Relate the components of The HITECH Act and Meaningful Use to health management technology Identify whether existing systems meet requirements Communicate technology needs and request feedback from end users for a smooth transition Implement best practices to move people and systems forward under these new requirements

1. HITECH and Meaningful Use:
The Impact on the Future of Healthcare Technology
Management
Amy Walker MS, RN, CPHQ, FACHE, NEA-BC
Practice Director Health IT +
Member HIMSS Public Policy Committee

2. • Relate the components of The HITECH Act and
Meaningful Use to health management technology
• Identify whether existing systems meet requirements
• Communicate technology needs and request
feedback from end users for a smooth transition
• Implement best practices to move people and
systems forward under these new requirements
2
What We Will Cover…..

3. 3
Clinical Informatics
New Clinical Informatics Initiatives
Healthcare Operations
Information Technology
Communication
Communication
The Foundation

4. Definitions
• Ecosystem
• Requirement
4

5. Leading from good to great does not mean coming
up with the answers and then motivating everyone
to follow your messianic vision. It means having the
humility to grasp the fact that you do not yet
understand enough to have all of the answers and
then to ask the questions that will lead to the best
possible insights.
(Jim Collins, Good to Great)

6. What This Presentation Is
Not About
The thoughtless application of IT, for slash and
burn downsizing, restructuring,
and outsourcing.
6

7. 7
• President Bush’s goal in 2004
• Executive order established the Office of the National
Coordinator for Health Information Technology (ONCHIT)
as part of the Dept of Health & Human Services (HHS)
– Dr. David Brailer appointed the first National Coordinator
A quick trip down memory lane …
“… an Electronic Health Record for
every American by the year 2014. By
computerizing health records, we can
avoid dangerous medical mistakes,
reduce costs, and improve care.”
- State of the Union address,
Jan. 20, 2004
7

8. HITECH Act? hmm, sounds familiar…
• Signed into law February 2009
as part of ARRA
• Goal
– 90% of U.S. physicians and 70% of
hospitals using EHR by 2019
• How?
– Provide $19 Billion to doctors and
hospitals through DHS to
implement EHR by 2011

9. ARRA
• HITECH Care
• Care Coordination
• Disease Management
• Value-based Purchasing
• Bundled Payment
• Medical Home
• Comparativeness
Effectiveness
• Meaningful Use
• Public Reporting and
Accountability
• Reward Top Performers
• Penalize Bottom
Performers
9

10. 10
ARRA EHR Adoption –Incentive Requirements
• To encourage broad adoption of EHRs, ARRA offers
reimbursement to eligible providers/hospitals who meet
two requirements:
– Acquire a certified EHR product or service
– Demonstrate that the organization or provider are using that
product/service “meaningfully”
• ARRA creates HIT Policy and HIT Standards Committees
which must recommend:
– Criteria for certifying EHR products
– Criteria for demonstrating that an applicant is using the EHR
meaningfully

11. Why are We Here?
• 2011
• 2013
• 2015
• Improve quality, safety, efficiency, and reduce health
disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population and public health
• All the while maintaining privacy and security

12. 12
HITECH Framework for MU of EHRs
Taken from: Blumenthal, D.
“Launching HITECH,” posted
by the NEJM on 12-30-2009.
12

13. 13
MU Measures Quality Measures
13
VTE - 1 VTE Prophylaxis within 24 hours of
arrival
Stroke - 2 Ischemic Stroke - Discharge on
Antithrombotics
VTE - 2 VTE Prophylaxis within 24 hours of
arrival to ICU
Stroke - 3 Ischemic Stroke - Anticoagulation for
A-Fib/Flutter
VTE -3 VTE Diagnosis - Anticoagulation
Overlap Therapy
Stroke - 4 Ischemic Stroke - Thrombolytic
therapy for patients arriving within 2
hours of symptom onset
VTE -4 VTE - Platelet Monitoring on
unfractionated Heparin
Stroke - 5 Ischemic or Hemorrhagic Stroke -
Antithrombotic therapy by day 2
VTE - 5 VTE - Discharge Instructions Stroke - 6 Ischemic Stroke - Discharge on
Statins
VTE - 6 VTE - Incidence of potentially
preventable VTE
Stroke - 8 Ischemic or Hemorrhagic Stroke –
Education
ED - 1 ED throughput-arrival to departure
for admitted patients
Stroke -
10
Ischemic or Hemorrhagic Stroke -
Rehabilitation Assessment
ED – 2 ED throughput - Admit decision time
to ED departure time for admitted
patients.

14. 1
2
3
4
5
6
7
8
9

15. 15
HITECH Incentives for Hospitals – Medicare
Example
Four Year CMS Health IT Incentive Payment Scenarios:
2011 2012 2013 2014 2015 2016
2011 $20 $0 $0 $0 $0 $0
2012 $15 $20 $0 $0 $0 $0
2013 $10 $15 $20 $0 $0 $0
2014 $5 $10 $15 $15 $0 $0
2015 $0 $5 $10 $10 $10 $0
2016 $0 $0 $5 $5 $5 $0
2017 $0 $0 $0 $0 $0 $0
$50 $50 $50 $30 $15
Maximum
Medicare
health IT
incentive
payment
for this
year is:
If the first qualifying year is:
Total of Maximum over 4, 3,
or 2 Years' Medicare Health
IT Incentive Payments
Example Numbers
(millions)
Penalties
begin
100% 100% 100% 60% 30%
15

16. Current State for EMR Adoption in Home Health
• Over 80% use telemonitoring devices – from lo tech to hi tech
• EMR Technology Levels* (2007 survey data)
– 43% use EMR systems with following functionality
• Patient demographics 95%
• Point of care clinical documentation 29%
• Clinical notes 34%
• Clinical decision support 23%
• Record MD orders 50%
– 31% in process
Resnick, H.E., and Alwan, M. (2010). Use of health information technology in home health and
hospice agencies: United States, 2007. Journal of the American Medical Informatics
Association 17(4):389-395.

17. oes It Mean?
• Increased reliance on IT
• Greater need for informatics professionals
• SWOT analysis should come sooner rather than later
• Suddenly, certifications matters more than ever
• More governance / new regulatory and
reimbursement guidelines

18. Leveraging best practices to move
and systems forward
18

21. • Improve quality, cut costs
– Accountable Care Organizations
• Larger insurance footprint
• Not predetermined
• Focus on value
• Shift to outpatient care
• Data driven problem solving
• Refocus on fraud
• Growing information technology footprint
21
Goals of Healthcare Reform

22. • Proposed CMO
ACO rules
published
22
• Meaningful
Use Stage 2
• Advanced
Clinical
Process
• Medicare
Accountable
Care
Organizations
• Medicare Value-
based
Purchasing
• Reduced
Medicare
Payments for
Hospital
Readmissions
• Medicare
Bundle
Payment
Pilot
• ICD-10
Conversion
• Meaningful
Use Stage 3
Improved
Outcomes
• Health
Insurance
Exchanges
(electronic
eligibility)
• Reduced
Medicare
Payments for
Hospital
acquired
Infections
(HAI)
• Medicare
Expenditures
Capped
• Medicare
payment
adjustment
begins for
non
meaningful
users of IT

23. Accelerating Health Care Value
“Readiness for change is one of the hardest
problems we face”, Paul Tang, HIT Policy Committee vice chair and
Palo Alto Medical Foundation vice president and chief medical information officer.
“To realize our vision, we must foster a
pervasive culture of innovation”, Douglas D. French, former
Ascension Health president and chief executive officer.
23

24. 24
Clinical Informatics
New Clinical Informatics Initiatives
Clinical Operations
Information Technology
Communication
Communication

25. Health IT Strategic Framework
25

26. Meaningful Healthcare Reform A Journey
26
Industrial Strength
LEADERSHIP & MANAGEMENT
• Complete an enterprise assessment of the
organizational readiness to reform
• Evaluate the present situation, identify
recommendations, and best practices to optimize the
future state
• Identify obstacles, challenges, sources of issues, and
needed changes
• Identify indicators of healthcare reform and
changes in order to maximize operational
performance
• Create and heavily emphasize an EFFECTIVE &
INNOVATIVE change management and
communication plan
• Create a practical benefits realization plan

28. Certified EHR Technology
• Office of the National Coordinator for Health
Information Technology has approved two entities as
able to review and certify EHRs
– Certification Commission for Health Information
Technology (CCHIT)
– Drummond Group Inc.
• Unless your current system is homegrown, piecemeal
or older, your EHR vendor is likely already pursuing
certification
• (and/or trying to sell you a new or upgraded system – which they
promise will be certifiable)

29. 29
Aurora Health Care HITECH Gap Analysis
Look at each MU Criteria (and Gap) in 3 ways:
1. Technology – do you need software installed?
2. Adoption – do you have the required adoption?
3. Ability to Measure – can you measure?
Use these same categories in the
Work Plan for tracking
29

30. 30Slide #30
Aurora Health Care MU Dashboard

31. Slide #31
Aurora Health Care Project Tracking Tool

32. HIPAA
Privacy and Security
32

33. Today’s Privacy and Security Environment
Covered Entities
Medical Homes
Medical Homes
Medical Homes
Pharmacy
Laboratories
Medical Log
Physician
Portal
Personal
Healthcare
Records
Medical Records
Clinical Image Records
Wellness Centers
Outpatient Care
Accountable Care
Organizations
Exercise Log
EMR
Social Worker
Emergency
Payer
Primary Care
Physician
Patient

34. Increase in HIPAA Penalties
Under the ARRA:
All such violations of an identical provision in a calendar year
(A) Did Not Know ............................................. $100 $50,000 $1,500,000
(B) Reasonable Cause ..................................... 1,000 50,000 1,500,000
(C) Willful Neglect—Corrected ........................ 10,000 50,000 1,500,000
(C) Willful Neglect—Not Corrected .................. 50,000 1,500,000
34

35. A Sample of Questions for HIPAA-Security Assessment
• What is our single vulnerability from a technology or security
point of view?
• How vulnerable are we to attack on confidentiality, integrity,
and availability of our data and systems?
• What is the assessment of physical security controls at each
of our sites (data center, home office, field offices, and other
sites?
• How prepared are our incident response plans?
• Have we protected our company in contracts with vendors?
• Do we understand what PHI we produce, capture, store,
transport, and destroy?
35

36. Standards and Interoperability
36

37. HITECH Drives US Standards Efforts
• Goal: Transform healthcare through the
meaningful use of health data
• Data capture data sharing advanced clinical
processes
Improved Outcomes
• Requires organized structuring and effective use
of information to support decision making
37

38. Need for Health Data Standards
• Standards are foundational to development,
implementation and exchange of EHRs
• Clinicians need ubiquitous access to health
information to provide optimal care
• Providers, payers and public health entities must
exchange health information between
departments, across organizations and agencies
• Consumers need assurance that caregivers have
seamless access to correct information
38

39. ONC Standards and Interoperability Framework
39
Tools and Services
(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)
Tools and Services
(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)
Use Case Development
and Functional
Requirements
Use Case Development
and Functional
Requirements
Standards
Development
Standards
Development
Certification
and Testing
Certification
and Testing
Harmonization of
Core Concepts
Harmonization of
Core Concepts
Implementation
Specifications
Implementation
Specifications
Pilot Demonstration
Projects
Pilot Demonstration
Projects
Reference
Implementation
Reference
Implementation

40. ICD-10
40

41. ICD-10 Compliance Impact
• International Classification of Disease 10th Revision
• federally mandated by October 1, 2013 for all providers
• more flexible code set expands for new procedures, diagnoses and
technologies
• greater specificity translates to improved quality measurements and patient
safety standards
• Impact to include:
• Coding Medical Records/Health Information Management
• Registration/Scheduling
• Encounter Forms/Charge Tickets
• Clinical Documentation
– Information Systems; including EHR’s
…the entire Revenue Cycle
41

42. Home Health
42

43. Home Health Today
3.3 million seniors receiving care on any given day – over 14 million
per year*
• Over 10,000 agencies – coverage in every state
• Approx 1 million clinicians; multidisciplinary
• Most provide specialty programs
– Diabetes, Congestive Failure, COPD, Stroke
– Patient centered, self management focus
• Many specialize in geriatrics
• Lowest cost/best outcomes in chronic care management for
elderly**
*Medicare Payment Advisory Commission. (2011)
http://www.medpac.gov/documents/Mar11_EntireReport.pdf

44. Literature Shows
• Seniors do better at home for acute care on clinical
outcomes, costs, satisfaction
• Transitioning elders from acute to home with teaching for
self management and f/u more effective, low readmission
rates
• Use of telemonitoring in home for CHF and cardiac patients
w/PHR show optimal recovery and self management results.

45. Aging Demographics
• 7000 Baby Boomers turning 65 yrs every day
• 2011 Legislature targeting Medicare and
Medicaid cuts
• Current CMS spending and Baby-Boomer
impact vs. national fiscal goal of deficit
reductions
• HH positioned to provide highest quality and
best outcomes in care delivery for our elder
population
45

46. Key Initiatives in ACA
(CBO est. 13.5b savings 2011-19 Sec 3021-3027)
• CMI – Center for Medicare and Medicaid
Innovation – launched November, 2010
• Hospital at Home – for elderly
• Care Transition Program Pilot
• Readmissions Reduction Program
• Accountable Care Org/Bundling Pilots

48. Clinical Engineering
The Clinical Engineering Department provides multiple services to ensure that
the medical equipment needs for patients and staff are met. We provide
services with accuracy and integrity.
– Provide installation, preventive maintenance
– Provide mandatory pre-use inspections
– Performs investigations
– Provides assistance in the disposal of medical equipment
– Provides for in-service training and support
48

49. Perhaps Clinical Engineering Might Also Focus On
• Identifying improvement opportunities
• Participating in information technology and management
strategy
• Optimization in the use of devices
• Rounding to ensure feedback and evaluation of device
usage
• Expert resource in care coordination: technologies,
equipment and information flow
• Expert resource in equipment, process, and information
flow for meaningful use, and
• Expert resource for teams defining information technology
management
49

50. It’s Not What We Don’t Know
That Hurts, It’s What We
Know That Ain’t So
Will Rogers (1879-1935)

51. Planning for Quality the Systems Thinker
51
“Systems Thinking is a discipline for seeing
wholes, recognizing patterns and
interrelationships, and learning
how to structure those
interrelationships in more
effective, efficient ways.”
Senge, P., & Lannon-Kim, C., 1991

52. Five Dysfunctions of a Team
• Absence of Trust
• Fear of Conflict
• Lack of Commitment
• Avoidance of Accountability
• Inattention to Results
• Identify the behaviors?
• How do you know that these have been
overcome? The Five Dysfunctions of a Team: A Leadership Fable, San Francisco;
Jossey-Bass, 2002
52

53. Lean Incorporated into Our Teams
• People first
• Flexibility
• Walking the Talk
• Our colleagues are assets
• Always provide value
• Mentor and coach
• Bridge organizational boundaries
• Adjustments made as work flow indicates
• Applies frontline feedback
53

54. Listening Techniques
• Clarify-get more information
• Restate-check the meaning
• Remain neutral-convey interest
• Reflect-help them evaluate their feelings
• Summarize-bring the discussion into focus
54

55. Are the skills, knowledge, and experience of the
actors well matched with the tasks they are
asked to perform?
55

56. It is only after I have read, identified, and
stimulated your needs that I will be able
to energize our discussions while
irresistibly presenting my ideas to you.
(Robert Mayer, How to Win Any Negotiation)

57. Power/Influence is the ability to get people to
perceive that a given behavior (or performance) is the
best action they can take in the service of their values.

59. Care Providers
• At risk and accountable
• Will prepare for multiple reform outcomes
• Forge new partnerships
• Reliance on valid performance vs. faulty
• Increase in training
• Empowered to lead improvement
• Decrease in the size of the pie
• Increase in reliance in technology
• Driven by incentives and penalties
59

60. It Is Not The Strongest Who Survive, Or The Fastest.
It Is The Ones Who Can Change the Quickest.
Charles Darwin

61. Care Providers Must Simplify Communication
61

62. Communication Balancing Act
62

64. 64

65. Accountable Care Organizations
A concept that has the potential to revolutionize
the way healthcare is delivered, experienced, and
paid for in America.
– Care coordination
– Patient centered using to the full extent all health
care professionals
– Respects patient centeredness by respecting patient
choice of provider and shared decision making
– Positive patient experience
65

66. Medical Home
Six medical home standards
– Enhance access and continuity
– Identify and manage patient populations
– Plan and manage care
– Provide self-care and community support
– Track and coordinate care
– Measure and improve performance
•E-Visits
66

67. Innovative Systems
67
The Vscan by GE, is a new
mobile device designed for
doctors who are making
house calls.
FutureScan 2011: Healthcare Trends and Implications 2011 - 2016
Society for Healthcare Strategy and Market Development / Health Administration Press January 2011

68. Innovative Systems
68
AirStrip Technologies, has built
its revolutionary AppPoint™
software development platform
with a vision of securely sending
critical patient information
directly from hospital monitoring
systems, bedside devices, and
electronic health records to a
clinician's mobile device.

69. Further Impact to Information Systems
• Zero tolerance for negative unintended consequences will be
identified and resolved
• Increased support to care coordination
• Increased certification criteria based on measurable
achievements
• Mathematical and logical models will become the norm to
support healthcare reform
69

70. Perhaps Clinical Engineering Might Needs to Focus On
• Identifying improvement opportunities
• Participating in Information technology and management
strategy
• Optimization in the use of devices
• Rounding to ensure feedback and evaluation of device usage
• Expert resource in care coordination: technologies,
equipment and information flow
• Expert resource in equipment, process, and information flow
for meaningful use
70

71. Perhaps Clinical Engineering Might Needs to Focus On
• Identifying improvement opportunities
• Participating in Information technology and management
strategy
• Optimization in the use of devices
• Rounding to ensure feedback and evaluation of device usage
• Expert resource in care coordination: technologies,
equipment and information flow
• Expert resource in equipment, process, and information flow
for meaningful use
71

72. Health IT Strategic Framework
72
Enterprise
Commitment
and
Accountability
Organizational
Readiness A
Pervasive
Culture

73. • Industrial strength leaders
• Industrial strength organizations
• Un-ending curiosity and fact finding
• Ability to project what-if scenarios
• Ability to simplify every process
• Ability to act lean
• Zero tolerance for waste
73
Implement best practices to move people and systems
forward under these new requirements

74. Closing Thought…
74
We can build high performance teams that
together, determine and implement the
requirements for healthcare organizations that
operate as innovation engines, transforming
people, technology, and processes to advance
healthcare reform.
We realize it begins with us.

75. Thank you!
For more information, please contact:
awalker@optimizeitconsulting.com or
awalker@qssinc.com, 703-283-4678