Aligning Meaningful Use, Technology and Clinical Objectives to Develop an Enterprise Patient Record

CAPG ACO ConferenceCAPG ACO ConferenceAuthor: Tina Buop, CIOAuthor: Tina Buop, CIOOctober 26October 26thth, 2010, 2010

Agenda

Introduction

Meaningful Use

Technology

Clinical Objectives

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2

3

4

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1 http://www.nytimes.com/2006/09/27/technology/circuits/27health.html

5 Enterprise Chart

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Introduction1

Muir Medical Group IPA, Inc.

The Muir Medical Group IPA, Inc. (MMG) is an Independent Practice Association located in the San Francisco East Bay. MMG provides services to over 600+ Physicians & Mid-level Providers.

• MMG provides clinical and technical leadership, solutions and support to automate the independent practices and to connect them to an integrated eCommunity.

• 115 Physicians & Mid-Level Providers Implemented• 32 Practices across 52 connected locations• 193,000 patients in the system & growing• 1,700 - 2,300+ visits per day• Enterprise Chart Community• “The Physician is Our Customer. The Patient is Our

Priority!” TM

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Specialties: 

1.

Family Practice

2.

Internal Medicine

3.

Pediatrics 

4.

Obstetrics 

5.

Gynecology

6.

Neurology

7.

Allergy & Asthma 

8.

Gastroenterology

9.

Pediatric Gastroenterology

10.

General Surgery

11.

Vascular Surgery 

12.

Neurosurgery 

13.

Colon & Rectal Surgery 

14.

ENT 

15.

Urology – in progress

16. Pulmonary – in progress

17. Perinatology – in progress

18. Pediatric Neurology – in progress

Data and Services  (per month)• 29,550 patient visits 

• 21,500+ lab results 

• 9,200  imaging results

• 5,100 JMMC hospital notes

• Transcription Import

• Phone Appointment Reminders

• EKG, Spiro, Holter, Stress Tread, Vitals 

• Eligibility Verification

• Automated Patient Statements

• CPTs, ICD9s, Formularies, Medication Updates

•

IT management, patch management, remote 

assistance, upgrades and custom development

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Muir Medical Group IPA, Inc.

Pathways to Clinical Integration

EHR Implementation, Adoption & Support

MD Lead Clinical Objectives, Evidence Based Practice Guidelines & Compliance

Clinical Measurement, Adoption Measurement & Interoperability

eCommunity Advances, Clinical Integration, Meaningful Use, Patient Centered Medical Home (PCMH) & Accountable Care Organization (ACO)

COMMIT

IMPROVE

MEASURE

ADVANCE

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Meaningful Use2

PPACA / ACO

PCMH

OCR - administrative, physical, and technical safeguards to secure e-PHI.

American Rec. Reinv. ActHiTech Act

“Stimulus Bill”Interim Rules For EHR Meaningful Use

New HIPAA Rules IE/Breach Notification for Unsecured PHI

7/13/10 Final Ruling on

Meaningful Use Phase One of Four Phases

http://healthit.hhs .gov

HIT Standards and Certification Criteria

Electronic Health RecordCharting, eRx, Labs, Eligibility,

Reporting, Reconciliation, Patient Plan, Continuity of Care, Disease Management, Chronic Care, Connectivity with other EHRs,

Privacy & Security Standards, IT Standards, Support, and more.

Meaningful Use & ACOs

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Basic EMR, Fully Functional EHRPercentage of Office Based Physicians Using EMR or EHRs.

2009

44%

21%

6%

29%

Any EMR/EHR System

Basic System

Fully FunctionalSystem

Data from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.158.4942&rep=rep1&type=pdf

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ElectronicHealth Record

HL7

HL7

HOSPITAL or SURGERY CENTER

LABS

IMAGERESULTS

SCANNING

PAYERS

HL7

USB USB

Net‐worked

CONNECTED DEVICES & RESULTS

PHR /PORTAL

PHARMACY

PRINTING

Net‐worked

FAX

EHR

eCommunity

Fully Functional EHR

•Eligibility •Phone Appt Reminders•Statements

HL7

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Technology3

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TechnologyIT Standards / HIPAA / Bus. & Technical Support Systems

Network Configurations

Practice Management

EHRScanning Reports

Template Edits Offline Processor

Document Processor

Interface Engine Lab & Document

Match

Applications

Lab 1 Lab 2Lab 3

Imaging Results Hospital notes

Device Interfaces ECG

Spriometer Holter

Stress Treadmill

Interfaces

PCsLaptops WirelessPrinter

Card Scanners Copier/printersImage Scanners

RoutersSwitches

Monitoring Electrical

Hardware

WebServerWeb

ServerApp.

DatabaseApp.

DatabaseProfileServerProfileServer

ImageServerImageServer

ReportServerReportServer

ProxyServerProxyServer

Test Database

Test Database

Interface Server

Interface Server

Back Up Server

Back Up Server

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TS TS TS TS TS TS TS TS TS TS TS TS TS TS

MuirLab Results

Claims

Functional View

FP OB/Gyn Neuro Allergy & Asthma

GeneralSurgery

Neuro- Surgery

Peds Peds GIUrology Colon& Rectal

Surg.

BariatricVascular&

Thoracic

ENT GIIM

Relay Health as Data Source

MuirImaging Results

JMMC Hosp NotesNextGen EDI / Internet

Pharmacies& Mail Order

ERA

eRx & Mail Rx

Faxes

Telecom

Dx Tool

SearchDx

Formularies

Eligibility

Statements

TelephoneAppt.

Reminders

PatientsOther

Providers / Practices

Payors

ApptReminder

EDI

PedsNeuro

Peri-natology

Pulm. TBD TBD TBD TBD TBD

Other Labs: • To Be Developed

ExternalReferrals Bi-Directional

VPN

Tran- scription

RTF

Non IPA EMR Systems

Other Systems

Other Groups

Addt’l JMMC Hospital Interfaces

HIE = HL7, CCD & Referrals

PatientPortal

To Be Developed

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Clinical Objectives4

Pathways to Clinical Integration

EHR Implementation, Adoption & Support

MD Lead Clinical Objectives, Evidence Based Practice Guidelines & Compliance

Clinical Measurement, Adoption Measurement & Interoperability

eCommunity Advances, Clinical Integration, Meaningful Use, Patient Centered Medical Home (PCMH) & Accountable Care Organization (ACO)

IMPROVE

MEASURE

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COMMIT

ADVANCE

Note: Clinical Objectives should be included in the Integration Mission and Goals; however they need to be implemented with the EHR Implementation or shortly thereafter (situational adaptation).

MD Lead Clinical Objectives

MD Lead Clinical Objectives, Evidence Based Practice Guidelines & Compliance

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IMPROVE

Governance• Physician leadership /

Clinical Integration Committee

• Charter and focus

• Identified common clinical objectives

• Prioritize clinical objectives

• Began work in Q1, 2010

Goals Context

• Common workflow and data points for designated disease states

• Evidence based guidelines

• Similar data reporting

• Start to identify common measurement and compliance

• Same data points for DM, CAD & Hypertension in 3 systems

• 1 EBG selected for the community.

• Report content to drive consistency & relative comparisons

• …..measure

MD Lead Clinical Objectives

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Governance• Physician leadership /

Clinical Integration Committee

• Charter and focus

• Identify consequences for non compliance

• Identify mechanisms and communication of non-compliance

Goals Context

• Observable changes in patient care

• Documented use of Evidence based guidelines

• Standardized reporting & compliance mechanisms

• Non-compliance actions result in change

• I.e./Diabetic patients are meeting defined criteria / compliance

• EBG are being utilized by denominator of patient Dx.

• Actions taken for non compliance may include adoption &/or additional training.

• Direct improvement by compliance and/or adoption follow-up.

Clinical Measurement, Adoption Measurement & Interoperability

MEASURE

Enterprise Chart5

Enterprise Record Advances

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eCommunity Advances, Clinical Integration, Meaningful Use, Patient Centered Medical Home (PCMH) & Accountable Care Organization (ACO)

ADVANCE

MDs MU PCMH ACOCI

PCMH

Enterprise Record Advances

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eCommunity Advances, Clinical Integration, Meaningful Use, Patient Centered Medical Home (PCMH) & Accountable Care Organization (ACO)

ADVANCE

MDs

MU

ACOCI

PCMHPCMH

Enterprise Record Contributors

• Common Physician & Mid-Level provider workflows

• Enterprise templates

• Single data repository; discrete data

• Common reporting

• Common training, adoption & support processes

• Patient compliance

• Mitigate duplicate patient testing

• MU, PCMH & ACO – all centered towards advanced care!

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eCommunity Advances, Clinical Integration, Meaningful Use, Patient Centered Medical Home (PCMH) & Accountable Care Organization (ACO)

ADVANCE

Point of Care

Patient Arrives at Physicians

Practice

Check-in Process

ExamEHR

eRx eRx

Lab Lab

Ref Ref Imag

ing

Imag ing

Post Visit Claim(s)Post Visit Claim(s)

Electronic Health RecordCharting, eRx, Labs, Eligibility,

Reporting, Reconciliation, Patient Plan, Continuity of Care, Disease Management, Chronic Care, Connectivity with other EHRs,

Privacy & Security Standards, IT Standards, Support, and more.

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The Patient is our Priority!

• g{tÇ~ lÉâ4

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The following is from Michigan Association of Health Plans Annual Summer Conference – July 2010. http://www.mahp.org/2010summerconference.html . This is for reference & does not represent MMG ‘s interpretation of the two qualifications.

PCMH ACOPersonal physician, focus on patient-physician relationship (single practice)

Provider-led organization, multiple providers, practices organized

Physician-led team Culture of teamwork among staff of practices

Whole person model of care, patient and family- centered

Complete and timely information about patients and services they are receiving

Enhanced access to care

Care coordinated, integrated Resources & support for patient education and self management support

Comprehensive, continuous care Coordinated relationships of PCP with specialists and other providers

Continuous improvement Manage full continuum of care for populations

Quality and safety, guide all care individual/population

Accountable for quality and safety for populations Technology and skills for population management and coordination of careAbility to measure and report on quality

Payment supports patient-centered care, and is value driven

Accountable for overall costsInfrastructure and skills for management of financial riskLeaders committed to improving value of health care services

PCMH & ACO

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