A Meaningful Look at EHRs and Health Information Exchange ISCEBS Symposium - September 7, 2011 Susan Brown, Telligen Kory Schnoor, IDPH

Objectives  Describe federal and state health IT environments  Provide background on HITECH & meaningful use of health IT  Discuss Telligen’s HIT Regional Extension Center  Explain the background and services of the Iowa Health Information Network (IHIN)  Describe how IHIN can improve quality, safety and efficiency of health care 2

Objectives #1 & #2  Describe federal and state health IT environments  Provide background on HITECH & meaningful use of health IT 3

If you want to promote better coordination between doctors, you need to be able to quickly move health information wherever it’s needed. If you want to empower consumers to take charge of their health care, they need to be able to access their health information without calling up five different doctor’s offices. ― Kathleen Sebelius Secretary of Health and Human Services 4

Improved Quality, Safety and Efficiency Better Communication and care coordination Faster Delivery of information and results Safer Treatment via e-Prescribing More efficient Coding and billing

HITECH: Catalyst for Transformation HITECH ActEHRs & HIEPaper records Pre A system plagued by inefficiencies Meaningful Use Incentive Program and 62 Regional Extension Centers Widespread adoption and meaningful use of EHRs

Why Meaningful Use of Health IT?  Improve quality, safety, efficiency  Engage patients and families in their health care  Improve care coordination  Improve population and public health  Ensure privacy and security of electronic health information Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008

Snapshot of EHR Benefits  Quick access to patient records from inpatient and remote locations for more coordinated, efficient care  Enhanced decision support, clinical alerts, reminders, and medical information  Performance-improving tools, real-time quality reporting  Legible, complete documentation that facilitates accurate coding and billing  Interfaces with labs, registries, other EHRs and HIEs  Safer, more reliable prescribing For Providers:  Reduced need to fill out the same forms at each office visit  Reliable point-of-care information and reminders notifying providers of important health interventions  Convenience of e-prescriptions electronically sent to the pharmacy  Patient portals for online interaction with providers  Electronic referrals allow for easier access to follow-up care with specialists For Patients:

Opinions  Over 90% of all physicians with EHRs are satisfied with their EHR -New England Journal of Medicine 2008, 359:  78% of Americans favor the use of electronic medical records (NORC study: U of Chicago) – No more clipboards! – E-Prescribing! – Better informed! – Less duplicate testing!

The Key to Healthier Living “Take a Walk, Eat More Plants”

 According to preliminary estimates from a CDC survey released December, 2010, 24.9% of office-based physicians had access to a “basic” EMR system, while only 10.1% had a “fully functional” system. Physician EHR Adoption is Limited AMA, January 17, 2011, American Medical News

EHR Adoption in Iowa  Less than 50 percent of Iowa physicians have adopted EHRs  As late as 2009, 89 percent of Iowa’s hospitals still used some paper records

EHR Adoption Challenges Expense of system Uncertainty around ROI Provider and staff productivity Uncertainty about financial incentives Disruption of workflow and productivity Privacy and security concerns Maintaining patient centeredness and satisfaction Concerns about technically supporting a system Lack of necessary computer skills Finding right EHR to suit practice needs (“usability”) Having the right IT staff in place Possibility of information overload Financial Technical Organization Change

Meaningful Use Incentive Programs  Medicare – Up to $44,000 per eligible provider – Hospital: Payment formula – Payments began May 2011 – Penalties begin 2015  Medicaid – Up to $63,750 per eligible provider – Hospital: Payment formula – Payments began in Iowa January 2011 – Over $13M paid in Iowa to date

Stage 1 Objectives: Medicare

Objective #3  Discuss Telligen’s HIT Regional Extension Center. THE TRUSTED HEALTH IT ADVISOR

Regional Extension Centers Regional Extension Centers assist providers seeking to adopt & become meaningful users of certified electronic health records (EHRs)

Regional Extension Center Program Assisting small primary care practices, rural health clinics, and critical access/rural hospitals with EHRs and meaningful use through 2014!

Telligen REC  Territory: State of Iowa  Assisting:  1200 Primary Care Providers  87 Critical Access & Rural Hospitals

Telligen REC  Advocates for the provider  Team approach to services – EHR Advisors – Clinical Advisors – Help desk – Information architect – Physician informaticist – Attorney

Comprehensive Support Plan 12 Transition 3 Implement 4 Operate & Maintain

Common Vendors 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

Iowa REC Sign-Ups Ambulatory Providers: 883 Critical Access/Rural Hospitals: 57 “Trusted Health IT Advisors”

HITECH: How the Pieces Fit Together

Objectives #4 & #5: IDPH  Explain the background and services of the Iowa Health Information Network (IHIN)  Describe how IHIN can improve quality, safety and efficiency of health care