Universal Adoption of the EHR

1. Universal Adoption of the EHR What is Meaningful Use and why should it be important to me?

2. No, it’s not about HIT rulingthe world!

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4. The EHR Incentive Program • American Recovery and Reinvestment Act (ARRA) of 2009 • Programs funded through existing Medicare and Medicaid (Medical) reimbursement mechanisms • Must use certified EHR technology AND demonstrate meaningful use (adoption, implementation, and use) of such technology

5. Meaningful Use: Overview of Final Rule

6. Two Final Rules: July, 2010 Medicare and Medicaid Programs; Electronic Health Record Incentive Program (CMS) -864pp Requirements for an EP or hospital to achieve Meaningful Use and qualify for incentive payments HIT: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology (ONC) -254pp Requirements and standards for software to meet to be a certified EHR All MU requirements are predicated on the use of a “Certified EHR Technology”.

7. Health IT and Transformed Health Care: Key Goals • Ultimate goal is to enable significant and measurable improvements in population health through a transformed healthcare system • Meaningful Use is using certified EHR technology to: • Improve quality, safety, efficiency, and reduce health disparities • Engage patients & families in their health care • Improve care coordination • Improve population and public health • All the while maintaining privacy and security http://onc-chpl.force.com/ehrcert

8. Bending the Curve TowardsTransformed Health Achieving Meaningful Use of Health Data “These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth” “Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.” Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009

9. Achievable Vision for 2015 Prevention, and management, of chronic diseases A million heart attacks and strokes prevented Heart disease no longer the leading cause of death in the US Medical errors 50% fewer preventable medication errors Health disparities The racial/ ethnic gap in diabetes control halved Care Coordination Preventable hospitalizations and re-admissions cut by 50%

10. Achievable Vision for 2015 Patients and families All patients have access to their own health information Patient preferences for end of life care are knowna and followed consistently Public health All health departments have real-time situational awareness of outbreaks Immunization registries are on-line and updated to maximize full immunization and minimize unneeded immunizations 10

11. Relationship to Health Reform and Affordability Direct Cost Reductions Reduction in medication errors Formulary adherence Fewer redundant tests due to better information Information infrastructure for affordable expansions of health delivery Clinical quality measurement (outcomes) Care coordination (e.g., to reduce readmissions) Reduction in inappropriate care Expanding primary care capacity (e.g., non-visit-based care) Prevention

12. HIT-Enabled Health ReformAchieving Meaningful Use 2009 2011 2013 2015 HIT-Enabled Health Reform Meaningful Use Criteria ARRA: HITECH 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes) 12

13. Empower electronic clinician order entry Use electronic prescribing for permissible Rx Implement drug-drug, drug-allergy, drug-formulary checks Capture data in coded format Maintain current problem list, medication and allergy lists Record vital signs (height, weight, BP), smoking status Incorporate lab/test results into EHR Document key patient characteristics Manage populations Generate list of patients by specific conditions (outpatient only) Improve Quality, Safety, Efficiency: 2011 Objectives

14. Report quality measures using HIT-enabled quality measures Inpatient: Stroke management, VTE prophylaxis, ED management Ambulatory Diabetic control (A1C) Hypertensives with BP under control LDL under control Smokers offered smoking cessation counseling Patients with recorded BMI Colorectal screening, Mammograms Pneumovax status, Annual flu vaccination Aspirin prophylaxis for patients at risk for cardiac event Avoidance of high risk medications in elderly Quality reports stratified by race, ethnicity, gender, insurance type Improve Quality, Safety, Efficiency: 2011 Measures

15. Provide patients with electronic copy of- or electronic access to- clinical information per patient preference Includes labs, problem list, medication list, allergies Provide access to patient-specific educational resources Provide clinical summaries for patients for each encounter Electronic access to personal health information Access to patient-specific educational resources Clinical summary provided at transitions of care (electronic or paper) Engage Patients and Families2011 Objectives

16. Exchange key clinical information among providers of care Perform medication reconciliation at relevant encounters Clinical summary provided at transitions of care (electronic or paper) Ability to exchange health information with external clinical entities Problems, labs, medication lists, care summaries Improve Care Coordination2011 Objectives

17. Submit electronic data to immunization registries where required and can be accepted Submit electronic reportable lab results to public health agencies Submit electronic syndrome surveillance data to public health agencies according to applicable law and practice Improve Population and Public Health: 2011 Objectives

18. Compliance with HIPAA rules and state laws Conduct or update security risk assessments and implement security updates as necessary Ensure Privacy and Security Protections: 2011 Objectives

19. Hypothetical 275 bed hospital