Electronic Medical Records
Evaluation, Selection &
Implementation Process
Presented by:
Sherri L. Boston, MBA, COE, OCS
Session Objectives
Provide an overview of the Electronic Health
Records (EHR) provisions in the Economic
Stimulus Package.
Explain the EMR evaluation, selection and
implementation process.
Review the tools available to assist the practice
and staff during the EMR review and
implementation process.
President Obama signed H.R. 1, the “American Recovery and
Reinvestment Act of 2009” (ARRA) into law on 2/17/09.
Health Information Technology for Economic and Clinical Health Act
(HITECH) part of ARRA; encourages adoption of electronic health
records (EHRs) through incentive payments.
EHR provisions in HITECH:
$19.2 billion available to encourage adoption of EHR.
Qualified providers and hospitals earn incentive benefits beginning
in 2011 by demonstrating “meaningful use” of EHR systems.
Penalties for non-compliance begin in 2015.
On 1/13/10 the Centers for Medicare & Medicaid Services (CMS) and
the Office of National Coordinator of Health Information Technology
(ONC) published two coordinated sets of regulations for EHR
incentives.
ONC and CMS Regulations
HHS will accept comments on these regulations through March 15, 2010.
ONC
“Interim Final Rule”Certified EHR
Technology
Outlines requirements to be “certified:” • Standards • Implementation • Specifications • Certification Criteria Does not change HIPAA requirementsCMS
“Proposed Rule”Meaningful Use
Outlines criteria for demonstrating meaningful use of certified technology Provides proposed calculation and payment of incentives
Certified EHR Technology
Definitions:
“Qualified EHR:” An electronic record of health-related
information on an individual that:
1. Includes patient demographics and clinical health information.
2. Has the capacity to:
• Provide clinical decision support.
• Support MD order entry.
• Capture and query information relevant to health care quality.
• Exchange electronic health information with, and integrate
such information from, other sources.
“Certified EHR Technology:” Meets requirements of “qualified
EHR” and has been tested and certified by ONC program,
meeting all certification criteria.
Meaningful Use
Requirements:
HITECH Act requires that eligible professionals must be
“meaningful EHR user” of certified EHR technology and
meet three requirements:
1.
Demonstrate use of certified EHR technology in a
meaningful manner.
2. Demonstrate that such certified EHR technology is
connected in a manner that provides for electronic
exchange of health information, in accordance with
laws and standards, to promote quality health care.
3. Using certified EHR technology, submit information
Phased Roll-Out of Meaningful Use Criteria
CMS proposed rule sets forth three stages for demonstrating
meaningful use.
Stage 1: Criteria focus on electronically recording patient
data to facilitate coordination of care, implementation of
clinical decision support, and reporting clinical quality
measures.
Stages 2 & 3: Criteria not yet defined; will focus on
interoperability of EHR technology, increase in efficiency,
and improvement in population health.
Phased roll-out allows for incrementally improving and
expanding the adoption and implementation of EHR
technology.
Stages of Meaningful Use
2011
2012
2013
2014
2015
2011
Stage 1
Stage 1
Stage 2
Stage 2
Stage 3
2012
Stage 1
Stage 1
Stage 2
Stage 3
2013
Stage 1
Stage 2
Stage 3
2014
Stage 1
Stage 3
2015
Stage 3
Stage of Meaningful Use Criteria by Payment Year
• Only the Stage 1 criteria are currently proposed and include 25 objectives and functionality measures for eligible professionals.
• CMS is expected to provide guidance on Stage 2 & 3 measures beginning in 2013.
EMR Incentive Payments
Proposed rule calls for Part B Medicare carriers to make
payments once “meaningful use” is demonstrated for the
applicable reporting period.
Incentive payment is to equal 75% of the physician’s
allowable Medicare charges for up to five years; subject to a
maximum amount per physician.
Annual cap may be higher for professionals in designated
health professional shortage area.
Payment ceiling declines each year; penalizing late adopters.
To qualify for the full incentive benefit of $44,000,
EMR Incentive Payments
2011
2012
2013
2014
2015
2011
$18,000
2012
$12,000
$18,000
2013
$8,000
$12,000
$15,000
2014
$4,000
$8,000
$12,000
$12,000
2015
$2,000
$4,000
$8,000
$8,000
$0
2016
$2,000
$4,000
$4,000
$0
Total
$44,000
$44,000
$39,000
$24,000
$0
Maximum Annual Payment by Year Implemented
Payment Adjustments Beginning in 2015
Penalties for non-compliance begin in 2015.
Medicare reimbursement reduced by 1%, 2%, and 3% in
2015, 2016, and 2017 and each subsequent calendar year.
HITECH Act authorizes CMS to further reduce
reimbursement in 2018 if less than 75% of eligible
professionals are EHR users.
Proposed rule has an exemption for professionals due to a
significant hardship; however, no definition of significant
hardship has been provided by CMS.
Identify EMR Project Team ►Define clear vision of project
►Identify project team and include representatives from management, clinical, and physician teams
►Define scope of project and develop work plan outlining details of the process.
EMR Evaluation, Selection, Implementation
Identify EMR Project Team
Evaluation Phase
►Complete a self-assessment of your EMR “readiness”
►Review articles and publications related to EMR
►Evaluate risks/benefits of EMR implementation
►Make decision to go forward or delay selection and implementation process
EMR Evaluation, Selection, Implementation
Article:
Financial Impact of an EMR System
Identify EMR Project Team
Evaluation Phase
Investigational Phase
►Collect data from practices currently using EMR, schedule site visits
►Determine practice design requirements for EMR utilization
►Number of users
►Hardware needs
►Networking and connectivity
►Interface options with existing EPM
►Interface capability with diagnostic equipment
►Select 4 – 5 EMR vendors; send RFPs
EMR Evaluation, Selection, Implementation
Identify EMR Project Team
Evaluation Phase
Investigational Phase
Analysis & Decision Phase
►Identify 10 – 15 priority needs for EMR
►Complete a comparison of the EMR vendor RFPs
►Perform a cost benefit analysis
►Compare practice needs and costs with results of RFP
►Determine top 2 – 3 vendors, schedule on-site demonstrations
►Utilize EMR Project Team to make EMR selection
►Evaluate financing options
►Negotiate and sign hardware/software contracts
EMR Evaluation, Selection, Implementation
Sample Cost Benefit Analysis
Identify EMR Project Team
Evaluation Phase
Investigational Phase
Analysis & Decision Phase
Pre-Implementation Phase
►Identify implementation team
►Set realistic timeline for training & implementation
►Review and redesign every work process
►Evaluate hardware needs; purchase
►Arrange for networking/connectivity
►Assess and determine method of “phase in” to EMR with final goal of paperless
►Customize office visit templates
►Determine which old patient information is to be scanned into the new system; begin the scanning process
Identify EMR Project Team
Evaluation Phase
Investigational Phase
Analysis & Decision Phase
Pre-Implementation Phase
Training Phase
►Designate Training Team
►Develop training plan (preliminary training/vendor training)
►Arrange basic computer skill training for staff needing assistance
►Schedule preliminary training for staff and physicians
►Schedule vendor on-site training
►Implement vendor training plan for both staff and physicians (include hands-on training)
EMR Evaluation, Selection, Implementation
Implementation Phase Identify EMR Project Team
Evaluation Phase
Investigational Phase
Analysis & Decision Phase
Pre-Implementation Phase
Training Phase
►Modify patient schedule before going “live”
►Select day of week to launch EMR
►Make certain vendor trainers are present
►Assemble staff early to review processes
►Debrief at the end of the first day; adjust processes as needed
►Conduct regular meetings to address EMR concerns and needs
►Provide periodic quality review of charts
►Celebrate!
EMR Evaluation, Selection, Implementation
Implementation Phase Identify EMR Project Team
Evaluation Phase
Investigational Phase
Analysis & Decision Phase
Pre-Implementation Phase
Training Phase
►EMR evaluation, selection, and implementation is a long, difficult process; however it is one with many positive implications for the practice. Consider the following:
►Examine practice needs and resources carefully before deciding to proceed with EMR implementation.
►Make certain there is strong leadership from both administration and physicians
►Set realistic time goals for the project
Implementation Phase Identify EMR Project Team
Evaluation Phase
Investigational Phase
Analysis & Decision Phase
Pre-Implementation Phase
Training Phase
►Utilize a team to maximize efforts in planning and implementation
►Plan – Train – Implement – Reevaluate – Redesign – Retrain – Implement! It’s an ongoing process
►Celebrate accomplishments! Most practices with EMR would NEVER want to return to paper charts. If EMR is right for the practice, the arduous process is worth it!
►Both the challenges and opportunities can be yours!
