Meaningful What?

Electronic Medical Record and Health

Information Technology Initiatives:

The New Primary Care Practice

Christoph U Lehmann, MD

Disclosures

Disclosure: Pediatric Informatics

Disclosure: Applied Clinical Informatics

Sources Medicare and Medicaid Programs; Electronic Health Record Incentive Program - Notice

of Proposed Rule Makinghttp://edocket.access.gpo.gov/2010/pdf/E9-31217.pdf

Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology - Interim Final Rulehttp://edocket.access.gpo.gov/2010/pdf/E9-31216.pdf

Diamond L, Bates M. Quality Metrics Requirements for Obtaining Meaningful Use: Developing a Plan for Implementation. HIMSS

Minnesota health: http://www.health.state.mn.us/e-health/hitech/ht052009faqprov.pdf

Koss on Care LLC, Presentation for Medicaid

HIMSS: One stop for all ARRA information www.himss.org/economicstimulus

ONC: http://healthit.hhs.gov

CMS: www.cms.hhs.gov

Tennessee Office of eHealth Initiatives

California Center for Connected Health

Dr. Joseph Schneider, Past-Chair, COCIT

Jennifer Mansour & Beki Marshall, AAP

Acronyms AQA – Ambulatory Care Quality Alliance

ARRA – American Recovery and Reinvestment Act (a.k.a. the ―stimulus bill‖)

CDS – Clinical Decision Support

CPOE – Computerized Provider Order Entry

EH- Eligible Hospital as defined by the CMS EHR Incentive Program

EHR – Electronic Health Record

EP – Eligible Provider as defined by the CMS EHR Incentive Program

HIE – Health Information Exchange

HIT – Health Information Technology

HITECH - Health Information Technology for Economic and Clinical Health Act

HQA – Hospital Quality Alliance

IFR – Interim Final Rule

MU – Meaningful Use

NPRM – Notice of Proposed Rule Making

NQF – National Quality Forum

ONC – The Office of the National Coordinator for Health Information Technology

PHI – Protected Health Information

PI – Process Improvement

PQRI – Physician Quality Reporting Initiative

RHQDAPU – Reporting Hospital Quality Data for Annual Payment Update

HIT at the AAP

1980 2010

1985

Formation of AAP Section on

Computers and Other Technologies

1991

Formation of Task Force

on Medical Informatics

2002

Merger of SCOT

and TFOMI

2006

Merged group renamed Council on

Clinical Information Technology

2009

Establishment of

Child Health

Informatics Center

AAP Council on Clinical Information

Technology (COCIT)

600 members with special interest or training in applyingHIT to pediatrics

11-member Executive Committee

AAP Policy development

Web and educational resources

Six years ago...

10

George W. Bush, April 26,

2004

“…Within 10 years, every American must have a personal electronic medical record.

That's a good goal for the country to achieve.

The federal government has got to take the lead in order to make this happen..”

ARRA Legislation

• Passed & signed Feb 2009

• Anticipated HIT spending

• US $ 45+ Billion

• Stage One ―Meaningful Use‖

criteria July 2010

• STIMULUS BILL

A good Stimulus Bill

Increases confidence by

Promising spending

Promising better employment

Improving infrastructure

While spending as little money as

possible

Keeping the budget in check

Total Federal Health IT Spending (through ONC)

before HITECH:

$300,000,000

Total expected gross outlays through HITECH (up to):

$45,000,000,000

15,000% increase

Historical Look at Spending in Health IT

13

Source: http://www.kighealthcare.com/images/growth_chart.jpg (NextGen)

Meaningful Use 860+ page document for the Final Rule

Only STAGE ONE

15 core requirements

10 menu requirements

Quality Measures not pediatric friendly

Eligibility Challenges 20% Medicaid patient encounters

NEED for Advocacy and Advising Office of the National Coordinator

CMS

NEED for Education of Pediatricians

AAP Child Health Informatics Center

Authorized by AAP Board in October 2009

―Home‖ for health information technology

initiatives within the AAP

Medical Director Chris Lehmann, MD,FAAP ,Johns Hopkins University

Announced April 2010

Mission

HIT Advocacy for Pediatrics Congress, Office of the National Coordinator, CMS

etc.

Education Aid in EHR selection and implementation

Meaningful Use rule interpretation

Resources for pediatricians

Research & Development Influence EHR technology to be Child-Friendly

Collaborate with AAP partners in HIT

Child Health Informatics Center

May – September 2010

Education Chapter meetings

Publications

NCE activities

Resource Warehouse Meaningful Use Summaries

Regional Meaningful Use Resources

EHR evaluation tool

Advisory Board Creation

Collaboration ePros, PPI, COCIT, QuIIN (readiness assessment)

―The meaningful use framework will be about the goals of care, not the technology.”

―The HITECH Act makes clear that the adoption of records is not a sufficient purpose: it is the use of EHRs to achieve health and efficiency goals that matters.”

David Blumenthal, MDNational Coordinator, ONCIT

Meaningful Use

Periodic Survey: Pediatricians Use of EHRs

Basic – 19% (ALL 7 items) Fully functional – 6%(Basic + 11additional functions = ALL 18 items)

Patient demographics Highlights out-of-range lab results

Patient problem lists Clinical notes include medical history, follow-

up notes

Orders for prescriptions Orders for laboratory tests

Ability to view lab results Lab orders sent electronically

Ability to view imaging results Warnings of drug interactions,

contraindications

Patient medication lists Prescriptions sent to pharmacies

Clinical notes Orders for radiology tests

Radiology orders sent electronically

Electronic images returned

Guideline reminders (preventive)

Guideline reminders (chronic)

Improve quality, safety, efficiency and reduce disparities

Engage patients

Improve coordination of care

Ensure privacy and security of PHI

Improve population health and interact with public health programs

Meaningful Use - Objectives

HITECH's Framework for MU of EHRs

Blumenthal D. N Engl J Med. 2010 Feb 4;362(5):382-5.

Regional Extension Centers

$650 million under the HITECH Act

Creation of a network of up to 70 Regional Health Information Technology Extension Centers focusing initially on primary care providers in small

practices

offer advice on which EHR systems to purchase

assist physicians and hospitals in becoming meaningful EHR users.

Other HITECH Initiatives

Development of minimum capabilities that EHRs must meet in order to be "certified."

Certification process (DHHS)

Development of exchange capabilities within and across State jurisdictions ($560 million)

National infrastructure for health information exchange (Nationwide Health Information Network)

HITECH privacy protections under HIPAA

What is MU and who determines it?

There are three base requirements for ―meaningful use‖ identified in the new law, including:

Use of certified EHR technology.

Electronic exchange of health information

Use of EHR in reporting on clinical and other quality measures

Medicare & Medicaid (limited)

Certification Process NPRM

Released

Comments on NPRM

due (60 days)

Final Rule Released

(60 days to draft final

rule)

Final Rule effective (60

days after release)

Federal process to recognize

certification entities

established (60 days

after effective

date)

First certification

entities recognized by federal

government (60 days

after established)

Significant number of products

certified (6 months after first entity

recognized)

Hospitals select

products and establish

contracts (6 month

process)

Vendor places

hospital on schedule (6 month wait

time)

Installation (18 to 24 month

process)

Achieve meaningful use for the first time (90 day

reporting period)

Timeline for Meaningful Use

Mar 2010

May 2010

July 2010

Sep 2010

Nov 2010

Jan 2011

June 2011

July –Dec 2011

Jan –June 2012

July 2012 - Dec 2013

Jan –Mar 2014

Incentive program starts – FY 2011

Amount of incentive drops

for newly eligible hospitals – FY

2014

Penalties begin – FY 2015

FINAL RULE

First Certifications

Certification Process Two Certification Programs

TEMPORARY certification program to test and certify Complete EHRs and/or EHR Modules (until Q1 2012)

Assuring the availability of Certified EHR Technology prior to the date on MU incentives are available

Permanent certification program to replace the temporary certification program

Separate the responsibilities for performing testing and certification

Introduce accreditation requirements

Establish requirements for certification bodies authorized by the National Coordinator related to the surveillance of Certified EHR Technology

Three Certifying Agencies

21 Certified products as of Oct 1, 2010

What health care professionals are

eligible for MU incentives?

Under the HITECH Act, an eligible professional is defined as, ―a physician, as defined in section 1861(r)‖ of the Social Security Act. These professionals include: Physicians

Dentists

Podiatrists

Optometrists

Chiropractors

Under Medicaid also:

Nurse Practitioners (NPs)

Certified Nurse-Midwives (CNMs)

Dentists

Medicare & Medicaid Programs: EHR

Incentive Program

Defines eligible hospitals (EHs) and eligible

professionals (EPs)

Establishes payment years & reporting

periods

Creates 3 Stages of implementation;

Provides details on Stage 1 goals and

requirements— covering 2011 and 2012.

What is required for MU?

Provider

must use the certified EHR as the primary

record of care for patients

reports certain clinical quality measures to

CMS (or the State under Medicaid)

provides certain attestations regarding

EHR use.

How will physicians prove MU?

Demonstration of meaningful use and

information exchange may be satisfied

by:

an attestation

submission of claims with appropriate coding

survey response

reporting of clinical quality measures

Eligibility Under Medicaid Any Provider with a National Provider Identifier

who over a continuous, representative 90-day period in the calendar year prior to reporting

has at least 30% of all patient encounters

is a PEDIATRICAN and has at least 20% of all patient encounters

with Medicaid patients

Eligibility Under Medicaid 2 Any Provider for whom at least 50% of patient

encounters over a 6-month period occur in a Federally-Qualified Health Center (FQHC) or

Rural Health Center (RHC)

with at least 30% of patient encounters from individuals who: Receive medical assistance from Medicaid or CHIP;

Are furnished uncompensated care by the provider;

Are furnished services at no cost or reduced cost according to a sliding-scale determined by the individual’s ability to pay.

One of many emails..“ I'm a pediatrician in a 6 man group in the suburbs of

Chicago…

We were an early adopter of the XYZ EHR, based on the promise of reimbursement. Unfortunately, … with the unrealistic requirements of populations composed of 20% Medicaid …, we would have no chance to participate. … I have been repeatedly assured that provisions will be made for pediatricians to allow us to participate. ….

Right now, I feel as if we have wasted the over $100,000 for the system as well as the countless hours I've put in to the system to make it more usable for us.

I'm hoping you can offer some advice as to our next steps…”

Being a pediatrician has some

advantages:

No penalties for Medicaid participants

Medicare providers will experience penalties

as early as 2015

Implementation may start later

Medicaid Providers

Users of Certified EHR Technology in 2011

Do NOT need to demonstrate – Attestation ONLY!

Earliest Payment:

Register – January 2011

Attest – April 2011

Payment – May 2011

Stage Focus Date

Range

Stage 1 Electronic data capture, track & communicate

key conditions, CDS, quality measure &

public health data reporting

Starting

in 2011

Stage 2 expands on stage 1, covers disease

management dimensions, information

exchange in the most structured format

possible (CPOE and Diagnostic Study

Results like Labs & Rads)

Starting

in 2013

Stage 3 promotes improvements in quality, safety &

efficiency as well as population health,

focuses on CDS for national high priority

conditions & Patient self management tools

Starting

in 2015

MEDICARE Stages Start Dates

First Payment

Year

Payment Year

2011 2012 2013 2014 2015

2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3

2012 Stage 1 Stage 1 Stage 2 Stage 3

2013 Stage 1 Stage 2 Stage 3

2014 Stage 1 Stage 3

2015 Stage 3

1st payment year - EHR reporting period means any continuous 90-day period with meaningful use of certified

EHR technology

2nd payment year and subsequently - EHR reporting period means the entire payment year

Medicaid Providers

Year 1 and 2 – Stage 1 only

Year 3 – MUST meet criteria in effect

If 2012 is Year 1

providers will have to jump to Stage 2 in 2014

providers will have to jump to Stage 3 in 2015

If 2013 is Year 1

providers will have to jump to Stage 3 in 2015

States cannot leverage penalties

Start Date as late as 2016 (Medicare

starts penalties in 2015)

Medicaid Payments

Providers (30% Medicaid volume) up to 85% of ―net average allowable costs‖

related to EHR purchase, updates, training, implementation, and maintenance

Payment capped at $21,250 for payment year 1 and $8.500 for Years 2-6

Pediatricians (Medicaid volume of 20-29%)

Payment capped is $14,167 in Year 1 and $5,667 in Year 2-6

Payment Amount for Medicaid

Professionals

Cap on Net Average Allowable Costs

(HITECH Act)

Up to 85 percent

For Eligible

Professionals

Max Cumulative

Incentive over 6-

years

$25,000 in Year 1 for most professionals $21,250

$63,750$10,000 in Years 2-6 for most professionals $8,500

$16,667 in Year 1 for pediatricians (> 20 percent and

<30% Medicaid patient volume)

$14,167

$42,500

$6,667 in Years 2-6 for pediatricians (> 20

percent and <30% Medicaid patient volume)

$5,667

Nothing in the Act excludes

such payments from taxation or

as tax-free income!

Payments For Medicaid EPs (>30% Patient Volume)

Calendar

YearMedicaid EPs who begin adoption in

2011 2012 2013 2014 2015 2016

2011 $21,250

2012 $8,500 $21,250

2013 $8,500 $8,500 $21,250

2014 $8,500 $8,500 $8,500 $21,250

2015 $8,500 $8,500 $8,500 $8,500 $21,250

2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250

2017 $8,500 $8,500 $8,500 $8,500 $8,500

2018 $8,500 $8,500 $8,500 $8,500

2019 $8,500 $8,500 $8,500

2020 $8,500 $8,500

2021 $8,500

TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750

Payments For Medicaid EPs (>20% and <30% Patient Volume)

Calendar

YearMedicaid EPs who begin adoption in

2011 2012 2013 2014 2015 2016

2011 $14,167

2012 $5,667 $14,167

2013 $5,667 $5,667 $14,167

2014 $5,667 $5,667 $5,667 $14,167

2015 $5,667 $5,667 $5,667 $5,667 $14,167

2016 $5,667 $5,667 $5,667 $5,667 $5,667 $14,167

2017 $5,667 $5,667 $5,667 $5,667 $5,667

2018 $5,667 $5,667 $5,667 $5,667

2019 $5,667 $5,667 $5,667

2020 $5,667 $5,667

2021 $5,667

TOTAL $42,500 $42,500 $42,500 $42,500 $42,500 $42,500

Medicaid Incentive Program

Enrollment

NPI (National Provider Identifier)

Business address and phone

Taxpayer Identification Number

SSN (payment to individual)

EIN (payment to practice)

Decision on participation through Medicare or

Medicaid

If Medicaid – State selected (choose ONE state if

participating in more than on Medicaid program)

Stage 1: Goals for Meaningful Use

Provide access to comprehensive patient health data for patient’s healthcare team.

Use evidence-based order sets and computerized provider order entry (CPOE).

Apply clinical decision support at the point of care.

Generate lists of patients who need care and use them to reach out to those patients.

Report information for quality improvement and public reporting.

Meaningful Use Criteria

Stage 1

Core set (15) Providers must meet ALL criteria in the core set

Menu Set (10) Providers must meet 5 of the menu set

States may modify criteria ONLY related to Public health

Registries

Core Set

1. Use CPOE

Denominator: Unique patients with at least

one medication

Numerator: Number of patients with at least

one medication order in CPOE

Goal: >30%

Core Set

2. Drug-Drug & Drug-Allergy Check

Functionality enabled 100% of the time

3. ePrescribing

Denominator: permissible prescriptions

Numerator: prescriptions transmitted

electronically using the EHR

Goal: >40%

Core Set

4. Record Demographics

Preferred Language, Gender, Race,

Ethnicity, Date of Birth

Denominator: Unique patients

Numerator: Patients with recorded

demographics

Goal: >50%

Core Set

5. Up to date Problem List

6. Active Medication List

7. Active Medication Allergy List

Denominator: Unique patients

Numerator: Patients with 1+ entry

Goal: >80%

Core Set

8. Recording of Vital Signs

Height, weight, blood pressure, body mass

index, growth chart (including BMI)

Denominator: Unique Patients >= 2 years

Numerator: patients with recorded height,

weight, blood pressure as structured data

Goal: >50%

Core Set

9. Recording of Smoking Status

Denominator: Unique Patients >= 13 years

Numerator: patients with recorded smoking

status

Goal: >50%

Core Set

10. Clinical Decision Support

Implement one CDS rule

11. Report Ambulatory Clinical Quality

Measures

2011 – attestation

2012 – electronic submission

Discussed later in detail

Core Set

12. Electronic Copy of Health Information

Diagnostic test results, problem list,

medication list, medication allergy list

Denominator: All unique patients who

requested a copy

Numerator: Patients who received a copy

within 3 business days

Goal: >50%

Core Set

13. Clinical Summary

May include updated medication list, test

results, procedures and instructions

Denominator: All unique patients

Numerator: Patients who received a Clinical

Summary within 3 business days

Goal: >50%

Core Set

14. Capability to exchange key clinical

information

Perform >=1 test of EHR’s capacity to

exchange electronically

15. Protect EHR information

Security risk analysis, implement security,

correct deficits

Menu Set - select 5

1. Implement drug-formulary checks

Functionality enabled and access to 1 or more formularies

2. Incorporate Lab results

>40% of laboratory results are incorporated in EHR

3. Patient List by Condition

Generate >= 1 report of patients with a specific condition

Menu Set - select 5

4. Patient Reminders for Preventive/Follow-Up Care

>20% of patients >=65 years or <=5years received an appropriate reminder

5. Timely Electronic Access

>10% of unique patients are provided electronic access to health information within 4 business days Providers may withhold information

Menu Set - select 5

6. Patient Specific Resources

>10% of unique patients are provided patient specific resources (using EHR technology)

7. Medication Reconciliation

Medication Reconciliation is performed >50% of transitions of care to the provider

8. Summary of Care Document

>50% of transition of care or referrals include a summary of care record

Menu Set - select 5

9. Data Transmission to Immunization

registries/Information Systems

Perform 1 or more tests to test EHR’s capacity to

submit Immunization data

Submit if registry has the ability to accept data

10. Data Transmission of Syndromic Surveillance

Data to Public Health Agencies

Perform 1 or more tests to test EHR’s capacity to

submit Syndromic Surveillance data

Submit if public health agency has the ability to

accept data

Measures

―In order for an EP or an eligible hospital

to demonstrate that it meets these

proposed objectives, we believe a

measure is necessary for each objective‖

MU Measurement

Even though incentives are paid by

Medicare or Medicaid, the requirements

for MU apply to ALL patients.

MU measurements are based on a

percentage of ALL patients

Measure Reporting

Pediatricians required to report

3 ―core‖ measures

3 ―alternate core‖ measures

If the denominator is 0 for any core measure

-> replace with alternate core measures

If the denominator is 0 for all core and

alternate core measures -> report on 3 of the

―additional‖ measures

% of patient visits for patients aged 18 years and older with a

diagnosis of hypertension who have been seen for at least 2 office

visits, with blood pressure (BP) recorded.

% of patients 18 years of age and older who were current smokers

or tobacco users, who were seen by a practitioner during the

measurement year and who received advice to quit smoking or

tobacco use or whose practitioner recommended or discussed

smoking or tobacco use cessation medications, methods or

strategies.

% of patients aged 18 years and older with a calculated BMI in the

past six months or during the current visit documented in the

medical record AND if the most recent BMI is outside parameters,

a follow-up plan is documented.

Core Measures

Recording of BP in Hypertension

Smoking Cessation

Follow-up plan in patients with

abnormal BMI

Alternate Core Measures % of patients 2-17 years of age who had an outpatient visit with a

Primary Care Physician (PCP) or OB/GYN and who had evidence

of BMI percentile documentation, counseling for nutrition and

counseling for physical activity during the measurement year.

% of children 2 years of age who had 4 diphtheria, tetanus and

acellular pertussis (DTaP); 3 polio (IPV), 1 measles, mumps and

rubella (MMR); 2 H influenza type B (HiB); 3 hepatitis B (Hep B); 1

chicken pox (VZV); 4 pneumococcal conjugate (PCV); 2 hepatitis A

(Hep A); 2 or 3 rotavirus (RV); and 2 influenza (flu) vaccines by

their 2nd birthday.

The measure calculates a rate for each vaccine and 9 separate combination

rates.

% of patients aged 50 years and older who received an influenza

immunization during the flu season (September through February).

Recording of BMI, Nutrition &

Exercise counseling

Complete immunization at Age 2

Influenza shot in flu season

Additional Measures % of patients aged 5 through 40 years with a diagnosis of mild, moderate,

or severe persistent asthma who were prescribed either the preferred long-

term control medication (inhaled corticosteroid) or an acceptable

alternative treatment.

% of patients aged 5 through 40 years with a diagnosis of asthma and

who have been seen for at least 2 office visits, who were evaluated during

at least one office visit within 12 months for the frequency (numeric) of

daytime and nocturnal asthma symptoms.

% of children 2-18 years of age, who were diagnosed with pharyngitis,

dispensed an antibiotic and received a group A streptococcus (strep) test

for the episode.

The % of adolescent and adult patients with a new episode of alcohol and

other drug (AOD) dependence who initiate treatment through an inpatient

AOD admission, outpatient visit, intensive outpatient encounter or partial

hospitalization within 14 days of the diagnosis and who initiated treatment

and who had 2 or more additional services with an AOD diagnosis within

30 days of the initiation visit.

Long-term control treatment in

Asthma patients

Evaluation of Asthma symptoms

in Asthma Patients

Strep A test in Patients

prescribed Abx for Pharyngitis

Treatment for new diagnosis of

dependence

Additional Measures % of patients, regardless of age, who gave birth during a 12-month period who were

screened for HIV infection during the first or second prenatal care visit.

% of D (Rh) negative, unsensitized patients, regardless of age, who gave birth during

a 12-month period who received anti-D immune globulin at 26-30 weeks gestation.

% of women 15- 24 years of age who were identified as sexually active and who had

at least one test for chlamydia during the measurement year.

% of patients 5 - 50 years of age who were identified as having persistent asthma and

were appropriately prescribed medication during the measurement year. Report 3 age

stratifications (5- 11 years, 12-50 years, and total).

% of patients 18 - 75 years of age with diabetes (type 1 or type 2) who had

hemoglobin A1c > 9.0%.

% of patients 18-75 years of age with diabetes (type 1 or type 2) who had LDL-C <

100mg/dL).

% of patients 18 - 75 years of age with diabetes (type 1 or type 2) who had blood

pressure <140/90 mmHg.

% of patients aged 18 years and older with a diagnosis of heart failure and left

ventricular systolic dysfunction (LVSD) (LVEF < 40%) who were prescribed ACE

inhibitor or ARB therapy.

HIV screening in pregnancy

Rhogam in Rh neg, unsensitized patients

Chlamydia test in sexually active women

Appropriate medication Rx in persistent Asthma patients

Additional Measures % of patients aged 18 years and older with a diagnosis of coronary artery disease (CAD)

and prior myocardial infarction (MI) that were prescribed beta-blocker therapy.

% of patients 65 years of age and older who have ever received a pneumococcal vaccine.

% of women 40-69 years of age who had a mammogram to screen for breast cancer.

% of adults 50-75 years of age who had appropriate screening for colorectal cancer.

% of patients aged 18 years and older with a diagnosis of CAD who were prescribed oral

antiplatelet therapy.

% of patients aged 18 years and older with a diagnosis of heart failure who also have

LVSD (LVEF < 40%) and who were prescribed betablocker therapy.

The % of patients 18 years of age and older who were diagnosed with a new episode of

major depression, treated with antidepressant medication, and who remained on an

antidepressant medication treatment.

% of patients aged 18 years and older with a diagnosis of primary open angle glaucoma

(POAG) who have been seen for at least 2 office visits who have an optic nerve head

evaluation during one or more office visits within 12 months.

% of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a

dilated macular or fundus exam performed which included documentation of the level of

severity of retinopathy and the presence or absence of macular edema during one or more

office visits within 12 months.

•Meaningful Quality Reporting Measures for Pediatrics

are limited

•Reporting Measures are of limited use to Sub-specialists

•Many measures could have been expanded to include

pediatric patients

Are you hooked yet?

23% Do Not Intend To Pursue Stimulus

Incentives

Source: Texas Medical Association survey, 2009

17% Do Not Plan On An EMR

Source: Texas Medical Association survey, 2009

What’s the Problem With EMRs?

Source: TMA survey, 2009

So – what to do? Certified EHR – talk to your vendor!

National Provider Identifier

Choose Medicaid Program

AAP is monitoring resources for YOU! ONC

RECS

Local & State

Meaningful Use Resources

http://derm.med.jhmi.edu/AAP_MU/

Documentation Challenge

Pediatric EMR Rating:

www.aapcocit.org/emr

EMR Product Comparison

AllScripts (2.7 – 3 reviews) Peak Practice (5 - 1 rev)

e-MDs (4.7 – 3 reviews) MedInformatix (No Ratings)

GE Centricity (3.2 – 5 revs) NextGen (2.3 – 11 revs)

eClinicalWorks (3.7 – 7 revs) Practice Partner (3 – 2 revs)

AHRQ – Model EHR Development

$4.7M – 2 year project – Limited eligible bidders

AAP Subcontract from Westat

Technical Expert Panel

Environmental scan - content experts

Evaluation of existing EHRs

Development of model EHR format

Dissemination of model (QuINN, CAQI, COCIT)

Development of 3 new component/modules

AAP - Model EHR – Informatics Team

Stephen Downs

Williams Adams

Chris Lehmann

Kevin Johnson

Andrew Spooner

Ken Mandl

COCIT - Joe Schneider, Jeannie Marcus

NACHRI - Aileen Sedman, Feliciano Yu

APQ - Joy Kuhl

AAP - Model EHR – HIT Issues EHR Design

Vocabulary Standards

Human Computer Interface

Privacy and Security

Communication Standards

ePrescribing

Medication Safety and Mgmt

Implementation

Ambulatory Care

Inpatient Care

Personal Health Records

Registries

Health Information Exchange

Public and population health

Prenatal Care

Newborn Screening

Growth and Development

Immunizations

Quality Improvement

Clinical Decision Support

AAP - Model EHR – Policy Issues

Confidentiality and adolescent services

Medical Home

Foster care

School and community agencies information

Newborn metabolic and hearing screenings

Quality improvement and measurement

Guidelines integration

Plain language/literacy

CHIC Collaborations

Council on Clinical Information Technology

Federal Affairs Office

AAP Quality Activities Steering Committee on Quality Improvement and Management (SCOQIM)

Partnership for Policy Implementation (PPI)

Chapter Alliance for Quality Improvement (CAQI)

Quality Improvement Innovation Network (QuIIN)

Internal and External Collaborative Activities Alliance for Pediatric Quality (APQ)

CHIC Future Plans

Grant applications

Continued Member Education

Evaluate potential for web services

Contribute to future MU discussion / Advocacy

Evaluate QuIIN members' readiness for MU

AAP Staff

Jennifer Mansour Manager, Health Information Technology Initiatives

Beki Marshall Manager, HIT

Education and Implementation

Vanessa Shorte Program Manager, Child Health Informatics Center

Sunnah Kim, RN, MS, CPNP Director, Division of Practice

Ed Zimmerman, MS Director, Department of Practice

Dan Walters Division of State Governemnt Affairs,

DOCCSA

Bob Hall, JD Assistant Director,

Department of Federal Affairs

Jonathan Klein, MD, MPH Associate Executive Director

Meaningful Use

Thank you!

Christoph U. Lehmann, MD, FAAP

Director, Child Health Informatics Center

American Academy of Pediatrics

clehmann@jhmi.edu