Mu Presentation Jitesh Chawla
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Transcript of Mu Presentation Jitesh Chawla
Focus on Logistic Concerns In Physician Practices
By: Jitesh Chawla, MD
Chief Medical Information Officer
Patagonia Health, Inc.
SATISFYING MEANINGFUL
USE REQUIREMENTS
IMPORTANCE OF THIS DISCUSSIONFacilitators to Broad Adoption of Health IT
TOPICS TO COVER
1 Quick recap of MU
2. Common Concerns regards to achieving MU objectives
3. Solutions to these Concerns
4. Where MU fits into regular care
5. Why change is difficult
WHERE MEANINGFUL USE CAME FROM AND
WHY THE FEDS CARE ABOUT THIS
Social Security Act
ARRA (stimulus bill)
HITECH
Coordination of Care
Safety, Quality and Efficiency
Patient Engagement
Health Status of Populations
Privacy and SecurityFive Key Goals in the US
Healthcare System
(Hersh, 2010)
HOW DOES THIS INCENTIVE PROGRAM WORK?
• Usage of the electronic health record
• Certification through accreditation bodies
• Compliance tracked through CMS
• Money given through EHR incentive program
HOW MUCH MONEY CAN I GET?
(source: CMS)
• Under Medicare: Maximum of $42,000
• Under Medicare in areas of shortage: Maximum of $4,400
• Under Medicaid: Maximum of $63,750
AM I ELIGIBLE? (SOURCE: CMS)
MedicareDoctor of Optometry,
Doctor of Podiatry,
Chiropractor
MedicaidNurse Practitioners,
Certified Midwives,
Physician Assistants
in FQHC or RAC
Doctor of Medicine
Doctor of Osteopathy
Doctor of Dentistry
or Dental Surgery
WHO ARE THE KEY PLAYERS AND HOW AM I
AFFECTED?
EHR Implementation
ATCBs
RECs CMS
STAGES OF MEANINGFUL USE(SOURCE: CMS)
Stage 1
• Data Capture and Sharing
• 2011-2013
Stage 2
• Advanced Clinical Processes
• 2013-2015
Stage 3
• Improved Quality Measure Reporting
• 2015 and Beyond
ACHIEVING THE OBJECTIVESCommon Concerns Include:
Cost of EHR (NEJM, 2009) or MU implementation
1. Cuts other costs 2. Plans starting to reimburse for using EHR
Hampering proper workflow (CSC, 2009)
1. EHRs organize
a. Partitioned chart b. Codified data
2. Improves efficiency
a. Allows multiple users b. Decision Support
c. Documentation at point of care d. Smart text
ACHIEVING THE OBJECTIVES
Not enough staff
1. Auto populated data
2. Provider main user
Too complicated (HIMSS, 2010)
1. Data prompting
2. Help screens / IT support
3. MU compliant EHR
CASE EXAMPLE: CORE OBJECTIVE 12
(PAPER BASED VS. EHR)
Task or Constraint Paper Based Using EHR
Gathering information Multiple charts, staff time Click of a button
Compiling information Staff time, prone to error Click of a button
3 day time limit Interrupts work flow Not an issue
Need HIPPA consent Consent form passed
around
At point of care
Objective: Provide Patients with electronic copy of their
health information upon request
HOW MUCH EXTRA WORK IS IT, REALLY?
(SOURCE: CMS)
Objective # Task Most Doing already
8 Record Demographics X
10 Maintain Active Medication List X
11 Maintain Active Allergy List X
12 Record Vital Signs X
Objective # Benefit to you Additional investment
2 E-prescribing Less Rx errors iPad, PDA, EHR module
9 Record Smoking
status
Represents
quality
2 minutes
6 Provide clinical
summaries to
patient
Happy patient Few clicks of a button
ACHIEVING AN OBJECTIVE/MEASURE:
SUGGESTED SOLUTION
Quality Measure
Diabetic patients from 18 to 75 years old with high levels of hemoglobin A1c
Patients more than 50 years old who received a flu vaccine
Patients older than 18 with diagnosis of diabetic retinopathy with documentation or
absence of macular edema
Issues:
Where do I get all this information?
Who gathers the information?
How do I incorporate this into workflow?
Lab report screen, Immunization
Screen, Document notes screen
Provider – no need for staff help
Little to no change-at point of care
IS MU PART OF ROUTINE CARE?
Scenario Task Staff
Responsible
MU Criteria
Last A1c 3 months ago. Fasting 140s, PP 250.
Here for routine check and ER F/U
Record A1cs Lab Tech Additional
Quality
Got new lipid medication as LDL was >100, not
on ASA, d/c metformin
New dx of post MI and started on beta blocker
Update
Medication List
Provider/
Nurse
Core
Objective 5
Patient has rapidly rising creatinine but needs
ACEI due to CHF most MI. Needs to help to
decide if should use ACEI and, if yes, what dose
to start with
Use Clinical
Decision Support
Provider Core
Objective
12
“The EHR should not duplicate (often
inefficient) paper‐based workflow but
instead be implemented to achieve new
efficiencies as well as quality
and safety of care” (Kilo)
SUMMARY
1. Utilizing EHRs can help, not hinder your practice
2. Achieving MU is not difficult if you leverage the EHR’s
capabilities
3. Time to start is now, money is on the line
4. Help is available, just call
DON’T FEAR CHANGE, JUST CHANGE!
QUESTIONS ?• Jitesh Chawla, MD
Chief Medical Information Officer
• Abhi Muthiyan
Chief Technology Officer
APPENDIX: ADDITIONAL PAYMENT FOR
MEDICARE EPS IN HEALTHCARE SHORTAGE
AREAS
Year 2011 2012 2013 2014 2015
2011 1,800 - - - -
2012 1,200 1,800 - - -
2013 800 1,200 1,500 - -
2014 400 800 1,200 1,200 -
2015 200 400 800 800 0
2016 - 200 400 400 0
Total 4,400 4,400 3,900 2,400 0
(Source: CMS)
APPENDIX: HOW MUCH MONEY CAN I GET?
Year 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 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
Under Medicaid: (Source: CMS)
Federal EHR
Certification
Requirements
APPENDIX: HOW DO I GET STARTED?
• Information Needed:
• 1. Name of the Eligible Provider
• 2. National Provider Identifier (NPI)
• 3. Business address and business phone
• 4. Taxpayer Identification Number (TIN) to which the provider would like the
• incentive payment made to
• 5. Medicare or Medicaid program selection (may only switch once after
• receiving an incentive payment before 2015) for EPs
• 6. For Medicaid providers, selecting which state want to file under.
HOW DO I GET STARTED?
3. Register for EHR
Incentive program
1. Enroll in
CMS payment
programs
2. Enroll in PECOS