GhA Ceo Webinar 12 2009 Final

Helping Georgia Hospitals Prepare for Meaningful

Use and Improved QualityKent Giles, MPPM

Eric Bartholet

December 9, 2009

04/10/2023 BE09_0389 2© 2009 Computer Sciences Corporation

Agenda

• Welcome and Introductions

• Review Meaningful Use Requirements

• Review “where we are” in GHA Facilities

• Keys to Success

• Q&A


Introductions

• Kent Giles, MPPM, Partner, CSC Healthcare– 25 years of Hospital Administration, Physician Practice, Payor and Consulting– GHA Account Partner and Advisor to C-Level Executives across the SE US– Subject Matter expertise in strategy, planning, IT and Margin/Operations Improvement

• Eric Bartholet, Partner, CSC Healthcare– IT Strategy & Planning– Over 25 years working with healthcare systems– Subject Matter Expertise in It Strategy, Systems Implementation and Architecture


Adoption of Clinical IT in Hospitals is Low and Even Lower Among Physicians

• Transforming the health system will require hospitals and physicians to dramatically increase their use of HIT

• The latest data from HIMSS Analytics suggests that just over 40 percent of hospitals have basic clinical (nursing) documentation but less than2 percent have physician documentation(HIMSS Analytics, 2009)

• The level of current EMR adoption will be a major factor in how much investment will be necessary to satisfy the Meaningful Use requirements

Background


Meaningful Use and HIT-Enabled Health Reform Targets

2009 2011 2013 2015

HITECHPolicies

Capture & Share Data

Advanced Care Processes with

Clinical Decision Support Improved

Outcomes

Source: Meaningful Use Work Group Presentation at the HIT Policy Committee Meeting on June 16, 2009

The “meaningful use” criteria to be phased in, with the criteria building from year to year.

EHR Meaningful Use Timetable

HIT-Enabled Health Reform


First Year of Meaningful EHR

Use

Requirement Set #1 Requirement Set #2 Requirement Set #3

2011 2012 2013 2014 2015 2016 2017 2018 TOTALS

2011 $1,884,834 $1,413,625 $942,417 $471,208 $0 $0 $0 $0 $4,712,084

2012 $0 $1,884,834 $1,413,625 $942,417 $471,208 $0 $0 $0 $4,712,084

2013 $0 $0 $1,884,834 $1,413,625 $942,417 $471,208 $0 $0 $4,712,084

2014 $0 $0 $0 $1,413,625 $942,417 $471,208 $0 $0 $2,827,250

2015 $0 $0 $0 $0 $942,417 $471,208 $0 $0 $1,413,625

2016 $0 $0 $0 $0 -$307,855 $0 $0 $0 -$307,855

2017 $0 $0 $0 $0 -$307,855 -$615,710 $0 $0 -$923,565

2018 $0 $0 $0 $0 -$307,855 -$615,710 -$923,565 $0 -$1,847,130

2019 $0 $0 $0 $0 -$307,855 -$615,710 -$923,565 -$923,565 -$2,770,694

Example of Estimated Incentive Payment Schedule

• Payments are made over four years• Payments start based on when you achieve the

Meaningful Use requirements• Compression of incentive payments begins if you don’t

achieve Meaningful Use by 2013• Penalties begin in 2015 and are perpetual

EHR Meaningful Use Timetable


2011 2013 2015Computerized Physician Order Entry (orders directly entered by authorized provider)• Ten percent all orders (hospital) • All types of orders

• Evidence-based order sets• Electronic prescriptions (discharge)

Medication Reconciliation• At relevant encounters and each transition of

care• At transitions in care across care settings

Physician Documentation• Active medication list• Active medication allergy list• Up-to-date problem list

• Clinical documentation• Family medical history

Multimedia support

Nurse and Interdisciplinary Documentation• Demographics (preferred language, age,

gender, ethnicity, race)• Vital signs• Smoking status• Advance directives• Calculate and display BMI

• Clinical documentation (also other disciplines)• Electronic Medical Administration Record (eMAR)

and computer-assisted administration• Patient preferences

Medical device interoperability

Performance Improvement• Drug-drug, drug-allergy and drug-formulary

checks• One clinical decision rule for high-priority

condition• Generate lists of patients by specific condition

• Clinical decision support at the point of care• Manage chronic conditions using patient lists and

decision support• Improvement in NQF-endorsed measures of care

coordination

• Clinical decision support for national high-priority conditions

• Achieve minimal levels of performance– Safety, quality– Efficiency

• Automated real-time surveillance (ADEs, near misses, disease outbreaks)

Well positioned to meet Meaningful Use criteria

Effort may be required There is no active project to meet the requirements

This is a case study from a CSC assessment. The following charts are intended to identify areas where effort and investment may be required:

EHR Meaningful Use Requirements Summary


2011 2013 2015

Performance Measurement/Reporting• Report hospital quality measures to CMS • Stratify reports by gender, insurance type,

primary language, race and ethnicity

• Additional quality reports using HIT-enabled NQF-endorsed quality measures– Potentially preventable ED visits and

hospitalizations– Inappropriate use of imaging – Other efficiency measures TBD – NQF-endorsed measures of care

coordination• Specialists report to external registries

• Clinical outcome measures TBD• Efficiency measures TBD• Safety measures TBD• NQF-endorsed measures of care

coordination• Clinical dashboards• Dynamic and ad hoc quality reports

Health Information Exchange: Pharmacies• Transmit prescriptions (discharge)• Retrieve and act upon electronic prescription fill

data Health Information Exchange: Patients• Electronic copy of health information

upon request • Electronic copy of discharge instructions

and procedures at discharge upon request

• Access for all patients to personal health records (PHRs) populated in real time with data from HER

• Educational resources in primary language

Patients have access to self-management tools

Health Information Exchange : External Providers• Capability to exchange health information– Discharge summary, procedures– Problem list, med list, allergies– Test Results

• Produce and share an electronic record of care for every transition in care

– Place of service– Consults– Discharge

• Access comprehensive patient data from all available sources

• Aggregate clinical summaries from multiple sources

Health Information Exchange: Public and Private Payers• Check insurance eligibility, where possible• Submit claims electronically



2011 2013 2015

Health Information Exchange: Public Health Authorities

• Submit electronic data to immunization registries

• Electronic submission of reportable lab results

• Provide electronic syndromic surveillance data

• Receive immunization histories and recommendations from immunization registries

• Receive health alerts from public health agencies

• Provide sufficiently anonymized electronic syndrome surveillance data

HITECH Privacy and Security

• Comply with HIPAA• Comply with National Privacy and

Security Framework• Conduct a security risk assessment• Implement security updates as necessary

• Provide summarized or de-identified information when reporting health data for external use to minimize privacy risk

• Upon patient request, provide an accounting of PHI disclosures for treatment, payment and health care operations

• Incorporate and utilize technology to segment sensitive data



What CEO’s Want to Know

1. Can my application vendor make my hospital ARRA compliant?

2. Can we just accept the penalties and not achieve meaningful use?

3. Isn’t this an issue that I should delegate to my CIO?

4. How do we achieve MU and keep our medical staff and clinicians happy?

5. What is the financial impact on my organization?

6. What are the major CEO risks that I face?

Meaningful Use


Dim

ensi

on

s o

f H

ealt

hca

re D

eli

very

Urgent Need to Accelerate Preparation

Need to Continue Preparation for Readiness

Good Probability of Achieving Readiness

0% to 39% 40% to 79% 80% to 100%

1.Use of a

Certified Product

Staff works to deliver care safely and efficiently, but most tasks are not supported by certified electronic tools.

54% Your system captures many data points and makes information readily available. Your system is not certified, or its certification is about to expire.

Your integrated, certified system provides reliable decision support that anticipate opportunities for error.

2.Adoption

of Standards

Most systems use standards, but there is lack of harmonization and some standards may be out of date.

47% All systems are standardized using recent versions, and most are harmonized for internal consistency.

Fully harmonized standards are in use, and steps have already been taken to ensure adoption of future versions.

3.Meaningful Use

of the EHR

31% Some documentation is completed electronically by nurses or physicians. The EHR is not house-wide.

Some physicians enter orders electronically, using basic clinical decision support. Many physicians also document electronically.

Physicians enter orders electronically, using decision support. Documentation is electronic in all units.

4.Quality Management

and Reporting

Staff work with a mix of manual and electronic quality reporting tools. Methods for producing data are basic and sometimes inconsistent.

54% Some quality data are captured directly from the EHR. Data elements and nomenclatures are consistent, and you achieve high scores on quality measures.

Performance reviews on data captured from the EHR clearly demonstrate that your hospital consistently delivers safe and effective care.

5.HITECH

Protection

Current practices achieve basic security and HIPAA compliance.

72% You have assurance in writing from associates on privacy. Processes are in place to respond to breaches.

Policies and procedures prevent breaches, handle breach notifications. Staff are fully informed of requirements.

HITECH Scorecard: Results Of 17 GHA HospitalsOverall readiness can be determined by totaling the scores of all the categories, 80 is “likely to achieve MU”. To have a good probability of readiness, a hospital needs to score 80 percent or better in a given category.

HITECH Framework


MU is an operational and clinical issue rather than an IT issue.

Clinical Documentation and Quality Reporting

SOURCES OF DATA ELEMENTS

Acute myocardial infarction (AMI) patients without beta-blocker contraindications who received a beta blocker within 24 hr after hospital arrival

REG/ADTFACE SHEET

(4 data elements)

EDDOCUMENTATION(6 data elements

MDDOCUMENTATION(7 data elements)

RNDOCUMENTATION

(1 data element)

DISCHARGESUMMARY

(8 data elements)UB-04

(3 data elements)

DATA ELEMENTS NEEDED FOR:

• Arrival date/time• Beta blocker

administered (date/time)

• Principal dx of AMI-6 • Birth date• Admission date• Discharge date• Transfer from hospital/ED• Transfer out soon after arr.• Receiving CMO only• Involved in clinical trial• Discharged to hospice• Expired• Left against medical advice

• HF on arrival/within 24 hr• Shock on arrival/within 24 hr• Bradycardia day of/before disc• Heart transplant during stay• LVAD during hospital stay• Patient has pacemaker• 2nd or 3rd degree block on ECG• Allergy to beta blocker• Other contraindication to beta

blocker

1. INCLUSION 2. OUTCOME 3. EXCLUSION


Achieving “Meaningful Use” with Accelerated Project PlanOrganizations who address clinical change management and provide disciplined implementation management achieve sustainable results.

Success = Right Product x Right Implementation x Right Clinical Adoption

Imp

lem

enta

tio

n M

anag

emen

t

Clinical Change Management

Short Term Success (Good, Bad)

• Milestones Met • Low Customer Satisfaction• Organizational Readiness is

Low• Non-achievement

Project Success with Long Term Sustainability (Good, Good)• Milestones Met • High level of user satisfaction• Expectations are fulfilled • MU Achieved

Strong Commitment with Limited Success (Bad, Good)• Users are committed to

ideas/excited• Project milestones not met• Expectations unfulfilled• MU achievement unlikely

Limited Success (Bad, Bad)• Milestones not Met• No Project Rigor• Low User Satisfaction• Non-achievement


ARRA Costs vs. Incentives (350 bed facility w. limited CIS)

• ARRA costs (capital vs operating)– Capital: $ 2.75 million

• License and Installation – $1,550,000• Project Management - $450,000• Training - $150,000• Clinical Adoption - $450,000• Order Sets (250), Reports (50), Interfaces - $150,000

– Operating: $3.24 million / year• Hosting and Application Management - $850,000/year • Help Desk - $90,000• Additional FTEs in IT, Departments- $1,500,000/year• Back Up and Recovery - $ 800,000

• ARRA Revenues– Incentive Payments of $6,200,000

• Impact Analysis– Initial need to fund $2,750,000 with cash or financing– Additional Operating Budget of $3.24 million / ongoing– $3,670,000 in annual penalties if MU not achieved


Recommendations for Hospitals and Participating Providers

• Educate - Your Leadership– Understand the regulations, rewards, risks and costs. Proforma incentives and ongoing deductions.

• Form - Steering Committee Chaired by a C-Level Executive (CEO preferred)– MU is a major impact on clinical, business office, IT and medical staff– Include key clinical, IT, operational and financial leaders (Big Team)– Maximize quality improvement, patient safety and cost reduction opportunities– Reduce the number of initiatives across the Hospital to provide focus on MU

• Assess - Current State Assessment w. Road Map (GHA offers one)– Determine where you are currently using HITECH Framework– Develop overall timelines, major milestones, operational and capital budget– Develop measures and accountabilities with responsible parties

• Implement – CIS and Revise Clinical Processes and Work Flow– System Selection based upon criteria not vendor demos – Build a detailed project plan with PMO– Be honest about your internal capabilities and needs– Engage partners (application vendor (s), consulting resources, internal hires)– Focus on clinical adoption and implementation in a combined methodology with PMO– Focus on best practices and maximize opportunities for improvement

• Improve – Improve Performance – Receive Stimulus Dollars– Constant improvement of quality, service and process improvement / cost reduction

Recommendations


Elements of Meaningful Use of EHRs

Meaningful Use

RIGHTOUTCOME

RIGHT IMPLEMENTATION

RIGHTADOPTION

RIGHT PRODUCT

© 2009 Computer Sciences Corporation

Q & A


Questions or Comments?

Thank you!

Kent Giles, MPPM

404-483-7000

[email protected]

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