Transcript How to Mangle a Project

Electronic Health Record
Electronic Medical Record
Where are We?
The Electronic Health Record

What IT IS
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August 2009
Individual focused
Individual specific core data set
where elements reside in multiple
sources.
Mechanism for sharing health data
about an individual
Will Gaud
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The Electronic Health Record
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Longitudinal health information about
an individual from multiple sources
Support for clinical decision making
Accessible in all points of care in a
timely manner
Not a technology issue but a patient
care issue
August 2009
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The Electronic Health Record
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What IT IS NOT
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Provider focused
An operational system (operational
systems feed data to populate the EHR)
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August 2009
A data collection system
A single physical repository
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The Electronic Health Record
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August 2009
A Clinical Information
System/Electronic Patient Record nor
Physician’s Office System/Electronic
Medical Record, but they are
interrelated.
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The Electronic Health Record
Defined
The aggregate electronic record of healthrelated information on an individual that
is created and gathered cumulatively
across more than one health care
organization and is managed and
consulted by licensed clinicians and staff
involved in the individual’s health and
care
Source: National Alliance for Health Information Technology (NAHIT)
August 2009
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Global EHR Penetration
Primary Care Physicians
Australia
79%
Canada
23%
Germany
42%
The Netherlands
98%
New Zealand
92%
United Kingdom
89%
United States
28%
August 2009
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EHR Penetration in U.S. Hospitals
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Dismal – survey from 3049 nonfederal
acute-care hospitals
 1.5% had a comprehensive EHR
 7.6% had a basic system that lacked
decision support, only minimal order
capability and only had to be available
in one unit of the hospital (to be
classified as comprehensive, a system
had to be used throughout the facility
August 2009
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Barries to Adoption
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Complexity of operations
Cost
 Hardware
 Software
Unavailability of resources
Health Information Technology
August 2009
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Technology to the Rescue
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Cloud Computing - a general term for
anything that involves delivering hosted
services over the Internet.
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Infrastructure-as-a-Service (IaaS)
Platform-as-a-Service (PaaS)
Software-as-a-Service (SaaS)
Cloud computing can help mitigate much
of the cost associated with resources,
infrastructure and HIT management
August 2009
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The Future
Immediate and Beyond
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Health Information Exchange (HIE) the mobilization of healthcare
information electronically across
organizations within a region or
community.
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The Future
Immediate and Beyond
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The National Health Information
Network - a program under the Office of
the National Coordinator for Health
Information Technology (ONC),
established in 2004 to improve the
quality and efficiency of healthcare by
establishing a mechanism for nationwide
health information exchange
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What to look for in an EHR
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CCHIT Certification
Decision support
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Clinical practice guidelines
Actionable alerts
Drug interaction warnings
Flexibility of configuration
Registry / population management
with interoperable components
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What’s out there?
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Current EHRs are powerful, but they are
not optimized for population
management or population based
reporting – however, the current HRSA
EHR Guidelines/Specification specifically
asks vendors to provide this functionality
August 2009
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Keeping in mind that …
An EHR is an electronic record of patient
health information including patient
demographics, conditions, medications,
vital signs, medical history,
immunizations, notes, laboratory data
and radiology reports that can generate a
complete record of a clinical patient
encounter (California Health Care Foundation)
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… we should avoid
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Duplicating data among multiple clinical
systems as this
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Can be expensive and difficult to manage
Defeats the purpose of the EHR –
“longitudinal health information about an
individual from multiple sources with
support for clinical decision making and
accessible from all points of care in a timely
manner”
August 2009
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Adding flexibility to the EHR
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Most products in the marketplace are
configurable
Ask the vendor (through your functional
specification) to provide, as part of the
system, the functionality you desire
Ask also for the ability to introduce ‘user
defined/validated data elements’
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Adding flexibility …
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Full support for third party reporting
systems (if one is not already included in
the system)
Advice on strategy on how to migrate
data from existing systems to the EHR
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Methods
Vendors
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Adding flexibility …
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Remember that the objective should be
the implementation of a system to hold all
patient related demographic and clinical
data - migration to it from other systems
should happen as quickly as time permits
to avoid confusion, additional expense
and improving quality of care.
It is all about the ‘whole patient’
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Becoming “Meaningful Users”
What does this mean?
August 2009
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Meaningful Use
The ultimate goal is to enable significant
and measurable improvements in
population health
Recommendations, Meaningful Use
Workgroup to the Health HIT
Policy Committee, June 16, 2009
August 2009
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Meaningful Use
The ultimate vision is that all patients are
fully engaged in health care, providers
have real-time access to all medical
information and tools to help ensure
the quality and safety of the care
produced.
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August 2009
Recommendations, Meaningful Use
Workgroup to the Health HIT
Policy Committee, June 16, 2009
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Do I need to think about MU
(Meaningful Use)?
Yes!
22 objectives for EHRs by 2011. The
objectives call for qualified EHRs to:
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Allow patients to access clinical information;
Comply with state and federal privacy,
security and data sharing regulations;
Document patient progress and provide
clinical summaries;
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Do I need to think about
Meaningful Use (MU)?
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Exchange critical information with other care
providers;
Implement drug interaction safeguards;
Send patient reminders about follow-up and
preventive care;
Submit immunization and laboratory data to
relevant public health registries; and
Use computerized physician order entry systems to
transmit prescriptions.
August 2009
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HIT-Enabled Health Reform
Achieving Meaningful Use Paul Tang, Chair
George Hripcsak. Co-Chair HHS Policy Committee
2009
2011
2013
2015
HIT-Enabled Health Reform
HITECH Policies
Meaningful Use
Criteria
2011 Meaningful
Use Criteria
(Capture/share
data)
2013 Meaningful
Use Criteria
(Advanced care
processes with
decision support)
2015 Meaningful
Use Criteria
(Improved
Outcomes)
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August 2009
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Meaningful Use Matrix
June 16, 2009
August 2009
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Meaningful Use and ARRA
The American Recovery and Reinvestment
Act (ARRA) authorizes CMS to provide
reimbursement incentive for physicians and
hospital providers who are successful in
becoming “Meaningful Users” of an electronic
health record.
Providers who are “Meaningful Users” will be
eligible for $44,000 in increased Medicare
and Medicaid payments over 5 years.
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Medicare Provision
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Medicare:
Incentive payments through Medicare (the
federal insurance program for those 65 and
older) go to non-hospital based physicians and
hospitals paid through prospective payment
systems that are “meaningful users” of certified
EHR systems. In simple terms, “meaningful use”
requires that the EHR be installed and actively
used to collect and share patient information
and to support improved clinical care.
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Medicare Provision
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Meaningful use criteria for physicians
include ePrescribing, electronic reporting of
clinical quality data, and that the certified
EHR is connected for the electronic
exchange of health information.
Meaningful use criteria for hospitals are
similar to those for physicians but do not
include ePrescribing.
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Medicaid Provision
Medicaid: Incentive payments through Medicaid
(the federal/state program for low-income
individuals) go to non-hospital based providers
and hospitals. Providers include not only
physicians but also dentists, nurse practitioners,
certified nurse midwives, and, under specific
circumstances, physician’s assistants. In addition
to hospitals, federally qualified health centers
(FQHCs) and rural health clinics may receive
Medicaid incentives for EHR adoption.
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Medicaid Provision
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To qualify for Medicaid incentives, providers must
waive any right to the Medicare EHR incentives.
Providers must also demonstrate that a qualifying
percentage of their patients are Medicaid beneficiaries
(or, in the case of FQHCs, “needy individuals”). For
most providers, 30 percent of their patients must be
Medicaid beneficiaries. Children’s hospitals qualify if
they treat Medicaid patients (with no qualifying
percentage). Other acute care hospitals must have 10
percent of total patients as Medicaid beneficiaries.
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Other ARRA HIT Funding
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The legislation also allocates $2 billion in
discretionary funding to the Health and Human
Services Secretary, to be distributed through a mix of
grants and loans
Specific allocations are determined within the
legislation:
 $20 million to the National Institute of Standards
and Technology to “create and test standards
related to health security and interoperability”
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Other ARRA HIT Funding
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$300 million to the Office of the National
Coordinator for HIT for regional and subnational
efforts for health information exchange.
Additional and potential funding areas the bill
suggests include:
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Telemedicine, Technology to protect electronic
health information, HIT for public health, Loans
to providers for HIT adoption (via states)
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