1. REC Reported Practice Level Challenges to Achieving Meaningful Use Office of Provider Adoption Support Dawn Heisey-Grove, MPH September 10, 2012

2. Initial Program Goal: 100,000 priority primary care providers achieve meaningful use (MU) by 2014 62 RECs Cover 100% of the USA 2 Every REC: Has a defined service area and specific number of providers Provides unbiased, practical support throughout process Serves as two-way pipeline to federal and local resources Approach differs by REC: Independent operations Affiliation with QIOs and universities Partnership with other ONC grantees (Beacon and HIE) Variety of hospital and payer partnerships

3. Over 120,000 providers: ≈ 42% of all PCPs in US ≈ 70% of all rural providers ≈ 74% of FQHCs *Not shown: 10,000+ specialists Who RECs Are Helping 3 http://dashboard.healthIT.gov **Data as of 3-12-2012

4. Who Works with the RECs? 4 **Data as of 3-12-2012

5. Background In November, 2011, RECs were asked to enter site-level challenges in the CRM RECs are using the CRM Challenges feature in varying ways – Some are creating a “Challenges” for every site; for those sites on track, they are creating an “On Track” issue – Others are only creating “Challenges” issues for those practices that are stuck in the process 3 RECs are sending data files to OPAS external to the CRM. Those data are incorporated into these slides.

6. Challenges Categories One field captures the stage of adoption for the practice: are they trying to reach AIU, or MU? There are then 5 Challenges Types: Practice Issues, Vendor Issues, Attestation Process problems, problems with MU Measures, and an “On Track” classification Within each of the Challenges Types, there are sub-categories. A definition page is available upon request.

7. Primary and Secondary Challenges Categories Practice Issues Workflow adoptionProvider engagementTrainingVendor selectionAdministrativeFinancialStaffing Vendor Issues Upgrade Delays in implementation / installation Certification Reports slow / not available Training / support materials inadequate/not available Lack of vendor supportTechnical Inaccurate reports and/or data Attestation Process Issues Calculating patient volume Medicaid program not up yet Medicaid technical/ administrative Medicare technical/ administrative MU Measures Core CQMsAlternate Core CQMsAdditional CQMs Each of the Core / Menu Set measure Complete list of Challenges categories, including tertiary categories and descriptions of the categories, is available upon request.

8. Resolved Challenges: Site Level Challenges can be resolved with at the site level or provider level At the site level, a Challenges would be resolved if: – the REC indicates the issue is “Completed” – a new issue is created to indicate the site is now on track – An “on track” issue is resolved if a new Challenges issue is created

9. Resolved Challenges: Provider Level At the provider level, all challenges are resolved if the provider receives an MU payment from CMS. Other ways a provider may have a Challenges resolved: – Attestation Process issues are resolved when a payment is received from CMS – AIU issues are resolved if an AIU payment is received by CMS – Vendor selection issues are resolved if a provider reaches M2 and the issue was created before the M2 date – All issues except Attestation Process are resolved if a provider reaches M3 – All AIU Vendor Issues when the provider reaches M2, provided the issue was created before the M2 date

10. Top Ten Overall Challenge Categories by Number of Providers Impacted RankSecondary Challenge CategoryRank Last Month Total Providers Impacted (% resolved) New reports this month by number of providers (% of total providers with new reports) 1MU Measures14,556 (12%)364 (15%) 2Provider engagement23,853 (12%)249 (10%) 3Administrative practice issues43,063 (11%)510 (21%) 4Vendor selection32,974 (22%)72 (3%) 5Workflow adoption62,081 (10%)76 (3%) 6 Vendor delays in implementation/ installation 51,995 (9%)157 (6%) 7Medicaid Program not up yet71,645 (29%)32 (1%) 8Practice financial issues101,609 (14%)244 (10%) 9 Vendor EHR reports slow/ not available 81,408 (12%)66 (3%) 10Practice staffing issues131,191 (14%)77 (3%) Data as of August 5, 2012, pulled from the ONC CRM. A total of 19,237 challenge Issues have been reported by RECs, impacting 54,101 providers. A total of 1,197 challenge Issues were created between July 1 and August 5, 2012, affecting 3,251 providers. 2,942 providers had challenge issues resolved between July 1 and August 5, 2012.

11. Challenge Activity For The Month Top Ten New Challenge Issues Secondary Challenge Category Number of Providers (% of total providers with new reports) Administrative practice issues510 (21%) MU Measures364 (15%) Provider engagement249 (10%) Practice financial issues244 (10%) Vendor delays in implementation / installation 157 (6%) Vendor EHR reports slow/ not available 95 (4%) Staffing77 (3%) Workflow adoption76 (3%) Medicare technical issues75 (3%) Vendor selection72 (3%) Top Ten Resolved Challenges Secondary Challenge Category Number of Providers (% of total providers impacted by secondary category) Vendor selection192 (13%) MU Measures159 (11%) Provider engagement124 (8%) Vendor EHR reports slow/ not available 109 (7%) Administrative practice issues95 (6%) Vendor upgrades76 (5%) Practice staffing issues67 (5%) Vendor delays in implementation / installation 60 (4%) Medicaid program not up yet59 (4%) Workflow adoption54 (4%) Data as of August 5, 2012, pulled from the ONC CRM. A total of 1,197 challenge issues were created between July 1 and August 5, 2012, affecting 3,251 providers. 2,942 providers had challenge issues resolved between July 1 and August 5, 2012. The green circle represents the issue with the most movement this month. 6

12. Overall Top Ten MU Measures-Specific Challenges RankMeaningful Use Measure Number of Providers Impacted New Reports this month by number of providers impacted 1Core 13: Clinical Summary 1648 116 (28%) 2Menu 7: Medication Reconciliation 852 9 (2%) 3Core 15: Security Review 851 15 (4%) 4Menu 4: Patient Reminders 820 6 (1%) 5Menu 8: Summary Care Record 802 7 (2%) 6Menu 9: Immunization 607 11 (3%) 7Menu 6: Educational Resources 585 26 (6%) 8Core 14: Electronic Exchange 513 17 (4%) 9Core 9: Smoking Status 490 1 (0.2%) 10Core CQMs 444 7 (2%) Data as of August 5, 2012, pulled from the ONC CRM. Users may select multiple measure-specific issues as challenges within one report, therefore, these numbers may overestimate the total number of challenge reports for Measure-specific issues. The blue ribbon indicates the top reported issue for the month. The green circle represents the issue with the most movement this month. Measures to watch: Core 4 (eRx) is #13 overall this month (down from #8) with 21 (5%) new reports. Measures to watch: Core 4 (eRx) is #13 overall this month (down from #8) with 21 (5%) new reports. 575

13. Top Ten Newly Reported MU Measures-Specific Challenges: July 1-August 5, 2012 RankMeaningful Use MeasureNew Reports this month, by number of providers impacted Percent of total monthly providers impacted 1Core 13: Clinical Summary11628% 2Core 9: Smoking Status6215% 3Core 8: Vital Signs379% 4Menu 6: Educational Resources266% 5Core 4: eRx215% 6Core 14: Electronic Exchange174% 7Core 15: Security Review154% 8Additional CQMs123% 9Menu 9: Immunization113% 10Menu 2: Laboratory Tests102% Data as of August 5, 2012, pulled from the ONC CRM. Users may select multiple measure-specific issues as challenges within one report, therefore, these numbers may overestimate the total number of challenge reports for Measure-specific issues.

14. Top Ten Top Ten Challenge Categories for Providers Trying to Reach MU RankSecondary Challenge CategoryRank Last Month Total Providers Impacted (% resolved) Reports this month (% of total monthly reports) 1 MU Measures-specific issues 12,859 (8%)109 (14%) 2 Provider engagement 21,533 (5%)124 (16%) 3 Practice administrative issues 61,133 (3%)96 (13%) 4 Vendor EHR reports slow/ not available 31,064 (5%)16 (2%) 5 Workflow adoption 41,023 (2%)30 (4%) 6 Upgrade 5805 (3%)20 (3%) 7 Vendor delays in implementation/ installation 7565 (0.4%)45 (6%) 8 Practice staffing issues 13538 (1%)64 (8%) 9 Practice financial issues 9526 (2%)8 (1%) 10 Vendor reports and/or data inaccurate 10523 (1%)39 (5%) Data as of August 5, 2012, pulled from the ONC CRM. MU refers to the implementation phase the site is at for their EHR. A total of 11,991 providers have MU challenge Issues. The green circle represents the issue with the most movement this month; the blue ribbon indicates the top reported challenge for the month. 5

15. Top Ten Newly Reported Challenge Categories for Providers Trying to Reach MU: July 1-August 5, 2012 RankSecondary Challenge CategoryRank Last Month Total Providers Impacted Percent of total monthly providers impacted 1 Provider engagement 2 12416% 2 MU Measures 1 10914% 3 Administrative practice issues 6 9613% 4 Practice staffing issues 7 648% 5 Medicare technical issues 17 537% 6 Vendor delays in implementation/ installation 3 456% 7 Vendor reports and/or data inaccurate 9 395% 8 Practice staff training 4 324% 9 Workflow adoption 5 304% 10 Upgrade 15 203% 12 Data as of August 5, 2012, pulled from the ONC CRM. MU refers to the implementation phase the site is at for their EHR. A total of 2,773 providers have newly reported MU challenge Issues between July 1-August 5, 2012. The green circle represents the issue with the most movement this month. 5

16. Challenge and On Track Reports by Site Number of Reports Per Site Data as of August 5, 2012, pulled from the ONC CRM. 15,983 sites are represented in 19,237 challenge reports. Each site in the CRM may have multiple challenge issues created for it. *84% of sites have only 1 challenge/on track issue reported.

17. Overall Monthly Challenge Activity *Data as of August 5, 2012, pulled from the ONC CRM. A total of 19,237 challenge Issues have been reported by RECs.

18. Proportion of Providers Impacted by Challenge Types as Reported in CRM Unresolved Challenge IssuesResolved Challenge Issues Issue TypePercent Resolved Attestation Process29 MU Measures12.3 Practice Issues13.7 Vendor Issues15.9 Data as of August 5, 2012, pulled from the ONC CRM. 43,906 providers have open challenge issues; 33% (14,420) of those are on track. 10,195 providers have resolved issues.

19. Practice Issue Challenges Unresolved Practice Issue Challenges Resolved Practice Issue Challenges by Number of Providers Data as of August 5, 2012, pulled from the ONC CRM. A total of 17,015 providers have a practice issue challenges report; 1,425 (8%) do not have a sub-category. 2,337 (14%) providers have practice issues that have been resolved. Number of Providers

20. Vendor Issue Challenges Unresolved Vendor Issue Challenges Resolved Vendor Issue Challenges Data as of August 5, 2012, pulled from the ONC CRM. A total of 8,737 providers have a vendor issue challenge report ; 825 (9%) do not have a sub-category. 1,385 (16%) providers have resolved vendor issue challenges. Number of Providers

21. Attestation Process Challenges Unresolved Attestation Process Issues Resolved Attestation Process Issues Data as of August 5, 2012, pulled from the ONC CRM. A total of 4,878 providers have an attestation process challenge report; 1,230 (25%) do not have a sub-category. 1,419 (29%) providers have a resolved attestation process issue. Number of Providers

22. Top Five Challenges by Practice Type Data as of August 5 2012, pulled from the ONC CRM. Non-priority hospitals did not report any challenges. Attestation Process Practice Issue Vendor Issue MU Measures

23. Top Five MU Measures-Specific Challenges by Practice Type Rank CHCsCAHs Other Underserved Setting Practice Consortium Private Practice 1-10 Public Hospitals Rural Hospital Rural Health Clinic Specialty Practice 1 Core 15: Security Review Menu 4: Patient Reminders Core 13: Clinical Summary Core 15: Security Review Core 13: Clinical Summary Core CQMs Core 8: Vital Signs Core 4: eRx Core 9: Smoking Status 2 Menu 9: Immunization Core 13: Clinical Summary Menu 8: Summary Care Record Core 13: Clinical Summary Core 15: Security Review Core 13: Clinical Summary Core 9: Smoking Status Core 13: Clinical Summary Core 4: eRx 3 Menu 5: Electronic Access Menu 8: Summary Care Record Menu 4: Patient Reminders Core 14: Electronic Exchange Menu 9: Immunization Core 1: CPOEN/ACore CQMs Core 13: Clinical Summary 4 Core 4: eRx Menu 7: Medication Reconciliation Core 11: Implement CDS Core 14: Electronic Exchange Core 9: Smoking Status N/A Additional CQMs Core 15: Security Review 5 Core 12: Electronic Copy Menu 6: Educational Resources Core 9: Smoking Status Core 4: eRxN/A Core 10: Reporting Ambulatory CQMs Core 5: Active Medication List Data as of August 5, 2012,pulled from ONC CRM, Private Practices >10 and non-priority hospitals did not report any MU Measures challenges. Users may select multiple measure-specific issues as challenges within one report, therefore, these numbers may overestimate the total number of challenge reports for Measure-specific issues. Green arrows indicate measures with significant upward movement in the rankings. 65 11 89