This week, HHS, CMS, and the Office of the National Coordinator for Health IT announced an important health care milestone – more than 50% of eligible professionals nationwide are using electronic health records (EHRs) meaningfully in their offices and more than 80% of U.S. hospitals are using EHRs.

In the past three years, M-CEITA has been working with more than 3,500 providers across the state, including 23 Federally Qualified Health Centers and 31 Critical Access Hospitals.  We are proud to add that over 2,880 of these providers are live on an EHR and over 1,670 have attained meaningful use. Medicare and Medicaid EHR incentive programs have brought over $200M to Michigan’s economy thus far.

Better use of EHRs leads to more coordinated care, fewer medical errors, and lower costs to the system. It is an honor to act as a partner with providers across Michigan in achieving the different stages of meaningful use and using health IT as a springboard to the many initiatives that will be critical to the new health care landscape.

We would welcome the opportunity to help you continue or begin your participation in this movement. Providers throughout the country are finding that better use of EHRs leads to more coordinated care, fewer medical errors, and lower costs to the system.

Please contact us if you’re interested in using health IT as a springboard for the health care initiatives of tomorrow.

A physician recently complained about the wastefulness of patient visit summaries.  “The patients just scratch their heads and tear them up anyway,” he observed.  “We do it to reach meaningful use, but what’s the point?”

Without providing a worthwhile context and vision, i.e. how did we get here and where are we going, users often ask, “What’s the point?”  Clinicians can feel like a lab rat in a behavioral modification program otherwise known as “meaningful use.” Such frustrations will sap motivation, ultimately leading to delayed progress toward real gains in quality, safety, efficiency – and revenues.

In response to the physician quoted above, we discussed a scenario in which every clinic in the country had an electronic health record, but patients were not engaged in their own self-managed care. This helped the physician understand that we would probably continue seeing upward trends in BMIs and emergency rooms used for primary care.

Many meaningful use (MU) “experts” fail to educate physicians about their new responsibility: helping to change the patient mindset.  No, that’s not a MU performance measure, but it does address one of the five overall MU goals: patient and family engagement.  This is the broader context of patient visit summaries.

Who is better positioned to convince patients to start taking ownership of their healthcare than their trusted physician?  Best practice is for physicians to briefly review the visit summary with the patient at the point-of-care and for patients to receive a paper copy at checkout. Patients should be advised – again, by the physician – of the need to review the summary at home and before the next visit.

If we are successfully to bend the quality and cost curves, we need patients to become truly engaged in managing their own care.  Visit summaries are one example.  Encouraging patients to request an electronic copy of their patient records is another. Promoting and preparing patients for use of a patient portal or personal health record is not only a great next step – it is a MU Stage 2 requirement.

Every meaningful use measure is designed to support at least one of five overall goals.  If your meaningful use “expert” cannot explain how each performance measure relates to the goals (or even know what the five goals are), perhaps it’s time to seek a different advisor.  Meaningful use is more than simply pulling the right levers.

– Dan Belknap, MHSA, MBA – MCEITA Client Services Manager

Most Eligible Professionals (EPs) are already familiar with the core and menu objectives used to qualify them as meaningful users of certified electronic health record technology (CEHRT).  But are passing scores reported from CEHRT enough to prove the EP has truly met all of the program requirements for demonstrating meaningful use (MU)?  Considering the following, the answer is probably not.

Once a site is equipped with CEHRT, several of the MU measures must be based on all patients seen at that site during the reporting period.  While CEHRT MU dashboards are an essential tool for assessing progress toward these measures, the dashboards reflect only the patients whose records are included in CEHRT. If there are patient records which have yet to be documented in the CEHRT or will remain in paper form for some reason, then the reported dashboard scores are incomplete, regardless of how compliant they may appear.  In this scenario, the denominators for the problem lists, medication lists, allergy lists, demographics, timely electronic access, and patient education measures will require manual adjustments to include the patients excluded from CEHRT and to determine the true threshold scores.

Since the EP must attest that the information submitted is accurate and complete for numerators and denominators, failing to represent the actual denominators of these measure could put an EP’s meaningful user status and earned incentives at risk.

Another program requirement that is not typically reflected on CEHRT dashboard reports affects EPs working in multiple outpatient locations during their reporting period. For these providers, at least 50% of their encounters occurring during the reporting period must take place at sites equipped with CEHRT.  If the 50% threshold is not met, the provider has not achieved meaningful use regardless of what their dashboard scores indicate. Although this program requirement may not necessitate a specific question during the attestation process, compliance with this 50% threshold is a program eligibility requirement and an area of focus during meaningful use post incentive payment audits.

Contact M-CEITA for assistance with understanding your entire story.  M-CEITA’s technical assistance team stands ready to help all providers state-wide achieve meaningful and efficient use of EHR technology in patient care.

– Judy Varela, RHIA, M-CEITA Regional Manager

Ringing in the New Year usually means making personal resolutions to improve habits and health. The New Year and promises of change can carry on to the medical practice management side of life as well. It is a new year with a chance to improve habits and health of the practice. As with any resolution, change takes time, effort, and commitment. Change is not easy for everyone and for a practice that has been set in its ways for years— change may seem impossible. To make change seem more possible, it is helpful to think of current habits (processes) in terms of smaller pieces or steps. Making changes and adjustments over time to these smaller steps is more manageable. The PDCA cycle is a helpful approach to make resolutions to improve practice health a reality!

Here are the steps:

1. PLAN - Identify what you aim to accomplish and identify a change that could be made to make incremental improvement or reach the goal.
2. DO - Implement the planned change, even if it’s on a “trial basis.”
3. CHECK - Evaluate the effect of the change.
4. ACT - Act on what you have learned. If you have accomplished your goal, put controls into place to sustain the improvement. If you have not accomplished your goal, go through the cycle again, starting with the Plan step.

There are many medical practice New Year’s resolutions that can be achieved with PDCA:

• Improve Patient Satisfaction
• Track All Orders and Relay All Results to the Patients
• Reduce Phone Calls That Must Go on Hold
• Increase Access on the Schedule
• Maintain Medical Records Accuracy in Real Time
• Reduce Overtime
• Improve Collections on Date-of-Service

To achieve the resolution, practice leadership should communicate this goal to staff members and involve them in the PDCA cycles. Involving staff in identifying and implementing changes brings about awareness and ownership of the processes they execute. Using PDCA to improve the habits and health of the practice is continuous activity that staff can learn and apply to small or large resolutions!
 
– Shannon Bettenbrock and Lori Schultz, M-CEITA

This year has been eventful for M-CEITA and for providers across Michigan as we work together to adopt and meaningfully use electronic health records.  Let’s take a glance at the numbers to see how far we’ve come:

• 4,170 providers, 31 Critical Access Hospitals, and 23 Federally Qualified Health Centers are currently enrolled with M-CEITA for support on their Meaningful Use journey.  These providers are part of the 148,448 total providers currently enrolled with the 62 Health IT Regional Extension Centers (RECs) nationwide.

• M-CEITA has helped 2,860 of these providers go live on an EHR and 1,022 (and counting!) demonstrate Meaningful Use.  These providers join the 97,684 providers enrolled with RECs nationwide now live on an EHR, of which 22,903 have demonstrated Meaningful Use.

• 3,943 eligible professionals and 130 hospitals have received CMS EHR incentive payments in Michigan, bringing $234 million into the state.  These payments are part of $7.5 billion in CMS EHR incentive dollars distributed in 2012 to 152,691 providers and 4,674 hospitals around the country.

• This year M-CEITA launched new services for specialists, including vendor selection support, security risk analysis, implementation support, and Meaningful Use gap analysis. Now, experts from the same team that brought federally-funded Meaningful Use support to over 4,000 Michigan primary care physicians are available to support more providers than ever before.

REC support makes a difference.  Providers who received assistance from a Regional Extension Center were twice as likely to earn EHR incentive dollars as providers who did not receive REC assistance, according to a 2012 report from the Government Accountability Office.¹  And while changes in health care delivery don’t happen overnight, we’re already starting to see an impact.  A recent report from the Office of the National Coordinator for Health IT (ONC) showed that providers enrolled with M-CEITA who have successfully attested to Meaningful Use demonstrate better than average performance on tracking patient blood pressure measures.

In 2013, M-CEITA looks forward to helping Michigan providers use health IT as a springboard for broader, long-term health care objectives, including navigating new care delivery models, optimizing workflow, achieving quality and safety goals, tackling privacy and security challenges, and boosting patient and workforce satisfaction.  Call or email us today for more information on ways we can help you and your staff provide more effective and efficient patient care by leveraging the unique capabilities of health IT.

1.  GAO (2012). Electronic health records: Number and characteristics of providers awarded Medicare incentive payments for 2011.  GAO-12-778R.

If you’ve been using an EHR for several months or more, you should have an increasing amount of information recorded in your patient’s electronic charts, especially for patients with chronic conditions who have had multiple encounters since you went live with your EHR.  Now is a good time to look at some of the more advanced ways of using that information beyond an individual episode of care.

One of the most valuable things an EHR can do for health care providers is allow
you to see views of the data stored in the system – what we often call “reports.”  There are virtually limitless types and uses of reports, but this post focuses on clinical “care management” reports.  You can leverage this powerful EHR function above and beyond the simple Meaningful Use (MU) Menu 3 measure of generating at least one report listing patients with a specific condition.

Here is a basic framework for assessing your current reporting system and moving toward a clearly defined, optimized care management system within your EHR:

• As a practice, make a list of your current care management reports.  What conditions, preventive recommendations, orders, etc. are you currently tracking?  How are you tracking them, electronically or on paper (e.g. using a tickler file)?  Define who uses the information, the purpose, and the frequency needed.

• Define what you want your care management system to look like overall, including any changes you want to make.  Are there other things you want to know from a report about your patients, or things you should be tracking but aren’t?  Make a list of all the reporting needs of your practice that are not currently performed, but that are a priority for the quality and brand of care you provide.  If you’ve built reports that are now obsolete, consider deleting or modifying them.

• Compare your list of “custom reports” (built or to-be-built) with any vendor-built reports to avoid unnecessary duplication.  For example, many of the MU Clinical Quality Measures (CQMs) capture common parameters of high-priority conditions, diagnostic test results, or utilization rates.  Some EHRs allow you to drill-down from the aggregate data results into lists of specific patients that meet the qualifying criteria.  If your system does not allow this, you can replicate the report criteria to a custom report that could give you an actual list of patients.  If you’re in-tune with the latest reporting and incentive program buzz, you are well aware of the numerous programs competing for your attention: MU, PQRS, PCMH, ACO, PGIP, PIP, etc.  Any of these that you are involved in, or plan to be involved in, should be part of your considerations when designing a care management system and the various reports you’ll need, some of which may already be built for you.

• Identify the data source(s) for each report you need to build or modify.  If you want to identify all of your diabetic patients in need of a particular intervention, you’ll need to look up records of previous orders and their status.  Do you order preventive procedures such as eye or foot exams using the CPOE functionality in your EHR (like ordering a medication or a lab test), or write it as “free text” somewhere in the visit note?  Do you update the order status in the EHR when completed?  Changes to workflow and documentation habits are sometimes required for accurate reporting.  Ask your vendor for all user guides and system documentation that can be shared, or check your client support portal online if available.

• We might call this next step “debugging your report.”  After all the work you’ve done designing a report, you go to run it and there are no results or the results don’t make sense.  There are several reasons this could happen, but here are some of the most common:
  • The query is looking for values that you don’t have stored as structured data in the EHR.  Maybe you perform HgA1c tests in-house and enter results manually into the EHR and link to the original CPOE record, but what about those lipid panel tests that went to the lab you aren’t interfaced to?  If you only documented these orders on a paper lab requisition form, you might not even be able to query the orders, let alone the result values.
  • Mismatch between query parameters and end-user documentation patterns (think of your workflow).  You might be selecting for a higher level diagnostic code group when you should be selecting a more specific Dx name or code (ICD-9-CM) that is actually being used in your practice, or vice versa.
  • Logical syntax errors.  It’s possible to accidentally use the wrong syntax with certain query constraints such as ”equal to” versus “not equal to” or ”greater than” versus ”less than.”  A single error could yield misleading results that hide critical information.
  • Time constraints in the query may yield what appear to be incomplete results or none at all if the period of measurement is too narrow.  This is more likely if you are looking for uncommon events, conditions, or values.

While most EHRs allow you to create and run ad-hoc reports which can be very useful, carefully designing and maintaining a reporting program for your practice is something that takes effort and involvement of key people.

Proper system management and knowing how to effectively use your EHR reporting functions will help you avoid a snowball of un-owned, un-managed reports cluttering your system, and give you powerful insight into your patient population that was never possible with paper charts.

– Kevin Perdue, Client Services Manager, M-CEITA

Last week, we explored changes in the Vital Signs measure.   For pediatricians and specialists, the vitals adjustment will be a welcome relief from an unnecessary burden.  This week, our final post in the Changes to Stage 1 Meaningful Use (MU) in 2013 series, we turn our attention to the changes around electronic exchange of health information.

These changes represent small adjustments that you could leverage in 2013 to make your second year of Meaningful Use (or third if you completed your first MU year in 2011) a little easier.  Or, for those considering a 2013 start to MU, make the transition a little lighter.

Electronic Exchange of Health Information

This measure (previously Core 14) was removed for 2013′s Stage 1 criteria. There is a lot of discussion in the Final Rule about why this was removed, and M-CEITA has had a lot of real-life experience with the confusion it caused. If you recall completing this test the first time, it’s likely that you downloaded an XML file, attached it to an email or referral in your HIE (Health Information Exchange) system, and transmitted it along. Your vendor may also have implemented some integrated module to do this as well (i.e. P2P in eCW) so you never actually saw the XML file that was being sent.

In our experience, the confusion arose when the workflow described above was compared to that for the “Summary of Care” Measure.  That measure stipulated that you provide a Summary of Care Record to specialists for 50% of your referrals. While this record could be faxed, it could also be transmitted in the same manners as the Core 14 test. In essence, if you were completing the Summary of Care Record measure, you were likely completing the Core 14 Electronic Exchange Measure, too, unless you were faxing the records.

In removing this measure, the Department of Health and Human Services is paving the way for a more aggressive stance on the Summary of Care Record, namely where it specifies that the record must be transmitted electronically (not via fax) in a machine-readable format (i.e. XML not PDF).

Bottom Line

Taken together, the changes to computerized provider order entry (CPOE), electronic prescribing, vital signs, and electronic information exchange don’t represent a significant shift from what you’ve worked to achieve.

One thing to remember is that while these changes offer greater flexibility in meeting Meaningful Use, you are limited to what your vendor is willing to build by the end of 2013. These adjustments are rather minor for a report writing developer, but you’ll have to be vigilant to make sure that you (as a pediatrician, for example) have the ability to track the number of patients that have Blood Pressure recorded, separate from the Height and Weight - a new report that wasn’t previously required. Further, if that report isn’t made available until say June 2013, will it back-date results to January 1, 2013, to align with the 365-day reporting period? These are questions to ask as you consider leveraging the changes to Stage 1 MU in 2013.

Note: This series focused on changes that take effect January 1, 2013.  There are additional changes that start in 2014.  Visit the CMS EHR Incentive Program website for a complete list.

– Nick Glauch, Client Services Manager, M-CEITA

Last week, we discussed changes to Stage 1 Meaningful Use (MU) measures for computerized provider order entry (CPOE) and electronic prescribing that will take effect January 1, 2013.  This week, we explore the changes to the Vital Signs measure, also effective at the start of the new year.

The changes to Stage 1 represent small adjustments that you could leverage in 2013 to make your second year of Meaningful Use (or third if you completed your first MU year in 2011) a little easier.  Or, for those considering a 2013 start to MU, make the transition a little lighter.

Vital Signs

In 2013, providers will have the option of using an alternate measure of their compliance with the Vital Signs Meaningful Use objective. Whereas the original measure asked if you had captured Blood Pressure, Height, and Weight for all patients age 2 and older, the new measure offers much greater flexibility.

For this optional measurement of compliance (the old one can still be used if preferred), you’re asked to capture Blood Pressure for all patients age 3 and older and Height and Weight for all patients. Put another way, pediatricians no longer have to capture Blood Pressure for 2-year-olds to fulfill this measure.

HHS is also giving more flexibility to specialists within the Vital Signs rule. Whereas the exclusion previously was “all or nothing” when it came to vital signs (i.e. you could only claim it if none of the vital measures applied to your scope of practice), you are no longer asked to capture new vitals that don’t apply to you. For example, if Height and Weight aren’t appropriate for your scope of practice, your measure is only of those patients whose Blood Pressure is captured. It probably goes without saying, but to be clear, Height and Weight are dealt with together – you cannot be excluded from taking one of those two measurements.

While this does offer much more flexibility for providers than the original Stage 1 version of the Vital Signs rules, practices should expect their dashboards to get more complicated as these alternate measures start showing up, and make sure their vendors are intending to offer these updates to their Meaningful Use reporting “dashboards” in 2013, even before the 2014 version is provided.

Next week, we’ll conclude with changes in electronic exchange of health information.

– Nick Glauch, Client Services Manager, M-CEITA