1. TWS June 2011 A Stimulus Story

2. TWS June 2011 The ARRA Stimulus Reimbursement from a Patient Workflow Perspective

3. TWS June 2011 Devising a Plan – Getting Organized (Requirements Inventory) – Examining Workflow – Devising the Workflow (Examples) – Exclusions and Pitfalls

4. TWS June 2011 Requirements Inventory – 15 Core Requirements – 5 of 10 Menu Requirements – Where do they fit into the Clinical Workflow?

5. TWS June 2011 Core Requirements #RequirementButtonWorkflowifa Stats # C1CPOEeRx 6 C2Drug/Drug, Drug/AllergyeRxAttestation OnlyN/A C3Problem ListDiagnosis ICDExamination1 C4eRx 14 C5Maintain Medication ListeRx 2 C6Maintain Medication Allergy ListeRx 3 C7Record DemographicsDemographicsCheck in4 C8Vital Signs Check in7 C9Smoking StatusDemographicsCheck in/History8 C10Clinical Quality Measures (CQM)Stimulus StatisticsAttestation OnlyN/A C11Implement Clinical Decision SupportStatistic Med. RecordsAttestation OnlyN/A C12Provide Patients with electronic copyECPPCheckout10 C13Clinical Summaries Checkout15 C14Exchange clinical infoExchange Clinical InfoAttestation OnlyN/A C15Protect electronic health infoN/AAttestation OnlyN/A

6. TWS June 2011 Menu Requirements (5 of 10) M1Drug Formulary CheckseRxAttestation OnlyN/A M2Lab testsEnter Lab TestsHistory9 M3Generate Patient ListsSelectionAttestation OnlyN/A M4Send Patient RemindersReminder documentCheckout16 M5Timely AccessECPPCheckout13 M6Patient EducationAdd Patient Ed.Checkout5 M7Medication ReconciliationMedication Recon.Examination11 M8Summary Care Record-referral Checkout12 M9Immunization RegistriesImmunization ExportAttestation OnlyN/A M10 Syndromic Surveillance-Public Health N/AAttestation OnlyN/A

7. TWS June 2011 Check In History Examination eRx Check Out (Attestation Only) Workflow Proposal

8. TWS June 2011 Check in: – Core 7, Record Demographics – Core 8 (option), Record Vital Signs – Core 9 (option), Record Smoking Status Divide and Conquer

9. TWS June 2011 History: – Core 8 (option), Record Vital Signs – Core 9 (option), Record Smoking Status – Menu Set 2, Clinical Lab Test Results Divide and Conquer

10. TWS June 2011 Examination: – Core 3, Maintain Problem List – Menu Set 7, Medication Reconciliation Divide and Conquer

11. TWS June 2011 eRx: – Core 1, CPOE – Core 4, Generate and Transmit Permissible Prescriptions Electronically – Core 5, Active Medication List – Core 6, Medication Allergy List Divide and Conquer

12. TWS June 2011 Checkout: – Core 12, Electronic Copy of Health Information – Core 13, Clinical Summaries – Menu Set 4; Patient Reminders – Menu Set 5, Patient Electronic Access (Timely Electronic Access) – Menu Set 6, Patient Specific Education – Menu Set 8, Transition of Care Summary (Patient Summary Record) Divide and Conquer

13. TWS June 2011 Attestation Only (no measurement): – Core 2, Drug Interaction Checks – Core 10, Clinical Quality Measures – Core 11, Clinical Decision Support Rule – Core 14, Electronic Exchange of Clinical Information – Core 15, Protect Electronic Health Information – Menu Set 1, Drug Formulary Checks – Menu Set 3, Patient Lists – Menu Set 9, Immunization Registries Data Submission – Menu Set 10, Syndromic Surveillance Data Submission Divide and Conquer

14. TWS June 2011 Most Suitable? 1.Drug Formulary Checks (M1) 2. Patient Lists (M3) 3.Patient or Timely Electronic Access (M5) 4.Patient Specific Education (M6) 5.Medication Reconciliation (M7) Selecting Menu Requirements

15. TWS June 2011 Immunization Registries Data Submission (M9) Syndromic Surveillance Data Submission (M10) Exclusions? Selecting Menu Requirements

16. TWS June 2011 Clinical Lab Test Results (M2) Patient Reminders (M4) Transition of Care Summary (Patient Summary Record) (M8) Immunization Registries Data Submission 10. Syndromic Surveillance Data Submission Problematic? Selecting Menu Requirements

17. TWS June 2011 Last name First name Date of Birth Gender Workflow – Check In

18. TWS June 2011 Race (select one of the following): – White – Asian – Black or African American – Native Hawaiian or Other Pacific Islander – American Indian or Alaska Native Workflow – Check In

19. TWS June 2011 Ethnicity (select one of the following) – Hispanic or Latino – Non-Hispanic or Latino Preferred Language – English – Japanese – French – Italian – Portuguese – Spanish – Russian Workflow – Check In

20. TWS June 2011 Smoking Status (Can also be collected in Social History) – Current every day smoker – Current some day smoker – Former smoker – Never smoker – Smoker – Current status unknown – Unknown if ever smoked Workflow – Check In

21. TWS June 2011 Vital signs (Can also be collected during History) – Height – Weight – Blood Pressure Workflow – Check In

22. TWS June 2011 Stimulus/Non-Stimulus Provider Number Workflow – Encounter Type

23. TWS June 2011 Vital signs – Height – Weight – Blood Pressure Smoking status (use the abbreviations as noted). – SMED: current every day smoker – SMSMD: current some day smoker – SMFS: former smoker – SMNS: never smoker – SMOKE: smoker – SMCSU: current status unknown – SMUNK: unknown if ever smoked Clinical Lab Tests Results (if applicable) Workflow – History

24. TWS June 2011 “Problem List,” Dx or ICD-9 Medication Reconciliation Workflow – Exam

25. TWS June 2011 Core 1, CPOE Core 4, Generate and Transmit Permissible Prescriptions Electronically Core 5, Active Medication List Core 6, Medication Allergy List Attestation: – Drug Formulary – Drug-drug/drug-allergy interactions Workflow – eRx

26. TWS June 2011 Core 12, Electronic Copy of Health Information Core 13, Clinical Summaries Menu Set 4, Patient Reminders Menu Set 5, Patient/Timely Electronic Access Menu Set 6, Patient Specific Education Menu Set 8, Transition of Care Summary (Patient Summary Record) Workflow – Check Out

27. TWS June 2011 Thanks for your kind attention.