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Framework for Empowering Pathology in the Electronic Health Record. Walter H. Henricks, MD, FCAP, The Cleveland Clinic Foundation Jodi G. Daniel, JD, MPH, Office of the National Coordinator for Health Information Technology. Walter H. Henricks, MD, FCAP

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  • Walter H. Henricks, MD, FCAP, RecordThe Cleveland Clinic Foundation

  • Jodi G. Daniel, JD, MPH, Office of the National Coordinator for Health Information Technology


Walter h henricks md fcap framework for empowering pathology in the ehr may 8 2012

Walter H. Henricks, MD, FCAP Record

Framework for Empowering Pathology in the EHR

May 8, 2012


Objectives
Objectives Record

  • Review HIT Regulatory Framework

  • Discuss Two Regulatory Challenges & Policy Solutions

  • Note What CAP Can Do & What You Can Do



Pathology s two challenges
Pathology Record’s Two Challenges


Challenge 1
Challenge #1 Record

  • Suboptimal management of laboratory information in EHRs

  • CPOE design and configurationissues

  • Potential patient safety issues

  • Hidden costs


Suboptimal lab data handling in ehr

This EHR report is garbled, I need to call the lab Record

Suboptimal Lab Data Handling in EHR

We don’t control the EHR, you’ll have to call IT


Example garbled pap report in ehr
Example: Garbled PAP report in EHR Record

  • Example of unpublicized “nonstandard” view of Pap smear result in EHR – garbled text

  • Not widely used; was not known to lab at time of interface validation


Lab data problem symptoms
Lab Data Problem Symptoms Record

  • Reference ranges, comments, footnotes

  • Abnormal result flags, preliminary reporting and updates

  • Improper handling of:

    • Corrected results

    • Unsolicited results

    • Reflex tests

    • Performing lab name & address


Poor cpoe symptoms
Poor CPOE Symptoms Record

  • Incorrect, incomplete, inappropriate test orders

  • Inefficient lab/provider operations

  • Billing & compliance problems

  • Pitfalls – future orders, duplicate handling, canceled orders


Policy initiatives cap
Policy Initiatives – CAP… Record

  • Has submitted extensive comments on ONC Stage 2 (2014) Standards & Certification Proposed rule

    • Need for FULL testing of pending laboratory reporting guide before implementation

    • Need for laboratory data/vocabulary integrity as it moves throughout healthcare system

  • Is working for pathologist role as laboratory data stewards in EHR environment

    • Developing white paper

  • Desires to partner with ONC and others on solutions

    • e.g. domain expertise for standards and/or certification criteria


Challenge 2
Challenge #2 Record

  • Pathologists are “non-hospital based” (per CMS definition) eligible providers (EPs) for MU incentives and penalties

  • Challenged by MU requirements to:

    • Use certified EHRs

    • Report specified objectives

    • Report clinical quality measures (CQMs)


Incentive penalty rule challenges
Incentive/Penalty Rule Challenges Record

  • Certified EHRs: Pathologists do not practice in EHRs

  • Report certain objectives: Objectives not applicable to pathology practice (written for office-based providers)

  • CQMs: Not applicable to pathology practice


Regulatory relief possible
Regulatory Relief Possible Record

  • CMS considering criteria for relief from penalties for eligible providers that:

    • Lack face-to-face/telemedicine interaction with patients

    • Lack follow-up with patients

    • Lack control over availability of certified EHRs at their practices


Legislative solution on the table
Legislative Solution on the Table Record

  • H.R. 4066, “The Health Information Technology Reform Act” introduced by Rep. Tom Price MD (R-GA-6)

    • Removes pathologists from eligibility for MU incentives or payment adjustments

    • Penalty relief would be permanent


What cap is doing
What CAP is Doing Record

  • Advocating for regulatory relief

  • Seeking passage of H.R. 4066

  • Developing white paper on best practices for lab data/transmission



What you can do at home
What You Can Do at Home Record

  • Advocate for patients’ laboratory information in EHR

  • Develop some expertise:

    • Intradepartmental

    • Institutional

  • Raise awareness and provide domain expertise at institutional level


What you can do here
What You Can Do Here Record

  • When you visit your Senators/Congressmen….

  • Ask them to support H.R. 4066!


Summary
Summary Record

  • ARRA hastening EHR adoption

  • CAP working to advance HIT and protect pathologists

  • You have a role in DC and at home

  • Constructive dialogue with policymakers & other stakeholders to continue


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