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 NextGen 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 eRX Incentives
 Device Upgrades & Integration
 Preparing for Health Reform and participating in ACOs &
Health Information Exchange
 Others, ICD10 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 (eRx & 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
 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.

InfoGard 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&objID=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/EHRProductSearch
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
Vendor
Assessment &
Selection
1 to 3 months
Contract &
Implementation
Plan
1 to 2 months
Complete
Interfaces
for I/O
2 to 4 months
Training
Implementation
& Go-live
1 to 3 months
Total:
6 to 16 months depending on resources, size of group, PM integration and other variables.
Health Information Consulting, LLC
Reach
Meaningful
Use
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
PaceArt
Others
−

Comprehensive “one-stop shopping” for all 
patient records components from the

patient summary screen with individual
settings

Integration into clinic workflows
−
−
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
Interoperability - Your Device Integration

Echo, ECG, Stress, Holter, Nuclear, CT,
PV, etc.
Specialty Clinics: Limpid, AntiCoag, Device,
CHF, etc.
Lab Interfaces Quality Data / Measures – how is data
collected
Effective Clinical Decision Support –
documentation of non-std events
Executive Reporting / ease of use
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 eRx 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
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
Health
Information
Exchange
Platform
Health Information Consulting, LLC
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 eRx 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