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Deloitte Consulting LLP How National Initiatives have Improved eHealth Deployment in the US An Inspiration for Other Countries? Andrew M. Wiesenthal, MD,

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Presentation on theme: "Deloitte Consulting LLP How National Initiatives have Improved eHealth Deployment in the US An Inspiration for Other Countries? Andrew M. Wiesenthal, MD,"— Presentation transcript:

1 Deloitte Consulting LLP How National Initiatives have Improved eHealth Deployment in the US An Inspiration for Other Countries? Andrew M. Wiesenthal, MD, SM Director

2 You can always count on the Americans to do the right thing—after they’ve tried everything else. --Winston Churchill Has the natural order of things been reversed?

3 - 3 - MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Summary of HITECH Progress to date in the US What’s next for the US? Lessons learned Applicability outside the US Agenda

4 - 4 - MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx  NOT part of National Health Reform legislation  Key Components: o Requires use of certified electronic health record (EHR) technology o Provides monetary incentives for adoption by Eligible Hospitals and Eligible providers through 3 stages of o Meaningful use  A staged, increasingly more demanding, demonstration of capability over 5 years, followed by penalties for failure to comply o Supports Regional Extension Centers o Supports Increased training in informatics Summary of HITECH

5 - 5 - MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx  The American Recovery and Reinvestment Act (ARRA) includes the Health Information Technology for Economic and Clinical Health (HITECH) Act to accelerate the adoption of interoperable electronic health records and other health information technology.  The HITECH Act allocated $27 billion dollars of payment incentives to physicians and hospitals for achieving “Meaningful Use” (MU) of certified Electronic Health Records (EHRs).  To obtain Medicare incentive funding, providers must commence “Meaningful Use” of EHR technologies between 2011 and Medicaid funding is available between 2011 and 2021, with the last year to receive the first Medicaid incentive payment and qualify for maximum amount being  Hospitals are eligible to receive both Medicare and Medicaid Incentives simultaneously. Physicians who are eligible for both Medicare or Medicaid incentives must choose one. Stimulus $787 billion 2008 US Federal Budget $2.9 trillion $27+ billion total allocated towards HITECH expenditures HITECH Overview HITECH Meaningful Use 2016* *As currently proposed by CMS Hitech

6 - 6 - MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Stage 1 Data capture and sharing Stage 2 Advanced clinical processes Stage 3 Improved outcomes On Tuesday, September 4, 2012:  CMS released the Stage 2 Final Rule of the Medicare and Medicaid Electronic Health Record Incentive Programs  ONC released the 2014 Edition Standards and Certification Criteria Final Rule  Increase implementation and adoption of EHR systems  Capture structured data  Increase exchange of health information  Demonstrate care coordination across sites of care  Empower patients with health information  Drive use of real- time data at the point of care  Use outcomes- focused clinical quality measures  Utilize clinical decision support for prevention, disease management and safety Meaningful Use

7 - 7 - MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx  The CQMs are no longer a core objective, but simply a requirement to meet Meaningful Use (e.g., the 2014 CQMs are independent of MU Stage)  With Stage 2, complexity has increased and many objectives now have multiple measures to achieve Overview of Stage 2 Criteria Stage 2 of Meaningful Use will include the same concept of Core, Menu, and Clinical Quality Measures (CQMs) as in Stage 1, however there are a few key differences, as outlined below: Eligible Professionals 15 core objectives AND 5 of 10 menu objectives = 20 total objectives Eligible Hospitals & CAHs 14 core objectives AND 5 of 10 menu objectives = 19 total objectives Eligible Professionals 17 core objectives AND 3 of 6 menu objectives = 20 total objectives Eligible Hospitals & CAHs 16 core objectives AND 3 of 6 menu objectives = 19 total objectives MU Stage 1 ObjectivesMU Stage 2 Objectives

8 - 8 - MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Core ObjectiveDeltaMeasureKey Points 1. CPOEIncreased Threshold Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology orders −Optional for denominator in when attesting for Stage 1: No. of orders during the EHR Reporting Period (as opposed to unique patient) −Decreased % threshold for lab and radiology 2. DemographicsIncreased Threshold Record demographics for more than 80% of all patients 3. Vital SignsIncreased Threshold Record vital signs for more than 80% of all patients−Change in Age Limit: age 3 for Blood Pressure −No age limit for Height/Weight 4. Smoking StatusIncreased Threshold Record smoking status for more than 80% of all patients 5. InterventionsIncreased Threshold Implement 5 clinical decision support interventions + drug/drug and drug/allergy checking −Change from “rule” to “intervention” −5 CDS interventions must be related to the CQMs that will be reported 6. LabsIncreased Threshold Incorporate lab results for more than 55% of labs that have been ordered −Now a Core measure 7. Patient ListSameGenerate patient list by specific condition−Now a Core measure 8. eMARNeweMAR is implemented and used for more than 10% of medication orders −Using RFID or Barcode Technology Stage 2 EH Core Objectives / Measures EHs must select all 16 core objectives below. Changes from Stage 1 are indicated in bold.

9 - 9 - MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Core ObjectiveDeltaMeasureKey Points 9. Patient AccessNewProvide online access to health information for more than 50% (within 36 hours of discharge) with more than 5% actually accessing −Reduced from 10% to 5% from the Stage 2 Proposed Rule 10. Education Resources Increased Threshold Use EHR to identify and provide education resources to more than 10% of patients −Now a Core measure 11. Rx Reconciliation NewMedication reconciliation at more than 50% of transitions of care −Now a Core measure −Reduced from 65% in the Proposed Rule 12. Summary of Care NewProvide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR −Merged Problem List, Medication & Allergy List into this Measures −Reduced from 65% to 50% 13. ImmunizationsIncreased Performance Successful ongoing transmission of immunization data −Public Health measures −Now a Core measure −Requires real patient data with ongoing submission 14. LabsIncreased Performance Successful ongoing submission of reportable laboratory results 15. Syndromic Surveillance Increased Performance Successful ongoing submission of electronic syndromic surveillance data 16. Security Analysis SameConduct or review security analysis and incorporate in risk management process −Highlighted Importance of Reviewing Encryption Practices Stage 2 EH Core Objectives / Measures (cont.) EHs must select all 16 core objectives below. Changes from Stage 1 are indicated in bold.

10 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Menu Objective DeltaMeasureKey Points 1. Progress Notes NewEnter an electronic progress note for more than 30% of unique patients −Reduced from 40% to 30% from the Stage 2 Proposed Rule 2. E-RxNewMore than 10% electronic prescribing (eRx) of discharge medication orders −Measure includes Drug Formulary Checking 3. Imaging Results NewMore than 20% of imaging results are accessible through Certified EHR Technology 4. Family History NewRecord family health history for more than 20% of patients −Does not include exchanging this data electronically (most likely will in Stage 3) 5. Advanced Directives UnchangedRecord advanced directives for more than 50% of patients 65 years or older 6. LabsNewProvide structured electronic lab results to EPs for more than 20% of electronic lab orders received - If the EH receives an electronic order from an ambulatory provider, they would send an electronic result back (rather than a fax) EHs must select 3 out of the 6 below. Changes from Stage 1 are indicated in bold. Stage 2 EH Menu Objectives / Measures

11 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Core ObjectiveDeltaMeasureKey Points 1. CPOEIncreased Threshold Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology orders −Modified Calculation −Expanded to Lab and Radiology 2. E-RxIncreased Threshold E-Rx for more than 50% of all prescriptions−Now a Core measure −Included Formulary Objective as part of Measures −Reduced from 65% to 50% from Stage 2 Proposed Rule 3. DemographicsIncreased Threshold Record demographics for more than 80% of all patients 4. Vital SignsIncreased Threshold Record vital signs for more than 80% of all patients −Changed age from 2 to 3 for Blood Pressure 5. Smoking Status Increased Threshold Record smoking status for more than 80% of all patients 6. InterventionsIncreased Threshold Implement 5 clinical decision support interventions + drug/drug and drug/allergy checking −Change from “rule” to “intervention” −5 CDS interventions must be related to the CQMs that will be reported 7. LabsIncreased Threshold Incorporate lab results for more than 55% of labs that have been ordered −Now a Core measure 8. Patient ListUnchangedGenerate patient list by specific condition−Now a Core measure 9. Visit Summaries Increased performance Provide office visit summaries for more than 50% of office visits −Decreased from 3 days to 24 hours Stage 2 EP Core Objectives / Measures EPs must select all 17 core objectives below. Changes from Stage 1 are indicated in bold.

12 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Core Objective DeltaMeasureKey Points 10. Preventive Reminders Revised Denominator Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years −Removed age restriction −Decreased % threshold 11. Patient Access NewProvide online access to health information for more than 50% with more than 5% actually accessing information −Access on demand via portal or PHR −Requires Action by Patient 12. Education Resources Revised Denominator Use EHR to identify and provide education resources to more than 10% of patients −Now a Core measure 13. Secure Messages NewMore than 5% of patients send secure messages to their EP 14. Rx Reconciliation Unchanged Threshold Medication reconciliation at more than 50% of transitions of care −Now a Core measure −Reduced from 65% to 50% from Stage 2 Proposed Rule 15. Summary of Care NewProvide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR −Must meet both Measures for Stage 2 −Merged Problem List, Medication & Allergy List into this Measures 16. Immunization Increased Performance Successful ongoing transmission of immunization data −Now a Core measure −Requirement changed from ‘test’ to ‘ongoing transmission’ 17. Security Analysis UnchangedConduct or review security analysis and incorporate in risk management process −Highlighted Importance of Reviewing Encryption Practices Stage 2 EP Core Objectives / Measures (cont.) EPs must select all 17 core objectives below. Changes from Stage 1 are indicated in bold.

13 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Menu Objective DeltaMeasureKey Points 1. Imaging Results NewMore than 20% of imaging results are accessible through Certified EHR Technology −Can include indication and link to another technology 2. Family History NewRecord family health history for more than 20% of patients−Does not include exchanges data electronically 3. Syndromic Surveillance UnchangedSuccessful ongoing transmission of syndromic surveillance data −Public Health Core Measures −Requires real Patient Data with ongoing submission 4. CancerNewSuccessful ongoing transmission of cancer case information 5. Specialized Registry NewSuccessful ongoing transmission of data to a specialized registry 6. Progress Notes NewEnter an electronic progress note for more than 30% of unique patients Stage 2 EP Menu Objectives / Measures EPs must select 3 out of the 6 below. Changes from Stage 1 are indicated in bold.

14 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Adoption of Basic EHRs by Office-Based Practices Progress to Date in the US

15 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Hospital Adoption of EHRs Progress to Date in the US

16 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Progress to Date in the US

17 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx CMS routinely releases key statistics that result from the adoption of EHRs through Meaningful Use requirements. As of the end of June 2013, More than 309,000 health care providers have been paid by the Medicare and Medicaid EHR Incentive Programs Over 405,430 health care providers (including eligible professionals, eligible hospitals and critical access hospitals) are actively registered for the Medicare and Medicaid EHR Incentive Programs Total of over $15.2 billion in Medicare and Medicaid EHR Incentive Program payments since May 2011 Over $9.35 billion in Medicare EHR Incentive Program payments have been disbursed between May 2011 and the end of June 2013 Over $5.83 billion in Medicaid EHR Incentive Program payments were disbursed between January 2011 (when the first states launched their programs) and the end of June 2013 As of June 2013, over 76 percent of EPs have registered for the Medicare and Medicaid EHR Incentive Programs and almost 55 percent have been paid As of June 2013, over 89 percent of hospitals have registered for the Medicare and Medicaid EHR Incentive Programs and over 80 percent have been paid Progress to Date in the US

18 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx A flurry of hospital implementations is anticipated in the next 14 months due to both MU and ICD-10 conversion deadlines As physician practices consolidate, more of the outliers will also be EHR-enabled The vendors are continuing to adapt to the certification standards Comparison based on data flowing from EHRs will become more available to government, insurers/payors, and consumers Increased assumption of accountability for outcomes is a likely consequence What’s Next for the US?

19 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Money awarded, or the threat of withholding it, is a profound influencer of institutional and individual behavior In a low margin environment, it doesn’t require much money to build this influence It is possible to create an environment of inevitability Deadlines that do not shift are very influential; deadlines that shift breed cynicism A small national agency with an obvious, high-profile leader, has been effective The national government can set standards but need not be involved in procurement in any way Lessons Learned

20 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx National leadership, standard-setting, and incentives could translate smoothly into most environments outside the US In particular, monetary reward and punishment gets local health authority attention Demanding “meaningful use” looks promising, but the data has not begun to flow yet Applicability Outside the US

21 MU Stage 2 Final Rule Webinar #2 Held v7 FINAL.pptx Copyright © 2012 Deloitte Development LLC. All rights reserved. ?


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