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Stimulus Plan
Nancy Koenig
President Merge Fusion
• Level Set HITECH Act and it’s Implications• Movements underway
– Electronic Ordering with Decision Support– Radiology Market Response to Meaningful Use– CCHIT Certification
• What to Expect
Now Is the Time to Act...
• Over $30B of direct adoption incentives for “meaningful use” of certified EHRs. • Specifically,$17.7B in Medicare incentives and $12.4 in Medicaid incentives. • Over $2B for infrastructure, health information exchange (HIE) and clinical research
funding
HITECH Act: What’s at Stake?
Source: Title VIII Health Information Technology Act 2009
• Decrease in Reimbursements in 2015
• Patient demographics, medical history, problem lists
Definition of an EHR...Who Can Disagree?
Source: Title VIII Health Information Technology Act 2009
• Capacity to provide decision support, physician order entry, capture/query info related to health quality
• Exchange health info with and integrate info from other systems
• Facilitated by the Office of the National Coordinator (ONC)
However, Devil is in the Meaningful Use Details
Source: Title VIII Health Information Technology Act 2009
Health Policy Priority Primary Elements
Improve quality, safety, efficiency and reduce health disparities
CPOE with decision support, proactive care management
Engage Patients and Families Patient access to results and electronic records
Improve Care Coordination Share electronic records amongst providers
Improve population and public health Share electronic records amongst public agencies
Ensure adequate privacy and security for personal health information
HIPPAA compliance
The only mention of Radiology is:
[Reduce] inappropriate use of imaging by 2013
69%
5%
26%
Met by standardRIS/PACS
Apply but not standardRIS/PACS
Do not apply
...as well as the CCHIT Certification Criteria
Ambulatory EHR
“We don't currently have a [Radiology subspecialty] program nor is it on our immediate development roadmap. However, if ONC and CMS include this capability in upcoming decisions relative to standards, certification criteria and meaningful use, it is likely that it will be developed as an optional add-on or a module in our Ambulatory or Inpatient programs at some time in the future.”
• RIS/PACS investments are not eligible for stimulus monies
• Inpatient or multi-specialty group imaging gain reimbursement advantage through funding
• Costly system re-implementation and practice optimization lost
• ….Meanwhile reimbursements dropping due to increased utilization requirements
May 2009: Outlook Not Good
...Meanwhile, the eOrdering Coalition is Formed
• Primary goal – To promote computerized physician order entry with decision support as
an alternative to RBMs
• Members – American College of Radiology– Center for Diagnostic Imaging– GE Healthcare– Merge Healthcare– Nuance Communications– Medicalis
• Chaired by Merge; Merge users taking active role
• Working closely with ACR
• Objective: Make the definition of Meaningful Use Meaningful
...and it’s spinoff: The Provider Roundtable
• CMS is proposing a demo of electronic ordering with decision support tools
Our Grassroots Movement is Taking Hold...
• Healthcare Reform Bills DO NOT include a requirement for RBMs
• Provider Roundtable completed a DRAFT meaningful use matrix for Radiology
• ONC invited ACR and eOrdering coalition to a private audience to discuss Meaningful Use
• Added a ‘modular’ option in September to accommodate mixed EHR environments
• Does not require full EHR Certification on all criteria
• Unclear what this means for attaining grant monies
Recent CCHIT movement opens the door to RIS/PACS...
Source: CCHIT Townhall September, 2009
Take Advantage of the Momentum
• Sign onto the Provider Roundtable
• Read the Meaningful Use Matrix; give your input
• Recruit your colleagues and your industry affiliations to get on board
• Lobby your congressional representatives
• Schedule a site visit to demonstrate your adoption of ‘EHR’, how it improves efficiency and patient care
Merge is Taking a Leadership Position
• Early participant in the eOrdering Coalition
• Chairing the Provider Roundtable
• Demo eOrdering and automated decision support at RSNA
• Pursuing CCHIT certification
Learn More
• http://www.imagingeconomics.com/listenup/regulatory_watch/20090629.asp
• http://www.healthcarefinancenews.com/news/coalition-aims-cut-billions-waste-imaging-tests
Thank You
For Questions and to Get Involved, please see Nancy
Electronic Decision Support, How it Works
• Provide immediate access to evidence-based clinical guidance in the ordering of imaging
• E-ordering avoids problems associated with RBMS
– Variations in service performance and standards– Time and cost involved in obtaining authorization– Ability to create an electronic record of the interaction– Can analyze the data for quality improvement
purposes– Is consistent with HIT goals, interoperability and
interconnectivity
Electronic Decision Support (continued)
• How it can be incorporated into proposed legislation mandating RBMs for Part B ordering physicians:
– Ordering physicians allowed to elect the option of consulting a decision support guidance tool in lieu of a RBM
– Can be done by embedding the tool in their electronic medical records (EMR) or, for smaller providers, by accessing the tool by phone or e-portal through another entity that offers the service
– Medicare Administrative Contractors (MACs), or CMS, would contract with electronic decision support providers for the provision of services to ordering physicians to determine the payment arrangement
State Initiatives – Electronic Decision Support
• Massachusetts General Hospital
• Minnesota
• Washington State
Massachusetts General Hospital
State Initiatives
• Minnesota
– Not legislatively originated
– Began with the Institute for Clinical Systems Improvement (ICSI) which is funded by health plans and run primarily by metropolitan hospitals
– Demonstration will address how to provide decision support services to all providers including those in rural and underserved areas at the time of ordering
– CMS is reviewing these efforts as it begins implementation of its demo authorized under Section 135(b) of MIPPA which directs CMS to evaluate the use of electronic decision support at the time Medicare Part B imaging services are ordered
State Initiatives• Washington State
– Legislatively mandated through HB 2105– Applies to advanced diagnostic imaging services (ADIS) – MRI,
CT, PET, cardiac nuclear medicine services– Establishes a work group to analyze and identify evidence-
based practice guidelines applicable to ADIS and any decision support tools
– By July 1, identify practice guidelines and decision support tools to be implemented by all state purchased health programs
– By September 1, all state health care programs shall implement evidence-based best practice guidelines and decision support tools
Questions – Ariel Gonzalez, Esq., MA, [email protected]; (703)
715-3488
– Liz Quam, [email protected]; (952) 525-6308
– Hugh Zettel, [email protected]; (262) 544-3848
– Mike Fisher, [email protected]; (519) 579-5454 x223
– Nancy Koenig, [email protected]; (414) 977-4264
– Scott Cowsill, [email protected]; (248) 4137856
