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Published byFrank Nichols Modified over 9 years ago
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Framework for Empowering Pathology in the Electronic Health Record
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Walter H. Henricks, MD, FCAP, The Cleveland Clinic Foundation Jodi G. Daniel, JD, MPH, Office of the National Coordinator for Health Information Technology
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Walter H. Henricks, MD, FCAP Framework for Empowering Pathology in the EHR May 8, 2012
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Objectives Review HIT Regulatory Framework Discuss Two Regulatory Challenges & Policy Solutions Note What CAP Can Do & What You Can Do
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Regulatory Framework: ARRA
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Pathology’s Two Challenges
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Challenge #1 Suboptimal management of laboratory information in EHRs CPOE design and configuration issues Potential patient safety issues Hidden costs
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Suboptimal Lab Data Handling in EHR This EHR report is garbled, I need to call the lab We don’t control the EHR, you’ll have to call IT
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Example: Garbled PAP report in EHR Example of unpublicized “nonstandard” view of Pap smear result in EHR – garbled text Not widely used; was not known to lab at time of interface validation
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Lab Data Problem Symptoms Reference ranges, comments, footnotes Abnormal result flags, preliminary reporting and updates Improper handling of: Corrected results Unsolicited results Reflex tests Performing lab name & address
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Poor CPOE Symptoms Incorrect, incomplete, inappropriate test orders Inefficient lab/provider operations Billing & compliance problems Pitfalls – future orders, duplicate handling, canceled orders
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Policy Initiatives – CAP… Has submitted extensive comments on ONC Stage 2 (2014) Standards & Certification Proposed rule o Need for FULL testing of pending laboratory reporting guide before implementation o Need for laboratory data/vocabulary integrity as it moves throughout healthcare system Is working for pathologist role as laboratory data stewards in EHR environment o Developing white paper Desires to partner with ONC and others on solutions o e.g. domain expertise for standards and/or certification criteria
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Challenge #2 Pathologists are “non-hospital based” (per CMS definition) eligible providers (EPs) for MU incentives and penalties Challenged by MU requirements to: o Use certified EHRs o Report specified objectives o Report clinical quality measures (CQMs)
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Incentive/Penalty Rule Challenges Certified EHRs: Pathologists do not practice in EHRs Report certain objectives: Objectives not applicable to pathology practice (written for office-based providers) CQMs: Not applicable to pathology practice
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Regulatory Relief Possible CMS considering criteria for relief from penalties for eligible providers that: 1.Lack face-to-face/telemedicine interaction with patients 2.Lack follow-up with patients 3.Lack control over availability of certified EHRs at their practices
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Legislative Solution on the Table H.R. 4066, “The Health Information Technology Reform Act” introduced by Rep. Tom Price MD (R-GA-6) o Removes pathologists from eligibility for MU incentives or payment adjustments o Penalty relief would be permanent
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What CAP is Doing Advocating for regulatory relief Seeking passage of H.R. 4066 Developing white paper on best practices for lab data/transmission
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Partner with Stakeholders
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What You Can Do at Home Advocate for patients’ laboratory information in EHR Develop some expertise: o Intradepartmental o Institutional Raise awareness and provide domain expertise at institutional level
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What You Can Do Here When you visit your Senators/Congressmen…. Ask them to support H.R. 4066!
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Summary ARRA hastening EHR adoption CAP working to advance HIT and protect pathologists You have a role in DC and at home Constructive dialogue with policymakers & other stakeholders to continue
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