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Martha Cornwell Riddell, DrPH Meaningful Use Advisor, Kentucky Regional Extension Center

Kentucky EHR Initiatives. Martha Cornwell Riddell, DrPH Meaningful Use Advisor, Kentucky Regional Extension Center Assistant Professor, Health Services Mgmt., UK Martha.riddell@uky.edu Polly Mullins-Bentley, RN, RHIT, CPHQ Deputy Executive Director

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Martha Cornwell Riddell, DrPH Meaningful Use Advisor, Kentucky Regional Extension Center

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  1. Kentucky EHR Initiatives • Martha Cornwell Riddell, DrPH • Meaningful Use Advisor, Kentucky Regional Extension Center • Assistant Professor, Health Services Mgmt., UK • Martha.riddell@uky.edu • Polly Mullins-Bentley, RN, RHIT, CPHQ • Deputy Executive Director • Governor’s Office of Electronic Health Information • Polly.Mullins-Bentley@ky.gov

  2. Overview • Review the reasons advancing Health Information Technology • adoption • Provide a brief update on federal initiatives involving Health • Information Technology (HIT) • Review the role of the Regional Extension Center in assisting • clinicians’ move to meaningful use of HIT • Examine the Kentucky Health Information Exchange and • discuss the current status 2

  3. Why Health Information Technology (HIT)? • Implementation of HIT is proposed as a way to provide additional information to clinicians to facilitate a reduction in serious medical errors, rising healthcare costs and system inefficiencies. • (Thompson, 2004) • Estimate annual $10.6 billion outpatient savings and $31.2 billion inpatient savings based on HIT efficiency benefits (Girosi, Meili,& Scoville, 2005) • President Bush State of the Union (Jan 2006) President Obama State of the Union (Jan 2010) 3

  4. Where Healthcare is Going • Attempts to change how providers are paid have several common elements: • All payments are value based even if the major goal is cost containment; • It is assumed that medical guidelines, standards and quality measures will play important roles in management; • All systems require real-time electronic medical records; • Most of the systems use teams to provide care. 4

  5. National Quality Strategy (NQS) The Affordable Care Act (Public Law 111-148) calls on the Secretary of the Department of Health and Human Services (HHS) to establish a national quality strategy and a comprehensive strategic plan (the “National Quality Strategy”) and to identify priorities to improve the delivery of health care services, patient health outcomes, and population health. Affordable Care Act signed March 31, 2010 5

  6. NQS Framework 6

  7. National Quality Strategy Priorities • Ensuring that each person and family is engaged as partners in their care. • Promoting effective communication and coordination of care. • Promoting the mosteffective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.

  8. National Quality Strategy Priorities • Working with communities to promote wide use of best practices to enable healthy living. • Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models. • Making care safer by reducing harm caused in the delivery of care.

  9. Policies and Infrastructure needed to Support the National Quality Strategy • Payment • Public Reporting • Quality Improvement/Technical Assistance • Certification, Accreditation, and Regulation • Consumer Incentives and Benefit Designs • Measurement of Care Processes and Outcomes • Health Information Technology • Evaluation and Feedback • Training, Professional Certification, and Workforce and Capacity Development • Promoting Innovation and Rapid-Cycle Learning 9

  10. HITECH Framework: Meaningful Use at its Core Regional Extension Centers Workforce Training ADOPTION Beacon Communities Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery MEANINGFUL USE State Grants forHealth Information Exchange Standards & Certification Framework EXCHANGE Privacy & Security Framework 10

  11. American Recovery and Reinvestment Act (ARRA) Health Information Technology for Economic and Clinical Health (HITECH) 11

  12. Kentucky Regional Extension Center Federal eHealth Initiatives Kentucky Health Information Exchange JCTC Workforce Solutions

  13. Pillars of Meaningful Use Improve Public Health Improve Quality Improve Care Coordination Ensure privacy and security Engage Patients

  14. Pillars of Meaningful Use Explained 1) Improve quality, safety, efficiency, and reduce health disparities • Provide access to comprehensive patient health data for patient’s health care team • Use evidence-based order sets and CPOE • Apply clinical decision support at the point of care • Generate lists of patients who need care and use them to reach out to patients 2) Engage patients and families • Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health 3) Improve care coordination • Exchange meaningful clinical information among professional health care team 4) Improve population and public health • Submit immunization, syndromic surveillance and reportable disease data to public health agencies 5) Ensure privacy and security protection for personal health information • Protect confidential information through operating policies, procedures, and technologies • Provide transparency of data sharing to patient

  15. Kentucky Regional Extension Center (KY-REC) Strategic Framework Vision Statement The long-term vision of Kentucky Regional Extension Center is to improve the quality and value of health care for the people of Kentucky and to serve as a model for other areas that face similar challenges. Mission Statement The Kentucky Regional Extension Center based at the University of Kentucky will assist primary care providers and critical access/rural hospitals with EHR adoption, HIE participation, and achievement of meaningful use. 15

  16. HITECH Framework: Meaningful Use at its Core Kentucky Regional Extension Center 16

  17. Menu of KY-REC Services 17

  18. Who is Eligible for Incentives? 18

  19. How to get to MU: What are the Provisions? Eligible Providers must comply with 20 objectives to reach meaningful use. Providers must attest to15 core objectives along with another 5 objectives chosen off a menu list of 10 objectives. 19

  20. Core Set • Use computerized order entry for medication orders. • Implement drug-drug, drug-allergy checks. • Generate and transmit permissible prescriptions electronically. • Record demographics. • Maintain an up-to-date problem list of current and active diagnoses. • Maintain active medication list. • Maintain active medication allergy list. • Record and chart changes in vital signs. • Record smoking status for patients 13 years old or older. • Implement one clinical decision support rule. • Report ambulatory quality measures to CMS or the States. • Provide patients with an electronic copy of their health information upon request. • Provide clinical summaries to patients for each office visit. • Capability to exchange key clinical information electronically among providers and patient authorized entities. • Protect electronic health information (privacy & security) 20

  21. Menu Set • Implement drug-formulary checks. • Incorporate clinical lab-test results into certified EHR as structured data. • Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. • Send reminders to patients per patient preference for preventive/ follow-up care • Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) • Use certified EHR to identify patient-specific education resources and provide to patient if appropriate. • Perform medication reconciliation as relevant • Provide summary care record for transitions in care or referrals. • *Capability to submit electronic data to immunization registries and actual submission. • *Capability to provide electronic syndromic surveillance data to public health agencies and actual transmissions 21

  22. Thresholds Applicable core objectives and menu objectives have specific thresholds a provider must meet. 22

  23. Clinical Quality Measures In addition to the 20 core and menu measures, providers must report 6 clinical quality measures: • 3 core quality measures • and an additional 3 from a set of 38. 23

  24. Meaningful Use Stage 2: The Escalator Data Capture & Sharing Add in key elements of NQS/delivery system reforms 24

  25. Medicare Incentive Payment Schedule Fall 2010 EHR vendors receive certification April 2011 Attestation of meaningful use begins 2011-2012 Clinicians can begin using a certified EHR in a meaningful Manner (must use for 90 days) 2010 2011 Jan. 2011 Registration with CMS begins May 2011 CMS begins payments 25

  26. Healthcare Today: A Disconnected System • Disconnected islands of data • Poor coordination • Fragmented processes • Limited connectivity • Patients and clinicians often left without tools and data required Imaging Center IDN/Hospital Tightly Aligned Physician Offices Owned Practices Clinics Reference Lab Community Pharmacy Non-Affiliated Practices Patient Loosely Affiliated Physician Offices 26

  27. The KHIE Connection: Partnering to Improve Patient Health Outcomes Polly Mullins-Bentley, RN, RHIT, CPHQ Deputy Executive Director Governor’s Office of Electronic Health Information Polly.Mullins-Bentley@ky.gov 27

  28. Health Information Exchange: • The electronic movement of health-related data and information among organizations according to agreed standards, protocols, and other criteria (ONC) 28

  29. eHealth and Health Information Exchange in Kentucky • TODAY Kentucky has a LIVE operational state-wide health information exchange because… • eHealth Milestones • March/2005 • Legislation (Senate Bill 2) to create a secure interoperable statewide electronic health network • Kentucky eHealth Network Board (KeHN) • Appointment of Health Information Exchange committee • 2007 – 2008 • Medicaid Transformation Grant Funding – $4.9 million • Built the technical infrastructure for the KHIE • 2009 • ARRA/HITECH Funding - $9.75 million • Provides Kentucky the advantage in progressing towards STATE-wide HIE • Governor’s Office of Electronic Health Information • Executive Order of the Governor • Housed in the Cabinet for Health & Family Services 29

  30. How the Exchange ‘Works’ • Data Sharing! • ADT’s/Demographics • Populate the Community/Master Patient Index • Record Locator Service • Locates all the patient encounters • Consolidates patient information for presentation to the provider • Access • KHIE Community Portal/Virtual Health Record • Provider EHR Portal/Dashboard 30

  31. KHIE Community Portal (Virtual Health Record) 31

  32. KHIE Goal Provide HIE Connectivity to as many providers as possible over the next two years with little or no startup cost to the providers 32

  33. KHIE Hospitals 65 Intake Complete/PA in Process Updated 11/30/2011 Campbell Boone Kenton Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Franklin Boyd Scott Shelby Rowan Bourbon Jefferson Bath Elliott Woodford Lawrence Spencer Fayette Bullitt Montgomery Anderson Menifee Clark Meade Jessamine Morgan Hancock Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Garrard Boyle Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Perry Hopkins Edmonson Green Butler Muhlenberg Clay Livingston Caldwell Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Todd Cumberland Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton West Virginia (KHIE Counties) Raleigh Summers

  34. Implementation Contacts 235 Physician Practices/Labs/ Other by County Updated 11/30/2011 Campbell Boone Kenton Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Lewis Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Franklin Boyd Scott Shelby Rowan Bourbon Jefferson Bath Elliott Woodford Lawrence Spencer Fayette Bullitt Montgomery Anderson Menifee Clark Meade Morgan Hancock Jessamine Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Garrard Boyle Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Perry Hopkins Edmonson Green Butler Muhlenberg Caldwell Clay Livingston Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Todd Cumberland Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton Other Locations: Jellico, TN

  35. Combined Contacts 338 Combined Hospitals/Physicians/Labs/ Other by County Updated 11/30/2011 Campbell Boone Hospital Physician Both Kenton Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Franklin Boyd Scott Shelby Rowan Bourbon Jefferson Bath Elliott Woodford Lawrence Spencer Fayette Bullitt Montgomery Anderson Menifee Clark Meade Jessamine Morgan Hancock Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Garrard Boyle Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Perry Hopkins Edmonson Green Butler Muhlenberg Clay Livingston Caldwell Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Todd Cumberland Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton

  36. Participation Agreements Signed • Total 102 – represents 201 provider organizations • Healthcare Systems/Hospitals • Representing 56 hospitals • Physicians/Clinics/Health Departments • 86 Physicians/Clinics • 1 Health Department • Laboratories • LabCorp • Cumberland Medical Lab • Kentucky Division of Laboratories • Immunization Registry • Kentucky Cancer Registry

  37. KHIE Participation Agreements Hospitals/Physicians by County 102Signed PA’s Updated 11/30/2011 Campbell Boone Hospital Physician Lab Combination Kenton Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Franklin Boyd Scott Shelby Rowan Bourbon Jefferson Bath Elliott Woodford Montgomery Lawrence Spencer Fayette Bullitt Anderson Menifee Clark Meade Jessamine Morgan Hancock Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Garrard Boyle Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Perry Hopkins Edmonson Green Butler Livingston Muhlenberg Caldwell Clay Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Todd Cumberland Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton • Other Participation Agreements: • Kentucky Immunization Registry • Kentucky Cancer Registry • Kentucky State Laboratory • Cumberland Medical Lab • Labcorp

  38. LIVE Connections Hospitals/Physicians/Labs by County Updated 10/28/2011 Campbell Boone Hospital Physician Lab Combination Kenton Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Franklin Boyd Scott Shelby Rowan Bourbon Jefferson Bath Elliott Woodford Montgomery Lawrence Spencer Fayette Bullitt Anderson Menifee Clark Meade Jessamine Morgan Hancock Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Boyle Garrard Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Perry Hopkins Edmonson Green Butler Muhlenberg Clay Livingston Caldwell Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Cumberland Todd Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton • Others: • Kentucky Immunization Registry • State Lab (Microbiology) • Grundy, VA

  39. Current Data Exchange Total Facilities Connected: 35 As of 11/03/2011

  40. Kentucky Health Information Exchange Outreach Coordinator Regions Campbell Boone Kenton Region 1 – Laura Shonk Region 2 – Teresa Poff Region 3 – Ann O’Hara Region 4 – Dawn Gasser Region 5 – Pat Robinson Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Franklin Boyd Scott Shelby Rowan Bourbon Jefferson Bath Elliott Woodford Lawrence Spencer Fayette Bullitt Montgomery Anderson Menifee Clark Hancock Meade Jessamine Morgan Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Garrard Boyle Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Livingston Perry Hopkins Edmonson Green Butler Muhlenberg Clay Caldwell Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Todd Cumberland Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton 40

  41. KHIE and CHFS Cabinet Resources: The Advantage • KHIE is the resource for Cabinet data • 3 years of Medicaid Claims Data currently available in production with nightly data load updates • State Laboratory Results • Newborn Screenings • All other legally available state lab tests available • Currently in testing mode with the two lab vendors • Immunization Registry • Currently in design phase to connect the Immunization Registry to the KHIE • Public Health • Reportable Diseases • Syndromic Surveillance Reporting 41

  42. Benefits of HIE Participation • Access to comprehensive patient information • Encounters • Lab results • Radiology reports • Transcribed reports • Medication history/allergies • Meaningful Use criteria • Immunization Registry/Reportable diseases 42

  43. % of Patients Receiving Care Quality of Diabetes Care: Patients Treated by Physicians using EHR vs. Paper Medical Records A significantly higher proportion of patients being treated by physicians with EHRs received care that aligns with accepted treatment standards * Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.001

  44. Hospitals Imaging Center What’s Possible? With a Connected Community Tightly Aligned Physicians Owned Practices/ Clinics Better Coordination Safer Care More Cost-Effective Care Reference Lab Community Pharmacy Non-affiliated Practices Patients Loosely Affiliated Physicians

  45. Medicaid Incentive Payments • 62 Hospitals paid $45.8 million • 582 Providers paid $12.3 million • Total Paid $58.1 million • 81 hospitals registered for payment • 1024 providers registered for payment 45

  46. eHR Incentive Payment Hospitals Payments by County As of November 28, 2011 Campbell Total Hospital Incentive Payments to date $45,826,628.45 Boone Kenton Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Franklin Boyd Scott Shelby Rowan Bourbon Jefferson Bath Elliott Woodford Lawrence Spencer Fayette Bullitt Montgomery Anderson Menifee Clark Meade Morgan Hancock Jessamine Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Garrard Boyle Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Livingston Perry Hopkins Edmonson Green Butler Muhlenberg Clay Caldwell Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Todd Cumberland Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton

  47. eHR Incentive Payment Physician Payments by County As of November 28, 2011 Campbell Total Provider Incentive Payments to date $11,588,333.34 Boone Kenton Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Boyd Scott Shelby Franklin Rowan Bourbon Jefferson Bath Elliott Woodford Lawrence Spencer Fayette Bullitt Montgomery Anderson Menifee Clark Meade Morgan Hancock Jessamine Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Garrard Boyle Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Perry Hopkins Edmonson Green Butler Muhlenberg Clay Livingston Caldwell Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Todd Cumberland Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton

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  49. Questions? • Martha Cornwall Riddell, DrPH • Meaningful Use Advisor • KY Regional Extension Center • Assistant Professor, Health Services Mgmt, UK • Martha.riddell@uky.edu • Kentucky Regional Extension Center • 2333 Alumni Park Plaza, Suite 200 • Lexington, KY 40517 • 1-888-KY-REC-EHR • KYREC@uky.edu  www.ky-rec.org • www.facebook/ehrresource.com • Polly Mullins-Bentley, RN, RHIT, CPHQ • Deputy Executive Director • Governor’s Office of Electronic Health Information • Polly.Mullins-Bentley@ky.gov • Kentucky Health Information Exchange • Governor's Office of Electronic Health Information • Cabinet for Health and Family Services • 275 E. Main Street, 4W-A, Frankfort, KY 40621 • (502) 564-7992   • Polly.Mullins-Bentley@ky.gov    http://khie.ky.gov

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