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HITECH and Meaningful Use:
The Impact on the Future of Healthcare
Technology Management
Amy Walker MS, RN, CPHQ, FACHE, NEA-BC
CEO OptimizeIT Consulting
Healthcare IT Strategist
Past Member HIMSS Public Policy Committee
• Relate the components of The HITECH Act and Meaningful Use to health management technology
• Identify whether existing systems meet requirements
• Communicate technology needs and request feedback from end users for a smooth transition
• Implement best practices to move people and systems forward under these new requirements
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What We Will Cover…..
Your EcoSystem
Vision , Mission, and Strategic Goals
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Clinical Informatics
New Clinical Informatics Initiatives
Healthcare Operations
Information Technology
Communication
Communication
The Foundation
Leading from good to great does not mean coming
up with the answers and then motivating everyone
to follow your messianic vision. It means having the
humility to grasp the fact that you do not yet
understand enough to have all of the answers and
then to ask the questions that will lead to the best
possible insights.
(Jim Collins, Good to Great)
Your mind is like a parachute-
It only works when open
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What This Presentation Is Not About
The thoughtless application of IT, for slash and burn downsizing, restructuring,
and outsourcing.
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• President Bush’s goal in 2004
• Executive order established the Office of the National Coordinator for Health Information Technology (ONCHIT) as part of the Dept of Health & Human Services (HHS) – Dr. David Brailer appointed the first National Coordinator
A quick trip down memory lane …
“… an Electronic Health Record for
every American by the year 2014. By
computerizing health records, we can
avoid dangerous medical mistakes,
reduce costs, and improve care.”
- State of the Union address,
Jan. 20, 2004
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HITECH Act? hmm, sounds familiar…
• Signed into law February 2009 as part of ARRA
• Goal
– 90% of U.S. physicians and 70% of hospitals using EHR by 2019
• How?
– Provide $19 Billion to doctors and hospitals through DHS to implement EHR by 2011
ARRA
• HITECH Care
• Care Coordination
• Disease Management
• Value-based Purchasing
• Bundled Payment
• Medical Home
• Comparativeness Effectiveness
• Meaningful Use
• Public Reporting and Accountability
• Reward Top Performers
• Penalize Bottom Performers
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ARRA EHR Adoption –Incentive Requirements
• To encourage broad adoption of EHRs, ARRA offers reimbursement to eligible providers/hospitals who meet two requirements: – Acquire a certified EHR product or service
– Demonstrate that the organization or provider are using that product/service “meaningfully”
• ARRA creates HIT Policy and HIT Standards Committees which must recommend: – Criteria for certifying EHR products
– Criteria for demonstrating that an applicant is using the EHR meaningfully
Why are We Here?
• 2011
• 2013
• 2015
• Improve quality, safety, efficiency, and reduce health
disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population and public health
• All the while maintaining privacy and security
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HITECH Framework for MU of EHRs
Taken from: Blumenthal, D.
“Launching HITECH,” posted
by the NEJM on 12-30-2009.
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MU Measures Quality Measures
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VTE - 1 VTE Prophylaxis within 24 hours of
arrival
Stroke - 2 Ischemic Stroke - Discharge on
Antithrombotics
VTE - 2 VTE Prophylaxis within 24 hours of
arrival to ICU
Stroke - 3 Ischemic Stroke - Anticoagulation for
A-Fib/Flutter
VTE -3 VTE Diagnosis - Anticoagulation
Overlap Therapy
Stroke - 4 Ischemic Stroke - Thrombolytic
therapy for patients arriving within 2
hours of symptom onset
VTE -4 VTE - Platelet Monitoring on
unfractionated Heparin
Stroke - 5 Ischemic or Hemorrhagic Stroke -
Antithrombotic therapy by day 2
VTE - 5 VTE - Discharge Instructions Stroke - 6 Ischemic Stroke - Discharge on
Statins
VTE - 6 VTE - Incidence of potentially
preventable VTE
Stroke - 8 Ischemic or Hemorrhagic Stroke –
Education
ED - 1 ED throughput-arrival to departure
for admitted patients
Stroke -
10
Ischemic or Hemorrhagic Stroke -
Rehabilitation Assessment
ED – 2
ED throughput - Admit decision time
to ED departure time for admitted
patients.
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HITECH Incentives for Hospitals – Medicare Example
Four Year CMS Health IT Incentive Payment Scenarios:
2011 2012 2013 2014 2015 2016
2011 $20 $0 $0 $0 $0 $0
2012 $15 $20 $0 $0 $0 $0
2013 $10 $15 $20 $0 $0 $0
2014 $5 $10 $15 $15 $0 $0
2015 $0 $5 $10 $10 $10 $0
2016 $0 $0 $5 $5 $5 $0
2017 $0 $0 $0 $0 $0 $0
$50 $50 $50 $30 $15
Maximum
Medicare
health IT
incentive
payment
for this
year is:
If the first qualifying year is:
Total of Maximum over 4, 3,
or 2 Years' Medicare Health
IT Incentive Payments
Example Numbers(millions)
Penalties
begin
100% 100% 100% 60% 30%
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Current State for EMR Adoption in Home Health
• Over 80% use telemonitoring devices – from lo tech to hi tech
• EMR Technology Levels* (2007 survey data) – 43% use EMR systems with following functionality
• Patient demographics 95%
• Point of care clinical documentation 29%
• Clinical notes 34%
• Clinical decision support 23%
• Record MD orders 50%
– 31% in process
Resnick, H.E., and Alwan, M. (2010). Use of health information technology in home health and
hospice agencies: United States, 2007. Journal of the American Medical Informatics Association 17(4):389-395.
What Does It Mean?
• Increased reliance on IT
• Greater need for informatics professionals
• SWOT analysis should come sooner rather than later
• Suddenly, certifications matters more than ever
• More governance / new regulatory and reimbursement guidelines
Leveraging best practices to move and systems forward
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Patient Care Advancements
Healthcare Reform
Meaningful Use of
Technology
Clinical Engineering
Care Providers
• Improve quality, cut costs – Accountable Care Organizations
• Larger insurance footprint
• Not predetermined
• Focus on value
• Shift to outpatient care
• Data driven problem solving
• Refocus on fraud
• Growing information technology footprint
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Goals of Healthcare Reform
• Proposed CMO ACO rules published
2011 2012 2013 2014 2015
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• Meaningful
Use Stage 2
• Advanced
Clinical
Process
• Medicare
Accountable
Care
Organizations
• Medicare Value-
based
Purchasing
• Reduced
Medicare
Payments for
Hospital
Readmissions
• Medicare
Bundle
Payment
Pilot
• ICD-10
Conversion
• Meaningful
Use Stage 3
Improved
Outcomes
• Health
Insurance
Exchanges
(electronic
eligibility)
• Reduced
Medicare
Payments for
Hospital
acquired
Infections
(HAI)
• Medicare
Expenditures
Capped
• Medicare
payment
adjustment
begins for
non
meaningful
users of IT
Accelerating Health Care Value
“Readiness for change is one of the hardest problems we face”, Paul Tang, HIT Policy Committee vice chair and Palo
Alto Medical Foundation vice president and chief medical information officer.
“To realize our vision, we must foster a pervasive culture of innovation”, Douglas D. French, former
Ascension Health president and chief executive officer.
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Your EcoSystem
Vision , Mission, and Strategic Goals
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Clinical Informatics
New Clinical Informatics Initiatives
Clinical Operations
Information Technology
Communication
Communication
Health IT Strategic Framework
A learning health system is patient centered and uses information to continuously improve health and healthcare of individuals and the population
Information Technology
Transfor-mation
Innovation Engine
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Meaningful Healthcare Reform A Journey
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Communication
Transformational Readiness
Clinical & Operational
Leaders
Enterprise Commitment
and Accountability
Industrial Strength LEADERSHIP & MANAGEMENT
• Complete an enterprise assessment of the organizational readiness to reform • Evaluate the present situation, identify recommendations, and best practices to optimize the future state
• Identify obstacles, challenges, sources of issues, and needed changes
• Identify indicators of healthcare reform and changes in order to maximize operational performance
• Create and heavily emphasize an EFFECTIVE & INNOVATIVE change management and communication plan
• Create a practical benefits realization plan
Patient Care Advancements
Healthcare Reform
Meaningful Use of
Technology
Clinical Engineering
Care Providers
Certified EHR Technology
• Office of the National Coordinator for Health Information Technology has approved two entities as able to review and certify EHRs – Certification Commission for Health Information
Technology (CCHIT) – Drummond Group Inc.
• Unless your current system is homegrown, piecemeal or older, your EHR vendor is likely already pursuing certification
• (and/or trying to sell you a new or upgraded system – which they promise will be certifiable)
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Aurora Health Care HITECH Gap Analysis
Look at each MU Criteria (and Gap) in 3 ways:
1. Technology – do you need software installed?
2. Adoption – do you have the required adoption?
3. Ability to Measure – can you measure?
Use these same categories in the
Work Plan for tracking
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30 Slide #30
Aurora Health Care MU Dashboard
Slide #31
Aurora Health Care Project Tracking Tool
HIPAA
Privacy and Security
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Today’s Privacy and Security Environment
Covered Entities
Medical Homes
Medical Homes
Medical Homes
Pharmacy
Laboratories
Medical Log
Physician
Portal
Personal
Healthcare
Records
Medical Records
Clinical Image Records
Wellness Centers
Outpatient Care
Accountable Care
Organizations
Exercise Log
EMR
Social Worker
Emergency
Payer
Primary Care
Physician
Patient
Increase in HIPAA Penalties
Under the ARRA:
All such violations of an identical provision in a calendar year
(A) Did Not Know ............................................. $100 $50,000 $1,500,000
(B) Reasonable Cause ..................................... 1,000 50,000 1,500,000
(C) Willful Neglect—Corrected ........................ 10,000 50,000 1,500,000
(C) Willful Neglect—Not Corrected .................. 50,000 1,500,000
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A Sample of Questions for HIPAA-Security Assessment
• What is our single vulnerability from a technology or security point of view?
• How vulnerable are we to attack on confidentiality, integrity, and availability of our data and systems?
• What is the assessment of physical security controls at each of our sites (data center, home office, field offices, and other sites?
• How prepared are our incident response plans?
• Have we protected our company in contracts with vendors?
• Do we understand what PHI we produce, capture, store, transport, and destroy?
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Standards and Interoperability
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HITECH Drives US Standards Efforts
• Goal: Transform healthcare through the meaningful use of health data
• Data capture data sharing advanced clinical processes
Improved Outcomes
• Requires organized structuring and effective use of information to support decision making
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Need for Health Data Standards
• Standards are foundational to development, implementation and exchange of EHRs
• Clinicians need ubiquitous access to health information to provide optimal care
• Providers, payers and public health entities must exchange health information between departments, across organizations and agencies
• Consumers need assurance that caregivers have seamless access to correct information
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What are Data Standards?
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Data + Context + Structure Information
Information + Rules + Analysis Knowledge
They are standards
having to do with the
structure and content
of health information
ONC Standards and Interoperability Framework
4
0
Tools and Services (Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)
Use Case Development
and Functional
Requirements
Standards
Development
Certification
and Testing
Harmonization of
Core Concepts
Implementation
Specifications
Pilot Demonstration
Projects
Reference
Implementation
ICD-10
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ICD-10 Compliance Impact
• International Classification of Disease 10th Revision • federally mandated by October 1, 2013 for all providers
• more flexible code set expands for new procedures, diagnoses and technologies
• greater specificity translates to improved quality measurements and patient safety standards
• Impact to include: • Coding Medical Records/Health Information Management
• Registration/Scheduling
• Encounter Forms/Charge Tickets
• Clinical Documentation
– Information Systems; including EHR’s
…the entire Revenue Cycle
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Home Health
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Home Health Today
3.3 million seniors receiving care on any given day – over 14 million per year*
• Over 10,000 agencies – coverage in every state
• Approx 1 million clinicians; multidisciplinary
• Most provide specialty programs – Diabetes, Congestive Failure, COPD, Stroke
– Patient centered, self management focus
• Many specialize in geriatrics
• Lowest cost/best outcomes in chronic care management for elderly**
*Medicare Payment Advisory Commission. (2011) http://www.medpac.gov/documents/Mar11_EntireReport.pdf
Literature Shows
• Seniors do better at home for acute care on clinical outcomes, costs, satisfaction
• Transitioning elders from acute to home with teaching for self management and f/u more effective, low readmission rates
• Use of telemonitoring in home for CHF and cardiac patients w/PHR show optimal recovery and self management results.
Aging Demographics
• 7000 Baby Boomers turning 65 yrs every day
• 2011 Legislature targeting Medicare and Medicaid cuts
• Current CMS spending and Baby-Boomer impact vs. national fiscal goal of deficit reductions
• HH positioned to provide highest quality and best outcomes in care delivery for our elder population
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Key Initiatives in ACA (CBO est. 13.5b savings 2011-19 Sec 3021-3027)
• CMI – Center for Medicare and Medicaid Innovation – launched November, 2010
• Hospital at Home – for elderly
• Care Transition Program Pilot
• Readmissions Reduction Program
• Accountable Care Org/Bundling Pilots
Patient Care Advancements
Healthcare Reform
Meaningful Use of
Technology
Clinical Engineering
Care Providers
Clinical Engineering
The Clinical Engineering Department provides multiple services to ensure that the medical equipment needs for patients and staff are met. We provide services with accuracy and integrity.
– Provide installation, preventive maintenance
– Provide mandatory pre-use inspections
– Performs investigations
– Provides assistance in the disposal of medical equipment
– Provides for in-service training and support
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Perhaps Clinical Engineering Might Also Focus On
• Identifying improvement opportunities • Participating in information technology and management
strategy • Optimization in the use of devices • Rounding to ensure feedback and evaluation of device
usage • Expert resource in care coordination: technologies,
equipment and information flow • Expert resource in equipment, process, and information
flow for meaningful use, and • Expert resource for teams defining information technology
management
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It’s Not What We Don’t Know
That Hurts, It’s What We
Know That Isn't So
Will Rogers (1879-1935)
Planning for Quality the Systems Thinker 52
“Systems Thinking is a discipline for seeing wholes, recognizing patterns and interrelationships, and learning
how to structure those
interrelationships in more
effective, efficient ways.”
Senge, P., & Lannon-Kim, C., 1991
Five Dysfunctions of a Team
• Absence of Trust
• Fear of Conflict
• Lack of Commitment
• Avoidance of Accountability
• Inattention to Results
• Identify the behaviors?
• How do you know that these have been overcome? The Five Dysfunctions of a Team: A Leadership Fable, San Francisco;
Jossey-Bass, 2002
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Lean Incorporated into Our Teams
• People first
• Flexibility
• Walking the Talk
• Our colleagues are assets
• Always provide value
• Mentor and coach
• Bridge organizational boundaries
• Adjustments made as work flow indicates
• Applies frontline feedback
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Listening Techniques
• Clarify-get more information
• Restate-check the meaning
• Remain neutral-convey interest
• Reflect-help them evaluate their feelings
• Summarize-bring the discussion into focus
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Are the skills, knowledge, and experience of the actors well matched with the tasks they are
asked to perform?
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It is only after I have read, identified, and stimulated your needs that I will be able
to energize our discussions while irresistibly presenting my ideas to you. (Robert Mayer, How to Win Any Negotiation)
Power/Influence is the ability to get people to perceive that a given behavior (or performance) is the best action they can take in the service of their values.
Patient Care Advancements
Healthcare Reform
Meaningful Use of
Technology
Clinical Engineering
Care Providers
Care Providers
• At risk and accountable • Will prepare for multiple reform outcomes • Forge new partnerships • Reliance on valid performance vs. faulty • Increase in training • Empowered to lead improvement • Decrease in the size of the pie • Increase in reliance in technology • Driven by incentives and penalties
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It Is Not The Strongest Who Survive, Or The Fastest.
It Is The Ones Who Can Change the Quickest.
Charles Darwin
Care Providers Must Simplify Communication
• Provider to Provider
• Specialty to Specialty
• Provider to Consumer
• Patients as Consumers
• Payer to Employee
• Payer to Consumer
• Payer to Employee
Interoper-ability
Meaningful Data
Decision Support
Adherence Compliance
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Communication Balancing Act
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This is What I Asked
This is What I Heard
Patient Care Advancements
Healthcare Reform
Meaningful Use of
Technology
Clinical Engineering
Care Providers
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Accountable Care Organizations
A concept that has the potential to revolutionize the way healthcare is delivered, experienced, and paid for in America.
– Care coordination
– Patient centered using to the full extent all health care professionals
– Respects patient centeredness by respecting patient choice of provider and shared decision making
– Positive patient experience
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Medical Home
Six medical home standards
– Enhance access and continuity
– Identify and manage patient populations
– Plan and manage care
– Provide self-care and community support
– Track and coordinate care
– Measure and improve performance
• E-Visits
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Innovative Systems
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The Vscan by GE, is a new mobile device designed for doctors who are making house calls.
FutureScan 2011: Healthcare Trends and Implications 2011 - 2016
Society for Healthcare Strategy and Market Development / Health Administration Press January 2011
Innovative Systems
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AirStrip Technologies, has built its revolutionary AppPoint™ software development platform with a vision of securely sending critical patient information directly from hospital monitoring systems, bedside devices, and electronic health records to a clinician's mobile device.
Further Impact to Information Systems
• Zero tolerance for negative unintended consequences will be identified and resolved
• Increased support to care coordination
• Increased certification criteria based on measurable achievements
• Mathematical and logical models will become the norm to support healthcare reform
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Perhaps Clinical Engineering Might Needs to Focus On
• Identifying improvement opportunities
• Participating in Information technology and management strategy
• Optimization in the use of devices
• Rounding to ensure feedback and evaluation of device usage
• Expert resource in care coordination: technologies, equipment and information flow
• Expert resource in equipment, process, and information flow for meaningful use
71
Perhaps Clinical Engineering Might Needs to Focus On
• Identifying improvement opportunities
• Participating in Information technology and management strategy
• Optimization in the use of devices
• Rounding to ensure feedback and evaluation of device usage
• Expert resource in care coordination: technologies, equipment and information flow
• Expert resource in equipment, process, and information flow for meaningful use
72
Health IT Strategic Framework
A learning health system is patient centered and uses information to continuously improve health and healthcare of individuals and the population
Information Technology
Transfor-mation
Innovation Engine
73
Enterprise Commitment
and Accountability
Organizational Readiness A Pervasive Culture
• Industrial strength leaders
• Industrial strength organizations
• Un-ending curiosity and fact finding
• Ability to project what-if scenarios
• Ability to simplify every process
• Ability to act lean
• Zero tolerance for waste
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Implement best practices to move people and systems forward under these new requirements
Closing Thought…
75
We can bu i ld h igh per fo rmance
teams tha t toge ther, de te rm ine and
imp lement the requ i rements fo r
hea l thcare o rgan iza t ions tha t opera te
as innova t ion eng ines , t rans fo rm ing
peop le , techno logy, and p rocesses to
advance hea l thcare re fo rm.
We rea l i ze i t beg ins w i th us .
Thank you!
For more information, please contact:
703-283-4678