Transcript Slide 1

Mapping EMRAM and the
Ambulatory EMR Adoption Model
to Meaningful Use Criteria
September 9, 2009
Mike Davis
 2009 HIMSS Analytics
Overview
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The majority of “meaningful use” functions identified to this point in time for
2011measures require Stage 4 of the EMR Adoption ModelSM (EMRAM)
and Stage 3 of the Ambulatory EMR Model.
HIMSS Analytics believes that Stage 3 of the EMRAM and ambulatory EMR
model should be focused on as a minimum for meeting the majority of 2011
measures for hospitals.
HIMSS Analytics believes that Stage 6 of the EMRAM and Stage 4 of the
ambulatory EMR model should be accomplished by hospitals and clinics to
meet the majority of the 2013 measures.
HIMSS Analytics believes that Stage 6 and higher for the EMRAM and
Stage 5 of the ambulatory EMR model will need to be implemented by
hospitals and clinics to address the 2015 measures.
HIMSS Analytics believes that nursing applications (Stage 3 - flow sheets,
care plans, and eMAR) should be implemented before CPOE in hospitals.
 2009 HIMSS Analytics
Health Outcomes Policy Priority
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Improve quality, safety, efficiency, and reduce health disparities :
– Provide access to comprehensive patient health data for patient’s healthcare
team
– Use evidence-based order sets and CPOE
– Apply clinical decision support at the point of care
– Generate lists of patients who need care and use them to reach out to patients
(e.g., reminders, care instructions, etc)
– Report to patient registries for quality improvement, public reporting, etc
Engage Patients and Families
– Provide patients and families with timely access to data, knowledge, and tools to
make informed decisions and to manage their health
Improve Care Coordination
– Exchange meaningful information among professional healthcare teams
Improve Population and Public Health
– Communicate with public health agencies
Ensure Adequate Privacy and Security Protection for Personal Health Information
– Ensure privacy and security protection for confidential information through
operating policies, procedures, technologies, and compliance with applicable law
– Provide transparency of data sharing to patient
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2011 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions:
• Providers
– Use CPOE for all order types including medications [OP, IP]
(Ambulatory EMR Stage 2)
– Implement drug-drug, drug-allergy, drug-formulary checks [OP, IP]
(Ambulatory EMR Stage 3)
– Maintain an up-to-date problem list of current and active diagnoses
based on ICD-9 or SNOMED [OP, IP] (Ambulatory EMR Stage 3)
– Generate and transmit permissible prescriptions electronically (eRx)
[OP] (Ambulatory EMR Stage 3)
– Maintain active medication/allergy list [OP, IP] (Ambulatory EMR Stage
3)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2011 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions:
•
Providers
– Record demographics; primary language, insurance type, gender, race,
ethnicity [OP, IP] (Ambulatory EMR Stage 3)
– Record advance directives (Ambulatory EMRAM Stage 3)
– Record vital signs including height, weight, blood pressure [OP, IP]
(Ambulatory EMR Stage 3)
– Record smoking status (Ambulatory EMR Stage 3)
– Incorporate lab test data into EHR as structured data (Ambulatory EMR
Stage 3)
– Generate lists of patients by specific conditions to use for quality
disparities, and outreach (Ambulatory EMR Stage 3)
– Report ambulatory quality measures to CMS (Ambulatory EMR Stage 4)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2011 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions:
• Providers
– Send reminders to patients per patient preference for preventive/ follow
up care (Ambulatory EMR Stage 3)
– Implement one clinical decision rule relevant to specialty or high priority
care (Ambulatory EMR Stage 3)
– Document a progress note for each encounter (Ambulatory EMR Stage
3)
– Check insurance eligibility electronically from public and private payers,
where possible (Ambulatory Practice Management)
– Submit claims electronically to public and private payers (Ambulatory
Practice Management)
 2009 HIMSS Analytics
Engage Patients and Families
2011 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions:
• Providers
– Provide patients with an electronic copy of their e-health information
(including lab results, problem lists, medication lists, allergies, discharge
summary, procedures) upon request (Ambulatory EMR Stage 3)
– Provide patients with timely electronic access to their health information
(including lab results, problem lists, medication lists, allergies);
(Ambulatory EMRAM Stage 3)
– Provide access to patient specific education resources (Ambulatory
EMR Stage3)
– Provide clinical summaries for patients for each encounter (Ambulatory
EMR Stage 3)
 2009 HIMSS Analytics
Improve Care Coordination
2011 Objectives Goal is to electronically capture in
coded format and to report health information and to
use that information to track key clinical conditions:
• Providers
– Capability to exchange key clinical information (e.g. problem list,
medication list, allergies, test results) among providers of care
and patient-authorized entities electronically (Ambulatory EMR
Stage 4)
– Perform medication reconciliation at relevant encounters and
each transition of care (Ambulatory EMR Stage 3)
 2009 HIMSS Analytics
Improve Population and Public Health
2011 Objectives Goal is to electronically capture in
coded format and to report health information and to
use that information to track key clinical conditions:
• Providers
– Capability to submit electronic data to immunization registries
and actual submission where required and accepted
(Ambulatory EMR Stage 3)
– Capability to provide electronic syndromic surveillance data to
public health agencies and actual transmission according to
applicable law and practice (Ambulatory EMR Stage 4)
 2009 HIMSS Analytics
Ensure Adequate Privacy and Security
Protection for Personal Health Information
2011 Objectives Goal is to electronically capture in
coded format and to report health information and to
use that information to track key clinical conditions:
• Providers
– Compliance with HIPAA privacy and security laws (All
Ambulatory EMR Stages)
– Compliance with fair data sharing practices set forth in the
National Privacy and Security Framework (Ambulatory EMR
Stage 3)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2011 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions:
• Hospitals
– 10 percent of all orders (any type) entered by authorizing provider (e.g.
MD, DO, RN, PA, NP) through CPOE (EMRAM Stage 3 for RN, PA, NP;
Stage 4 for MD, DO)
– Implement drug-drug, drug-allergy, drug-formulary checks [OP, IP]
(EMRAM Stage 1, 3, and 4)
– Maintain an up-to-date problem list of current and active diagnosis
based on ICD-9 or SNOMED [OP, IP] (EMRAM Stage 3 and 6)
– Maintain active medication list [OP, IP] (EMRAM Stage 1 and 3)
– Maintain an active allergy list (EMRAM Stage 1 and 3)
– Record demographics; primary language, insurance type, gender, race,
ethnicity [OP, IP] (EMRAM Stage 2)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2011 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions:
• Hospitals
– Record advance directives (EMRAM Stage 3)
– Record vital signs including height, weight, blood pressure; calculate
and display BMI [OP, IP] (EMRAM Stage 3)
– Record smoking status (EMRAM Stage 3)
– Incorporate lab test data into EHR as structured data (EMRAM Stage 2)
– Generate lists of patients by specific conditions (EMRAM Stage 3)
– Report hospital quality measures to CMS (EMRAM Stage 3)
– Implement one clinical decision rule relevant to specialty or high priority
care (EMRAM Stage 3)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2011 Objectives Goal is to electronically capture in
coded format and to report health information and to
use that information to track key clinical conditions:
• Hospitals
– Check insurance eligibility electronically from public and private
payers, where possible (Patient Access function)
– Submit claims electronically to public and private payers
(Revenue Cycle Management function)
 2009 HIMSS Analytics
Engage Patients and Families
2011 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions:
• Hospitals
– Provide patients with an electronic copy of their e-health information
(including lab results, problem lists, medication lists, allergies, discharge
summary, procedures) upon request (EMRAM Stage 3)
– Provide patients with an electronic copy of their discharge instructions
and procedures at time of discharge, upon request (EMRAM Stage 3)
– Provide access to patient specific education resources (EMRAM Stage
3)
 2009 HIMSS Analytics
Improve Care Coordination
2011 Objectives Goal is to electronically capture in
coded format and to report health information and to
use that information to track key clinical conditions:
• Hospitals
– Capability to electronically exchange key clinical information
(e.g. problem list, medication list, allergies, test results) among
providers of care and patient authorized entities (EMRAM Stage
3)
– Perform medication reconciliation at relevant encounters and
each transition of care (EMRAM Stage 3)
 2009 HIMSS Analytics
Improve Population and Public Health
2011 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions:
• Hospitals
– Capability to submit electronic data to immunization registries and
actual submission where required and accepted (EMRAM Stage 3)
– Capability to provide electronic submission of reportable lab results to
public health agencies and actual submission where it can be received
(EMRAM Stage 1)
– Capability to provide electronic syndromic surveillance data to public
health agencies and actual transmission according to applicable law
and practice (EMRAM Stage 3)
 2009 HIMSS Analytics
Ensure Adequate Privacy and Security
Protection for Personal Health Information
2011 Objectives Goal is to electronically capture in
coded format and to report health information and to
use that information to track key clinical conditions:
• Hospitals
– Compliance with HIPAA privacy and security laws (All EMRAM
Stages)
– Compliance with fair data sharing practices set forth in the
National Privacy and Security Framework (EMRAM Stage 2)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2011 Measures:
– Report quality measures, including:
• Percent diabetics with A1c under control [EP]
• Percent hypertensive patients with BP under control [EP]
• Percent of patients with LDL under control [EP]
• Percent of smokers offered smoking cessation counseling [EP, IP]
(EMRAM Stages 3 and 6; Ambulatory EMR Stage 4 for all of the
above)
– Percent of patients with recorded BMI [EP] (EMRAM Stage 3;
Ambulatory EMR Stage 3)
– Percent eligible surgical patients who received VTE prophylaxis [IP]
(EMRAM Stage 3)
– Percent of orders (for medications, lab tests, procedures, radiology, and
referrals) entered directly by physicians using CPOE (EMRAM Stage 4;
Ambulatory EMRAM Stage 3)
– Use of high-risk medications (Beer’s criteria) in the elderly (EMRAM
Stage 1, 3, and 4; Ambulatory EMRAM Stage 3)
– Percent of patients over 50 with annual colorectal cancer screenings
[EP] (EMRAM Stage 3; Ambulatory EMR Stage 3)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2011 Measures:
– Percent of females over 50 receiving annual mammogram [EP] (EMRAM Stage
3; Ambulatory EMR Stage 3)
– Percent of patients at high-risk for cardiac events on aspirin prophylaxis [EP]
(EMRAM Stage 1 and 3; Ambulatory EMR Stage 4)
– Percent of patients who received flu vaccine [EP] (EMRAM Stage 1 and Stage 3;
Ambulatory EMR Stage 3)
– Percent of lab results incorporated into the EHR in coded format [EP, IP]
(EMRAM Stage 2; Ambulatory EMR Stage 3)
– Stratify reports by gender, insurance type, primary language, race ethnicity [EP,
IP] (EMRAM Stage 3, Ambulatory EMR Stage 3)
– Percent of all medications entered into EHR as generic, when generic options
exist in the relevant drug class [EP, IP] (EMRAM stage 1, 3 and 4; Ambulatory
EMR Stage 3)
– Percent of orders for high-cost imaging services with specific structured
indications recorded [EP, IP] (EMRAM Stage 1, 3, and 4; Ambulatory EMRAM
Stage 3)
– Percent claims submitted electronically to all payers [EP, IP] (RCM functions)
– Percent patient encounters with insurance eligibility confirmed [EP, IP] (RCM
and PM functions)
 2009 HIMSS Analytics
Engage Patients and Families
2011 Measures:
– Percent of all patients with access to personal health
information electronically [EP, IP] (EMRAM Stage 2;
Ambulatory EMR Stage 4)
– Percent of all patients with access to patient specific
educational resources [EP, IP] (EMRAM Stage 3;
Ambulatory EMR Stage 3)
– Percent of encounters for which clinical summaries
were provided [EP] (Ambulatory EMR Stage 3)
 2009 HIMSS Analytics
Improve Care Coordination
2011 Measures:
– Report 30 day readmission rate [IP] (Patient Access
Management)
– Percent of encounters where med reconciliation was performed
[EP, IP] (EMRAM Stage 3; Ambulatory EMR Stage 3)
– Implemented ability to exchange health information with external
clinical entity (specifically lab, care summary and medication lists
[EP, IP] (EMRAM Stage 3; Ambulatory EMR Stage 3)
– Percent of transitions of care for which summary care record is
shared (e.g. electronic paper, e-FAX) [EP, IP] (EMRAM Stage 3;
Ambulatory EMR Stage 3)
 2009 HIMSS Analytics
Improve Population and Public Health
2011 Measures:
– Report up-to-date status for childhood immunizations
[EP] (Ambulatory EMR Stage 3)
– Percent of reportable lab results submitted
electronically [IP] (EMRAM Stage 2)
 2009 HIMSS Analytics
Ensure Adequate Privacy and Security
Protection for Personal Health Information
2011 Measures:
– Full compliance with HIPAA privacy and security laws
(All Stages)
– Conduct or update a security risk assessment and
implement security updates as necessary (All Stages)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2013 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions
Providers
– Use CPOE for all orders (Ambulatory EMR Stage 3)
– Use evidence-based order sets [OP, IP] (Ambulatory EMR Stage 4)
– Manage chronic conditions using patient lists and decision support [OP,
IP] (Ambulatory EMR Stage 3)
– Provide clinical decision support at the point of care (e.g., reminders,
alerts) [OP, IP] (Ambulatory EMR Stage 3)
– Specialists report to relevant external disease (e.g., cardiology, thoracic
surgery, cancer) or device registries approved by CMS (Ambulatory
EMR Stage 4)
 2009 HIMSS Analytics
Engage Patients and Families
2013 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions
Providers
– Access for all patients to PHR populated real time with health data
(Ambulatory EMR Stage 4)
– Offer secure patient-provider message capability (Ambulatory EMR
Stage 4)
– Provide access to patient-specific educational resources in common
primary languages (Ambulatory EMR Stage 3)
– Record patient preferences (e.g. preferred communication media,
advance directive, healthcare proxies, treatment options) (Ambulatory
EMR Stage 3)
– Document family medical history in compliance with GINA (Ambulatory
EMR Stage 4)
– Upload data from home monitoring device (Ambulatory EMR Stage 4)
 2009 HIMSS Analytics
Improve Care Coordination
2013 Objectives Goal is to electronically capture in
coded format and to report health information and to
use that information to track key clinical conditions
Providers
– Retrieve and act on electronic prescription fill data (Ambulatory
EMR Stage 3)
– Produce and share an electronic summary care record for every
transition of care (place of service, consults, discharge)
(Ambulatory EMR Stage 4)
– Perform medication reconciliation at each transition of care from
healthcare setting to another (Ambulatory EMR Stage 3)
 2009 HIMSS Analytics
Improve Population and Public Health
2013 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions
Providers
– Receive immunization histories and recommendations from
immunization registries (Ambulatory EMR Stage 4)
– Receive health alerts from public health agencies (Ambulatory EMR
Stage 4)
– Provide sufficiently anonymized electronic syndrome surveillance data
to public health agencies with capacity to link to personal identifiers
(Ambulatory EMR Stage 4)
 2009 HIMSS Analytics
Ensure Adequate Privacy and Security
Protection for Personal Health Information
2013 Objectives Goal is to electronically capture in
coded format and to report health information and to
use that information to track key clinical conditions
Providers
– Use summarized or de-identified data when reporting data for
population health purposes (e.g. public health, quality reporting,
and research), where appropriate, so that important information
is available with minimal privacy risk (Ambulatory EMR Stage 4)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2013 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions
Hospitals
– Use CPOE for all orders (EMRAM Stage 4)
– Use evidence-based order sets (EMRAM Stage 4)
– Record clinical documentation in EHR (EMRAM Stages 3 and 6)
– Generate and transmit permissible prescriptions electronically (EMRAM
Stage 4)
– Manage chronic conditions using patient lists and decision support
(EMRAM Stage 3 and Stage 6)
– Provide clinical decision support at the point of care (e.g., reminders,
alerts) (EMRAM Stage 3, 5, and 6)
– Specialists report to relevant external disease (e.g. cardiology, thoracic
surgery, cancer) or device registries (EMRAM Stage 6)
– Conduct closed loop medication administration management, including
eMAR and computer-assisted administration (EMRAM Stage 5)
 2009 HIMSS Analytics
Engage Patients and Families
2013 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions
Hospitals
– Access for all patients to PHR populated real time with health data
(EMRAM Stage 2 and higher)
– Provide access to patient-specific educational resources in common
primary languages (EMRAM Stage 3)
– Record patient preferences (e.g. preferred communication media,
advance directive, healthcare proxies, treatment options) (EMRAM
Stage 3)
– Document family medical history in compliance with GINA (EMRAM
Stage 6)
 2009 HIMSS Analytics
Improve Care Coordination
2013 Objectives Goal is to electronically capture in
coded format and to report health information and to
use that information to track key clinical conditions
Hospitals
– Retrieve and act on electronic prescription fill data (EMRAM
Stage 4)
– Produce and share an electronic summary care record for every
transition in care (place of service, consults, discharge) (EMRAM
Stage 3 and 6)
– Perform medication reconciliation at each transition of care from
one healthcare setting to another (EMRAM Stage 3)
 2009 HIMSS Analytics
Improve Population and Public Health
2013 Objectives Goal is to electronically capture in coded format
and to report health information and to use that information to
track key clinical conditions
Hospitals
– Receive immunization histories and recommendations from
immunization registries (EMRAM Stage 3)
– Receive health alerts from public health agencies (EMRAM Stage 2 and
higher)
– Provide sufficiently anonymized electronic syndrome surveillance data
to public health agencies with capacity to link to personal identifiers
(EMRAM Stage 3 and higher)
 2009 HIMSS Analytics
Ensure Adequate Privacy and Security
Protection for Personal Health Information
2013 Objectives Goal is to electronically
capture in coded format and to report health
information and to use that information to
track key clinical conditions
Hospitals
– Nothing noted
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2013 Measures:
– Additional quality reports using HIT-enabled NQF-endorsed quality
measures [EP, IP] (EMRAM Stage 3 and higher; Ambulatory EMR Stage
4)
– Percent of all orders entered by physicians through CPOE [EP, IP]
(EMRAM Stage 4; Ambulatory EMR Stage 3)
– Potentially preventable Emergency Department Visits and
Hospitalizations [IP] (Ideally accomplished with business intelligence
and/or a clinical data warehouse that can be effectively implemented at
Stage 3 or higher)
– Inappropriate use of imaging (e.g. MRI for acute low back pain) [EP, IP]
(Ideally accomplished with business intelligence and/or a clinical data
warehouse that can be effectively implemented at Stage 3 or higher)
– Other efficiency measure (TBD) [EP, IP]
 2009 HIMSS Analytics
Engage Patients and Families
2013 Measures:
– Percent of patients with full access to PHR populated in real time with
EHR data [OP, IP] (EMRAM Stage 2 and higher; Ambulatory EMR
Stage 3 and higher)
– Additional patient access and experience reports using NQF-endorsed
HIT-enabled quality measures [EP, IP] (EMRAM Stage 3 and higher;
Ambulatory EMR Stage 4)
– Percent of patients with access to secure patient messaging [EP]
(Ambulatory EMR Stage 4)
– Percent of educational content in common primary languages [EP, IP]
(EMRAM Stage 3; Ambulatory EMR Stage 3)
– Percent of all patients with preferences recorded [IP] (EMRAM Stage 3)
– Percent of transitions where summary record is shared [EP, IP]
(EMRAM Stage 3 and higher; Ambulatory EMR Stage 4)
– Implemented ability to incorporate data uploaded from home monitoring
devices [EP] (Ambulatory EMR Stage 4)
 2009 HIMSS Analytics
Improve Care Coordination
2013 Measures:
– Access to comprehensive patient data from all
available sources (EMRAM Stage 7; Ambulatory
EMR Stage 4)
– 10 percent reduction in 30 day re-admission rates
for 2013 compared to 2012 (EMRAM Stage 6 and
higher)
– Improvement in NQF-endorsed measures of care
coordination (EMRAM Stage 3 and higher;
Ambulatory EMR Stage 4)
 2009 HIMSS Analytics
Improve Population and Public Health
2013 Measures:
– Percent of patients for whom an assessment of immunization
need and status has been completed during the visit [EP]
(Ideally accomplished with CDSS and business intelligence and
a clinical data warehouse that can be implemented at Stage 3 or
higher)
– Percent of patients for whom a public health alert should have
triggered, and audit evidence that a trigger appeared during the
encounter (Ideally accomplished with CDSS and business
intelligence and a clinical data warehouse that can be
implemented at Stage 3 or higher)
 2009 HIMSS Analytics
Ensure Adequate Privacy and Security
Protections for Personal Health Information
2013 Measures:
– Provide summarized or de-identified data when
reporting data for health purposes (e.g. public health,
quality reporting, and research), where appropriate,
so that important information is available with minimal
privacy risk (Ideally accomplished with business
intelligence and a clinical data warehouse that can be
implemented at Stage 2 or higher)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2015 Objectives Goal is to achieve and improve performance and
support care processes and on key health system outcomes:
– Achieve minimal levels of performance on quality, safety, and efficiency
measures (EMRAM Stages 5 and above; Ambulatory EMR Stage 4 and
above)
– Implement clinical decision support for national high priority conditions
(EMRAM Stages 3 and above; Ambulatory EMR Stage 4)
– Medical device interoperability (EMRAM Stage 3 as the initial stage for
integration with medical devices)
– Multimedia support (e.g. x-rays) [OP, IP] (EMRAM Stage 3 and above;
Ambulatory EMR Stage 4)
 2009 HIMSS Analytics
Engage Patients and Families
2015 Objectives Goal is to achieve and improve
performance and support care processes
and on key health system outcomes:
– Patients have access to self management tools (Web
services to provide access to sites such as WebMD or
MayoClinic.com)
– Electronic reporting on experience of care (provided
by a service such as Press Ganey of SF-36 providers)
 2009 HIMSS Analytics
Improve Care Coordination
2015 Objectives Goal is to achieve and improve
performance and support care processes
and on key health system outcomes:
– Access comprehensive patient data from all available
sources (EMRAM Stage 7; Ambulatory EMR Stage 5)
 2009 HIMSS Analytics
Improve Population and Public Health
2015 Objectives Goal is to achieve and improve
performance and support care processes and on key
health system outcomes:
– Use of epidemiologic data (EMRAM Stage 7; Ambulatory EMR
Stage 5)
– Automated real-time surveillance (adverse events, near misses,
disease outbreaks, bioterrorism) (EMRAM Stage 3; Ambulatory
EMR Stage 4)
– Clinical dashboards (EMRAM Stage 2; Ambulatory EMR Stage
3)
– Dynamic and ad hoc quality reports (EMRAM Stage 7;
Ambulatory EMR Stage 5)
 2009 HIMSS Analytics
Ensure Adequate Privacy and Security
Protections for Personal Health Information
2015 Objectives Goal is to achieve and improve
performance and support care processes and on key
health system outcomes:
– Provide patients, upon request, with an accounting of treatment,
payment, and healthcare operations disclosures (EMRAM Stage
3; Ambulatory EMR Stage 3)
– Protect sensitive health information to minimize reluctance of
patient to seek care because of privacy concerns (All Stages of
Both Models)
 2009 HIMSS Analytics
Improve Quality, Safety, Efficiency, and
Reduce Health Disparities
2015 Measures:
– Clinical outcome measures (TBD) [OP, IP] (Projected
EMRAM Stage 6 and 7; Projected Ambulatory EMR
Stage 5)
– Efficiency measures (TBD) [OP, IP] (Projected
EMRAM Stage 6 or 7; Projected Ambulatory EMR
(Stage 5)
– Safety measures (TBD) [OP, IP] (Projected EMRAM
Stage 5 or higher; Projected Ambulatory EMR Stage
5)
 2009 HIMSS Analytics
Engage Patients and Families
2015 Measures:
– NPP quality measures related to patient and family
engagement [OP, IP] (EMRAM Stage 7; Ambulatory
EMR Stage 5)
 2009 HIMSS Analytics
Improve Care Coordination
2015 Measures:
– Aggregate clinical summaries from multiple sources
available to authorized users [OP, IP] (EMRAM Stage
7; Ambulatory EMR Stage 5)
– NQF-endorsed care coordination measures (TBD)
(EMRAM Stage 7; Ambulatory EMR Stage 5)
 2009 HIMSS Analytics
Improve Population and Public Health
2015 Measures:
– HIT-enabled population measures [OP, IP] (EMRAM
Stage 7; Ambulatory EMR Stage 5)
– HIT-enabled surveillance measures [OP, IP] (EMRAM
Stage 7; Ambulatory EMR Stage 5)
 2009 HIMSS Analytics
Ensure Adequate Privacy and Security
Protection for Personal Health Information
2015 Measures:
– Provide patients, on request, with a timely accounting
of disclosures for treatment, payment, and healthcare
operations, in compliance with applicable law(s)
(EMRAM Stage 3; Ambulatory EMR Stage 3)
– Incorporate and utilize technology to segment
sensitive data (EMRAM Stage 7; Ambulatory EMR
Stage 5)
 2009 HIMSS Analytics
Hospital & Provider Advice
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Ensure that your EMR vendor can deliver the functions identified within the levels of
the EMRAM and ambulatory EMR model.
If you are not at a Stage 3 or Stage 4 for EMR functions on the EMRAM or
ambulatory EMR model, submit a request for information to your EMR vendor(s) to
generate written documentation as to their capabilities in meeting the 2011 and 2013
measures with their EMR applications and implementations.
Determine whether your existing vendor can meet the 2011 and 2013 measurements
within the timeframes you have for implementation and adoption of EMR applications
in your facility. If your requirements can’t be met, institute replacement proceedings
immediately (vendor/product evaluation and selection processes).
Negotiate an implementation timeline and process that meets your needs and define
penalties for missing deadlines (this is a two way street, and vendors may also assign
penalties for missing deadlines for hospital and clinic functions of the
implementation).
Create a strategy for meeting 2015 measures to be identified that can be
implemented soon after 2013 using business intelligence and clinical data warehouse
functions.
 2009 HIMSS Analytics