Minimizing Surprise in Meaningful Use: Moving from Stage 1 to Stage 2

1. Minimizing Surprise in Meaningful Use: Moving from Stage 1 to Stage 2 September 17, 2014 Alysen Ficklin, RN, BHA - Clinical Consultant Supporting the Healthcare Foundations of Our Communities Excellence  |  Trust  |  Community Form No. 0074-0914

2. Speaker Alysen Ficklin, RN, BHAWide River Clinical Consultant Alysen has a number of years of experience in healthcare, she brings the background of an active floor nurse paired with advanced education in healthcare administration.  She has experience with implementation and strategic planning of comprehensive patient portal solutions, including direct messaging, billing and mobile app components.  Alysen excels at clinician engagement and change acceleration, using her personal strengths to facilitate excitement and excellence in the field of patient care.

3. Objectives • Stage 1 Groundwork • Leveraging earlier work • Stage 2 General Challenges • Timeline • Upgrade Costs • Ongoing Staff Education • CMS Audits • Stage 2 Measurement Challenges • Patient Engagement • Transitions of Care • Clinical Decision Support • Clinical Quality Measures • Public Health Reporting • Keys to Success • Physician Engagement – How to secure it • Meaningful Use Team – Who to invite to the table • Portal Strategies – How to engage your patients

4. Stage One Where We Have Been

5. Stage 1 Groundwork • Stage 1 is the foundation on which to build • “Can you put data into the system?” • We are documenting the basics of good care • Focus was on adoption and creation of workflows • Re-evaluate workflows for Stage 2 • Not all workflows will require re-writes, but evaluating them all will prevent surprises after the start of the reporting period • Do your policies reflect the approved workflows? • Remember “Lessons Learned” when informing staff • How did they feel about training at GoLive? • Can you improve on it? • Do you have a culture of change acceptance?

6. Stage Two Facing the General Challenges

7. Stage 2 Challenges • Upgrade Costs • 2014 Certification is required to report on Stage 2 • CMS recently finalized the proposed rule – vendor delays have clearly been an issue • Many sites did a full rip/replace in 2014 • Ongoing Staff Education • The nature of frequent upgrades means staff have to be flexible and willing to accept change • Communication • CMS Audits • Can happen up to 6 years after attestation • Site may be on a new version • CMS can reclaim past incentive payments with interest in the case of a failed audit

8. Timeline – Reporting Periods

9. Stage Two Problem Measures

10. Transitions of Care • CMS Defines: • Transition of Care – The movement of a patient from one setting of care (hospital, ambulatory PCP, ambulatory specialty, long term care, home health, rehab) to another. • For EH: At a minimum this includes all discharges from the inpatient department and ED when follow-up care is ordered. • For EP: At a minimum this includes all referrals ordered by the EP, including direct admits to inpatient and instructions to go to the ED. • What about Swing Beds? • Inpatient – PoS 21 • ED – PoS 23 • Swing – PoS 30/31

11. Summary of Care Record • Summary of Care record is how providers communicate vital information with each other about the care of a patient. • CMS says the summary of care record must include the following elements: • Patient name • Referring or transitioning provider's name and office contact information (EP only) • Procedures • Encounter diagnoses • Immunizations • Laboratory test results • Vital signs (height, weight, blood pressure, BMI) • Smoking status • Functional status, including activities of daily living, cognitive and disability status

12. Elements, Continued • Demographic information (preferred language, sex, race, ethnicity, date of birth) • Care plan field, including goals and instructions • Care team including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider • Reason for referral • Current problem list (EPs and hospitals may also include historical problems at their discretion) • Current medication list • Current medication allergy list

13. Summary of Care – EP/EH

14. Medication Reconciliation • CMS defines Med Rec: • The process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital or other provider.

15. Patient Portals • The Patient Portal is how providers communicate vital information with their patients • 2014 Certified System needed • Prior to 2014 – Only needed to provide an “electronic copy” of the patient’s health record, and even that was only “on request” • Prior to 2014 – Menu measure • Patient Portal = Patient Engagement • Engaged patients are more involved and typically more satisfied with their care • Explaining the value of portal use to a patient requires an “elevator speech”

16. Portal Requirements • CMS states the following information must be available to the patient via the portal: • Patient name • Admit/Discharge date and location (EH) • Provider’s name and office contact information (EP) • Reason for hospitalization (EH) • Care team • Procedures performed • Current and past problem list • Current med list and med history • Current med allergy list and allergy history

17. Portal Info Continued • Vital signs at discharge (EH) • Vital signs including height, weight, BP, BMI and growth charts (EP) • Lab test results • Summary of Care record for transitions of care or referrals to another provider • Care plan fields, including goals and instructions • Discharge instructions for patient (EH) • Demographics • Smoking status

18. Patient Electronic Access • CMS Defines “Access” • When a patient possesses all of the necessary information needed to view, download or transmit their information.

19. EP – Clinical Summary The EH/CAH will typically use the Summary of Care record as their discharge summary, but the EP has a separate measure for this List of minimum elements required for the EP clinical summary

20. EP – Use Secure Electronic Messaging

21. Clinical Decision Support • CMS defines Decision Support • HIT functionality that builds upon the foundation of an EHR to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.

22. Using CDS to Improve Quality • Encourage technology use as a tool • Identify patients at risk at point of care • What do your providers want to know about their patient populations? • Decision support tracking • What can alert triggers tell us about our patient populations? • Beware of “Popup Fatigue” • Define tools that make sense for you • Evidence-based, MU, Quality • Consider your patient population • Tracking improvement in population health for the community • Public Health Reporting

23. Public Health Reporting Register with DHHS DHHS staff will then contact you to work through the onboarding and testing process – helping you create a connection from your EHR to their registries.

24. Other Objective Changes • Many other measures also see significant changes, either in percentages or details/definitions. • CPOE – adds lab and radiology orders while increasing the medication percentage • Demographics – increased to 80% • Problem List – CDA/Visit Summary • Medication List – CDA/Visit Summary • Vital Signs – increased to 80% and some detail changes

25. Clinical Quality Measures CMS offers 29 different clinical quality measures for EH and 64 for EP Select based on your practice and patient population for attestation as well as need to participate in IQR/OQR or PQRS

26. MU Leadership Strategies for Success

27. Generating Success:Your MU Team • Experts at the table • EHR staff - informatics/IT • Physician leadership • Nurse leadership • Pharmacy leadership • Other voices, depending on workflow/measure • Meet weekly or bi-weekly, depending • Evaluate MU numbers • Brainstorm tactics/strategies for improvement

28. Generating Success:Physician Engagement • Physician/Provider Champion of the EHR • Does your organization have one? • Are they allocated hours to work on MU or other changes? • Did you have provider input during the EHR selection process? • Areas to gain engagement: • Patient portal – problem list • Clinical Decision Support • Clinical Quality Measures • ICD-10 and SNOMED

29. Generating Success: Portal Strategies • Strong Leadership • Select a “portal champion” • Do you need a separate team? • Compare document requirements • EP Clinical summary vs. portal elements • EH Summary of care record vs. portal elements • Minimize duplication and simplify workflows where possible • Engage the Patient • Marketing the portal • Help them login and view, download or transmit • Test messages • Determine workflows for proxy access • Parents and guardians of minors • Children of elderly patients/POA

30. Audits • Any EP or EH (including the CAHs) who have attested to receive an incentive payment for either the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program may be subject to an audit. • When can audits happen? • The contractors can audit a given attestation up to 6 years after incentive payment was made. • What happens if I fail? • In a failed audit, CMS will require full repayment of incentives, plus interest within 30 days.

31. How to Fail an Audit • Mistakes we’ve seen: • MU is one person’s responsibility. • Waiting until an audit letter is received to generate supporting documentation. • Change of EHR Vendors. • The belief that small clinics and systems are not audited. • Ignoring the details of the yes/no measures. • Waiting too long to ask for help.

32. Questions?

33. Wide River offers the following services: • Meaningful Use Assistance • Onsite Consulting • Audit Preparation • Expert Help Desk • Regulatory and Quality Improvement Consulting • Clinical Workflow Redesign • Project Management Services • Informatics Training / Mentoring • Contract Staffing • EHR Rip-and-Replace Assessments • EHR Customization, Optimization and Training Excellence  |  Trust  |  Community At Wide River, everything begins and ends with the pursuit of Excellence.  When we earn our clients' Trustwe build strong, mutually beneficial relationships that enable our healthcare Communities to thrive.

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