The Road to Meaningful Use and Beyond: Higher Payment, Better Patient Care

1. The Road to Meaningful Use and Beyond: Higher Payment, Better Patient Care Trudi Matthews Director of Policy and Public Relations HealthBridge Tri-State Regional Extension Center

2. Meaningful Use Basics What do you need to know to get paid?

3. MU Definition Meaningful use (MU) is defined as: • Use of a certified Electronic Health Record (EHR) • Electronic exchange of health information • Quality reporting

4. Meaningful Use Stages *Indicates “payment year” in which each Stage is first introduced. Actual compliance timeframe depends on an EP’s first payment year.

5. MU Final Rule • Moved away from “all or nothing approach.” • 15 core requirements for Eligible Professionals • 14 core requirements for Hospitals. • “Menu” of 10 additional requirements – have to chose 5 of the 10.

6. MU Final Rule • Thresholds must be met for many requirements (e.g., 40% e-prescribing) • Reporting by attestation required in 2011, electronic reporting to CMS required in 2012. • Quality measures required for reporting: • 6 for EPs – 3 core* + 3 menu • 15 measures for hospitals *3 alternative core measures available for those EPs that cannot report on 3 core measures.

7. The Challenges • The final government regulations are complex (864 pages long). • As many as 30% of all EHR implementations fail. • EHR Use is not enough – Reporting and electronic interchange are key requirements

8. Meaningful Use (MU) Final Rule – EPs – Core Set ** Core • Use computerized order entry for medication orders. • Implement drug-drug, drug-allergy checks. • Generate and transmit permissible prescriptions electronically. • Record demographics. • Maintain an up-to-date problem list of current and active diagnoses. • Maintain active medication list. • Maintain active medication allergy list. • Record and chart changes in vital signs. • Record smoking status for patients 13 years old or older. • Implement one clinical decision support rule. • Report ambulatory quality measures to CMS or the States. • Provide patients with an electronic copy of their health information upon request. • Provide clinical summaries to patients for each office visit. • Capability to exchange key clinical information electronically among providers and patient authorized entities. • Protect electronic health information (privacy & security) 3. Generate and transmit permissible prescriptions electronically. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

9. Meaningful Use (MU) Final Rule – EPs – Core Set ** Core • Use computerized order entry for medication orders. • Implement drug-drug, drug-allergy checks. • Generate and transmit permissible prescriptions electronically. • Record demographics. • Maintain an up-to-date problem list of current and active diagnoses. • Maintain active medication list. • Maintain active medication allergy list. • Record and chart changes in vital signs. • Record smoking status for patients 13 years old or older. • Implement one clinical decision support rule. • Report ambulatory quality measures to CMS or the States. • Provide patients with an electronic copy of their health information upon request. • Provide clinical summaries to patients for each office visit. • Capability to exchange key clinical information electronically among providers and patient authorized entities. • Protect electronic health information (privacy & security) 11. Report ambulatory quality measures to CMS or the States. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

10. Meaningful Use (MU) Final Rule – EPs – Core Set ** Core • Use computerized order entry for medication orders. • Implement drug-drug, drug-allergy checks. • Generate and transmit permissible prescriptions electronically. • Record demographics. • Maintain an up-to-date problem list of current and active diagnoses. • Maintain active medication list. • Maintain active medication allergy list. • Record and chart changes in vital signs. • Record smoking status for patients 13 years old or older. • Implement one clinical decision support rule. • Report ambulatory quality measures to CMS or the States. • Provide patients with an electronic copy of their health information upon request. • Provide clinical summaries to patients for each office visit. • Capability to exchange key clinical information electronically among providers and patient authorized entities. • Protect electronic health information (privacy & security) 14. Capability to exchange key clinical information electronically among providers and patient authorized entities. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

11. Meaningful Use (MU) Final Rule – EP – Menu Set Menu: • Implement drug-formulary checks. • Incorporate clinical lab-test results into certified EHR as structured data. • Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. • Send reminders to patients per patient preference for preventive/ follow-up care • Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) • Use certified EHR to identify patient-specific education resources and provide to patient if appropriate. • Perform medication reconciliation as relevant • Provide summary care record for transitions in care or referrals. • Capability to submit electronic data to immunization registries and actual submission. • Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission. *Language from the final rule has been changed in places for brevity. ** These requirements are for eligible professionals (EPs). A table that includes hospital requirements is available at www.healthbridge.org. 3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research and outreach.

12. Meaningful Use (MU) Final Rule – EP – Menu Set Menu: • Implement drug-formulary checks. • Incorporate clinical lab-test results into certified EHR as structured data. • Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. • Send reminders to patients per patient preference for preventive/ follow-up care • Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) • Use certified EHR to identify patient-specific education resources and provide to patient if appropriate. • Perform medication reconciliation as relevant • Provide summary care record for transitions in care or referrals. • Capability to submit electronic data to immunization registries and actual submission. • Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission. *Language from the final rule has been changed in places for brevity. ** These requirements are for eligible professionals (EPs). A table that includes hospital requirements is available at www.healthbridge.org. 8. Provide summary care record for transitions in care or referrals.

13. CMS Incentive Program Timeline • Registration with CMS begins in January, • EPs will be required to register for participation in either the Medicare or the Medicaid incentive program. • Medicaid Incentive Payments should start by June. • Full Medicare incentive requires completion by December, 2012

14. Tri-State Regional Extension Center An Overview REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

15. What is the Tri-State REC? • New federally-funded collaboration led by HealthBridge • GOAL: Help eligible professionals • implement technology • achieve meaningful use and • qualify for incentives REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

16. Who Do We Serve?

17. Who Do We Serve? • Priority Primary Care Practitioners (PPCP) • Primary Care = FPs, OB/Gyn, Peds, Int. Med • Additional focus on: • Small practices (<10 prescribers; physicians, PAs, ARNPs) • Community health centers • Rural clinicians and those with critical access hospitals • Practices and clinics that serve the underserved REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

18. What Services Do We Provide? • Meaningful Use Strategy and Planning • EHR Selection Support • Standard RFP • Pre-negotiated Prices and Terms for five Supported Vendors • EHR Implementation Support • Workflow and process improvement • Health Information Exchange Support • Quality Reporting Support REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

19. REC Supported Vendors • Allscripts - Professional • Athenahealth - AthenaNet • eClinicalWorks - eCW EHR • GE Healthcare - Centricity • NextGen Healthcare - NextGen EHR ALSO: • REC will work with any practice regardless of vendor. • REC will work with practices that choose a hospital supported EHR. REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

20. Why Work with the Tri-State REC? Bottom line: REC will help practices and health centers • maximize funding • minimize expenses and • improve quality and efficiency of the practice • REDUCE RISK of PROJECT FAILURE REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

21. Greater Cincinnati Beacon Collaboration An Overview

22. Beacon Community Program: Overview • 17 Beacon Communities Extend advanced health IT and exchange infrastructure • Demonstrate a vision of the future where: • Hospitals, clinicians and patients are meaningful users of health IT; and, • Communities achieve measurable & sustainable improvements in health care quality, safety, efficiency, and population health. Leverage data to inform specific delivery system and payment strategies

23. Beacon Community Programs

24. GCBC Activities HIT/HIE Interventions – HealthBridge • Core Infrastructure Enhancements • Master Patient Index, • Repository & • Enhanced Connectivity to EHRs • Alert system for ER & Hospital visit/discharge to ambulatory providers • Disease registries & EHRs with clinical decision support • Summary record exchange • Patient portal availability • Race, ethnicity and language data enhancement

25. Contact Us • For answers to your questions, additional information or to sign up to work with us: • Call 513-469-7222 • Visit our website, www.healthbridge.org • Email rec@healthbridge.org REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

26. Contact: Rob Edwards Acting Executive Director, Kentucky REC Rob.Edwards@uky.edu 859-323-3193

27. Kentucky REC KY REC Tri-State REC

28. Strategic Framework Vision Statement The long-term vision of Kentucky Regional Extension Center is to improve the quality and value of health care for the people of Kentucky and to serve as a model for other areas that face similar challenges. Mission Statement The Kentucky Regional Extension Center based at the University of Kentucky will assist primary care providers and critical access/rural hospitals with EHR adoption, HIE participation, and achievement of meaningful use.

29. REC Goals & Services • Provide a comprehensive, coordinated array of services and strategies which will address barriers and enhance support for EHR adoption by priority primary care providers (PPCPs) throughout the state of Kentucky • Tailor the needs of each practice by combining well-developed educational resources and systems, UK’s state-of-the-art continuing education resources, experience in EHR Adoption and implementation, and on-site PCPP consultation and coaching during the EHR adoption process

30. Menu of KY REC Services Estimated 50.5+ hours needed per practice from recruitment to MU

31. Targeted Providers Primary Care Physicians • FPs, OB/Gyn, Peds, Int. Med • Small practices (<10 prescribers; physicians, PAs, ARNPs) • Community health centers • Practices and clinics that serve the underserved Critical Access Hospitals FQHCs/ PCCs

32. Specialty Providers The KY REC does not target specialty providers, however, we do want to help you. • We can help you find the best price for your EHR • Let us introduce you to a technology consultant

33. Medicare Incentive Payment Schedule *Medicaid EHR incentives will be managed by states Fall 2010 Certification of EHR vendors will start April 2011 Attestation of meaningful use begins 2011-2012 Clinicians can begin using a certified EHR in a meaningful Manner (must use for 90 days) 2010 2011 Jan. 2011 Registration with CMS can begin. This will be done through PECOS May 2011 CMS payments Will begin

34. Medicare Incentives

35. Medicaid Incentives

36. We look forward to working with you.

37. Questions & Answers Rob Edwards rob.edwards@uky.edu