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Taking the HITECH Ground –Understanding Meaningful Use, Health Information
Exchange and the Future of Lab Outreach
Rob AtlasCEO & President
andBob Gregory
SVP, Corporate Strategy
April 27, 2010
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Tsunami Warning!
You’re about to lose control. Control of:
• Your relationships with your physician customers• Clean Orders• Accurate Billing• Profits
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Calm Seas
In the past, labs offered IT solutions to:
• Reduce errors
• Improve service
• Ensure accurate billing
• Strengthen traditional consultative relationship
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Business RulesLab specific workflow
Electronic HIS registration
Payer directed testing
Departmental driven requisitions
Flow through accessioning
Site customizablemanifests
Billing RulesMedical necessity
verification
Payer specific requirements
Insurance & relationship cross referencing
Unapproved insurances
Required/optional fields
Field pattern matching
Clinical RulesDuplicate order
checking
Cascading AOE Questions
Reflex testing
Unsolicited results
Business, Billing & Clinical Rules
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Dangerous Swells
With introduction of EMRs:
• Point-to-point interfaces
• “Dirty” orders
• Decreased efficiencies
• Reduced lab branding
• Jeopardized physician relationships – loss of control
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EMR Weaknesses/Complexities:• Accept unsolicited results?• Need an EMR order number, or Patient ID?• EMR’s test and result codes mapped correctly with the lab’s
codes? Is the mapping up-to-date?• “Ask at Order Entry” questions?• Specimen Requirements?• Medical Necessity Verification?• Office-based versus Internet-based?• Images in reports? PDFs?• Support for partials and finals?• Discrete Micro?• Split requisitions?• Payer Plan-driven routing?• Exception handling?• Costs?
EMR Integration – Challenges
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www.seedie.org
“…SEEDIE recognizes that data exchange should only occur after a lengthy and
expensive custom integration process.”
“…SEEDIE promotes healthcare IT systems that
play well in the sandbox if, and only if, it is in the best interests
of a particular vendor.”
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A Perfect Storm
Accelerated EMR/EHR adoption
• Increase in physicians purchasing solutions from vendors
• Growing importance of HIEs
• Clouds, portals, and other emerging business models
• Health System/Enterprise decisions
Driven by ARRA HITECH, “Meaningful Use” and theevolution of the connected care paradigm
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The background…
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HITECH Act Definition of “Meaningful Use”
In Sections 1848(o)(2)(A) and 1886(n)(3) of the Act, the Congress specified three types of requirements for meaningful use:
(1) Use of certified EHR technology in a meaningful manner (for example, electronic prescribing);
(2) the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and
(3) that, in using certified EHR technology, the provider submits tothe Secretary information on clinical quality measures and such other measures selected by the Secretary.
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Meaningful Use – What and How
• Electronic Health Record (EHR) systems will qualify physicians for between $44,000 and $64,000 in Medicare and Medicaid incentive payments under the American Recovery and Reinvestment Act (ARRA).
• Physicians must demonstrate their “meaningful use” of an EHR before they can claim the stimulus incentives, which first become available in 2011. – 25 Stage 1 Objectives (Ambulatory / Eligible Professionals) – $30,000 of the incentives can be earned in the first two years– Incentives disappear after 2016
• Providers can combine functionality from disparate systems with integration (interfaces) to achieve certification
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Meaningful Use – Stage 1 Objectives
• CPOE• Drug-Drug, Drug-Allergy, Drug
Formulary Checks• Maintain problem list of current and
active diagnoses (ICD-9 / SNOMED CT)
• ePrescribe• Active medication list• Active medication allergy list• Record demographics• Record/Chart Vital Signs• Record smoking status (ages 13+)• Incorporate clinical lab test results
into EHR as structured• Generate list of patients by condition • Report ambulatory quality measures• Send patient reminders for preventive
care• Implement clinical decision support
rules
• Insurance Eligibility• Submit electronic claims • Provide patient with electronic copy of
health info• Provide patients with electronic
access to their health information• Clinical summaries• Exchange key clinical information
amongst providers• Medical reconciliation• Submit electronic data to
immunization registries• Syndromic surveillance data to public
health agencies• Electronic submission of reportable
lab results to public health agencies• Protect electronic health information
created or maintained by certified EHR technology
25!
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Meaningful Use – Objectives
• Three stages of the criteria reporting requirements– Stage 1 2011 and 2012– Stage 2 2013 and 2014– Stage 3 2015
• Stage 1 requirements are always applied to the physician’s first year of MU, regardless of when they start.
• Physicians will want to act soon! Early adopters can qualify for greater financial incentives.
• Approximately 95% of all eligible professionals will participate in the federal incentive program (CMS)
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HIE – Wikipedia Definition
Health information exchange (HIE) is defined as the mobilization of healthcare information electronically across organizations within a region, community or hospital system.
HIE provides the capability to electronically move clinical information among disparate healthcare information systems while maintaining the meaning of the information being exchanged.
The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.
HIE is also useful to Public Health authorities to assist in analyses of the health of the population.
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HIE Models
• State-wide/Local Community-based
• Health System Sponsored
• Physician-driven (Medical Home)
Source: eHealth Initiative (eHI) 2009 edition of the Sixth Annual Survey of Health Information Exchange
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HIE Statistics
• Federal government is projected to spend at least $300 million in support of HIE activities in 2009 and 2010
• 193 active HIE initiatives in the country (150 of which responded to the survey)
• 40% increase in HIE initiatives - from 42 in 2008 to 57 in 2009
Source: eHealth Initiative (eHI) 2009 edition of the Sixth Annual Survey of Health Information Exchange
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HIE Statistics – Nationwide
Source: eHealth Initiative (eHI) 2009 edition of the Sixth Annual Survey of Health Information Exchange
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HIE Data Exchange – Utilization
Increase in Type of Data Exchanged
26 25 23 23 27
49
48
45 43 39 36
Laboratory Medication Outpatient Lab OutpatientEpisodes
Radiology Emergency DeptEpisodes
Data
# H
IEs
20092008
Source: eHealth Initiative (eHI) 2009 edition of the Sixth Annual Survey of Health Information Exchange
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Stakeholder Organizations
Source: eHealth Initiative (eHI) 2009 edition of the Sixth Annual Survey of Health Information Exchange
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“Currently, the HIE service vendor landscape is
undergoing an evolution in an attempt to meet
market demands including offering robust electronic
health record (EHR), ‘EHR lite’ systems, and
practice management services as part of their HIE
functionality.”
HIE Evolution
Source: HIE Implications in Meaningful Use Stage 1 Requirements, HIMSS Health Information Exchange Steering Committee, March 2010
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Labs Face an Intermediated Future • A dramatic increase in order volume coming from
systems you do not control
• Potential competitive “land grab”
• Loss of $$$
Tsunami Warning!
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Treading Water – Options for the Lab
Offer a complete MU solution from the Lab, with a Partner, or through Referral Relationship(s)
Interface to EMRs/EHRsSponsor or become a stakeholder in HIE(s)
Drive the lab’s agenda at the enterprise level
A B C
FORWARD-LOOKING LABS WILL WANT TO EMPLOY MULTIPLE STRATEGIES TO FACE THE CHALLENGES AHEAD
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Offer a complete MU solution:
• Through Partnership with an EMR/EHR vendor
• Through referral relationships with one or more vendors
• Can be a single solution or menu of best-of-breed capabilities
If you have an existing “Clean Orders” strategy, leverage it.
Option A - Control the Intermediary
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• Identify HIE activities in the community including: – State Initiatives– Hospital and Health Systems– Medical Homes
• Become a sponsor or stakeholder (not just a data provider)
• Drive the selection process to ensure robust CPOE for lab ordering
Option B - Influence the Intermediary
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Interface with a plethora of disparate systems.
Either:• Point-to-point (e.g., EMR/EHR to LIS)
• Manual processes to manage variability in quality and format of requisitions and labels
• Manual processes to maintain accurate billing
• Manual processes to deal with inevitable customer service problems
Or:• Use IT solution to orchestrate workflow and dataflow across
disparate systems
Option C – Coexist with the Intermediary
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Orchestrated Workflow and Dataflow
Lab to EMR
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“Must Do”
• Build the business case– Assess the impact of intermediated orders on your
organization’s efficiency and bottom line
• Educate your sales force on the potential impact– Start gathering business intelligence on your market – Ensure your team can engage the customer
• Be aggressive– Pursue multiple strategies– Assume you will need “Option C” (effectively process orders
from a large number of foreign systems)
• Drive a “Clean Orders” strategy– If you have one, use it; if you don’t have one, get one.
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“Must Avoid”
• Complacency – disruptive forces are at work
• Being marginalized - brand and relationships at stake
• “Betting” your business on one approach –remain open and flexible
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Thank You.
For more information, please contact Atlas Medical at:
Phone: 800.333.0070
Email: [email protected]
Web: www.AtlasMedical.com
