EHR - Adoption

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Russell B Leftwich, MD
Chief Medical Informatics Officer Office of eHealth Initiatives, State of Tennessee

Failing to plan, is planning to fail.

Eligible providers and hospitals can receive incentives for meaningful use of certified EHR technology.

Missing information o Quality improvement o Care coordination o Computer decision support o Patient safety
o

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Engage patients and families in their health care

Improve care coordination Improve population and public health

Improve quality, safety, efficiency, and reduce health disparities

Meaningful Use

Maintaining privacy and security

Stage I
‡ Collect structured data electronically (coded)

Stage II
‡ Use data to improve quality at point of care ‡ Exchange data

Stage III
‡ Improve safety, quality, efficiency with decision support

Stage I
2011-2012

Stage II
2013-2014

Stage III
2015 and beyond

Defined by Final Rule published July 2010

Draft proposal released January 2011

think uncarved block of wood

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1.

Where do you want to be in the future?

2. 3.

Where are you now? What is the plan to get from #2 to #1?

Must complete: ‡15 core objectives ‡5 out of 10 from menu objectives ‡6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from menu set)

EPs ±15 Core Objectives 1. Computerized physician order entry (CPOE) 2. E-Prescribing (eRx) 3. Report ambulatory clinical quality measures to CMS/States 4. Implement one clinical decision support rule 5. Provide patients with an electronic copy of their health information, upon request 6. Provide clinical summaries for patients for each office visit
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7.

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10. 11.

Drug-drug and drug-allergy interaction checks Record demographics Maintain an up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list

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12. 13. 14.

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Record changes in vital signs Record smoking status > 13 yo Capability to exchange key clinical information among providers of care & patient-authorized entities electronically Protect electronic health information

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Drug-formulary checks Incorporate lab test results as structured data Lists of patients by specific conditions Send reminders to patients per patient preference for preventive/follow up care Provide patients with timely electronic access to their health information Use EHR technology to identify patient-specific education resources

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Medication reconciliation Summary of care record for each transition of care/referrals Capability to submit electronic data to immunization registries/systems* Capability to provide electronic syndromic surveillance data to public health agencies* * at least 1 public health objective

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EPs must report 3 core CQM, and if the denominator of a core measure is 0, then report results for up to 3 alternate core measures EPs also must select 3 additional CQM from a set of 38 additional CQM In sum, EPs must report on 6 total measures: 3 required core measures and 3 additional measures

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Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention Adult Weight Screening and Follow-up

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Weight Assessment and Counseling Children and Adolescents Influenza Immunization for Patients Years Old or Older Childhood Immunization Status

for

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Must complete: ‡15 core objectives ‡5 out of 10 from menu objectives ‡6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from menu set)

Paper elimination ` Charge capture ` Remote access ` Patient recall & scheduling ` Diagnostic test ordering ` ePrescribing ` High risk patient identification ` Patient Centered Medical Home
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Discrete data ` Data element has a defined value or set of values ` Necessary to create interoperability and enable information exchange
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«.. incentives for using certified EHR technology in a meaningful way «..

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Who developed the certification criteria? Office of National Coordinator Who is going to do the certifying? Organizations that have applied/qualified
x ATCB ± includes CCHIT x not to be confused with CCHIT 2011 certification

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Where do we find out what EHR is certified? ONC web site will list - CHPL How many are certified so far?
150+ complete ambulatory EHRs as of March 2011 50 + certified modules

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Certification is not about usability Only assures that the criteria can be met 44 potential Clinical Quality Measures
Listed with check boxes Some complete EHRs enabled for fewer than 10

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Additional software required

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It¶s not about picking a piece of software

It¶s about transforming your practice

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Identify a physician champion & leader Use formal project management tools Establish timeline that is informed & adequate Change management & practice re-engineering
process mapping of current workflows redesign of workflows for EHR begin training early ± computer skills, redesign

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Practice readiness assessment Involve everyone from the beginning

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That¶s all for now.

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