10 Steps to Meaningful Use Success

1. 10 Steps to Meaningful Use Success March 7-10, 2012 Manchester Grand Hyatt San Diego, CA Krishna Ramachandran Executive Director Value Driven Health Care

2. DuPage Medical Group - Vitals • Largest independent multi-specialty group in Chicago metro area • 330+ Physicians; 2500 employees • ~$375 million Revenue • 40 Specialties; 45+ Sites • 21 PCP sites recognized by NCQA as Patient-Centered Medical Homes • 350,000 Active patients; Serve 1/3 of DuPage County (Locations in 4 counties –DuPage, Will, Kane and Cook) • Ancillaries include Imaging; Ambulatory Surgery Center; Lab; Physical Therapy; Infusion Therapy; Sleep labs • Dominant Physician Group at 3 area hospitals • Established in 1999 (from groups practicing since the ’60s)

3. Value Driven Health Care • DMG’s transformation to adapt to and lead the changing health care environment  • Focusedon: • Improving patient outcomes, experience • Reducing health care costs • Streamlining business processes • Increasing patient access to care • Assisted by VDHC Departments: • Quality Improvement Project Management • Training and Implementation Marketing and Communication

4. Meaningful Use by the Numbers 20 3 Stage 1 Measures (15 Core, 5 Menu) Stages 9 Quality Measures (Stage 1) $44,000 276 Max incentive per Provider (Medicaid is $64k) Pages in Final Rule (Stage 1) 90 $19,000,000 Day reporting period (year 1); full year then HITECH Act, part of ARRA

5. How does MU impact Quality? DMG’s QI Focus CMS MU Goals As one of our doctors said: “Stage 1 is Meaningful ‘Click-the-damn-button’ Use”

6. Sample Stage 1 Objectives • Implement drug interaction & formulary alerts • Computerized Provider Order Entry for med orders (> 30% of patients) • E-prescribing (at least 40% of non-controlled meds) • Active Med, Allergy and Problem Lists (> 80% of patients) • Record BP, height and weight (at least 50% of patients 2 & over) • Record smoking status (at least 50% of patients 13 & older ) • Give patients After Visit Summaries (at least 50% of all visits) • Provide electronic access to health information (at least 10% of patients) • Report on quality measures (3 core, 3 alternate, 3 additional)

7. Stage 1 Quality Measures • Core • NQF 0013: Hypertension blood pressure measurement • NQF 0028A&B: Tobacco use and cessation intervention • NQF 0421: Adult weight screening and follow-up • Alternate Core • NQF 0024: Weight assessment and counseling for children and adolescents • NQF 0038: Childhood immunization status • NQF 0041: Influenza immunization patients ≥50 years old • Additional (Pick 3 out of 38) • NQF 0059: Diabetes HbA1c poor control • NQF 0061: Diabetes blood pressure management • NQF 0064: Diabetes LDL management and control • Note: No Thresholds in Stage 1

8. Our Journey– 99.2% achieved MU

9. Step 1: Select & Implement EHR • CMS requires certified EHR Technology • Tested and certified by ONC designate • Does not need to be in place prior to registering for MU with CMS • Complete list on ONC website (healthit.hhs.gov)

10. We use Epic’s Ambulatory suite • Phased EHR implementation 2006-2010 • Chart Review/Results Review • Computerized Provider Order entry • Clinical Documentation • Additional features (2010 & after) • 2010: E-prescribing (Retail & Mail Order) • 2011: After Visit Summary (AVS), MyChart Patient Portal, Care Everywhere (for HIE test), Immunization Interface (test)

11. Step 2: Perform Gap Analysis • Review Final Rule & CMS Reference Materials (CMS.gov) • Review vendor documentation • Understand vendor reporting logic • Complete readiness assessment • Generate/review baseline reports to identify gaps • Develop project plan/scope • Identify owners

12. Step 3: Fill the Gaps - Technology

13. Step 3: Fill the Gaps - Workflow • “Switch” – by Chip and Dan Heath • “How to Change things when Change is Hard” • Rational Mind, Emotional Mind • Used several elements in MU strategy

14. Step 4: Point to the Destination • Dashboard - at-a-glance Red/Yellow/Green status • Transparency creates competition between docs and staff • Useful for physician and administrative leadership too

15. Step 5: Script the Critical Moves • Handbook - Simple, specific and actionable instructions on what physicians and staff need to do in the EHR

16. Step 6: Engage Doctors & Staff Over 60 Road Shows; Over 1000 miles logged • In-person site visits with physicians, managers and staff • Personal contact to address questions • Stress the importance of the staff role (most measures impacted by staff functions)

17. Step 7: Repeat Key Messages E-mail & Intranet series: New topic every 2 weeks

18. Step 8: Track and Share Progress • Monthly dashboard updates • Show progress, target further work

19. Monthly Update to Leadership

20. Challenges: Smoking Status Meaningful Use Roadshows

21. Challenges: Problem List EHR Alert

22. Challenges: After Visit Summary Meaningful Use Roadshows

23. Step 9: Simplify Attestation • Individual Provider registration/attestation or Proxy • Review attestation screens to prep data (Order of screens/fields; Exceptions) • ~ 10 minutes per attestation via Proxy

24. Step 10: Plan Ahead • Year 2 onward: Full-year of data • Keep MU on everyone’s radar • Analyze Stage 2 needs and gaps • Plan for upgrades, new feature implementations • Strategize how to sync MU with ongoing QI, ACO, CI, PQRS (and other acronym soup) activities

25. Questions? • Krishna Ramachandran Krishna@DupageMD.com 630-545-4038