Making sense of ehrs and the ehr incentive program hitech
Sponsored Links
This presentation is the property of its rightful owner.
1 / 67

Making Sense of EHRs and the EHR Incentive Program (HITECH) PowerPoint PPT Presentation

  • Uploaded on
  • Presentation posted in: General

Making Sense of EHRs and the EHR Incentive Program (HITECH). Northern California ACP Chapter San Jose, CA October 29, 2011. Michael S. Barr, MD, MBA, FACP Senior Vice President Division of Medical Practice, Professionalism & Quality 202-261-4531 [email protected] Disclosures.

Download Presentation

Making Sense of EHRs and the EHR Incentive Program (HITECH)

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript

Making Sense of EHRs and the EHR Incentive Program (HITECH)

Northern California ACP Chapter

San Jose, CA

October 29, 2011

Michael S. Barr, MD, MBA, FACP

Senior Vice President

Division of Medical Practice, Professionalism & Quality


[email protected]


  • Grants for program development (ACP) from:

    • Pfizer

    • UnitedHealth Care

    • NovoNordisk

    • Endo Pharmaceuticals

    • Merck

    • Sanofi

    • Wyeth


  • Focus on patient-centered care

  • Highlight key provisions of the HITECH Act

  • Examine Meaningful Use & its relation to PCMH

  • Explore a road map for building technology-enabled practices

  • Introduce resources available

HITECH = Health Information Technology for Economic and Clinical Health Act 2009

Patient-Centered Medical Home

Health Care Home

Person-Centered Health Care Home

Meaningful Use

Certified EHR Technology

Complete EHRs

EHR Modules

Accountable Care Organizations

Affordable Care Act (PPACA, ACA)

Maintenance of Certification

Physician Quality Reporting Initiative - PQRI


E-prescribing Incentive Program

What is Patient-Centered Care?

  • One of IOM’s six domains of quality

  • “Nothing about me without me”

  • The right care, the right way, at the right time

  • Providing the care that the patient needs in the manner the patient desires at the time the patient desires

Shaller, D. Patient-Centered Care: What Does It Take?

The Joint Principles of the PCMH

Team-based care:



Medical Assistant

Office Staff

Care Coordinator



Behavioral Health

Case Manager

Social Worker

Community resources

DM companies


  • Personal physician

  • Physician directed medical practice

  • Whole person orientation

  • Care is coordinated and/or integrated

  • Quality and safety

  • Enhanced access to care

  • Payment to support the PCMH

Strategy without tactics

is the slowest route to victory.

Tactics without strategy

is the noise before defeat.

Sun Tzu – Chinese Military General


Berwick, Nolan & Whittington; Health Affairs 2008


Berwick, Nolan & Whittington; Health Affairs 2008


Berwick, Nolan & Whittington; Health Affairs 2008

Information Organization Critical to Improving Care




Referral Requests

Vendors & Suppliers


Home Health





Prior Auths

Front Desk = Link to the “World”

Organized Charts Critical to Care

The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.

Bill Gates

640K ought to be enough for anybody. Bill Gates

Quality Pyramid

Quality Pyramid

  • Right number, skill sets, competencies

    • Clinical & administrative

    • Cross-trained

  • Assessment of readiness for change

  • Recognize potential “threats” to staff

  • Assess satisfaction with job activities

  • Remove barriers to working at level of training


  • Identify any cultural issues that impede team-work and collaboration

  • Review hierarchy and org chart

  • Introduce team-huddles

  • Improve communication

  • Review facility layout and lines of sight


  • Evaluate work flow of common processes as well as uncommon yet critical pathways

  • Eliminate extraneous steps, layered “solutions” and misapplied technology

  • Consider the functionality of well-implemented technology to assist clinicians, staff, patients & families



  • Right product(s)

  • Right prep & training

  • Right implementation

  • Right support

  • Right optimization

  • Right maintenance


  • Organized, pro-active, responsive, accountable and accessible

  • Culturally competent

  • Addresses health literacy/numeracy

  • Focused on quality & safety

  • Addresses needs of individuals and the population

  • Incorporates patient preferences, stated needs/desires in formulating care strategies and follow-up

  • Uses health information technology to facilitate care

Bending the Curve Towards Transformed HealthAchieving Meaningful Use of Health Data

  • Improved outcomes

  • Advanced clinical processes

  • Data capture and sharing

HITECH Act(Medicare Provisions)

  • Provides monetary incentives for adoption of health IT ($44,000 per physician over 5 years)

  • Introduced concept of “Meaningful Use”

  • Decreasing incentives if start after 2012

  • Must begin by 2014 to receive any payment

  • Reimbursement Penalty begins 2015

HITECH = Health Information Technology for Economic and Clinical Health Act 2009

HITECH Act(Medicaid Provisions)

  • Medicaid – EPs who adopt, implement, upgrade, or meaningfully use certified EHR technology in their first year of participation in the program and successfully demonstrate meaningful use in subsequent years may be eligible for an incentive payment amount, subject to an annual limit.

  • Maximum = $63,750

HITECH = Health Information Technology for Economic and Clinical Health Act 2009

EHR Incentive Program

  • Core Set has 15 measures – need to meet all

  • Menu Set has 10 measures of which 5 have to be met

    • At least 1 of the measures needs to be:

      • Test of reporting to an immunization registry

      • Test of reporting to a public health agency for syndromic surveillance

Blumenthal, D: NEJM, online July 13, 2010; in print, August 4, 2010


Meaningful Use in Practice

Use the EHR (and staff) for the following 6 things:

  • Create problem lists

  • Enter allergies

  • Keep track of vaccinations and preventive care

  • Collect basic demographic data (date of birth, gender, race, ethnicity, and preferred language)

  • Check height, weight and blood pressure

  • E-prescribing

AmericanEHR Blog Entry:

And You Can…

Satisfy 8 Core Set and 3 Menu Set Measures:

  • Core Set: 1) Computerized Physician Order Entry; 2) Drug-drug/Drug-allergy interactions; 3) Maintain up-to-date problem list; 4) E-prescribing; 5) Active medication list; 6) Active allergy list; 7) Recording of demographics; 8) Record/chart vital signs.

  • Menu Set: 1) Drug-formulary check (at least 1); 3) Generate list of patient with a specific condition; 4) Send reminders for preventive/follow-up care.

AmericanEHR Blog Entry:

Quality Measure Reporting

  • Six (6) total Clinical Quality Measures

    • 3 Core or Alternate Core, and…

    • 3 out of 38 from menu set

  • Align with PQRS quality measurement set

Quality Measure Reporting

Core Set/Alternate Core

Paper | EHR | EHR+MU

Registration for EHR Incentive Program

Case Study

  • 10 physician multi-specialty practice

  • IM, ID, Rheum, Neuro


  • Considering CMS EHR Incentive Program

  • Uncertainty about EHR meeting the needs of all specialists

  • Rural area; concerned about health IT support

  • Recently invested in new practice management system

Educational Resources

ACP Medical Home Builder®

Modules Cover PCMH/QI/Health IT…

  • Facilitate Transitions

  • Use of Technology

  • Improve Quality

  • Manage Populations

  • Manage Patients’ Medications

  • Engage Patients

  • Organize Your Practice

  • Work as a Team

  • Communicate with Patients

  • Enhance Patient Access

  • Deliver Patient-Centered Care

  • Coordinate Care

From the ACP Medical Home Builder – Practice Biopsy®

From the ACP Medical Home Builder – Biopsy Report

From the ACP Medical Home Builder –Resource Library

Focus on “Capabilities” of EHR Systems

  • Collect, store, and exchange health info

  • Facilitate team care

  • Collect & report on the processes, outcomes and quality of care

  • Provide clinical decision support

  • Engage patients/consumers in their health care

Collect, Store and Manage Data

  • Collect standardized, accurate and essential data elements and exchange externally:

    • Demographic and clinical data

    • Results reporting to ordering or covering physician

    • Patient notification of lab results

    • Forward appropriate clinical information

    • Online order entry and tracking

    • Identify patients receiving care in another facility

Facilitate Team-Based Care

  • Care Coordination

    • Medication reconciliation

    • E-Prescribing

    • Evidence-based flowsheets

    • Track referrals and labs

    • Send/receive health summary information

    • Structured documentation

    • Create/maintain list of consultants

Report on Quality of Care

  • Registry-like reporting and linking to community resources

    • Identify practice-specific important conditions, frequent diagnoses

    • Recommend patient-specific care: chronic conditions, immunizations, preventive health

    • Maintain list of community resources

    • Risk stratification by age appropriate measures

Clinical Decision Support

  • Incorporate clinical guidelines into flow sheets, standing order sets, training …

  • Medication selection and dosing support

  • Prompts/reminders for preventative care services

  • Simple, effective alerts

Patient Engagement

  • Personal Health Records

  • Interactive, personalized educational activities & materials

  • Remote monitoring/telemedicine

  • Web-based visits & consultation

  • Virtual group visits

Michael S. Barr, MD, MBA, [email protected]


  • Login