards and Technology to “create and test standards related to health security and interoperability” Jayne Bertovich

33. Other ARRA HIT Funding • $300 million to the Office of the National Coordinator for HIT for regional and subnational efforts for health information exchange. • Additional and potential funding areas the bill suggests include: • Telemedicine, Technology to protect electronic health information, HIT for public health, Loans to providers for HIT adoption (via states) Jayne Bertovich