MED3OOO Blog

MED3OOO's ICD-10 Strategic Plan

In April, HHS announced a proposed rule to defer implementation of ICD-10 by one year. Multiple professional organizations had urged HHS to consider the delay based on the industry’s overall lack of readiness for the transition and concerns that other statutory initiatives, including Meaningful Use, were stretching already limited resources. 

While the proposed October 1, 2014 deadline gives providers an additional year to prepare for change, MED3OOO has opted not delay our long-standing plans for testing, training, and implementing the new code set.  A smooth transition to ICD-10 is vital to the financial success of our clients and we are committed to providing customers with all the required technology and training in a timely fashion.

Our ICD-10 strategic plan includes: 

• Developing a senior level implementation team that includes representatives from all departments touched by ICD-10, including EHR, revenue cycle management, coding and compliance, and account management
• Certifying all senior Coding and Compliance staff members as ICD-10 trainers
• Incorporating cursory ICD-10 preparatory review within all client coding audits beginning in the second quart of 2013. The audits will include an introduction of ICD-10 and initial education on the ICD-10 rules.
• Developing a “Train the Trainer” program to be offered to all clients
• Customization of training and reference materials for clients and internal staff 
• Creating educational webinars to be offered monthly to clients and internal staff

In the coming months we will continue to provide updates on our progress. The implementation of ICD-10 remains one of our top priorities and we are committed to providing customers with the tools necessary for a successful transition.

Ready or Not, Here Comes Quippe!

InteGreat EHR Release 6.5 is now ready for general availability to all MED3OOO customers. Included in V6.5: the much anticipated Quippe visit documentation tool.

The Quippe technology, developed by Medicomp Systems, improves documentation recorded within the Visit Entry application area. A few things to know about Quippe:

    •    Quippe Technology is powered by the MEDCIN Engine
    •    Quippe assists providers by intuitively suggesting visit questions that the provider can consider at the point of care
    •    Quippe’s suggestions are based on information collected during the patient visit
    •    Both patient reported symptoms and observations recorded by a provider can be used to prompt additional visit questions for the provider to consider
    •    Quippe templates send information to the Orders and Prescriptions tabs within a visit; Charge Ticket calculations consider information recorded through a Quippe Template
    •    Useful prompts can be stored as shared content that providers can share with colleagues within their clinic.

The bottom line on Quippe is that this technology provides true end-to-end integration with the MEDCIN Engine, a proven knowledge software tool that adapts to the unique clinical presentation of each patient and provides all the codes required for compliance and reimbursement.

In addition to Quippe integration, other key enhancements in V6.5 include:

    •    Layout and functionality changes within the Audit Log that meet the CCHIT 2011 standards and improve the retrieval process of audit records.
    •    An improved layout for the Immunization Schedule View and a new pre-configured Immunization Series that allows for easier tracking of required doses.
    •    Enhancements to the Health Summary to highlight vital signs outside the normal range.
    •    Changes to the Intuit Patient Portal that improve patient communication and meet Meaningful Use requirements.
    •    Additional tracking tools in the Order Requisition application area.
    •    Numerous other enhancements that enhance workflow and efficiency.

We’d like extend a big thank you to both our in-house and ASP clients who participated in our InteGreat EHR beta cycles and allowed us to evaluate the product’s stability, usability, and performance. To coordinate your practice’s upgrade to InteGreat 6.5, please contact your Account Manager or Customer Support Analyst.

EHR Adoption Trends Climb

Thanks to the Meaningful Use program, PQRS incentives, and new reimbursement models, EHR adoption rates continue to climb. In fact, between 2002 and 2011, the percentage of office-based physicians using any type of EHR jumped from 18% to 55%. Despite the tremendous gains, certain types of physicians and practices are less likely than others to embrace EHR technology, according to a recently published study in Health Affairs.

The study examined EHR adoption trends over the last decade. The conclusion: physicians in non primary care and small practices and those over the age of 55 were less likely to be using any sort of EHR system. Moreover, adoption rates for these physician groups have grown more slowly than for physicians in primary care, for younger providers, and for those working in larger groups.

For example, in 2002 18% of specialists and 19% of primary care providers were using EHRs. By 2011 the adoption gap had widen, with 59% of primary care physicians using EHRs, compared to only 50% of specialists. Similarly, in 2002, 14% of physicians in one to two physician offices used EHRs, compared to 17% in groups with 10 or more doctors. By 2011, these percentages were 26% for small offices and 55% for the larger groups.

The study’s authors note that as younger physicians get older, adoption differences based on age may decrease, though the process will be slow. Additionally, overall adoption will likely increase as more small practices merge with larger groups or become part of hospital systems.

The researchers blame certain federal policies for the adoption gap between primary care providers and specialists. Several current programs, such as Regional Extension Centers, target primary care providers. To encourage more widespread adoption, the authors call for policy makers expand services and programs focused on specialists.

User friendly technology, such as InteGreat EHR with Quippe™, also encourages EHR adoption. InteGreat EHR with Quippe allows physicians to document patient encounters using iPads and supports handwriting recognition, gestures, and a variety of annotation tools. Quippe provides physicians with quick access to clinical decision support and patient management tools at the point of care.

InteGreat EHR v6.5 with Quippe is now in general release. Contact your MED3OOO account representative for more details.

ACA Hit Impact

How will the Supreme Court’s ruling on the Affordable Care Act (ACA) impact health IT? Are EHRs going to become irrelevant? Will money stop flowing to providers for their Meaningful Use of EHR?
While the outcome of the ruling is still unknown, here are a few points to consider:

• The EHR Meaningful Use program was part of the HITECH Act, a separate piece of legislation passed a year prior to ACA.  Regardless of the Supreme Court decision on healthcare reform, the EHR incentive program will not be in jeopardy. Keep working to achieve Meaningful Use!

• Several provisions in the ACA rely on a strong HIT foundation, most notably state health insurance exchanges (HIX), accountable care organizations (ACO), and consumer access to data. If the complete the ACA legislation is overturned, these programs would be in jeopardy.

• The components of the health reform law most relevant to physicians and hospitals are those pertaining to quality care initiatives, including the creation of ACOs. Achieving ACO targets for quality care and cost reductions will be difficult, if not impossible, without HIT systems. EHRs and other reporting tools are essential for analyzing and reporting on quality measures, for capturing data for pay for performance benchmarks, and for meeting Physician Quality Reporting program requirements.

The impact on HIT will vary depending on how the Supreme Court rules. The Court may allow the law to stand as is, or it may overturn the complete legislation, or it may strike only certain provisions.  HIMSS and other professional HIT organizations predict that regardless of how the Supreme Court rules, quality care initiatives in healthcare will continue in one form or another, meaning technology will still play an important role in healthcare.

For now, providers should remain focused on earning their Meaningful Use dollars and consider other HIT tools to improve the delivery of affordable, quality care.

Patient Centered Medical Home (PCMH)

As more practices embrace the Patient Centered Medical Home (PCMH) model, new evidence indicates the model can lead to improved health outcomes, a reduction in hospital admissions, and increases in patient satisfaction.  Additionally, the PCMH model can result in higher morale and job satisfaction rates among physicians and staff members.

Key to the PCMH model is an emphasis on patient engagement, data sharing, patient population management, care tracking and coordination between providers, and quality measurement and improvement. Without a solid HIT infrastructure, achieving some or all PCMH objectives can be difficult at best.

 Consider how HIT tools can support care delivery and effective communication:

• Automated patient recalls and reminders engage patients in their care. Likewise, a patient portal or practice Website can provide educational resources and give patients the ability to request prescription refills and appointments and securely communicate with providers.
• Central to the success of the PCMH model is data sharing between care givers. Technology such as EHRs and HIE platforms facilitate the capture and exchange of clinical information electronically between providers.
• EHRs, along with reporting tools to analyze and interpret data, help monitor and manage the health of a patient population. Analytics programs help providers identify chronic or high-risk patients and in order to pro-actively manage their care.
• HIT functionality facilitates the development and management of patient-specific care plans that can be shared electronically with other providers. Online access to clinical data from other providers ensures a more complete patient record, which ultimately improves safety and quality of care. When records are shared, duplicate testing (and duplicate costs) can be avoided.
• The first step to measuring and improving quality is capturing patients’ clinical data. Using an EHR that is easy to use at the point of care facilitates the documentation process and ensures a more complete patient record.  Care is further enhanced when providers have automated decision support tools and evidence-based guidelines at the point of care, such as the ones available in InteGreat with Quippe.

 

E-Prescription Improves Medication Adherence

Beginning in 2012, CMS will impose a one percent penalty on physicians not using e-prescribing technology.  Are you or your physicians still resisting e-prescribing despite the government’s promise of financial penalties?  If so, consider new findings that show e-prescribing improves medication adherence, which in turns improves outcomes and reduces healthcare costs.

Earlier this year the e-prescribing network Surescripts looked at 40 million prescription records from 2008 to 2010 and compared first-fill medication adherence rates when prescriptions were delivered electronically, via paper, phoned-in, and faxed.  The findings:  new prescriptions ordered electronically were picked up 10% more often than new prescriptions ordered via other methods.

Two key factors are thought to contribute to the higher first-fill adherence rates. First, as many as 28% of paper prescriptions never make it to the pharmacy. With e-prescribing, the script is sent by the physician immediately to the patient’s pharmacy of choice.

Second, with e-prescribing, physicians have better access to patients’ insurance information and can more easily identify which clinically appropriate medications offer a lower out-of-pocket cost for patients. Previous studies have found that the higher the co-pay, the more likely a patient will not pick up the prescription.

Poor medication adherence is costly, both in terms of healthcare spending and loss of life. The World Health Organization estimates that as many as 50% of patients do not adhere fully to their medication treatment, which contributes to 125,000 premature deaths annually and adds as much as $290 billion in healthcare costs a year in the form of hospitalizations and other complications.

While e-prescribing will not eliminate non-adherence to medication, it is already making significant contributions to improving the quality of care and to reducing overall healthcare costs. If you are an InteGreat EHR user, you already have built-in e-prescribing capabilities through InteGreat Script. InteGreat Script utilizes SureScripts’ e-Prescribing service and is fully integrated with InteGreat EHR.

If you are interested in learning more about MED3OOO’s options for e-prescribing, contact your MED3OOO account manager.

Patient Engagement: Stage 2 Meaningful Use

Thanks to the newly proposed Stage 2 Meaningful Use (MU) rule, practices may soon be jumping on board the patient portal bandwagon. Healthcare portals provide patients with online access to their records, offer secure communication tools, allow patients to request appointments or prescription refills, and offer numerous other self-service benefits that can enhance patient satisfaction.

Keep in mind that the proposed Stage 2 MU rule includes multiple requirements that build on Stage 1 objectives. For example, the thresholds for CPOE use and e-prescribing are higher and several menu objectives are now required core measures. The bar has also been raised for online patient engagement, highlighting how important it is for providers to communicate with patients and give them access to their clinical information.

Stage 2 steps up the patient engagement requirements in several ways. To meet Stage 1 objectives, eligible professionals (EPs) must provide patients with electronic access to their health data upon request within three business days; the data, however, does not need to be in an electronic format. Stage 1 also includes an option for EPs to provide at least 10% of their patients with electronic access to their health information within four days of the information becoming available to the EP.

The proposed Stage 2 rule requires EPs to provide patients with direct electronic access to their information, meaning EPs must offer patients the ability to view and download information online; the access must be made available within four business days of being provided to the EP. Additionally, EPs must offer patients clinical summaries for each office visit and use secure electronic messaging to communicate with at least 10% of patients. EPs must also use certified EHR technology to identify patient-specific education resources and provide those resources to the patient. Finally, the rule requires providers to show that at least 10% of patients view, download, or transmit their online health information.

Patient portals provide an ideal solution for the new patient engagement requirements. While there are numerous patient portal solutions on the market, MED3OOO offers Intuit Health’s Patient Portal integrated with InteGreat EHR. The integrated workflow makes it easy for practices to communicate with patients, provide visit summaries and other clinical data, offer patient education resources, and deliver automated health maintenance notices.

If you’d like to learn more about how MED3OOO customers are using the Intuit Health Patient Portal with InteGreat EHR, you may download an on-demand Webinar panel discussion here, or check with your MED3OOO account manager.

Stage 2 Summary

Late last month CMS released its notice of proposed rulemaking for Stage 2 of the EHR incentive program. The proposed objectives include the next set of criteria that EPs and hospitals must demonstrate in order to achieve Meaningful Use (MU.) While much of the proposed Stage 2 objectives expand on Stage 1 measures, overall the new rule is more focused on increasing the electronic capture of health information in a structured format, as well as increasing the exchange of clinically relevant information between providers of care at care transitions.

Some of the notable elements:

• The core and menu structure in Stage 2 is the same as in Stage 1, but EPs must meet, or qualify for an exclusion to, 17 core objectives and three of five menu objectives.
• Many of the thresholds from Stage 1 have been raised. For example, the requirement for CPOE for medications jumps from 30% to 50%; the recording of demographics, vital signs, and smoking status increases from 50% of patients to 80% of patients; and, the e-prescribing requirement for EPs rises from 40% of prescriptions to 65%.
• Some menu objectives from Stage 1 are now required core measures. For example, drug-formulary checking is now incorporated into the e-prescribing requirement; reminders for preventative and follow-up care is now required for 10% of patients seen in the last 24 months; and, lab information must be incorporated as structured data for 55% of lab results.
• A number of new requirements have been added, including a menu option that 40% of all scans and images are available for viewing in the EHR; a requirement that 10% of patients send at least one message to EPs; and, a menu option that EPs identify and report patients to cancer or other specialized registries.
• The proposed clinical quality measures for EPs are aligned with existing quality programs, including PQRS, Medicare Shared Savings Program, and NCQA medical home accreditation. In order to reduce the burden of reporting quality measures for multiple programs, CMS is proposing that clinical quality measure data be submitted electronically.
• The electronic reporting of quality measures would be required by 2014. The proposal stipulates that EPs report a total of 12 measures from each quality domain: patient safety, care coordination, population and public health, efficient use of resources, and clinical effectiveness.

The complete proposed rule is available on the CMS Website. Over the next 60 days, CMS will accept public comment.

ACO HIT Infrastructure

The goal of the Accountable Care Organization (ACO) model is to provide high quality care to specific populations through coordination and integration of care.  To meet this objective, organizations must have a comprehensive and robust HIT infrastructure. But what specific HIT elements do ACOs need in order to achieve their care coordination and patient management goals? That’s a question recently explored by eHealth Initiative.

The eHealth Initiative is an independent, non-profit affiliated organization dedicated to driving quality, safety, and efficiency in healthcare and technology. In an eight month study, the eHealth Initiative examined the issue of HIT infrastructure in the ACO model and identified several key attributes that were necessary for ACO success. Some of the recommendations include:

• A flexible HIT infrastructure to support the changing needs of an ACO model
• An infrastructure that supports  the secure transfer, collection, and storage of personal health records
• A patient-centered system to engage and educate patients and caregivers
• A system that supports care coordination across the healthcare team and the patient
• Technology that supports evidence-based, clinical decision tools
• An infrastructure that facilitates the gathering, tracking, and aggregation of patient data through the organization.

The authors conclude that it may be difficult for ACOs to accomplish their objectives without a strong technology base that facilitates care coordination and gives doctors the tools they need to provide quality and affordable care.

If your organization is considering a transition to an ACO model, keep in mind that MED3OOO’s Accountable Care division has a team of industry experts in place to help you achieve your clinical, operational, and financial goals. MED3OOO’s ACO offerings include products and services that align with the eHealth Initiative’s recommendations and facilitate coordination and communication between physicians, hospitals, patients, and health plans.  For example, MED3OOO offers both online and point-of-care solutions to advance patient education and manage personal health records. Our InteGreat EHR product has integrated decision support tools and supports the secure transfer of clinical data to other providers. We also offer advanced business intelligence and reporting solutions to monitor patient outcomes and analyze overall population health.  

With a solid HIT infrastructure in place, the ACO model offers a tremendous opportunity for organizations to improve the health of their patient population.

 

 

Don't Miss MED3OOO at HIMSS12!

Going to HIMSS12 in Las Vegas this month? While MED3OOO won’t be exhibiting you can find us at the Medicomp booth (#855) demonstrating InteGreat EHR with Quippe. A number of other MED3OOO folks will be on hand to meet with customers, attend educational sessions, and check out new technology on the exhibit floor.

One of the most fascinating aspects of the annual HIMSS conference is networking with other HIT professionals and understanding the top issues facing healthcare organizations. Every year a few topics stand out in terms of creating a buzz; this year will be no exception. A few of the themes we expect to be top of mind for attendees include: 

• Usability. As EHR adoption becomes more widespread, providers are looking for ways to maximize their technology investment. The easier a product is to learn and use, the more likely physicians will be to embrace the technology and incorporate it into their clinical workflow. Thus providers are now looking beyond a basic checklist of features and functions and focusing more on the usability of products deployed in their offices and hospitals.
  • Stage 2 Meaningful Use. The final rules for Stage 2 Meaningful Use are rumored to be announced sometime in February.  If the rules aren’t published before HIMSS, people will be speculating about what will Stage 2 will and won’t include. If the regulations are published prior to HIMSS, plenty of folks will be sharing their analysis and theorizing how the rules will impact various stakeholders. Meanwhile, providers will be trying to understand the impact to their organizations and vendors will be talking about how their solutions can help providers achieve the new objectives.
  • Interoperability. Regardless of the Stage 2 specifics, Meaningful Use requires data exchange. More standards are now in place to facilitate data and HIEs are becoming a reality in more and more communities. Look for vendors promoting different HIE platforms, as well as tools for managing and interpreting the flood of incoming data.

Other buzz-worthy topics include quality reporting, care coordination, cloud computing, accountable care organizations, new reimbursement models, the 5010 transaction set, and ICD-10.

Sign-up for a time to view InteGreat EHR with Quippe in Vegas - click here!