Implementation of Health Information Technology · 2016. 5. 4. · 3 | Implementation of Health Information Technology Role of IT in Accountable Care IT is essential to achieving

Pillsbury Winthrop Shaw Pittman LLP

Implementation of Health InformationTechnology

Gerry HinkleyCo-Chair, Health Care Industry TeamPillsbury Winthrop Shaw Pittman LLP

National Forum on Clinical IntegrationWashington, DC, November 15 - 17, 2010

2 | Implementation of Health Information Technology

Overview

Role of IT in Accountable Care

Implications for choosing and contracting with HIT vendors

Utilizing federal HIT incentive programs to buildan electronic system


Role of IT in Accountable Care

IT is essential to achieving clinical integrationCare coordination

at least 5,000 Medicare beneficiariesschedulingpatient monitoringreferrals

Data reportingQuality measuresPatient satisfaction

Implications for antitrust compliance

Significant challenge to limited resources for IT forPractice/hospital specific technologyHealth Information exchange


Implications for Choosing andContracting with HIT Providers

The once in a lifetime experienceFunctionalitySupport and maintenance

Approach to vendor selectionThe RFPMultiple finalists

The importance of the license and services agreement

Developing a working relationship


Vendor Selection – Basic EHR Functionality

Identify and maintain a patient record Manage patient demographics Manage problem lists Manage medication lists Manage patient history Manage clinical documents and notes Capture external clinical documents Present care plans, guidelines, and protocols Manage guidelines, protocols and patient-specific care plans Generate and record patient-specific instructions


Vendor Selection – Additional Functionality

Specialized templatesInteroperability

CPOEePrescribingHealth information exchange

Patient connectivityData reporting

Disease registriesPublic healthQuality data

Evidence based clinical practice guidelinesFormulariesReferral tracking


Vendor Selection – the Basics beyond Functionality

Project managementStaffing

Choice of who is on the vendor implementation teamClause for not soliciting the hiring of practice staff

TimingImplementation and payment milestones

Technical environmentPractice requirements for readinessHardware specifications



Training supportInitial training and on-goingIncluded in the maintenance agreement

Maintenance support24/7 help deskOn-site within 24 hours, if issue cannot be resolved remotelyFinancial remediation



UpdatesFixes to minor issuesCommitment to provide regular updatesIncluded in the maintenance fees

New releases

Errors and Lost FunctionalityCritical errorsRepair/replaceSubstitute software/equipment



Terminating maintenanceRequirements to return or destroy softwareTimeframes for notification

Application no longer supported

TaxesPhysical media versus electronic transmissionStrategies to mitigate


Vendor Selection – License and Services Agreement

Functional specificationsDocumentationAcceptance testingChange ordersProprietary rightsIs the vendor your HIPAA business associate?WarrantiesIndemnificationDamages, disclaimers and limitations on liabilityReciprocal obligationsSoftware escrow


Utilizing Federal HIT Incentive Programs to Build an Electronic System

Regional Extension Centers

Medicare/Medicaid Incentive Payments for EHR Adoption and “Meaningful Use”


Regional Extension Centers

The HITECH Act authorizes a Health Information Technology Extension Program

The extension program consists of Health Information Technology Regional Extension Centers (RECs) pursuant to 60 cooperative agreement awards and a national Health Information Technology Research Center (HITRC)

The HITRC will build a virtual community of shared learning to advance best practices that support providers’ adoption and meaningful use of EHRs

RECs will be fully operational by December 2010

$643 million ARRA funds for 2010 – 2012, $42 million thereafter

By December 2012, the RECs will be largely self-sustaining and their need for continued federal support in the remaining two years of the program will be minimal

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REC Charters

RECs willProvide training and support services to assist doctors and other providers in adopting EHRs Offer information and guidance to help with EHR implementation Give direct, individualized and on-site technical assistance in

Selecting a certified EHR product that offers best value for theproviders' needsAchieving effective implementation of a certified EHR productEnhancing clinical and administrative workflows to optimally leverage an EHR system's potential to improve quality and value of care, including patient experience as well as outcome of careObserving and complying with applicable legal, regulatory, professional and ethical requirements to protect the integrity, privacy and security of patients' health information

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What’s a REC to do? – EHR Implementer and Provider Education

Emphasis on Security – Brochures emphasizeUnderstand your areas of risk by doing a risk assessment, as required by HIPAATrain your staff on proper security techniquesDefine staff roles and responsibilitiesPhysically secure your portable computing and storage devicesSelect EHR vendors that provide certified EHR technologiesDevelop security policies that are simple, understandable and enforceable Know what you must do, under the law, to protect your patients’ information


Federal Incentives to Reward “meaningful use”

To receive the financial incentives, beginning in 2011, eligible professionals and hospitals must achieve “meaningful use” of a certified electronic health record (“EHR”)How do hospitals and eligible professionals qualify for incentive payments? How is “meaningful use” defined and what are its goals? July 13, 2010 – Final Rules:

CMS Final Rule on Meaningful UseONC Final Rule on Certification


Broad Goals for Meaningful Use

Vision: Enable significant and measurable improvements in population health through transformed health care delivery system

Goals: Improve quality, safety, efficiency, and reduce health disparitiesEngage patients and familiesImprove care coordinationEnsure adequate privacy and security protections for personal health informationImprove public health


Incentive Payments: Basic Details

Medicare and Medicaid incentives for hospitals and eligible professionals achieving “meaningful use” of EHR technology beginning as early as 2011

Three stages of implementation, tied to year of adoption.

Eligible professionals and hospitals must meet specific criteria

Report by attestation in 2010/2011For first year, must report for a 90 day consecutive period

Initial implementation timeline may have been to aggressive


Medicare Incentives for Eligible Professionals

Incentive payment for certain professionals for the “meaningful use” of a certified EHR“Eligible professionals” means all physicians participating in Medicare, except hospital-based physicians, and includes Medicare Advantage participating physicians as determined by HHS“Certified EHR Technology”Incentive payments equal to 75% of allowed charges for all Medicare covered services provided by a physician, not to exceed stated caps – payable to the physicianRural provider in a Health Professional Shortage Area (HPSA) will get an extra 10% of allowed charges


Medicare Incentives for Eligible Professionals

Source: HIMSS; IFR+NPRM; maximum incentive for Eligible Providers, Medicare (not Medicaid or underserved geographies)


Medicare Incentives for Hospitals

Incentives under the IPPS for hospitals participating in Medicare that demonstrate meaningful use of EHR

Formula for incentives: $2 million plus $200 multiplied by the number of discharges between 1,150 and 23,000 and multiplied by the hospital’s Medicare percentage, adjusted upward for charity care

Diminishing over a 4-year period


Medicare Incentives for Hospitals

Incentive payments calculation: ($2,000,000 + Discharge Amount) (Medicare Share) (Transition Percentage)Source: HIMSS


Incentives for Critical Access Hospitals

Incentive structure takes into account cost-based reimbursement for CAH

EHR incentive payments will be made to a CAH for a Medicare fiscal year equal to the product determined by multiplying:

Reasonable costs incurred for the purchase of Certified EHR Technology (including depreciation and interest expense), byThe lesser of the following: 100%; the Medicare share percentage plus 20 percentage points

CAH that is not a meaningful user by 2015 will have reimbursement cut for 2015, 2016, 2017


Medicaid Incentives

Eligible professionals: professionals not hospital-based with 30% Medicaid patients or 20% for pediatricians; or FQHC-based with 30% needy population; children’s hospitals; acute hospitals with 10% Medicaid load

Includes Physicians, Nurse Practitioners (NPs), Certified Nurse-Midwives (CNMs), Dentists, and Physician Assistants (PAs) who provide services in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is led by a PA

Professionals: 85% of allowable cost of certified EHR for up to 5 years (deducting amounts funded by other government sources) up to $25,000 for year 1 and $10,000 for years 2-5; starting no later than 2015 and ending by 2021; pediatricians get 66% of these amounts unless Medicaid share is 30% or moreHospitals: about half of EHR allowable amount times Medicaid share over 6 years; can receive both Medicare and Medicaid incentives


HITECH Definition of “Meaningful Use”

An eligible provider and an eligible hospital shall be considered a meaningful EHR user if they meet the following three requirements:

(1) demonstrates use of certified EHR technology in a meaningful manner;(2) EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care such as promoting care coordination; (3) using its certified EHR technology to submit to the Secretary, in a form and manner specified by the Secretary, information on clinical quality measures and other measures.


CMS Final Rule

Final Rule – July 13, 2010For STAGE ONE, meaningful use includes both a “core set” and a “menu set” of objectives. For eligible professionals, there are 25 meaningful use objectivesA total of 20 must be completed to qualify for an incentive payment15 of these are core objectives are required, and the remaining 5 may be chosen from a list of 10 menu set objectives


Core Set of Meaningful Use Objectives

From the core set of objectives, the following must be achieved:

Use CPOEImplement drug to drug and drug allergy interaction checksE-Prescribing (EP only)Record demographicsMaintain an up-to-date problem listMaintain active medication listMaintain active medication allergy listRecord and chart changes in vital signs


Core Set of Meaningful Use Objectives (continued)

Record smoking statusImplement one clinical decision support ruleReport quality measures as specified by the SecretaryElectronically exchange key clinical informationProvide patients with an electronic copy of their health informationProvide patients with an electronic copy of their discharge instructions (Eligible Hospital/CAH Only)Provide clinical summaries for patients for each office visit (EP Only)Protect electronic health information created or maintained by certified EHR

Each of the core objectives must be met unless a provider qualifies for an exclusion


Menu Set of Meaningful Use Objectives

Of the menu-set objectives, choose five with which to comply:Implement drug formulary checksRecord advanced directivesIncorporate lab results as structured dataGenerate lists of patients by conditionSend reminders to patients (EP only)Provide patients with timely electronic access (EPs only)Provide educational resourcesPerform medication reconciliationSummary care record for transfersSubmit electronic data to immunization registriesSubmit reportable lab results to public health (hospitals only)Submit electronic surveillance data to public health


ONC Final Rule – Certification

Standards, implementation specifications, and certification criteria for EHR technology

Physicians and hospitals must adopt and use to satisfy “meaningful use” standard

General criteria, criteria specific to ambulatory settings, criteria specific to inpatient settings

“Qualified EHR”

“EHR Module”

“Certified EHR Technology”


ONC Final Rule – Certification (continued)

Content exchange and vocabulary implementation specifications

Transport standards

Privacy and security standards

HIPAA electronic transactions and code set standards

Certification criteria and accounting of disclosures standards


Reporting and Payment

For 2011, CMS will accept provider attestations to demonstrate all the meaningful use measures, including clinical quality measures

Starting in 2012, CMS will continue attestation for most of the meaningful use objectives, but plans to initiate the electronic submission of the clinical quality measures

CMS expects to begin Medicare incentive payments nine months after publication of the final rule (which would be April of 2011)

States will support attestation initially and then subsequent electronic submission of clinical quality measures for Medicaid providers' demonstration of meaningful use

States are determining their own deadlines for launching their Medicaid EHR incentive programs, but are required to make timely payments

CMS expects that the majority of states will have launched their programs by the summer of 2011


Challenges Ahead

Program “voluntary,” so compliance with standards may be uneven

Meaningful use criteria will change over time

Rate of adoption – difficult to predict

Ultimate impact on expenditures for medical treatments (e.g., reducing errors, expedited treatment, etc.) unknown


Other Considerations

For eligible professionals: is effort worth the recompense?

“Hospital-based eligible professionals” definition

Minimum recompense for Critical Access Hospitals

Widening digital divide between early adopters and those without significant resources (e.g., rural hospitals)

Administratively burdensome to both providers and CMS


The purpose of this presentation is to inform and comment upon recent developments in health law. It is not intended, nor should it be used, as a substitute for specific legal advice – legal counsel may only be given in response to inquiries regarding particular situations.


Contact information

Gerry HinkleyPillsbury Winthrop Shaw Pittman LLP

50 Fremont StreetSan Francisco, CA 94105

Direct: (415) [email protected]

Documents

Implementation of Health Information Technology · 2016. 5. 4. · 3 | Implementation of Health Information Technology Role of IT in Accountable Care IT is essential to achieving