1. Tri-State REC Kick Off Meaningful Use Basics: Developing a Solid Plan for Your Electronic Practice June 18, 2010 Session 1A

2. You have left this world behind Dr. David Trachenburg

3. A small community with successful EMR adoption

4. Matt Waldron, MD from Paoli, Indiana Location independent work “It won’t make you faster and won’t save you money,” he said. Why make the move? “EMR has portability and accessibility. I can read patients’ charts at any office location and log in anywhere I can get Internet access,” Dr. Waldron explained.

5. At work with EMR Lite Using Clinical Messaging Using eRx Using dragon dictate for office visits Using forwarding to send reviewed path reports to Surg Ctr Reporting to registry with BH labs

6. HIE or EMR…need both Hospitals Primary care physician Specialty physician Ambulatory center (e.g. imaging centers) Payors Pharmacy Laboratory Public health Without planning Specialty physician Pharmacy Laboratory Hospitals Primary care physician Ambulatory center (e.g. imaging centers) Payors Public health Health Information Exchange Health Information Exchange Model

7. Indiana, Ohio HIEs reach milestone in clinical data exchange "Coordination of care requires information sharing," said Jim Laughlin, MD, of Southern Indiana Pediatrics. "While many medical practices have systems that can share information internally, the connection between different regions and organizations allows me to track patient results from many labs or specialists. It is only through this kind of information sharing that we can hope to coordinate care in an efficient manner."

8. Physicians we know… Positives Assertive Productive Negatives Assertive Critical In the middle of every difficulty lies opportunity… Albert Einstein These are the customers of our Primary Care outreach for Meaningful Use Throughout our area….

9. Tri-State REC Service Area 9 State Ohio (11 counties) Kentucky (37 counties) Indiana (19 counties)

10. Integrate physician leaders in meaningful use plans – both inpatient and outpatient

11. Assessing your EMR Empty vs. Empowered Medical Record –Receiving results before to upload –Receiving results at start up –Managing ordering EMR and EMR lite—both are options

12. Finding the missing parts Gap analysis –Going thru the full MU list –Defining the missing pieces –Timelining them –Getting help for the hard ones –See MU criteria in clumps instead of individual items

13. Example of gap analysis 25 Meaningful Use Criteria In Use Not In UsePlan to implementDateComment 8 Record and chart changes in vital signs Visit Note 19 Provide clinical summaries to patients for each office visit Visit Note\Patient Portal 2 Implement drug‐drug, drug‐allergy, drug‐ formulary checks eRx 4 Generate and transmit permissible prescriptions electronically eRx 5 Maintain active medication list eRx 6 Maintain active medication allergy list eRx 21 Perform medication reconciliation at relevant encounters and each transition of care eRx

14. Example of gap analysis 25 Meaningful Use Criteria In Use Not In UsePlan to implementDateComment 10 Incorporate clinical lab- test results into EHR as structured data HIE Interface 9 Record smoking statues for patients 13 years old or older History 1 Use CPOE Orders 17 Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request Patient Portal 18 Provide patients with timely electronic access to their health information( including lab results, problem list, medication lists, allergies) Patient Portal 15 Check insurance eligibility electronically from public and private payers Practice Management Integration

15. Example of gap analysis 25 Meaningful Use Criteria In Use Not In UsePlan to implementDateComment 7 Record demographics Registry 11 Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach Registry 12 Report ambulatory quality measures to CMS or the States Registry 23 Capability to submit electronic data to immunization registries and actual submission where required and accepted Registry 24 Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice Registry (Public Health)

16. Example of gap analysis 25 Meaningful Use Criteria In Use Not In UsePlan to implementDateComment 14 Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic testing ordering, along with the ability to track compliance with those rules Alerts 13 Send reminders to patients per patient preference for preventive/ follow-up care Alerts\Patient Portal 20 Capability to exchange key clinical information( for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically CCD 22 Provide summary care record for each transition of care and referral CCD

17. Example of gap analysis 25 Meaningful Use Criteria In Use Not In UsePlan to implementDateComment 16 Submit claims electronically to public and private payers Claims 25 Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities. Security 3 Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT

18. Pushing the vendor Each EMR practice have invested much in their vendor Vendors provide service to the practice Meaningful use achievement relies heavily upon their provisions to the practice The REC will help identify what to push on You keep the pressure on, the heat turned up

19. Staying ahead of the curve Tri-State wants to give time for change –Start now –Plan the steps –Meet the milestones –Accomplish the goal Remember change is two part— –Technical change –Personnel change

20. Three areas to improve coordination Join the Tri-State REC Participate actively with your coach Attend education we will provide Network with other “like” practices

21. Hitting a homerun with Tri-State A network tool Your home team card

22. Divide and Share time Raise hands for different EMRs Separate into like groups Share cards and plan network opportunities

23. Questions Time for Q&A Thank you Dr. Todd Rowland and Kathy Church

24. Accessory slides To follow

25. Why healthLINC = Connect = technology, coordination, connected to patients Care = care coordination, health care Collaborate = coordination, across organizations Consumers = inclusive of patient and families Confidential = respectful of privacy and confidentiality Communicate = enhance communication Cost-effective = reduce administrative burden Comfortable = safe, secure place Community = oriented to larger community

26. Clinical perspective at the front line… Linda Wells, NP: I get my results faster… The patients phone number is right there, making communication easier…

27. Souheil Haddad, MD: Good, timely, easy to use, intuitive, hopefully we can extend to a full EMR lite at our office

28. Components of CCD-- Continuity of Care Document Header Purpose Problems Procedures Family History Social History Payers Advance Directives* Alerts (allergies) Medications Immunizations Medical equipment Vital signs Functional stats Results Encounters Plan of care