Population Management & Reporting

Federally-designated Regional Extension Center for the State of Missouri  University of Missouri:  Department of Health Management and Informatics  Center for Health Policy  Department of Family and Community Medicine  Partners:  Hospital Industry Data Institute (Critical Access Hospitals)  Kansas City Quality Improvement Consortium  Missouri Primary Care Association  Missouri Telehealth Network  Primaris

Assist Missouri's health care providers in using electronic health records to improve the access and quality of health services; to reduce inefficiencies and avoidable costs; and to optimize the health outcomes of Missourians

This regional extension center is funded through an award from the Office of the National Coordinator for Health Information Technology, Department of Health and Human Services Award Number 90RC0039/01 Cerner and the University of Missouri Health System have an independent strategic alliance to provide unique support for the Tiger Institute for Health Innovation, a collaborative venture to promote innovative health care solutions to drive down cost and dramatically increase quality of care for the state of Missouri. The Missouri Health Information Technology Assistance Center at the University of Missouri, however, is vendor neutral in its support of the adoption and implementation of EMRs by health care providers in Missouri as they move toward meaningful use.

 Team of experienced, Missouri based Health IT professionals  Part of a national network designated by HHS to assist providers with modernizing their practices  Direct, rapid and reliable access to a pipeline of key information on health IT and meaningful EHR use 5

 For providers who do not have a certified EHR system - We help you choose and implement one in your office  For providers who already have a system - We help eligible providers meet the Medicare or Medicaid criteria for incentive payments 6

 Continuing Education and Training for ALL Providers  Vendor Selection and Group Purchasing  EHR Implementation and Project Management  Practice Workflow Analysis and Redesign  Functional Interoperability and HIE  Help Providers Achieve “Meaningful Use”

Missouri Primary Care Association MO-HIT Assistance Center July 27, 2011

 Brief overview of population management & reporting as it relates to meaningful use  What are the benefits and barriers to meeting the standards  Why is this important to you  How to make sure you're on the right track for meeting the standards

Population management –a method used to identify and target a group of patients with specific health care needs and aims to improve the overall care for the targeted patients  HIT can be used to help generate reports  Examples of target populations may include  Patients with chronic illness; Diabetes, Heart Disease, Asthma  Total population in a clinic or hospital  A provider panel  At risk patients; pregnant women, immunocompromised patients

 The use of HIT to improve population based health outcomes  Provides more timely access to quality measure reporting  Removes the need for manual chart audits to measure quality

 Core Measures Examples  Maintain an up-to-date problem list of current and active diagnosis  Record demographics  Menu Set Measures Examples  Incorporate clinical lab-test results into EHR as structured data.  Generate patient list by specific conditions to use for quality improvements, reduction of disparities, research, or outreach  All Clinical Quality Measures  Breast Cancer Screenings (US Department of Health & Human Services Agency for Healthcare Research and Policy) (Centers for Medicare and Medicaid Services)

 The goal is to increase the quality of care of all patients seen. This means managing care on the patient level as well as a population. This will help to treat patients in a preventative manner, reducing the number of acute incidences in your patient population.

 As with all change the main barrier is the change itself  Data collection barriers  Ineffective communication  One vision

 Help to manage a target populations chronic conditions by identifying them through reporting capabilities  Implement preventive care and chronic care initiatives to improve care outcomes  Reduce the number of “no shows”  Increase preventive screenings  Increase positive outcome for chronic conditions

 Tools used to identify target population  EHR  Registry  Other IT software (MS Excel)  Reporting  Point-of-care  Exception reporting

 Value:  Improving patients health and reducing health care cost  Having accurate and timely data to make informed patient care decisions.  Minimize staffing resources  Consolidated view of patient population  Track progress of goals in a timely and accurate method  $$$$ - Receive Meaningful Use Incentive money

 Step 1: Make sure you are using a certified EHR  Step 2: Know how to pull MU reports from your system  Step 3: Document all necessary items for reports in structured fields to for the purpose of capturing usable data

 Identify the appropriate patient population  Start off with small changes in process  Plan out the intervention  Know what kind of reporting you are wanting and work towards capturing that data  Exception reporting  Point-of-care  Apply the intervention  Review often and make changes as necessary

 Get Started  PDSA -  Accept imperfection initially: process are not perfect instantly  Celebrate accomplishments even if they are small  Be relentless: Persistence and determination will pay off

Centers for Medicare and Medicaid Services. "Stage 1 EHR Meaningful Use Specification Sheets for Eligible Professionals." 4 April EHR Incentive Programs. June US Department of Health & Human Services Agency for Healthcare Research and Policy. National Quality Measures Clearinghouse. June

Ryan Krull, MPH Missouri Primary Care Association 3325 Emerald Lane Jefferson City, MO (573)

 August 10 Missouri’s Statewide Health Information Exchange Presenter: Raul Recarey, president, Missouri Health Connection

 Contact MO HIT Assistance Center for details and pricing

 Website:  ◦  Phone: ◦