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MGH Licensed Technology MGH Licensed Technology Nuance, Inc. Nuance, Inc. Powerscribe, Commissure, RadWhere, RadCube Powerscribe, Commissure, RadWhere,

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Presentation on theme: "MGH Licensed Technology MGH Licensed Technology Nuance, Inc. Nuance, Inc. Powerscribe, Commissure, RadWhere, RadCube Powerscribe, Commissure, RadWhere,"— Presentation transcript:

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2 MGH Licensed Technology MGH Licensed Technology Nuance, Inc. Nuance, Inc. Powerscribe, Commissure, RadWhere, RadCube Powerscribe, Commissure, RadWhere, RadCube Clinical Decision Support, RadPort, Leximer NLP Clinical Decision Support, RadPort, Leximer NLP LifeIMAGE, Inc. LifeIMAGE, Inc. Image Sharing, Data Mining, Render Image Sharing, Data Mining, Render Medical Advisory Boards Medical Advisory Boards McKesson McKesson Philips Medical Philips Medical General Electric General Electric Siemens Siemens Carestream Carestream Visage Imaging Visage Imaging Vital Image Vital Image Nuance Nuance LifeIMAGE LifeIMAGE Conflict of Interest

3 Objectives  Federal Healthcare Reform  Preparing for Radiology Meaningful Use  Demonstration of New Technologies  Summary

4 “ To lower health care cost, cut medical errors, and improve care, we ’ ll computerize the nation ’ s health records in five years, saving billions of dollars in health care costs and countless lives. ”

5 Health Initiatives: To incentivize the ‘Meaningful Use’ of certified EHR technology

6  EHR  Electronic Health Record  Certified  Tested and Certified in accordance with the HHS Certification Program  Meaningful Use (MU)  Demonstrate the use of IT in the practice of medicine to:  Enhance Quality  Improve Patient Safety  Decrease Costs  Demonstrate Improved Outcomes

7 Transformational Change in Health Care Delivery & Population Health Technology Adoption Time

8 MU Criteria Improved Outcomes MU Criteria Clinical Decision Support MU Criteria Capture & Share Data MU Criteria HITECH Policies HIT-Enabled Health Reform *Report of Health IT Policy Committee

9 Meaningful Use Incentives by Adoption Year $1.5B incentive opportunity for US radiologists $10B annual penalty impact for US radiologists

10  Centers for Medicare and Medicaid Services (CMS)  Office of the National Coordinator (ONC) for Health IT  Branch of Health and Human Services (HHS)  Dr. David Blumenthal, MGH - Chair  Dr. John Glaser, PHS - Senior Advisor  Policy Committee  Meaningful use (MU) of healthcare information technology (HIT)  Certification and adoption of electronic health record (EHR) products  Strategy for health information exchange (HIE)  Standards Committee  Quality measurement  Clinical operations  Privacy and security

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13 Radiology Meaningful Use Matrix American College of Radiology Computerized Physician Order Entry Clinical Decision Support Image Management Interpretation Process Communication Management Radiation Safety & Quality Management

14  Centers for Medicare and Medicaid Services  Proposed Rule  Meaningful Use Requirements for:  Eligible Hospitals (EH), Eligible Professionals (EP)  EP - 25 Meaningful Use Objectives and Measures  Office of the National Coordinator for Health IT  Interim Final Rule  Certification Criteria  Standards  Implementation Specifications

15  Office of the National Coordinator  Interim Final Rule (IFR) of Standards and Certification Criteria  End of Public Comment Period - March, 2010  Centers for Medicare & Medicaid Services  Notice of Proposed Rulemaking (NPRM) on Meaningful Use  End of Public Comment Period – March, 2010 Each measure was reviewed and discussed in the context of a radiology practice

16 POS: 11, Office POS: 20, Urgent Care Facility POS: 21, Inpatient Hospital POS: 22, Outpatient Hospital POS: 23, Emergency Room POS: 24, Ambulatory Sx Center POS: 49, Independent Clinic The definition of EH and EP has been changed Eligible HospitalEligible ProfessionalCMS Place of Service Codes 84% of all Physicians Eligibility Determination: If 10% (or more) of your CMS practice is from POS 11, 20, 22, 24, 49 you are considered an eligible professional.

17 Relaxed the requirements for in response to public comments  15 ‘Core Set’ Measures (5 are eligible for exclusion)  Must meet all non-excluded measures  10 ‘Menu Set’ Measures (6 are eligible for exclusion)  Must meet 5 out of 10 measures  44 Clinical Quality Measures  Must report 6 of the 44 measures (3 Core and 3 Non-Core)  To receive all incentives, must begin by 2012  Incentives will be single annual payments

18 Did NOT relax the requirements for as much as CMS  All products must be Certified  Full EHR Certification  EHR Module Certification  A module can measure one or more objectives  Certification is more stringent than CMS requirements  CPOE: CMS Stage 1 for medications, Cert. requires radiology orders  All EPs must be capable of measuring ALL objectives  Regardless of exclusions or menu selections  Testing and certification process will begin Sept

19 Objectives  Federal Healthcare Reform  Preparing for Radiology Meaningful Use

20 Required: Technology probably does not exist in your department 1.Implement one clinical decision support rule 2.Electronically exchange key clinical information among patient authorized providers 3.Report ambulatory clinical quality measures to CMS/States 4.Conduct annual Security Risk Analysis, HIPAA 45 CFR (a)(1) Required: Technology may exist within your department 1.Provide patients with an electronic copy of their health information, upon request 2.Provide clinical summaries for patients for each office visit 3.Drug-drug and drug-allergy interaction checks 4.Record demographics 5.Maintain active medication allergy list 6.Record smoking status for patients 13 years or older 7.Maintain an up-to-date problem list of current and active diagnoses 8.Maintain active medication list Most radiologists excluded 1.Computerized physician order entry (CPOE) 2.Record and chart changes in vital signs 3.E-Prescribing (eRx)

21 Required: Two of the following seven 1.Provide patients access to their health information via an electronic portal 2.Generate lists of patients by specific conditions 3.Drug-formulary checks 4.Incorporate clinical lab test results as structured data 5.Send reminders to patients for preventive/follow up care 6.Use of certified EHR to identify patient-specific education resources 7.Capability to provide electronic syndromic surveillance data Most radiologists excluded 1.Medication reconciliation 2.Summary of care record for each transition of care / referrals 3.Capability to submit electronic data to immunization registries/systems

22 Objectives  Federal Healthcare Reform  Preparing for Radiology Meaningful Use  Demonstration of New Technologies

23 Technology Implement one clinical decision support rule Provide patients access to their health information via an electronic portal Electronically exchange key clinical information among patient authorized providers Generate lists of patients by specific conditions Report ambulatory clinical quality measures to CMS/States Security Audit Conduct annual Security Risk Analysis, HIPAA 45 CFR (a)(1)

24  Decision Support At Point of Order  Appropriateness score (1-9) given selected exam and clinical indications  Suggests alternatives to currently selected exam  Duplicate Exam Alert  Prior related exam reports and images available  Radiation Alert  Extra Decision Support for Primary Care  Headache and low back pain pathways  Hard Stop on Red (non clinicians)  Continuous User Feedback  Modification of indication check boxes  Addition of new exam types  Changes to rules by consensus of PCP, Specialists, Radiologists

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26 Head CT Page1 Selecting a Patient Doctor or Staff Can Log In

27 Selecting A Study To Order

28 Considerations / Protocols (here for Head CT)

29 Indications Specific To Study Type (here for Head CT)

30 Duplicate Exam / Radiation Warning

31 Decision Support Feedback Screen Here user chose Head CT with indication of dementia only

32 Screen To Proceed On Red

33 Exam Ordered But Not Yet Scheduled

34 Office staff can schedule the exam

35 Automatically select the first available time slot

36 Or, pursue web scheduling calendar

37 View, Cancel, Reschedule, Print Instructions

38 Patient Instructions Directions To Imaging Center

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41 Effect of Decision Support on HCI Adjusted Annual Compound Growth Rate 12% Adjusted Annual Compound Growth Rate 1% 19% Decrease (2005 – 2008)

42 19% Decrease (2005 – 2008)

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44 Technology Implement one clinical decision support rule Provide patients access to their health information via an electronic portal Electronically exchange key clinical information among patient authorized providers Generate lists of patients by specific conditions Report ambulatory clinical quality measures to CMS/States

45 Initially created technology to manage patient’s outside imaging exams From incoming CDs to the department, ER, OR, clinics and physician offices Electronically from other institutions via secure dropboxes Directly from registered patients ROE

46 Enterprise RIS / PACS / EMR 5. Gatekeeper reconciles patient and study information, and push to RIS / PACS / EMR 1. Physician’s office receive CDs from patients, upload images & reports 4. Physician can nominate to PACS for distribution and/or interpretation by radiology 2. Physician review images & reports directly using any PC or Mac on the network 3. Physicians can share studies with other physicians with access to the facility’s network CD Import Workflow

47 Main Login

48 Initiate Study Upload

49 Locate Image Files

50 Confirm Upload

51 Upload in process

52 View Images using Inbox

53 Confirm Demographics for Import to MGH

54 Importing of Study to MGH complete Request Interpretation

55 PACS and EMR Outside Exam Notification

56 PACS and EMR Outside Images

57 Progress to secure, cloud-based distribution of patient imaging exams To transfer to patient authorized providers* To patients directly via secure web portal* For patients to transmit to their preferred authorized providers To national registries (accreditation, dose monitoring, etc) * Stage I - Meaningful Use Objective Secure Internet Distribution ROE

58 Technology Implement one clinical decision support rule Provide patients access to their health information via an electronic portal Electronically exchange key clinical information among patient authorized providers Generate lists of patients by specific conditions Report ambulatory clinical quality measures to CMS/States

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60 Noise Reduction LNLN Signal Extraction LSLS Clinical Findings Recommendations Bilateral subdural hemorrhages with subarachnoid hemorrhage. A follow up MRI of the brain is recommended within 7 days to assess progression of hemorrhage. Classification LCLC Discretization LDLD Phrase Isolation LPLP Structured Brief SNOMED-Terms RadLex-ID Findings: Hemorrhage Locations: Subdural Subarachnoid Side: Bilateral Etiology: Unspecified Recommendation: Brain MRI Time: Days Quantity: STRUCTURED OUTCOMES This study is reviewed with Dr Smith. Standard protocol was used to obtain an MRI of the brain with MRA of the circle of Willis and DWI imaging. Dizziness and recurrent syncope. Please evaluate the posterior circulation. Comparison is to a CT of the head performed 3 September 99. Comparison is also to a CT performed the day after the MRI on 5 September Bilateral subdural hemorrhages are present. The right sided subdural hemorrhage appears improved when compared to the prior CT. It has a component extending further posteriorly than appreciated on the CT, appearing to involve the occipital lobe on the right side. The left subdural hemorrhage is worse than it appeared on the initial CT. There is extensive subarachnoid hemorrhage better appreciated on MRI than on CT. There is no evidence of tentorial subdural hematoma. The subsequent CT did show such a bleed, this must have occurred in the interval between studies. DWI imaging of the brain parenchyma is normal in appearance. There is no evidence of acute infarction. The circle of Willis was imaged with particular attention to the posterior circulation. The right vertebral artery appears prominent. The posterior circulation appears entirely normal. Because imaging was centered on the posterior circulation, the MCA's are not completely evaluated. The ventricular system and CSF spaces do not show evidence of abnormal dilation. The visualized extracranial structures are normal in appearance. Impression. No evidence of acute infarction on diffusion weighted imaging. Bilateral subdural hemorrhages with subarachnoid hemorrhage. The posterior circulation appears entirely normal. A follow up MRI of the brain is recommended within 7 days to assess progression of hemorrhage.

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68 Technology Implement one clinical decision support rule Provide patients access to their health information via an electronic portal Electronically exchange key clinical information among patient authorized providers Generate lists of patients by specific conditions Report ambulatory clinical quality measures to CMS/States

69 Objectives  Federal Healthcare Reform  Preparing for Radiology Meaningful Use  Demonstration of New Technologies  Summary

70  Meaningful Use will definitely impact radiology (Billions at risk)  MU is moving rapidly, but with a visible trajectory  Next up for Radiology (Stage II, III):  Radiology Structured Reporting

71 Radiology Structured Reporting  Structured Reporting  Radiological Society of North America (RSNA) - Structure Reporting Initiative (SRI)  Use of RadLex for approved terminology and Procedure Mapping  Standard Library of Reports freely available from RSNA.org  Implementation of RSNA SRI into industry products has occured Administrative Information – Imaging facility – Referring provider – Date of service – Time of service Patient Identification – Name – Identifier (e.g., medical record number or Social Security Number) – Date of birth – Gender Clinical History – Medical history – Risk factors – Allergies, if relevant – Reason for exam, including medical necessity Imaging Technique – Time of image acquisition – Imaging device – Image acquisition parameters, such as device settings, patient positioning, interventions (e.g., Valsalva maneuver) – Contrast materials and other medications administered (including name, dose, route, and time of administration) – Radiation dose Comparison – Date and type of previous exams reviewed, if applicable Observations – Narrative description or itemization of findings, including measurements, image annotations, and identification of key images Summary (or Impression) – An itemized list of key observations, including any recommendations. Signature – The date and time of electronic signature for each responsible provider, including attestation statement for physicians supervising trainees, if applicable

72  Meaningful Use will definitely impact radiology (Billions at risk)  MU is moving rapidly, but with a visible trajectory  Next up for Radiology (Stage II, III):  Radiology Structured Reporting  Radiology Order Entry  Radiology Clinical Decision Support - ACR Appropriateness Criteria  NHIN - Image Sharing  National Registries – Radiation Dose Monitoring  Stay tuned, stay informed!

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