1. Improving Patient Care Through Meaningful Use of an Electronic Health Record: An Introduction EHR CAC Basic Training (OP) October 18, 2010 IHS Office of Information Technology

2. 2 Today’s Session This training will introduce the following topics: 1.American Reinvestment and Recovery Act (ARRA) and Health Information Technology for Economic and Clinical Health (HITECH) 2.Centers for Medicare & Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Programs 3.Regional Extension Centers (RECs) 4.Meaningful Use (MU) and Indian Health Service (IHS) 5.Contacts and Resources

3. 3 ARRA and HITECH 1.CMS EHR Financial Incentives – Offers incentive payments to eligible health care providers who achieve meaningful use of an EHR 2.Regional Extension Centers (REC) – Assist health care providers seeking to achieve meaningful use of an EHR 3.Beacon Communities – funding to build and strengthen health IT infrastructure and exchange capabilities 4.HIT educational grants – certificate through university level The American Recovery and Reinvestment Act of 2009 (ARRA) included the HITECH act which “seeks to improve American health care delivery and patient care through an unprecedented investment in health information technology” through:

4. 4 CMS EHR Financial Incentive Programs Two CMS EHR Financial Incentive Programs were established under ARRA HITECH Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx) Both programs are voluntary however eligible providers must choose which program they will participate in Both programs require use of certified EHR technology Medicare program requires demonstration of meaningful use during first year of participation Medicaid provides for payment of financial incentives to EPs who meet patient volume requirements and adopt/upgrade/implement during their first year of participation 1.Medicare- administered by CMS 2.Medicaid – joint administration by CMS and state

5. 5 Medicare and Medicaid Incentive Programs MedicareMedicaid Federal Government will implement starting in January 2011 Voluntary for States to implement - Most are expected to start by late summer 2011 Payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use No Medicaid payment reductions Must demonstrate MU in Year 1A/I/U option for 1 st participation year Maximum incentive is $44,000 for EPs (bonus for EPs in HPSAs) Maximum incentive is $63,750 for EPs MU definition is common for MedicareStates can adopt certain additional requirements for MU Last year a provider may initiate program is 2014; Last year to register is 2016; Payment adjustments begin in 2015 Last year a provider may register for and initiate program is 2016; Last payment year is 2021 Only physicians, subsection (d) hospitals and CAHs 5 types of EPs, acute care hospitals (including CAHs) and children’s hospitals Slide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

6. 6 Definitions Adopt/Implement/Upgrade Adopt - Acquire and Install Implement – Begin to Use Upgrade – EHR certification or addition of new functionality Meaningful use refers to using certified EHR technology to: 1.Improve quality, safety, efficiency, and reduce health disparities 2.Engage patients and families in their health care 3.Improve care coordination 4.Improve population and public health 5.Maintain privacy and security Slide content provided by CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

7. 7 Meaningful Use Basic Requirements 1.Use of certified EHR in a meaningful manner (e.g., e-prescribing) 2.Use of certified EHR technology for electronic exchange of health information to improve quality of health care 3.Use of certified EHR technology to submit clinical quality measures (CQM) Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

8. 8 Certification vs Meaningful Use Certification is an official stamp of approval indicating that the EHR is fully functional. The EHR vendor is responsible for obtaining certification. IHS OIT performs this function for the RPMS EHR. Meaningful Use is how the EHR is used. This is the responsibility of providers with assistance from local, area, and national staff Health program staff are responsible for knowing the MU requirements and using the EHR to meet MU requirements

9. 9 Real Life Example of MU

10. 10 Medicare Incentives Amount of Payment Each Year if Continues Meeting Requirements 1 st Calendar Year EP Receives a Payment CY 2011CY 2012CY 2013CY2014 CY 2015 and later CY 2011$18,000 CY 2012$12,000$18,000 CY 2013$8,000$12,000$15,000 CY 2014$4,000$8,000$12,000 CY 2015$2,000$4,000$8,000 $0 CY 2016$2,000$4,000 $0 TOTAL$44,000 $39,000$24,000$0 Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

11. 11 Medicare Penalties An Eligible Professional (who accepts Medicare) but does NOT demonstrate meaningful use by 2015 will be subject to payment reductions in Medicare reimbursements These reductions apply to all providers who accept Medicare even if the provider only participates in the Medicaid EHR Financial Incentive program Medicaid-only EPs who are not eligible for the Medicare incentive are not subject to the Medicare payment reductions Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

12. 12 Medicaid Incentives Amount of Bonus Each Year if Continues Meeting Requirements 1 st Calendar Year EP Receives a Payment CY 2011CY 2012CY 2013CY 2014CY 2015CY 2016 CY 2011$21,250 CY 2012$8,500$21,250 CY 2013$8,500 $21,250 CY 2014$8,500 $21,250 CY 2015$8,500 $21,250 CY 2016$8,500 $21,250 CY 2017$8,500 CY 2018$8,500 CY 2019$8,500 CY 2020$8,500 CY 2021$8,500 TOTAL$63,750 Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

13. 13 CMS Financial Incentives Summary MEDICAREMEDICAID Incentives Start CY 2011 Incentives End CY 2016 (max. 5 years) 2021 (max. 6 years, must start by 2016) Incentive Amount Up to $44,000 total per provider; based on % Medicare claims (bonus for EPs in HPSAs) Up to $63,750 total per provider; based on 85% of EHR costs Patient Volume Requirements None 30% Medicaid* (20% for pediatricians) 30% needy individuals (FQHC or RHC) Reimbursement Reduced CY 2015No penalties

14. 14 Stages of Meaningful Use Stage 1 2011-2012 Stage 2 2013-2014 Stage 3 2015+ Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

15. 15 Stage 1 Reporting Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx) 15 core objectives Most require achievement of performance targets 5 objectives out of 10 from menu set Most require achievement of performance targets Some MU objectives will not apply to every provider (i.e. dentists who do not perform immunizations) and the eligible provider will not be required to meet the measure. Exclusions do NOT count against the 5 deferred measures. States can request CMS approval for inclusion of 4 additional objectives as core measures for state Medicaid providers. 6 total Clinical Quality Measures do not have performance targets - 3 core or alternate core - 3 out of 38 from menu set

16. 16 Eligible Professionals Medicare Doctors of medicine or osteopathy Doctors of dental surgery or dental medicine Doctors of podiatric medicine Doctors of optometry Chiropractors Medicaid Physicians Nurse practitioners Certified nurse-midwives Dentists Physicians assistants* * working in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) led by a physician’s assistant Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

17. 17 Eligible Provider Registration Eligible providers can register on the CMS EHR Incentive Program website beginning January 2011 http://www.cms.gov/EHRIncentivePrograms All Eligible Providers must: 1. Participate in Medicaid or Medicare program 2.Have a National Provider Identifier (NPI) 3.Medicare providers must be enrolled in PECOS NOTE: CMS EHR Incentive Program website will interface with state(s) registration website. States will ask providers to provide and/or attest to additional information (patient volume, licensure, certified EHR) in order to make accurate and timely payments. Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

18. 18 EHR Certification Certified EHR Technology is required in order to achieve meaningful use Standards and certification criteria were announced on July 13, 2010 IHS OIT is currently preparing to submit the RPMS EHR for certification under the new criteria Information about certification bodies and certified EHRs available at http://healthit.hhs.gov/certificationhttp://healthit.hhs.gov/certification Slide content adapted from CMS (EHR_Incentive_Program_EP_Training_Final ONC changes 8 10 10.pptx)

19. 19 Indian Health Service and Meaningful Use IHS is ahead of the curve with some of the Meaningful Use requirements RPMS EHR deployment is consistent with the Meaningful Use goal of increasing EHR adoption across the U.S. Public Health surveillance – IHS has reported information on H1N1 since 2009 Electronic clinical quality reporting - IHS has reported clinical quality measures with the Clinical Reporting System (CRS) since 2002 IHS has ongoing relationship with Office of the National Coordinator (ONC) and Center for Medicare and Medicaid Services (CMS)

20. 20 Meaningful Use Contacts Theresa Cullen, RADM, MD, MS IHS Chief Information Officer (301) 443-9848 Theresa.Cullen@ihs.gov Stephanie Klepacki, Meaningful Use Project Lead, IHS (505) 821-4480 Stephanie.Klepacki@ihs.gov MB Leaf, Meaningful Use Project Manager, Contractor (505) 798-1448 MaryBeth.Leaf@ihs.gov Tom Kauley, Director AI/AN National REC (202) 507-4078 tkauley@nihb.org

21. Area Meaningful Use Coordinators AreaMU CoordinatorContact Information AberdeenCAPT Scott AndersonScott.Anderson@ihs.gov ; (605) 335-2504 Alaska Richard Hall Kimi Gosney Erika Wolter rhall@anthc.org; 907-729-2622 kgosney@anthc.org; 907-729-2642 ewolter@anthc.org; 907-729-3907 ABQ Vacant Bemidji Jason Douglas Alan Fogarty Jason.Douglas@ihs.gov; (218) 444-0550 Alan.Forgarty@ihs.govAlan.Forgarty@ihs.gov ; (218) 444-0538 BillingsCAPT James SabatinosJames.Sabatinos@ihs.gov; (406) 247-7125 CaliforniaMarilyn FreemanMarilyn.Freeman@ihs.gov; (916) 930-3981, ext. 362 NashvilleRobin BartlettRobin.Bartlett@ihs.gov ; (615) 467-1577 NavajoLCDR Andrea ScottAndrea.Scott@ihs.gov; (928) 292-0201 OklahomaAmy RubinAmy.Rubin@ihs.gov; (405) 951-3732 PhoenixCAPT Lee SternLee.Stern@ihs.gov; (602) 364-5287 Portland CAPT Leslie Dye Donnie Lee, MD Leslie.Dye@ihs.gov; (503) 326-3288 Donnie.Lee@ihs.gov; (503) 326-2017 TucsonScott Hamstra, MDScott.Hamstra@ihs.gov; (520) 295-2532

22. 22 Regional Extension Centers (RECs) A nationwide system of Regional Extension Centers (RECs) has been established to support and serve health care providers to help them quickly become adept and meaningful users of electronic health records (EHRs) There are currently 62 RECs. All but one of the RECs are state or area specific The AI/AN National Indian Health Board (NIHB) National REC was formed to support health care providers in Indian Country RECs will: Provide training and support services to assist eligible providers in adopting EHRs and achieving meaningful use Offer information and guidance to help with EHR implementation Give technical assistance as needed

23. 23 Resources IHS Meaningful Use Website http://www.ihs.gov/recovery/index.cfm?module=dsp_arra_me aningful_use AI/AN National REC www.nihb.org CMS EHR Financial Incentive Programs www.cms.gov/EHRIncentivePrograms EHR certification (and other ONC programs designed to support providers in the transition to EHR) http://healthit.hhs.gov

24. 24 Learn More… Contact your site, area, and/or or national MU representative(s) Contact your Regional Extension Center Sign up for the IHS Meaningful Use listserv (see instructions at the top of the Meaningful Use website) Read material available and training sessions offered by IHS, CMS, and RECs

25. 25 It’s time to…