GET STARTED TODAY
REACH—Regional Extension
Assistance Center for HIT
Shirley Eichenwald, MBA, RHIA, FAHIMA
Assistant Professor, College of St, Scholastica
Paul Kleeberg, M.D.
Clinical Director, REACH
Terry Hill, M.P.A.
EHR functionality,
reporting,
connectivity
Patient safety,
care quality,
efficiency,
incentive dollars
Executive Director, National Rural Health Resource Center
Minnesota Rural Health Conference
June 29th 2010
REACH
- Achieving
meaningful
REACH - Achieving
meaningful
use of youruse
EHRof your EHR
Meaningful Use
by 2012
Objectives
• Understand the driving forces behind
transforming America’s Health Care system
• Understand who REACH is and its purpose
• Understand the services and approach used
by REACH to help providers achieve
meaningful use
• Understand available subsidies, costs, and
what you need to do to sign up
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National Academies Reports
• To Err is Human: Building a Safer Health System (1999)
– At least 44,000 and perhaps as many as 98,000 hospitalized
Americans die every year from medical errors
• Crossing the Quality Chasm (2001)
– A concerted national commitment to building information
infrastructure is needed to support health care delivery
• Preventing Medication Errors (2007)
– Medication errors injure 1.5M people and cost $3,058 per
year (exclusive of lost wages and productivity) in the U.S.
• Computational Technology for Effective Health Care:
Immediate Steps and Strategic Directions (2009)
– "Crossing the Health Care IT Chasm:" Even in organizations
with advanced HIT, it is rarely used to provide clinicians with
evidence-based decision support or for data-driven process
improvement
Source: Margret Amatayakul, Health IT Certification, March 15, 2010, used with permission
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U.S. Health Care Problems:
Costs vs. Quality
• Highest per capita health
care spending
• Ranked 37th of 191 in
quality*
• Threatens affordable care
– 46 million currently
uninsured
– 71% of uninsured adults
are employed full-time
• $2T (2005)  $4T (2015)
– Increasing % of GDP
* World Health Organization Data, 2000 (http://www.who.int/whr)
Figure from: www.cbo.gov/ftpdocs/89xx/doc8948/01-31-HealthcareSlides.pdf
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Underinvestment in HIT
Per Capital Spending on HIT
$250.00
$200.00
$192.79
$150.00
$100.00
$31.85
$50.00
$21.20
$11.43
$4.93
$0.43
Australia
United
States
$United
Kingdom
Canada Germany Norway
Source: Anderson, G. F., Frogner, B. K., Johns, R. A., & Reinhardt, U. E. (2006). Health Care Spending
And Use Of Information Technology In OECD Countries. Health Affairs, 25(3), 819-831.
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Patients Want More Accessible,
Coordinated, Well-Informed Care
Percent reporting it is
very important/important that:
Total:
Very important
or important
Very
important Important
You have easy access to your
own medical records
94
68
27
All your doctors have easy
access to your medical records
96
72
24
You have information about the
quality of care provided by
different doctors/hospitals
95
63
32
Source: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2008.
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Placing Our Bet on HIT:
The “Stimulus Package” Feb 2009
• American Recovery and Reinvestment
Act (ARRA) - $787 B
• HIT for Economic and Clinical Health
(HITECH) Act - $26 B
– $24 B ($17.2 B net) starting in 2011 to
incent Medicare- and Medicaidparticipating physicians and hospitals to
use certified EHR systems in a
―meaningful‖ way
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HITECH Act Framework
Blumenthal D. Launching HITECH. N Engl J Med posted online Dec 30 2009.
http://healthcarereform.nejm.org/?p=2669
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HITECH Funding Initiatives
Funding Initiative
Focus
CMS Incentives
(Section 4201) For ―meaningful use”
Incentive payments to eligible professionals and
hospitals participating in Medicare and Medicaid programs
that adopt and meaningfully use certified EHRs
Regional Extension Centers
(Section 3012)
Establish up to 70 Regional Extension Centers to support
providers in adopting and becoming meaningful users
of health information technology (HIT)
Health Information Exchange
(Section 3013)
Support state programs to ensure the development of
health information exchange
HIT Workforce Development
(Section 3016)
University-based Training; Community College Consortia;
Curriculum Development; Competency development
Create several distinct programs that aim to support the
education of HIT professionals. Train up to 45,000 new
HIT workers to assist providers in becoming meaningful
users of EHRs
Beacon Community Program
(Section 3011)
Create up to 15 demonstration communities to show how
the meaningful use of EHRs can achieve measurable
improvement in the quality and outcomes
Strategic Health Information Technology Advanced
Research Projects (SHARP) - (Section 3011)
Achieving breakthroughs to address well-documented
problems that have impeded adoption of HIT, including the
security, cognitive support, health care application and
network architectures, and secondary use of EHR data
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HIT Regional Extension Centers
• One of 60 HIT Regional Extension Centers
across the country
• Provide education and technical
assistance to help providers
– Select, implement, and achieve meaningful
use of certified EHR technology
– Exchange health information with other
providers and agencies
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REACH
• Regional Extension Assistance Center
for Health IT (REACH)
– Nonprofit federal HIT Regional Extension Center
– Dedicated to helping providers in Minnesota and
North Dakota implement and use electronic health
records (EHR)
• Mission - assure that each of our clients
achieves meaningful use of EHR
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Key Health Alliance
• REACH is a program KHA
• Partnership of:
– Stratis Health
– National Rural Health Resource Center
– The College of St. Scholastica
• Collaborates for REACH with:
– North Dakota Health Care Review
– University of North Dakota, School of Medicine and
Health Sciences, Center for Rural Health
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Minnesota and North Dakota
Councils
• Minnesota Council
– Minnesota Department of Health - Jim Golden
– Minnesota Department of Human Services/State
Medicaid Agency - Brian Osberg
– University of Minnesota, Academic Health Center Kevin Peterson
• North Dakota Council
– North Dakota HIT Advisory Committee (HIE grant
applicant for ND) - Lynette Dickson
– North Dakota Health Care Review - Barb Groutt
– North Dakota State Medicaid Agency - Maggie
Anderson
– North Dakota Medical Association - Bruce Levi
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REACH Goals
• Provide technical assistance services and
support to primary care physicians and
other clinicians in Minnesota and North
Dakota
– 5,100 through to meaningful use certification
within four years
– 3,600 within the first 2 years
• In addition to primary care practices,
REACH services will be available to all
providers regardless of specialty
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REACH Expertise
• Organizations that make up REACH have a
proven track record on improving quality and
safety of patient care using technology
– Collectively have helped over 300 primary care clinics, hospitals,
and other health care organizations; with emphasis on meeting
the needs of rural and underserved providers
– Expert in delivering cost-effective HIT services
– Manage federal subsidy funds to lower overall costs for adopting
and optimizing HIT
– Close coordination with state health information exchange
programs, e-health initiatives, workforce training programs, other
regional extension centers, and other Recovery Act funded
initiatives in our states
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REACH Staff
• Individuals who have implemented and
use EHRs, including:
– Physicians
– Nurses
– Health information managers
– Information technology (IT) experts
– Leadership and communication coaches
– Process and quality improvement
specialists
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REACH Assistance
• Services available to Minnesota and North
Dakota providers of all types and sizes across
the continuum of care
• If you are ready to commit to achieving
meaningful use, REACH is ready to assist
you – whether you have:
– No EHR
– Installed EHR that is difficult to use
– Working EHR that needs to be optimized to fully
benefit you and meet federal meaningful use
requirements
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Federally Subsidized Services
• Providers without an EHR or with an EHR who wish to
achieve meaningful use and beyond
• Greatest discount for primary care providers
– Physicians and health care professionals with prescriptive
privileges
• Physicians, physician assistants, nurse practitioners, nurse midwives
– Providing primary care
• Family medicine, internal medicine, Ob/Gyn, pediatrics
• Subsidized services also available
– Large multispecialty clinics with primary care providers
• Nonprofit rates available for specialty clinics and other
settings of care
• Small and Critical Access Hospital funding pending
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REACH Services
• Readiness assessments
– Evaluate your strengths and opportunities to prepare your organization for
EHR adoption and effective use
• Practice and workflow redesign
– Reevaluate workflows and processes for EHR to be an efficient tool
• Assist in selecting a certified EHR product that
offers the best value for your needs
– From developing your system requirements/needs through helping you
identify the right vendor for you
• Vendor contracting
– Provide contract coaching to ensure you get a fair deal from your vendor
• Process for EHR project management
– Help you to develop a process to work with your selected vendor to
ensure effective implementation of a certified EHR product
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REACH Services (cont.)
• EHR optimization and meaningful use
– Assist with leveraging your EHR's potential to improve quality and value of
care by enhancing clinical and administrative workflows, focusing on process
improvement, and guidance in template building and clinical decision support
• Technical reporting
– Assist with technical services to support attestation and quality data
submission to CMS, i.e., Crystal Report writing, SQL programming
• Privacy and security best practices for your EHR
– Training to enable you to comply with legal requirements to protect patient
health information, i.e., breach notification, risk mitigation, policy and
procedure templates, business associate management
• Functional interoperability and HIE
– Assessment and guidance from basics of e-prescribing to preparing you to
participate in health information exchange with other provider
organizations and other entities for things such as the immunization
registry, public health and quality reporting
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Education and Outreach
• Varied types of assistance
– Individualized, on-site assistance with direct
hands-on support
– Virtual consultations
– E-newsletter
– Virtual knowledge sharing forums
• By profess type, EHR status or vendor
– Toolkits: clinic, hospital, nursing home, home health
– Educational Webinars
– Web site
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Virtual Knowledge Sharing
Forums
– Create a knowledge community
– Network with peers
– Provide input to REACH
– Receive education from EHR/HIT leaders
and experts
– Access tools and resources from ONC
and REACH
– Build a sustainable EHR culture
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Webinars
• Free Webinar sessions for REACH
participants throughout the year
• No limit on number of participants on a line
• Interactive with speaker
• Potential topics
–
–
–
–
REACH registration
Eligibility for incentives
Definition of meaningful use
HIT workforce
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REACH Approach
• EHR Roadmap guides consultation process
• Focus on organizational change required for
success
– Leadership, culture, workflow redesign
• Provide tools to support your HIT
sustainability
• Medicare and Medicaid incentives companion
– Assist primary care providers and small hospitals
to achieve meaningful use of their EHR
– Enables eligible providers to qualify for
Medicare/Medicaid incentive payments
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Where You Spend Your Time….
REACH Phase
Assess
12%
Implement/Optimize –
51%
Plan
14%
Select
23%
• Almost ½ of our effort is spent on: assessment, planning and selection
• We believe you need to go slow to go fast
• Our goal is to understand your culture, concerns, and unique strengths
to ensure you prepare for the upcoming change
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Why the Emphasis on the Front End?
Implemented
and Supported
Productivity
Implement EHR
Little or No HIT
Leadership and
management
determine how
long you’re in the
valley of despair.
Choices, planning,
and execution
determine extent of
slide
Slide from Terry Hill of NHRC, derived from
Dr. Norman Okamoro, University of Hawaii
REACH - Achieving meaningful use of your EHR
Good choices and
management
determine level of
productivity and
satisfaction
Possible Future
Time
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Assess
Would you diagnose without examining?
Key Actions
Key Deliverables
Define Roles
Name steering team,
project manager
People in place
Survey Staff
Cultural surveys
Leadership surveys
Attitudes surveys
Understanding of key
liabilities to mitigate
and assets to leverage
Perform Assessment
Visit clinic
Interview key staff
Analyze surveys
Completed REACH
Readiness Assessment
Develop Work Plan
Create clinic specific
work plan
Written plan, dates on
calendars
Roles identified, risks clarified, culture understood, and plans in place
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Planning
Key Actions
Empower Team
Review key roles in
light of actual work
People in place 
Skilled people in place
Vision workshop
Vision of future with
sufficient to pull through
Valley of Despair
Create flowcharts of
current state
Agreement on current
state. Low hanging fruit
(start picking!)
Calculate realistic
costs
Clarity on financial impact
Clarify Vision
Document
Processes
Calculate Total
Cost of Ownership
Key Deliverables
Strong team, shared vision, agreed-upon current state and clarity on
financial implications
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Select
Key Actions
Key Deliverables
Attend and view
demos
Understand how
options affect your
practice
Migration plans
Plan integration w/
other systems and
how to handle data
Clarity on affect of
software choices on
current infrastructure
Narrow the field
Review findings,
eliminate non-starters
From many to 2 or 3
Select final choice
A (probable) choice
Establish cost, time,
Ts & Cs, etc.
Contract that avoids
pitfalls
Vendor Demos
Choose
Negotiate
Contracted vendor
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Onward  Implementation!
REACH Time Allocation
REACH - Achieving meaningful use of your EHR
• You’re walking on firm
ground
• People organized
• Vision set
• Plan in place
• Vendor selected
Conditions set to move
quickly through the
Valley of Despair
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Implement & Optimize
Key Actions
Key Deliverables
Oversee Vendor Build
Identify and manage
On time, on budget
issues, track progress deliverables
Finalize Hardware
Design
Review hardware
needs, determine
solutions
Hardware deployment
plan
Identify Training
Requirements
Determine who
needs to know what
Training plan
Develop Go Live
Plans
Test, training,
conversion, support,
etc. plans
Written plans with
resources and go/no
points
Go Live
Implement above
plans
Working EHR
Implemented EHR
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Meaningful Use/Improve
Eyes on the Prize
Meaningful
Use
• Technical support for
– Attesting to meaningful use (MU)
– Submitting quality data
• Measure benefits realization
–
–
–
–
Conduct surveys
Observe users
Analyze results
Establish monitors as needed
• Prepare for interoperability and
health information exchange
EHR Process Improvement
Incentives
M.U. Attestation for 2011
M.U. Data Submission for
2012
Benefits Realization
Clinician Satisfaction
Patient Satisfaction
Monitoring Goal
Achievement
Root Cause Analysis
Quality Improvement
Patient Safety
Return on Investment
Ongoing Maintenance
Patches/Upgrades
User Preferences
Hardware Upgrade
& Maintenance
CDS Maintenance
Health Info Exchange
Interoperability
HIO, NHIN
Public Health
Biosurveillance
Personal Health Record
Disease Registries
Patient Centered
Medical Home
Clinical Trials
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Providers well on their way to
meaningful use
• Helping you achieve 2011 criteria for meaningful use and
preparing you for 2013 and 2015 criteria
• Meaningful use criteria are based on National Priorities
Partnership goals for transforming America’s Healthcare
– Improve quality, safety, efficiency and reduce health
disparities
– Engage patients and families in their care
– Improve care coordination across locations of care
– Improve population and public health
– Ensure adequate privacy and security protections for
personal health information
• Subsidized services for activities that help you achieve
these goals
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REACH Subsidies
• Subsidies for services are based upon
meeting milestones toward meaningful
use
• To receive greatest REACH subsidies
and CMS incentives, you must be
certified for meaningful use by January
2012
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Register Now
• Greatest subsidies now!
• No commitment with registration
• After registration, we call to understand
your situation and see what subsidies we
can bring to you
• Design a custom work plan to fit your needs
• Staff of consultants and subject matter
experts with experience to meet your needs
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Fees for Clients Signing Now
Without an EHR
With an EHR
Multi–site
Medical Group
>30 sites or
>260 providers
Clinics with
Primary Care
Fee / Co-pay
$1,000/ site
$500/ site
Go through
$500/ PCP
$250/ PCP
scoping process
$1,000/ specialist * $500/ specialist *
Critical Access/
Rural Hospital
<50 Beds
Fee / Co-pay‡
$,1350 / hospital
PCP = primary care provider
$1350 / hospital
N/A
Specialist = specialty provider
* Provider fees up to cap TBD
‡ Hospital funding is pending. Anticipated award 6/12/10
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Website: www.khaREACH.org
• Registration application
• EHR resources
• Links to other HITECH initiatives
– Health information exchange
– Workforce development
– Beacon grants
• National resources and best practices
• Staff contacts
• Training event registration
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Website: www.khaREACH.org
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How is REACH different?
• Preparing you for a
future of HIT
Teach you how to make HIT
decisions, empowering you for the
future because processes and
technologies are constantly evolving
• Trusted, unbiased
assistance
Represent physicians and patients.
Not supported by any vendor
• Mission-driven
Nonprofit organizations of REACH
are dedicated to improving care
quality and patient safety
REACH - Achieving meaningful use of your EHR
• Low-cost rates
Able to provide services at a
significant discount, through
support of ONC
• Committed
Committed to getting our clients to
stage 1 meaningful use in
12 months or less
• Provider focused and
experienced
Proven success in implementing
EHR with organizations like yours
39
Questions?
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More Information
• Bring additional questions or staff to a
future Info Call
• (866-939-8416 code: 8695985#)
July
TH 7/8, 1:00 pm
T 7/13, 10:00 am
W 7/21, 11:00 am
W 7/28, noon
• Register or learn more
– http://khaREACH.org 877-331-8783, ext. 222
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Resources
• Meaningful Use
– http://healthit.hhs.gov/meaningfuluse
• HIT Extension Centers
– http://healthit.hhs.gov/portal/server.pt?open=512&o
bjID=1495&parentname=CommunityPage&parentid
=58&mode=2&in_hi_userid=11113&cached=true
– (or go to http://healthit.hhs.gov/, select ―HITECH
Programs‖ in the left column, then select ―Health
Information Technology Extension Program‖)
• Stratis Health HIT Toolkits
– http://www.stratishealth.org/expertise/healthit/
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Key Health Alliance—Stratis Health, National Rural Health Resource
Center, and The College of St. Scholastica.
www.khaREACH.org
(877) 331-8783 ext. 222
REACH is a project federally funded through the Office of the National Coordinator, Department of Health and
Human Services (grant number EP-HIT-09-003).
REACH
- Achieving
meaningful
REACH - Achieving
meaningful
use of youruse
EHRof your EHR
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