Information Technology Compliance, Solutions & Trends

Information Technology Information Technology Compliance, Solutions & Trends Compliance, Solutions & Trends

ABC ConferenceABC Conference

Tampa FloridaTampa Florida

January 2011January 2011

Health Information Consulting, LLCHealth Information Consulting, LLC

Mike Mytych BioMike Mytych Bio

35 year career in healthcare

20 years in Consulting with an emphasis on clinical systems and focus on physician adoption of I/T

Clients range from small physician groups to large multi-hospital organizations

Conducted over 200 vendor selections for both hospitals and physicians with over 50 cardiology engagements ranging from small practices to complete heart hospital I/T strategies

Worked with 6 major HIEs including Chicago, Minneapolis, Wisconsin, Washington DC, New York City

Spent 15 years in the vendor community and is former VP of Sales for the physician systems division at Baxter

Adjunct Faculty member at University of Wisconsin Milwaukee Healthcare Informatics Graduate program teaching Healthcare I/T Procurement


Provide industry education for CDW, GE and NextGen in partnership with Wakerly Partners and C-Suite Resources− We do not provide competitive analysis or benchmarking to any

vendor

Participate on 3 investor advisory company panels for publically traded company assessment and prohibited from disclosing any information that is not included in the public domain.

DisclosureDisclosure


What are the key I/T drivers for today's practice?

Impact of ARRA / HITECH / Healthcare Reform on impact on I/T decisions.

What are the critical EMR/EHRs – CV Requirements?

What will the future look like for the CV Practice ?

Today’s ObjectivesToday’s Objectives


EMR Today?

Buying an EMR?

Integrated with Hospital?

Integration Discussions?

Audience SurveyAudience Survey

Today’s Key I/T DriversToday’s Key I/T Drivers


ARRA / HITECH Meaningful Use Rules

Hospital Integration – Care Coordination

Documenting care that enables quality / performance assessment

Maintaining reimbursement and getting greater operational efficiency

I/T DriversI/T Drivers


Driving Practice I/T DecisionsDriving Practice I/T Decisions

EHRs and Meeting Meaningful Use

Integration with Hospitals

PM System Decisions

Cardiology PACS

HIPAA Compliance

Regulatory/Quality Measure Compliance

PQRI and eRX Incentives

Device Upgrades & Integration

Preparing for Health Reform and participating in ACOs & Health Information Exchange

Others, ICD10 etc.


Decisions - DecisionsDecisions - Decisions

There is a lot to get done !

Priorities

Resources

Timing

Timeline

Dependencies


Questions We Hear…Questions We Hear…

With all that is happening around us, what are my best options for a good long term decision regarding I/T?

How can I optimize the use of systems for better patient care and provider satisfaction without losing productivity?

How can I minimize wasteful decisions?

Will the government programs like HITECH be changed substantially in the near future?

Will my integration with a hospital change the way my providers will utilize EHRs?

What is an HIE, is it real and when do I need to participate?

Dozens of others…

ARRA – HITECH Compliance ARRA – HITECH Compliance Have a Road Map as to How you Have a Road Map as to How you get there & Operate under the get there & Operate under the new Rulesnew Rules

““I don't like mysteries. They give me a I don't like mysteries. They give me a bellyache and I got a beauty right now.” bellyache and I got a beauty right now.” James James KirkKirk

Health Information Consulting, LLCHealth Information Consulting, LLC| 12 |

Non-compliance Is An Expensive ChoiceNon-compliance Is An Expensive Choice

2011 is the first year for partial qualification for meeting Meaningful Use (Stage 1)

2013 and 2015 will have different rules that build out toward the HITECH objectives (Stage 2 and Stage 3) and the preliminary objectives were released January 2011

Physicians and hospitals must meet government’s definition of meaningful use of Electronic Health Records (EHR) Technology” in order to be paid their bonuses or be prepared to have the penalties kick in in 2015.


Refresh - “Meaningful Use”Refresh - “Meaningful Use”

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Meaningful use is defined as:

Use of a certified EHR in a meaningful manner (ex: clinical documentation, e-prescribing, etc.)

Use of certified EHR technology for electronic exchange of health information

Use of certified EHR technology to submit clinical quality and other measures.

To insure Meaningful Use and to ensure continued adoption and subsequent use of the EHR there are specific rules for demonstration of that use.


Reporting Requirements Summary Reporting Requirements Summary

Requirements vary based on whether the applicant is an “eligible professional” or eligible hospital.”

Reporting Period –for any consecutive 90 days for first year; one year subsequently

For 2011 –Providers required to submit summary quality measure data to CMS or States by attestation

For 2012 –Providers required to electronically submit quality measure data to CMS or States

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ARRA/HITECH− Meaningful Use 2011 – 2013 – 2015− Medicare Penalties 2015+− Data Analytics

Setting the Stage for Healthcare Reform− Increased utilization demand from the uninsured/underinsured− Changes in plans / employer offerings− Bundled payments – reward for quality performance− Quality / outcomes evolution − Medical Home− Development and operation of ACO's − Comparative Effectiveness

Nationwide goal to remove cost from the delivery system while improving quality

The March Toward ReformThe March Toward Reform


Data and More DataData and More Data

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Point of Care

CV Data

EHRs and Meaningful UseEHRs and Meaningful Use


• When should we buy?

• Who is the right vendor?

• Can they get us to meaningful use?

• Do we have time for PM?

• Who will help us through all of these changes?

Leadership ConcernsLeadership Concerns


Meaningful Use ImplicationsMeaningful Use Implications

• Physician clinics will have to carefully assess their ability to meet meaningful use by 2011/2012.

• Just having an EHR does not mean that a clinic will meet the criteria.

• Each physician’s group will need to understand what it will take to have the required interoperability, system interfaces, data standards and timeline requirements.

• Physicians may be invited to participate in HIE technologies offered by the Hospitals to assist in complying with Meaningful Use criteria.

• Few Physician Clinics have integration or interchange with Imaging systems for movement of diagnostic reporting (PACS, CPACS, RIS).


Common Questions from those who Common Questions from those who already have an EMR?already have an EMR?

1. Is my vendor certified?

2. What is the current state of implementation and quality of use by my clinicians? (still using dictation?)

3. What gaps do we have to complete the EHR implementation (eRx & Lab are key)

4. Are we capturing the required discreet data?

5. Lab results are discreet and complete?

6. Interchange capabilities with our referring physicians and hospitals?


MU is not just about EHRMU is not just about EHR

Unless you are the only practice on an island, no one vendor can enable the physician to meet meaningful use.

The stimulus law compels the creation of ways to exchange health information within states and across a nationwide HIT infrastructure…

Cardiovascular Patient Records and related discrete data are a primary target of these efforts…

http://govhealthit.com/newsitem.aspx?nid=72400

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Reporting – QC what you can do and how you are measuring up to the standards

Know how data is generated and by whom

Change behavior to become compliant

MU ComplianceMU Compliance

EHR’s for the CV PracticeEHR’s for the CV Practice


Vendor Certification

PM Vendor

Hospital Vendor

Vendor Stability

Cost

Performance

Others

Vendor Selection ConsiderationsVendor Selection Considerations


Surescripts LLC - Arlington, VADate of authorization: December 23, 2010.Scope of authorization: EHR Modules: E-Prescribing, Privacy and Security.

ICSA Labs - Mechanicsburg, PADate of authorization: December 10, 2010.Scope of authorization: Complete EHR and EHR Modules.

SLI Global Solutions - Denver, CODate of authorization: December 10, 2010.Scope of authorization: Complete EHR and EHR Modules.

InfoGard Laboratories, Inc. – San Luis Obispo, CADate of authorization: September 24, 2010.Scope of authorization: Complete EHR and EHR Modules.

Certification Commission for Health Information Technology (CCHIT) - Chicago, ILDate of authorization: September 3, 2010.Scope of authorization: Complete EHR and EHR Modules.

Drummond Group, Inc. (DGI) - Austin, TXDate of authorization: September 3, 2010.Scope of authorization: Complete EHR and EHR Modules

EHR Vendor CertificationEHR Vendor Certification

http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3120


Currently 193 vendor products are certified

Not all are comprehensive EHRs

Very few offer a comprehensive CV EHR

Make sure your vendors are certified and contractually commit to remaining certified

http://onc-chpl.force.com/ehrcert/EHRProductSearch

Certified VendorsCertified Vendors


EHR Evaluation Considerations EHR Evaluation Considerations

Performance

• Depth in Cardiology and Interoperability

• Ability to interoperate with others

• Patient identity management

• Inbound unsolicited data management

• Market share in your region

• Validation of capability and contractual commitment

• Pre-contract integration and interoperability plan


EHR Implementation TimelineEHR Implementation Timeline

Total: 6 to 16 months depending on resources, size of group, PM integration and other variables.

1 to 3 months 1 to 2 months 2 to 4 months 1 to 3 months 1 to 4 months


Summary Physician / EHR requirementsSummary Physician / EHR requirements

Meeting Cardiology Workflow

Flexibility of design / settings

Interfaces with Devices – Patient ID, Orders, Results− CPACS− PaceArt− Others

Comprehensive “one-stop shopping” for all patient records components from the patient summary screen with individual settings

Integration into clinic workflows− Nursing triage− Physician in-box of new records / results

Ease of mapping to existing records – both paper and electronic, patient identifiers

Ease of validation of data prior to upload into the permanent record from outside systems

Key Focal Points

Interoperability - Your Device Integration

− Echo, ECG, Stress, Holter, Nuclear, CT, PV, etc.

Specialty Clinics: Limpid, AntiCoag, Device, CHF, etc.

Lab Interfaces -

Quality Data / Measures – how is data collected

Effective Clinical Decision Support – documentation of non-std events

Executive Reporting / ease of use

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Mapping to your ACO partners

Management of change to national standards

Health Information Exchange Requirements – Regional, State, Enterprise

Referral coordination for exchange – changes in workflows

Patient / Consumer Compliance Requirements – access to electronic copies of their records

Others

Other RequirementsOther Requirements


Component Early Developing Sustainable Supporting I/T

Member Engagement

Episode of Care Pre-care intervention Prevention:Lifestyle coaching; Remote monitoring

CRMHRAPatient ID Mgt

Cross Continuum Medical Management

Case Management Care Coordination Disease Management & Health Maintenance

Patient ID MgtProvider DirectoryConsent Mgt.Disease RegistriesEMR

Clinical Information Exchange

Read only access; User request – pull

Push & PullCCD

Dynamic context sharing; Patient access

EMR w/ CCDPatient ID Mgt.Provider DirectoryHIE

Quality Reporting Manual entry into Excel

EHR feed to Quality DB Real time access to data Data dashboardsExecutive reporting

EMR w/ Clinical Documentation Analytical Data Warehouse

Business Intelligence/ Predictive Modeling & Analytics

Patient focused; Episode & encounter focused data; retrospective clinical and financial data

Population based; continuum of care data; predictive health analytics

Social and network data; Behavior based analytics; Real time data analysis

Analytical Data Warehouse – cross continuumClinical DashboardComparative Effectiveness Analytics

ACO Risk & Revenue Management

Cost accounting across the continuum of care; global contracting; member data management

Provider management; allocation of payment

Pool management; disease improvement

RCM for ACOAnalytical Data Warehouse

Example of ACO I/T RequirementsExample of ACO I/T Requirements


Hospital bias toward enterprise system choices

Lack of granular understanding of practice workflows, requirements

Nomenclature and data integration and normalization between hospitals and physicians

Patient identifiers between hospitals and clinics

Orders being received by hospitals from physician EHRs

Physician use of multiple clinical documentation systems

Hospital portal access and download of data to EHR

Hospital links to office EHR via web− Images− Security issues

Enterprise Data Analytics – common clinical model − E.g. Marshfield Semantic interoperability project

Example - Hospital / Physician Example - Hospital / Physician Integration Integration


Lab Information Systems – reference labs, hospitals etc.− Orders− Results− Status

Pharmacy− Outbound eRx to Retail− Outbound patient record to

hospital – active meds− Inbound patient history –

CCD− Inbound patient active meds –

hospital discharges – medication reconciliation

Documents− Outbound CCD/CCR− Outbound referral request− Outbound referral results

(CCD)

Imaging− Links to Hospital PACS from

hospital results records− Links to Clinic PACS from

hospital devices

Orders / Results – Hospitals− Radiology− Cardiology − Others

Example: Physician EHR Environment Example: Physician EHR Environment Summary HIE RequirementsSummary HIE Requirements


Have a plan as to how you will make your decision

Include as many clinicians and operations members as you can

Map all of the your detailed requirements to what the vendor says they can do and make sure they are transferred into the contract

Don’t rush your decision

Speak to as many references as you can

Don’t sign their standard contract

Buying an EHRBuying an EHR

Health Information Exchange Health Information Exchange & & Care CoordinationCare Coordination



Data and Information Exchange Data and Information Exchange

Point of Care

Clinical Information /

Data

Care Continuum


Health Information Exchange (HIE)Health Information Exchange (HIE)

Definition: HIE refers to the process associated with the electronic movement of health-related data and information among organizations at the community, regional, statewide, or nationwide levels according to agreed standards, protocols, and other criteria.


Health Information Exchange (HIE) Health Information Exchange (HIE)

Primary Functions:

Health Information

ExchangePlatform

Long TermCare

PHYSICIAN

HOSPITALS

LAB

GROUPPRACTICE

Imaging Center

OTHER HIE’s

Rx

Consumer

• Secure clinical information sharing

• Coordination of care• Support Accountable Care

Organizations• Quality and health status

reporting• Shared platform

State of IL

Public Health


Cardiovascular HIE RequirementCardiovascular HIE Requirement

Cardiovascular groups will be a significant target for health information exchange over the next 2 years with target for implementation by 2013 (Stage 2)

Coordination of care and reduction of duplicate testing are the primary objectives

ED access to CV patient records – Wisconsin Study

CCD exchange

PHR service


Physician EHR Environment Summary HIE Physician EHR Environment Summary HIE RequirementsRequirements

Lab Information Systems – reference labs, hospitals etc.− Orders− Results− Status

Pharmacy− Outbound eRx to Retail− Outbound patient record to

hospital – active meds− Inbound patient history –

CCD− Inbound patient active meds –

hospital discharges – medication reconciliation

Documents− Outbound CCD/CCR− Outbound referral request− Outbound referral results

(CCD)

Imaging− Links to Hospital PACS from

hospital results records− Links to Clinic PACS from

hospital devices

Orders / Results – Hospitals− Radiology− Cardiology − Others


EMR - MU – Stage 1, 2 & 3 - CV

Patient Centric Care Coordination Processes

HC Reform Rule Flexibility

ACO Development

Data supports Quality Outcomes

Consumer Focus & Engagement

ConclusionsConclusionsDawn of a New EraDawn of a New Era


Thanks !Thanks !

Health Information Consulting, LLC

Mike Mytych

[email protected]

262-253-9110