Achieving Meaningful Use – A FQHC Approach

1. Achieving Meaningful Use – A FQHC Approach Andres Gutierrez, CIO Family Health Centers of San Diego September 24, 2010

2. About Family Health Centers of San Diego • Family Health Centers of San Diego is the second largest federally qualified health center in the country.  We were founded by community activists 1970. Our mission is to provide caring, affordable, high quality healthcare to anyone in need, with a special commitment uninsured, low income, and medically underserved families.  We have 29 locations and provided over ½ million patient visits in 2009.

3. An Approach to Meaningful Use • Suggested Steps • Systematic Review/Goal Alignment • Inventory Information Assets and Capability • Analyze and Conduct Gap Analysis • Assess Information Technology Infrastructure • Environmental Scan to Assess Other Impacts • Organize to Manage and Meter Established Meaningful Use Objectives/Benchmarks • Monitor, Track and Report

4. Improve Quality, Safety, Efficiency & Reduce Health Disparities Engage patients and families in their healthcare Ensure adequate Privacy & Security protections for PHI Improving population & public health Improve Care Coordination Meaningful Use Goals Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health. Exchange meaningful clinical information among professional health care team. Provide access to comprehensive patient health data for patient’s healthcare team. Use evidence-based order sets and CPOE. Apply clinical decision support at point of care. Generate lists of patients who need care and use lists to reach out to those patients. Report information for quality improvement and public reporting. 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. The patient’s health care team communicates with public health agencies.

5. Improve Quality, Safety, Efficiency & Reduce Health Disparities Engage patients and families in their healthcare Ensure adequate Privacy & Security protections for PHI Improving population & public health Improve Care Coordination Systematic Approach for Alignment GOALS Systems Process Measures Policy Review Research Patient Communication Services Survey Structured Data Continuously Improve Information Exchange Consent Network Standards Structured Data Registries Surveillance Research Structured Data Reporting Systems Administration Consent Policy Regulation ALIGN WITH:

6. Inventory Information Assets and Capability • Assume that Meaningful Use is an integrated solution, requiring information sourced from an organization’s HIT information assets • HIT Systems • Practice Management System • Laboratory Information Systems Considerations • Send Outs • In-house Reference Laboratory • Electronic Health Records • Integrations • Visit Summary • Computer Provider Order Entry • e-Prescriptions • Pharmacy Information Systems • Decision Support/Business Intelligence/Reporting • Data Mart • Radiology Information Systems • Interfaces • Immunization Registries • Information Exchanges • Other partner systems

7. Gap Analysis - Example

8. Assess Information Technology Infrastructure • Technology Infrastructure Assessment • Security Management • Encryption • VPN • Advanced Directory Services • Physical Security • Data Center / Server Room • Network • Services • Management (Fault, Capacity, Accounting, Performance, Security) • Policy and Procedure Review • Backup and Recovery; Disaster Recovery/Planning

9. Environmental Scan • ICD-9 to ICD-10 • Potential Meaningful Use Impacts • Problem List • Claims • Clinical Terminology • Refer to the ICD-10 and Version 5010 Compliance Timelines (January 2010 – October 2013) – Overlapping Period • HITECH Act 2010 • Vendor Management/Responsiveness • Some vendors are limited by licensing, for example, Drug- Drug Interaction is a capability in the pharmacy information system, but can’t be messaged to the EHR system. As such, this function needs to be available in the selected EHR system.

10. A Tactical Approach to Meaningful Use • Organize for Meaningful Use • Clinical Outcomes Management • Instrumentation • Numerators/Denominators • Surveillance of process • Patient Communications • Process Review and Improvement • Standardization • Policy Deployment • Utilization Reviews • Financial Management/Oversight • Meaningful Use Assurance • Future – Penalty Avoidance

11. Biography Mr. Gutierrez comes to FHCSD with over 25 years’ experience in IT management, software engineering, and consulting. He received a Bachelor of Science degree and a MBA from New Mexico State University. Mr. Gutierrez provides strategic and tactical planning for the operational management and development of all FHCSD technology infrastructures. He provides leadership in the development of its practice management, dental electronic health records, nursing electronic health records. He manages IT operations in addition to leading the integration and deployment of certified EHR at FHCSD, Health Information Exchanges and Registries. Mr. Gutierrez serves on the University of California San Diego Extension HIT Advisory Board.