Universal Adoption of the EHR

What is Meaningful Use and why should it be important to me?

No, it’s not about HIT rulingthe world!

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The EHR Incentive Program

• American Recovery and Reinvestment Act (ARRA) of 2009

• Programs funded through existing Medicare and Medicaid (Medical) reimbursement mechanisms

• Must use certified EHR technology AND demonstrate meaningful use (adoption, implementation, and use) of such technology

Two Final Rules: July, 2010• Medicare and Medicaid Programs; Electronic

Health Record Incentive Program (CMS) -864pp– Requirements for an EP or hospital to achieve

Meaningful Use and qualify for incentive payments

• HIT: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology (ONC) -254pp– Requirements and standards for software to meet

to be a certified EHR– All MU requirements are predicated on the use

of a “Certified EHR Technology”.

Health IT and Transformed Health Care: Key Goals• Ultimate goal is to enable significant and measurable

improvements in population health through a transformed healthcare system

• Meaningful Use is using certified EHR technology to:– Improve quality, safety, efficiency, and

reduce health disparities– Engage patients & families in their health

care– Improve care coordination– Improve population and public health– All the while maintaining privacy and security

http://onc-chpl.force.com/ehrcert

Bending the Curve TowardsTransformed Health

“Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.”

“These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth”

Connecting for Health, Markle Foundation“Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009

Achieving Meaningful Use of Health Data

Achievable Vision for 2015

• Prevention, and management, of chronic diseases– A million heart attacks and strokes prevented– Heart disease no longer the leading cause of death in

the US• Medical errors

– 50% fewer preventable medication errors• Health disparities

– The racial/ ethnic gap in diabetes control halved• Care Coordination

– Preventable hospitalizations and re-admissions cut by 50%

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Achievable Vision for 2015

• Patients and families – All patients have access to their own health

information– Patient preferences for end of life care are

knowna and followed consistently• Public health

– All health departments have real-time situational awareness of outbreaks

– Immunization registries are on-line and updated to maximize full immunization and minimize unneeded immunizations

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Relationship to Health Reform and Affordability• Direct Cost Reductions

– Reduction in medication errors– Formulary adherence– Fewer redundant tests due to better information

• Information infrastructure for affordable expansions of health delivery– Clinical quality measurement (outcomes)– Care coordination (e.g., to reduce readmissions)– Reduction in inappropriate care– Expanding primary care capacity (e.g., non-visit-based care)– Prevention

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2009 2011 2013 2015

HIT-Enabled Health Reform

ARRA:HITECH 2011 Meaningful

Use Criteria (Capture/share

data)2013 Meaningful

Use Criteria(Advanced care processes with

decision support)

2015 Meaningful Use Criteria (Improved Outcomes)

HIT-Enabled Health ReformAchieving Meaningful Use

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• Empower electronic clinician order entry– Use electronic prescribing for permissible Rx– Implement drug-drug, drug-allergy, drug-formulary

checks

• Capture data in coded format– Maintain current problem list, medication and allergy

lists– Record vital signs (height, weight, BP), smoking status– Incorporate lab/test results into EHR– Document key patient characteristics

• Manage populations– Generate list of patients by specific conditions

(outpatient only)

Improve Quality, Safety, Efficiency: 2011 Objectives

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• Report quality measures using HIT-enabled quality measures– Inpatient:

• Stroke management, VTE prophylaxis, ED management– Ambulatory– Diabetic control (A1C)

• Hypertensives with BP under control• LDL under control• Smokers offered smoking cessation counseling• Patients with recorded BMI• Colorectal screening, Mammograms• Pneumovax status, Annual flu vaccination• Aspirin prophylaxis for patients at risk for cardiac event• Avoidance of high risk medications in elderly

• Quality reports stratified by race, ethnicity, gender, insurance type

Improve Quality, Safety, Efficiency: 2011 Measures

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• Provide patients with electronic copy of- or electronic access to- clinical information per patient preference – Includes labs, problem list, medication list, allergies

• Provide access to patient-specific educational resources

• Provide clinical summaries for patients for each encounter

• Electronic access to personal health information• Access to patient-specific educational resources• Clinical summary provided at transitions of care

(electronic or paper)

Engage Patients and Families2011 Objectives

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• Exchange key clinical information among providers of care

• Perform medication reconciliation at relevant encounters

• Clinical summary provided at transitions of care (electronic or paper)

• Ability to exchange health information with external clinical entities– Problems, labs, medication lists, care summaries

Improve Care Coordination2011 Objectives

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• Submit electronic data to immunization registries where required and can be accepted

• Submit electronic reportable lab results to public health agencies

• Submit electronic syndrome surveillance data to public health agencies according to applicable law and practice

Improve Population and Public Health: 2011 Objectives

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• Compliance with HIPAA rules and state laws

• Conduct or update security risk assessments and implement security updates as necessary

Ensure Privacy and Security Protections: 2011 Objectives

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Hypothetical 275 bed hospital