Optimizing your EHR Valuethrough Patient Engagement

Judy Murphy, RN, FACMI, FHIMSS, FAAN Deputy National Coordinator for Programs and Policies, ONC

HIMSS 2012Physician IT Symposium

Conflict of Interest DisclosureJudy Murphy, RN, FACMI, FHIMSS, FAAN

Has no real or apparent

conflict of interest to report.

Objectives

• List the Stage 1 and Stage 2 Meaningful Use objectives that fall under the National Patient Priority of "Engaging Patients and Families"

• Describe ways in which physicians can use HIT to facilitate patients and families to become an integral part of the care team

• Identify ways for physicians to prioritize use of PHRs, including consumer portals for improving access to healthcare and engaging with consumers in managing their health

• ONC Program Update

2

Back in the Day…

“The obedience of a patient to the prescriptions of his physician should be prompt and implicit. [The patient] should never permit his own crude opinions as to their fitness to influence his attention to them.”

-- AMA’s Code of Medical Ethics (1847)

3

And Now…

“Patients share the responsibility for their own health care….”

--AMA’s Code of MedicalEthics (current)

4

“Patients can help. We can be a second set of eyes on our medical records. I corrected the mistakes in my health record, but many patients don't understand how important it will be to have correct medical information, until the crisis hits. Better to clean it up now, not when there’s time pressure.”

– Dave deBronkart (ePatient Dave)

Why Should You Use Health IT to Engage Your Patients?

• Patient as Partner

• Engaged patients demonstrate better health outcomes

• Patients increasingly expect engagement via IT, as in many other aspects of their lives

• Meaningful Use criteria

5

66% of Americans say they would consider switching to a physician who offers access to medical records through a secure Internet connection – according to a 2011 Deloitte Survey

Stage 1 Final Rule HITPC Proposed Stage 2Key: Red indicates proposed change based on HITPC 5/11 comments

EH:Provide >50% of all discharged

patients patients with an electronic copy of their discharge instructions

Hospitals: ≥ 25 patients receive electronic discharge instructions at time of discharge

Hospitals: 10% of patients/families view and have ability to download [took out “relevant”]

information about a hospital admission; information available for all patients within 36 hours

of the encounter

EH Menu: Provide >10% of all unique

patients with timely electronic access to health information (EP)

Move to Core: EPs: >10% of patients/families view & have ability to download their

longitudinal health information; information available to all patients within 24 hours of an

encounter (or within 4 days after available to EPs) [P&S TT to consider whether a P&S

warning should be put in S&C criteria]

EP:Provide Clinical Summaries to

patients for >50% of all office visits within 3 business days

EPs: patients are provided a clinical summary after 50% of all visits, within 24 hours

(pending information, such as lab results, should be available to patients within 4 days of

becoming available to EPs; (electronically accessible for viewing counts)

EP Menu: Use certified EHR

technology to identify patient-specific educational resources and provide to

patient if appropriate for >10% of all

unique pts.

Move to Core: Both EPs and hospitals: 10% of patients are provided with EHR-enabled

patient-specific educational resources; make core; take out “if appropriate” instead of raising

threshold

EPs: patients are offered secure messaging online and at least 25 patients have sent secure

messages online

EPs: Patient preferences for communication medium recorded for 20% of patients

Stage 3: Provide mechanism for patient-entered data (supply list); consider “information

reconciliation” for stage 3 to correct errors

Stage 1 and Draft Stage 2 MU ObjectivesFrom the June 8, 2011 HITPC Meeting

Engaging Patients and Families

6

How can you use Health IT to Support Patient Engagement?

Within the clinical encounter

Between clinical encounters

7

Within the Clinical Encounter

8

Some Relevant Information

2011 ONC-funded survey & focus group research on EHRs (by Mathematica): • Most patients have favorable perceptions of EHRs• Majority believe EHRs improve quality of care• < 5% lack confidence in security of EHRs• < 10% feel computer in exam room negatively impacts interaction/quality of care

Top perceived benefits of EHRs: • Convenience to patients• < Efficiency and accuracy of recording information and tracking patient progress• Better coordination of care

Top perceived potential drawbacks of EHRs:• System breakdowns• Privacy concerns• Inability to completely eliminate human error• Inability of systems to communicate with each other

What You Can Do

• Arrange the exam or hospital room so you and the patient can both see the computer screen/device

• Sit at the same height as or lower than the patient to make them feel at ease

• During the transition from paper, explain that you’re still learning and there may be some bumps while your practice is “under construction”

• Less important than any technology is the sense of connection you create through empathy, posture, gesture and tone of voice (It’s not about the EHR!)

• Customize delivery of information to the patient -electronic copy of discharge instructions and summary of care

• Advocate for use of portal/PHR during clinic encounter or hospitalization

9

Between Clinical Encounters

Some Relevant Information

• Approximately 50 million Americans (roughly 20%) have accessed their health information online . (Manhattan Research, 2011)

• More than half (52%) of Americans say they would use a smart phone or PDA to monitor their health if they were able to access their medical records and download information about their medical condition and treatments. (Manhattan Research, 2011)

• 26% of Americans use mobile phones for health. This has more than doubled since the previous year. (Manhattan Research, 2011)

• Remote patient monitoring is expected to grow by 25% per year (Kalorama Information, 2011)

10

What You Can Do

• Use electronic reminders to help patients schedule a screening or regular checkup

• Communicate via e-mail (or text) using recommended best practices (See next slide)

• Participate in health information exchange activities –EHRPHR, EHREHR, EHRpublic health, etc.

• Improve care coordination between all care venues -hospitals, clinics, physicians, home care, pharmacies

11

• “Patient as Partner” - increase patient accountability for and participation in their own health and wellness care

• Give patients easy, electronic access to their own health information (portal, “blue button”, tethered PHR)

• Encourage patients to look at their information and ask questions, help identify and fix data quality issues

Best Practices forProvider eMail Use*

• Establish a turnaround time for messages (don’t use for urgent matters)

• Talk to patients re privacy issues, such as who will see the messages

• Use subject lines to help filter (e.g. “prescription”)

• Configure automatic reply to acknowledge receipt of message

• Save and file e-mails in a folder for each patient

• Make sure the patient's name and yours are on each message

• Be careful about sending messages to more than one patient at a time (they may see each other’s e-mail addresses)

• Do not deliver bad news via e-mail

• Establish clear guidelines patients should use, and remind them when they do not adhere to them

* Developed by Danny Sands, MD and Beverly Kane, MD for the AMIA Internet Working Group (this is a partial list)

12

ONC Consumer Pledge Program

13

Join ONC’s Pledge Program! www.healthit.gov/pledge

ONC’s Consumer Pledge Program is designed to support organizations that are working to empower individuals to be partners in their own health and health care.

There are two types of pledges:

1. Data holders -- Make it easier for individuals to get secure electronic access their health info (through Blue Button or Direct) – and encourage them to do it.

2. Non-data holders – Spread the word about the importance of getting access information, and develop tools to make that information actionable.

Pledge Program

14

More than 250 organizations have taken the Pledge. Collectively, they will provide access to personal health information to 100 million (1/3 of) Americans…

Benefits of Pledge Program

• Public recognition of consumer access to/use of information efforts

• Opportunities to network and partner with other organizations who share a similar goal of greater consumer engagement in health

• A forum to elevate issues and provide input on policy barriers/challenges for the federal government to address

• Input into the development of and access to materials/tools to spread the word

• Opportunities to exchange best practices and learn from leaders in consumer engagement

15

Pledge Participation…

16

To learn more or to take the pledge: www.healthit.gov/pledge

ONC Program Update

• ONC Websites

• Putting the “I” in Health IT Campaign

• Meaningful Use Update - Attestation Activity

• AHA Survey – Health IT Supplemental Questions

• Health IT Resource Center

• Health Information Exchange

• Beacon Communities

• Workforce Training

• The HITECH Story and Three Part Aim17

HealthIT.hhs.gov website

18

19

HealthIT.gov website

19

http://www.healthit.gov/buzz-blog/from-the-onc-desk/consumer-health-information/20

Health IT Buzz Blog

20

21

22

ePatient Dave Cancer Survivor and Proud Father23

Nikolai “Koyla” Kirienko Crohn’s Disease Patient and Trailblazer24

Lillianne Smith Diabetes Patient and Loving Mother25

Donna Cryer Liver Transplant Survivor and Style Maven26

HITECH Framework forMU of EHRs

Taken from: Blumenthal, D. “Launching HITECH,” posted by the NEJM on 12-30-2009.

27

Meaningful Use Takes Off

28

– 52% percent of office-based physicians intend to take advantage of EHR incentives

– The percentage of primary care providers who have adopted EHRs in their practice has doubled from 20% to 40% between 2009 to 2011

– ONC’s Regional Extension Centers (RECs) have signed up more than 100,000 primary care providers

– This means that roughly one third of the nation’s primary care providers have committed to meaningfully using EHRs by partnering with their local REC. Momentum is building!

– Hospital adoption has more than doubled since 2009, increasing from 16% to 35%

– Most (85%) of hospitals intend to attest to Meaningful Use by 2015

2011 Medicare and Medicaid EligibleProvider EHR Incentive Payments

29

Source: Number of professionals registered and paid are from CMS EHR Incentive Program Data as of 12/31/2011.

Note: Figures reflect number of unique professionals who have registered or received a payment from either the Medicare or Medicaid EHR Incentive Payment Programs. Figures may be slightly different than the number of payments that have been made to eligible professionals by the programs.

30

Note: Figures reflect number of unique hospitals that have received a payment from either the Medicare or Medicaid EHR Incentive Payment Programs. Figures are different than the number of payments that have been made to eligible hospitals by the programs because hospitals can receive payments under both programs.

Source: Number of hospitals registered and paid are from CMS EHR Incentive Program Data as of 12/31/2011.

2011 Medicare and Medicaid EligibleHospital EHR Incentive Payments

2011 AHA Survey Data

31

13

16

19

35

8

10

14

27

23

4

9

0

5

10

15

20

25

30

35

40

2008 2009 2010 2011

Pe

rce

nt

of

ho

spit

als

At Least Basic At Least Basic (Rural Hospitals) Comprehensive

Key points – in one year, from 2010 to 2011:• Hospitals increased their use of Basic EHRs from 19% to 35% (84%)• Hospitals doubled their use of Comprehensive EHRs from 4% to 9% (125%)

AHA Survey – implementation %by state of at least Basic EHR

32

CCC SHARP

REC

Beacon

HIE

Health IT Resource Center

Work with external communities and shares

knowledge

Tools

Resources

Communities

of Practice

(CoPs)

Work with REC community and shares

knowledge

33

National Learning System

Collaboration

Portal

Knowledge Sharing

Network (KSN)

Training Services

Practice

Transformation

Support

Communities of

Practice (CoPs)

Customer

Relationship

Management

(CRM)

Tools &Support

for Adoption

and MU

Public Website

Learning

Systems

HITRC Resources

34

When will we see this Curve for Transition of Care Summaries or Lab Exchange?

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

Dec-0

6

Feb-0

7

Apr-

07

Jun-0

7

Aug-0

7

Oct-

07

Dec-0

7

Feb-0

8

Apr-

08

Jun-0

8

Aug-0

8

Oct-

08

Dec-0

8

Feb-0

9

Apr-

09

Jun-0

9

Aug-0

9

Oct-

09

Dec-0

9

Feb-1

0

Apr-

10

Jun-1

0

Aug-1

0

Oct-

10

Dec-1

0

Feb-1

1

Apr-

11

Jun-1

1

Number of e-Prescribers in US by Method of Prescribing

Stand-alonee-Rx System

EHR

Total

35

Health Information Exchange

51.953.1

54.0

40.742.0

28.5

33.7 34.3

18.019.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Patient Demographics Radiology Reports Lab Results Medication History Clinical Care Records

Pro

po

rtio

n o

f U

.S. H

osp

ital

s

Within system 2010 Outside system 2010

Hospital Exchange Activity with Ambulatory Care Providers

36

17 Beacon Communities

37

University of Hawaii at

Hilo

Southeastern Michigan

Health Association

Detroit, MI

Louisiana Public Health Institute

New Orleans, LA

Delta Health Alliance

Stoneville, MS

Geisinger Clinic

Danville, PA

HealthInsight

Salt Lake City, UT

Inland Northwest Health

Services

Spokane, WA

Community Services

Council of Tulsa

Tulsa, OK

Mayo Center Clinic

Rochester, MN

Rhode Island Quality Institute

Providence, RI

HealthBridge

Cincinnati, OH

Southern Piedmont

Community Care Plan

Concord, NCThe Regents of the

University of California

San Diego, CA

Western NY Clinical

Information Exchange

Buffalo, NY

Rocky Mountain HMO

Grand Junction, CO

Eastern Maine Healthcare

Systems

Brewer, ME

Indiana HIE

Indianapolis, IN

Sample Beacon Early Results

38

5.18

4.19

3.34

0.0

1.0

2.0

3.0

4.0

5.0

6.0

1 2 3

Ra

te (

pe

r 1

00,0

00

)

Measurement Period

Colorado Beacon ConsortiumUncontrolled Diabetes Admissions

(AHRQ PQI #14)

8592 94

0

10

20

30

40

50

60

70

80

90

100

1 2 3

Ra

te (

%)

Measurement Period

Bangor Maine Beacon CommunityCardiovascular Disease: Blood Pressure Control

(< 140/90 mmHg)

52 5458

0

10

20

30

40

50

60

70

80

90

100

1 2 3

Ra

te (

%)

Measurement Period

Utah IC3 Beacon CommunityDiabetes Control: HbA1c (575) < 8

Source: Self-reported data from Beacon Program Quarterly submission.

Community College ConsortiaWorkforce Program

• 5 regions

• $6 – $ 21 M per region

• April 2010 award

• 2 Years

• 10,500 to be trained

REGION A

REGION C

REGION B

REGION D

REGION E

39

Workforce Training Enrollment and Graduation

2104

1005 1370 1252 1398

813

1107

22533322

1441

375

720

750

917

1018

0

1,000

2,000

3,000

4,000

5,000

6,000

Bellevue(8 Colleges)

Los Rios(13 Colleges )

Cuyahoga(17 Colleges)

Pitt(20 Colleges)

Tidewater(22 Colleges)

Community College Students

November 2011

Successfully Completed* Actively Enrolled Dropped-out

Students Enrolled or Completed: 16,065Attrition Rate: 18%

* Enrollment to date includes unique students reported in December 2011 cycle

40

Community College Consortia

Students Enrolled and Students Completed(Cumulative)

0

5,000

10,000

15,000

20,000

25,000

Au

g-1

0

Sep

-10

Oct

-10

No

v-10

Dec

-10

Jan

-11

Feb

-11

Mar

-11

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-11

Enrolled Completed

21,022

7,129

41

In Summary … the HITECH Story

42

What is America doing to modernize its Healthcare System through Health IT?

How is ONC helping America modernize?

Why does America need to modernize using Health IT?

• Enable providers to securely and efficiently exchange patient health information.

• Give providers the right information, at the right time to offer their patients the right care.

• Give consumers tools to know their health information so that they can improve their health.

• Foundational to building a truly 21st century health system where we pay for the right care, not just more care.

-Promoting Standards & Interoperability (HIE)

- Stimulation Innovation (Beacon, Sharp)

- Helping Providers Adopt (REC, Workforce)

Accelerating Meaningful Use

Showing Outcomes

Protecting Privacy and Security

Keeping Patients Safe

Promoting Exchange

Engaging Consumers

2012

Health Information Technology

Improving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity.

Better healthcare

Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care.

Better health

Lowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries.

Reduced costs

$

Health IT lays the Foundation forNew Payment and Delivery Modelsto Enable the Three-Part Aim

43

Thanks!

Judy

Judy.Murphy@hhs.gov