Electronic Health Records What They Are and Why They Matter

1. Electronic Health RecordsWhat They Are and Why They Matter Cora Butler, JD, RN, CHC MO-11-22-PR Notice: Primaris is not acting in any capacity as the Federally designated Quality Improvement Organization (QIO) for Missouri in developing this presentation. Preparation of the slides used in this presentation was not performed under the QIO contract Primaris holds with the Centers for Medicare & Medicaid Services (CMS). This presentation is not sanctioned or endorsed by CMS. The content of the presentation is based on material available in the public domain. This presentation is intended for educational purposes only. Primaris is not responsible for, and expressly disclaims all liability for, damages of any kind arising out of use, reference to, or reliance on any information contained herein. All presentation slides are the property of Primaris. No part of the presentation may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of Primaris.

2. Reform: Large Moving Target with Multiple Moving Parts • Umbrella Term • Informal Reform • Societal and Economic Trends That Exist Regardless of Laws or Regulations • Increasingly driven by payers • Formal Reform • Patient Protection and Affordable Care Act (ACA) • American Recovery and Reinvestment Act (ARRA) • HITECH Provisions [Funds for health IT]

3. Reform: Large Moving Target with Multiple Moving Parts • Transformative Effect of Healthcare Reform (Formal and Informal) • Reform was necessary and inevitable • Impetus of informal reform would likely have spurred change without formal reform • Imperatives will increasingly be to: deliver healthcare services that are considered to be safe, quality care in a cost effective manner; improve care coordination through the exchange of key clinical information among providers; engage patients and families and measure and report quality metrics. • Providers who successfully leverage clinical and claims data will be able to enhance the quality, cost, safety and efficiency of care at an individual patient level as well as across populations while improving business performance for their practice(s).

4. Health Information Technology: The Foundation for Patient-Centered Care • Health Information Technology (HIT) • Hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for or support use by healthcare entities or patients for the electronic creation, maintenance, access, or exchange of health information. • Electronic Health Records (EHR) • Aggregate electronic record of health-related information (may be individual application or bundle of applications) on an individual created and gathered cumulatively across more than one healthcare organization and is managed and consulted by clinicians and staff involved in an individual’s healthcare. • EHR includes patient demographic and clinical health information such as medical histories and problem lists. It also has the capacity to provide clinical decision support; support physician order entry; capture and query information relevant to healthcare quality; and exchange electronic health information with other sources.

5. Health Information Technology: The Foundation for Patient-Centered Care • Electronic Medical Record (EMR) • The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in an individual’s health and care. • Personal Health Record (PHR) • An electronic universally available (relies on nationally recognized interoperability standards) record of health-related information for an individual drawn from multiple sources that can be used to make health and care decisions. The PHR is managed, shared and controlled by the individual.

6. Health Information Technology: The Foundation for Patient-Centered Care • Health Information Exchange (HIE) • The electronic movement of health-related information securely among organizations according to nationally recognized standards. • Health Information Organization (HIO) • Oversees and governs HIE. Missouri HIO is the Missouri Health Connection. • Nationwide Health Information Network (NHIN) • A national effort to establish a network to improve the quality and safety of care, reduce errors, increase the speed and accuracy of treatment, improve efficiency, and reduce healthcare costs.

7. Health Information Technology: The Foundation for Patient-Centered Care • Data • The elemental components of recorded content within a business entity. • Data Warehousing • Databases that make it possible to access data from multiple databases and combine the results into a single query and reporting interface.

8. Health Information Technology: The Foundation for Patient-Centered Care Source : IBM Center for Applied Insights

9. Health Information Technology: The Foundation for Patient-Centered Care Business Intelligence • Ability to evaluate and improve operating cost for practice by improving workflows, consolidating buying decisions, reducing unnecessary administrative costs and improving timeliness of communications with patients and within the practice. • Increased revenue realization and optimization • Real time auditing of billing for appropriateness reduced coding errors and faster collections. • Identifying practice expansion opportunities. • Measuring and increasing productivity. • Informed fact based negotiations with payers. Challenges: Effective analytics requires structured data.

10. How One Practice Used EHR as a Tool to Understand and Improve Clinical Care and Operational Results • Organization Background • multi-specialty group with 32 providers, 300 employees. EHR securely connects with clinical and non-clinical settings including clinics, nursing homes, provider residences and other authorized entities. • Stage One Meaningful Use Goal(s): • Improve care coordination, patient and family engagement and quality measure reporting through real time data access, auditing and reporting. • Changing provider and patient behavior and improving healthcare at the population level by giving providers immediate access to relevant patient and performance data. • Add tools and processes to allow real-time performance reporting and auditing against national quality-of-care standards. • Move beyond meeting standards on a patient-by-patient basis to meeting standards across broad patient populations by employing framework that allowed for informed decisions and continuous quality improvement processes

11. How One Practice Used EHR as a Tool to Understand and Improve Clinical Care and Operational Results • Strategies: • Tracking – individual patient at the point of care to ensure that preventive, screening and quality standards embedded within the EHR workflow are met. • Auditing – over specific patient populations, daily audits examine care patterns by provider, practice or the entire clinic to identify gaps in care and opportunities for care improvement. • Analysis – performance audits to measure improvement by practice, clinic or provider - and to understand the meaning behind processes and outcome measures. Analysis focuses on any care discriminators – such as ethnicity, age, gender, payer or treatment frequency disparities to identify opportunities for care improvement. • Reporting – various reporting mechanisms, including dashboards, used to identify trends, adjust processes to improve the system and inform and motivate providers regarding effectiveness of care, satisfaction with care, as well as utilization and costs. • Improvement – enables the identification of initiatives to pursue, such as initiative to address population wide trends in care.

12. How One Practice Used EHR as a Tool to Understand and Improve Clinical Care and Operational Results • Results • Incorporation of comprehensive disease management tools within the EHR workflow helped facilitate best practices in the diagnosis and treatment of chronic illnesses and conditions, such as: diabetes, hypertension, lipid abnormalities, renal disease, cardiac disease, and congestive heart failure. Group has documented: • 98% treatment compliance for providers on preventive services for chronic conditions like diabetes, congestive heart failure and hypertension. • Improved chronic disease management for diseases such as chronic kidney disease, diabetes, hypertension, lipid abnormalities by creation of highly personalized treatment plans that are shared with the patients.

13. Health Information Technology: The Foundation for Patient-Centered Care • Summary: • Fundamental Issues are affecting our US Healthcare System have provided the impetus for change: • Increasing Cost • Inconsistent quality • Limited access to timely care for many • Healthcare providers pressured by factors beyond their control

14. Health Information Technology: The Foundation for Patient-Centered Care • Transformation of the healthcare system is fast becoming a reality • Measuring, monitoring and adjusting clinical and business practices and processes will be essential to a provider’s ability to develop the strategies necessary to meet practice goals and priorities. • Adoption and integration of EHR into clinical and business practices are key to surviving and thriving in the evolving environment.