Healthcare IT Podcast» meaningful use

Working with the CMIO & Tackling Readmissions

Spencer — Fri, 06 Jan 2012 05:06:21 +0000

Two topics in this week’s podcast. First, a quick discussion about the CIO / CMIO relationship. The second and extremely urgent topic is the necessity for hospitals to gain control of their readmission rates or risk penalization in the form of reduced Medicare payments.

Chief Information Officers (CIOs) in hospitals are still learning how to work with their Chief Medical Information Officers (CMIOs). The relationship in some organizations is wonderful, in others the relationship is tenuous, and at some the relationship is non-existent. On this show, I talk a bit about the CIO / CMIO relationship, and the necessity of the CIO learning to work with, not against, their CMIO. I also devote significant time discussing what is going to be a hot topic in 2012 and 2013, right up there with achieving Meaningful Use, the evolution of HIPAA 5010 compliance, and ICD-10 implementations – reducing hospital readmissions.

I am continually surprised how many CIOs are unaware of the penalties that will face hospitals with high Medicare readmission rates beginning in 2013. Penalties in federal fiscal year (FFY) 2013 will begin at 1% of all IPPS payments to offending hospitals, climbing to 2% in 2014 and up to 3% in 2015.

CIOs need to work closely with their CMIOs to begin addressing these issues now, if work has not already begun. With the clinical process redesign activities hospitals are undertaking as part of their Meaningful Use initiatives, right now is the perfect time to begin incorporating changes that can positively impact readmission rates.

I hope you enjoy this podcast. If you have any questions or comments, please feel free to email me at spencer@itpodcast.org or log into this website and post your own comments. I guarantee that I will personally respond to anyone who emails or posts comments.

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Thank you for listening!

Spencer Hamons
ITPodcast.org

Differences between Medicare and Medicaid EHR Incentive Programs

Spencer — Thu, 18 Aug 2011 05:51:46 +0000

In this week’s show, we explore the differences between the Medicare and Medicaid EHR incentive programs. Yes, there are significant differences between the two programs, ranging from how much the incentives are worth, who is considered an eligible provider (EP), and even the deadlines for filing. One of the most significant differences between the two programs is that while the Medicare EHR incentive program requires an eligible provider to demonstrate meaningful use to receive payment, the Medicaid program requires the EP only to sign a contract for a certified EHR. Yes, you read that correctly. The podcast about this and other differences is below, and further down in this post is a matrix detailing the differences between the two programs, along with other useful links.

You can listen to the podcast streaming directly from this site, or add the feed to your iTunes or RSS consolidator using these links:

Below is the matrix detailing the high-level differences between the two programs. Further down are the links that I mention in this episode’s podcast.

Useful Links:

As always, I look forward to hearing your thoughts and comments. Please feel free to email me at spencer@itpodcast.org and I will get back with you. I answer all listener emails.

Thank you again for listening,

Spencer Hamons

ARRA and “Meaningful Use”

Spencer — Sat, 04 Jul 2009 02:34:10 +0000

As I said on the last show, the Kuskokwim River break up here in Bethel, Alaska brought around some great fishing and hunting, and it has been a busy project season at work as well. The best part is the sunset at 1:00am, with the perpetual dusk and dawn, there is always enough light outside to play by. It is extremely nice to get off work at 6:00pm and still have hours of daylight to play.

Before I get down to business about today’s podcast, I do have to show off a picture of my son and his King Salmon from the Kuskokwim River.

On todays show, I talk about the American Recovery and Reinvestment Act of 2009 and how we can expect to see it impact our industry. Don’t worry, I keep it short…less than 10 minutes even with bumper music.

In the podcast, I talk about a presentation provided by the working group. A link to the Meaningful Use Presentation can be found here.

To view a report by the American Health Information Management Association regarding physician incentive payments, you can follow this link.

For another article on HITECH and Meaningful Use, specifically about the physician incentives for meaningful use, follow this link.

And here, you will find some updated and very comprehensive information about meaningful use and physician incentives.

Meaningful Use Objectives	Corresponding EHR Software Features	Meaningful Use Measures
Use Computer Provider Order Entry (CPOE)	Enable a user to electronically record, store, retrieve, and manage, at a minimum, the following order types: Medications; Laboratory; Radiology/imaging; Provider referrals; Blood bank; Physical therapy; Occupational therapy; Respiratory therapy; Rehabilitation therapy; Dialysis; Provider consults; and Discharge and transfer.	CPOE is used for at least 80% of all orders; 10% for hospitals
Implement drug/allergy checks	(1) Real-time, alerts at the point of care for drug-drug and drug-allergy contraindications; (2) Electronically check if drugs are in a formulary or preferred drug list; (3) Provide certain users rights to deactivate, modify, and add rules for drug-drug and drug-allergy checking; (4) Track number of alerts users respond to	Function is enabled
Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®	Electronically record, modify, and retrieve a patient’s problem list over multiple visits	At least 80% of all unique patients have at least one entry or an indication of none recorded.
E-prescribing (EP only)	Electronically transmit prescriptions	At least 75% of all permissible prescriptions written by the EP are transmitted electronically
Maintain active medication/allergy list	Electronically record, modify, and retrieve a patient’s active medication/allergy list	At least 80% of all unique patients have at least one entry or an indication of “none”
Record demographics	Electronically record, modify, and retrieve patient demographic data	At least 80% of all unique patients have demographics recorded
Record and chart changes in vital signs	(1) Enable a user to electronically record, modify, and retrieve a patient’s vital signs; (2) Automatically calculate and display body mass index (BMI); (3) Plot and electronically display, upon request, growth charts for patients 2-20 years old.	For at least 80 percent of all unique patients age 2 and over seen by the EP or admitted to the eligible hospital, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20
Record smoking status for patients 13 years old or older	Electronically record, modify, and retrieve the smoking status of a patient	At least 80% of all unique patients 13 years old or older have “smoking status” recorded
Incorporate clinical lab-test results into EHR as structured data	(1) Electronically receive clinical laboratory test results and display such results in human readable format; (2) Electronically display in human readable format any clinical laboratory tests that have been received with LOINC® codes; (3) Electronically display all the information for a test report; (4) Electronically update a patient’s record based upon received laboratory test results	At least 50% of all clinical lab tests results are incorporated as structured data
Generate lists of patients by specific conditions	Electronically select, sort, retrieve, and output a list of patients and patients’ clinical information	Generate at least one report listing patients with a specific condition
Report ambulatory quality measures to CMS or the States (EP only)	(1) Calculate and electronically display quality measure results as specified by CMS or states; (2) Electronically submit calculated quality measures	For 2011, an EP/hospital would attest this has been done
Send reminders to patients for preventive/follow-up care	Electronically generate a patient reminder list for preventive or follow-up care	Reminders sent to at least 50% of all unique patients that are 50 and over
Implement five clinical decision support rules relevant to specialty or high clinical priority	(1) Implement automated, electronic clinical decision support rules according to specialty or clinical priorities; (2) Automatically and electronically generate real-time alerts and care suggestions based upon clinical decision support rules and evidence grade; (3) Automatically and electronically track, record, and generate reports on the number of alerts responded to by a user	Implement five clinical decision support rules relevant to the clinical quality metrics the EP/Eligible Hospital is responsible for
Check insurance eligibility electronically	Electronically record and display patients’ insurance eligibility, and submit insurance eligibility queries	Insurance eligibility checked electronically for at least 80% of all unique patients
Submit claims electronically to public and private payers.	Electronically submit claims	At least 80 % of all claims filed electronically
Provide patients with an electronic copy of their health information upon request	Enable a user to create an electronic copy of a patient’s clinical information and provide to a patient on electronic media, or through some other electronic means	At least 80% of all patients who request an electronic copy of their health information are provided it within 48 hours
Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request (Hospital only)	Enable a user to create an electronic copy of the discharge instructions and procedures for a patient, in human readable format, at the time of discharge to provide to a patient on electronic media, or through some other electronic means	At least 80% of all patients who are discharged from an eligible hospital and who request an electronic copy of their discharge instructions and procedures are provided it
Provide patients with electronic access to their health information within 96 hours of the information being available (EP only)	Enable a user to provide patients with online access to their clinical information	At least 10% of all unique patients are provided timely electronic access to their health information
Provide clinical summaries to patients for each office visit. (EP only)	(1) Enable a user to provide clinical summaries to patients (in paper or electronic form) for each office visit; (2) If the clinical summary is provided electronically (i.e., not printed), it must be provided in: 1) human readable format; and 2) and on electronic media, or through some other electronic means.	Clinical summaries provided to patients for at least 80% of all office visits
Exchange key clinical information among providers of care and patient authorized entities electronically and provide summary care record	(1) Electronically receive a patient summary record, from other providers and organizations; (2) Electronically transmit a patient summary record, to other providers and organizations	Provide summary of care record for at least 80 % of transitions of care and referrals; Perform at least one test of certified EHR technology’s capacity to electronically exchange key clinical information
Perform medication reconciliation at relevant encounters and each transition of care and referral	Electronically complete medication reconciliation of two or more medication lists into a single medication list that can be electronically displayed in real-time	Perform medication reconciliation for at least 80 % of relevant encounters and transitions of care
Submit electronic data to immunization registries and actual submission where required and accepted	Electronically record, retrieve, and transmit immunization information to immunization registries	Performed at least one test submission to immunization registries and public health agencies
Provide electronic submission of reportable lab results to public health agencies and actual submission where it can be received (Hospital only)	Electronically record, retrieve, and transmit reportable clinical lab results to public health agencies	Performed at least one test of certified EHR technology capacity to provide electronic submission of reportable lab results to public health agencies
Provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice	Electronically record, retrieve, and transmit syndrome-based (e.g., influenza like illness) public health surveillance information to public health agencies	Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies
Protect electronic health information through the implementation of appropriate technical capabilities	(1) Assign unique user names; (2) Permit certain users to access health information in an emergency; (3) Terminate an electronic session after a predetermined time of inactivity; (4) Encrypt and decrypt electronic health information that is stored and exchangd; (5) Record actions (e.g., deletion) related to electronic health information; (6) Track alterations of electronic health information; (7) Set up user verification measures; (8) Record disclosures made for treatment, payment, and health care operations	Conduct or review a security risk analysis and implement security updates as necessary

To summarize, the government now has told physicians and hospitals what tasks they should be using their EHR for (meaningful use); what EHR software features are needed to accomplish those tasks (certified EHR technology); and how the government is going to measure those tasks to determine whether or not they are being performed to their satisfaction.

I hope you enjoyed this month’s show. Please feel free to contact me if you have any questions or comments.

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Thank you for listening.

Spencer