Central Jersey Family Health Consortium

2 King Arthur CT, 2nd FLR Conference RM, N Brunswick, NJ May 23, 2012

AGENDA Welcome and Introductions Presentation: HITEC and the Meaning of Meaningful Use, Anne Lorenzo, AAP/NJ, NJ HITEC Program Coordinator Committee Reports: •Education Committee – Megan Avallone, RN and Leslie Leonard, RN •Vaccine Hesitancy QI Program – Sandy Van Sant, RN •School Immunization Regulation Workgroup Report – Jenish Sudhakaran, MPH and Marlene Dolan, RN •NJIIS – Simi Octania-Pole, PhD •Interfaces and Technology – Larry Frenkel, MD

Central Jersey Family Health Consortium

2 King Arthur CT, 2nd FLR Conference RM, N Brunswick, NJ May 23, 2012

NJDHSS Update – Barbara Montana, MD Issues of Interest: •Funding Update •Other Adjourn Next Meeting Dates: June 27,2012 August 22, 2012

New Jersey Immunization Network Meeting May 23, 2012

Anne Lorenzo

Program Manager American Academy of Pediatrics, New Jersey Chapter

H

I

T

E

C

H

ealth

nformation

echnology for

conomic and

linical

ealth Act of 2009

Improve the health of Americans and the performance of the nation’s health system through health information technology (HIT)

Established the Office of the National Coordinator for Health Information Technology (ONCHIT) within the Office of the Secretary for the US Department of Health and Human Services

Appropriated funding for financial

incentives under Medicare and Medicaid for hospitals and eligible professionals (EPs) who demonstrate Meaningful Use of certified EHRs.

Technical Assistance

• Health Information Technology Extension Program

Health Information

Exchange

• State and nationwide Health Information Network Activities

Breakthrough Examples

• Beacon Communities Program

• Strategic Health IT Advanced Research Projects (SHARP)

Human Resources

• Workforce training programs

Health Information Technology Research Center (HITRC)

• Gathers information on effective practices and helps RECs work with one another and with relevant stakeholders to identify and share best practices in EHR adoption, Meaningful Use, and provider support.

National Network of 62 Regional Extension Centers (RECs)

• Provide education, outreach and technical assistance to primary care providers to ease the challenge of becoming Meaningful Users of EHRs.

NJ-HITEC is the only federally-designated Regional Extension Center in New Jersey

The goal of the program is to provide outreach and support services to primary care providers

Provide information and guidance to help in the selection, implementation and Meaningful Use of EHR technology

Help physicians in the ability to exchange health information

Provides incentive payments

for certain healthcare providers

to use EHR technology in ways that can positively impact

patient care.

An electronic health record (EHR)—sometimes called an electronic medical record (EMR)—allows healthcare providers to record patient information electronically instead of using paper records.

Eligible Professionals (EPs) must achieve Meaningful Use of a certified EHR

– Centers for Medicare and Medicaid Services (CMS) has established the Meaningful Use objectives that must be met to receive an incentive payment

– CMS and the Office of the National Coordinator for Health Information Technology (ONC) have established standards and other criteria for structured data that EHRs must use in order to be certified for this incentive program

Every state runs its own program

Maximum incentive is $63,750 (across 6 years program participation)

Voluntary participation – no Medicaid payment reductions

First year incentive payment is based on AIU (Adoption, Implementation or Upgrade) of a certified EHR

All remaining years require providers to achieve Meaningful Use objectives

Physicians (primarily doctors of medicine and doctors of osteopathy)

Nurse practitioners

Certified nurse-midwives

Dentists

Physician assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant

Have a minimum 30% Medicaid patient volume*

Have a minimum 20% Medicaid patient volume, and be a pediatrician*

Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals

* Children's Health Insurance Program (CHIP)

patients do not count toward the Medicaid patient volume criteria.

EPs must register for the Medicaid EHR Incentive Program with Centers for Medicare and Medicaid Services (CMS)

EPs must register on the NJ Medicaid Management Information System (NJMMIS)

EPs must attest to Meaningful Use through NJMMIS

EPs must register for the Medicaid EHR Incentive Program with Centers for Medicare and Medicaid Services (CMS)

EPs must register on the NJ Medicaid Management Information System (NJMMIS)

EPs must attest to Meaningful Use through NJMMIS

Using certified Electronic Health Record (EHR) technology to: – Improve quality, safety,

efficiency, and reduce health disparities

– Engage patients and family

– Improve care coordination

– Ensure privacy and security protections for personal health information

– Improve population and public health

The HITECH Act specifies 3 main components of Meaningful Use: Use of certified EHR technology in a

meaningful manner (e.g. for e-prescribing)

Use of certified EHR technology for electronic exchange of health information to improve quality of health care

Use of certified EHR technology to report clinical quality measures (CQM) and other such measures selected by the Secretary US DHHS

Primary care providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity .

Better clinical outcomes

Improved population health outcomes

Increased transparency and efficiency

Empowered individuals

More robust research data on health systems

Data Capture and Sharing

Advanced Clinical Processes

Improved Outcomes

STAGE 2 (expected to be implemented in 2014)

STAGE 1 (2011,2012 & 2013)

STAGE 3 (expected to be implemented in 2015)

Objectives Measures What every eligible professional is

required to achieve in order to be able to show that they are meaningfully

using their EHR.

The minimum requirement to achieve each objective. Every objective has an associated measure, which the eligible

professional must meet or surpass

Stage 1 Objectives and Measures Reporting

Some objectives have Exclusions that exempt the provider from having to meet specific objectives and still be able to achieve Meaningful Use and receive a

full incentive payment

15 5 6 MU

Core Measures

Menu Measures

CQMs Meaningful Use

15 Core Objectives

5 out of 10 Menu Set Objectives

6 total Clinical Quality Measures (3 core or alternate core, and 3 out 38 from additional set)

1. Use Computerized Provider Order Entry (CPOE) 2. Implement drug to drug and drug allergy interaction checks 3. E-Prescribing 4. Record demographics 5. Maintain an up-to-date problem list 6. Maintain active medication list 7. Maintain active medication allergy list 8. Record and chart changes in vital signs 9. Record smoking status 10. Implement one clinical decision support rule 11. Report CQM as specified by the Secretary 12. Electronically exchange key clinical information 13. Provide patients with an electronic copy of their health

information 14. Provide clinical summaries for patients for each office visit 15. Protect electronic health information created or maintained by

certified EHR

All 15 Core Objectives must be met to qualify for incentives:

5 out of 10 Menu Set Objectives required – at least one of 5 must be a Public Health objective

1. Drug Formulary Checks 2. Incorporate clinical lab test results 3. Generate lists of patients by specific conditions 4. Send reminders to patients for preventive/follow-up care 5. Patient-specific education resources 6. Electronic access to health information for patients 7. Medication reconciliation 8. Summary of care record for transitions of care 9. Submit electronic data to immunization registries 10. Submit electronic syndromic surveillance data to public health

agencies

To qualify for incentive payments, every EP is required to report on:

– 3 Core CQM (substituting Alternate Core CQM where necessary)

– 3 additional CQM from a list of 38

CQMs do not have thresholds — EP simply required to report data on them

CQMs are calculated by certified EHR and reported during attestation process

NQF Measure Number & PQRI Implementation Number

Clinical Quality Measure Title

NQF 0013

Hypertension: Blood Pressure Measurement

NQF 0028 Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention

NQF 0421 PQRI 128

Adult Weight Screening and Follow-up

Must report on a total of 3 Core CQM – substitute one or more Alternate Core CQM for any Core CQM with zero denominator.

Substitute one or more Alternate Core CQM for any Core CQM with zero denominator.

NQF Measure Number & PQRI Implementation Number

Clinical Quality Measure Title

NQF 0024 Weight Assessment and Counseling for Children and Adolescents

NQF0041 PQRI 110

Preventive Care and Screening: Influenza Immunization for Patients50 Years Old or Older

NQF 0038 Childhood Immunization Status

Must report on 3 out of 38 Additional CQM

Examples of Additional CQM – full list available at: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/CQM_EPs_2012_02_02.pdf

1. Diabetes: Hemoglobin A1c Poor Control 2. Diabetes: Low Density Lipoprotein (LDL) Management and Control 3. Diabetes: Blood Pressure Management 4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) 6. Pneumonia Vaccination Status for Older Adults 7. Breast Cancer Screening 8. Colorectal Cancer Screening 9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD 10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic

Dysfunction (LVSD)

Acquire…

• a certified EHR system or module

Use ...

• the system as rules require

Attest ...

• the data was submitted as rules require

Reporting of Meaningful Use objectives takes place through an

attestation process on the NJMMIS website. Attestation is a legal statement that you have met the

thresholds and all of the requirements of the Medicare EHR Incentive Program.

The attestation process allows EPs to enter information on all of the following: – 15 core objectives – 5 out of 10 menu objectives – 3 core (or 3 alternate core) clinical quality measure – 3 out of 38 additional clinical quality measures

One of the two choices that EPs may select for their mandatory Public Health Menu Set Objective

1. Submit electronic data to immunization registries

2. Submit electronic syndromic surveillance data to public health agencies

EPs must select at least one of the Public Health objectives to be part of their 5 Menu Set Objective requirements

If an EP administers immunizations, they must choose the immunization registry objective

What the Measure Requires

• Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful

What Does It Mean

• Your EHR comes equipped with the ability to electronically send immunization data. You have to test your EHR’s ability to electronically transmit that information to a public health registry. Even if the test fails, you have successfully met this objective

Is There an Exclusion?

• You could be excluded from meeting this objective for either of these reasons:

• You don’t administer immunizations

• There’s no immunization registry to which you can send information

• Providers can attest for Meaningful use without completing the NJIIS requirement based on this exclusion.

• Providers will still need to continue working towards setting the Immunization Interface

“if for any reason (e.g. waiting list, on-boarding

process, other requirements, etc) the

registry cannot test with a specific EP or hospital, that EP or hospital can

exclude the objective.” – CMS FAQ – 10714

Provider must be enrolled with NJIIS – Attend a training session (face to face)

– Obtain a username and password

– Type of interface and frequency of upload of the file will be decided by the provider with vendor’s help

– File type has to be HL7

Vendors must test with NJIIS – Use NJIIS interface specifications document and the

HL7 specifications document

– Vendor also communicates with NJIIS

– Providers should take responsibility to facilitate this

Interface is an added cost – not included with start-up

No set fee for interface – varies from vendor to vendor

No oversight of vendor practices

EPs may have to manually claim patients in some cases

Data points missing from vendor file – VFC program

List of 10 questions to ask an EHR vendor before purchasing a system

Contract negotiation checklist – to clarify what you are buying and what the vendor is selling

25 ways to control costs when negotiating an EHR contract

To be considered for membership in NJ-HITEC: – Vendor must complete a Request for Information

(RFI) – Vendor product must be ONC certified and

interoperable with NJ HIEs/IDNs and the NJ statewide network when available to be considered for membership

– Vendor must also provide link for Meaningful Use demo of their product

– NJ-HITEC meets with vendor and reviews RFI before making decision on vendor’s membership into NJ-HITEC

– Vendor signs MOU with NJ-HITEC

General Information – Company and client demographics, average implementation

time, certification/accreditations, willingness to offer discount and group pricing, etc.

Policies – Including access, authorization, data ownership, audit,

commitment to Meaningful Use, etc.

Proposed Pricing – Software licensing fees – One-time implementation fees

• configuration, training, template design, scanning, etc.

– Interface fees • Including labs, hospitals, practice management etc.

– Other software and service fees • E-Rx Hubs, drug databases, formulary updates, patient portals, etc.

– Hardware fees

Five Year Cost Projections

NJ Health Information Technology Extension Center (NJ-HITEC) website: http://www.njhitec.org/

NJ Health Information Technology (HIT) website:

http://www.nj.gov/njhit/ Centers for Medicare and Medicaid Services

(CMS) – EHR Incentive Program website: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html