PR’s Journey Towards Electronic Health Records Adoption & Meaningful Use

1. PR’s Journey TowardsElectronic Health Records Adoption & Meaningful Use PRESENTATION TO PR HIT SUMMIT Antonio Fernandez Regional Extension Center for PR and USVI

2. ADOPTION MEANINGFUL USE Health IT Practice Research Regional Extension Centers Medicaid EHR Program 1st Year Incentive Workforce Training Medicare and Medicaid EHR Incentive Programs State Grants forHealth Information Exchange Medicaid Administrative Funding for HIE Standards & Certification Framework Privacy & Security Framework EXCHANGE HITECH: How the Pieces Fit Together Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery 2

3. Program Timeline

4. EHR ADOPTION PROGRESS IN PR • Physicians who have selected a Certified EHR 3,900 • Installations in Physician Practices 2,512 • Meaningful Users 325 • Dentists in Process of Adoption 197 • FQHC’s in EHR Adoption Process 49 • Hospitals Having Attested under Medicaid AIU 21 • Number of eRx’s during Month of May 451,110 • Pharmacies Dispensing e-Rx’s in May 1,012 • Active E-Prescribers during month of May 1,854

5. Physician Adoption by Health Region

6. Hospitals Attesting under AIU for 2012 Medicaid Incentives

7. FQHC’s in Process of Certified HER Adoption

10. Puerto Rico Monthly ePrescriptions

11. Stage 1 Data capture and sharing Stage 2 Advanced clinical processes Stage 3 Improved outcomes Ascending Meaningful Use Stages Improved quality of patient care • Better clinical outcomes • Improved population health outcomes • Increased transparency and efficiency • Empowered individuals • More robust research data on health system For more information on meaningful use of EHRs, visit: http://www.cms.gov/EHRIncentivePrograms/35_Meaningful_Use.asp

13. Eligible Professionals 15 core objectives 5 of 10 menu objectives 20 total objectives Eligible Hospitals & CAHs 14 core objectives 5 of 10 menu objectives 19 total objectives Eligible Professionals 17 core objectives 3 of 6 menu objectives 20 total objectives Eligible Hospitals & CAHs 16 core objectives 3 of 6 menu objectives 19 total objectives Meaningful Use: Changes from Stage 1 to Stage 2 Stage 1 Stage 2

16. Stage 2 EP Core Objectives EPs must meet all 17 core objectives:

17. Stage 2 EP Core Objectives EPs must meet all 17 core objectives:

18. Stage 2 EP Menu Objectives EPs must select 3 out of the 6:

19. Stage 2 Hospital Core Objectives Eligible hospitals must meet all 16 core objectives:

20. Stage 2 Hospital Core Objectives Eligible hospitals must meet all 16 core objectives:

21. Stage 2 Hospital Menu Objectives Eligible Hospitals must select 3 out of the 6:

22. Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals. • The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals. • At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR. Closer Look at Stage 2: Electronic Exchange • Stage 2 focuses on actual use cases of electronic information exchange:

23. Objective= Objective= Provide patients the ability to view online, download and transmit their health information Provide patients with e-copy of health information upon request Provide electronic access to health information Changes to Stage 1: E-Copy & Online Access • Current Stage 1 Objective New Stage 1 Objective • The measure of the new objective is 50% of patients are provided access to their information; there is no requirement that 5% of patients do access their information for Stage 1. • The change in objective takes effect in 2014 to coincide with the 2014 certification and standards criteria 23

24. Requirements for Patient Action: • More than 5% of patients must send secure messages to their EP • More than 5% of patients must access their health information online Closer Look at Stage 2: Patient Engagement • Patient engagement – engagement is an important focus of Stage 2. • EXCULSIONS – CMS is introducing exclusions based on broadband availability in the provider’s county.

25. CQM Selection and HHS Priorities • All providers must select CQMs from at least 3 of the 6 HHS National Quality Strategy domains: • Patient and Family Engagement • Patient Safety • Care Coordination • Population and Public Health • Efficient Use of Healthcare Resources • Clinical Processes/Effectiveness

26. Aligning CQMs Across Programs • CMS’s commitment to alignment includes finalizing the same CQMs used in multiple quality reporting programs for reporting beginning in 2014 • Other programs include Hospital IQR Program, PQRS, CHIPRA, and Medicare SSP and Pioneer ACOs, and Patient-Centered Medical Homes Children’s Health Insurance Program Reauthorization Act Medicare Shared Savings Program and Pioneer ACOs Hospital Inpatient Quality Reporting Program Physician Quality Reporting System

27. Patient-Centered Medical Homes • Model for care provided by physician practices that seeks to strengthen the physician-patient relationship and replaces episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship. • It is a Model of care where each patient has an ongoing relationship with a personal physician who leads a team that takes collective responsibility for patient care. The physician-led care team is responsible for providing all the patient’s health care needs and, when needed, arranges for appropriate care with other qualified physicians .

28. Patient-Centered Medical Home • Six MUST PASS elements are considered essential to the patient-centered medical home, and are required for practices at all recognition levels by NCQA. Practices must achieve a score of 50% or higher on must-pass elements: • 1.PCMH 1, Element A: Access During Office Hours • 2.PCMH 2, Element D: Use Data for Population Management • 3.PCMH 3, Element C: Care Management • 4.PCMH 4, Element A: Support Self-Care Process • 5.PCMH 5, Element B: Referral Tracking and Follow-Up • 6.PCMH 6, Element C: Implement Continuous Quality Improvement

29. Meaningful Use Criteria • PCMH 1: Access and Continuity • PCMH 2: Identify and Manage Patient Populations • PCMH 3: Plan and Manage Care • PCMH 4: Self- Management Support • PCMH 5: Track and Coordinate Care • PCMH 6: Performance Measurement and Quality Improvement • Improving quality, safety, efficiency, and reducing health disparities • Engage patients and families in their health care • Improve care coordination • Ensure adequate privacy and security protections for personal health information • Improve population and public health • Patient-Centered Medical Home

30. REC 2.0 Scope of Services • Medicaid/Medicare EHR Incentive Program Eligible Provider Registration & Attestation Support • Outreach to Other Eligible Providers (Hospitals, Physicians Specialists & Dentists) • Meaningful Use Education and Provider Support • Privacy & Security Education & Risk Assessment • Direct Messaging/Health Information Exchange • ADT (Admissions/Discharge/Transfer) Care Transitions Coordination • Accountable Care Organizations, Patient-Centered Medical Homes & Transformation Project Support • Meaningful User Groups/Communities of Practice • HIT Education, Training, and Workforce Development • Healthcare Analytics

31. AREAS OF OPPORTUNITY • Specialized EHR Needs for Key specialty areas: • Psychiatric/Behavioral Health Care • Pediatric/Children’s HealthCare • Correctional Health Care • Strategies for Consumer Engagement & Mobile Health Applications for Consumers, Patients and Families • Population Health Management • Privacy & Security Education, Risk Assessment & Management • Designing Integrated Models of Care which could be adapted to Serving Underserved Populations outside of Puerto Rico

33. Stage 2 Resources • CMS Stage 2 Webpage: • http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html Links to the Federal Register Tipsheets: • Stage 2 Overview • 2014 Clinical Quality Measures • Payment Adjustments & Hardship Exceptions (EPs & Hospitals) • Stage 1 Changes • Stage 1 vs. Stage 2 Tables (EPs & Hospitals)

34. RECPR.ORG/BLOG

35. Other Links U.S. Department of Health & Human Services http://www.hhs.gov Welcome to the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) https://pecos.cms.hhs.gov National Plan & Enumeration System https://nppes.cms.hhs.gov/NPPES/LoginPage.do?userType=PROVIDER Puerto Rico Immunization Registry https://prir.salud.gov.pr/PRIRPRD/portalInfoManager.do Puerto Rico Health Informatio Network (PRHIN) https://www.prhin.net Mi Salud http://www.salud.gov.pr/Pages/default.aspx

36. Contact Information Antonio Fernandez afernandez@psm.eduRegional Extension Center (REC) Ponce School of Medicine & Health Sciences