Your Answer to All Things EHR

Federally-designated Regional Extension Center for the State of Missouri

University of Missouri: Department of Health Management and InformaticsCenter for Health PolicyDepartment of Family and Community Medicine

Partners:Hospital Industry Data Institute (Small Rural and Critical Access Hospitals)Kansas City Quality Improvement OrganizationMissouri Primary Care AssociationMissouri Telehealth NetworkPrimaris

Vision: Assist Missouri's health care providers in using electronic health records to improve the access and quality of health services; to reduce inefficiencies and avoidable costs; and to optimize the health outcomes of Missourians

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FinancialFinancial

Organization ChangeOrganization Change

• Expense of system• Uncertainty around ROI• Provider and staff productivity• Uncertainty about financial incentives

• Disruption of workflow and productivity• Privacy and security concerns• Maintaining patient centeredness and

satisfaction

•Concerns about technically supporting a system•Lack of necessary computer skills •Finding the right EHR to suit practice needs

(“usability”)•Having the right IT staff in place•Possibility of information overload

TechnicalTechnical

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Require significant support to carry out proper workflow re-design

Result can be piecemeal and less effective use of EHR capabilities and fewer financial and quality benefits Substantial time spent customizing forms and redesigning

workflow More time spent with patients leading to longer workdays

or fewer patients during the initial period Overburdened planning and implementing without

additional technical support

MEDICARE

Doctors of medicine or osteopathy, doctors of dental surgery or dental medicine, doctors of podiatry, doctors of optometry and chiropractors who participate in the physician fee schedule (PFS)

General rule of thumb, MDs or Osteopaths who bill under Medicare Part B are likely eligible.

No volume requirement

MEDICAID

Doctors of medicine or osteopathy only (in some limited cases optometry

Nurse practitioners Certified nurse-midwifes Dentists EPs must have 30%

Medicaid patient volume to qualify (20% for pediatricians)

EPs must choose Medicare or Medicaid Incentives

Professionals who “practice predominantly” in an FQHC or RHC may use “needy individual” volume to meet their 30% threshold A professional must have more than 50% of

encounters that occurred at an FQHC/RHC over a six-month period

CMS defines “needy individuals” as patients who: Receive medical assistance from Medicaid or the

Children’s Health Insurance Program; Are furnished uncompensated care by the provider; or Are furnished services at either no or reduced cost

based on a sliding scale

MEDICARE

Acute care (or subsection d) hospitals paid under the Medicare Inpatient Prospective Payment System (IPPS)

Critical Access Hospitals

(CAHs)

MEDICAID

Acute care hospitals

Children’s hospitals

Cancer hospitals

Critical Access hospitals Requires 10% Medicaid

patient volume to qualify (except Children’s hospitals)

Hospitals qualify for both Medicare and Medicaid incentives

Priority: Primary care providers, including physicians (Internal Medicine, Family Practice, OB/GYN, Pediatrics) and other health care professionals (NP, PA) with prescribing privileges in the following settings:

•Small group practices (10 or fewer providers with prescriptive privileges•Ambulatory clinics connected with a public or critical access hospital•Community health centers and rural health clinics•Other ambulatory settings that predominately serve uninsured, underinsured, and medically underserved populations

55 Critical Access and Rural Hospitals

The Missouri Hospital Association through the Hospital Industry Data Group (HIDI) has the responsibility of working with Critical Access Hospitals to achieve Milestones 1, 2, and 3. Individual providers receive services through the HIT Assistance Center.

Population - 5,874,327

Primary Care Providers - 5300

Priority PCPs - 2400

Priority PCPs Served - 1167

Total Providers - 17,946

CAH and Rural Hospitals - 55

Team of experienced, Missouri based Health IT professionals

Part of a national network designated by HHS to assist providers with modernizing their practices

Direct, rapid and reliable access to a pipeline of key information on health IT and meaningful EHR use

For providers who do not have a certified EHR system - We help you choose and implement one in your office

For providers who already have a system - We help eligible providers meet the Medicare or Medicaid criteria for incentive payments

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RHC recruited as pilot site based relationship Their desires - support resolving challenges:

Increase patient throughput Resolve IT infrastructure issues Reduce no-shows Decrease time wasted looking for patient-information Increase point of care documentation Improve reporting and management of chronic/preventive

care Command attention from the vendor

Additional observations: Improve staff satisfaction related to EHR use and adoption Improve communication between clinicians and staff

Recommendation focusing on three key areas: 1. Patient throughput

Ensure the E H R supports patient flow Encourage point of care documentation(at least meaningful use

documentation) Reduce patient waiting time

2. User experience Improve system performance – uptime and speed Consistency in documentation and work steps Arrange training for all E H R Users Improve document management and scanning process

3. Data reporting Enhance management reporting capabilities Decrease time spent in data collection activities Implement Meaningful Use tracking tool

Top 3 Priorities were determined after consulting with staff and physicians

Address the issues related to point of care documentation

Command attention from vendor leadership Coordination between IT vendor and practice Practice administrator hired Training on certified version Adopting modified workflow - define process and role Conclusion – total value of REC is TBD but one Physician

reduced the time of chart completion from two weeks to one day

Continuing Education and Training for ALL Providers

Vendor Selection and Group Purchasing Group Purchasing Vendor Selection

EHR Implementation and Project Management Practice Workflow Analysis and Redesign

Practice Readiness Assessment Change Management Workflow Re-Design

Functional Interoperability and HIE Resources for Health Information Exchange Security Risk Analysis

Help Providers Achieve “Meaningful Use”

Website: http://ehrhelp.missouri.edu MO HealthNet EHR Incentive Program

website: http://www.dss.mo.gov/mhd/ehr

CMS EHR Incentive Program website: https://www.cms.gov/EHRIncentivePrograms

HIT Assistance Center E-Mail: EHRhelp@missouri.edu

Phone: 1-877-882-9933