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February 2007 — Volume 2, No. 2 Take the Digital Office 20-second Survey Pay for Performance Share your opinion on pay-for-performance in just 20 seconds...the Digital Office 20-second Survey wants your thoughts. Take the survey to be entered into a drawing for Guide to the Electronic Medical Practice: Strategies to Succeed, Pitfalls to Avoid edited by Steven L. Arnold MD, MS, CPE. Written by physicians, nurses, and IT professionals, this book brings a hands-on perspective to the challenges and solutions of implementing the electronic health record in the medical practice. So just access the survey and look for the results in the March edition of the Digital Office. Special Issue – Bridges to Excellence The Digital Office talked with Francois de Brantes, National Coordinator, Bridges to Excellence, and COO of the eHealth Initiative. Following is a question-and-answer interview with Mr. de Brantes. As an introduction to this article, the paragraph that follows (from the BTE Web site) defines Bridges to Excellence and provides a link for more information. Bridges to Excellence is a multi-state, multi-employer coalition developed by employers, physicians, healthcare services researchers and other industry experts. The BTE mission is to reward quality across the health care system, and is a grantee of the Robert Wood Johnson’s Rewarding Results grant program. BTE is a not-for-profit organization created to encourage significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they deliver safe, timely, effective, efficient and patient-centered care. Visit the BTE Web site to learn more. An Interview with: Q. Please elaborate on your position as National Coordinator for Bridges to Excellence? Q. What is the general mission of BTE and how has the organization "rewarded quality" for participating organizations, especially in the ambulatory care setting? A. BTE has been rewarding physicians across the country for delivering good quality care to patients with diabetes and cardiovascular disease and has also been rewarding physicians for adopting better systems of care. We have found that physicians who go through an internal assessment of the quality of care they deliver are energized by the prospect of improving that quality. These physicians then use the incentives as a means to invest in the right types of processes in their practices Q. In a recent white paper, you discuss the Prometheus system - ie - "family physicians would get justly rewarded for saving money by keeping patients healthier." Can you elaborate on this system and its success...and barriers to adoption? A. PROMETHEUS Payment(TM) is a new payment model that we are still in the process of developing and that is based on the creation of Evidence-informed Case Rates (ECRs). These ECRs cover all the care a patient should get for a specific condition, inpatient and outpatient. As such, it provides an opportunity for any provider that delivers care paid for by an ECR to reap the rewards of better patient management. For example, assume a normal patient with Type 2 diabetes is covered by an ECR with a price of $10,000 annually. If the physician manages the patient well, that patient's total cost is likely to be less than $10,000 because the $10,000 includes an allowance for hospitalization. And if the physician can manage that (and other patients with type 2 diabetes) for say $9,000 on average, then that physician would get to keep the difference between actual and case rate, or $1,000 per patient. The single biggest obstacle to the launch of PROMETHEUS is that it's complicated, as anyone would expect a new payment model to be. Q. How has BTE made rewarding quality in healthcare easier? Better?
Today, most quality measurement and incentive efforts are adopting these critical lessons, and they're having secondary effects. For example, the focus on intermediate and full outcomes is making policy-makers and agencies like AHRQ focus on how to measure quality through EHRs. Additionally, health information exchanges are being looked at as potential vehicles to facilitate the systematic collection of key data from medical records that will help everyone get a better measure of the output created by the $1.7 trillion invested in health care every year. It may take a while to get to the point where physician performance is measured systematically through EHRs, but we're on the path. Q. What are the next steps that you consider vital in the ongoing quest for improved delivery of healthcare? A. Reforming the payment system has got to be one of the top priorities. The way money flows into physician offices and hospitals today creates a barrier to quality improvement, and we need to remove that barrier. That's what PROMETHEUS is all about, and the way to get to that more fundamental reform is to start with programs like BTE. A. There are BTE implementations in more than a dozen states now and we hope to almost double that by year end, hitting most of the highly populated States in the country. In addition, we'll be launching the Spine Care Link in Q1 of 2007, and the Internal Medicine Care Link later this year. The Practice Manager’s Perspective What Your Provider Wants In an by Nancy Babbitt, FACMPE Nancy Babbitt’s perspective as a practice manager will appear in three parts in the Digital Office. This first installment covers educating the physicians about the new EMR system. Roswell Pediatric Center is a 2003 Ambulatory Davies Award of Excellence recipient. Are you ready to take the plunge and start looking for an EHR? Are your doctors finally ready to start the search? David Brailer, MD, PhD, the first Coordinator of the Office of the National Coordinator for Health Informatics Technology (ONC), stated 50 percent of all EHR implementations fail because physicians do not understand the process. Developing strategies for success before starting your search will help you integrate technology into your practice and excel in these career-defining decisions. Most physicians want be educated about beginning the search and have their time used wisely.
Some physicians want to know and understand all the acronyms, like the difference between an EMR, EHR, CCR, CPR etc., and some want to know all the “Techie terms.” Acronyms and definitions can vary from vendor to vendor and organization to organization; they may also change from year to year. Some physicians may be interested in functionality or disease state management for their specialty, while others might concentrate on cost and return on investment. Some physicians will want to know it all.
If goals and deadlines are set and achieved, the project and the momentum will keep moving forward. Some physicians may think they are too busy to spend time on the search. The temptation exists to buy the system they talked to their friend about at the hospital that morning or that their college buddy is selling. It is tempting for them to ask their practice administrator to pick out a system for them.
But remember, the physicians and clinical staff will be using the EMR every day for patient care, not the administrator. Just because the system works for a colleague down the street, it may not work for your practice. Even practices using the same system typically use them in different ways. It is imperative to have some physician involvement during the evaluation of the practice needs, the search, and the implementation. Privacy & Security in EMRS – Find out more about privacy and security related to EMRs and government action.
HIMSS07 - The 2007 Annual HIMSS Conference & Exhibition is just days away in New Orleans, La. It will be held from Feb. 25 – March 1 at the Ernest N. Morial Convention Center. Visit the HIMSS Web site each day during the conference for updates. Dates to Remember
May 3 - Orlando, Fla. National Patient, or Provider, Identifier/NPI: A system for uniquely identifying all providers of healthcare services, supplies and equipment. Pay for Performance: Pay-for-performance, or pay-for-quality, is a payment approach used in healthcare that is based on clinical information-driven reform. The fundamental concept is to tie payment to how well providers adhere to practice standards. The practice standards are evidence-based and tied to clinical outcomes. The primary areas of focus are preventive care delivery and disease management for chronic illnesses. PROMETHEUS – Find out more about the PROMETHEUS model in “New Financing Model Could Reward Primary Care,” an article from AAFP News Now. A Call to Action: National Provider Identifier The impact on your office
It is less than 100 days and counting until the healthcare ecosystem will evolve from a cache of unique and inconsistent alpha & numeric identifiers to a personal unique National Provider Identifier. Physicians, ancillary providers, hospitals, and health plans and payers have been struggling with how to meet the government’s deadline for implementation in May 2007. A majority of providers may be relatively unaware of the impact that this May deadline will have on their “cash flow” and operational processing. Many providers have obtained an NPI and state that “they have not been asked” for the number. The number can only be obtained by the providers. Unless the provider proactively provides it to all trading partners that the provider issues bills to and receives payment from, the trading partner does not have a mechanism to update its data files. Points to remember:
This is a transformational event for the healthcare ecosystem with unknown impact, but with the potential to disrupt CASH FLOW. Professionals on the business side of healthcare understand the operational impact when beginning a relationship with a new health plan or a payer, or when technology updates impact data files. Disruptions can include:
This is a call-to-action as the potential impact of the NPI to business is real. Many of the major payers and health plans have not initiated the testing phase in their transformation, some because providers have not shared their NPI. Providers must take responsibility to obtain a number and provide the number to all of their trading partners. CCHIT Announces 18 New Products Earn Certification 
In January, the Certification Commission for Healthcare Information Technology (CCHIT) announced that 18 additional electronic health record products for office-based physicians have been awarded CCHIT certification – a milestone for the organization, which now estimates it has certified about 25 percent of companies in the ambulatory EHR market in just nine months. Upcoming Dates for Public Comments, Applications
Final Public Comment Period for Ambulatory EHRs
In July 2006, HIMSS formed the Ambulatory Community Health Organizations (ACHO) Task Force. The purpose of the ACHO Task Force is to bring together information technology and clinical experts who work for organizations that deliver healthcare to underserved populations (safety net populations) and vendors that develop and support technology used by ACHOs. ACHOs include Federally Qualified Health Centers (FQHCs), non-FQHC community health centers (other CHCs), rural health clinics, Indian Health Service clinics and public health department clinics. About 8,000 ACHO clinics exist and are represented in every US state and territory. They serve close to 20 million Americans. The Ambulatory CHO Task Force includes organizations across the country that are of many types, cultures, and sizes. The task force has 80 members and is growing, thanks to the aggressive recruiting efforts of the groups founding members and HIMSS staff. The primary purpose of this group is to create a forum where innovative ideas on healthcare information technology adoption can be shared to promote the widespread use of HIT by ambulatory community health organizations. The accompanying map graciously provided by the National Association of Community Health Centers (NACHC) shows as black dots (which may not show well) the locations of 3,800 community health centers. The map link following depicts geographic areas with either or both the community health centers and 3,500 rural health clinics, http://www.nrharural.org/groups/graphics/safetynet-lg.gif. The vision of the HIMSS ACHO Task Force is to be a national constituency of ambulatory community health organizations that encourages the informed development and adoption of interoperable HIT for improving patient care and cost-effectiveness for the underserved. The mission of ACHO is to foster collaboration and information-sharing among ACHOs and IT vendors that
If you are interested in information about or wish to join the ACHO Task Force, please contact Jill Redenius at jredenius@himss.org.
Grove Medical is affiliated with Central Massachusetts Independent Physician Association (CMIPA), a 150-physician IPA in Worcester, Ma. Grove Medical implemented its electronic medical record in August 2005, and noticed efficiencies as early as October 2005. At first, just joining Bridges To Excellence (BTE) seemed somewhat complex, however, the local Quality Improvement Organization (QIO), MassPRO, provided a webinar that simplified the process enabling their physicians to readily participate. By joining the BTE, Grove received its first payment ’05 just as a result of having implemented an EMR. Grove’s EMR, eClinicalWorks, includes functionality that allows for preventive screening measures (such as A1c, eye exam, lipids for diabetes, mammography, and cardiovascular measures) to appear on the same screen as the patient record. “Awareness makes you work harder to make screenings happen. As well, being able to easily pull a list of patients who are due for a certain preventive screening, makes it possible for the front desk, triage, billing, and the patient to all be actively involved in focusing on these preventive measures, taking the weight solely off of the physician”, explained Gail Cetto, RN, at Grove. By using the EMR to leverage this knowledge for the benefit of the patient, BTE criteria are met for incentive pay. This was possible with paper, but with the EMR, it is much simpler, creating greater awareness for all involved. Nurses can provide important reminders through electronic reports that are far more accurate and less time consuming than paper, however, patients still need to become actively engaged. Patients, who are not compliant, even with the increased knowledge, awareness, and prompting of the entire practice staff, will tend to be those with a trend of hospitalization for their conditions that could have been avoided with preventive screening measures. “I would love to talk to any of the nurses out there. Truly... there is so much in the EMR to allow the nurses to speak to any patient in their facility...and actually know what they are talking about vs. ‘okay, well, I am going to pull your chart and call you back’ and then try to figure it out by riffling through the chart (if they can find the chart). When I am covering someone...I call up the patient, click quickly to Medical Summary and know diagnosis, meds and alerts. It does not get any better than that... we were just talking about how inefficient we use to be (and we thought we were efficient)... I AM SO HAPPY TO BE ON THIS SIDE OF THE FENCE.” Grove Medical is looking forward to its next phase of EMR implementation, incorporating a patient portal. Staff has been able to access the EMR from home, which has been a great advantage. However, the opportunity for patients to be even more actively engaged in their care via the patient portal opens up very exciting opportunities. Thinking About Implementing Health IT The 2007 HIMSS Interoperability Showcase For any healthcare organization or physician practice thinking about transitioning from paper to digital records, the 2007 HIMSS Interoperability Showcase features cutting-edge technology and standards that create an interactive environment where attendees experience interoperability up close and personal. HIMSS and its industry partners are working together to continue to demonstrate the value and benefits of an interoperable EMR at the Interoperability Showcase on the exhibit floor at HIMSS 2007. Visit http://www.himss07.org/exhibition/interop.aspx to read more about the HIMSS Interoperability Showcase on the HIMSS07 Web site. Already There…Implemented Health IT
Our EMR Improved Patient Care & Billing Systems The transition from a paper office to a paperless office can seem like a daunting task. In our experience at Mount Kisco, we learned that you need to find an EMR solution that is equal in product quality to vendor support, and for us that choice was Misys EMR. This is a major key to implementation success and is how we were able to increase the time focused on patient care while decreasing time wasted and money spent. Mount Kisco Medical Group PC (MKMG) is the oldest multi-specialty medical group in New York State with 130 healthcare professionals. We annually serve about 250,000 patients and perform more than 400,000 patient contacts per year, not including laboratory and imaging. We switched to an EMR because of our desire for a paperless office, and were amazed with all the benefits that came attached. Having universal availability of the medical record provides physicians with more time to focus on patient needs and their immediate care instead of looking for charts or for a report. Patient confidence is also essential. With a group practice like ours, physicians constantly travel to various offices. Yet, with our EMR, we have achieved a continuum of care. If a patient that was seen in a different office calls with a follow-up question, the doctor has immediate access to that information. Our patients feel secure; knowing that they are receiving the highest possible level of care. The rewards are clear. We now have far more space to continue to grow and expand our practice. Our record room takes up the same area--and our group has more than doubled in size. We are now seeing three times the amount of patients and we only need a small fraction of the record room staff that we formerly had. Abe Levy, M.D., is the Medical Director and Chief Quality Officer at Mount Kisco Medical Group PC. Christopher J. Sclafani, is the Chief Operating Officer of Mount Kisco Medical Group PC.
The HIT Dashboard The latest information on over 500 state, federal, and private HIT initiatives
Your peers belong. Your mentors belong. |
by Ellen Van Buskirk 
CCHIT Seeks Public comment on Inpatient EHR Criteria
Shelton Barnes, MD, rebuilt his practice with assistance from the HIMSS Foundation’s Katrina Phoenix project. Now equipped with an EMR, Dr. Barnes, whose practice is in New Orleans, continues to serve his patients who returned after the storm as well as new patients. He is a family practitioner and his wife, Dr. Janet Barnes, is a pediatrician; they have practiced medicine together for more than two decades. Of the EMR, he noted, “I wish I would have had this 25 years ago.”
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