powerpoint lawrence m. preston
DESCRIPTION
April 18 AIIM Show Las VegasTRANSCRIPT
Lawrence M. Preston, MBA, FHFMA
Professional Medical Consultants, Inc.April 18, 2012
AIIM and ARMA
Background• 19 years in hospital management-California,
Hawaii and Nevada• 20 years in healthcare consulting-based in LV• Primary focus-Physician Practice
Management• Own Primary Care Practice in Mexico• Starting IPA in Nevada• Application in for ACO in Nevada• Board of Directors-ACHE and HFMA Nevada
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Meaningful Use-Phase ICore Measurements -15 criteria must be met
Menu Set – choose 5 of 10 criteria
Must meet 100% of each or no incentive payment
Payment for Medicare is up to $44,000 over 5 years ($63,750 for Medicaid over 6 years)
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Core Measurements1. E-prescribing at least 40% of all RX2. At least 30% of patient seen must have a
medication entered into system 3. EMR software must have drug to drug
interaction/allergy alert4. At least 80% of patients seen must have an
active medication list
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Core Measurements-continued5. At least 80% of patients seen must have up
to date diagnosis6. At least 80% of patients seen must have an
active allergy list7. At least 50% of patients seen must have
smoking status and history documented8. Need to implement one clinical decision
support rule
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Core Measurements-continued9. Need at least 50% of patients seen to have
documented the following questions:a. Preferred languageb. Genderc. Raced. Ethnicity (Hispanic or Non-Hispanic)e. Date of Birth
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Core Measurements-Continued10.Need at least 50% of patients to have seen
the following vitals signs recorded:a. Heightb. Weightc. Blood Pressured. BMI (calculated by Height & Weight)e. Plot and display growth charts for children
ages 2-20
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Core Measurements-continued11.Need to report ambulatory clinical quality
measures to CMS (Medicare)12.Need to provide at least 50% of patients
with an electronic copy of their health information within 3 business days-when requested
13.Need to provide at least 50% of patients seen a clinical summary of their visit within 3 business days from the date seen
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Core Measurements-continued14.Need to perform at least one test of
electronically exchanging clinical information with another provider
15.Need to have a security risk analysis conducted
Meet each and everyone one of the above criteria to pass this section (no exceptions)
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Menu Set Measurements1. Implement drug formulary check2. Have a least 40 % of lab results reported
into system3. Need to generate a least one list of patients
by specific condition (i.e.-Diabetes)4. Need at least 10% of patients to be able to
obtain their medical information within three business days
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Menu Set Measurements5. Need at least 20% of patients 65 and older
to be sent a reminder for preventative or follow up care
6. Need at least 10% of patients seen be given patient specific education resources that are generated from the EMR system
7. Need to update at least 50% of patients seen medication list when seen by another doctor
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Menu Set Measurements8. Need to send a referral, summary of care
and any other pertinent information on at least 50% of patients being referred out
9. Need to perform at least on test of sending electronic immunization records to an immunization registry
10.Need to perform at least one test of sending electronic syndromic surveillance data to a public health agency
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Meaningful Use• Must meet all 15 Core at 100%
• Must meet 5 of the 10 Menu set
• Miss any of the above-no incentive payment
• Check your software to make sure it can do the above and that it has been approved by CMS standards board-now your ready to go
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How to ImplementAsk for help from your vendor
Don’t get to complicated
KISS
Physician buy in—largest and most difficult
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How to order a Rx through the EHR
Pull Chart Go to Assessment and Plan Choose existing medication from patient’s medication list
For new medication go to search, then change Data Source to Medications, enter dosage, frequency, quantity and refills
Press Output Choose Pharmacy Enter Password Press OK Sign Off Enter Password Change Encounter Type to Prescription Only Press OK
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How to add an addendum to EHR chart
Double click on the office visit that needs the addendum (located on the face sheet in the upper R hand corner)
Click on pencil (located in the L upper corner)Click on what section you want to add
information to (hover your mouse over the pictures, A+P, vitals, etc)
Type the information into the box provided.Click OK
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EHR Implementation Schedule
Week 1: All staff (including physicians) needs to start using messaging system.
Example: Front desk staff can send message to MA that a patient keeps calling and leaving messages for them, and haven’t received a call back yet.
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EHR Implementation ScheduleWeek 2: Physicians need to start reviewing
all lab results through system and message to their MA’s anything needed. No labs should be printed unless needed.
MA’s need to start entering all medications and allergies of the morning patients into the system. MA’s also need to enter entire social history, medications, allergies, medical problems of all new patients.
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EHR Implementation Schedule
Week 3: Physicians need to start with 4 patients daily doing only the review of systems in the system.
MA’s need to start entering all medical problems of the morning patients into the system. (They continue adding medications/allergies)
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EHR Implementation Schedule
Week 4: Physicians start with 4 patients daily doing physical exam and review of systems in the system.
MA’s need to start entering all vital signs and chief complaints of morning patients into the system. (They continue adding medical problems and medications/allergies)
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EHR Implementation Schedule
Week 5: Physicians start with 4 patients daily doing entire patient (review of systems, physical exam, assessment and plan) they will do all new patients and then select others from there. The MA’s will also do their part for these patients.
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EHR Implementation Schedule
Week 6: No new patient charts will be made from this point on. They all need to be done in the EHR.
MA’s will need to start sending faxes to the physician to review. Only print out Rx refill requests that will need to continue to be done through the e-prescribe in the EHR.
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EHR Implementation Schedule
Week 7: Physicians will continue to increase the number of patients done in the EHR by one in the morning and one in afternoon each week. (So, 3 in the am, 3 in the pm x 1 wk, and then 4 in am, 4 in pm, etc)
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Examples of weekly reportsRun weekly reports and compare to previous
week—look for progress and regress
Set goal of what to accomplish-by doctor
These are individual attestations-don’t slow down to the slowest participant
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Meaningful Use Status Update 08-04-2011
Dr AA: the following measures not meeting threshold:
Core 9-Smoking Status: currently listed 4%. Needs to be >50%
Core 13 - Clinical summaries: currently listed as 0%. Needs to be >50% (missing report)
Core – Clinical Information Exchange: need to submit 1 test data as a CCR/CCD record to another provider of care.
Menu set – Patient Reminders. Need >20% (missing report)
Menu set – Patient Education. Need >10%. (missing report) 26Professional Medical Consultants, Inc.
Meaningful Use Status Update 08-04-2011Dr BB: the following measures not meeting
threshold:Core 3 – eRX: currently listed 30%. Needs to be >50% Core 7 – Allergy list: currently listed 46.6%. Needs to
be >80% Core 13 – clinical Summary: currently listed 0%. Need
>50% (missing report)Core – Clinical Information Exchange: need to submit 1
test data as a CCR/CCD record to another provider of care.
Menu set – Patient Reminders. Need >20% (missing report)
Menu Set – Patient Education. Need >10%. (missing report)
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Meaningful Use Status Update 08-04-2011
Dr CC: the following measures not meeting threshold:Core 7 – Allergy list: currently listed 37.3%. Need >80%Core 9 – Smoking status: currently listed 43.4%. Need to be
>50% Core 13 – clinical Summary: currently listed 0%. Need
>50% (missing report)Core – Clinical Information Exchange: need to submit 1 test
data as a CCR/CCD record to another provider of care.Menu set – Patient Reminders. Need >20% (missing
report)Menu Set – Patient Education. Need >10% (missing
report)
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Lessons learnedDon’t slow downFocus on daily and weekly reportingFocus on positive changesCompliment staff-not just physiciansHold your EMR vendor accountableDon’t give in-fight for your goal and timetablePrepare for M U 2-started January 1, 2012
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SummaryDon’t be afraid to call your competitorsCall other vendors for inputListen to 3-4 webinars a weekAsk your vendor to provide constant updatesHold frequent meetings with key staffDon’t stop asking your staff how can I helpIf you get frustrated-tackle another issue
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Questions-???Thank you very much---
You can always call me at
702 598-0600
Larry Preston
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