Slide Number 8/19/2011 Martha Cornwell Riddell, DrPH Meaningful Use Advisor, Kentucky Regional Extension Center Assistant Professor, Health Services Mgmt., UK Polly Mullins-Bentley, RN, RHIT, CPHQ Deputy Executive Director Governor’s Office of Electronic Health Information Kentucky EHR Initiatives

Slide Number Overview Review the reasons advancing Health Information Technology adoption Provide a brief update on federal initiatives involving Health Information Technology (HIT) Review the role of the Regional Extension Center in assisting clinicians’ move to meaningful use of HIT Examine the Kentucky Health Information Exchange and discuss the current status 2

Slide Number 3 Why Health Information Technology (HIT)? Implementation of HIT is proposed as a way to provide additional information to clinicians to facilitate a reduction in serious medical errors, rising healthcare costs and system inefficiencies. (Thompson, 2004) Estimate annual $10.6 billion outpatient savings and $31.2 billion inpatient savings based on HIT efficiency benefits (Girosi, Meili,& Scoville, 2005) President Bush State of the Union (Jan 2006) President Obama State of the Union (Jan 2010)

Slide Number 4 Where Healthcare is Going Attempts to change how providers are paid have several common elements: – All payments are value based even if the major goal is cost containment; – It is assumed that medical guidelines, standards and quality measures will play important roles in management; – All systems require real-time electronic medical records; – Most of the systems use teams to provide care.

Slide Number 5 National Quality Strategy (NQS) The Affordable Care Act (Public Law ) calls on the Secretary of the Department of Health and Human Services (HHS) to establish a national quality strategy and a comprehensive strategic plan (the “National Quality Strategy”) and to identify priorities to improve the delivery of health care services, patient health outcomes, and population health.Affordable Care Act (Public Law ) Affordable Care Act signed March 31, 2010

Slide Number 8/19/ NQS Framework

Slide Number Ensuring that each person and family is engaged as partners in their care. Promoting effective communication and coordination of care. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. National Quality Strategy Priorities 7

Slide Number Working with communities to promote wide use of best practices to enable healthy living. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models. Making care safer by reducing harm caused in the delivery of care. National Quality Strategy Priorities 8

Slide Number 9 Policies and Infrastructure needed to Support the National Quality Strategy 1.Payment 2.Public Reporting 3.Quality Improvement/Technical Assistance 4.Certification, Accreditation, and Regulation 5.Consumer Incentives and Benefit Designs 6.Measurement of Care Processes and Outcomes 7.Health Information Technology 8.Evaluation and Feedback 9.Training, Professional Certification, and Workforce and Capacity Development 10.Promoting Innovation and Rapid-Cycle Learning

Slide Number 10 HITECH Framework: Meaningful Use at its Core Privacy & Security Framework Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery ADOPTION EXCHANGE State Grants for Health Information Exchange Standards & Certification Framework Regional Extension Centers Workforce Training MEANINGFUL USE Beacon Communities

Slide Number 11 American Recovery and Reinvestment Act (ARRA) Health Information Technology for Economic and Clinical Health (HITECH) $19.2B $17.2B Provider Incentives $2B HIT (HHS/ONC )

Slide Number 12

Slide Number 13 Improve Quality Engage Patients Improve Care Coordination Improve Public Health Ensure privacy and security Pillars of Meaningful Use

Slide Number Pillars of Meaningful Use Explained 1) Improve quality, safety, efficiency, and reduce health disparities ▪ Provide access to comprehensive patient health data for patient’s health care team ▪ Use evidence-based order sets and CPOE ▪ Apply clinical decision support at the point of care ▪ Generate lists of patients who need care and use them to reach out to patients 2) Engage patients and families ▪ Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health 3) Improve care coordination ▪ Exchange meaningful clinical information among professional health care team 4) Improve population and public health ▪ Submit immunization, syndromic surveillance and reportable disease data to public health agencies 5) Ensure privacy and security protection for personal health information ▪ Protect confidential information through operating policies, procedures, and technologies ▪ Provide transparency of data sharing to patient 14

Slide Number 15 Kentucky Regional Extension Center (KY-REC) Strategic Framework Vision Statement The long-term vision of Kentucky Regional Extension Center is to improve the quality and value of health care for the people of Kentucky and to serve as a model for other areas that face similar challenges. Mission Statement The Kentucky Regional Extension Center based at the University of Kentucky will assist primary care providers and critical access/rural hospitals with EHR adoption, HIE participation, and achievement of meaningful use.

Slide Number 8/19/ HITECH Framework: Meaningful Use at its Core Kentucky Regional Extension Center

Slide Number 17 Menu of KY-REC Services Complete Practice Readiness Assessment Identify Target Improvement Opportunities Address Practice Readiness Barriers Initiation Phase Conduct a Practice Workflow Assessment Perform MU Gap Analysis Create a MU Work Plan Planning Facilitate Change Management on EHR Resources Assist with Selection and Purchase of HER EHR Implementation or Modification for MU Facilitate HIE Connectivity Implementation Phase Provide Supplemental UK REC Services Continuing Education Onsite Coaching and Mentoring Monitoring Phase Demonstrate MU to CMS Achieving Meaningful Use

Slide Number Who is Eligible for Incentives? Eligible Providers- MedicareEligible Providers- Medicaid Eligible Professionals (EPs)* Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Optometry Doctor of Podiatric Medicine Chiropractor Eligible Professionals (EPs) Physicians (Pediatricians have special eligibility and payment rules) Nurse Practitioners (NPs) Certified Nurse-Midwives CNMs) Dentists Physician Assistant (PAs) who lead a FQHC)or rural health clinic Eligible Hospitals* Acute Care Hospitals Critical Access Hospitals (CAHs) Eligible Hospitals Acute Care Hospitals, Critical Access Hospitals Children’s Hospitals 18

Slide Number How to get to MU: What are the Provisions? Eligible Providers must comply with 20 objectives to reach meaningful use. Providers must attest to15 core objectives along with another 5 objectives chosen off a menu list of 10 objectives. 19

Slide Number Core Set 1.Use computerized order entry for medication orders. 2.Implement drug-drug, drug-allergy checks. 3.Generate and transmit permissible prescriptions electronically. 4.Record demographics. 5.Maintain an up-to-date problem list of current and active diagnoses. 6.Maintain active medication list. 7.Maintain active medication allergy list. 8.Record and chart changes in vital signs. 9.Record smoking status for patients 13 years old or older. 10.Implement one clinical decision support rule. 11.Report ambulatory quality measures to CMS or the States. 12.Provide patients with an electronic copy of their health information upon request. 13.Provide clinical summaries to patients for each office visit. 14.Capability to exchange key clinical information electronically among providers and patient authorized entities. 15.Protect electronic health information (privacy & security) 20

Slide Number Menu Set 1.Implement drug-formulary checks. 2.Incorporate clinical lab-test results into certified EHR as structured data. 3.Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. 4.Send reminders to patients per patient preference for preventive/ follow-up care 5.Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) 6.Use certified EHR to identify patient-specific education resources and provide to patient if appropriate. 7.Perform medication reconciliation as relevant 8.Provide summary care record for transitions in care or referrals. 9.*Capability to submit electronic data to immunization registries and actual submission. 10.*Capability to provide electronic syndromic surveillance data to public health agencies and actual transmissions 21

Slide Number 22 Thresholds Applicable core objectives and menu objectives have specific thresholds a provider must meet. Core ObjectiveStage 1 measure Generate and Transmit permissible prescriptions electronically (eRx) More than 40% of all permissible prescriptions written by the eligible provider are transmitted electronically using EHR certified technology

Slide Number 23 Clinical Quality Measures In addition to the 20 core and menu measures, providers must report 6 clinical quality measures: 3 core quality measures and an additional 3 from a set of 38.

Slide Number 24 Meaningful Use Stage 2: The Escalator Add in key elements of NQS/delivery system reforms

Slide Number 25 Medicare Incentive Payment Schedule Fall 2010 EHR vendors receive certification April 2011 Attestation of meaningful use begins Jan Registration with CMS begins May 2011 CMS begins payments Clinicians can begin using a certified EHR in a meaningful Manner (must use for 90 days)

Slide Number 26 Healthcare Today: A Disconnected System Disconnected islands of data Poor coordination Fragmented processes Limited connectivity Patients and clinicians often left without tools and data required IDN/Hospital Imaging Center Tightly Aligned Physician Offices Patient Community Pharmacy Loosely Affiliated Physician Offices Non- Affiliated Practices Reference Lab Owned Practices Clinics

Slide Number 27 The KHIE Connection: Partnering to Improve Patient Health Outcomes Polly Mullins-Bentley, RN, RHIT, CPHQ Deputy Executive Director Governor’s Office of Electronic Health Information

Slide Number 28 Health Information Exchange: The electronic movement of health-related data and information among organizations according to agreed standards, protocols, and other criteria (ONC)

Slide Number 8/19/ eHealth and Health Information Exchange in Kentucky TODAY Kentucky has a LIVE operational state-wide health information exchange because… eHealth Milestones March/2005 Legislation (Senate Bill 2) to create a secure interoperable statewide electronic health network Kentucky eHealth Network Board (KeHN) Appointment of Health Information Exchange committee 2007 – 2008 Medicaid Transformation Grant Funding – $4.9 million Built the technical infrastructure for the KHIE 2009 ARRA/HITECH Funding - $9.75 million Provides Kentucky the advantage in progressing towards STATE-wide HIE Governor’s Office of Electronic Health Information Executive Order of the Governor Housed in the Cabinet for Health & Family Services

Slide Number 30 How the Exchange ‘Works’ Data Sharing! ADT’s/Demographics Populate the Community/Master Patient Index Record Locator Service Locates all the patient encounters Consolidates patient information for presentation to the provider Access KHIE Community Portal/Virtual Health Record Provider EHR Portal/Dashboard

Slide Number 31 KHIE Community Portal (Virtual Health Record)

Slide Number 32 KHIE Goal Provide HIE Connectivity to as many providers as possible over the next two years with little or no startup cost to the providers

Slide Number KHIE Hospitals 65 Intake Complete/PA in Process Updated 11/30/2011 Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancoc k Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon McCracken McCreary McLean MadisonMagoffin Marion Marshall Martin Mason Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford    West Virginia (KHIE Counties) Raleigh Summers

Slide Number Implementation Contacts 235 Physician Practices/Labs/ Other by County Updated 11/30/2011 Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancoc k Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon McCracke n McCreary McLean MadisonMagoffin Marion Marshall Martin Mason Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simps on Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford    Other Locations: Jellico, TN Lewis

Slide Number Combined Contacts 338 Combined Hospitals/Physicians/Labs/ Other by County Updated 11/30/2011 Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancoc k Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon McCracken McCreary McLean MadisonMagoffin Marion Marshall Martin Mason Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford    Hospital Physician Both

Slide Number Participation Agreements Signed Total 102 – represents 201 provider organizations Healthcare Systems/Hospitals Representing 56 hospitals Physicians/Clinics/Health Departments 86 Physicians/Clinics 1 Health Department Laboratories LabCorp Cumberland Medical Lab Kentucky Division of Laboratories Immunization Registry Kentucky Cancer Registry

Slide Number KHIE Participation Agreements Hospitals/Physicians by County 102Signed PA’s Updated 11/30/2011 Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancoc k Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon McCracken McCreary McLean MadisonMagoffin Marion Marshall Martin Mason Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford   Hospital Physician Lab Combination Other Participation Agreements: Kentucky Immunization Registry Kentucky Cancer Registry Kentucky State Laboratory Cumberland Medical Lab Labcorp

Slide Number LIVE Connections Hospitals/Physicians/Labs by County Updated 10/28/2011 Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancoc k Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon McCracken McCreary McLean MadisonMagoffin Marion Marshall Martin Mason Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford   Hospital Physician Lab Combination Others: Kentucky Immunization Registry State Lab (Microbiology) Grundy, VA

Slide Number Current Data Exchange ParticipantADTLABRADTRNMRGPATHVXU Silver (pull CCD) Other # of Facilities Pikeville Medical CenterX1 University of KentuckyX1 Trover ClinicX1 University of LouisvilleXXXXX1 Murray Calloway County HospitalXXX1 Commonwealth Health Corporation (Bowling Green)XXXXXX3 Ephraim McDowell HospitalXXXXX2 Baptist Healthcare System, Inc.X1 King’s Daughters Medical CenterXXXX1 Twin Lakes Medical CenterXXXXX1 Big Sandy Health CareX5 Harrison Memorial HospitalXX1 Ky. Div. of Laboratory ServicesMicro results1 Lourdes HospitalXXX2 Ky. Immunization RegistryPhase 1 live1 Appalachian Regional HealthcareXX7 Rockcastle Regional HospitalXX1 Wayne County HospitalX1 Murray Vision CenterCCD via edge services3 As of 11/03/2011 Total Facilities Connected: 35

Slide Number 8/19/ Kentucky Health Information Exchange Outreach Coordinator Regions Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancock Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon McCracken McCreary McLean MadisonMagoffin Marion Marshall Martin Mason Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford    Region 1 – Laura Shonk Region 2 – Teresa Poff Region 3 – Ann O’Hara Region 4 – Dawn Gasser Region 5 – Pat Robinson

Slide Number 8/19/ KHIE and CHFS Cabinet Resources: The Advantage KHIE is the resource for Cabinet data – 3 years of Medicaid Claims Data currently available in production with nightly data load updates State Laboratory Results – Newborn Screenings – All other legally available state lab tests available – Currently in testing mode with the two lab vendors Immunization Registry – Currently in design phase to connect the Immunization Registry to the KHIE Public Health – Reportable Diseases – Syndromic Surveillance Reporting

Slide Number 8/19/ Benefits of HIE Participation Access to comprehensive patient information Encounters Lab results Radiology reports Transcribed reports Medication history/allergies Meaningful Use criteria Immunization Registry/Reportable diseases

Slide Number Quality of Diabetes Care: Patients Treated by Physicians using EHR vs. Paper Medical Records Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365: Retrieved from * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.001 % of Patients Receiving Care A significantly higher proportion of patients being treated by physicians with EHRs received care that aligns with accepted treatment standards *

Slide Number What’s Possible? With a Connected Community Community Pharmacy Imaging Center Loosely Affiliated Physicians Hospitals Patients Tightly Aligned Physicians Better Coordination Safer Care More Cost-Effective Care Owned Practices/ Clinics Reference Lab Non-affiliated Practices

Slide Number 8/19/ Medicaid Incentive Payments 62 Hospitals paid $45.8 million 582 Providers paid $12.3 million Total Paid $58.1 million 81 hospitals registered for payment 1024 providers registered for payment

Slide Number eHR Incentive Payment Hospitals Payments by County As of November 28, 2011 Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancock Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon McCracken McCreary McLean MadisonMagoffin Marion Marshall Martin Mason Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford    Total Hospital Incentive Payments to date $45,826,628.45

Slide Number eHR Incentive Payment Physician Payments by County As of November 28, 2011 Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancoc k Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon McCracke n McCreary McLean MadisonMagoffin Marion Marshall Martin Mason Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simps on Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford    Total Provider Incentive Payments to date $11,588,333.34

Slide Number 8/19/

Slide Number 8/19/2011 Questions? Martha Cornwall Riddell, DrPH Meaningful Use Advisor KY Regional Extension Center Assistant Professor, Health Services Mgmt, UK Kentucky Regional Extension Center 2333 Alumni Park Plaza, Suite 200 Lexington, KY KY-REC-EHR  Polly Mullins-Bentley, RN, RHIT, CPHQ Deputy Executive Director Governor’s Office of Electronic Health Information Kentucky Health Information Exchange Governor's Office of Electronic Health Information Cabinet for Health and Family Services 275 E. Main Street, 4W-A, Frankfort, KY (502) 