American e-Health

1. American e-Health A guide for Meaningful Use & EMR’s

2. Topics • Meaningful Use; Economic Stimulus; EMR certifications • Do’s & Don’t’s of going paperless; buying computers & hardware • Red flags & warnings during EMR sales process • EMR purchase contracts • Best Practices, Evidence-Based Medicine, & EMR’s

3. Meaningful Use • Definition • $44,000.00 to $64,000.00 per eligible doctor • Certifications: 758 certified ambulatory EMR’s, as of September 14, 2011 • Items tested for EMR’s to achieve certification • http://www.ama-assn.org/amednews/2011/01/24/bisf0126.htm • http://healthit.hhs.gov • http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__onc-authorized_testing_and_certification_bodies/3120 • www.HealthIT.gov

4. American Reinvestment & Recovery Act of 2009 • Expanding affordable health insurance coverage for all • Reducing costs and increasing value in health care services • Eliminating excessive administrative burdens • Increasing investments in wellness and prevention services • Empowering physicians to improve quality through evidence-based medicine • Reforming government insurance programs by providing adequate physician payments to assure timely access for patients • Implementing essential payment and delivery reforms to optimize health care expenditures, including medical liability and antitrust reforms • http://www.ama-assn.org/ama/no-index/news/rhetoric-reality-stimulus-package.page

5. AMA Interpretation of ARRA • $19BB to qualifying physicians during the next 5 years who buy & implement qualified HIT • HHS to develop & update uniform standards • Incentives through Medicare Part B • Doctors who don’t adopt EHR by 2015 face reduction in Medicare • 10% extra bonus to doctors in rural areas • http://www.ama-assn.org/resources/doc/washington/arra-hit-provisions.pdf

6. ARRA Incentives & Reductions

7. Institute of Medicine (IOM) View The “American Recovery and Reinvestment Act of 2009” (ARRA) provides a meaningful, initial down payment on CER (comparative effectiveness research) that will strengthen the delivery of evidence-based medicine while preserving physician decision-making autonomy. Title VIII of ARRA includes a $1.1 billion appropriation to fund additional CER administered by the Agency for Healthcare Research and Quality (AHRQ), the National Institutes of Health (NIH), and the Secretary of the Department of Health & Human Services (HHS). This funding will “be used to conduct or support research to evaluate and compare clinical outcomes, effectiveness, risk, and benefits of two or more medical treatments and services that address a particular medical condition” as specified in the Conference Report concerning the CER provisions. The corresponding statutory language of ARRA signifies the preeminence of clinical outcome-based research and analysis (as opposed to research driven by cost analysis and cost containment). Also, the Conference Report “recognizes that ‘a one-size-fits-all’ approach to patient treatment is not medically appropriate.” • Source: CMS Report 5 (A-08)

8. ONC-Authorized Testing and Certification Bodies (ATCBs) • Surescripts LLC  - Arlington, VADate of authorization: 12/23/2010Scope of authorization: EHR Modules: E-Prescribing, Privacy and Security • ICSA Labs  - Mechanicsburg, PADate of authorization: 12/10/2010Scope of authorization: Complete EHR and EHR Modules • SLI Global Solutions  - Denver, CODate of authorization: 12/10/2010Scope of authorization: Complete EHR and EHR Modules • InfoGard Laboratories, Inc. – San Luis Obispo, CADate of authorization: 9/24/2010Scope of authorization: Complete EHR and EHR Modules • Certification Commission for Health Information Technology (CCHIT) - Chicago, ILDate of authorization: 9/3/2010Scope of authorization: Complete EHR and EHR Modules • Drummond Group, Inc. (DGI) - Austin, TXDate of authorization: 9/3/2010Scope of authorization: Complete EHR and EHR Modules • Ambulatory & Inpatient EMR certification checker: http://onc-chpl.force.com/ehrcert

9. Going Paperless for Doctors Do Don’t Scan every piece of paper in your office Buy more than you need Be fully swayed by administrative staff hesitations Fear change Fall into “blind leading the blind” situations • Back up all of your existing computerized data • Familiarize yourself with EXAM PORTIONS of EMR’s • Learn about Server-Based systems versus Cloud Computing • Develop a realistic go-forward strategy • Consider warranty programs

10. Reputable Vendors (New & Refurb) In addition to BestBuy, Dell.com, the Mac Store, Staples, & other reputable retailers, you may wish to explore: • www.CompUSA.com • www.MicroCenter.com • www.NewEgg.com • www.TigerDirect.com

11. Discussions • Antiviruses • Firewalls • Personal emails, Facebook, etc. • Wi-Fi • HOW HIPAA PLAYS A ROLE IN ALL OF THIS

12. Understanding Change • Recredentialling if you change billing software • Suggestions for scanning • e-Lab implementations; to pay, or not to pay? • Staff training & vendor support • Setting provisions for additional administrative & clinical time; calculating losses • Adding responsibilities to staff members to compensate for time loss

13. Pitfalls • Infrastructure versus Internet • Schedulers • e-Notes • Billing • eRx • e-Labs • Who owns your data? • Big Brother? • Common sales tricks • Google your sales rep • Verify integrity of EMR company • Verify solvency of EMR company (public vs. private) • If you’ve been tricked… • Grant pitfalls • Don’t spend your Stimulus $ before you get it

14. Contracts • Understand training, sales & support contracts, & renewals • Practice obligations w/r/t hourly rates, travel, etc. • In-house versus outsourced training & support • Implementation schedules • Small print • Refund policies

15. 3rd Parties • Patient portals • eRx • Billing software • and more Also, should you incur 3rd party IT support?

16. Anatomy of an EMR • Scheduler/PM • Communications • Patient Records • Accounting/Billing • Education • eRx • Compliance & Data Pooling (Health Information Exchange/HIE)

17. Best Practices & Evidence-Based Medicine • Definitions • Creating decision trees • Programming into EMR systems • Helping doctors examine • Helping to bill properly • Following guidelines

18. Definition of Best Practice A best practice is a technique or methodology that, through experience and research, has proven to reliably lead to a desired result. A commitment to using the best practices in any field is a commitment to using all the knowledge and technology at one's disposal to ensure success. The term is used frequently in the fields of health care, government administration, the education system, and more.

19. Definition of Evidence-Based Medicine • Evidence-based medicine (EBM) or evidence-based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making.[1] It seeks to assess the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic tests.[2] Evidence quality can range from meta-analyses and systematic reviews of double-blind, placebo-controlledclinical trials at the top end, down to conventional wisdom at the bottom. • EBM/EBP recognizes that many aspects of health care depend on individual factors such as quality- and value-of-life judgments, which are only partially subject to scientific methods. EBP, however, seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best prediction of outcomes in medical treatment, even as debate continues about which outcomes are desirable. • http://en.wikipedia.org/wiki/Evidence-based_medicine

20. US Preventative Services Task Force • Level I: Evidence obtained from at least one properly designed randomized controlled trial. • Level II-1: Evidence obtained from well-designed controlled trials without randomization. • Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. • Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. • Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

21. Categorizations • Level A: Good scientific evidence suggests that the benefits of the clinical service substantially outweigh the potential risks. Clinicians should discuss the service with eligible patients. • Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients. • Level C: At least fair scientific evidence suggests that there are benefits provided by the clinical service, but the balance between benefits and risks are too close for making general recommendations. Clinicians need not offer it unless there are individual considerations. • Level D: At least fair scientific evidence suggests that the risks of the clinical service outweighs potential benefits. Clinicians should not routinely offer the service to asymptomatic patients. • Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.

22. Limitations • Ethics • Cost • Time • Generalizability • Publication bias • Ghost writers • Populations, clinical experience, and dubious diagnoses • Illegitimacy of other types of medical reports • Political criticism • Science Based Medicine

23. Additional Explanations • Clinical algorithms are instructions relating to the management of clinical issues, which are organized on the basis of conditional, branching logic • Clinical informatics is deals with clinical practice, and extends into medical billing & database expert systems • Clinical pathways are interlinked clinical practice guidelines which organize, sequence and time the care given to a typical uncomplicated patient • Schoenbaum SC (ed.) (1995) Using clinical practice guidelines to evaluate quality of care. V1. US Department of Health & Human Services, Bethesda, MD).

24. Evaluating Internet Data BACKGROUND: The advent of virtually free Internet access has opened large vistas of health care information to those willing to invest a small amount of time and energy learning how to perform searches using browser software. Health care providers, organizations, and professional associations, among many others, publish "best practices" information for both administrative and clinical audiences, making these recommendations among the fastest-growing types of health care information appearing on the World Wide Web. The problem is how to find best practices among the wealth of resources on the Internet and then how to separate the proverbial wheat from the chaff. WHO IS SEEKING BEST PRACTICES ON THE INTERNET? Best practice describes a process or technique whose employment results in improved patient and/or organizational outcomes. Health care providers, managed care organizations, administrators, payers, and policy analysts are all interested in improving the quality of health care and are likely to be customers of best practices informational resources. HOW TO EVALUATE THE QUALITY OF BEST PRACTICES INFORMATION? Once the information is available on the Internet, the problem for the searcher shifts from one of quantity to quality. The best practices information seeker should stop and ask a number of questions about the quality of information, its sources, and the methods used to obtain it. CONCLUSION: The "truth" may be out there some-where in cyberspace, but locating best practices information and evaluating its quality require new skills and patience and time to practice and develop them to the point of efficiency. • http://www.ncbi.nlm.nih.gov/pubmed/9476203

25. Contact Us American eHealth Collaborative Website: www.AeHC.us • In NYC • (212) 300-5126 • In Washington, DC • (202) 486-5548 Email: Info@AeHC.us