Coherent Connections Wiring the Patient Centered Medical Home

Coherent Connections: Wiring the Patient Centered Medical Home in a Meaningful Way August 18, 2009 David C. Kibbe, MD, MBA, Senior Advisor, American Academy of Family Physicians, and Chair, ASTM International E 31 Technical Committee and Principal, The Kibbe Group Dennis Saver, MD <need info>

The Health IT Landscape – “Meaningful Use” Defined – EHR Certification Who will certify, and when?

• • • Meaningful Use: Meaningful Connections Identifies health IT as a “critical platform” of the PCMH. (Re) Conceptualizes health IT as an e-platform and set of tools. Health IT functional priorities to support a PCMH. Critical capabilities to engage consumers with health IT. Explores the current use of health IT by primary care physicians.

Cross Walk: HIT for PCMH with Meaningful Use Objectives Ce. HIA Meaningful Connections Report: Capabilities HIT Policy Committee Recommendations: Priorities Ability to collect, store, manage and transmit health data Improve quality, safety, and efficiency, and reduce health disparities Ability to communicate and exchange care planning Engage patients and families Improve care coordination Ability to report quality and performance measures Ability to engage decision support and evidence-based systems Improve population and public health Ensure privacy and security protections for personal health information Ability to inform and educate patients online "Health Outcomes Policy Priorities" from the HIT Policy Committee

Defining Meaningful Use 2011 Objective: “Improve quality, safety, efficiency, and reduce health disparities. ” Eligible Providers: . “Ability of providers and practices to engage in decision support for evidencebased treatments and tests. ” - Implement drug-drug, drug-allergy, drug-formulary checks. - Maintain up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED. - Generate and transmit permissible prescriptions electronically (e. Rx). - Maintain active medication list and active medication allergy list. - Record demographics: preferred language, insurance type, gender, race, ethnicity. - Record advance directives. - Record vital signs: height, weight, blood pressure, calculate and display BMI. - Record smoking status. - Incorporate lab-test results into EHR as structured data. - Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, and outreach. - Report ambulatory quality measures to CMS - Send patient reminders, per patient preference for prev/follow-up care. - Implement one clinical decision rule relevant to specialty or high clinical priority. - Document a progress note for each encounter. - Check insurance eligibility electronically from public and private payers, where possible. - Submit claims electronically to public and private payers.

Defining Meaningful Use 2011 Objective: “Improve quality, safety, efficiency, and reduce health disparities. ” 2011 Measures: . “Ability of providers and practices to engage in decision support for evidence-based treatments and tests. ” - Report quality measures to CMS including: - % diabetics with A 1 c under control. ; % hypertensive patients with BP under control; % of patients with LDL under control; % of smokers offered smoking cessation counseling; % of patients with recorded BMI; % eligible surgical patients who receive VTE prophylaxis; % of orders (for meds, lab tests, procedures, radiology, and referrals) entered directly by physicians through CPOE. - Use of high-risk medications (Re: Beers criteria) in the elderly. - % of patients over 50 with annual colorectal cancer screenings. - % of females over 50 receiving annual mammogram. - % of patients who received flu vaccine. - % lab results incorporated into EHR in coded format. - Stratify reports by gender, insurance. type, primary language, race, ethnicity. -% of all meds entered into EHR as generic, when generic options exist in the relevant drug class. -% of orders for high-cost imaging services with specific structured indications recorded. - % claims submitted electronically to all payers. - % patient encounters

Defining Meaningful Use 2011 Objective: “Engage patients and families. ” . “Ability of consumers and patients to be informed and literate about their health and medical conditions and appropriately self -manage with monitoring and coaching from providers. ” Eligible Providers: -Provide patients with an electronic copy of their health information (including lab results, problem list, medication lists, allergies) upon request. -Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies). - Provide access to specific educational resources. - Provide clinical summaries for patients with each encounter. 2011 Measures: -% of all patients with access to personal health information electronically. -% of all patients with access to patient-specific educational resources. -% of encounters for which clinical summaries were provided. .

Defining Meaningful Use 2011 Objective: “Improve care coordination. ” . “Ability of providers, patients and other members of the care team to communicate. ” Eligible Providers: - Capability to exchange key clinical information (e. g. , problem list, medication list, allergies, test results) among providers of care and patients’ authorized entities electronically. [per HIE workgroup] - Perform medication reconciliation at relevant encounters and each transition of care. 2011 Measures: - Report 30 -day readmission rate. - % of encounters where med reconciliation was performed. - Implemented ability to exchange health information with external clinical entity (specifically labs, care summary, and medication lists). - % of transitions in care for which summary care record is shared (e. g. electronic, paper, e-Fax).

Defining Meaningful Use 2011 Objective: “Improve population and public health. ” . “Ability to collect, store, measure and report on the processes and outcomes of individual and population performance and quality of care. ” Eligible Providers: -Capability to submit electronic data to immunization registries and actual submission where required and accepted. -Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice. 2011 Measures: -Report up-to-date status for childhood immunizations. -% reportable lab results submitted electronically.

Defining Meaningful Use 2011 Objective: “Ensure privacy and security protections for personal health information. ” . “Ability to collect, store, manage and exchange relevant personal health information” Eligible Providers: - Compliance with HIPAA Privacy and Security Rules. -Compliance with fair data sharing practices set forth in the Nationwide Privacy and Security Framework 2011 Measures: -Full compliance with HIPAA Privacy and Security Rules. -Conduct or update a security risk assessment and implement security updates as necessary.

Cross-Walk: MU Requirements and Certifiable EHR Technology Components Practice management/billing, w/ online Access eligibility and submit claims online. Generate and refill e. Prescriptions. -Meds Decision Support, e. g. drug-drug, etc. Maintain active patient data, structured format. -Demographics, Problems, Medications -Allergies, Vital Signs, Immunizations -Advance directives, Lab results, Smoking hx Generate progress note at each visit. Generate lists of patients by condition. Generate reports per CMS measures. Implement at least one CDS rule. Enable pts. to view/receive copy of summary data. Enable pts. to access education, coaching. Enable exchange of summary health data. Generate reports for public health and surveillance. Comply with all HIPAA privacy and security rules. eligibility. e. Prescribing with alerts and reminders. Office-based Registry application -Report generator either locally or as web service remotely -Care plans based on guidelines Documentation module Patient web portal/PHR, with secure messaging and CCR-compliant viewing, downloading, and patient education/engagement capability. Internet access to secure web server; local hospital, regional, national. HIPAA privacy officer and program.

Clinical Groupware = Modular, mobile, and modestly-priced platforms and software applications for physicians’ practices and hospitals that meet ONC/NIST certification criteria for meaningful use, security, and interoperability

Dennis Saver, MD “Boots on the Ground” A view from a practicing physician

Questions and Comments? Dennis Saver, MD David C. Kibbe, MD MBA The Kibbe Group LLC email: kibbedavid@mac. com telephone: 913. 205. 7968 home office: 594 D Woodbury Road Fearrington Post Pittsboro, NC 27312