Meaningful Use Discussion

1. Meaningful Use Discussion Charles Jarvis VP, Healthcare Services and Government Relations NEXTGEN HEALTHCARE Keith Kramer, MD, FACC Wellmont CVA Jack Sunderman Director of IT Wellmont CVA Billy Parrish Director, EDI Products and Services NEXTGEN HEALTHCARE

2. Meaningful Use Discussion • Overview of Meaningful Use • Meaningful Use - Embracing the process in your practice • Selecting Objectives and Tracking • CQM and the HQM tool • Reporting to CMS

3. Overview of Meaningful Use

4. Meaningful Use • The Health Information Technology for Economic and Clinical Health (HITECH) Act provides HHS with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health information technology • Under HITECH, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments (27 billion over 10yrs – 44K/provider Medicare). • Two regulations have been released, one of which defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other which identifies the technical capabilities required for certified EHR technology.

5. Meaningful Use Update(through 8/15) • Meaningful Use Medicare Payments started this past quarter. • According to CMS, about 2,300 ambulatory providers and 100 hospitals received over $149 million in stimulus money through July 31. • NextGen ambulatory providers total 90 and have received about $1.6 million during this time. • Wellmont CVA has 33 providers that have attested. • Ark. Heart has 14 providers that have attested.

6. Meaningful Use Update(through 8/15) • For Medicaid, 23 states have opened registration. • CMS reports 3,500 providers, including hospitals, qualified for stimulus money and received over $248 million through July 31. • NextGen has had 150 ambulatory providers and 4 hospitals qualify. They received $5.3 million of the total reported above.

7. Meaningful Use Core Objectives • Vital Signs • Smoking Status • Clinical Decision Rule • Report CQM to CMS • Electronic Copy of Record • Clinical Summary • HIE test • Security risk test • CPOE • Drug-Drug/Drug-Allergy checks • e-Rx • Demographics • Diagnosis/problem list • Active Medications • Allergies

8. Meaningful Use Menu Objectives • Drug Formulary Check • Lab Results as structured data • Patient List for a condition • Send Reminders • Electronic Access • Patient education • Medication Reconciliation • Summary of care record • Immunization or public health

9. CQM Quality Measures • Hypertension • Tobacco Use Assessment & Smoking Cessation • Weight Screening • For Cardiology Groups, I (Jack) recommend the following menu selections: • #4 - ACE/ARB Rx for LVSD • #10 - Beta Blocker for LVSD • #26 – Warfarin for A-Fib

10. Complete Timeline • EMR Decision (NextGen)  06/2007 • “Go Live” first office (1 doc)  06/2008 • Completed implementation of EHR  02/2009 • Completed implementation of EPM  05/2009 • Started Meaningful Use Process  10/2010 • Attested for Meaningful Use Phase 1  03/2011

11. MU Timeline • Organized internal planning  07/2010 • MU Leadership Team  08/2010 • Physician education  09/2010 • Testing on system  11/2010 • Tracking/reporting tools  12/2010 • Pre-launch meetings  01/2011 • Upgrade to certified NG version  1/22/11 • 90-day Attestation Period starts  1/24/11 • MU Kick-Off Celebration  02/2011 • All E.P.’s registrations completed  03/2011

12. Meaningful Use

13. Meaningful Use – Embracing the process in your practice Keith Kramer, MD Wellmont CV Heart Institute

14. Key Factors for Providers

15. Single Physician Leader

16. Organizational Commitment

17. Physician/IT leader relationship

18. Reassess current workflows but don’t “over-engineer”

19. Regular feedback & mechanism for provider feedback

20. Make it fun • Sliding Rock, WNC

21. Involve your staff

22. Reminder that it’s about quality

23. MU Challenges

24. Interpretation of MU rules

25. Clinical Summary

28. Top 5 Reasons to Pursue Meaningful Use

29. #5. “Enhancements” • Bonnaroo • Heart Center lobby renovations

30. # 4 - $$$$$$$$$$$$ • 44K/eligible provider – Medicare • 64K/eligible provider - Medicaid

31. # 3 - EMR will help clarify & document “marital status”

32. # 2 - Sooner or later you have to jump

33. AND THE #1 REASON WHY YOU WOULD PURSUE MU

34. #1 - Meaningful Use may get you a meeting with President Obama

35. Congressman Roe Presenting the $558,000 “Check”

36. Questions?

37. Selecting Objectives and Tracking

38. Meaningful Use Core Objectives • Vital Signs • Smoking Status • Clinical Decision Rule • Report CQM to CMS • Electronic Copy of Record • Clinical Summary • HIE test • Security risk test • CPOE • Drug-Drug/Drug-Allergy checks • e-Rx • Demographics • Diagnosis/problem list • Active Medications • Allergies

39. Meaningful Use Menu Objectives • Drug Formulary Check • Lab Results as structured data • Patient List for a condition • Send Reminders • Electronic Access • Patient education • Medication Reconciliation • Summary of care record • Immunization or public health

40. Unique Patient The phrase “Unique Patient” appears more than 50 times in the Federal Register. The definition starts on page 44333 as a response to one of the questions about the CPOE objective. Regardless of how many times a patient is seen by the provider, they are only counted once. The patient information is combined.

41. CPOE • Intent – All orders are captured discretely in an EHR system. • Measure is tracking the number of medication entered by a licensed professional. • If a patient seen by more than one provider, any medication order counts for all the providers who saw that patient.

42. eRX Prescriptions transmitted via Nextgen Fax do not count as eRX. Recommend monitoring the number of faxes sent to pharmacies that are setup for eRX.

43. HIE Test Intent is your system has the capability to send and receive patient information. Send a CCD or CCR record from your Nextgen system to another system not in your Tax ID • Sneaker net is not acceptable, in other words you can send it via flash or CD. The rules want it sent via a network connection. CMS attestation question is a yes or no

44. Clinical Decision Support Intent is the system is calculating and / or reminding clinical staff about patient care decisions. Nextgen has an number of areas that meet this, one example is the BMI calculation. CMS attestation question is a yes or no

45. Electronic Patient Record Intent is the system is able to provide the patient with an electronic copy of their medical record. The denominator are patients who request their record in an electronic format, no paper or faxing. When we reported CMS could not handle a denominator of 0 (zero). Hopefully this is fixed.

46. Approaches to Meaning Use Tracking and Reporting • Nextgen Recommended Approach • Upgrade to 5.6.5.x – Currently UD3 • Patch or upgrade your KBM • Use NG provided Crystal Reports and HQM • Positives • You will be following a standard approach • Challenges • If you have lots of customization the KBM upgrade will be time consuming. • You will need to insure you are capturing data per the reporting requirements. This requires SQL and Crystal Reports expertise.

47. Approaches to Meaning Use Tracking and Reporting • Wellmont CVA Approach • Upgrade to 5.6.5.x – Currently UD2 • Develop custom reports for MU objectives • Positives • This approach is quicker to reaching attestation • Challenges • You will not be following a standard. • You will need someone with strong SQL skills as the objectives have a lot of grey areas.

50. EHR Champion • He addresses individual physician issues and intervenes to correct performance. • Assist with interpretation of rules and data. • Makes for a great beta tester.