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Adoption and Meaningful Use of EHR

Technology in a Hospital

Sanjay Shah, MBA, CMPE, FHIMSS

President, HCIT+

(Former) VP & CIO, Cabell Huntington Hospital

Anthony Adkins, RN

Director of Clinical Solutions Cabell Huntington Hospital Monday, March 1, 2010

12:15 – 1:15 pm

Sanjay Shah,

MBA, CMPE, FHIMSS President, HCIT+

(Former) VP & CIO, Cabell Huntington Hospital

Anthony Adkins,

RN Director, Clinical Solutions

Cabell Huntington Hospi

tal

Have no real or apparent conflict of interest

• Identify the different aspects of meaningful use of electronic health record technology

• Identify strategies that lead toward achieving meaningful use

• Describe the value of creating awareness and promoting education, communication, and clinical workflow transformation for successful adoption

• Assess one’s own organization’s readiness for adoption and meaningful use

• Create an action plan for lasting adoption and meaningful use of EHR technology

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Source: PWC, March 2005

“A fully digital hospital would not produce or use paper records. It would have digital imaging, order transmission, clinical notes and other aspects of the electronic health record. It would have integrated supply chain management and integrated revenue cycle management.”

David Brailer, MD, PhD National Health Information Technology Coordinator; U.S. Department of Health and Human Services

“Don’t focus on a technical or engineered vision; this process is not comparable to constructing a dam or a building. It can’t be context free – how do you define success? You must build a vision with the technology. The digital hospital must have a care vision and a process vision.”

John Glaser, MD, PhD, VP and CIO; Partners HealthCare System

“A digital hospital means all digital, with EMR, CPOE, PACS and labs that dump into

EMR. A digital hospital should be as paperless and wireless as you can make it.” Brad Bjornstad, MD, CMO; University Community Hospital “A digital hospital needs to be defined in chunks because healthcare is a grouping

of so many different businesses. Typically you try to automate systems from a patient-experience point of view. The digital hospital could be paperless, but many will still have some paper and some film. Either way, it is an iterative process.”

Laureen O’Brien, Regional CIO; Providence Health System

“The digital hospital is an effort, a spectrum, and a concept. It is a process of

managing more by computer and less by manual processes.” Dick Gibson, MD, PhD, CMIO; Providence Health System “A digital hospital is the use of electronic information beyond administrative and

billing purposes – really integrating electronic information into the clinical aspects of the delivery of care. A digital hospital makes use of electronic information to provide the highest quality status and most efficient care possible.”

Suzanne Delbanco, PhD, CEO; The Leapfrog Group

“A digital hospital uses digital technology for communications, tracking and

information flow.” Cindy Slaydon, RN, MSN, CHE, CNO; Centennial Medical Center

• Defined by Centers for Medicare and Medicaid

Services (CMS) as:

– The use of Health IT to further

• Improve quality, safety, efficiency, and reduce health disparities • Engage patients and Families

• Improve care coordination

• Ensure adequate privacy and security protections for personal health information

• Improve population and public health

• Further the goal of information exchange among health professionals

• Stage 1 (Begins 2011)

– Focused on

• Electronically capturing health information

• Implementing clinical decision support tools to facilitate disease and medication management

• Reporting clinical quality measures and public health information

• Stage 2 (Begins 2013)

– Focused on

• Using captured information to improve care • Electronic transmission of diagnostic test results • Computerized provider order entry (CPOE)

• Stage 3 (Begins 2015)

– Focused on

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• Final Notice of Proposed Rulemaking (NPRM)

– January 13, 2010

– Public Comments till March 10, 2010

• Ruling details:

– Roll out in will begin in 2011 – Roll out will occur in three stages – Stage 1 criteria can be used until 2015 – 23 Meaningful Use Criteria

– Medicaid payments will be provided through state – Hospital payment year is based on the Federal Fiscal

Year (Oct 1-Sept 30)

• CPOE is used for at least 10 percent of all orders • Implement drug-drug, drug-allergy, drug- formulary checks • Maintain an up-to-date problem list of current and active

diagnoses based on ICD-9-CM or SNOMED CT

• Record and chart changes in vital sign for patients age 2 and over. Chart blood pressure, BMI and plot a growth chart for age 2-20.

• Record demographics • Maintain active medication list • Maintain active medication allergy list

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• Record smoking status for patients 13 years old or older • Incorporate clinical lab-test results into EHR as structured

data for at least 50 percent of all tests with either a positive/negative or numeric format.

• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. (At least one)

• Report hospital quality measures to CMS or the States.

– 2011 – Through attestation (Section II.A.3) – 2012 – Through electronic transfer (Section II.A.3)

• Implement five clinical decision support rules relevant to the clinical quality metrics of the hospital

• Check insurance eligibility electronically from public and private payers

• Submit claims electronically to public and private payers. • Provide patients with an electronic copy of their health

information (including diagnostic test results, problem list, medication lists, allergies, discharge summary, and procedures), upon request within 48 hours.

• Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request.

• Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronically. (One Test) • Perform medication reconciliation at relevant encounters and

each transition of care.

• Provide summary care record for each transition of care and referral.

• Capability to submit electronic data to immunization registries and actual submission where required and accepted. (One Test)

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• Capability to provide electronic submission of reportable lab results to public health agencies and actual submission where it can be received. (One Test)

– May be ruled out of public agencies have not means to accept

• Capability to provide electronic syndrome surveillance data to public health agencies and actual transmission according to applicable law and practice.

– May be ruled out of public agencies have not means to accept

• Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.

• Meaningful use designation now not tied to dates

• Hospitals and providers can qualify for stage one

up till 2014

• 3 months of meaningful use data needs to be

proven in first year only

• To get maximum Medicare payments, eligible

providers need to qualify by 2012 with hospitals in

2013

• Both eligible providers and hospitals need to meet

stage 3 criteria by 2015 to avoid penalties

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To be the hospital of choice for all ages in the

community we serve by strategically using our

advanced clinical system to streamline service,

quality, and efficiency.

Medical Record Data Capture Standardization Workflow Optimization Knowledge Driven Patient Focus Technology Culture Paper Based Hand-written or dictated

when Convenient Codified, Real-time

Practitioner Specific Evidence Driven

Break / Fix Focus Quality Driven;

Results/Measurement

Memory Based Practice Decision Support; Results Focused Event Driven (Episode Centric) Person Driven (Cross Venue) Minimal Technology Paper Based

Cutting Edge Technology

Task-Focused TransformationAligned for Electronic

• Enhance patient satisfactionby reducing documentation redundancy

• Standardize the way we communicateand receive patient information

• Expedite the delivery of careby increasing real time access to data

• Improve patient safetyby providing clinical alerts and unifying patient documentation

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2004

• Nursing requested cleanup of paper chart to help with documentation and compliance

• Nursing complained too much distractions with charting and not enough integration

2005

• Administration approved committee to research a hospital based electronic medical record

2006

• Three primary vendors were narrowed down by demos and clinician reviews • EMR Choice made by clinicians

2007

• Big Bang Go Live complete with implementation of 24 solutions including CPOE in ED, nursing documentation and orders hospital wide, paperless emergency room, pharmacy, radiology, health information, and a physician inbox for electronic results and orders signature.

2008 onwards

• Continue adoption efforts, and ensure hospital meets meaningful use criteria

Cerner Partnership Timeline

2006 2007 2008 2009

July Aug Nov Dec Jan Mar July Aug Oct Dec Jan April July Oct Dec Jan April July Oct Dec

2006 2007 2008 2009

July Aug Nov Dec Jan Mar July Aug Oct Dec Jan April July Oct Dec Jan April July Oct Dec

CPDI – Document Imaging Power Insight Upgrade

Early Rollout Facility Coding (paper)

Big Ban g GO LIVE

Clinical Data Repository, Orders Management, Clinical Documentation, eMAR and Point of Care Basic, Critical Care, APACHE Pharmacy, ED Nursing Documentation, ED Physician Orders & Doc, ED Facility Coding, HIM Deficiency Tracking, Physician Inbox / eSignature, EMPI - Master Person Index, Radiology w Dept Scheduling And more… Medical Record Data Capture Standardization Workflow Optimization Knowledge Driven Patient Focus Technology Culture Paper Based Hand-written or dictated

when Convenient Codified, Real-time

Practitioner Specific Evidence Driven

Break / Fix Focus Results/MeasurementQuality Driven;

Memory Based Practice Decision Support; Results Focused Event Driven (Episode Centric) Person Driven (Cross Venue) Minimal Technology Paper Based

Cutting Edge Technology

Task-Focused Aligned for

Transformation Electronic 1 1 1 1 1 1 1 1

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• Patient issue of electronic chart too slow

• E-Prescribing needed hospital wide

• CPOE only in emergency department

• Potential upgrade needed for EHR Certification

Cerner Partnership Timeline

2010 2011

Jan Feb Mar April May June July Sept Oct Nov Dec Jan Feb Mar April May June July Sept Oct Nov Dec

2010 2011

Jan Feb Mar April May June July Sept Oct Nov Dec Jan Feb Mar April May June July Sept Oct Nov Dec

Physician Automation Anesthesia Automation Certification Upgrade with E-Prescribing RAC Audit Printing

Multi-Media Integration Physician Portal View Integrated Regulatory Compliance Solution

Surgery Automation

The Journey continues…..

Medical Record Data Capture Standardization Workflow Optimization Knowledge Driven Patient Focus Technology Culture Paper Based Hand-written or dictated

when Convenient Codified, Real-time

Practitioner Specific Evidence Driven

Break / Fix Focus Results/MeasurementQuality Driven;

Memory Based Practice Decision Support; Results Focused Event Driven (Episode Centric) Person Driven (Cross Venue) Minimal Technology Paper Based

Cutting Edge Technology

Task-Focused Aligned for

Transformation Electronic 2 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2

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• Create awareness committees with key stake holders • Use Interim Final Rule (IFR) and Notice of Proposed

Rulemaking (NPRM) as guide, and print • Certification Criteria – (IFR pg 51-61)

• Adopted Content Exchange, Vocabulary, and Privacy/Security Standards -(IFR pg 79-81, and 85)

• Stage 1 Criteria for Meaningful Use – (NPR pg 103-108)

• Work with other facilities to make recommendations on any rules that need clarity or adjustments

• Develop final policies and strategies from rules • Assure your EHR vendor is certified

• Review 23 meaningful use criteria for gaps • Educate staff on the requirements during solution

implementation

• Incorporate meaningful use audits into tracers

Achieve Vision

Define Meaningful Use For Your Institution

Review Your Digital Continuum

Establish Short & Long Term Goals

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Sanjay Shah

President, HCIT+ (304) 638-1738 ss@hcitplus.com

Anthony Adkins

Director of Clinical Solutions (304) 399-6792

References

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