Health Information Technology
in the Real World
Goals for a satisfying practice
–
Do what we are trained to do without
distracting hassles
–
Have some independence and freedom in
decision-making
–
Have enjoyable relationships with our
patients and colleagues
–
Be regarded as competent and caring
clinicians
–
Be compensated fairly for our efforts
–
Have the means necessary to accomplish the
above
Tools for clinical practice
–
Stethoscope, BP cuff, scale, etc.
–
Recording/retrieving mechanism/system:
pen/paper, dictation, keyboard, medical
assistant
–
Communication methods: Telephone, letters,
internet
–
Practice management system for
billing/insurance, etc.
–
Trained employees
–
Resources for learning and reference: books,
journals, lectures, seminars, consultants
Physician have various levels of
utilization and adoption
My Remarks try to address those
–
With no IT and just starting, to those with
–
Complete or Full integration
–
Ideas on how to get the most benefit from
current opportunities
–
HealthInsight Video excerpt from National
TEPR show 2005 in SLC
Workflow Redesign is Critical
–
New tools to do familiar tasks more
efficiently
–
New training (i.e., Medical Assistant
documentation)
–
New communication methods (i.e.,
Internet, etc.)
–
Analyze and Review and Improve
Hardware
–
Computer, Tablet PC, Smartphone, IPad,
etc.
•
Patient interaction
•
Simplest form, replace pen and paper
–
Network/Server
•
Wireless
•
Internet connection
Software
–
Notetaking/drawing/photos
•
Journal/Microsoft OneNote
–
EMR lite vs Full-featured, certified EHR
•
Fast, not get in the way, easily customizable and
usable
•
Ability to retrieve, reconcile, analyze and report
•
Registries, structured data, report generators
•
Interoperability, CCD, certification (CCHIT)
•
Collaborate with Colleagues and Patients
(Facebook)
•
PM: Integrated vs Interfaced
–
Notepad vs Microsoft Word vs Microsoft
Exchange/Sharepoint
Interfaces: Ic
3“Improving Care through
Connectivity and Collaboration”
–
Internet Browser
• Patient Handouts – AAFP – Mayo Clinic • Decision-making – eMedicine – Up to Date – MD Consult/MerckMedicus–
Labs/Imaging
–
Clinical records
–
Pharmacies
–
Public Health/Immunizations
–
Patient Portal
–
cHIE
Incentives
•
More Satisfying Practice
•
Healthcare and Payment reform
–
Even before Obama, Secretary Leavitt
about Value and Quality Measures: “If you
don’t, the MBA’s will”
–
MCMP/PQRI
Meaningful use: The Good, the Bad
and the Ugly?
–
What are the Incentives? (The Good!)
•
Medicare: Up to $44,000 per provider, over
five years or
•
Medicaid: Up to $63,750 per provider, over
six years
How to Earn Incentives? To be eligible
for the incentives providers must:
–
1. Use a certified EHR in a
“meaningful” manner; (i.e., electronic
prescribing, etc.)
–
2. Exchange health information to
improve the quality of care (through a
health information exchange, like the
cHIE); and
What is a certified EHR?
•
Certification Programs: CCHIT vs ONC-ATCB
–
The CCHIT Certified® 2011 certification programs
include a rigorous inspection of integrated EHR
functionality, interoperability, and security
according to criteria independently developed by
the CCHIT's broadly representative, expert work
groups using CCHIT's published testing methods.
• Ambulatory EHR
• Inpatient EHR
• Emergency Department EHR
• Behavioral Health EHR
• Long Term and Post Acute Care EHR
What is a certified EHR?
•
Certification Programs: CCHIT vs ONC-ATCB
–
The ONC-ATCB 2011/2012 certification
program tests and certifies that
Complete EHRs meet all of the
2011/2012 criteria of the criteria
approved by the Secretary of Health
and Human Services (HHS)
CCHIT 2011 Certified in Ambulatory EHR
(as of 10/2/2010, some pre-market)
– ABELMed EHR-EMR/PM 11
– Allscripts Professional EHR 9.1
– Aprima 2011
– Benchmark Systems Benchmark Clinical 2.0
– BizMatics Inc PrognoCIS Version 2.0
– Compulink Advantage/EHR 10
– CureMD EHR Version 10
– E-Health Partners, Inc. EHRez 3.5
– eClinicalWorks 8.0.100
– Eclipsys Corporation Sunrise Ambulatory Care™ 2011 Suite 5.5
– Epic Systems Corporation EpicCare Ambulatory - Core EMR Summer 2009
– Epic Systems Corporation EpicCare Ambulatory - Core EMR Spring 2008
CCHIT 2011 Certified in Ambulatory
EHR (as of 10/2/2010) cont.
– GE Healthcare Centricity Practice Solution 9.5
– GE Healthcare Centricity Advance 10.1
– Glenwood Systems LLC GlaceEMR 4.5
– Greenway Medical Technologies, Inc. PrimeSuite 2011
– IGI Health, Inc Orbit EMR 7.0
– Ingenix CareTracker 7
– Integritas, Inc. Agility EHR 10
– Intuitive Medical Software UroChartEHR 4.0
– IO Practiceware 7.0
– KeyMedical Software, Inc. KeyChart 4.0.0.0
– ManagementPlus 5
– MCS - Medical Communication Systems, Inc. iPatientCare 10.8
CCHIT 2011 Certified in Ambulatory
EHR (as of 10/2/2010) cont.
– Medical Informatics Engineering WebChart EHR Version 5.1
– Medicat, LLC Medicat 2011 10.0
– meridianEMR Version 4.2
– NeoDeck Software NeoMed EHR 3.0
– NexTech Practice 2011 9.7
– NextGen Ambulatory EHR 5.6
– Nortec EHR 7.0
– Pulse Systems 2011 Pulse Complete EHR 2011
– Streamline EHR 10.8
– SuccessEHS 5.3
– The DocPatientNetwork.com Doctations 2.0
ONC-ATCB 2011/2012 Certified
(as of 10/2/2010)
– ABELMed EHR - EMR / PM 11
– Allscripts Professional EHR 9.2
– Aprima 2011
– athenaClinicals 10.10
– CureMD EHR 10
– The DocPatientNetwork.com Doctations 2.0
– eClinicalWorks 8.0.48
– Ambulatory - Core EMR Spring 2008
– GE Healthcare Centricity Advance 10.1
– gloEMR 6.0
– Intuitive Medical Software UroChart EHR 4.0
ONC-ATCB 2011/2012 Certified
(as of 10/2/2010)
– Medical Informatics Engineering WebChart EHR 5.1
– Meditab Software, Inc. IMS v. 14.0
– NeoDeck Software NeoMed EHR 3.0
– NextGen Ambulatory EHR 5.6
– Nortec EHR 7.0
– Pulse Systems 2011 Pulse Complete EHR 2011
– Success EHS 6.0
– PARADIGM (QRS Inc.)
– ifa EMR (ifa united i-tech Inc.)
Final Rule: Beauty or the Beast?
(the Ugly?)
–
Stage 1 (2011 and 2012)
•
Must meet “coreset”, but can defer 5 from
optional “menu set”
•
To meet certain objectives/measures, 80%
of patients must have records in the
certified EHR technology
•
EPs have to report on 20 of 25 MU
objectives
Meaningful Use: Core Set Objectives
EPs –15 Core Objectives (all req.)
–
Computerized physician order entry (CPOE)
–
E-Prescribing (eRx)
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Report ambulatory clinical quality measures to
CMS/States
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Implement one clinical decision support rule
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Provide patients with an electronic copy of their
health information, upon request
–
Provide clinical summaries for patients for each
office visit
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Drug-drug and drug-allergy interaction checks
–
Record demographics
Meaningful Use: Core Set Objectives
EPs
–15 Core Objectives cont.
–
Maintain an up-to-date problem list of current and
active diagnoses
–
Maintain active medication list
–
Maintain active medication allergy list
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Record and chart changes in vital signs
–
Record smoking status for patients 13 years or older
–
Capability to exchange key clinical information
among providers of care and patient-authorized
entities electronically
Menu Set Objectives*-10 Menu
Objectives (pick 5/10)
– Eligible ProfessionalsDrug-formulary checks
– Incorporate clinical lab test results as structured data
– Generate lists of patients by specific conditions
– Send reminders to patients per patient preference for preventive/follow up care
– Provide patients with timely electronic access to their health information
– Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate
– Medication reconciliation
– Summary of care record for each transition of care/referrals
– Capability to submit electronic data to immunization registries/systems*
– Capability to provide electronic syndromic surveillance data to public health agencies*
CQM: Eligible Professionals Core,
Alternate Core, and Additional CQM
–
EPs must report on 3 required core CQM, and if the
denominator of 1 or more of the required core
measures is 0, then EPs are required to report results
for up to 3 alternate core measures
–
EPs also must select 3 additional CQM from a set of
38 CQM (other than the core/alternate core
measures)
–
In sum, EPs must report on 6 total measures: 3
required core measures (substituting alternate core
measures where necessary) and 3 additional measures
Clinical Quality Measures
–
CQM: Core Set for EPs
•
Hypertension: Blood Pressure Measurement
•
Preventive Care and Screening Measure Pair: a)
Tobacco Use Assessment, b) Tobacco Cessation
Intervention
•
Adult Weight Screening and Follow-up
–
CQM: Alternate Core Set for EPs
•
Weight Assessment and Counseling for Children
and Adolescents
•
Preventive Care and Screening: Influenza
Immunization for Patients 50 Years Old or Older
•
Childhood Immunization Status
CQM: Additional Set for EP (pick 3)
– Diabetes: Hemoglobin A1c Poor Control
– Diabetes: Low Density Lipoprotein (LDL) Management and Control
– Diabetes: Blood Pressure Management
– Heart Failure (HF): Angiotensin-Converting Enzyme (ACE)
Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
– Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
– Pneumonia Vaccination Status for Older Adults
– Breast Cancer Screening
– Colorectal Cancer Screening
– Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD
CQM: Additional Set for EP cont.
– Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
– Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment
– Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
– Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
– Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
– Asthma Pharmacologic Therapy
– Asthma Assessment
– Appropriate Testing for Children with Pharyngitis
– Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
CQM: Additional Set for EP cont.
– Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients
– Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
– Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing
Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies
– Diabetes: Eye Exam
– Diabetes: Urine Screening
– Diabetes: Foot Exam
– Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol
– Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation
CQM: Additional Set for EP cont.
– Ischemic Vascular Disease (IVD): Blood Pressure Management
– Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
– Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement
– Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
– Prenatal Care: Anti-D Immune Globulin
– Controlling High Blood Pressure
– Cervical Cancer Screening
– Chlamydia Screening for Women
– Use of Appropriate Medications for Asthma
– Low Back Pain: Use of Imaging Studies
– Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
Resources
–
HealthInsight’s Regional Extension Center:
Services to be Available
•
Initial readiness assessment: Clinic needs and goals
•
Workflow analysis: Map out and improve current work
processes
•
Pinpoint areas to be simplified and streamlined with
EHR
•
Assess current EHR system and usage gaps
•
Tailored selection tools: Help narrow vendor choices
and facilitate clinic directed vendor demonstrations
•
Vendor check sheets: Help practice assess whether
their current vendor is on track to support meaningful
use
HealthInsight’s Regional Extension Center
Services cont.
•
Referrals to visit mentor clinics: Site visits to
evaluate clinics that have thoroughly implemented
EHR systems
•
Contract negotiation tools: Tailored support of
contracting needs
•
Project management and implementation:
Planning resources
•
Plan development: Address deficiencies and reach
meaningful use requirements
•
Privacy and security best practice: Policy and
procedures templates
•
Health information exchange: Connection
assistance
Beacon
Community-Salt Lake-Toole Area
–
cHIE connection: Financial assistance available
for a limited time to support connection to the state
clinical health information exchange (cHIE)
–
Meaningful Use Support: Priority assistance from
the Regional Extension Center in achieving
meaningful use requirements for federal incentives
–
Care Process Redesign: Analysis of and support in
improving current processes for managing the care
of patients and other chronic illnesses
–
Diabetes Care Coordination: Improved
communication between providers
Beacon
Community-Salt Lake-Toole Area cont.
–
Community-wide Collaboration: Learning and
networking opportunities that support clinical process
improvement, improve health information flow, and
encourage community-wide adoption of best practices
–
Tools and Resources: Access to electronic decision
support tools, as well as patient education and
self-management resources
–
Quality Data Feedback and Benchmarks: Access to
clinical quality improvement data and benchmarks on
diabetes measures
–
Beyond Diabetes: Improved connectivity to public
health systems
Clinical Health Information
Exchange (cHIE)
–
UHIN website declared Benefits:
• Access to Clinical Information from Multiple Sources
• Get information from hospitals, reference labs, the Utah Department of Health, and other clinicians.
• Electronic Delivery of Reports
• Order and receive labs and reports electronically from a single system.
• Access to E-Lite, a baseline EMR at no additional charge
• If your organization has limited resources for an EMR or only needs a baseline tool, this may solve your needs. Call UHIN for details.
• Single interface
Clinical Health Information
Exchange (cHIE) cont.
–
Virtual Health Record:
•
Consolidation of all current medical summary
information in one place
•
Via Continuity of Care Document (CCD)
– Current problem list
– Current medication list and record of prescribing
– Current immunization records
– Current Allergies
– Recent Labs and Imaging results
– Recent Clinical notes
– Hospital H&P, Discharge, Consult notes
Clinical Health Information
Exchange (cHIE) cont.
–
Real-time query capability for additional
information
–
Potential for Bidirectional Integration with
your EMR (via CCD)
•
Reconciliation
•
Registry and Quality Reporting
–
Potential for Patient interaction with
Health IT Blessing or Curse?
–
Rate of information change: “You Ain’t
Seen Nothing Yet.”
• Last year, despite the global recession, the Digital Universe set a record. It grew by 62% to nearly 800,000 petabytes. A petabyte is a million gigabytes. Picture a stack of DVDs
reaching from the earth to the moon and back.
• This year, the Digital Universe will grow almost as fast to 1.2 million petabytes, or 1.2 zettabytes. (There’s a word we haven’t had to use until now.)
• This explosive growth means that by 2020, our Digital
Universe will be 44 TIMES AS BIG as it was in 2009 (Figure 1). Our stack of DVDs would now reach halfway to Mars.