The Iowa e-Health Connection

Iowa has been a national leader in the EHR incentive payment program.  As of March 31, 2012, Iowa Medicaid has paid out $40,569,459 to qualifying eligible professionals and hospitals.  These payments represent 866 providers across the state who are benefiting from Iowa Medicaid’s EHR incentive payment program.  As of February 29, 2012, 373 Iowa providers have received incentive payments from the Medicare meaningful use program for $26,000,000.

Iowa Medicaid EHR Incentive Payments

Life of the Program

The Iowa Medicaid Enterprise is looking forward to continuing this momentum into 2012 by approving payments to providers applying for Year Two Meaningful Use payments beginning April 2. Providers have until 2016 to initiate participation in the incentive payment program. To find out if you qualify for incentives, contact Kelly Peiper, Iowa Medicaid HIT Coordinator, at 515-974-3071, or by email at imeincentives@dhs.state.ia.us.

“We know that broader adoption of electronic health records can save our health care system money, save time for doctors and hospitals, and save lives,” said Health and Human Services Secretary Kathleen Sebelius.  “We have seen great success and momentum as we’ve taken the first steps toward  adoption of this critical technology.  As we move into the next stage, we are encouraging even more providers to participate and support more coordinated, patient-centered care.”

 Adoption of EHRs could save money, time and lives.  On February 24, The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology jointly issued proposed regulations for Stage 2 Meaningful Use of Electronic Health Records (EHR).  Provisions in the Health Information Technology for Economic and Clinical Health Act, part of the American Recovery and Reinvestment Act of 2009, allow eligible health care professionals and hospitals to qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it in a meaningful way.   Through the Stage 2 requirements of the Medicare and Medicaid EHR Incentive Programs, CMS hopes to expand the meaningful use of certified EHR technology.  

 The proposed regulations allow providers until 2014 to implement Stage 2 criteria for those who demonstrated Stage 1 meaningful use in 2011.  Like Stage 1 requirements, to qualify for incentive payments under the EHR program, eligible providers, hospitals, and critical access hospitals must report on specified quality measures.  The core quality measures will be aligned with those in other federal programs – an administrative streamlining of efficiencies for reporting.   The Stage 2 requirements have the same core and menu structure as Stage 1 criteria and continue to catapult the Medicare and Medicaid incentive program to expand the use of EHR. 

 Certified EHR technology used in a meaningful way is one piece of a broader more robust infrastructure needed to improve our health care system through heightened quality, efficiency, and patient safety.  The proposed regulations will alleviate administrative burdens associated with clinical quality reporting in order to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs.  The proposed regulations also specify Medicare payment adjustments; hence, beginning in 2015, Medicare payment adjustments are required by statute to take effect.   Providers will face adjustments if they fail to demonstrate meaningful use of certified EHR technology and fail to meet other program participation requirements.  CMS did propose, however, that any Medicare eligible provider or hospital that demonstrates meaningful use in 2013 would avoid payment adjustment in 2015.

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Suppose you live in a rural community, suffer a head injury and arrive at the local hospital for treatment. Your local hospital may have a CT scanning system, but there’s no radiologist available to interpret the severity of your injury. Health information technology now gives many rural hospitals and their patients a solution to this problem.

Mercy Medical Center in Des Moines has established a telemedicine program with 11 rural hospitals that gives the participating hospitals access to Mercy services 24 hours a day. Digital diagnostic images including CT and MRI scans, nuclear medicine and X-rays captured at the rural hospitals are transmitted to Mercy for either storage or interpretation by radiologists.   For some of the rural facilities, Mercy radiologists interpret the images and send reports back to the rural hospital.

Susan Johnson, Administrative Director of Medical Imaging at Mercy-Des Moines, says the technology helps physicians provide faster and better care, as well as contain health care costs.

“It offers the patient a way to stay in the community versus having to drive an hour or two hours, to Des Moines,” Johnson says. “It’s just like the images were being captured here at Mercy.”

Johnson says the imaging telemedicine program was started in 2001 with an arrangement between Mercy and Stewart Memorial Hospital in Lake City. Stewart Memorial lost its on-site radiologist and, out of necessity, needed to figure out how to meet patient needs with regard to radiological testing.  Stewart Memorial wanted to have images read by the Mercy physicians, which led to development of this program. The program has expanded in recent years to include the ability to meet HIPAA guidelines for secure storage of patient images, which had previously been cost prohibitive for the small, rural facilities. 

Before telemedicine, trauma and emergency patients often were transferred from their local hospitals by ambulance or helicopter because on-site interpretation was not available.  Even though the radiology equipment and technologists were readily available, access to radiologists to read and interpret images was limited, causing treatment delays in some cases. Implementation of this program has helped reduce the amount of time trauma and emergency patients must wait to receive care.  During life threatening situations, timeliness of care can be a matter of life and death. 

Now the imaging can be completed at the patient’s local hospital and the results come back within minutes. This improved process allows the emergency physician to determine if the patient can be treated locally or if the patient should be transported to a tertiary center for care. The radiologist also is available to discuss findings with the treating physician via phone while each doctor views the images at their respective sites.  If the patient is transferred to Mercy for additional care, the images are on-site at Mercy for surgeons or other physicians to plan for the patient’s care before the patient arrives.

“Now the local facility is able to treat more patients in the community and keep people employed in their local communities,” Johnson adds.

Des Moines Area Community College (DMACC), a member of the Midwestern Community College Consortium, has been granted an extension to provide training targeted for 100 individuals with previous medical or technical experience for roles that support the installation, implementation or management of EHR systems.  A national curriculum, developed by five universities, and complemented by access to an EHR lab for hands-on experience, is designed to be completed in 6 months or less and leverages previous professional experience.  Enroll now to be eligible for grant funding.

One successful graduate of the program had this to say, “I am LOVING my career in Health IT! The DMACC program has opened so many doors! At the time I did not know how much of a big deal this program was. What a great experience.”

   Key training roles at DMACC include:

• Implementation Support Specialists: Workers provide on-site user support before and during implementation of health IT systems in clinical and public health settings.
• Implementation Manager:  Workers provide on-site management of mobile adoption support teams before and during implementation of health IT systems in clinical and public health settings.
• Technical/Software support staff: Workers maintain systems in clinical and public health settings, including patching/ upgrading of software and helpdesk support to users. 
• Trainers: Workers design and deliver training programs to employees in clinical and public health settings.  Individuals in this role have experience as health professionals or health information management specialists.

These are rapidly transitioning areas within health care.  Hospitals, physician practices and EHR vendor organizations are seeking qualified individuals now and in the future! 

For more information or to apply:  www.dmacc.edu/conteddesc/hit/

Or contact:   Marcelo Erazo, 515-964-6864

The Telligen HIT Regional Extension Center is the trusted health IT advisor in Iowa for EHR adoption and meaningful use.  Their team of 10 field staff have prior hands-on EHR implementation experience and bring a combination of clinical and IT expertise to their roles.  They provide technical assistance for primary care provider and critical access/rural hospital settings across the state. 

Telligen is proud of the staff and their ability to provide valuable meaningful use consulting services to providers and hospitals in Iowa. We congratulate team members who recently achieved “Certified Professional in Electronic Health Records” status, including Michelle Brunsen, Marlene Hodges, Cathey Halsten and Denise Warren. The CPEHR exam is conducted by Health IT Certification and offers the opportunity to gain professional certification for those responsible for planning, selecting, implementing and managing electronic health records.

“Even though I have over 15 years of EHR experience, my goal in taking the CPEHR exam was to expand and update my knowledge base so that I can be a better resource for all of the Regional Extension Center clients,” says Cathey. She also plans to complete the Certified Professional in Health Information Technology exam in the next few months.

“Knowledge combines experience and education,” says Michelle. “My previous experience working for an EHR company gave me the exposure I need to better understand the challenges as well as the successes that arise from implementing an EHR. Obtaining the CPEHR certification gave me more education which I can use when helping my clients.”

The Telligen team looks forward to applying the knowledge gained through the CPEHR process to benefit REC clients and ultimately patient care in Iowa.

Dr. James Holsinger of Keokuk accepts the HIMSS Davies Award from Board Chairwoman Charlene Underwood.

Implementing a complete electronic health record system does not have to be a nightmare. Dr. James Holsinger is living proof. His success implementing a fully electronic health record system has earned the Keokuk family physician the Healthcare Information and Management Systems Society’s Davies Award for ambulatory care physician practices. The Davies Award is the society’s highest honor for providers who have adopted EHR systems and have achieved meaningful use of their electronic health record.

Holsinger, who accepted the award in Las Vegas at the HIMSS Convention on February 22, offers lessons for his colleagues who still may be on the fence about using an electronic health records system:

1. Communicate in ways that your patients do. “Medical doctors have been behind the curve for years in terms of writing out charts and doing things hand-written, and they’re not recognizing the need to communicate with a whole segment of the population that is now electronic.”
2. Don’t fight the software. “Don’t try to adapt the computer to your way of thinking. Go with the way the system is designed.”
3. Expect electronic health records systems to pay for themselves and reduce health care costs over time. “It takes 5.6 persons to support each full-time physician. Our experience is that number can be halved if you use an electronic system.”
4. Set a firm launch date. “Circle a date on the calendar and that’s the day you start. And, you make no paper records after that date.”
5.  Once launched, have nurses spend an extra five to ten minutes re-interviewing each patient to recreate their medical and surgical histories and enter them into the system. Over time, every patient will have a complete electronic health record.

Holsinger credits his EHR system for helping him practice better medicine. Not only are patient records fully legible, they’re more up-to-date, allowing him to make better-informed decisions. 

Remember, there is technical help available to help you succeed with whatever EHR system you choose. For more information about technical assistance in this area, visit Telligen’s Iowa HIT Regional Extension Center website at www.telligenhitrec.org.

Iowans interested in pursuing careers in the rapidly growing field of health information technology have until March 31 to enroll in grant-supported HIT Certificate training programs offered by Des Moines Area Community College and Kirkwood Community College.

The on-line training courses are designed for people with backgrounds in either health care or information technology.  Students will learn how to help physician offices, hospital systems and other health care facilities implement electronic health records systems.  Both schools say many of the students enrolled in training are current employees of hospitals or doctors’ offices. 

“The intent was to identify people who had a background in health care or IT so they’d come in with some of the requisite skills,” says Jane Herrmann, director of the program at DMACC. “It would take their clinical experience and train them on the IT side and those who had an IT background would train on the health care side of the curriculum.”

The six-month training courses require students to commit to 15 hours of instruction per week. Robbin Rekemeyer, director of the Kirkwood program, says the time commitment has made it difficult for many enrollees to complete the courses. She says, however, 17 students have earned certificates and as many as 40 others are enrolled currently. Herrmann says 40 students have completed the training at DMACC and another 65 students are working toward completion.

The two Iowa schools are among colleges around the nation that were awarded federal grants to cover most or all of the tuition. Trainees at DMACC pay only $250 for the program. At Kirkwood, tuition is fully covered by the grant. However, Rekemeyer says students who enroll after the grant ends March 31 will be charged full tuition.

“It’s quite an expensive course because there is quite a bit of content in it,” Rekemeyer adds. “So the people who can get in there before the scholarship ends will be saving $1,860.”

For more information about the DMACC program, visit   https://go.dmacc.edu/conteddesc/hit/.

Information about Kirkwood’s program can be found at: http://www.kirkwood.edu/hitconsortium.

Converting from paper to electronic health records has been a long and sometimes bumpy ride for the physicians and other clinicians at Cass County Health System. But, Dr. Elaine Berry says the transition is starting to pay dividends.

Berry, who treats patients in the system’s Atlantic clinic and at satellite locations in Anita, Griswold and Messina, can pull an up-to-date electronic chart for nearly every patient seen by the system’s 12 primary care doctors and physician assistants.

“It’s helped a lot,” she said. “You have the entire chart always at your fingertips.”

Especially helpful is the ability to access medication records, even from home, to determine if patients are due for refills or whether they are taking prescribed medications properly.

Berry says moving to an EHR system that meets Medicare’s meaningful use standards has been a “painful growing process.” Cass County clinicians have adapted to three different systems during the past 10 years. Records kept in the earlier systems still are being converted from paper or other formats so they can be accessed through the new system.

“Part of our problem has been learning three different in-the-office computer systems and then having to start over, start fresh, and you keep jumping back and forth,” Berry said.

Still, Berry is confident the transition soon will be complete and that the clinic will be able to access even more patient information through the Iowa Health Information Network, including records of patients treated by specialists or in hospitals in Des Moines, Omaha and elsewhere.

The Telligen Health Information Technology Regional Extension Center (REC) assists Iowa primary care providers and critical access/rural hospitals with the meaningful use of electronic health records. The REC achieved 100 percent of its provider recruitment goal by surpassing 1,200 priority primary care provider sign ups in December 2012.  The REC has signed 1,287 priority primary care providers and 71 critical access/rural hospitals as of January 26, 2012. 

 ”It’s exciting to envision how our work with over 1,200 primary care providers on the meaningful use of health information technology will impact patient care in Iowa,” says Susan Brown, Director of the Telligen REC.

Many REC clients have also successfully achieved stage one meaningful use and received incentive payments.

 ”The EHR system allows me to provide better care to my patients when they’re in the hospital or the ER. I can tap into the system at home or the hospital to view patient records. It allows me to provide better care and access to charts for continuity of care,” says REC client, Dr. Catherine Wolff of Southwest Iowa Internal Medicine, P.C. in Red Oak, Iowa.

 In addition to the recruitment goal, 45 percent of Telligen’s REC clients are live on an EHR and are actively e-prescribing and quality reporting. 

 ”We look forward to working with all of our clients as they implement EHRs and work toward achieving Meaningful Use,” Brown says.

 For additional information on the Telligen REC along with a schedule of upcoming webinar topics, please visit: www.telligenhitrec.org and follow us on Twitter at: @telligenhitrec.