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FQHC in Western NC
Four Comprehensive School-Based Health
Centers – over 2,000 students served with 9,430
encounters for nursing, medical, dental,
behavioral health, & nutrition services
Serve over 16,000 total patients annually with
over 70,000 encounters for primary care,
dental, behavioral health, nutrition, migrant
outreach services, and school health
Joint Commission accredited for ambulatory
care/slated for PCMH recognition in early 2013
Vetted five different, certified vendors –
took more than 6 months to coordinate
site visits & demonstration
 Key stakeholders involved in process, but
providers and clinical staff made final
choice on the EMR
 GE Centricity v9.0 chosen in 2010;
completed upgrade to v10.0 in 08/12
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After selection, created an EMR implementation
team that consisted of provider staff, billing staff,
administration, support staff, IT staff and senior
administration
Equipment review to ensure wireless capabilities and
ordering of laptops/tablets; inventory and tagging of
all equipment; creation of “responsibility forms” for
staff signing out tablets
Assigned a project manager (internal staff) to help
guide the project (previous experience with software)
– other duties were minimized to ensure adequate
time was given to project
Clinical Project Manager assigned from software
company
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Implemented in phases:
› Phase 1: Six months before go-live, began using
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registration process and billing systems (October
2010)
Phase 2: Determined which patient records should
be scanned into system (any patient with a visit in
the last 3 years) and hired outside company to scan
records into system (October 2011-February 2011)
Phase 3: First “go-live” with family practice and
school-based health centers (February 2011)
Phase 4: Lessons learned from Phase 3, used for rollout of next phase: Behavioral Health and Pediatrics
Phase 5: Dental go-live
Clinical Champion on staff essential – SBHC
staff provider took this role (double win!)
 Make decisions based on consensus and
find a middle ground for items
 After implementation, project manager
could not get away from software
management (staff looked to this person as
an expert)
 Ongoing support and number of staff
involved to maintain EMR can add
additional FTE to organizational budget
($$$)
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SBHC data management specialist is a “super
user” on the practice management side
Provider “champion” for EMR is an SBHC
provider
Ability to view records across organization – if
student seen in night clinic after hours, provider
has access to SBHC records
Integrated record – all services in one
Easier reporting/management of data
Faster turn around for supervising physician to
sign documents and review records for clinical
supervision protocols
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Meaningful use is using certified electronic
health record (EHR) technology to:
› Improve quality, safety, efficiency, and reduce
health disparities
› Engage patients and family
› Improve care coordination, and population
and public health
› Maintain privacy and security of patient health
information
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Ultimately, it is hoped that the
meaningful use compliance will result in:
› Better clinical outcomes
› Improved population health outcomes
› Increased transparency and efficiency
› Empowered individuals
› More robust research data on health systems
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Simply put, "meaningful use" means
providers need to show they're using
certified EHR technology in ways that
can be measured significantly in quality
and in quantity.
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The three stages of Meaningful Use are
designed to support eligible professionals
and hospitals with implementing and
using EHRs in a meaningful way to help
improve the quality and safety of the
nation’s healthcare system. Stage 1 of
the EHR Incentive program began in
2011, with Stages II and III to be
established by future CMS rules.
The Meaningful Use criteria, objectives and measures will evolve in three stages
over the next five years:
Stage 1
2011-2012
Data Capture
and Sharing
Stage 1 Focus:
Stage 2
2013
Advanced
Clinical
Processes
Stage 2 Focus:
Stage 3
2015
Improved
Outcomes
Stage 3 Focus:
Electronically capturing
health information in a
standardized format
More rigorous health
information exchange
(HIE)
Improving quality, safety,
and efficiency, leading to
improved health outcomes
Using that information to
track key clinical
conditions
Increased requirements for
e-prescribing and
incorporating lab results
Decision support for national
high-priority conditions
Communicating that
information for care
coordination processes
Electronic transmission of
patient care summaries
across multiple settings
Patient access to selfmanagement tools
Initiating the reporting of
clinical quality measures
and public health
information
More patient-controlled
data
Access to comprehensive
patient data through
patient-centered HIE
Using information to
engage patients and their
families in their care
Improving population health
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An important objective set forth in the
Meaningful Use Stage 1 final rule is that eligible
professionals and hospitals who participate in
the program must be able to record, store, and
report clinical quality measures (CQM).
In the Meaningful Use Stage 1 final rule, CMS
defines CQM as the “processes, experience,
and/or outcomes of patient care, observations
or treatment that relate to one or more quality
aims for health care such as effective, safe,
efficient, patient-centered, equitable, and
timely care.”
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Who is an “eligible professional”?
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Physicians
Pediatricians
Dentists
Optometrists
Nurse Practitioners
Physician Assistant (must be in an FQHC/RHC led by a Physician Assistant)
Can be part-time or full-time providers
Must meet criteria for patient volume, depending on if attesting
to Medicare or Medicaid
 For FQHCs, patient volume for Medicaid also includes uninsured
 Meaningful use criteria for eligible professionals
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 15 core objectives
 5 out of 10 from menu set objectives
(1) Use CPOE for medication orders directly entered by any licensed
healthcare professional who can enter orders into the medical record
per state, local and professional guidelines.
(2) Implement drug-drug and drug-allergy interaction checks
(3) Maintain an up-to-date problem list of current and active diagnoses.
(4) Generate and transmit permissible prescriptions electronically (eRx).
(5) Maintain active medication list.
(6) Maintain active medication allergy list.
(7) Record all of the following demographics:
(A) Preferred language.
(B) Gender.
(C) Race.
(D) Ethnicity.
(E) Date of birth.
(8) Record and chart changes in the following vital signs:
(A) Height.
(B) Weight.
(C) Blood pressure.
(D) Calculate and display body mass index (BMI).
(E) Plot and display growth charts for children 2–20 years, including BMI.
(9) Record smoking status for patients 13 years old or older.
(10) Report ambulatory clinical quality measures to CMS or, in the
case of Medicaid EPs, the States.
(11) Implement one clinical decision support rule relevant to
specialty or high clinical priority along with the ability to track
compliance with that rule.
(12) Provide patients with an electronic copy of their health
information (including diagnostics test results, problem list,
medication lists, medication allergies) upon request.
(13) Provide clinical summaries for patients for each office visit.
(14) Capability to exchange key clinical information (for example,
problem list, medication list, allergies, and diagnostic test results),
among providers of care and patient authorized entities
electronically.
(15) Protect electronic health information created or maintained by
the certified EHR technology through the implementation of
appropriate technical capabilities.
(1) Implement drug formulary checks.
(2) Incorporate clinical lab-test results into EHR as structured data.
(3) Generate lists of patients by specific conditions to use for quality improvement,
reduction of disparities, research, or outreach.
(4) Send patient reminders per patient preference for preventive/follow-up care.
(5) Provide patients with timely electronic access to their health information
(including lab results, problem list, medication lists, and allergies) within 4
business days of the information being available to the EP.
(6) Use certified EHR technology to identify patient-specific education resources
and provide those resources to the patient if appropriate.
(7) The EP who receives a patient from another setting of care or provider of care or
believes an encounter is relevant should perform medication reconciliation.
(8) The EP who transitions their patient to another setting of care or provider of care
or refers their patient to another provider of care should provide summary care
record for each transition of care or referral.
(9) Capability to submit electronic data to immunization registries or immunization
information systems and actual submission according to applicable law and
practice. (THROUGH EXCLUSION, NCIR CANNOT OFFER THIS RIGHT NOW)
(10) Capability to submit electronic syndromic surveillance data to public health
agencies and actual submission according to applicable law and practice.
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Must meet two years of Stage 1 criteria before
moving to Stage 2 in the third year
In the first year of participation, providers must
demonstrate meaningful use for a 90-day EHR
reporting period; in subsequent years, providers will
demonstrate meaningful use for a full year EHR
reporting period
For 2014 only: All providers regardless of their stage
of meaningful use are only required to demonstrate
meaningful use for a three-month EHR reporting
period. CMS is permitting this one-time three-month
reporting period in 2014 only so that all providers who
must upgrade to 2014 Certified EHR Technology will
have adequate time to implement their new
Certified EHR systems.
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Stage 2 retains this core and menu structure for
meaningful use objectives. Although some
Stage 1 objectives were either combined or
eliminated, most of the Stage 1 objectives are
now core objectives under the Stage 2 criteria.
For many of these Stage 2 objectives, the
threshold that providers must meet for the
objective has been raised.
To demonstrate meaningful use under Stage 2
criteria—
› EPs must meet 17 core objectives and 3 menu
objectives that they select from a total list of 6, or a
total of 20 core objectives.
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Stage 2 also replaces the previous Stage 1
objectives to provide electronic copies of
health information or discharge instructions
and provide timely access to health
information with objectives that allow patients
to access their health information online.
Stage 2 criteria place an emphasis on health
information exchange between providers to
improve care coordination for patients.
New Stage 2 measures for several objectives
require patients to use health information
technology in order for providers to achieve
meaningful use.
Choose a MU-certified EHR system – essential to Stage 1
 Determine eligible professionals
 Create MU performance improvement team (PI team) to
determine additional objectives to be measured/tracked
– making sure to meet attestation requirements
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› MU PI Team combined staff from EHR implementation team
(provider champion)
› MU PI Team reviewed needed forms edits and other revisions in
EHR needed to track discrete data
Use of local Regional Extension Center/AHEC
representative to assist with step-by-step process in
selecting additional measures & reviewing EMR
capabilities
 Internal MU reports are completed weekly and shared with
provider staff to promote immediate improvement in
process to capture needed data
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Choosing a MU certified EMR from the beginning is
essential
It will take a lot longer to implement than you realize
› Changes to forms
› Edits to information in the EMR
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Important to have a provider champion who can
work with clinical staff to implement needed
changes and be “on the floor” to answer questions
as they arise
When recruiting providers, must be aware of which
program(s) they have attested to and for which years
Must strategically look ahead to next wave of
technology – especially patient portals – and budget
accordingly to meet needs
There are many requirements that you
must meet for both PCMH and MU
 PCMH/MU Crosswalk
 Implementing Meaningful Use will
actually help in achieving PCMH
 It all begins with EMR implementation
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Formulary Checks
Lab Data in EMR
Pt lists by condition
Pt reminders
Pt e-access to info
Pt ed resources
Medication Reconciliation
Care Summary @Transition
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Submit to Imm. Registry
Pub Health Surveillance
CPOE for med orders
Drug-drug/drug allergy cks
Problem list
E-Prescribe
Active Med list
Allergy List
Demographics
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Ht/Wt/BP/BMI
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Smoking status
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Report to CMS
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Clinical Decision Support
Standing Orders
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Pts get info
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Clin summaries of encounter x
Exchange info btw providers x
Protect info
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www.hrsa.gov/healthit/meaningfuluse
www.cms.gov
www.amc.org
www.cdc.gov
www.himss.org
www.managemypractice.com
http://www.ihi.org/IHI/Topics/Improveme
nt/ImprovementMethods/Measures/
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Contact Information:
Tammy Greenwell, COO
Blue Ridge Community Health Services,
Inc.
828-233-2288
tgreenwell@brchs.com