Health Information Technology: The Next Frontier

1. Health Information Technology: The Next Frontier Amanda Parsons M.D., M.B.A. Assistant Commissioner Primary Care Information Project NYC REACH presentation to NNPHI June 8th , 2010

2. AGENDA • EMR Adoption Landscape & Federal Strategy • PCIP & NYC REACH

3. WE ARE HERE TODAY BECAUSE MEDICINE ON THE VERGE OF TRANSFORMATION

4. BUT THAT IS ALL RAPIDLY CHANGING… Existing forces • New providers going straight to EMR • Stark law relaxation • More EMR choices • Almost all other industries have digitized • Internet Age • Within the next 5-10 years • The paper chart will no longer exist, particularly in hospitals & outpatient primary care sites New forces • $48 billion in Medicaid/Medicare Meaningful Use incentives • $598 million for Regional Extension Centers • Other incentives: PCMH, eprescribing • Health care reform • At least 100,000 providers, nationwide, are going through this transformation together • We’ve gotten 2,018 NYC providers live in 2 years 3

5. FEDERAL FUNDING SOURCES 1) ~ $38 billion through CMS • “Meaningful Use” funding goes to providers and practices to partially reimburse and reward investment in, and use of, EMRs 2) $2.1 billion through HHS (ONCHIT) • ~ $600 million “Extension Center” funding goes to extension centers to provide technical assistance to providers • Other funding includes • Health information exchange, Workforce development, Beacon communities

6. HOW ALL IT ALL FITS TOGETHER Regional Extension Centers Wide scale EMR Adoption Beacon Communities Workforce development Improve: • individual & population health • health outcomes • transparency & efficiency • Ability to study & improve care delivery Meaningful Use framework Meaningful Use of EMR CMS Meaningful Use incentives State Health Information Exchange Standards & Certification framework Exchange of health information Privacy & Security framework NHIN Direct

7. OVERVIEW OF MEANINGFUL USE • The American Recovery and Reinvestment Act (ARRA) authorizes the Centers for Medicare & Medicaid Services (CMS) to offer a financial incentive to physician and hospital providers who demonstrate the “meaningful use” of an electronic health record (EHR). According to the CMS, a provider uses an EHR “meaningfully” when he or she: • 1) Improves quality, safety, efficiency, and reduce health disparities • 2) Engages patients and families • 3) Improves care coordination • 4) Improves population and public health • 5) Ensures adequate privacy and security protections for personal health information

8. WHY MEANINGFUL USE? Why meaningful use? Why not just reward EHR adoption? “Because better health care does not come solely from the adoption of technology itself but through the exchange and use of health information to best inform clinical decisions at the point of care.”

9. WORKING BACKWARD FROM THE GOAL 3 Stages of Meaningful Use • Improved quality of care Stage 3 Stage 2 Stage 1

10. MEANINGFUL USE GOALS OVER THE NEXT 5 YEARS • 1) Improve quality, safety, efficiency, and reduce health disparities • Provide access to comprehensive patient health data for patient’s health care team • Use evidence-based order sets and CPOE • Apply clinical decision support at the point of care • Generate lists of patients who need care and use them to reach out to patients • Report to patient registries for quality improvement, public reporting, etc. • 2) Engage patients and families • Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health • 3) Improve care coordination • Exchange meaningful clinical information among professional health care team • 4) Improve population and public health • Submit immunization, syndromic surveillance and reportable disease data to public health agencies • 5) Ensure adequate privacy and security protection for personal health information • Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law • Provide transparency of data sharing to patient

11. A SNAPSHOP OF PROVIDER REQUIREMENTS BY YEAR FOR MEANINGFUL USE- WHAT TO FOCUS ON Source: www.healthit.hhs.gov, Meaningful Use Matrix

12. WHO WILL BE ELIGIBLE FOR MEANINGFUL USE? • Medicaid • Eligible professionals include doctors of Medicine, Osteopathy, dental surgery, podiatric medicine, optometry, nurse practitioners and some physician assistants • Must meet minimum Medicaid patient volume percentages • 30% minimum for physicians treating adults • 20% minimum for pediatricians • Payments are fixed and not proportional to Medicaid billings. Up to $63,750 over 6 years • If pediatricians qualify at 20%, only eligible for 67% (2/3) of payments Cannot receive duplicative Medicaid and Medicare Ambulatory EHR incentives • Medicare • Eligible professionals include doctors of Medicine, Osteopathy, dental surgery, podiatric medicine and optometry,   • Hospital-based physicians who substantially furnish their services in a hospital ambulatory setting are now eligible • Payments increased by 10% for physicians practicing in a Health Professional Shortage Area

13. Federally designated non-profit organization • One per region • NYC- NYC REACH • Rest of NY State - NYeC • Provides assistance with • EHR vendor selection & pricing • Go-live project management & support • Onsite training & Quality Improvement • Achievement of Meaningful Use • Ensure providers have a place to get qualified and unbiased support Why do I need an Extension Center? WHAT IS AN EXTENSION CENTER?

14. ELECTRONIC HEALTH RECORD HAVE MANY BENEFITS… • For Patients: • Ability to see health record print outs, and in some cases, online • Prescriptions electronically sent to the appropriate pharmacies • Reduction in “hand-carried” information • Patient portal for on-line interaction with providers • Reduction in forms needed to be filled out • Less time answering same questions For Providers: • Remote access to data • Enhanced quality of patient care • Electronic decision support (clinical alerts & reminders) • Performance improvement tools (e.g. real-time quality reports) • Legible documentation facilitates accurate coding & billing • Add scanned documents, import transcribed notes & integrate with dictation software • Interfaces with labs, registries, etc…

15. AGENDA • EMR Adoption Landscape & Federal Strategy • PCIP & NYC REACH

16. PCIP- WE’RE IN THIS FOR THE RIGHT REASONS ELECTRONIC HEALTH RECORDS oriented to prevention Vision: Healthcare that maximizes health POPULATION MANAGEMENT & practice workflows to support prevention PAYMENT that rewards disease prevention & chronic disease management Mission: To improve population health in disadvantaged communities through the use of HIT. In order to accomplish this transformation, EHR adoption is not enough. We must re-orient EHRs, practice workflows, and healthcare reimbursement towards prevention with an emphasis on clinical interventions with the greatest potential to save lives *Frieden TR, Mostashari F. JAMA. 2008 Feb 27;299(8):950-2. 15

17. AND A TRUSTED EXPERIENCED PARTNER… Meaningful Use Extension Center Panel management CDSS / Pay for quality Qualityimprovement & PCMH EHR Implementation Strategy and procurement / Public Health Development Vision 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 16

18. POTENTIAL DEATHS PREVENTED BY GREATER USE OF CLINICAL PREVENTIVE SERVICES Number of deaths prevented Percent eligible utilizing service Farley TA, Dalal MA, Frieden TR. Unpublished data

19. PUBLIC PRIVATE PARTNERSHIP MODEL NYC Dept. of Health & Mental Hygiene Primary Care Information Project Fund for Public Health in NY ONC Funds NYC funds Robin Hood >$35 million+ staff support NY State funds Engelberg >$30 million AHRQ, CDC, DHS IPRO >$ 4 million Private donors Provider technical assistance contributions • Managing ~ $70 million in funding and ~30-40 projects

20. EXTENSION CENTER GOVERNANCE AND STRUCTURE FPHNY Primary Care Information Project PCIP DOHMH Extension Center Core Management Executive Director FPHNY Act. Asst Commissioner & Project Director • Fiscal management • Grants & contracts administration • Membership services website • Provider invoicing • Private fundraising • ARRA reporting • Biosurveillance • Public health development • Quality reporting • Evaluation • Health Information Exchange • Regional Center Accountability • Adoption support • Meaningful Use training • Workforce development • National Learning Consortium • Stakeholder Community* • DOHMH • NYS Extension Center • IFH • CHCANYS • PCDC • PCHIC • GNYHA • NYS DOH • NYEC • Others TBD • Clinical Advisory Board* • Small Practice physicians

21. WE ARE THE LARGEST EHR COMMUNITY PROJECT IN THE NATION Providers enrolled in PCIP 2,018 are live

22. WE’VE MADE OVER 1,600 ONSITE VISITS TO PRACTICES TO ASSIST WITH WORKFLOW REDESIGN 1,018 332 269 2010 2009 2008 21

23. WE JUST FINISHED YEAR 1 OF OUR EHEARTS PROGRAM • Novel design • No administrative hassle – based on EMR data • Payor agnostic • Designed to reward additional effort for sicker patients • No minimum thresholds Total available funding for incentives: $1.6 million Average incentive per provider: $10,000 to $20,000 Maximum incentive per practice: $100,000

24. Preliminary Results Preliminary Results RATES OF PATIENTS MEETING PREVENTION GOALS AMONG PROVIDERS FIRST USING THE SYSTEM (3-18 MONTHS POST GO LIVE) *Manual chart abstraction from a random sample of 3000 patients (120 patients at each of 25 small practices)

25. Preliminary Results RATES OF PATIENTS MEETING PREVENTION GOALS HAVE INCREASED WITHIN 6 MONTHS *Manual chart abstraction from a random sample of 3000 patients (120 patients at each of 25 small practices)

26. Preliminary Results THE BAD NEWS: WE HAVE A LOT OF WORK TO DO BECAUSE WE KNOW IMPROVEMENT DOESN’T JUST HAPPEN…

27. NYC REACH – A NEW PROJECT OF PCIP • Primary Care • Information Project • Non profit program, founded by PCIP in 2010, funded through a federal grant • Will help 2,400 additional providers go live on approved EHRs, including eCW • Will help 4,543 providers get to Meaningful Use (2012) • REC members have priority for other PCIP programs • PCIP seeks to improve population health through health IT and data exchange. • Part of NYC government • Responsible for the initial eCW program • Facilitates ongoing programs from implementation through improving health: • Pay for Performance • Patient Outreach • Public Health Surveillance

28. Unbiased Vendor Selection & Negotiation Project Management Education • EMR training • Billing training • Interface training • Assessing practice IT needs • Negotiating vendor contracts • Holding vendors accountable • Support a “choice of offerings” • Practice readiness • Follow up with practice & vendor • Adherence to timelines • Problem solving Practice and Workflow Redesign Privacy and Security EXTENSION CENTER SERVICES: EHR ADOPTION Health Information Exchange • Help practices connect to HIE infrastructures : • Clearinghouse • Labs • Medication refill history • Immunization registries • Public Health reporting • Forms (e.g., M11Q) • RHIOs • Mapping work processes to quality improvement initiatives • Updating roles and responsibilities • Supporting workflow to meet federal Meaningful Use criteria • Physical security • Access controls • Back up and Recovery • HIPAA compliance • Best practices training

29. SERVICES WE PROVIDE TO PRACTICES TO GET THEM LIVE AND TO MEANINGFUL USE • Go • live • Contemplation • Implementation • Post go live • Meaningful use • Provider outreach & education • Conferences • Webinars • Vendor selection • Readiness assessments • IT consultation • Partners for financing & workforce development • Contract accountability • Project management • Workflow redesign • Social networking • Communication outreach • CME credits for training • Revenue cycle optimization • EMR consulting • QI consulting • PCMH preparation • Privacy & security consulting • Work flow redesign Patient portal training • Interfaces (e.g.,labs, registries) • Pilots • Quality measures • Interoperability • Patient engagement • Biosurveillance • Pay-for-Quality programs • MU application support

31. Thank you, from the PCIP & NYC REACH teams • www.nycreach.org 30