Health Information Technology and YOU! The Role of AAP Chapters in Supporting Member Practices District IV and IX 6/23/2012 Joseph H Schneider, MD

Objectives Provide an overview of Meaningful Use (MU) Detail the role of AAP Health Information Technology Leadership in supporting chapters with adoption and use of health information technology (HIT) Provide ideas for Chapter activities

ARRA Legislation Passed on February, 2009 Stage 1 Meaningful Use criteria released in July 2010 Stage 2 Meaningful Use Notice of Proposed Rule Making released February 2012  Final Rule expected Summer 2012  Start Dates: October 2013/January 2014

HITECH Meaningful Use Framework

MU & EHR Adoption in Pediatrics Over $2B in Medicaid EHR Incentive payments made between 1/11 - 3/12 (Office of the National Coordinator, 2012). 2009: ~25% of pediatricians using an EMR (AAP Periodic Survey of Fellows, 2009 ; 2012 being fielded this fall). 2012: Over 50% of physicians using EHRs system ~16% of physicians working with Regional Extension Centers are pediatricians (Office of the National Coordinator, 2012).

MU Objectives Improve quality, safety, efficiency Reduction in health disparities Improve care coordination Ensure privacy and security of personal health information Improve population health and interact with public health programs

Key Differences in MU Stages Multiple Stage 1 objectives would be combined into more unified Stage 2 objectives  Changes to seven objectives  Elimination of two objectives CQMs would be aligned with existing quality programs (e.g. PQRS, NCQA, CHIPRA) CQM reporting would be part of the definition of “meaningful EHR user” instead of as a separate meaningful use objective

Children in CHIP programs in States with Medicaid expansion (7) or combined Medicaid/CHIP programs (26 states) now count towards patient volume thresholds. The expansion of the current definition of "encounter" to also include any service rendered on any one day to an individual "enrolled" in a Medicaid program AAP Advocacy

How is the AAP supporting chapters with HIT implementation?

HIT Leadership Entities Child Health Informatics Center  Serves as the AAP “home” for HIT initiatives  Directed by Christoph U. Lehmann, MD, FAAP (founding Medical Director)  Governed by an 7-person Project Advisory Committee (Chaired by Stephen Downs, MD MS FAAP) Council on Clinical Information Technology  Comprised of 500 members with special interest and training in applying HIT to pediatrics  11-member executive committee

Key Resources and Education Resources on EHR Adoption and Use  State Pages Meaningful Use Resources EMR Review Site (aapcocit.org/emr)aapcocit.org/emr Collaboration with the Office of the National Coordinator and Regional Extension Centers

Top 10 by Count #Average EncounterPRO Office Practicum NextGen EMR Amazing Charts eClinicalWorks Allscripts (formerly Misys) Centricity EMR (formerly Logician) Epic Ambulatory MEDENT EMR System Allscripts Enterprise 52.6 Allscripts Professional 54 e-MDs 54.6 Noteworthy 54.2

Key Resources and Education 2012 NCE Educational Programs  COCIT H-Program  The Pediatric Office of Today  HIT Networking Forum  HIT related general sessions

Meaningful Use Pediatric Specific EHR Functionality  EHR Vendor Consortium  Regional Extension Centers (RECs) AAP Resources:  Immunization Information Systems Toolkit  Child Health Informatics Advocacy Brief  HIT and Medical Home Fact Sheet Advocacy

Vendor Consortium Investigate ways to partner with the vendor community to distribute AAP knowledge and expertise in an electronic format that can be linked to, or embedded within and EHR Includes 11 vendors Areas for Collaboration  Advocacy around common pediatric forms  Decision Support Based on Evidence‐Informed Guidelines  Standardized pediatric vocabulary  Improved implementation of Bright Futures  Advancing the Medical Home and the development of patient facing technologies to collect data  Standardization of growth and specialty growth charts

How can AAP Chapters Support Member Practices with HIT implementation?

AAP Chapters Can: Educate and spread learnings to chapter members  Recognize member successes (and lessons learned!)  Identify the needs of your members regarding HIT education & plan around those needs Encourage participation in Academy HIT initiatives & groups Encourage Advocacy at the Chapter member level

Connecticut, Hawaii, Indiana, and Pennsylvania were awarded $4,000 to:  Provide education to help chapter members adopt/implement electronic health records.  Engage their regional extension centers (REC) and sharing of strategies for how members can access REC services.  Share pediatric specific success stories and challenges about EHR adoption. Chapter Educational Grants

Connecticut  Meaningful Use, incentive money, CT & pediatric specific EHR implementation, security of EMRs, Hall of Experts Hawaii Hawaii  Adoption of EHR for the solo practitioner Indiana Indiana  Implementing Meaningful Use and EHRs in pediatric practices with a specific focus on MU Stage 2 Pennsylvania Pennsylvania  Pediatric-specific support for EHR adoption and effective use

Considerations for AAP Chapters Develop an HIT committee or appoint a chapter champion Interact with your local Regional Extension Center (REC) or Health Information Exchange (HIE) Work with Immunization Information Systems at the state level to ensure optimal product development

Thank you !!

Appendix Slides

MU Stage 1 Objectives Provide access to comprehensive patient health data for patient’s healthcare team Use evidence-based order sets and computerized provider order entry (CPOE) Apply clinical decision support at the point of care Generate lists of patients who need care and use them to reach out to those patients Report information for quality improvement and public reporting

Increased expectations for health information exchange Greater use for e-Rx, incorporation of structured laboratory results, and exchange of patient care summaries across unaffiliated physicians, settings, and EHR systems Encourage the use of health IT for continuous quality improvement at the point of care Focus on patient engagement NPRM for MU Stage 2 Objectives

AAP Advocacy Pediatricians 20% threshold States have option for physicians to calculate total Medicaid or total needy individual patient encounters in any 90-day period in the 12 months before eligible professional (EP) attestation. Calculation of total Medicaid patients assigned to the EPs panel in any representative, continuous 90-day period in either the preceding calendar year, as is currently permitted, or in the 12 months preceding the EPs attestation when at least 1 Medicaid encounter took place with the Medicaid patient in the 24 months prior to the beginning of the 90-day period.

Appendix: Implications for Pediatricians Record smoking status for patients 13 years old or older (core objective #5) Provide clinical summaries for patients for each office visit (core objective #7) Provide patients with the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP (core objective #12).

Key Differences in MU Stages Meaningful Use MU Stage 1NPRM MU Stage 2 Transferring data to EHRs and being able to share information, including electronic copies and visit summaries for patients. Includes standards such as online access for patients to their health information and electronic health information exchange between providers

Key Differences in MU Stages Core and Menu Objectives MU Stage 1NPRM MU Stage 2 15 Core Objectives 10 Menu Set (5 out of 10) 6 CQMs Began in Core Objectives 5 Menu Set (3 out of 5) 12 CQMs To be implemented in 2014

Appendix: States with Separate Child Health Plans Alabama Arizona Colorado Connecticut Georgia Kansas Mississippi New York Nevada Oregon Pennsylvania Utah Vermont Washington West Virginia Wyoming Texas Source: