Meeting Stage 1 Meaningful Use: A View from a Healthcare System

Pamela McNuttSr. VP & CIO

Methodist Health System

Chair, College of Health Information Management Executives Policy Advisory Committee

Member, AHA IT Advisory Committee

Methodist Health System Overview Acute Care Hospitals

• Methodist Dallas Medical Center – 515 beds• Methodist Charlton Medical Center – 254 beds• Methodist Mansfield Medical Center – 106 bed• Methodist Richardson Medical Center - 209 beds• Methodist McKinney– 14 bed specialty physician JV • Methodist Hospital for Surgery – 44 bed specialty physician JV (opens 11/2010)

15 Satellite Family Practice Care Centers and Teaching ClinicsMidlothian Imaging CenterMethodist Rehabilitation Hospital1,120 active physiciansGraduate Medical Educational Programs

• Ob-Gyn• Surgery• Medicine• Internal Medicine• Family Practice/Sports Medicine Physicians

-Physician dictated reports-Nurse documentation-Admission assessment-Medication Administration-Bedside Medication Verification-Care Plans-ED Physician’s record-Cath reports-ECHO reports-GI reports-EKG reports-Lab reports + reference labs + blood gases + point of care testing

-Perioperative charting-Radiology reports-Physician Notes-CPOE -Flowsheet-Monitor Data -Patient Portal-Scanning and Archiving

Enterprise IndexDemographics, allergies and medication profile

Image Repository

-Xray-Ultrasound-CT-MRI-Nuclear Medicine-Cath Lab-ECHO-Mammography (digital only)

Acute CareSingle Vendor -Visit Data - Patient Portal

-Histories - Interface to acute-Problem List care system-Medications-ePrescribing

Ambulatory Care

-Prenatal Data-Prenatal Chart-Labor and delivery record-Fetal monitor data

Linking of patients across visits and

site of service

LegendIn Production Planned 2012-2013Planned 2010/2011In Progress

Hosted major vendor offering

- Teaching Clinics Fall 2008 – 2011 (90 physicians and residents)

- Private Physicians 2011 ->

- Pavilion Practice Management offering

to MedHealth clinics and managed practices

(78 physicians)

- Private Physicians 10/2010 -> (75 planned)

Methodist Health SystemElectronic Medical Record

April 2010

Completely Filmless

Fetal Monitor Charting &Archive System

Product tightly integrated to acute

care vendor

Changes in/or Affirmations of Strategic DirectionDelayed some initiatives:• ED order entry • Monitor interfaces• Nursing documentation in outpatient and specialty areas• Short case surgical documentation

Accelerated some initiatives:• Patient portals• CPOE in acute care

Affirmation of initiatives:• ED system replacement• Developing an interface between our acute care and physician office

system• Scanning and archiving to capture loose paper records

Methodist’s Expectation for Obtaining Stimulus Funds

$450,000 for physicians in the teaching clinics Medicare - $10.4 million for 4 acute care hospitals

Like amount for Medicaid

Late 2011/early 2012 with relief on the “all or nothing” meaningful use approach

2013, at best, if the meaningful use and quality metric reporting remain “as is”

Believe we will only get 2 years of funding, Stage 2 and 3 are out of reach

Challenges with HITECH/Stimulus Requirements

Manual calculations needed for meaningful use measuresRequirement for structured data setsQuality metrics that must be calculated by the electronic record rather than allowing for other data compilation toolsTiming of new certification process, upgrades may be neededLack of functional Health Information Exchanges

• Vendors pricing on data upload/down load routines

Concurrent 5010 billing and ICD-10 implementationsShortage and cost of clinical informatics resources HIPAA change treating the use of EHRs for Treatment, Payment and Operations as a reportable disclosure