Regional Extension Centers (REC) Reported Practice Level Challenges to Achieving Meaningful Use

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Slide 1

REC Reported Practice Level Challenges to Achieving Meaningful Use

Office of Provider Adoption Support
Dawn Heisey-Grove, MPH
September 10, 2012

Slide 2

62 RECs Cover 100% of the USA

Initial Program Goal:

100,000 priority primary care providers achieve meaningful use (MU) by 2014.

Every REC:

• Has a defined service area and specific number of providers.
• Provides unbiased, practical support throughout process.
• Serves as two-way pipeline to federal and local resources.

Approach differs by REC:

• Independent operations.
• Affiliation with QIOs and universities.
• Partnership with other Office of the National Coordinator for Health Information Technology (ONC) grantees (Beacon and health information exchange [HIE]).
• Variety of hospital and payer partnerships.

Image: A map of the United States shows the locations of the 62 RECs.

Slide 3

Who RECs Are Helping

Image: A pie chart shows a breakdown of providers working with RECs as of March 12, 2012:

• Private Practice 1- 10 (46,613).
• Public Hospitals (16,994).
• Community Health Center (20,834).
• Practice Consortium (17,591).
• Rural Health Clinic (3,618).
• Rural Hospital (1,447).
• Critical Access Hospital (4,050).
• Other Underserved Setting (16,592).

Image: A pie chart shows Primary Care Providers (PCPs) in the U.S. Working with RECs (60%) and Not Working with RECs (40%).

Over 120,000 providers:

~ 42% of all PCPs in U.S.
~ 70% of all rural providers
~ 74% of Federally Qualified Health Centers (FQHCs)

*Not shown: 10,000+ specialists.

http://dashboard.healthIT.gov

Slide 4

Who Works with the RECs?

Image: Two pie charts show specialties working with RECS:

• Family Practice Providers (52,665).
• Pediatricians (21361).
• Internal Medicine Practitioners (29,320).
• OB-GYNs (14,702).
• General Practice Providers (5,579).
• Other Providers (1,665).
• Geriatricians (882).
• Adolescent Medicine Providers (222).
• Gynecologists (926).

Slide 5

Background

• In November, 2011, RECs were asked to enter site-level challenges in the CRM.
• RECs are using the CRM Challenges feature in varying ways:
  • Some are creating a "Challenges" for every site; for those sites on track, they are creating an "On Track" issue.
  • Others are only creating "Challenges" issues for those practices that are stuck in the process.
• 3 RECs are sending data files to OPAS external to the CRM. Those data are incorporated into these slides.

Slide 6

Challenges Categories

• One field captures the stage of adoption for the practice: are they trying to reach AIU [adopt/implement/upgrade or use], or MU?
• There are then 5 Challenges Types: Practice Issues, Vendor Issues, Attestation Process problems, problems with MU Measures, and an "On Track" classification.
• Within each of the Challenges Types, there are sub-categories. A definition page is available upon request.

Slide 7

Primary and Secondary Challenges Categories

Practice Issues

• Workflow adoption.
• Provider engagement.
• Training.
• Vendor selection.
• Administrative.
• Financial.
• Staffing.

Vendor Issues

• Upgrade:
  • Delays in Implementation/ Installation.
• Certification:
  • Reports slow/not available.
  • Training/support materials inadequate/ not available.
• Lack of vendor support.
• Technical.
• Inaccurate reports and/or data.

Attestation Process Issues

• Calculating patient volume.
• Medicaid program not up yet.
• Medicaid technical/administrative.
• Medicare technical/administrative.

MU Measures

• Core CQMs.
• Alternate Core CQMs.
• Additional CQMs.
• Each of the Core/Menu Set measure.

Complete list of Challenges categories, including tertiary categories and descriptions of the categories, is available upon request.

Slide 8

Resolved Challenges: Site Level

• Challenges can be resolved with at the site level or provider level
• At the site level, a Challenges would be resolved if:
  • The REC indicates the issue is "Completed."
  • A new issue is created to indicate the site is now on track.
  • An "on track" issue is resolved if a new Challenges issue is created.

Slide 9

Resolved Challenges: Provider Level

• At the provider level, all challenges are resolved if the provider receives an MU payment from the Centers for Medicare & Medicaid Services (CMS).
• Other ways a provider may have a Challenges resolved:
  • Attestation Process issues are resolved when a payment is received from CMS.
  • AIU issues are resolved if an AIU payment is received by CMS.
  • Vendor selection issues are resolved if a provider reaches M2 and the issue was created before the M2 date.
  • All issues except Attestation Process are resolved if a provider reaches M3.
  • All AIU Vendor Issues when the provider reaches M2, provided the issue was created before the M2 date.

Slide 10

Top Ten Overall Challenge Categories by Number of Providers Impacted

Data as of August 5, 2012, pulled from the ONC CRM. A total of 19,237 challenge Issues have been reported by RECs, impacting 54,101 providers. A total of 1,197 challenge Issues were created between July 1 and August 5, 2012, affecting 3,251 providers. 2,942 providers had challenge issues resolved between July 1 and August 5, 2012.

Slide 11

Challenge Activity For The Month

Top Ten New Challenge Issues

Top Ten Resolved Challenges

Data as of August 5, 2012, pulled from the ONC CRM. A total of 1,197 challenge issues were created between July 1 and August 5, 2012, affecting 3,251 providers. 2,942 providers had challenge issues resolved between July 1 and August 5, 2012. The green circle represents the issue with the most movement this month.

Slide 12

Overall Top Ten MU Measures-Specific Challenges

Data as of August 5, 2012, pulled from the ONC CRM. Users may select multiple measure-specific issues as challenges within one report, therefore, these numbers may overestimate the total number of challenge reports for Measure-specific issues. The blue ribbon indicates the top reported issue for the month. The green circle represents the issue with the most movement this month.

Measures to watch:
Core 4 (eRx) is #13 overall this month (down from #8) with 21 (5%) new reports.

Slide 13

Top Ten Newly Reported MU Measures-Specific Challenges: July 1-August 5, 2012

Data as of August 5, 2012, pulled from the ONC CRM. Users may select multiple measure-specific issues as challenges within one report, therefore, these numbers may overestimate the total number of challenge reports for Measure-specific issues.

Slide 14

Top Ten Top Ten Challenge Categories for Providers Trying to Reach MU

Data as of August 5, 2012, pulled from the ONC CRM. MU refers to the implementation phase the site is at for their EHR. A total of 11,991 providers have MU challenge Issues. The green circle represents the issue with the most movement this month; the blue ribbon indicates the top reported challenge for the month.

Slide 15

Top Ten Newly Reported Challenge Categories for Providers Trying to Reach MU: July 1-August 5, 2012

Data as of August 5, 2012, pulled from the ONC CRM. MU refers to the implementation phase the site is at for their EHR. A total of 2,773 providers have newly reported MU challenge Issues between July 1-August 5, 2012. The green circle represents the issue with the most movement this month.

Slide 16

Challenge and On Track Reports by Site

Images: A pie chart shows proportion of sites with challenge/on track reports:

• On Track Report: 8%.
• Barrier Issue: 13%.
• No Barrier Issue: 79%.

A bar graph shows number of reports per site. 84% of sites have only 1 challenge/on track issue reported.

Data as of August 5, 2012, pulled from the ONC CRM. 15,983 sites are represented in 19,237 challenge reports. Each site in the CRM may have multiple challenge issues created for it.

Slide 17

Overall Monthly Challenge Activity

Image: A bar graph shows monthly challenge activity from November 2011 to August 2012. Activity was highest in March and June 2012.

Data as of August 5, 2012, pulled from the ONC CRM. A total of 19,237 challenge Issues have been reported by RECs.

Slide 18

Proportion of Providers Impacted by Challenge Types as Reported in CRM

Image: A pie chart shows unresolved challenge issues:

• Practice Issues: 50%.
• Vendor Issues: 25%.
• MU Measures: 13%.
• Attestation Process: 12%.

Resolved Challenge Issues

Data as of August 5, 2012, pulled from the ONC CRM. 43,906 providers have open challenge issues; 33% (14,420) of those are on track. 10,195 providers have resolved issues.

Slide 19

Practice Issue Challenges

Images: A pie chart shows unresolved practice issue challenges:

• Administrative: 15%.
• Financial: 10%.
• Provider Engagement: 21%.
• Workflow Adoption: 10%.
• Vendor Selection: 31%.
• Staffing: 8%.
• Training: 5%.

A bar graph shows resolved practice issue challenges by number of providers from November 2011 to August 2012.

Data as of August 5, 2012, pulled from the ONC CRM. A total of 17,015 providers have a practice issue challenges report; 1,425 (8%) do not have a sub-category. 2,337 (14%) providers have practice issues that have been resolved.

Slide 20

Vendor Issue Challenges

Images: A pie chart shows unresolved vendor issue challenges:

• Delays in Implementation/ Installation: 27%.
• Inaccurate Reports and/or Data: 11%.
• Certification: 12%.
• Lack of Support: 3%.
• Reports Slow/Not Available: 16%.
• Technical: 12%.
• Training/Support Materials: 4%.
• Upgrade: 15%.
• Vendor Selection: 0%.

A bar graph shows resolved vendor issue challenges from November 2011 to August 2012.

Data as of August 5, 2012, pulled from the ONC CRM. A total of 8,737 providers have a vendor issue challenge report ; 825 (9%) do not have a sub-category. 1,385 (16%) providers have resolved vendor issue challenges.

Slide 21

Attestation Process Challenges

Images: A pie chart shows unresolved attestation process issues:

• Medicaid Program Not Up Yet: 34%.
• No Sub-Type: 26%.
• Medicaid: 19%.
• Medicare: 15%.
• Calculate Patient Volume: 6%.

A bar graph shows resolved attestation process issues from November 2011 to August 2012.

Data as of August 5, 2012, pulled from the ONC CRM. A total of 4,878 providers have an attestation process challenge report; 1,230 (25%) do not have a sub-category. 1,419 (29%) providers have a resolved attestation process issue.

Slide 22

Top Five Challenges by Practice Type

* MU Measures
** Attestation Process
*** Practice Issue
**** Vendor Issue

Data as of August 5 2012, pulled from the ONC CRM. Non-priority hospitals did not report any challenges.

Slide 23

Top Five MU Measures-Specific Challenges by Practice Type

Data as of August 5, 2012,pulled from ONC CRM, Private Practices >10 and non-priority hospitals did not report any MU Measures challenges.
Users may select multiple measure-specific issues as challenges within one report, therefore, these numbers may overestimate the total number of challenge reports for Measure-specific issues.
Green arrows indicate measures with significant upward movement in the rankings.