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Powerpoint lawrence m. preston
1. Lawrence M. Preston, MBA, FHFMA
Professional Medical Consultants, Inc.
April 18, 2012
AIIM and ARMA
2. Background
• 19 years in hospital management-California, Hawaii
and Nevada
• 20 years in healthcare consulting-based in LV
• Primary focus-Physician Practice Management
• Own Primary Care Practice in Mexico
• Starting IPA in Nevada
• Application in for ACO in Nevada
• Board of Directors-ACHE and HFMA Nevada
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3. Meaningful Use-Phase I
Core Measurements -15 criteria must be met
Menu Set – choose 5 of 10 criteria
Must meet 100% of each or no incentive payment
Payment for Medicare is up to $44,000 over 5 years
($63,750 for Medicaid over 6 years)
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5. Core Measurements
1. E-prescribing at least 40% of all RX
2. At least 30% of patient seen must have a medication
entered into system
3. EMR software must have drug to drug
interaction/allergy alert
4. At least 80% of patients seen must have an active
medication list
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6. Core Measurements-continued
1. At least 80% of patients seen must have up to date
diagnosis
2. At least 80% of patients seen must have an active
allergy list
3. At least 50% of patients seen must have smoking
status and history documented
4. Need to implement one clinical decision support
rule
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7. Core Measurements-continued
1. Need at least 50% of patients seen to have
documented the following questions:
a. Preferred language
b. Gender
c. Race
d. Ethnicity (Hispanic or Non-Hispanic)
e. Date of Birth
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8. Core Measurements-Continued
1. Need at least 50% of patients to have seen the
following vitals signs recorded:
a. Height
b. Weight
c. Blood Pressure
d. BMI (calculated by Height & Weight)
e. Plot and display growth charts for children ages 2-20
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9. Core Measurements-continued
1. Need to report ambulatory clinical quality measures
to CMS (Medicare)
2. Need to provide at least 50% of patients with an
electronic copy of their health information within 3
business days-when requested
3. Need to provide at least 50% of patients seen a
clinical summary of their visit within 3 business days
from the date seen
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10. Core Measurements-continued
1. Need to perform at least one test of electronically
exchanging clinical information with another
provider
2. Need to have a security risk analysis conducted
Meet each and everyone one of the above
criteria to pass this section (no exceptions)
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11. Menu Set Measurements
m Implement drug formulary check
o Have a least 40 % of lab results reported into system
% Need to generate a least one list of patients by
specific condition (i.e.-Diabetes)
o Need at least 10% of patients to be able to obtain
their medical information within three business
days
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12. Menu Set Measurements
m Need at least 20% of patients 65 and older to be sent
a reminder for preventative or follow up care
r Need at least 10% of patients seen be given patient
specific education resources that are generated from
the EMR system
o Need to update at least 50% of patients seen
medication list when seen by another doctor
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13. Menu Set Measurements
m Need to send a referral, summary of care and any
other pertinent information on at least 50% of
patients being referred out
e Need to perform at least on test of sending
electronic immunization records to an
immunization registry
i Need to perform at least one test of sending
electronic syndromic surveillance data to a public
health agency
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14. Meaningful Use
• Must meet all 15 Core at 100%
• Must meet 5 of the 10 Menu set
• Miss any of the above-no incentive payment
• Check your software to make sure it can do the above
and that it has been approved by CMS standards
board-now your ready to go
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15. How to Implement
Ask for help from your vendor
Don’t get to complicated
KISS
Physician buy in—largest and most difficult
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16. How to order a Rx through the EHR
Pull Chart
Go to Assessment and Plan
Choose existing medication from patient’s medication list
For new medication go to search, then change Data Source to
Medications, enter dosage, frequency, quantity and refills
Press Output
Choose Pharmacy
Enter Password
Press OK
Sign Off
Enter Password
Change Encounter Type to Prescription Only
Press OK
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17. How to add an addendum to EHR chart
Double click on the office visit that needs the
addendum (located on the face sheet in the upper R
hand corner)
Click on pencil (located in the L upper corner)
Click on what section you want to add information
to (hover your mouse over the pictures, A+P, vitals,
etc)
Type the information into the box provided.
Click OK
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18. EHR Implementation Schedule
Week 1: All staff (including
physicians) needs to start using
messaging system.
Example: Front desk staff can send
message to MA that a patient keeps
calling and leaving messages for them,
and haven’t received a call back yet.
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19. EHR Implementation Schedule
Week 2: Physicians need to start reviewing all lab
results through system and message to their MA’s
anything needed. No labs should be printed unless
needed.
MA’s need to start entering all
medications and allergies of the morning patients
into the system. MA’s also need to enter entire
social history, medications, allergies, medical
problems of all new patients.
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20. EHR Implementation Schedule
Week 3: Physicians need to start with 4 patients
daily doing only the review of systems in the system.
MA’s need to start entering all medical
problems of the morning patients into the system.
(They continue adding medications/allergies)
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21. EHR Implementation Schedule
Week 4: Physicians start with 4 patients daily doing
physical exam and review of systems in the system.
MA’s need to start entering all vital signs
and chief complaints of morning patients into the
system. (They continue adding medical problems
and medications/allergies)
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22. EHR Implementation Schedule
Week 5: Physicians start with 4 patients daily doing
entire patient (review of systems, physical exam,
assessment and plan) they will do all new patients
and then select others from there. The MA’s will also
do their part for these patients.
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23. EHR Implementation Schedule
Week 6: No new patient charts will be made from
this point on. They all need to be done in the EHR.
MA’s will need to start sending faxes to the
physician to review. Only print out Rx refill requests
that will need to continue to be done through the e-
prescribe in the EHR.
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24. EHR Implementation Schedule
Week 7: Physicians will continue to increase the
number of patients done in the EHR by one in the
morning and one in afternoon each week. (So, 3 in the
am, 3 in the pm x 1 wk, and then 4 in am, 4 in pm, etc)
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25. Examples of weekly reports
Run weekly reports and compare to previous week—
look for progress and regress
Set goal of what to accomplish-by doctor
These are individual attestations-don’t slow down to
the slowest participant
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26. Meaningful Use Status Update 08-04-2011
Dr AA: the following measures not meeting
threshold:
Core 9-Smoking Status: currently listed 4%. Needs to be
>50%
Core 13 - Clinical summaries: currently listed as 0%. Needs
to be >50% (missing report)
Core – Clinical Information Exchange: need to submit 1
test data as a CCR/CCD record to another provider of care.
Menu set – Patient Reminders. Need >20% (missing
report)
Menu set – Patient Education. Need >10%. (missing
report) Professional Medical Consultants, Inc. 26
27. Meaningful Use Status Update 08-04-2011
Dr BB: the following measures not meeting
threshold:
Core 3 – eRX: currently listed 30%. Needs to be >50%
Core 7 – Allergy list: currently listed 46.6%. Needs to be
>80%
Core 13 – clinical Summary: currently listed 0%. Need
>50% (missing report)
Core – Clinical Information Exchange: need to submit 1
test data as a CCR/CCD record to another provider of care.
Menu set – Patient Reminders. Need >20% (missing
report)
Menu Set – Patient Education. Need >10%. (missing
report)
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28. Meaningful Use Status Update 08-04-2011
Dr CC: the following measures not meeting threshold:
Core 7 – Allergy list: currently listed 37.3%. Need >80%
Core 9 – Smoking status: currently listed 43.4%. Need to be
>50%
Core 13 – clinical Summary: currently listed 0%. Need >50%
(missing report)
Core – Clinical Information Exchange: need to submit 1 test
data as a CCR/CCD record to another provider of care.
Menu set – Patient Reminders. Need >20% (missing report)
Menu Set – Patient Education. Need >10% (missing report)
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29. Lessons learned
Don’t slow down
Focus on daily and weekly reporting
Focus on positive changes
Compliment staff-not just physicians
Hold your EMR vendor accountable
Don’t give in-fight for your goal and timetable
Prepare for M U 2-started January 1, 2012
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30. Summary
Don’t be afraid to call your competitors
Call other vendors for input
Listen to 3-4 webinars a week
Ask your vendor to provide constant updates
Hold frequent meetings with key staff
Don’t stop asking your staff how can I help
If you get frustrated-tackle another issue
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31. Questions-???
Thank you very much---
You can always call me at
702 598-0600
Larry Preston
Professional Medical Consultants, Inc. 31
