1. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services The 411 on Medicare Meaningful Use Incentives and the Attestation Process for Physician Practices

2. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 2. Mary Zile, Director of Practice Consulting, Tri-State REC (moderator) Michelle Emerson, Practice Consultant, Tri-State REC Stefanie Strinko, Practice Consultant, KY REC Dr. Mark Frazer, Summit Family Physicians Leah Brunie, Certified Nurse Practitioner, Summit Family Physicians Speakers:

3. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Meaningful What? 3. I am Busy, Give Me the 10 Second Summary. Who Thought Meaningful Use was a Good Idea? What’s The Point? Looks like Everyone Else has Started Without Me. What if I Am the Only One Who Doesn’t Want to Do This? Is it Getting Too Late to Start? Am I in This Alone? What’s in it for Me?

4. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services I Am Busy, Give Me the 10 Second Summary 4. The Purpose of Meaningful Use Process to incorporate “evidence-based practice, effective use of information technology, quality measurement and improvement, cost awareness, care coordination, leadership of interdisciplinary teams, and shared decision making” that needs to occur in parallel with the reshaping of US healthcare. -Glenn Hackbarth Recognition that Health IT is an Important Enabler of the new delivery models and payment structures that are Improving Health Care Health Affairs, 3, 2012 31:3 pg 481

5. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Who Thought Meaningful Use Was a Good Idea? 5. HITECH provisions of the ARRA of 2009 committed $14-$27 billion in incentives over ten years for providers and hospitals American Association of Medical Colleges, 1998 Howard Hughes Medical Institute and the American Association of Medical Colleges American Board of Medical Specialties, October 2011 American Medical Informatics Association The National Board of Medical Examiners Liaison Committee on Medical Education The Accreditation Council for Graduate Medical Education

6. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services What’s The Point? 6. Improve quality, safety (such as e-prescribing), efficiency, and reduce health disparities Engage patients and families for patient centered care (such as providing health information to patient upon request) Improve care coordination (electronically sending health information to other providers) Improve population and public health Ensure privacy and security protection for personal health information Efforts for cost containment by improving efficiency, reducing redundancy, and providing information in real time

7. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Looks Like Everyone Else Has Started Without Me 7. Number of physicians reporting use of an EHR doubled since 2008, from 16.9% to 33.8%, with acceleration expected due to attainment of incentive program objectives. Congressional Research Service anticipates that the HITECH incentives will increase EHR growth; by 2019 70% hospitals and 90% providers. 90% of medical school students gave their student some access to EHRs as early as 2006. –Atul Grover, chief public policy officer, Association of American Medical Colleges, 12/20/ 2011).

8. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services What if I am the Only One Who Doesn’t Want to Do This? 8. Physician licensure is state specific with precedent set. 2008 Massachusetts enacted legislation requiring that physicians adopt electronic health records by 2015 in order to obtain or renew licenses. Recommendations for other states to follow, including recommendations to tie physician licensure to meaningful-use standards. American Board of Medical Specialties has already taken steps to incorporate health IT training and skills assessment maintenance of board certification for primary care physicians, with ‘self-assessment’ modules related to Meaningful Use. Regional and national health insurance payment methodologies being developed based on NCQA PCMH, MU, and public reporting. Penalties start in 2015.

9. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Am I in This Alone? There Is Help Tri-State Regional Extension Center (REC) WHAT IS IT? New federally-funded collaboration led by HealthBridge GOAL: Help eligible professionals implement technology achieve meaningful use and qualify for incentives 9

10. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services State Ohio (11 counties) Kentucky (37 counties) Indiana (19 counties)

11. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Tri-State REC Partners 11

12. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. Eligible Providers in MedicareEligible Providers in Medicaid Eligible Professionals (EPs) Doctor of Medicine or OsteopathyPhysicians (Pediatricians have special eligibility & payment rules) Doctor of Dental Surgery or Dental Medicine Nurse Practitioners (NPs) Doctor of Podiatric MedicineCertified Nurse-Midwives (CNMs) Doctor of OptometryDentists ChiropractorPhysician Assistants (PAs) who lead a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) Eligible Hospitals Acute Care Hospitals Critical Access Hospitals (CAHs)Children’s Hospitals Eligibility for Incentives

13. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. MEDICARE EP Incentive Payment - Based on First Calendar Year EP receives Calendar Year CY 2011CY 2012CY 2013CY 2014CY 2015 and later 2011 $18,000 2012 $12,000$18,000 2013 $8,000$12,000$15,000 2014 $4,000$8,000$12,000 2015 $2,000$4,000$8,000 0 2016 $2,000$4,000 0 TOTAL $44,000 $39,000$24,0000 Is it Getting Too Late to Start? Medicare

14. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Is It Getting Too Late to Start? Medicaid REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. MEDICAID EP Incentive Payment - Based on First Calendar Year EP receives Calendar Year CY 2011CY 2012CY 2013CY 2014CY 2015CY2016 2011 $21,250 2012 $8,500$21,250 2013 $8,500 $21,250 2014 $8,500 $21,250 2015 $8,500 $21,250 2016 $8,500 $21,250 2017 $8,500 2018 $8,500 2019 $8,500 2020 $8,500 2021 $8,500 TOTAL $63,750

15. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. MEDICARE EP Incentive Payment - Based on First Calendar Year EP receives Calendar Year CY 2011CY 2012CY 2013CY 2014CY 2015 and later 2011 $18,000 2012 $12,000$18,000 2013 $8,000$12,000$15,000 2014 $4,000$8,000$12,000 2015 $2,000$4,000$8,000 0 2016 $2,000$4,000 0 TOTAL $44,000 $39,000$24,0000 What’s in it for Me? Medicare

16. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services What’s in it for Me? Medicaid REC support is provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services. MEDICAID EP Incentive Payment - Based on First Calendar Year EP receives Calendar Year CY 2011CY 2012CY 2013CY 2014CY 2015CY2016 2011 $21,250 2012 $8,500$21,250 2013 $8,500 $21,250 2014 $8,500 $21,250 2015 $8,500 $21,250 2016 $8,500 $21,250 2017 $8,500 2018 $8,500 2019 $8,500 2020 $8,500 2021 $8,500 TOTAL $63,750

17. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Summit Family Physicians (513) 424-0122 1010 Summit Dr Middletown, OH 45042 Discussion by Dr. Mark Frazer Dr. Timothy Wourms, M.D. Dr. Kevin Strait, M.D. Lean Brunie C.N.P.

18. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Milestone 1 Tri-State REC sign up Practice Management Implementation: 6/2011 EHR Implementation: 9/20/2011 Milestone 2 EHR Go-Live, Quality Reporting, e-Prescribing: 11/4/2011 90 day Attestation Period: 10/2011-12/2011 Meaningful Use Attestation: 12/30/2011 Meaningful Use Payment Received: 3/2/2012 Summit Family Physicians

19. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services What is Meaningful Use? 19 Meaningful Use is a list of objectives that an eligible provider must meet in order to participate in the EHR Incentive Program.

20. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Core Set 1. Use computerized order entry for medication orders. 2. Implement drug-drug, drug-allergy checks. 3. Generate and transmit permissible prescriptions electronically. 4. Record demographics. 5. Maintain an up-to-date problem list of current and active diagnoses. 6. Maintain active medication list. 7. Maintain active medication allergy list. 8. Record and chart changes in vital signs. 9. Record smoking status for patients 13 years old or older. 20

21. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Core Set (cont.) 10. Implement one clinical decision support rule. 11. Report ambulatory quality measures to CMS or the States. 12. Provide patients with an electronic copy of their health information upon request. 13. Provide clinical summaries to patients for each office visit. 14. Capability to exchange key clinical information electronically among providers and patient authorized entities. 15. Protect electronic health information (privacy & security) 21

22. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Core Measure 6: Allergies 22

23. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Core Measure 7: Demographics 23

24. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Core Measure 8: Vital Signs 24

25. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Core Measure 9: Smoking Status 25

26. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Core Measure 13: Clinical Summaries 26

27. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Clinical Workflow Analysis

28. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Clinical Workflow Analysis

29. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services How the EHR Implementation Affected: Processes Staff Communication Workflow Discussion by Lean Brunie C.N.P.

30. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Privacy and Security Tools Risk Assessment Questionnaire Fact and Guidance Sheets Business Impact/Disaster Recovery Template Policy and Procedure Templates Staff and Admin User Security Training Presentations BAA and Confidentiality Agreement Templates Privacy and Security Overview available at http://www.tristaterec.org/ http://www.tristaterec.org/

31. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Vendor Dashboard – e-MDs

32. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Vendor Dashboard – eClinical Works 32

33. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Medicaid Registration Guidance

34. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services CMS Registration Page

35. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services CMS EHR Incentive Home Page

36. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Select SSN only if the Provider receives Medicare payments to his/her SSN Select EIN if group receives payment (You will also need to select the Group Name.) Payment Assignment

37. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Attestation for Numerical Criteria

38. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Attestation for Yes/No Criteria

39. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Menu Measure 9: Immunization Registry Kentucky Providers MUST connect to the Immunization Registry via the Kentucky Health Information Exchange. Charlese BlairCharlese Blair, KHIE Intake Coordinator Charlese.Blair@ky.gov (502) 564-7992, Ext. 2656

40. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Impact of EHR Implementation and Meaningful Use Discussion by Dr. Frazer

41. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Lessons Learned Involve entire team – get early buy-in Identify a clinical champion and MU lead Select Medicare/Medicaid incentive program Register early Create a plan Discuss menu items early Take advantage of REC and vendor tools and training Monitor progress weekly/biweekly and report to staff Have attestation reports printed and ready to go when attest Remember this is an iterative process Breathe! You can do this!

42. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Questions?