Introduction to Healthcare and Public Health in the US

1. Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a This material (Comp1_Unit10a) was developed by [University Name], funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number [enter the award number(s)].

2. Meaningful Use (MU) of Health Information Technology Learning Objectives • Define meaningful use (MU) of health information technology in the context of the Health Information Technology for Economic and Clinical Health (HITECH) Act (Lecture a) • Describe the major goals of meaningful use (Lecture a) • Define the criteria for Stage 1 of meaningful use for eligible professionals and eligible hospitals (Lecture b) • Describe the standards specified for Stage 1 of meaningful use, including those devoted to privacy and security (Lecture b) • Discuss the likely criteria for Stages 2-3 of meaningful use (Lecture b) Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a

3. Entering a new “ARRA” • Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA) • Incentives for electronic health record (EHR) adoption by physicians and hospitals (up to $27B) • Direct grants administered by federal agencies ($2B) • Other provisions in other areas of ARRA, e.g., • Comparative effectiveness research • NIH and other research funding • Broadband and other infrastructure funding Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 3

4. The new “ARRA” of health information technology (HIT) in the US • HITECH provides financial incentives for “meaningful use” (MU) of HIT (Blumenthal, 2010; Blumenthal, 2010; Trotter, 2011) • All initiatives administered by the Office of the National Coordinator for Health IT (ONC, http://healthit.hhs.gov/) Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 4

5. MU is driven by underlying goals for healthcare system • All MU criteria must “map” to one or more of five goals for the healthcare system • Improving quality, safety, and efficiency • Engaging patients in their care • Increasing coordination of care • Improving the health status of the population • Ensuring privacy and security • Examples • Implement drug-drug interaction checks → Improving quality, safety, and efficiency • Provide summary of care to patients → Engaging patients in their care Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 5

6. Overall requirements for MU • Use certified EHR technology in a meaningful manner • Use certified EHR technology connected in a manner that provides for health information exchange to improve the quality of care • Using certified EHR technology, the provider submits information on clinical quality measures Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 6

7. Certified EHR • A qualified EHR certified by an approved certifying entity • A qualified EHR is an electronic record of health-related information on an individual that • Includes patient demographic and clinical health information, such as medical history and problem lists • Has the capacity to • Provide clinical decision support • Support physician/provider order entry • Capture and query information relevant to healthcare quality • Exchange electronic health information with, and integrate such information from, other sources Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 7

8. MU implemented in three stages (Drazen, 2011) Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 8

9. Implementation • Implemented through increased Medicare or Medicaid reimbursement to • Eligible professionals (EPs) • Medicare: MD, DO, DDS/DMD, DPM, OD, DC • Medicaid: MD, DO, DDS/DMD, Certified Nurse Midwives, Nurse Practitioners, Physicians Assistants operating at an FQHC/RHC • Hospital-based EPs not eligible (>90% service in hospital, e.g., pathologist, emergency physician) • Eligible hospitals (EHs) • Medicare: Acute Care Hospitals, Critical Access Hospitals (CAHs) • Medicaid: Acute Care Hospitals, CAHs, Children’s Hospitals • Within the 50 states and DC • Various differences in Medicare vs. Medicaid for amount reimbursed, rules, and other aspects Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 9

10. Payment for EPs • Medicare • Up to $44,000 over five years if start in 2011 or 2012; less if start later • Up to extra $4,400 if practice in Health Professional Shortage Area • Medicaid • Up to $63,750 over six years, with one-third in first year • Can receive money for first year just for implementing or upgrading to a certified EHR Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 10

11. Payment for EHs • More complex depending on Medicare vs. Medicaid, hospital type, and share of patients • Multi-campus hospitals count as one EH • General formula is that payment is multiplication of • Initial amount – $2M + $200 per discharge for 1,150th to 23,000th discharge (maximum for 21,850 discharges is $2M + $4.37M = $6.37M) • Medicare or Medicaid share • Transition factor – 1.0, 0.75, 0.5, and 0.25 over four years depending on when became eligible Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 11

12. How does one get the $$$? • Meet and report on the MU criteria! • In 2011, must achieve MU for 90 consecutive days; after 2011 must achieve it all 12 months • First year reporting will be “attestation”; subsequent years will require full data reporting to CMS • Medicaid exceptions • In first year, EP/EH can demonstrate they adopted, implemented, or upgraded (A/I/U) a certified EHR • Can “skip” years but must begin by 2016 • Program began on • January 1, 2011 for EPs • October 1, 2010 for EHs Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 12

13. Rules • Stage 1 final rules published on July 28, 2010 • CMS – Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule • ONC – Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology • For those without time to read hundreds of pages, there are excellent summaries and other materials from HHS, HIMSS, CSC, and Geek Doctor blog • CMS Web site for program • http://www.cms.gov/ehrincentiveprograms/ • EHR certification process guided by Temporary Certification Rule released on June 24, 2010, to be superseded by Permanent Certification Rule released in January, 2011 to start in 2012 • http://healthit.hhs.gov/certification/ Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 13

14. Connecting CMS and ONC rules • HITECH ties the standards, implementation specifications, and certification criteria adopted in ONC rule to the incentives under the CMS Medicare and Medicaid EHR Incentive Programs by requiring the meaningful use of certified EHR technology • ONC rule requires specific standards in 2011 in four areas • Vocabulary • Content exchange • Transporting of information • Privacy and security Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 14

15. Connecting MU and EHR certification • Temporary Certification Rule will cover certification of EHRs for Stage 1 MU, to be replaced by Permanent Rule in 2012 • A clear departure from previous program of Certification Commission for Health IT (CCHIT) • Certification criteria are highly aligned with MU criteria • Highlights of temporary and (later) permanent rules • Cover all inpatient and outpatient systems for vendor-supplied and self-developed systems • Certify complete systems or modules that meet criteria • Users can buy a system that covers all MU or demonstrate that combination of modules do so • ONC designates authorized testing and certification bodies (ATCBs) to use tools and techniques developed by National Institute for Standards and Technology (NIST) • http://healthcare.nist.gov/use_testing/ Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 15

16. Meaningful Use of Health Information Technology Summary – Lecture a • The HITECH Act of ARRA legislated incentives for the “meaningful use” (MU) of health IT • MU means that criteria for use of IT are tied back to goals of the health care system • These criteria are met by eligible professionals and eligible hospitals to receive incentive payments for use of EHRs Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 16

17. Meaningful Use of Health Information TechnologyReferences – Lecture a References Anonymous. (2010). Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule. Washington, DC: Federal Register Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf. Anonymous. (2010). Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Final Rule. (E9-31216). Washington, DC: Federal Register Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf. Blumenthal, D. (2010). Launching HITECH. New England Journal of Medicine, 362, 382-385. Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 363, 501-504. Drazen, E. (2011). Update on Stage 2: Current Direction and Timing of Meaningful Use Requirements. Waltham, MA: Computer Sciences Corp. Retrieved from http://www.csc.com/health_services/insights/67921-update_on_stage_2_current_direction_and_timing_of_meaningful_use_requirements Trotter, F., & Uhlman, D. (2011). Getting to Meaningful Use and Beyond. Sebastopol, CA: O'Reilly Media. Images Slide 8: Overview: What is Meaningful Use?, Missouri Health Information Technology Assistance Center, Retrieved from http://assistancecenter.missouri.edu/node/17 (Drazen, 2011) Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture a Health IT Workforce Curriculum Version 3.0/Spring 2012 17