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. Meaningful Use Goals 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 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. 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. The patient’s health care team communicates with public health agencies. 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.

5. Systematic Approach for Alignment 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 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 GOALS 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 Stage 1 ObjectiveCriteriaCurrent ProcessGap(s)Requirement Use Computerized Provider Order Entry (CPOE) Enable a user to electronically record, store, retrieve, and manage, at a minimum, the following order types: 1.Medications; 2.Laboratory; 3.Radiology/imaging; 4.Referrals 1.Medication – CMIS Medical supports electronic ordering of Sample Medications only. Prescriptions are paper. 2.Laboratory already electronically ordered. 3.Radiology order is electronic and/or paper. 4.Referrals are “mostly” electronic. UCSD referrals will be all electronic via the HIE. 1.ePrescribing; DEA doesn’t allow controlled substances to be e- prescribed. 2.Laboratory (none) 3.Radiology – dependent on partner systems. An in-house system would easily comply. 4.Referrals are dependent on partner capability. Support the electronic ordering of 80% of medications, laboratory, radiology/imagi ng, and referrals (direct entry by an authorizing provider). Implement drug- drug, drug-allergy and drug formulary checks. 1.Automatically and electronically generate and indicate (e.g. pop-up message or sound) in real-time, alerts at the point of care for drug-drug and drug-allergy contraindications based on medication list, medication allergy list, age, and CPOE. 2.Enable a user to electronically check if drugs are in a formulary or preferred drug list in accordance with the standard specified in Table 2A row 2. 3.Provide certain users with administrator rights to deactivate, modify, and add rules for drug-drug and drug-allergy checking. 4.Automatically and electronically track, record, and generate reports on the number of alerts responded to by a user. 1.Pharmacy Information System (HBS) has this capability for fulfilled prescriptions ordered within HBS (a closed system). 1.Paper-based prescriptions. 2.Sample Med Medication Management requires linkage to First Data Bank or a similar database to include this function. Hl7 interface between WorldVistA, CMIS Medical and HBS.

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.