Information Technology Compliance Solutions Trends ABC Conference

Information Technology Compliance, Solutions & Trends ABC Conference Tampa Florida January 2011

Mike Mytych Bio 35 year career in healthcare 20 years in Consulting with an emphasis on clinical systems and focus on physician adoption of I/T Clients range from small physician groups to large multi-hospital organizations Conducted over 200 vendor selections for both hospitals and physicians with over 50 cardiology engagements ranging from small practices to complete heart hospital I/T strategies Worked with 6 major HIEs including Chicago, Minneapolis, Wisconsin, Washington DC, New York City Spent 15 years in the vendor community and is former VP of Sales for the physician systems division at Baxter Adjunct Faculty member at University of Wisconsin Milwaukee Healthcare Informatics Graduate program teaching Healthcare I/T Procurement Health Information Consulting, LLC

Disclosure Provide industry education for CDW, GE and Next. Gen in partnership with Wakerly Partners and C-Suite Resources − We do not provide competitive analysis or benchmarking to any vendor Participate on 3 investor advisory company panels for publically traded company assessment and prohibited from disclosing any information that is not included in the public domain. Health Information Consulting, LLC

Today’s Objectives What are the key I/T drivers for today's practice? Impact of ARRA / HITECH / Healthcare Reform on impact on I/T decisions. What are the critical EMR/EHRs – CV Requirements? What will the future look like for the CV Practice ? Health Information Consulting, LLC

Audience Survey EMR Today? Buying an EMR? Integrated with Hospital? Integration Discussions? Health Information Consulting, LLC

Today’s Key I/T Drivers

I/T Drivers ARRA / HITECH Meaningful Use Rules Hospital Integration – Care Coordination Documenting care that enables quality / performance assessment Maintaining reimbursement and getting greater operational efficiency Health Information Consulting, LLC

Driving Practice I/T Decisions EHRs and Meeting Meaningful Use Integration with Hospitals PM System Decisions Cardiology PACS HIPAA Compliance Regulatory/Quality Measure Compliance PQRI and e. RX Incentives Device Upgrades & Integration Preparing for Health Reform and participating in ACOs & Health Information Exchange Others, ICD 10 etc. Health Information Consulting, LLC

Decisions - Decisions There is a lot to get done ! Priorities Resources Timing Timeline Dependencies Health Information Consulting, LLC

Questions We Hear… With all that is happening around us, what are my best options for a good long term decision regarding I/T? How can I optimize the use of systems for better patient care and provider satisfaction without losing productivity? How can I minimize wasteful decisions? Will the government programs like HITECH be changed substantially in the near future? Will my integration with a hospital change the way my providers will utilize EHRs? What is an HIE, is it real and when do I need to participate? Dozens of others… Health Information Consulting, LLC

ARRA – HITECH Compliance Have a Road Map as to How you get there & Operate under the new Rules “I don't like mysteries. They give me a bellyache and I got a beauty right now. ” James Kirk

Non-compliance Is An Expensive Choice Physicians and hospitals must meet government’s definition of meaningful use of Electronic Health Records (EHR) Technology” in order to be paid their bonuses or be prepared to have the penalties kick in in 2015. 2011 is the first year for partial qualification for meeting Meaningful Use (Stage 1) 2013 and 2015 will have different rules that build out toward the HITECH objectives (Stage 2 and Stage 3) and the preliminary objectives were released January 2011 Health Information Consulting, LLC | 12 |

Refresh - “Meaningful Use” Meaningful use is defined as: Use of a certified EHR in a meaningful manner (ex: clinical documentation, e-prescribing, etc. ) Use of certified EHR technology for electronic exchange of health information Use of certified EHR technology to submit clinical quality and other measures. To insure Meaningful Use and to ensure continued adoption and subsequent use of the EHR there are specific rules for demonstration of that use. Health Information Consulting, LLC | 13 |

Reporting Requirements Summary Requirements vary based on whether the applicant is an “eligible professional” or eligible hospital. ” Reporting Period –for any consecutive 90 days for first year; one year subsequently For 2011 –Providers required to submit summary quality measure data to CMS or States by attestation For 2012 –Providers required to electronically submit quality measure data to CMS or States Health Information Consulting, LLC | 14 |

The March Toward Reform ARRA/HITECH − Meaningful Use 2011 – 2013 – 2015 − Medicare Penalties 2015+ − Data Analytics Setting the Stage for Healthcare Reform − − − − Increased utilization demand from the uninsured/underinsured Changes in plans / employer offerings Bundled payments – reward for quality performance Quality / outcomes evolution Medical Home Development and operation of ACO's Comparative Effectiveness Nationwide goal to remove cost from the delivery system while improving quality Health Information Consulting, LLC

Data and More Data CV Data Point of Care Health Information Consulting, LLC 16

EHRs and Meaningful Use

Leadership Concerns • When should we buy? • Who is the right vendor? • Can they get us to meaningful use? • Do we have time for PM? • Who will help us through all of these changes? Health Information Consulting, LLC

Meaningful Use Implications • Physician clinics will have to carefully assess their ability to meet meaningful use by 2011/2012. • Just having an EHR does not mean that a clinic will meet the criteria. • Each physician’s group will need to understand what it will take to have the required interoperability, system interfaces, data standards and timeline requirements. • Physicians may be invited to participate in HIE technologies offered by the Hospitals to assist in complying with Meaningful Use criteria. • Few Physician Clinics have integration or interchange with Imaging systems for movement of diagnostic reporting (PACS, CPACS, RIS). Health Information Consulting, LLC

Common Questions from those who already have an EMR? 1. Is my vendor certified? 2. What is the current state of implementation and quality of use by my clinicians? (still using dictation? ) 3. What gaps do we have to complete the EHR implementation (e. Rx & Lab are key) 4. Are we capturing the required discreet data? 5. Lab results are discreet and complete? 6. Interchange capabilities with our referring physicians and hospitals? Health Information Consulting, LLC

MU is not just about EHR Unless you are the only practice on an island, no one vendor can enable the physician to meet meaningful use. The stimulus law compels the creation of ways to exchange health information within states and across a nationwide HIT infrastructure… Cardiovascular Patient Records and related discrete data are a primary target of these efforts… http: //govhealthit. com/newsitem. aspx? nid=72400 Health Information Consulting, LLC 21

MU Compliance Reporting – QC what you can do and how you are measuring up to the standards Know how data is generated and by whom Change behavior to become compliant Health Information Consulting, LLC

EHR’s for the CV Practice

Vendor Selection Considerations Vendor Certification PM Vendor Hospital Vendor Stability Cost Performance Others Health Information Consulting, LLC

EHR Vendor Certification Surescripts LLC - Arlington, VA Date of authorization: December 23, 2010. Scope of authorization: EHR Modules: E-Prescribing, Privacy and Security. ICSA Labs - Mechanicsburg, PA Date of authorization: December 10, 2010. Scope of authorization: Complete EHR and EHR Modules. SLI Global Solutions - Denver, CO Date of authorization: December 10, 2010. Scope of authorization: Complete EHR and EHR Modules. Info. Gard Laboratories, Inc. – San Luis Obispo, CA Date of authorization: September 24, 2010. Scope of authorization: Complete EHR and EHR Modules. Certification Commission for Health Information Technology (CCHIT) - Chicago, IL Date of authorization: September 3, 2010. Scope of authorization: Complete EHR and EHR Modules. Drummond Group, Inc. (DGI) - Austin, TX Date of authorization: September 3, 2010. Scope of authorization: Complete EHR and EHR Modules http: //healthit. hhs. gov/portal/server. pt? open=512&mode=2&obj. ID=3120 Health Information Consulting, LLC

Certified Vendors Currently 193 vendor products are certified Not all are comprehensive EHRs Very few offer a comprehensive CV EHR Make sure your vendors are certified and contractually commit to remaining certified http: //onc-chpl. force. com/ehrcert/EHRProduct. Search Health Information Consulting, LLC

EHR Evaluation Considerations Performance • Depth in Cardiology and Interoperability • Ability to interoperate with others • Patient identity management • Inbound unsolicited data management • Market share in your region • Validation of capability and contractual commitment • Pre-contract integration and interoperability plan Health Information Consulting, LLC

EHR Implementation Timeline 1 to 3 months 1 to 2 months 2 to 4 months 1 to 3 months Total: 6 to 16 months depending on resources, size of group, PM integration and other variables. Health Information Consulting, LLC 1 to 4 months

Summary Physician / EHR requirements Meeting Cardiology Workflow Key Focal Points Flexibility of design / settings Interfaces with Devices – Patient ID, Orders, Results − − − CPACS Pace. Art Others Interoperability - Your Device Integration − Echo, ECG, Stress, Holter, Nuclear, CT, PV, etc. Specialty Clinics: Limpid, Anti. Coag, Device, CHF, etc. Comprehensive “one-stop shopping” for all patient records components from the patient summary screen with individual settings Lab Interfaces - Quality Data / Measures – how is data collected Integration into clinic workflows Effective Clinical Decision Support – documentation of non-std events Executive Reporting / ease of use − − Nursing triage Physician in-box of new records / results Ease of mapping to existing records – both paper and electronic, patient identifiers Ease of validation of data prior to upload into the permanent record from outside systems Health Information Consulting, LLC 29

Other Requirements Mapping to your ACO partners Management of change to national standards Health Information Exchange Requirements – Regional, State, Enterprise Referral coordination for exchange – changes in workflows Patient / Consumer Compliance Requirements – access to electronic copies of their records Others Health Information Consulting, LLC

Example of ACO I/T Requirements Component Early Developing Sustainable Supporting I/T Member Engagement Episode of Care Pre-care intervention Prevention: Lifestyle coaching; Remote monitoring CRM HRA Patient ID Mgt Cross Continuum Medical Management Case Management Care Coordination Disease Management & Health Maintenance Patient ID Mgt Provider Directory Consent Mgt. Disease Registries EMR Clinical Information Exchange Read only access; User request – pull Push & Pull CCD Dynamic context sharing; Patient access EMR w/ CCD Patient ID Mgt. Provider Directory HIE Quality Reporting Manual entry into Excel EHR feed to Quality DB Real time access to data Data dashboards Executive reporting EMR w/ Clinical Documentation Analytical Data Warehouse Business Intelligence/ Predictive Modeling & Analytics Patient focused; Episode & encounter focused data; retrospective clinical and financial data Population based; continuum of care data; predictive health analytics Social and network data; Behavior based analytics; Real time data analysis Analytical Data Warehouse – cross continuum Clinical Dashboard Comparative Effectiveness Analytics ACO Risk & Revenue Management Cost accounting across the continuum of care; global contracting; member data management Provider management; allocation of payment Pool management; disease improvement RCM for ACO Analytical Data Warehouse Health Information Consulting, LLC

Example - Hospital / Physician Integration Hospital bias toward enterprise system choices Lack of granular understanding of practice workflows, requirements Nomenclature and data integration and normalization between hospitals and physicians Patient identifiers between hospitals and clinics Orders being received by hospitals from physician EHRs Physician use of multiple clinical documentation systems Hospital portal access and download of data to EHR Hospital links to office EHR via web − Images − Security issues Enterprise Data Analytics – common clinical model − E. g. Marshfield Semantic interoperability project Health Information Consulting, LLC

Example: Physician EHR Environment Summary HIE Requirements Lab Information Systems – reference labs, hospitals etc. − Orders − Results − Status Documents − Outbound CCD/CCR − Outbound referral request − Outbound referral results (CCD) Pharmacy Imaging − Outbound e. Rx to Retail − Links to Hospital PACS from hospital results records − Outbound patient record to hospital – active meds − Links to Clinic PACS from hospital devices − Inbound patient history – CCD Orders / Results – Hospitals − Inbound patient active meds – − Radiology hospital discharges – − Cardiology medication reconciliation − Others Health Information Consulting, LLC

Buying an EHR Have a plan as to how you will make your decision Include as many clinicians and operations members as you can Map all of the your detailed requirements to what the vendor says they can do and make sure they are transferred into the contract Don’t rush your decision Speak to as many references as you can Don’t sign their standard contract Health Information Consulting, LLC

Health Information Exchange & Care Coordination

NO MATTER WHAT THE HOSPITAL RELATIONSHIP… CV PRACTICES ARE GOING TO BE ASKED TO BE A CRITICAL COMPONENT OF CARE COORDINATION Health Information Consulting, LLC

Data and Information Exchange Clinical Information / Data Point of Care Health Information Consulting, LLC Care Continuum

Health Information Exchange (HIE) Definition: HIE refers to the process associated with the electronic movement of health-related data and information among organizations at the community, regional, statewide, or nationwide levels according to agreed standards, protocols, and other criteria. Health Information Consulting, LLC

Health Information Exchange (HIE) GROUP PRACTICE Imaging Center LAB OTHER HIE’s Primary Functions: HOSPITALS Rx PHYSICIAN Consumer Long Term Care Public Health Information Consulting, LLC Health Information Exchange Platform State of IL • Secure clinical information sharing • Coordination of care • Support Accountable Care Organizations • Quality and health status reporting • Shared platform

Cardiovascular HIE Requirement Cardiovascular groups will be a significant target for health information exchange over the next 2 years with target for implementation by 2013 (Stage 2) Coordination of care and reduction of duplicate testing are the primary objectives ED access to CV patient records – Wisconsin Study CCD exchange PHR service Health Information Consulting, LLC

Physician EHR Environment Summary HIE Requirements Lab Information Systems – reference labs, hospitals etc. − Orders − Results − Status Documents − Outbound CCD/CCR − Outbound referral request − Outbound referral results (CCD) Pharmacy Imaging − Outbound e. Rx to Retail − Links to Hospital PACS from hospital results records − Outbound patient record to hospital – active meds − Links to Clinic PACS from hospital devices − Inbound patient history – CCD Orders / Results – Hospitals − Inbound patient active meds – − Radiology hospital discharges – − Cardiology medication reconciliation − Others Health Information Consulting, LLC

Conclusions Dawn of a New Era EMR - MU – Stage 1, 2 & 3 - CV Patient Centric Care Coordination Processes HC Reform Rule Flexibility ACO Development Data supports Quality Outcomes Consumer Focus & Engagement Health Information Consulting, LLC

Thanks ! Health Information Consulting, LLC Mike Mytych mmytych@hicllc. com 262 -253 -9110 Health Information Consulting, LLC