Connect eNews Winter 2014

LEVERAGING TECHNOLOGY— EMPOWERING PHYSICIANS

ISSUE 6, Winter 2014

Connect eNews

Gina Pistulka serves as Chief Nursing Officer of the Capital Clinical Integrated Network (CCIN), a multi-partner organization funded by a three-year Health Care Innovation grant, awarded in July 2012 and running through June 2015, of nearly $15 million from the Center for Medicare and Medicaid Services (CMS). The grant program is designed to support innovative healthcare projects in the District of Columbia to improve the health outcomes of recipients of Medicaid, help to navigate members to the most appropriate health service for their health issue and save money for the community.

Through a city-wide database, care teams, and telehealth, the CCIN project

communicates with its participants, develops care plans for them, and manages their care as they are transitioned into patient-centered medical homes. The projected savings to the community are estimated to be approximately $17 million, from reductions in duplicated services, fewer hospitalizations and lower transportation costs.

Dr. Pistulka previously headed operations, nursing, and health promotion activities at Mary’s Center for Maternal and Child Care, an organization that provides health care, family literacy and social services to underserved individuals and the primary applicant for the innovation grant. Founded in 1988, the Center offers high-quality, professional care in a safe environment to residents from the entire District metropolitan region, including individuals from over 110 countries.

Dr. Pistulka joined Mary’s Center in 2006, after earlier work in public health nursing in rural Minnesota, international health in Central America, and health education in an urban community health center in Minnesota. In 2001 she received a dual master’s degree in Public Health and Community Health

Welcome to ZaneNet Connect eNewsOnce again, welcome to the online newsletter of our ZaneNet community of healthcare providers and innovators who are leading the initiative to transform patient care through the use of Health Information Technology.

In this issue, we look for our Leader in HIT to the District of Columbia, featuring Dr. Gina Pistulka and the story of the Capital Clinical Integrated Network (CCIN), which she heads. Dr. Pistulka recounts the accomplishments and challenges of this innovative and collaborative venture.

Each issue features a Success Story, profiling a provider who has successfully initiated the meaningful use of electronic health records and qualified for incentive payments. Experiences vary, as do the size and needs of practices, and we can all learn from each other’s experience. In this issue we profile Dr. Yvette Weir, whose dental practice early on adopted electronic records and helped vendors learn to adapt to the specific requirements of specialists such as dental practitioners.

Be sure to check out the initiatives offered by ZaneNet Connect, supporting our community in utilizing new forms of organization that offer improved quality of care and new sources of savings in the rapidly evolving field of health care.

We welcome your feedback and any suggestions on how this newsletter can best serve all our community.

Leader in Health Information Technology: Gina Pistulka

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Success Story: Yvette Weir, DDS

Connect e-News is delighted to profile Dr. Yvette Weir, DDS, in the latest Success Story in our profiles of healthcare providers who have successfully transformed their practices by implementing electronic records.

Dr. Weir graduated from Howard University Dental School in 1992. After her general practice residency at Howard, she worked for the General Conference of Seventh Day Adventists at their Yaoundé clinic in Cameroun, West Africa. Since those early days, she has owned a practice in Rockville, in addition to managing practices in Fredrick and Gaithersburg.

An early adopter of electronic medical records, Dr. Weir found herself in the vanguard for dental practices, educating her EHR vendor in the expectations of dental offices. At a time when no certified system was yet available for dentists, she worked with DigiDMS to customize their system to her needs. Pursuing that goal required time and persistence, and she was eventually successful.

On a mentor’s recommendation, Dr. Weir contracted with ZaneNet Connect for its MSO services and learned about the

benefits achievable through the Federal incentive program. With the data available from a roster of predominantly Medicaid patients, her practice was clearly eligible for incentive payments. She recalls that the ZNC representative was there for her through the process, always responsive and professional.

As a participant in the first year of the Federal incentive program, she successfully attested to Meaningful Use and received the full incentive payment offered to providers serving Medicaid patients.

Overall, Dr. Weir is satisfied with her progress. Submitting data for the second round, she was pleased to find that the appropriate patient data had been captured and that the office’s familiarity with the system eased the attestation process. She looks forward to the time when patient information will be available through the HIE.

This past fall, as a member of the planning committee, Dr. Weir contributed to the success of the Second Annual Let’s Walk event, as part of Michelle Obama’s Let’s Move initiative. Her interest in the community led her to join other local

community members, including ZaneNet Connect, for a 3.5 mile walk highlighting the importance of exercise for the entire family.

Through its Encounter Notification System (ENS), CRISP is now offering a service, customizable by practice and free to any provider affiliated with a participating hospital, that enables physicians to receive real-time alerts when a patient is hospitalized. The service is offered in partnership with participating hospitals at no cost to ambulatory providers. For active patients in the practice, the CRISP ENS will send secure email messages to providers. Practices may choose which alerts are most relevant to them, such as hospital admission, hospital discharge, or emergency room visit. By coupling the ENS with the CRISP HIE portal, participating physicians will be able to

access relevant clinical documents to better coordinate care for their patients. The benefits of participating in ENS include real-time notification of patients’ hospital visits (admits, discharges, or ER) for active patients in the practice, proactive coordination of patient care and scheduling of follow-up treatment or visits, and review of medical records from patients’ hospital stay. In conjunction with the CRISP query portal, ENS notifications are delivered securely to providers via DIRECT email messaging. For more information on ZNC’s related services, please contact us.

New CRISP Service Offers Alerts

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Maryland Health IT NewsInnovative Health Care Delivery to Improve Cost, OutcomesOn January 10th, Governor O’Malley and Lt. Governor Brown joined Sen. Barbara Mikulski, Sen. Ben Cardin and senior officials from the Centers for Medicare and Medicaid Services (CMS) in announcing a new system of health care delivery for Maryland that could serve as a nationwide model. The new system, a five-year demonstration program authorized by the innovation office of HHS, will allow Maryland to set global budgets and other alternative approaches to payment that reward systems of care that provide improved outcomes at lower cost.

Support for this new model has come from a coalition of the hospitals, the insurance companies, the state and CMS. Later, in his State of the State address, the governor added, “Ten of our forty-six hospitals in Maryland have already adopted this new approach – partnering with nursing homes, public health agencies, primary care doctors, wellness professionals and others, to keep their communities well.”

To get HHS approval, officials promised to increase Medicare spending more slowly in Maryland than in the rest of the country over the next five years, generating $330 million in federal savings. Hospitals also agreed to sharply cut infections acquired inside the hospital and expensive readmissions of patients discharged up to a month earlier. The plan “will contain costs for Medicare and Maryland families, reduce readmissions faster than the rest of the country and see a dramatic decline in hospital-acquired conditions,” said Dr. Joshua Sharfstein, Maryland’s health secretary.

A key to cost savings is shifting hospitals from being paid per test or treatment — known as fee for service — to payment of fixed amounts to care for all the patients in their communities. Making hospitals accountable for patients’ health before they show up in the emergency room is intended to strengthen ties with community caregivers and deliver treatment more efficiently.

Maryland is the only state in the nation to operate an all-payer hospital rate-setting system, allowing all patients to pay the same rate for services at the state’s hospitals. “For nearly four decades, Maryland’s unique system has been a model for patient access, cost containment, and financial stability, providing more equitable payment levels among payers than anywhere else in the nation,” said Senator Cardin. “The revised Medicare waiver will allow us to continue our state’s commitment to increasing quality and reducing health care costs, while giving the federal government the opportunity to evaluate innovative approaches to reform.”

Photos by Jay Baker, Executive Office of the Governor. Healthcare Reform Initiative Announcement, January 2014. Photos used with permission.


ZaneNet Assists Mississippi ACO Medical Mall, Offers ACO ServicesZNC has contracted with Medical Mall Services of Jackson, Mississippi, to provide technical support for its Accountable Care Organization (ACO) work. Medical Mall is comprised of networks of individual ACO practices and a federally qualified health center, with 487 physicians. Operating in the counties of Coahoma, Hinds, Madison and Rankin, it will serve Medicare beneficiaries in the state. Through the Advance Payment ACO Model, selected participants will receive upfront and monthly payments, which they can use to make important investments in their care coordination infrastructure. The Advance Payment Model is designed for physician-based and rural providers who have come together voluntarily to give coordinated high-quality care to the Medicare patients they serve.

ZNC hopes to work to provide all its practices with the ACO education necessary to become an ACO participant, including educational material specific to the ACO measures, metrics for quality improvement, and workflow assessment to fully utilize and expand the use of the practice’s EHR. Onsite assistance is available under a separate agreement.

Nursing from Johns Hopkins University; in 2007, she received her PhD in Nursing, also from Johns Hopkins. She has conducted independent qualitative research and has assisted a large academic team in cross-cultural intervention research. In addition, Dr. Pistulka has served on boards to further nurse training through the Catholic University of America and the nonprofit Truth about Nursing.

In our interview, Dr. Pistulka spoke about how the CCIN project has been developed in the District and her vision for its future.

1. How did your work with Mary’s Center prepare you for the challenge of

leading a sizable partnership of Medicaid managed-care organizations (MCOs), community health centers, mental health providers, hospitals, and health technology specialists?

My years with Mary’s Center gave me perspective on the challenges faced by the District’s healthcare providers. I learned that the role of the Center and what it offers is vital to the community. The holistic and thoughtful approach of the Center to issues unique to its community offers positive experiences to patients not used to accessing the system with beneficial results.

Thinking about change in care delivery

requires operational systems at every entity to meet systematic standards that require real change. Down the road, more patients will enter the system, people in need of assistance. We are aligning ourselves with what’s happening in the District.

2. The project employs care teams led by registered nurses and staffed by community health workers (CHWs), who are frontline public health workers with a close understanding of the community they serve. Please describe how these teams are intended to operate to improve health outcomes.

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PQRS Guidance Added for ProvidersZNC is offering assistance to eligible professionals to guide them through reporting to the CMS Physician Quality Reporting System (PQRS). The basic PQRS education consists of educational material and access to webinars specific to the CMS. Interested providers should give us a call at 301-830-7799.


ZaneNet Connect: Ongoing Support for Practices ZaneNet Connect is a certified Management Service Organization (MSO) under CRISP, the Regional Extension Center (REC) for Maryland as designated by the Office of the National Coordinator (ONC). As an organization, we have assisted over 120 primary care providers to achieve Meaningful Use, attest to CMS/DHMH and receive their federal incentive funds.

Our goal is to assist our diverse membership to leverage appropriate health IT tools and programs to support practice growth and innovation.

Member Benefits • Receive EHR Readiness Assessment and

Implementation assistance to include: Assessment of your practice, EHR System Selection Consulting and Workflow Analysis and Guidance.

•WecanhelpyouandyourofficestaffwithMeaningful Use Attestation to include: Meaningful Use Support for Stage One and Stage Two, Registration and Compliance Assistance, Meaningful Use Education, Gap Analysis and Meaningful Use Dashboard Review, Attestation Assistance, Privacy and Security Risk Review and CMS Audit Preparation.

•Ourcertifiedstaffcanprovideguidance to practices participating in value-based care delivery and payment models, such as Accountable Care Organizations and Patient Centered Medical Homes.

•Wehavedata analytic and reporting capabilities to support evaluation of National Quality Forum measures within a practice’s electronic health record system to report PQRS and other similar measures.

•WecanassistpracticestoleverageCRISP, the state’s health information exchange, to obtain critical patient data from hospitals to include: Secure Direct Messaging Support and Encounter Notification System Enrollment and Utilization Assistance.

JOIN US!Join online at www.zanenetconnect.com

Or call 301-830-7799

Email us at: [email protected]

ZaneNet Connect MSO Membership

In the evolving world of medicine, Health IT is critical in the delivery of health care services. We see dramatic transformation in the delivery of health care with the use of technology — making it safer, more effective and more efficient. ZaneNet Connect’s role is to help you maximize your health IT investments based on the goals and needs of your practice.

ZNC is moving to a fee-based membership model that offers our participating providers a convenient and simplified way to continue working with us after attesting to Stage 1 of Meaningful Use, when our free services end. Providers are invited to join us at that point as paying members. Paying membership is open to all Primary Care and Specialist Providers that wish to access the consultative services, products, and other benefits associated with ZNC membership. Discounted services, such as continued Meaningful Use support, Accredited CMS Data Registry Services, Group Purchasing, Physician HIE Services, Privacy and Security Analysis and Remediation Plans, Direct Secured Email Services, Patient Centered Medical Home (PCMH) Training and Accreditation, Accountable Care Organization (ACO) Assistance, and other services will be available.

For more information and to view the full membership agreement, interested providers may contact us at 301-830-7799.

ZNC Initiates Membership Model


Federal Health IT NewsHHS Names Karen DeSalvo the New Head of ONCIn December, Dr. Karen DeSalvo became the National Coordinator heading the Office of the National Coordinator for Health Information Technology (ONC), according to a staff announcement made by Department of Health & Human Services (HHS) Secretary Kathleen Sebelius. “Dr. DeSalvo’s hands-on experience with health delivery system reform and health IT and its potential to improve healthcare and public health will be invaluable assets to the Office of the National Coordinator and the department,” wrote HHS Secretary Kathleen Sebelius, in announcing the appointment.

As the City of New Orleans Health Commissioner and senior health policy advisor to New Orleans Mayor Mitch Landrieu, Dr. DeSalvo spearheaded efforts to modernize the New Orleans healthcare system, including leading health IT-focused projects to augment the city’s neighborhood-based medical homes to improve access to care for underserved populations and overseeing the construction of the city’s newest hospital, which will feature a fully integrated health IT network. Dr. DeSalvo is a graduate of Suffolk University, Tulane Schools of Medicine and Public Health, and the Harvard School of Public Health. She began her new position on January 13.

Located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS), ONC is the principal federal entity charged with coordinating the nationwide efforts to implement advanced health information technology and the electronic exchange of health information.

Patient Matching Recommendations from ONC Draft Report On December 16, 2013, the Office of the National Coordinator for Health Information Technology (ONC) released its draft report on patient matching challenges and best practices. The report considered current practices and delivered eight recommendations for actions that would improve patient matching. The report drew from interviews with more than 50 large health systems and health IT software developers. The recommendations are as follows:

1. Require standardized patient identifying attributes.

2. Introduce certification criteria requiring certified EHR technology to capture standardized patient identifying attributes.

3. Study the ability of additional, non-traditional data attributes to improve patient matching.

4. Develop or support an open source algorithm for vendors to use in building or testing the accuracy of patient matching algorithms.

5. Introduce certification requiring certified EHR technology to perform patient matching and generate potential duplicate patient records reports.

6. Convene industry stakeholders to consider a more formal structure for establishing best practices for the matching process and data governance.

7. Develop best practices and policies to encourage consumers to keep their information current and accurate.

Risk of HIPAA violations posed by Microsoft changeAs of April 8, 2014, Microsoft will no longer support the Windows XP operating system, including its security functions. This means that storing and transmitting personal health information (PHI) using Windows XP will become a HIPAA violation after that date. Computers running on Windows XP will require an upgrade to Windows 7 or Windows 8, which may require hardware updates as well. Healthcare providers should contact their IT provider or ZaneNet Connect for technical assistance.


In a December press release, HIMSS announced that the organization will collaborate with the U.S. Department of Health and Human Services (HHS) to move forward on the creation of a nationwide patient data matching strategy.

Through the HHS “Innovator in Residence” (IIR) program, HIMSS will recruit an IIR to develop a vision, strategy, and implementation plan for the near-term deployment of consistent patient data matching in health, drawing on the work of the Office of the National Coordinator for Health IT (ONC) and healthcare community partners. The IIR will also assess the longer-term applicability of identity management methods, processes and technologies currently in use in healthcare and other sectors.

“To improve the quality and safety of patient care, we must develop a nationwide strategy to match the right patient to the right record every time,” said Lisa Gallagher, HIMSS Vice President of Technology Solutions. “The IIR will create a framework for innovative technology and policy solutions to help provide consistent matching of patient health records and patient

identification. We look forward to collaborating with HHS to find the optimal candidate for this opportunity.”

HIMSS is one of several groups participating in an ONC Patient Data Matching Initiative announced in September. The project’s recommendations provide insight into identifying the common attributes that achieve high positive match rates across disparate systems, and begin defining the processes and best practices that are most effective to support high positive patient matching rates utilizing the common attributes, according to the release.

The Innovator in Residence will work with stakeholders in business, research, healthcare organizations, consumers/patient organizations, technology vendors and others with an interest in positively transforming the healthcare system in America. Candidates with experience in innovative approaches to health information technology development and project management are invited to apply to join HIMSS and HHS in this opportunity to positively impact healthcare in America. Interested parties may visit the HIMSS website for more information on the responsibilities and required qualifications.

HHS & HIMSS Collaborate on Patient Identification and Data Matching

In a January ruling, the Federal Trade Commission determined that it has the authority to take action against HIPAA-covered entities in issues of data security. The commission denied a request from LabMD, a medical testing laboratory, to dismiss an FTC suit against it alleging that a data breach was the result of LabMD’s “failure to employ reasonable and appropriate measures to prevent unauthorized access to personal information,” an unfair act or practice under Section 5 of the FTC Act.

The laboratory had argued that by enacting HIPAA, Congress implicitly stripped the FTC of its ability to enforce data security requirements at covered entities and had given that power to HHS. However, in a 4-0 vote, the FTC rejected LabMD’s claims, asserting the FTC’s enforcement authority does not conflict with that of HHS in the area of data security.

“The patient-information protection requirements of HIPAA are largely consistent with the data security duties that the Commission has enforced pursuant to the FTC Act,” the

commission stated, noting that the FTC and the HHS “have worked together ‘to coordinate enforcement actions for violations that implicate both HIPAA and the FTC Act’” and that “the two agencies have obtained favorable results by jointly investigating the data security practices of companies that may have violated” both laws.

The FTC and HHS announced joint enforcement actions resulting in large fines against national drug store chains Rite Aid in July 2010 and CVS Caremark Corp. in February 2009.

“LabMD and other companies may well be obligated to ensure their data security practices comply with both HIPAA and the FTC Act. But so long as the requirements of those statutes do not conflict with one another, a party cannot plausibly assert that, because it complies with one of these laws, it is free to violate the other,” the commission said.

HIPAA-Covered Entities Subject to FTC Data Security Enforcement Action


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The target population is Medicaid and Alliance clients. The staff is drawn from the local area; we look for people who are cultural brokers who can help to translate what we are doing and know how to work in the medical home structure with the care teams. RN Care Coordinators support clinical issues, such as medication reconciliations, and bring a public health theoretical perspective to the program, i.e., how to approach care in the community. The community health worker (CHW) program aims at helping patients prioritize their own health. CHWs work within their scope to provide education in healthy habits, identify barriers, and help set up reminders for participants’ self-management and coach to promote engagement in their own care. Participants may need assistance to get to primary care and to take their meds; CHWs can accompany them on visits to providers.

The technology will allow linkages between the primary care teams’ medical records and the CCIN care coordination systems. Care teams know that in supervising and when working in the community, being able to help is simpler when the supportive technology provides coordination and communication.

3. CCIN’s partners include AmeriHealth DC, Trusted, DC Healthcare Finance, DC Primary Care Association, La Clínica del Pueblo, Mary’s Center, Providence Hospital, So Others May Eat, Unity Health Care, and Children’s National Medical Center. How do these diverse partners cooperate to create a patient care model that will improve healthcare delivery and outcomes and deliver shared savings?

Our clinics are committed to the vision, to the future of healthcare, and to being part of the change. We are inclusive and work to build on current infrastructures. We are not looking to duplicate services among the different entities. Rather, we spread out

our resources to achieve shared goals for the District.

4. Among its goals, the project seeks to improve health care delivery by employing both high-touch (CHWs) and high-tech (data-sharing and telemedicine technology). Do the front-line workers feel empowered by technological innovation? In what other aspects does technological innovation play a role?

High touch is vital for the relationships you build. The CHW-nurse model is proving effective, and we hear from them how things have changed for the better. The partnership offers an opportunity for providers and care teams in clinics and hospitals to understand what’s happening to their patients. That’s a very enticing thing for clinicians in ambulatory care settings.

Technology is changing to support new models in the healthcare delivery world, which means that systems must change. We want flexible processes on the technology side, in order not to have to alter work flow too much.

Software allows us to schedule assignments of participants to CHWs, track outreach, create goals and objectives that are participant focused, and collect data from surveys and tools that allow care teams to flag issues related to patient satisfaction and needs. To allow movement throughout the community, tablets and cell phones are supplied to the care workers, although internet coverage is spotty. They carry jetpacks to help patients monitor vitals such as blood sugar level. We are moving away from paper.

In some areas, we’ve identified Maryland policies that have been in use that we would like to apply in the District. The Chesapeake Regional Information System for our Patients (CRISP), Maryland’s state-designated health information exchange that electronically connects healthcare providers across the region, will

be adopted in the District.

5. From the vantage point of just over a year of operation, what do you now see as crucial to the success of the project?

Continued partnership is vital: marketing to potential participants and the community and working closely with our subscribers, such as clinicians, nurses, and care teams to identify people who might benefit. We also need to be able to measure outcomes, both short-term and long-term changes, on an on-going basis; monitoring that data, both cost and medical, will give insight into the effects that we are having on health and costs related to utilization of the health care system.

Continued parameters in a strong network allow us to measure our model as we work. The innovation grant allows us to alter things like protocols and processes as necessary as feedback indicates. We have already learned a lot that will be helpful to the wider community.

Documents

Connect eNews Winter 2014