1. HIT-REC ServicesGold Vs. SilverWhich is Right for Me?May 18, 2011

2. Presenters: Cathey Halsten – EHR Advisor • Michelle Brunsen – Quality Improvement Advisor • IFMC Health Information Technology REC

3. Regional Extension Centers Regional Extension Centers will assist providers seeking to adopt & become meaningful users of HIT. - ARRA 2009 “Health IT is the means, not the end.” David Blumenthal, M.D., M.P.P. National Coordinator for HIT

4. Regional Extension Center Program National goal: 100,000 primary care providers adopt health IT and achieve meaningful use by 2012 to improve patient care and safety 4

5. IFMC HIT Regional Extension Center Heavily subsidized to work with primary care physicians through Feb. 2014 • Mission • To work with 1,200 PCPs to become certified users by 2014 • Goal • Help providers adopt and meaningfully use certified EHR technology • Help providers qualify for meaningful use incentive payments • Our Success • Is measured by how many providers become meaningful users of certified EHR technology Miller, R.H, et al (2004) “Physicians’ Use of Electronic Medical Records: Barriers And Solutions”. Health Affairs

6. Initial Focus: Small Practices and CAHs • Physicians, PAs, NPs • Prescriptive privileges • Family Practice, Internal Med, Peds, OB/GYN in: • Individual and small group practices (10 or fewer professionals) • Critical Access & Rural Hospitals • Community Health Centers & Rural Health Clinics • Uninsured and underserved populations • With or without an EHR

7. Discuss services of Iowa’s RegionalRECExtension Center THE TRUSTED HEALTH IT ADVISOR

8. Two scopes of services Gold Silver

9. Side by Side Comparison - Summary Silver Gold Max - 30 onsite hours IFMC HITREC POC EHR Toolkit/CD Meaningful Use Guidebook/CD Security & Privacy Risk Assessment Tool • 1 onsite per Milestone or virtual hours • Email/phone access to assigned POC • EHR Toolkit/CD

10. EHR Toolkit EHR Toolkit

11. Sample of Tools Provided

12. Cost Per Provider Silver Milestone 1 - $0 Milestone 2 - $0 Milestone 3 - $0 Gold Milestone 1 - $510* Milestone 2 - $410* Milestone 3 - $305* • One time fee

13. Add-ons to Silver • Security Risk Assessment • Meaningful Use Guidebook Solo - $250 2-5 Providers - $500 5-10 Providers - $750

14. Security Risk Assessment 14

15. Meaningful Use Guidebook

16. Add-ons to Silver • Security Risk Assessment • Meaningful Use Guidebook Solo - $250 2-5 Providers - $500 5-10 Providers - $750

17. Available REC Services • Vendor Selection • Selected vendor list • Technical Assistance • Meaningful use gap analysis • Implementation • Field staff support • Education/Outreach • Web site/FAQ • Webinars/face to face events

18. Available REC Services Practice & Workflow Redesign On-site Assessments Health Information Exchange Connection and advice Privacy & Security Security Risk Assessment Consultative Resources Provide national resources Best practices

19. We can help you choose a vendor • Iowa REC: • Advocates for the provider • Works with any EHR chosen by our clients • Has no financial interest in products • Does not purchase or install EHRs

20. Registration We can also help you register and complete attestation for meaningful use!

21. Webinars • Ongoing Free Educational Webinars • Library of previously recorded webinars • All webinars provided at 12 noon • Register at www.IowaHITREC.org

22. Available REC Services-EHR Users Already have an EHR? Focus on achieving all aspects of meaningful use Assist with Registration and Attestation

23. Can I switch services? • As you move from milestone to milestone you can switch to gold or silver • Your needs may change • Your advisor can give you details

24. REC Timeline Improving Patient Care Achieve Meaningful Use EHR Selection Assessment & Planning Sign up with the REC Purchase EHR Evaluation & Improvement Implementation & EHR Usage Training & Go-Live Prep Quality Reporting & e-Rx Receive Financial $$$ Design/Redesign Workflow In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0004/01. IA-HITREC-12/10-177

25. REC Expanded Services IFMC now offers Services for “grant ineligible” providers

26. Information and Resources • Signup with the Regional Extension Center! • You will be assigned an Advisor • It’s FREE! No risk to your clinic • Start services when YOU are ready CatheyHalsten: chalsten@ifmc.org www.IowaHITREC.org Email: IowaHITREC@ifmc.org 800-373-2964

27. Meaningful Use Stages 2 & 3 HIT Policy Committee’s Proposed Recommendations for Eligible Professionals May 18, 2011

28. Background Information - HITPC • As a federal advisory group, the Health Information Technology Policy Committee: • Advises U.S. Department of Health and Human Services at ONC on federal HIT policy issues, including how to define Meaningful Use • 1/12/11 – HITPC published its proposed Stage 2 and 3 Meaningful Use recommendations for public comment • A 45 day public comment period ended February 25, 2011 on proposed objectives • 3Q11: Final HITPC recommendations on Stage 2 Meaningful Use expected

29. Points to Remember • These are PROPOSED recommendations that are applied to Eligible Professionals • Objectives that apply to Eligible Hospitals ONLY are not included here • Stage 2 is a stepping stone to Stage 3, so Stage 3 is included for context purposes

30. Core 1 - CPOE • Stage 1 – Medication Orders – 30% • Stage 2 – Medication Orders and 1 lab or radiology – 60% • Stage 3 – Medication Orders and 1 lab or radiology – 80%

31. Core 2 – Drug-Drug and Drug-Allergy Checks • Stage 1 – Enable Drug-Drug and Drug-Allergy Checks • Stage 2 – Employ checks on appropriate evidence-based interactions • Stage 3 – Add drug age, drug dose, drug lab and drug condition checking

32. Core 3 – eRx • Stage 1 – Generate and transmit permissible prescriptions – 40% • Stage 2 – 50% • Stage 3 – 80%

33. Core 4 – Problem List • Stage 1 – Maintain Problem List – 80% • Stage 2 – 80% • Stage 3 – 80% of problem lists are up-to-date

34. Core 5 – Active Medication List • Stage 1 – Maintain active medication list – 80% • Stage 2 – 80% • Stage 3 – 80% of medication lists are up-to-date

35. Core 6 – Active Medication Allergy List • Stage 1 – Maintain active medication allergy list – 80% • Stage 2 – 80% • Stage 3 – 80% of medication allergy lists are up-to-date

36. Core 7 – Demographics (Preferred Language, Gender, Race, Ethnicity and Date of Birth) • Stage 1 – 50% • Stage 2 – 80% and can use them to produce stratified quality reports • Stage 3 – 90% have demographics recorded (including IOM categories)

37. Core 8 – Vital Signs (Ht, Wt, BP, calculate and display BMI, plot/display growth charts for children 2-20, including BMI) • Stage 1 – 50% • Stage 2 – 80% • Stage 3 – 80%

38. Core 9 – Smoking Status (Age 13 and older using structured data) • Stage 1 – 50% • Stage 2 – 80% • Stage 3 – 90%

39. Core 10 – Report Clinical Quality Measures • Measures reported to CMS or Iowa electronically • Stage 1 - 3 Core or Alternate Core and 3 Additional Clinical Quality Measures (choose from 38 Measures) • Stage 2 & 3 – Handled by Quality Measures Workgroup

40. Core 11 – Clinical Decision Support Rule • Stage 1 – Implement 1 rule • Stages 2 & 3 – Use CDS to improve performance on high-priority health conditions. Establish attributes for purposes of certification: • Authenticated • Credibility • Patient-context sensitive • Invokes relevant knowledge • Timely • Efficient workflow • Integrated with EHR • Presented to appropriate party who can take action

41. Core 12 – Patient Health information • Provide patients with an electronic copy of their health information (diagnostic test, problem list, medication list, allergies, discharge summary and procedures) • Stage 1 –Upon request within 3 business days – 50% • Stage 2 – 50% • Stage 3 – 90%

42. Core 14 – Clinical Summaries to Patients • Provide clinical summaries to patients at each office visit • Stage 1 – 50% of ALL office visits within 3 business days • Stages 2 & 3 – Allow patients to view or download within 24 hours of encounter data in readable and structured form • Follow up tests linked to encounter included in future summaries within 4 days of becoming available

43. Core 15 – Exchange Key Clinical Information • Exchange key clinical information electronically among providers of care • Stage 1 – Perform test • Stage 2 – Connect to at least 3 external providers in “primary referral network” or establish bidirectional connection to at least 1 information exchange • Stage 3 – Connect to at least 30% of providers in “primary referral network” or connect to at least 1 information exchange

44. Core 16 – Protect Electronic Health Information • Protect electronic health information created or maintained by an EHR • Stage 1 – Protect through implementation of appropriate technical capabilities • Stages 2 & 3 – Additional privacy and security objectives are under consideration by the HIT Policy Committee’s Privacy and Security Tiger Team

45. Menu 1 – Drug-Formulary Check • Stage 1 – Implement check • Stage 2 – Move to core • Stage 3 – 80% of orders are checked against relevant formularies

46. Menu 2 – Advance Directive • Stage 1 – For hospitals only. • Stage 2 – Includes EPs. 50% of patients >=65 years have recorded in their EHR the result of an advance directive discussion and the directive itself if it exists • Stage 3 – 90% of patients >=65 years have recorded in their EHR the result of an advance directive discussion and the directive itself if it exists

47. Menu 3 – Incorporate Lab Results into EHR • Incorporate clinical lab test results into an EHR as structured data • Stage 1 – 40% • Stage 2 – Move to core • Stage 3 – 90% and reconcile with structured lab orders, when available

48. Menu 4 – Generate Lists of Patients by Condition • Generate lists of patients by specific conditions for quality improvement, reduction of disparities and outreach • Stage 1 – Generate lists by specific conditions • Stage 2 – Move to core • Stage 3 – Use the lists to manage patients for high-priority health conditions

49. Menu 5 – Reminders to Patients • Stage 1 – 20%; For use in preventive/follow up care • Stage 2 – Move to core • Stage 3 – 20% of patients who prefer to receive reminders electronically receive preventive or follow-up reminders

50. Menu 6 – Electronic access to health information • Provide patients with timely electronic access to their health information – include lab results, problem lists, medication lists and medication allergies • Stage 1 – For use in preventive/follow up care within 4 business days of information becoming available • Stage 2 – 20% of patients use a web-based portal to access their information at least once • Stage 3 – 30% of patients use a web-based portal to access their information at least once • Exclusions: Patients without ability to access the Internet