Since the HITECH Act was passed, healthcare providers have been on a fast track to implement the EMR and achieve Stage I Meaningful Use

1. Electronic Medical Records and
Meaningful Use
2011 PACAH Annual Conference
Seven Spring Mountain Resort
Thursday October 27, 2011
Electronic Medical Records and Meaningful Use
William “Buddy” Gillespie
Director Healthcare Solutions
Distributed Systems Services

2. William ‘Buddy’ Gillespie
Mr. Gillespie is currently the Director of Healthcare Solutions for Distributed
Systems Services (DSS) a PA based corporation which provides a broad
portfolio of technology solutions that drive business value including a
world-class tier III data center and professional services for Collaboration,
Virtualization, and Networking. His responsibilities include direct
consulting with clients, assessing and improving healthcare solution
offerings, helping drive the DSS brand into the healthcare community, and
initiating relationships with hospitals and practices for future business
development. Mr. Gillespie is the former (retired) Vice President, Chief
Technology Officer and CIO Emeritus at WellSpan Health, an integrated
delivery system based in York, Pennsylvania. WellSpan has been named a
Top 100 Most Wired and a Top 25 Best Connected health system six-years
running. Gillespie joined WellSpan Health in 1996 after serving as vice
president of information services at Allegheny General Hospital in
Pittsburgh. He has been active in healthcare informatics for more than 25
years in both the development and implementation of technology solutions.
He also serves on the PAeHI Board where he is Chair of the Health
Information Exchange Committee.
Mr. Gillespie can be contacted at: wgillespie@dsscorp.com

3. Electronic Medical Records and
Meaningful Use
• Since the HITECH Act was passed
as part of the ARRA in February
2009, healthcare providers have
been on a fast track to implement
the Electronic Medical Record and
achieve Stage I Meaningful Use.

4. Electronic Medical Records and
Meaningful Use
• In the wake of this activity hospitals
and physicians have been faced
with the daunting task to not only
acquire and implement the EMR
technology but also change the
existing clinical process.

5. Electronic Medical Records and
Meaningful Use
• The presentation will reflect on the
definition of the EMR/Meaningful
Use:
–What is it?
–Who qualifies?
–What are the incentives?
–What do hospitals and physicians
need to do to qualify?

6. Electronic Medical Records and
Meaningful Use
What Progress Has Been Made and
What Challenges Lie Ahead With the
Advent of Stage II & III and
Healthcare Reform?

7. Healthcare Spending

8. Healthcare Spending
• The Centers for Medicare and Medicaid
services estimate that nearly 18% of
Medicare patients are re-hospitalized
within 30 days of discharge and that 13%
of all admissions costing $12 billion
dollars are potentially avoidable
Evidence on the Costs and Benefits of Health
Information Technology. Congressional Budget
Office

9. HIT Drivers
Homecare
• Home Health Care
• Telemedicine
• Remote Patient Monitoring
• Fiber
Mobile Devices/
Wireless Access
• iPAD
• Other Slate Devices
• Smart Phones
• Security
• BIOMED Devices-
Integration with Electronic
Health Record Homecare
Restructure of Medical
Records Department
• Health Information
• Management
• Reporting Relationship
• Patient Portal
ETL & Analytics
• Cloud Hosting
• ONC – MU Templates
• Data Warehouse
Meaningful use
•Three Stages
•Physician Adoption
•Regional Extension Centers
HIPPA 5010
• 2012

10. HIT Drivers
Clinical Documentation
and CPOE
• Multiple vendors with semi-
mature to mature products
• Still only small percent
adoption by hospital
physicians
• A couple of well-publicized
failures/difficult starts
• Studies of ROI and safety
benefits are mixed
• Doc’s don’t want to be data
entry clerks, slowed down or
continually warned about
the obvious
• e-prescribing gaining steam
• Part of Meaningful Use!
Quality measures
• Six-Sigma
• Clinical Decision Support
• Analytics
HITECH Privacy & Security
• Fraud/abuse litigation
increase
• Breaches on the rise
• OCR website list of
breaches
• Breach Notification
• Cost
• Insurance
• Single Sign-on – Account
Provisioning
• Encryption
• Portable devices
• USB devices

11. HIT Drivers
Medical Home
• Smart Medical Devices
Accountable Care
Organizations (ACOs)
• Rules Published
• Reduced Revenue
• Cost pressure from
downward revenue trend
• First 3-years during
start up
• Collaboration
• HIE Role
• Competition vs. cooperation
between providers
• Hospital
• Physician
• Coordinated services and
Patient Experience
• Patient role/provider-patient
relationship
Mergers & Acquisitions
• Vendors
• Technical
• ISPs
• Payers into clinical and
HIE market
• Providers
• Hospitals
• Physicians
• Payers
• Payers buying HIE
vendors
Other
• Disease management
• Evidence-based medicine
• Personalized medicine
• Genetic testing
• Value-based
Reimbursement
• Individual insurance growth
• Medicare payment cuts
• Medicaid expansion

12. Hospitals
Physician
Practices
Clinics
Patients
Electronic Medical Record
Enterprise Person Identifier
One System – One Patient – One Record
Right Patient – Right Record

13. EMR Investment
• 2009: $2 billion
• 2015: $3.8 billion
• 2020: $ ?

14. HIMSS Survey-Priorities

15. What is Meaningful Use?
Three Primary Components:
• Use of a Certified EMR in a Meaningful Manner
• Use of Certified EMR Technology for
Electronic Exchange of Health Information to
Improve Quality of Healthcare (HIE)
• Use of Certified EMR Technology to Submit
Clinical Quality and Other Measures
(Analytics)

16. HIT Policy Committee -
MU Goals
– Improve quality, safety, efficiency, and
reduce health disparities
– Engage Patients and Families
– Improve Care Coordination
– Ensure adequate privacy and security
protections for personal health
information
– Improve Population and Public Health

17. Purpose of Meaningful Use
• Improve Quality, Safety, and Efficiency of Patient Care
• Engage Patients and Families
• Improve Care Coordination & Patient Experience
• Ensure Privacy and Security Protection for Personal
Health Information (PHI)
• Improve Population Health

18. Building Blocks to Better Outcomes
Source: HIT Policy Committee meeting,
June 8, 2011

19. HITECH - MU Timeline

20. MU Stage I Requirements
• What are the requirements for Stage 1 of Meaningful Use
(2011 and 2012)?
– Meaningful use includes both a core set and a menu set of
objectives that are specific to eligible professionals or
eligible hospitals as well as Clinical Quality Measures
• For eligible professionals, there are a total of 25 meaningful
use objectives. To qualify for an incentive payment, 20 of
these 25 objectives must be met.
– There are 15 required core objectives.
– The remaining 5 objectives may be selected from the list
of 10 menu set objectives.

21. MU Stage I Requirements
• Stage 1 Requirements:
– Computerized physician Order Entry (CPOE)
– Patient visit summaries
– One Health Information Exchange Transaction
– ePrescribing
– Drug-Drug interaction checks
– Maintain active Med List
• List of patient Med allergies,
– diagnoses, demographics, vital signs, smoking status
– Electronic copy of records to patients
– HIPAA Compliance
– Submit quality reports/analytics to CMS
– Implement one Decision Support rule

22. MU Critical Success Factors
• Continuously keep an eye on your Stage I plans
and metrics and tweak workflow and process as
necessary to remain not only compliant but so it
becomes almost seamless
• While CPOE in Stage 1 is limited to Medication
orders and ties in with several other objectives
(Meds Reconciliation, Medication Lists) it will
expand. Do CPOE the right way (ensure your
compendiums or orders catalogs are physician
friendly etc) so your Providers are ready to enter
all orders

23. MU Critical Success Factors
• Stay in close contact with your vendor and
make sure they certify against Stage II as soon
as possible, regardless of your plans to attest
to Stage I
• Become engaged in your state HIE and REC
programs. Participating will eventually become
a MU objective and early engagement ensures
you have a voice and are ready

24. MU Challenges
• Inter-Professional, Collaborative Patient-
Centered Care
• Workflow & Hand-Off Issues
• Effective Use of Technology
• Change Management
• Evidence-Based Care
• Quality Improvement Programs
• Adoption of Technology

25. HIMSS EMR Adoption Model
Hospitals continue to move up the HIMSS Analytics EMR Adoption Model

26. Meaningful Use Incentives for Hospitals
• $2,000,000 base payment plus
–$200/Medicare discharge
–Year 2 - 4 drop from 75% to 50%
to 25% of Year 1
• 4 Year cap of $11,000,000

27. Meaningful Use Incentives for MDs
• 2011 - $18k
• 2012 - $18k
• 2013 - $15k
• 2014 - $12k
• 2015 - $ 2k
–Total $65k
• 2016 - Owe Penalties

28. MU Stage I Payout
• Paid out September 2011:
–$652,000,000
–99,000 Registered

29. MU Stage II
• Stage II Requirements:
–Align Meaningful Use (MU) objectives
with National Quality Strategy priorities
–Ensure MU lays adequate HIT
infrastructure to achieve delivery
system changes required for Affordable
Care Act (ACA) reforms
–Ensure technical and implementation
feasibility
–Encourage and reward early adopters

30. Health Information Exchange

31. Health Information Exchange
• Community/Local
• IDN/Regional
• Statewide

32. The 50,000 Foot View of a HIE Infrastructure
Health Care Provider or
Population Health User
Requests Data from the
HIE.
If Authorized,
Patient Data Viewed on
HIE Website Portal or in
Provider’s Certified
Electronic Health Record
Product.
HIE
Procured Application and
Hosted Services
Hospital
Pharmacy
Benefit
Manager
Medicaid Payer System
Department
of Health
State Level Systems
Payer System
RHIE
Lab Diagnostic Imaging
Health System
Many Touch Points
Supply Procured
Application with Patient
Data
1. Security and Privacy
2. User Provisioning
3. Enterprise Master Patient Index
4. Record Locator Service
5. Data Display, Usage, and
Interoperability
Internet Based
Access
24 x 7 x 365
Availability
Security and
Privacy
Backup and
Recovery
Hardware and
Software
Customer Service
Supported by Interfaces and
Data Usage and Reciprocal
Sharing Agreements
National Health Information Network

33. PA eHealth Collaborative
– Governor Corbett issued Executive Order 2011-04 on July 27,
2011 establishing PA eHealth Collaborative
• Executive Council
• Advisory Committee
• PA eHealth Collaborative Office

34. PA eHealth Collaborative
• March, 2011 Operational Plan approved by ONC with limited access to
implementation funds pending reengagement of stakeholders and
development of a detailed plan.
• Funding Available = $17,140,446
– Match Requirements:
– 10% 2/1/2011 - 1/31/2012
– 14% from 2/1/2012 – 1/31/2013
– 33% from 2/1/2013 – 2/7/2014
– Private sector contributions and in-kind services can be used to help
with match.
• Revised strategic and operational plans, endorsed by stakeholders, need
to be developed by January, 2012.
• Governance model needs to be established by July 1, 2012

35. PA eHealth Collaborative
– Per ONC-HIE-Program Information Notice (PIN)-001
• Must enable point to point exchanges in 2011 (Direct
Project)
• Must address:
– Gaps in use of e-prescribing by pharmacies
– Gaps in the ability of independent labs to send
structured lab results electronically
– Gaps in provider ability to electronically share patient
care summaries across unaffiliated organizations.

36. PA eHealth Collaborative
– Re-launched project with a stakeholder planning session on
July 26 and 27, 2011
• 134 individuals participated representing many sectors of
the healthcare industry and consumers
• Compiled information from our planning session
• Received positive feedback on re-launch efforts;
particularly level of information provided, degree of
stakeholder engagement and commitment to transparency
• Organized 5 working committees and began work

37. What is the Direct Project?
– What is the Direct Project?
• The Direct Project is an open government initiative started
by the Department of Health and Human Services’ Office of
the National Coordinator (ONC) for Health Information
Technology.
• The Direct Project specifies a simple, secure, scalable,
standards-based way for participants to send
authenticated, encrypted health information directly to
known, trusted recipients over the Internet.

38. What is the Direct Project?
– In simple layman’s terms:
• A Direct Project implementation encompasses packaging message content,
securing it, and transporting it from one location to another; basically, in a form
of “secure email.”
• The Direct Project focuses on the technical standards and services necessary to
securely push content from a sender to a receiver and not on the actual content
exchanged.
• The Direct Project seeks to benefit patients and providers by improving the
transport of health information, making it faster, more secure, and less
expensive.
• The Direct Project seeks to facilitate “direct” communication patterns with an eye
toward approaching more advanced levels of interoperability than simple paper
can provide.
• The Direct Project itself will not enable health information exchange (HIE)
services.

39. Summary
• Meaningful Use has a long road ahead
with many challenges including EHR
adoption, competing projects, sustaining
technology and costs.
• HIT Infrastructure is expanding and will be
difficult to sustain.
• HIT Drivers come in many forms –
including mobile devices, meaningful use,
HIE and shifts to the cloud.
• Each driver has specific technology needs
making it difficult to focus and strategize.

40. Thank youThank you
Questions & Discussion
Electronic Medical Records and
Meaningful Use

41. Contact Information
For additional information, please feel
free to contact:
• William “Buddy” Gillespie
wgillespie@dsscorp.com
(717) 891-0550