Taking the HITECH Ground. Understanding Meaningful Use, Health Information Exchange and the Future of Lab Outreach

Transcription

1 Taking the HITECH Ground Understanding Meaningful Use, Health Information Exchange and the Future of Lab Outreach Rob Atlas CEO & President and Bob Gregory SVP, Corporate Strategy April 27, Tsunami Warning! You re about to lose control. Control of: Your relationships with your physician customers Clean Orders Accurate Billing Profits 2

2 Calm Seas In the past, labs offered IT solutions to: Reduce errors Improve service Ensure accurate billing Strengthen traditional consultative relationship 3 Business, Billing & Clinical Rules Business Rules Lab specific workflow Billing Rules Medical necessity verification Clinical Rules Duplicate order checking Electronic HIS registration Payer directed testing Departmental driven requisitions Payer specific requirements Insurance & relationship cross referencing Unapproved insurances Cascading AOE Questions Reflex testing Unsolicited results Flow through accessioning Required/optional fields Site customizable manifests Field pattern matching 4

3 Dangerous Swells With introduction of EMRs: Point-to-point interfaces Dirty orders Decreased efficiencies Reduced lab branding Jeopardized physician relationships loss of control 5 EMR Integration Challenges EMR Weaknesses/Complexities: Accept unsolicited results? Need an EMR order number, or Patient ID? EMR s test and result codes mapped correctly with the lab s codes? Is the mapping up-to-date? Ask at Order Entry questions? Specimen Requirements? Medical Necessity Verification? Office-based versus Internet-based? Images in reports? PDFs? Support for partials and finals? Discrete Micro? Split requisitions? Payer Plan-driven routing? Exception handling? Costs? 6

4 SEEDIE promotes healthcare IT systems that play well in the sandbox if, and only if, it is in the best interests of a particular vendor. SEEDIE recognizes that data exchange should only occur after a lengthy and expensive custom integration process. 7 A Perfect Storm Accelerated EMR/EHR adoption Increase in physicians purchasing solutions from vendors Growing importance of HIEs Clouds, portals, and other emerging business models Health System/Enterprise decisions Driven by ARRA HITECH, Meaningful Use and the evolution of the connected care paradigm 8

5 The background 9 HITECH Act Definition of Meaningful Use In Sections 1848(o)(2)(A) and 1886(n)(3) of the Act, the Congress specified three types of requirements for meaningful use: (1) Use of certified EHR technology in a meaningful manner (for example, electronic prescribing); (2) the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and (3) that, in using certified EHR technology, the provider submits to the Secretary information on clinical quality measures and such other measures selected by the Secretary. 10

6 Meaningful Use What and How Electronic Health Record (EHR) systems will qualify physicians for between $44,000 and $64,000 in Medicare and Medicaid incentive payments under the American Recovery and Reinvestment Act (ARRA). Physicians must demonstrate their meaningful use of an EHR before they can claim the stimulus incentives, which first become available in Stage 1 Objectives (Ambulatory / Eligible Professionals) $30,000 of the incentives can be earned in the first two years Incentives disappear after 2016 Providers can combine functionality from disparate systems with integration (interfaces) to achieve certification 11 Meaningful Use Stage 1 Objectives 25! CPOE Drug-Drug, Drug-Allergy, Drug Formulary Checks Maintain problem list of current and active diagnoses (ICD-9 / SNOMED CT) eprescribe Active medication list Active medication allergy list Record demographics Record/Chart Vital Signs Record smoking status (ages 13+) Incorporate clinical lab test results into EHR as structured Generate list of patients by condition Report ambulatory quality measures Send patient reminders for preventive care Implement clinical decision support rules Insurance Eligibility Submit electronic claims Provide patient with electronic copy of health info Provide patients with electronic access to their health information Clinical summaries Exchange key clinical information amongst providers Medical reconciliation Submit electronic data to immunization registries Syndromic surveillance data to public health agencies Electronic submission of reportable lab results to public health agencies Protect electronic health information created or maintained by certified EHR technology 12

7 Meaningful Use Objectives Three stages of the criteria reporting requirements Stage and 2012 Stage and 2014 Stage Stage 1 requirements are always applied to the physician s first year of MU, regardless of when they start. Physicians will want to act soon! Early adopters can qualify for greater financial incentives. Approximately 95% of all eligible professionals will participate in the federal incentive program (CMS) 13 HIE Wikipedia Definition Health information exchange (HIE) is defined as the mobilization of healthcare information electronically across organizations within a region, community or hospital system. HIE provides the capability to electronically move clinical information among disparate healthcare information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patientcentered care. HIE is also useful to Public Health authorities to assist in analyses of the health of the population. 14

8 HIE Models State-wide/Local Community-based Health System Sponsored Physician-driven (Medical Home) Source: ehealth Initiative (ehi) 2009 edition of the Sixth Annual Survey of Health Information Exchange 15 HIE Statistics Federal government is projected to spend at least $300 million in support of HIE activities in 2009 and active HIE initiatives in the country (150 of which responded to the survey) 40% increase in HIE initiatives - from 42 in 2008 to 57 in 2009 Source: ehealth Initiative (ehi) 2009 edition of the Sixth Annual Survey of Health Information Exchange 16

9 HIE Statistics Nationwide Source: ehealth Initiative (ehi) 2009 edition of the Sixth Annual Survey of Health Information Exchange 17 HIE Data Exchange Utilization Increase in Type of Data Exchanged # HIEs Laboratory Medication Outpatient Lab Outpatient Episodes Data Radiology Source: ehealth Initiative (ehi) 2009 edition of the Sixth Annual Survey of Health Information Exchange Emergency Dept Episodes 18

10 Stakeholder Organizations Source: ehealth Initiative (ehi) 2009 edition of the Sixth Annual Survey of Health Information Exchange 19 HIE Evolution Currently, the HIE service vendor landscape is undergoing an evolution in an attempt to meet market demands including offering robust electronic health record (EHR), EHR lite systems, and practice management services as part of their HIE functionality. Source: HIE Implications in Meaningful Use Stage 1 Requirements, HIMSS Health Information Exchange Steering Committee, March

11 Tsunami Warning! Labs Face an Intermediated Future A dramatic increase in order volume coming from systems you do not control Potential competitive land grab Loss of $$$ 21 Treading Water Options for the Lab A B C Offer a complete MU solution from the Lab, with a Partner, or through Referral Relationship(s) Sponsor or become a stakeholder in HIE(s) Drive the lab s agenda at the enterprise level Interface to EMRs/EHRs FORWARD-LOOKING LABS WILL WANT TO EMPLOY MULTIPLE STRATEGIES TO FACE THE CHALLENGES AHEAD 22

12 Option A - Control the Intermediary Offer a complete MU solution: Through Partnership with an EMR/EHR vendor Through referral relationships with one or more vendors Can be a single solution or menu of best-of-breed capabilities If you have an existing Clean Orders strategy, leverage it. 23 Option B - Influence the Intermediary Identify HIE activities in the community including: State Initiatives Hospital and Health Systems Medical Homes Become a sponsor or stakeholder (not just a data provider) Drive the selection process to ensure robust CPOE for lab ordering 24

13 Option C Coexist with the Intermediary Interface with a plethora of disparate systems. Either: Point-to-point (e.g., EMR/EHR to LIS) Manual processes to manage variability in quality and format of requisitions and labels Manual processes to maintain accurate billing Manual processes to deal with inevitable customer service problems Or: Use IT solution to orchestrate workflow and dataflow across disparate systems 25 Orchestrated Workflow and Dataflow Lab to EMR 26

14 Must Do Build the business case Assess the impact of intermediated orders on your organization s efficiency and bottom line Educate your sales force on the potential impact Start gathering business intelligence on your market Ensure your team can engage the customer Be aggressive Pursue multiple strategies Assume you will need Option C (effectively process orders from a large number of foreign systems) Drive a Clean Orders strategy If you have one, use it; if you don t have one, get one. 27 Must Avoid Complacency disruptive forces are at work Being marginalized - brand and relationships at stake Betting your business on one approach remain open and flexible 28

15 Thank You. For more information, please contact Atlas Medical at: Phone: Web: 29