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Today’s topic

Health IT: How to Achieve Interoperability Across the Continuum of Care

During today’s discussion, feel free to submit questions at any timeby using the questions box. A follow-up e-mail will be sent to all

attendees with links to the presentation materials online.

Dr. Richard SchreiberChief medical information officer, Holy Spirit Hospital,Camp Hill, Pa.

Dr. Clifford Martin Chief medical officer,St. Joseph PhysicianNetwork,Mishawaka, Ind.

Erica GalvezInteroperability andexchange portfoliomanager,Office of the NationalCoordinator for Health IT

HousekeepingHousekeeping1. Viewer Window 2. Control Panel

Joseph Conn

Reporter,

Modern Healthcare

Now speaking...

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to submit comments to our moderator

Erica Galvez

Interoperability and exchange portfolio manager,

Office of the National Coordinator for Health IT

Now speaking...

Please use the questions box on your webinar dashboard

to submit comments to our moderator

Meaningful Use & Certification Relationship for

Transitions of Care

• When looked across both Stages 1 & 2, the ToC objective includes 3 measures:

• Measure #1: requires that a provider send a summary care record for more than 50% of transitions of care and referrals (Stage 1 and 2)

• Measure #2 requires that a provider electronically transmit a summary care record for more than 10% of transitions of care and referrals using CEHRT or eHealthExchange participant (Stage 2)

• Measure #3 requires at least one summary care record electronically transmitted to recipient with different EHR vendor or to CMS test EHR (Stage 2)

Meaningful Use 2014 Edition Certification

• Two 2014 Edition EHR certification criteria

• 170.314(b)(1) : Transitions of care—receive, display, and incorporate transition of care/referral summaries.

• 170.314(b)(2) : Transitions of care—create and transmit transition of care/referral summaries.

Feature Focus: ToC Measure(2)

• The eligible provider, eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10% of such transitions and referrals either:

• (a) electronically transmitted using

CEHRT to a recipient; or

• (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network.

ToC Measure #2 170.314(b)(2)

• Transitions of care—create and transmit transition of care/referral summaries.

• (i) Enable a user to electronically create a transition of care/referral summary formatted according to the Consolidated CDA with, at a minimum, the data specified by CMS for meaningful use.

• (ii) Enable a user to electronically transmit CCDA in accordance with:

• “Direct” (required)

• “Direct” +XDR/XDM (optional, not alternative)

• SOAP + XDR/XDM (optional, not alternative)

1

2

Patient Electronic Access to Health Info

EPs and EHs: View, Download, TransmitMeasure 1:

• More than 50% patients are provided timely online access to their health information

Measure 2:• More than 5% of patients must access their health information

online

EPs: Secure MessagingMeasure 1:

• A secure message was sent using the electronic messaging function of CEHRT by more than 5% of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.

Patient Electronic Access to Health Info

VDT objectiveVDT and secure

messaging objective

Secure messaging

objective

Measures

Does the EP/EH

need to use

CEHRT to send

initial information

to patient?

Does the patient

need to

receive/view/downl

oad information

using CEHRT?

Does the patient

need to use CEHRT

to transmit

information?

Does the EP need to

use CEHRT to

receive information

from patient?

VDT measure 1: 50% of unique

patients provided timely online

access to their health information

No Yes N/A N/A

VDT measure 2: 5% of unique

patients view, download or

transmit their health information

to a 3rd party

No YesThey may, but are

not required toN/A

Secure messaging measure 1: 5%

of unique patients send a secure

message to the EP

N/A N/AThey may, but are

not required toYes

Dr. Richard Schreiber

Chief medical information officer,

Holy Spirit Hospital, Camp Hill, Pa.

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Meaningful Use 2 and Interoperability

• Definitely stresses importance of interoperability

• Patient Portal replaces “electronic copy of discharge

information”

• Settles on C-CDA (Consolidated clinical document

architecture)

• Requires sending C-CDA to another vendor, but only once

Meaningful Use 2 and Interoperability, cont.

•Direct Messaging (DM)

–NOT an interoperable requirement

–very hard to achieve interoperability with DM

• Outside of EMR

• No clear way to add data to EMR

•Submit labs from EH’s to EP’s

–Nice, but actually done via interfacing, not true

interoperability

–Why not more emphasis on HIE?

• especially for those on different EMRs?

Transfer of Care Documents

Most difficult interoperability requirement of MU 2

• HISPs don’t talk to HISPs (lack connectivity)

• Dismally low adoption of direct addresses

• Offset of the reporting periods

–EHs: Federal Fiscal Year (attest Oct 1)

–EPs: Calendar year (attest by Jan 1)

• EPs have not caught up with EHs

• Puts EHs at disadvantage

With thanks to Michael Zaroukian, Colin Banas, Matthew Shafiroff

AMA Letter to CMMS and ONC“JASON2 report funded by the Agency for Healthcare Research

and Quality concisely described the current state of

interoperability, finding “[a]t present, large-scale interoperability

amounts to little more than replacing fax machines with the

electronic delivery of page-formatted medical records.”3 If we

are to move away from this approach, the certification process

must be keenly focused on achieving true interoperability that is

deployed in a fashion that requires minimal user intervention.

We believe ONC should focus less on what specific data points

are exchanged, and more on identifying and coordinating the

standards needed to exchange information.”

• Lack of interoperability standards still impedes progress

1http://www.ihealthbeat.org/~/media/Files/2014/PDFs/CMS%20ONC%20Letter%20Stage%203.

ashx2named for the Greek hero3JASON, A Robust Health Data Infrastructure, November 2013

http://www.healthit.gov/sites/default/files/ptp13-700hhs_white.pdf

Meaningful Use Stage 3

• Nothing about improved care: disappointing

• Pharmacy benefit/Surescripts/similar pharmacy fill data companies

• To improve med rec we need better “source of truth” of home

med list.

–We already pay for eRx via Surescripts, and they possess

fill data; there is no requirement that they share this data

that in a sense we have already paid for

Meaningful Use Stage 3

• No pressure on insurance companies to support

HIE

– They benefit the most financially from reductions in

wasteful duplication and better ability to keep patients out

of the hospital1

• Metric for medication reconciliation still 50%

– Is it ok to let ½ our patients leave the hospital with poor

med lists?

– HITPC declined to• Strengthen the metric

• Demand that pharmaceutical intermediaries share their data (cited

lack of authority in the law)

1Vest JR, et al. Association between use of a health information exchange system and hospital admissions. Appl Clin Inform 2014;5(1):219-231.

What are the current limitations?

• Lack of nationwide HIE

• Unclear and non-harmonized regulations regarding

send/receive messaging for Direct Messages vs HIE

• Many vendors have certified EHRs which in fact do

not conform to MU requirements

– They can send, but can they

• Receive at all?

• Record upon receipt by intended recipient and

generate a report?

What are the current limitations?

• Multiple portals confuse patients

• Requirements for meaningful use with multiple

dependencies all to be achieved simultaneously—

impossible– Need milestones first, then meaningful use goals

– We are the first MU 2 certified EHR that is trying to connect to an HIE that has been in Pennsylvania the longest—why is it so hard?

• Ability to attach, forward, and consolidate data so

patients can access one portal, in absence of

centralized HIE

Where do we go from here?

• FHIR: Fast Healthcare Interoperable Resource

• JASON recommends:

– Public APIs (application program interfaces)

– “Interoperability issues can be resolved only by

establishing a comprehensive, transparent, and overarching

software architecture for health information.”

–Open software architecture

–Common mark up language (it alone will not support

semantic interoperability—also need APIs)

A Robust Health Data Infrastructure. JASON. The MITRE Corporation. http://healthit.gov/sites/default/files/ptp13-700hhs_white.pdf

Dr. Clifford Martin

Chief medical officer,

St. Joseph Physician Network, Mishawaka, Ind.

Now speaking...

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Saint Joseph Physician Network

• Division of Saint Joseph Regional Medical Center- South Bend, IN.

• Member of CHE-Trinity Health

• Comprised of 72 physicians and 18 Non-Physician Providers

• 65% Primary Care Providers & 35% Specialty Providers

•43 providers eligible for Meaningful Use 2

Key Components & Partners in our MU 2

Success

•Use of Cerner EMR and NextGen practice management software

• Strong community Health Information Exchange (HIE)

Michiana Health Information Network (MHIN)

• Community laboratory service provider with widespread use in

area

• Experience leadership in HIE and our organization with

implementation of a project of this scope

Most Recent Components Installed

• Preventive Care / Health Maintenance Modules

• Patient Specific Education for Exit Care

• Establishing Continuity of Care Documents

• Community Patient Portal

•Strategies to Engage Patients in use of Portal

Most Significant Challenges to Success• Certification of Medical Assistants

• Rapid implementation of required software changes/bundles

• Increased need to utilize data in discrete fields

• Lab test and Radiology procedure terminology

• Processing Speed interruptions

Today’s panelists...

Health IT: How to Achieve Interoperability Across the Continuum of Care

During today’s discussion, feel free to submit questions at any time by using the questions box.

Joseph ConnReporter,Modern Healthcare

Dr. Clifford MartinChief medical officer,St. Joseph Physician

Network,Mishawaka, Ind.

Erica GalvezInteroperability and

exchange portfolio manager,Office of the National

Coordinator for Health IT

Dr. Richard SchreiberChief medical information officer, Holy Spirit Hospital,Camp Hill, Pa.

TODAY’S MODERATOR

Thank you...

... for attending today’s editorial webinar on achieving interoperability across the care continuum.

We also thank our panelists, Erica Galvez, interoperability and exchange portfolio manager, Office of the National

Coordinator for Health IT; Dr. Clifford Martin, chief medical officer, St. Joseph Physician Network,

Mishawaka, Ind.; and Dr. Richard Schreiber, chief medical information officer, Holy Spirit Hospital, Camp Hill, Pa.

Expect a follow-up e-mail within two weeks. For more information,

send an e-mail to webinars@modernhealthcare.com

For more information about additional editorial webinars this year,

please visit modernhealthcare.com/webinars