HIT in the Patient-Centered Medical Home

An E-Quality Update from Kaiser Permanente
by Ted Epperly, MD, and Dana Hamilton, RHIT

All of us in the medical community face challenges as we implement more integrated and coordinated patient-centered care for our patients, but perhaps none more than primary care physicians. The Patient-Centered Medical Home — coupled with health information technology — is proving to be a successful model that allows physicians to provide comprehensive primary care in communities across the country. Similar to Kaiser Permanente's care model, PCHMs facilitate partnerships between individual patients and their personal physicians and their teams, and when appropriate, the patient's family.

In our PCHM, a large integrated family medicine residency practice in Idaho, there are three essential points that have helped HIT revolutionize our operation. These points have not only helped us grow, but have enabled us to thrive:

1. Do not skimp on IT resources. Having the right equipment is crucial. This includes enough computing power to not only run your practice management and electronic health record software, but to also allow for immediate growth. Growth starts before you even get the new server out of the box, so be sure to include capacity for extra users, storage, and add-on software when calculating for hardware needs.

2. Hire qualified IT support staff. Historically, IT support has been a place of bare-bones staffing in the health care arena. That has changed in the last few years, and having IT staff with health care knowledge will move you light years ahead. There are a number of teaching institutions that graduate-qualified health information management folks — including the Office of the National Coordinator for HIT, which now has its own program to educate HIT staff. Ensuring that your IT staff "gets" what is happening in the clinic will foster great working relationships with end users.

3. Training! Too often, we start the provider workforce with too little training to get started successfully. Technology is made to look easy, but operating the huge number of applications requires, at least, basic training. This has been, in our opinion, the greatest downfall for health information technology working for the masses. Too many times we give just barely enough training to get teams started, but we don't give enough to make the end user successful. By improving training, we can set up users to be knowledgeable enough to not just squeak by, but to be efficient and more independent of IT support for daily tasks.

Bringing the PCMH to Idaho and other parts of rural America poses challenges of its own, including fragmented care and lack of communication for follow-up. With few providers going into these rural areas, patients are shunted throughout communities to get the care they need for preventive services, chronic diseases, and specialty care. The PCMH model addresses these challenges directly by creating a broad-based team, which can include multiple providers, community services, and specialists. The PCMH model and the associated IT services can create a well-formed home for high-risk patients and integrates the rural community as one team.

Access, quality, management, continuity and integration of care, test and referral tracking, and registry creation are all enhanced by HIT. When implemented well, they can start working for the practice to reduce costs, improve quality, and increase patient and team satisfaction.

It is an exciting time to be a primary care provider, and to start to see what the promise of HIT and the Information Age will bring to the practice of medicine.

Ted Epperly, MD, is a primary care physician, CEO of the Family Medicine Residency of Idaho, co-chair of the Patient-Centered Primary Care Collaborative Center on Accountable Care, and Past President and Past Chairman of the Board American Academy of Family Physicians.

Dana Hamilton is Director of Clinical Informatics Family Medicine Residency of Idaho.

Heart of the Rockies Regional Medical Center 2nd CAH in Colorado to Attest to Meaningful Use!

Heart of the Rockies Regional Medical Center successfully attested for Stage 1 Meaningful Use of their Electronic Health Records on October 25th making them the second Critical Access Hospital in Colorado to attest and apply for Medicare EHR Incentive Funds. During the last year, they overcame many obstacles on their journey to Meaningful Use and could not have reached their goal without strong leadership and perseverance. CRHC is delighted to have had the opportunity to work with Heart of the Rockies as it's CO-REC partner to help guide and council them along the way.


Congratulations Heart of the Rockies Regional Medical Center!

Critical Considerations for CAHs Seeking EHR Payments

When I attested to our organization's ability to meaningfully use electronic health records on April 18, 2011, I thought the really hard part of Phase I was behind me. Talking to colleagues who were at prospective payment system hospitals, their payment process was simple; as soon as they attested for meaningful use, the CMS site locked them for payment, did the calculations of what they were entitled to receive, and three to four weeks later, they had a check.

For a critical-access hospital, it is "Not so fast, Grasshopper."

To read the rest of Stephen Stewart's, CIO of Henry County Health Center in Mount Pleasant, Iowa, article click here.

CENTURA Health Connects to the CORHIO Health Information Exchange Network

All Centura facilities went live on CORHIO on October 24, 2011. By connecting its current electronic health record with CORHIO’s secure network, Centura's physicians and other medical care providers from across the state are linked to important real-time health information about their patients.

Centura Health Uses Industry-Leading Technology to Improve Care Coordination For Residents in Metro Denver, Boulder, Colorado Springs, Pueblo, Summit County and Cañon City.

To read Centura Health's press release, click here.

To read CORHIO's press release, click here.

A Quick Guide to Clinical Quality Measures

August 30, 2011, CMS hosted a webinar about the Clinical Quality Measures and Meaningful Use. The following document contains questions and answers from the live Q&A portion of the webinar, and provides answers to the remaining unanswered questions that were received by CMS during the webinar and in follow-up emails.

To read the document, click here.

CRHC’s 2012 Membership Drive Now Underway!

Over the past 20 years, CRHC has become our state’s most trusted resource for rural healthcare. In the current economic landscape, it is more important than ever that we continue to support and advocate on behalf of rural healthcare and the safety net community. We remain loyally committed to ensuring our members have the resources and support they need to keep their communities healthy and vibrant. CRHC is well positioned to provide 20+ more years of support to ensure access to healthcare for all Coloradans, and we recognize that our work would be impossible without the dedication of our loyal members.

CRHC has three levels of membership to suit your organizational/individual needs:
• Investing Member
• Classic Sponsor
• Partner

Joining is easy. Click here to join today!

At the Classic Sponsor and Partner level memberships, your organization is given additional opportunities to support and reach out to rural healthcare providers. Please visit our website for more information on the benefits of each level. Feel free to contact Cari Fouts, Director of Communication & Development (cf@coruralhealth.org, or 303-565-5847) if you have questions about your membership or visit our website for more information.

With your support, we can continue to ensure all Coloradans have access to high quality healthcare services in 2012 and beyond.

CMS is Holding a Second Webinar on the CQMs and the EHR Incentive Programs for Small-Practice Providers

What: Webinar- The CMS EHR Incentive Programs: Small-Practice Providers and Clinical Quality Measures (CQMs)
When: October 25 from 1:00 – 2:30 p.m. EDT
Why: To help small-practice providers successfully report CQMs
How: Register online

The Centers for Medicare & Medicaid Services (CMS) is holding a second webinar on CQMs and their importance in attesting to meaningful use for the EHR Incentive Programs. CMS hopes to help small-practice and rural providers become more knowledgeable in the topics below:

• An overview of the CQMs
• How to report CQMs during attestation
• Why CQMs are included in the EHR Incentive Programs
• Answers to many FAQs on the CQMs and the EHR Incentive Programs

Although, small-practice providers are the intended audience of this webinar, anyone is welcome to join.

The webinar presentation, a document with over 300 questions and answers from the webinar held on August 30, and an informational CQM fact sheet will be provided to participants before the webinar as downloadable handouts.

Additionally, registrants will be given an opportunity to submit questions through the registration site before the webinar that will be answered by CMS subject matter experts and posted to the CMS EHR website a few weeks after the webinar has been completed.

Registration

Individuals can register online for the webinar. After successfully registering, they will be sent a confirmation message with a link to the webinar site. Space is limited, so interested participants should register now to secure their place.

Health IT and Quality Webinars from HRSA

Health IT and Quality webinars are technical assistance webcasts for HRSA grantees and other safety net providers who are either using or planning to use health IT to improve the quality of patient care. Each webinar features experts with hands-on experience from within the safety net community, as well as speakers with various grantee experiences and federal expertise.

Upcoming Webinars
■October 21: " Tips for Going Live with your Health IT System", 2pm ET (Registration Open)

■November 18: “Tips For Overcoming the Gray Areas of Meaningful Use Stage 1 for Safety Net Providers” (Registration Open)

■December 13: “Tips for Using Your Health IT System for Population Health Management” (Registration Open)

■January 20: “Tips For Engaging Safety Net Patients Using Health IT”(Registration Open)
Topics and dates subject to change.

These webinars focus on health IT and quality topics based on feedback from HRSA grantees that includes becoming meaningful users of health IT. Any topic suggestions are welcome and can be sent to healthit@hrsa.gov.

THE Consortium October Webinar: EHR Policies & Procedures Continued

Join us for the October Consortium webinar EHR Policies & Procedures Con't on Thursday, October 20th from 12:00-1:15 pm MT where we will continue September's discussion of best practice policies and procedures needed once an Electronic Health Record is implemented and share more Meaningful Use notes from the field.

To register, click here.

CMS Clarifies Process for Attesting to Meaningful Use Quality Measures

The Centers for Medicare & Medicaid Services (CMS) today issued a clarification on the requirements for attestation to the clinical quality measures (CQMs) needed to meet the definition of "meaningful use" under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The clarification also addresses the documentation needed to demonstrate compliance in this area. The CQMs are only one part of the attestation process.

Hospitals have expressed considerable concern about the accuracy of the CQM data generated by their certified EHR products. Given that the attestation statements for meaningful use require an affirmation that the CQM data are "true and accurate," it has been unclear what is required for attestation in this area. In response, CMS posted the following listserve message today:

What Does Attestation for the EHR Incentive Programs Entail?
Over 114,000 eligible professionals and hospitals have registered for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. As more hospitals move towards meeting meaningful use and attesting, the Centers for Medicare & Medicaid Services (CMS) wants to make sure everyone understands what attestation entails.

In order to attest, successfully demonstrate meaningful use, and receive an incentive payment under the Medicare EHR Incentive Program, eligible hospitals must indicate that they agree with several attestation statements.

Eligible hospitals must agree that the information submitted:

• is accurate to the knowledge and belief of the hospital or the person submitting on behalf of the hospital.


• is accurate and complete for numerators, denominators, exclusions, and measures applicable to the hospital.


• includes information on all patients to whom the measure applies.


• for clinical quality measures (CQMs), was generated as output from an identified certified EHR technology.

By agreeing to the above statements, the hospital is attesting to providing all of the information necessary from certified EHR technology, uncertified EHR technology, and/or paper-based records in order to render complete and accurate information for all meaningful use core and menu set measures except CQMs.

Attesting to CQM Data's Validity
CMS considers information to be accurate and complete for CQMs to the extent that it is identical to the output that was generated from certified EHR technology. In other words, the hospital is only attesting that what was put in the attestation module is identical to the output generated by its certified EHR technology. Therefore, the numerator, denominator, and exclusion information for CQMs must be reported directly from information generated by certified EHR technology.

CMS, through meaningful use, does not require any data validation. Eligible hospitals are not required to provide any additional information beyond what is generated from certified EHR technology in order to satisfy the requirement for submitting CQM information, even if the reported values include zeros. If a hospital has concerns about the accuracy of its output, the hospital can still attest but should work with its vendor and/or the Office of the National Coordinator for Health Information Technology to improve the accuracy of the individual product and/or the level of accuracy guaranteed by certification.

CMS recommends that hospitals print out or save an electronic copy of the CQM report used at attestation from their certified EHR. The eligible hospital should retain this copy for its records so that the hospital can show its numbers in the event of an audit. Upon audit, this documentation will be used to validate that the hospital accurately attested and submitted CQMs.

Hospitals have until Nov. 30 to attest to meaningful use and be eligible for a Medicare EHR incentive payment for fiscal year (FY) 2011. They must report on a 90-day reporting period ending on or before Sept. 30 (the last day of FY 2011). For more information about the EHR Incentive Programs, including a description of the CQMs and the other requirements to meet meaningful use, visit the CMS EHR website at http://www.cms.gov/EHRIncentivePrograms.

If you have questions or need additional information, please contact David Ginsberg, Senior Advisor, THE Consortium at dg@coruralhealth.org.

EMR/Computer Hardware and Services at Discounted Prices

As a reseller for Dell, Hewlett Packard and Equus, Istonish, a classic sponsor of CRHC and THE Consortium, can almost always provide cheaper pricing than the EMR vendors on all servers, laptops, desktops, tablets and network gear. Call Istonish today to make sure that you are getting the best possible prices for your EMR implementation!

Services associated with hardware purchases include:

• Providing onsite installation of new computers to ensure network and printer connectivity



• Providing support for installing, moving, adding, or changing computers in your facility



• Providing disposal of obsolete items

For more information, contact Matt Commander, Regional Account Executive at Istonish—mcommander@istonish.com or 720-529-4625.

The First Critical Access Hospital to Attest in Colorado

Spanish Peaks Regional Medical Center successfully attested for Stage 1 Meaningful Use on October 13th! They are the first Critical Access Hospital in Colorado to attest and apply for Medicare EHR Incentive Funds.

During the last year, they have overcome many obstacles on the way to Meaningful Use and could not have reached their goal without the hard work of Todd Oberheu, CEO, Bill Bolt, CIO, Mark See, IT Manager and Cindy Brooks, DON. CRHC is delighted to have had the opportunity to work with Spanish Peaks as it's CO-REC partner.

Congratulations Spanish Peaks Regional Medical Center!

Five ways telemedicine can boost care in rural communities

It’s no secret telemedicine has had a profound impact on the industry, both nationally and globally. Organizations in big and small cities are seeing the benefits of employing such technology, and the biggest impression could arguably be on those living in rural communities.

To read the entire article, click here.

HRSA Webinar: Tips for Going Live with a Health IT System

Friday, October 21, 2011 – 12:00-1:30 PM MDT

This webinar will explore the experiences of safety net providers who have gone live with a health information technology (IT) system in the last 18 months. Even with much preparation, it is difficult to prepare for all the unexpected bumps in the road. Speakers will present lessons learned and provide tips for successfully planning and triaging problems during the first weeks of going live. Topics include:

• The impact on a provider’s clinical and business workflow;
• Making critical changes with your health IT vendor;
• Meeting meaningful use stage 1 functionality; and
• Identifying useful resources and/or training.

Speakers will also provide advice on change management and how to ensure that this period does not affect patient care. The webinar will cover both primary and inpatient care for rural and urban safety net providers. Presenters include:

• Kirby Craft, Chief Information Officer, Magee General Hospital
• Francis Aframgyening, Executive Director, Care Alliance Health Centers
• Lynn Hudson, Consultant, South Carolina Regional Extension Center

Register at: http://webcast.streamlogics.com/audience/index.asp?eventid=99703614

Key EHR Incentive Program Registration Dates Reminder from CMS

CMS wants to remind eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) of the key registration dates for the Electronic Health Record (EHR) Incentive Programs, and provide information to help them successfully register and start their path to payment for 2011.

Important Registration Dates to Remember:
 Nov 30, 2011 – Last day for eligible hospitals and CAHs to register and attest to receive a Medicare incentive payment for FY2011.
 Feb 29, 2012 – Last day for EPs to register and attest to receive a Medicare incentive payment for CY2011.

When Should Providers Register?
CMS encourages providers to register for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as possible to avoid payment delays. Note that not all states have launched a Medicaid EHR Incentive Program yet; providers in Colorado will be able to register for the Medicaid EHR Incentive Program in Spring 2012.

Registration Resources
CMS has a number of resources to help providers successfully register for the EHR Incentive Programs:
 Step-by-step registration guides, available on the CMS EHR Registration page
 A number of FAQs about registration on the EHR Incentive Programs website
 Webinars on YouTube to help guide providers through the registration process – one for EPs and one for hospitals

HIT Adoption Toolboxes developed by HRSA's OHITQ

HRSA's Office of Health Information Technology and Quality (OHITQ) has developed a series of HIT Adoption Toolboxes to help implement health IT applications. The toolboxes are designed to serve the needs of a broad audience within health centers and other safety net providers. Key IT stakeholders have reviewed and contribed to the toolboxes to ensure they are accurate, relevant, and effective in supporting health IT in safety net organizations.

Rural Health IT Adoption Toolbox
Contains a range of resources for rural health providers as they consider implementing health IT. Topics and modules include telehealth; health IT selection and implementation; project management and staffing; financing and sustainability; opportunities for collaboration; and patient quality improvement, evaluation and optimization.

Health IT for Children Toolbox
A compilation of health IT information targeted at children's health care needs, ranging from pediatric electronic medical records to children's health insurance coverage. Provides specific health IT resources online to support information technology in children's health promotion and disease prevention, and identifies opportunities to link other systems that serve children, including Head Start, schools, foster care, etc.

For more information on the above toolkits, click here.

Materials from CMS' “Medicare and Medicaid EHR Incentive Programs: Registration and Attestation for Eligible Professionals” Call Now Available

CMS hosted a National Provider Call on Fri Sep 9 on the topic of Registration and Attestation for Medicare and Medicaid EHR Incentive Programs for Eligible Professionals, including:

 Path to Payment
 Highlights of Registration and Attestation Processes
 Third Party Proxy
 Troubleshooting
 Helpful Resources
 A question & answer session

The presentation, transcript, and audio recording from this call and other selected calls can now be found under the “Presentations for Providers” section on the Educational Materials page of the CMS EHR website.

Please refer to the transcript for clarifications to the audio recording for the Fri Sep 9 call.

CRHC’s First Rural Clinic Reaches Meaningful Use and Attests to Medicare for Incentive Funding

The Colorado Rural Health Center (CRHC) started working with MidValley Family Practice as their Regional Extension Center (REC) partner in June 2011. At that point, Dr. Glenn Kotz and his practice manager, Joyce, were well on their way to reaching Meaningful Use (MU) and they began their 90-day reporting period on June 26th. During their 90-day reporting period, CRHC assisted in performing four Meaningful Use Gap Analyses which assessed the measures the practice was meeting and which measures still needed adjustments, including changing current workflows to accommodate the collecting the new measures. In addition, MidValley performed a data exchange test with a pediatric practice in Boulder also using Centricity’s software.

The practice initially struggled with delivering the mandatory clinical summaries to patients after each visit which are both time consuming and require printing off mass amounts of paper. However, they were able to find a temporary solution which will be fixed once a patient portal is implemented and patients can access their summary electronically after their visit.

MidValley Family Practice successfully attested with Medicare on September 26th and takes great pride in the fact that they are the first to attest to MU as a CRHC REC partner. CRHC is delighted to have had the privilege to work with MidValley Family Practice and help them achieve MU which shows their commitment to providing excellent patient care. Congratulations MidValley Family Practice!

CRHC Congratulates Montrose Memorial Hospital on Successfully Attesting to the Medicare Program

CRHC wishes to congratulate Montrose Memorial Hospital on being one of the first rural hospitals in Colorado to successfully attest to the Medicare Incentive Program as a Meaningful User of their EHR system. Montrose Memorial Hospital attested on September 29th further proving their committment to excellent patient care.

Congratulations Montrose Memorial Hospital!

CMS Has Two New YouTube Videos

CMS has posted new videos to the CMS YouTube page, including:

• An overview video, titled EHR: Delaware Meaningful Use Recognition Ceremony, where providers participating in the Medicare EHR Incentive Program were honored.
• An overview video, titled EHR: Cherokee Nation Receives Medicaid EHR Incentive Payment, where Dr. Woitte and the Cherokee Nation were honored for participating in the Medicaid EHR Incentive Program and for being the first tribe to receive an incentive payment.

Make sure to visit the CMS YouTube page to see the rest of our EHR Incentive Program videos.