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Volume 7, Issue 3


When you see 20 patients a day, applying online can be a real lifesaver. At NJ PURE, we understand how strapped you are for time. As a direct provider of malpractice insurance, we work closely with thousands of physicians. Keeping your busy schedule in mind, we’ve created the industry’s first online application. Just a few simple keystrokes and you’ll be taking advantage of our new discounts. So switch to an insurer that values the same things you do: your time and your money. Visit njpure.com.

Physician Advocate (ISSN 1555-5054) is published quarterly (winter, spring, summer, fall) by the Medical Society of New Jersey (MSNJ), 2 Princess Road, Lawrenceville, NJ 08648. Free to MSNJ Members. Periodicals postage paid at Trenton, NJ, and at additional mailing offices. POSTMASTER: send address changes to Physician Advocate, 2 Princess Road, Lawrenceville, NJ 08648


Lawrence Downs, Esq. Chief Executive Officer General Counsel

“Getwired”tosurvive andthriveinhealthcare.

I

n my position, I have the great privilege of interacting regularly with both primary care and specialist physician leaders across New Jersey. As I look back over the past year, my conversations with physicians on the topic of electronic medical records (EMR) have centered on their “go live” experience. This year, many physicians have moved beyond “considering the investment” in technology to full-on training and implementation of those systems. The typical practice reports a slower workflow and a steeper learning curve for the first few months after adoption. In 2012, we hope to report an increase in efficiency, quality and revenue for the typical wired medical practice. However, the most powerful and strategic advantage of implementing an EMR system in a physician practice is the ready access to patient care data. This data will allow physicians to make faster and better medical decisions and will be critical for physicians to fairly evaluate new payment models in the future. I am proud that MSNJ is a partner in leading the effort for adoption of health information technology (HIT) among private practice physicians. Our partnership with the New Jersey Health Information Technology Extension Center (NJ-HITEC) has resulted in hundreds of educational sessions, technology fairs, and exhibits all designed to foster the adoption and Meaningful Use of HIT to improve healthcare. This issue of Physician Advocate is focused on HIT and is a year-end celebration of physicians who have adopted and are using the technology successfully in their practices. It is also a celebration of MSNJ’s successful partnership with NJHITEC to accelerate the use of HIT to improve clinical care. As of this publication, more than 5,000 physicians in New Jersey have joined NJ-HITEC and 218 physicians have certified as meaningful users of the new technologies. For primary care physicians still on the fence about the technology, it is not too late to take advantage of substantial government subsidies to adopt and use HIT in your practice. The information in this issue will help you get started. Even if you plan to retire from active clinical practice in the next few years, it may still make sense to invest HIT, should you plan to sell your practice. From a business valuation perspective, practices that are electronically connected may be worth more. For specialists, even though they may not be eligible for federal incentives for adoption, the benefits of adopting HIT are undeniable. HIT is a business asset and may also be necessary for new models of care under healthcare reform.

If you are already using HIT, MSNJ is launching several programs in 2012 to make you a better end-user. Watch for MSNJ user groups that will allow physicians to interact with HIT developers to learn how to maximize the use of their information systems for better patient care. MSNJ members will also have access to programming in 2012 that will demonstrate ways to easily increase practice revenues through the use of data and technology. The ringing in of a new year is a great time to reflect on the past and think about the future. We can predict, with a high degree of confidence, that the business of medicine will undergo significant changes over the next several years. Medical practices in New Jersey will need information and data systems to be prepared for this shift. MSNJ will continue to develop programs, services and partnerships to assist our members in the changing healthcare arena. Please accept my sincere wishes for a healthy and happy new year.

Cheers! 1

The Medical Society of New Jersey, established 1766 ✦ “Leaders in healthcare, leaders in life”


ELECTRONIC MEDICAL RECORDS CAN OFFER LONG-TERM BENEFITS, IF YOU COMMIT TO THE SHORT-TERM ADJUSTMENTS Niranjan (Bonki) Rao, MD, 219th President, Medical Society of New Jersey Technology buzz words are flying around the healthcare community. Physicians can’t spend a day in the office or hospital without hearing phrases such as “meaningful use,” “EMR system” or “workflow redesign.” In my own surgical practice in New Brunswick, we are beginning the transition from paper to electronic records. The phrase I’m hearing most is “return on investment.” As I research possible EMR systems for my practice, my goal is to be as thorough and analytical as possible. This process has forced me to prepare a cost-benefit analysis, a tool I believe to be critical for other physicians also evaluating EMRs. My input does not come from scientific methodology, but rather from practical application I’ve seen in my more than 25 years as a New Jersey surgeon in private practice. My analysis is based on a physician office with two practicing specialists. I looked at costs involving the production of a single chart, including: paper forms, manila folders, adhesive tabs, etc. Depending on the complexity of a practice’s filing system, the cost of one chart may be between $3 and $5. The charts in my office cost about $5 each. Our office processes many new and returning patient consults per month. If the assumption is based on an average of 100 new patients per month, we will create 1,200 new charts per year. When I multiply the 1,200 new charts that we’ve created by the $5 per chart cost, this equals approximately $6,000 per year spent on paper materials. We did not factor labor and retrieval into our equation, nor does my analysis take into consideration the cost to lease office space for storage. If included in the calculation, these factors would certainly increase the per-chart cost. While our two-physician group spends close to $6,000 per year for paper charts, there is the additional cost of medical record transcription. Based on my practice costs, I estimate this to be roughly $10,000 per year. A simple cost analysis yields the following equation: Chart generation ($6,000)

+

Transcription ($10,000)

= $16,000/year

Based on my research, the average subscription cost for an EMR system is around $500 per doctor, per month. For a 2-doctor practice, this equals costs of $1,000 per month and $12,000 per year – totaling $4,000 less than the costs associated with paper chart generation and transcription (without including labor). Chart generation ($6,000)

+

Transcription ($10,000)

– Annual Lease of EMR ($12,000)

= $4,000/year in savings

I understand that there are significant upfront “costs,” such as navigating the learning curve and the initial set-up, consulting fees and the agony of going through a system conversion. However, the long-term profitability will far exceed the headaches you may experience in the short-term. This cost savings is why I am making the move to an EMR system and away from my current system of paper records. Even at this stage in planning, I already see the convenience of utilizing an electronic system. From a business standpoint, I will decrease my labor costs, as there will be minimal time lost in populating, pulling or filing a chart. A simple query for patient information is right at my practice manager’s fingertips. Not only will I be able to share information with my colleagues securely, but I now have the capability of accessing records remotely. I will be able to see patient information from the office, my home or from the MSNJ offices by entering a username and password. By capturing new data from my patients, I can generate automatic e-mail reminders about appointments instead of assigning staff the task of making phone calls. Depending on website integration, patients could even schedule their appointments online. By utilizing an EMR efficiently, an office could potentially lower labor costs and maintain, if not increase, productivity. I haven’t addressed all of the factors surrounding the transition from paper to electronic records, but a basic cost-benefit analysis showing the long-term benefits should make the decision to switch to an EMR a clear one. I hope you will consider this move for your practice if you have not done so already. 2

Physician Advocate ✦ Winter 2011


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The Medical Society of New Jersey, established 1766 ✦ “Leaders in healthcare, leaders in life”


Attestation – A Click Away By Denise Anderson, Ph.D.

Attesting can be as easy as one click when all of the core requirements for Stage I Meaningful Use (MU) have been met in the implementation of a federally certified Electronic Health Record (EHR) system. However, getting to the point of attestation can become frustrating for providers if their EHR system is not fully certified, or if they are not clear on the specific requirements outlined by the Center for Medicaid and Medicare Services (CMS). Here is where the experience of the New Jersey Health Information Technology Extension Center (NJ-HITEC) is invaluable. Meaningful Use Manager, Balavignesh Thirumalainambi, outlines three scenarios where NJ-HITEC can assist physicians in ensuring that they are on the correct path to attestation. NJ-HITEC’s MU expert explains,“In the first situation, a practice is using an EHR system that is not certified by the Office of the National Coordinator (ONC). In the second scenario, the EHR system is only partially certified. Finally, in the third case, the practice is using a certified EHR system, but is having trouble meeting the criteria.”

Balavignesh Thirumalainambi

In each scenario, NJ-HITEC has a solution to assist the provider. The first item of business is to determine if the provider’s EHR system is ONC certified. This issue is resolved by cross-referencing the providers EHR system to the ONC’s Certified HIT Product List (CHPL). If the system is not certified, NJ-HITEC verifies if the vendor is not certified or if the system just needs an upgrade to meet the criteria. Whatever the outcome, the NJ-HITEC team helps the practice to outline a timeline to resolve the issue. If the practice is working on an EHR system that is partially certified, NJ-HITEC then determines the gaps in certification and assists the provider in finding a product or upgrade that addresses the disparity in the system. Lastly, if the EHR system meets all of the certification criteria but the provider is still unable to meet the Stage I MU criteria, NJ-HITEC performs a MU Gap Analysis. The Gap Analysis first learns where the MU report is being run on the system. Thirumalainambi notes, “A key point to understand is that providers do not need to count their patients for the 90-day period. The system should do that for them and generate a MU report by default.” Once the issues in above scenarios are resolved, the NJ-HITEC team reviews the MU report and gives providers a status of how they are fairing in meeting the MU core requirements. “Most of the systems provide MU reports that give the correct numbers; the required numerators and denominators. If the provider is falling behind on any of the core requirements, we advise the provider on the steps to take to rectify the situation. Most of the time it’s a workflow issue.”

“In each scenario, NJ-HITEC has a solution to assist the provider.” 4

Physician Advocate ✦ Winter 2011


A provider must meet the following requirements within the 90-day period to be eligible to attest to Stage I MU: ❖ 15 Core Objectives ❖ Five out of 10 Menu Objectives (One of the five must be a Public Health Objective) ❖ Six Clinical Quality Measures (CQMs) out of a list of 44 items (The CQM is also one of the 15 Core Objectives.) There are a number of misconceptions regarding the criteria. Thirumalainambi explains one of the most significant misunderstandings, “Providers are under the impression that they have to meet all the requirements for the entire 90-day period. That is not case. They have to meet the thresholds of all of the criteria within the 90-day period as well as meet all the requirements on the 90th day.” Fully reporting demographics and recording vital signs are two of the most common pitfalls that providers encounter when trying to meet Stage I MU requirements. There are a couple of issues regarding demographics. First, the regulation requires the provider to record five different data points – date of birth, gender, race, ethnicity, and preferred language. If a provider fails to record one of these data points, the patient record will not be counted in the demographic reporting measure. Second, if the data is being recorded properly but not properly entered in the EHR system, the system will not recognize the data when the MU report is run. Another example of workflow deficiency occurs in recording vital signs. “All providers record vital signs but their reporting measures will not increase until height, weight, and blood pressure are collectively reported at least once during the same patient visit,” states Thirumalainambi. “We recommend that providers select one qualified staff member to record all three data points so they can ensure the requirement is met.”

“The implementation of an EHR system can be challenging, but a simple change in workflow design can alleviate some of the frustration.”

NJ-HITEC understands the dynamics of a practice as well as the demands faced by providers and their staff. The implementation of an EHR system can be challenging, but a simple change in workflow design can alleviate some of the frustration. Regardless of where a practice is in the implementation of an EHR system, NJ-HITEC can provide the necessary support to keep the process moving forward. For more information or assistance in achieving Stage I MU, please contact NJ-HITEC at (973) 642-4055, email at info@njhitec.org, or visit our website at www.njhitec.org.

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The Medical Society of New Jersey, established 1766 ✦ “Leaders in healthcare, leaders in life”


NJ-HITEC MUVers Celebration A Success The New Jersey Health Information Technology Extension Center (NJ-HITEC) honored 25 providers who have achieved Stage I Meaningful Use in the implementation of an Electronic Health Record (EHR) system in their practices in mid-September at the New Jersey Institute of Technology (NJIT) in Newark. These physicians will or have received checks from the Center for Medicaid and Medicare Services (CMS) because they have met the federal requirements for EHR use. The recognized physicians achieved this milestone with the assistance of NJ-HITEC. Moreover, Dr. Amit Tailor performed a live attestation with NJ-HITEC’s Meaningful Use Manager, Bala Thirumalainambi, demonstrating the ease of attesting when all of the parameters have been met.

Dr. Amit Tailor performs a live attestation with NJ-HITEC's Meaningful Use Manager Bala Thirumalainambi during the MUVers event.

The over 240 attendees also received updates from the CIO of NJ Medicaid, Thomas Jordan; NJ State HIT Coordinator, Colleen Woods; CIO of Somerset Medical Center, David Dyer; and President and CEO of Health-e-cITi, Maria Vizcarrondo. In addition, participants heard a heartwarming story from Pam Kaur emphasizing the importance of EHRs from a patient’s point of view. Kaur is a client relations manager with Blue Print Healthcare IT and a dedicated advocate in the transition to EHRs. Further, a panel discussion was led by the CIO of the NJ Hospital Association, Joe Carr, discussing the how hospitals are facilitating and encouraging the transition from paper to EHRs. The panel included: CIO of St. Joseph's Hospital Medical Center, Jim Cavanagh; AVP of Medical Affairs of Holy Name Medical Center, Dr. Craig Hersh; CIO of Somerset Medical Center, David Dyer; and CIO of NJ Medicaid, Thomas Jordan. Currently, NJ-HITEC is assisting 5,000 physicians in NJ to reach their IT goals. For more information on NJ-HITEC call 973-642-4055, email info@njhitec.org or visit our website at www.njhitec.org.

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Physician Advocate ✦ Winter 2011

State HIT Coordinator, Colleen Woods, speaks about the state's efforts in supporting the implementation of EHRs.


NJ-HITEC celebrates all of the MUVers that are successfully implementing EHRs.

NJ-HITEC Deputy Executive Director, Pam Kathuria & Executive Director, Bill O'Byrne, MUVer Dr. Stephen Thomsen, and NJIT Senior VP for Research & Development, Don Sebastian (left to right)

CIO of NJ Medicaid, Tom Jordan updates the attendees on the role of Medicaid in the EHR process.

The panel (left to right) of CIO of NJ Medicaid, Tom Jordan; CIO of St. Joseph's Hospital Medical Center, Jim Cavanagh; AVP of Medical Affairs of Holy Name Medical Center, Dr. Craig Hersh; and CIO of Somerset Medical Center, David Dyer discuss how hospitals are transitioning to EHRs. 7

The Medical Society of New Jersey, established 1766 ✦ “Leaders in healthcare, leaders in life”


NJ-HITEC Reaches the 5,000 Member Milestone Supporting NJ Physicians in the Transition to Electronic Health Records The New Jersey Health Information Technology Extension Center (NJ-HITEC) announced in mid November that it has reached the 5,000 primary care providers member milestone in support of the healthcare evolution to transition to patient Electronic Health Records (EHRs). Each of its member doctors signed an agreement pledging to work with NJ-HITEC to become a meaningful user of EHRs; to earn the federal incentive funds pursuant to President Obama's Stimulus Plan; and to improve the timely delivery of high quality medical care through the effective use of health information technology. This major milestone, achieved six months ahead of the April 2012 deadline, demonstrates NJ-HITEC’s commitment to assist primary care providers effectively utilize their EHR systems to meet the federal requirements for incentive funds. Executive Director, Bill O’Byrne explains, “NJ-HITEC has a deeply committed and highly talented staff who welcomes the challenge to now train and educate 5,000 New Jersey primary care providers as Meaningful Users of electronic health information technology. We are convinced that our efforts will significantly improve the quality and timeliness of healthcare delivery in New Jersey.” NJ-HITEC was established in June 2010 by the New Jersey Institute of Technology (NJIT) through a $23 million grant from the U.S. Department of Health and Human Services, Office of the National Coordinator as part of the American Reinvestment and Recovery Act (ARRA) of 2009. NJIT’s Senior Vice President of Research and Development, Dr. Donald H. Sebastian, the principal investigator of the grant, adds, “We knew it was a stretch goal to start a new organization while also enrolling one of the largest cohorts of physicians for any center in the country. It’s a credit to the entire organization that NJ-HITEC made its mark ahead of plan and will now

press forward in the assistance program for these doctors. As the 5,000 physicians begin to demonstrate the value of EHR adoption, we look forward to the rest of the state’s practitioners joining the movement – and then our state’s eight million residents will begin to see how this movement will result in reduced cost and improved quality of healthcare delivery.” The next phase of the grant is to assist NJ-HITEC’s primary care providers utilize their EHR systems to meet the federal criteria of Meaningful Use established by the Centers for Medicare and Medicaid (CMS). O’Byrne explains, “NJHITEC will now commence a provider-centered focus to assist each doctor to select a fully accredited EHR system and work intensively with these physicians and their staff to demonstrate the proper way to use these systems to benefit the patient and the practice.” O’Byrne adds, “This phase of work will continue until 2015 as it is expected that electronic health information technology will increasingly become a part of how high quality healthcare is delivered to Americans. Ultimately, every patient will have an interoperable, safe, and secure electronic health record that is accessible in a nationwide interoperable health information network.” NJ-HITEC is one of 62 federally designated Regional Extension Centers (REC) nationwide established to improve American healthcare delivery and patient care through the investment in health information technology. As New Jersey’s lone REC, O’Byrne recognizes the scope of work ahead of NJ-HITEC as well as those organizations that have helped in its success, “NJ-HITEC is grateful to NJIT, our parent organization for the guidance, staffing, and technological support that we receive. NJIT and its students are an essential part of the success of NJ-HITEC and we look forward to a continued relationship. We also want to thank the State of New Jersey for its support in this effort as well as the ONC who is committed to this nationwide initiative.”

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Physician Advocate ✦ Winter 2011


NJ Medicaid & HMO’s Support NJ-HITEC’s Mission New Jersey Medicaid along with its four Health Maintenance Organizations (HMOs) jointly sent a letter to their providers urging them to take advantage of the available federal incentives to make the transition from paper records to Electronic Health Records (EHRs) by registering with the New Jersey Health Information Technology Extension Center (NJ-HITEC). This unique collaboration demonstrates the urgency of implementing information technology into medical practices. Amerigroup NJ, Healthfirst NJ, Horizon NJ Health, and UnitedHealthcare Community Plan along with NJ Medicaid confirmed their commitment to improve the quality of healthcare delivery in the Garden State through their partnership with NJ-HITEC. These healthcare organizations recognize the valuable resources available through NJ-HITEC to assist their providers in this transition. For more information, please call 973-642-4055, email info@njhitec.org, or visit www.njhitec.org.

NJ-HITEC Opens New Office in South Jersey A ribbon cutting ceremony announcing the opening of an additional location for the New Jersey Health Information Technology Extension Center (NJ-HITEC) in partnership with the Virtua Healthcare System was held in late summer in Camden. This partnership demonstrates NJ-HITEC’s and Virtua’s commitment to assist primary care providers take advantage of federal incentive programs in health information technology to better serve the healthcare needs of the citizens of Camden. The event included over 30 participants including Executive Director of the Camden Coalition of Healthcare Providers, Dr. Jeff Brenner; Virtua’s Vice President and CIO Alfred Campanella; NJIT’s Vice President of Research and Development, Dr. Donald Sebastian; NJ-HITEC’s Executive Director, Bill O’Byrne, Founding Dean of the Rowan University Medical School, Dr. Paul Katz, MD; Chairman and CEO of Continuum Health Alliance and Advocare, Dr. John Tedeschi, MD; Vice President, Medical Affairs and Chief Medical Officer of Lourdes Health System, Dr. Alan Pope, MD; and Cooper University Hospital, Director of Inpatient Medical Informatics Dr. Snehal Gandhi, MD. NJ-HITEC’s O’Byrne states, “We are extremely proud to open this office with our Virtua partners as we are dedicated to support those primary care providers in the Camden area who treat some of the neediest individuals in our state.” Virtua’s Campanella adds, “The use of Electronic Health Records in physician practices facilitates the delivery of quality patient care. Virtua is pleased to support NJ-HITEC’s efforts to encourage EHR adoption in the physician community.” In NJ-HITEC’s continued efforts to offer statewide support to New Jersey’s physicians in their transition to effectively utilized EHRs and achieve Meaningful Use, NJ-HITEC opened a satellite office at the Medical Society of New Jersey in Lawrenceville. This once again demonstrates NJ-HITEC’s commitment to work with its partners to improve healthcare delivery in the Garden State. Executive Director of the Camden Coalition of Healthcare Providers, Dr. Jeff Brenner, speaks about the importance of implementing EHRs at the ribbon-cutting ceremony in Camden.

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The Medical Society of New Jersey, established 1766 ✦ “Leaders in healthcare, leaders in life”


A P at i e n t ’ s S t o r y

Parmjit “Pam” Kaur Pam Kaur is employed in the healthcare industry by BluePrint Healthcare IT and understood the value of an Electronic Medical Record (EMR) even before her diagnosis. Her case is an excellent example of why EMRs are critical to improving patient healthcare delivery in the United States through the effective use of health information technology. Kaur’s medical journey began with misdiagnoses, numerous tests, and months of waiting. Moreover, Kaur had to explain her medical situation several times to multiple doctors at their office and in the emergency room. She finally received an accurate diagnosis in June 2008. Kaur explains, “After months of testing, misdiagnosis, and lots of money spent, I finally had gotten answer… I, Pam Kaur, have Multiple Sclerosis (MS). Throughout this process, three times she was given other patients’ medical records as well as received a bill for a treatment performed on another individual. Due to these mishaps and Kaur’s concern about privacy and security issues for all involved, she decided to find a physician who is successfully implementing an EMR system. Even though her primary care provider’s (PCP) office is an hour away from her home, she is willing to drive those extra miles for the piece of mind of knowing her medical information is accurate, accessible, and up-to-date. Kaur explains, “The first thing I noticed when I entered my new PCP’s office was that there were no large filing cabinets, no large stacks of paper, and only three staff members. First, the medical assistant met with me. She kept me engaged for the entire conversation and confirmed all of my information. When the PCP entered the room, she asked me another series of questions and entered that information into my EMR. The quality of questions were better than in the past and we truly had a conversation.” Although critics of EMR systems maintain that inputting information into a computer or tablet during a patient visit disrupts physicians’ interaction with their client, Kaur couldn’t disagree more, “While my PCP occasionally looked at the computer screen to ensure the information she was entering was precise, she kept me engaged, maintained eye contact, and probably spent more time getting to know me and my ailments than any other physician that I had visited.”

“I feel comfortable knowing that my medical record will be quickly accessible.”

Kaur’s story clearly reinforces the message that the timeliness of patient health information is critical in the testing, diagnosis, and treatment of individuals, but even more importantly, it is essential in overall patient case management. She adds, “I feel comfortable knowing that important aspects of my medical history such as my blood type, prescribed drugs, and medical conditions can be accounted for more accurately. Moreover, being a MS patient, should an emergency rise, I feel comfortable knowing that my medical record will be quickly accessible.”

Kaur is an advocate for MS being named “Cranford’s Most Inspirational Walker” by the National Multiple Sclerosis Society in April 2010. She is also an advocate with the New Jersey Metro Chapter of the MS Society and volunteers on the New Jersey Health Information Technology (HIT) Consumer Advocacy Quality Care Subcommittee.

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Physician Advocate ✦ Winter 2011


Dr. Masucci found a better way. power of a web-based network like athenahealth is that “The it has created a seamless integration between our billing and clinical services, allowing us to focus on patient care, which is our ultimate goal.

Here’s what he did. After 30 years running a solo pediatric practice, Dr. Peter E. Masucci found a better way to manage his practice. Now, he spends more time with patients than ever and he’s getting paid the money he’s owed — when he’s owed it. With athenahealth’s integrated web-based billing, practice management, and electronic es, he’s been able to: health record services, e Days in Accounts A cou ounts Receivable Rec f Reduce by 65% Increase the percentage per entag of claims paid at f Increase c contr acted ed rate r fr their contracted from 62% to 99% f Find that th elusive ive work/life iv work/life balance bal he’s been searching for f searching

Here’s Her e’s how w he did it. it f Low-cost, Low-c web-based, sed, CCHIT-certifi CCHIT ed sof software f A constantly updated, patented database of insurance and clinical rules f Back-office services to handle your most time-consuming tasks Sound interesting? As a Medical Society of New Jersey member, you may qualify for a discount on athenaCollectorSM. To learn more about our billing, practice management and EHR services, visit

l

athenahealth.com/msnj or call 800.981.5085

*Dr. Peter E. Masucci participates in athenahealth’s National Showcase Client Program. For more information on this program, please visit www.athenahealth.com/NSC.

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The Medical Society of New Jersey, established 1766 ✦ “Leaders in healthcare, leaders in life”


NJ-HITEC Partners with Community College for More than Training

Rick Crespo

“When Bill and Pam came into class to talk about NJ-HITEC, I was hooked.”

The New Jersey Health Information Technology Extension Center (NJ-HITEC), since its inception, partners with community colleges to hire graduates who have completed the Office of the National Coordinator’s (ONC) Health Information Technology Certificate. NJ-HITEC delivers introductory sessions to primary care providers who are thinking about Electronic Health Record (EHR) systems as well as supports these providers through the process of implementation to become Meaningful Users of this technology. Take Rick Crespo as a prime example. Looking to channel his past work experience to a new career, Crespo’s background includes a bachelor’s degree in Business Administration from Muhlenberg College in Pennsylvania followed by working in the insurance industry and staffing for a visiting nurse agency. “I wanted to enhance my skills to strengthen my marketability. I was looking in the IT direction and the certificate program in health information technology at Essex County College (ECC) seemed like the perfect fit. It’s a six-month program meeting three times a week. When Bill and Pam came into class to talk about NJ-HITEC, I was hooked,” explains Crespo. NJ-HITEC Executive Director, Bill O’Byrne, and Deputy Executive Director, Pamela Kathuria provide insight into NJ-HITEC’s role in the federal initiative to assist primary care providers transition to EHR systems. Their discussions with students have sparked interest in this challenging undertaking. Crespo was hired as a Service Provider Representative assisting the South Jersey Regional Director, Jack Hueter. Crespo will be working with field agents to assist in supporting new NJ-HITEC members, presenting NJ-HITEC to hospitals, following up with primary care providers who are NJ-HITEC members, and guiding providers through the process of EHR implementation. “My background in outside sales, dealing with physicians, and business management plus the knowledge gained through the certificate program provide me the tools I needed to make a career change,” adds Crespo. This is a win-win situation for all involved.

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Physician Advocate ✦ Winter 2011


Contact Information New Jersey Health Information Technology Extension Center at the New Jersey Institute of Technology William J. O’Byrne Executive Director New Jersey Health Information Technology Extension Center 973-642-4055 obyrne@njhitec.org Pamela Kathuria Deputy Executive Director Mobile: 973-368-7588 kathuria@njhitec.org Ron Manke North Jersey Regional Director Mobile: 201-632-5990 manke@njhitec.org

Michael A. Zegar Central Jersey Regional Director Mobile: 732-698-8730 mzegar@njhitec.org

Denise Anderson, Ph.D. Director, Strategic Initiatives Mobile: 732-618-3867 denisea@adm.njit.edu

Jack Hueter South Jersey Regional Director Mobile: 609-388-1887 jhueter@njhitec.org

Balavignesh Thirumalainambi Meaningful Use Manager Mobile: 518-301-0150 balat@njhitec.org

New Jersey Health Information Technology Extension Center (NJ-HITEC) is one of 62 Regional Extension Centers (RECs) throughout the country established through the Health Information Technology for Economic Clinical Health (HITECH) Act of 2009 to improve American healthcare delivery and patient care through the investment in health information technology. By making an investment in health information technology, every patient will benefit from an Electronic Health Record (EHR) as part of a modernized, interconnected, and vastly improved system of health care delivery. The benefits for both the doctor and patient include: quick access to patient records, real time reporting to and from patients, hospitals, and specialists; legible and complete health care records; easily tracked health maintenance reminders; time savings through less chart chasing and fewer calls; and better coding accuracy for error reduction and faster reimbursement. NJ-HITEC is the federally designated REC for New Jersey established by the New Jersey Institute of Technology (NJIT) through a grant from the U.S. Department of Health and Human Services, Office of the National Coordinator. NJ-HITEC provides support and assistance to New Jersey's primary care providers in the selection, implementation, and achievement of "Meaningful Use" of an EHR system. NJ-HITEC Enterprise Development Center (EDC) New Jersey Institute of Technology 211 Warren Street Newark, NJ 07103 Phone: 973-642-4055 • Fax: 973-622-2075 • Email: info@njhitec.org

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The Medical Society of New Jersey, established 1766 ✦ “Leaders in healthcare, leaders in life”


Interview with Dr. Jeffrey Brenner by Bill O’Byrne Camden is New Jersey’s poorest city with two out of five residents below the national poverty level. Its population of approximately 79,000 live in one of the nation’s most dangerous places, a place where taking a walk for exercise can be fatal. Fully one percent of the city’s population accounts for 30 percent of its healthcare costs. Except Camden can lead the nation in lowering the cost of healthcare through the effective implementation and utilization of health information technology to improve patient case management, if Dr. Jeffrey Brenner, MD, has his way. Dr. Brenner is the founder and executive director of the Camden Coalition of Healthcare Providers. The Coalition was established nine years ago with a mission to “improve the quality, capacity, and accessibility of the healthcare system for vulnerable populations in the City of Camden.” Prior to leading the Coalition, Dr. Brenner, a family physician, owned a private practice in Camden for 11 years serving individuals of all ages. As a citywide organization in Camden, the Coalition is made up of nurses, physicians, administrators, social workers, hospitals, health service organizations and clinics that serve patient needs in Camden. It provides community outreach and education; advocates for healthcare models that it has developed; improves coordination among various points of care; collects and evaluates healthcare data; and manages high need patient cases. Dr. Brenner is on a mission to implement health information technology throughout the Camden healthcare system to better serve its citizens and help to reduce costs. The sharing of information is instrumental for these goals to be met. Consequently, Camden introduced the first Health Information Exchange (HIE) in New Jersey in November 2010 with funding from its three hospital partners - Cooper University Hospital,

Lourdes Health System, and Virtua Health- along with the Merck Company Foundation, and the New Jersey Department of Health and Senior Services. The Camden HIE is web-based technology that offers providers access to important medical information for patients. When the New Jersey Health Information Technology Extension Center (NJ-HITEC) opened its doors in June 2010 with a mission to assist primary care providers in underserved areas to adopt and effectively utilized an EHR system, a partnership between Dr. Brenner and NJ-HITEC Executive Director Bill O’Byrne was inevitable. NJ-HITEC is the Garden State’s only federally designated Regional Extension Center (REC) established by the New Jersey Institute of Technology (NJIT) through a grant from the U.S. Department of Health and Human Services’ Office of the National Coordinator (ONC).

O’Byrne: How is the implementation of Camden’s HIE progressing? Dr. Brenner: We have the following hospitals – Cooper University Hospital, Lourdes Health System, Virtua Health, Underwood Memorial Hospital and Kennedy Health System – sharing information such as lab results, radiology reports, and discharge summaries as well as the CAMcare Health Corporation and Project Hope, Inc., who are both Federally Qualified Health Centers (FQHCs). As we expand our HIE across the city of Camden, we plan to connect to other HIEs in the state and receive lab results and medication data from additional sources. We were also awarded federal funding from the ONC which will be channeled through New Jersey’s Health IT Coordinator’s office to continue building our HIE. Our goals are to decrease healthcare costs while improving access to healthcare and the quality of patient visits. O’Byrne: Your medical strategy of “unique care” has attracted the attention of the healthcare industry. Can you explain the process?

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Physician Advocate ✦ Winter 2011


“Our goals are to decrease healthcare costs while improving access to healthcare and the quality of patient visits.” Dr. Brenner: We implemented our Care Management Project in 2007 to reach patients who are the most frequent utilizers of Camden’s emergency departments and hospitals. These individuals usually suffer from chronic disease, mental illness, or substance abuse and lack consistent primary medical care. This type of patient may only make up one percent of the population, but accounts for 30 percent of the healthcare resources. These patients are our high cost, complex cases. The Care Management Project has over 115 participating patients and employs a team approach to patient care consisting of a social worker, a nurse practitioner, and a health outreach worker/medical assistant. The team enrolls the patient into our program and then begins to stabilize his or her social environment and health condition. The goal is to find a long-term medical home. The team also helps patients apply for government assistance benefits, secure temporary shelter, and enroll in medical day programs, while coordinating primary and specialty care. Our staff goes to the patient, whether that place is a homeless shelter, hospital room, street corner, or abandon home. We could not be successful without the collaboration of our partners and the sharing of information to address the challenges and develop solutions. O’Byrne: As you know, our mission at NJ-HITEC is to assist doctors become Meaningful Users of an Electronic Health Record (EHR) system. The ability to share information to effectively treat a patient is the one of most compelling reasons for doctors to adopt EHRs. How have you moved this initiative along? Dr. Brenner: We have about 15 primary care practices in the city of Camden with a total of approximately 75 doctors. We are in the early stages of EHR implementation. EHRs are another resource for physicians to better manage their patient’s care and share information. We are continuing to make progress in this area. Currently, we have AmeriCorps volunteers shadowing doctors and working on our care management teams who assist in utilizing EHRs. O’Byrne: You advocated for the Medicaid Accountable Care Act in New Jersey. Now that the legislation was adopted, what are the plans moving forward? Dr. Brenner: Medicaid Accountable Care Organizations (ACOs) make sense in New Jersey because of our fragmented

provider, hospital, and payer landscape. In addition, we have a high percentage of Medicaid recipients in our urban, impoverished cities. This challenge will make the ACO model easier to implement because it is based on a multi-stakeholder, geographic platform. Providers will continue to receive their Medicaid payments, and the ACO, if the providers meet quality benchmarks, would be eligible for shared saving payments. It is a win-win situation for all. Moreover, similar to Camden, Newark and Trenton have established citywide coalitions that will also streamline ACO implementation. We plan to launch our Medicaid ACO in early 2012, yet another way we are expanding our collaboration and supporting our healthcare delivery models.

Become a member of MSNJ today! Scan the QR code on your Smartphone or visit www.msnj.org to register online. Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. The organization and its dues-paying members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician–patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. This allows response to the patients’ individual, varied needs, in an ethical and compassionate environment, in order to create a healthy Garden State and healthy citizens.

15

The Medical Society of New Jersey, established 1766 ✦ “Leaders in healthcare, leaders in life”


By Colleen Woods

New Jersey physicians received nearly $4 million in Electronic Health Record (EHR) incentive payments by November 2011. That’s $18,000 each for the 222 physicians who achieved the first stage of Meaningful Use of EHRs on a certified system. Over five years, they and other New Jersey physicians serving Medicare patients will have the opportunity to receive up to $44,000 each in incentive payments. In November 2011, physicians serving Medicaid patients started registering on the newly opened NJ Medicaid portal which handles the EHR Incentive program for those eligible professionals. Physicians and their colleagues serving Medicaid patients will have the opportunity to receive up to $63,750 each in EHR incentive payments over six years. By November 2011, 5,000 primary care physicians and other eligible professionals had signed up for New Jersey’s Regional Extension Center (REC) called NJ Health Information Technology Extension Center (NJ-HITEC) that assists physicians in practices of 10 physicians and under, as well as physicians in Federally Qualified Health Centers (FQHCs), in the adoption and Meaningful Use of certified EHRs. NJHITEC had reached its initial 5,000 goal ahead of schedule, and is one of the top three RECs in the country in attracting physicians. By November 2011, three of the state’s five health information organizations (HIOs), regional collaborations of hospitals and physicians, have claimed initial portions of the majority of federal funds managed by the state to step up the infrastructure for exchanging health information in those regions – $11.3 million was awarded to the state to step up the infrastructure to exchange personal health information among providers. By November 2011, three New Jersey hospitals had received a total of $3 million in their initial EHR incentive payments, with another five hospitals set to receive their first EHR incentive payments shortly. In November 2011, several of my colleagues leading various aspects of this health IT initiative in the state and I represented New Jersey at the second Annual Conference of the Office of National Coordinator for Health Information Technology, a part of the US Department of Health and Human Services, in Washington, DC. Sitting and talking with health IT leaders from across the country, it is easy to appreciate the unique leadership role New Jersey is taking, as well as how far New Jersey and the other 49 states , plus territories, have to go. The goal is to have everyone in New Jersey and across the country have his or her own electronic health records by 2014.

New Jersey’s Three Part Approach The New Jersey Health Information Technology Coordinator’s Office oversees the state’s planning and implementation for the federal/state transformation of medical records from paper to EHRs that was initiated by the HITECH Act of 2009. The New Jersey Operational HIT Plan, approved by ONC in January 2011, focuses on three areas—EHR adoption, establishing HIOs, and connecting to a statewide/national structure to exchange clinical information.

1. Helping Healthcare Providers Make the Transition to Electronic Health Records In mid-2011, 8,330 physicians New Jersey physicians reported their use of EHRs in one of their practice locations, and another 3,211 planned to implement use of EHRs in the next two years according to the NJ Board of Medical Examiners (BME). That translates to about 25 percent of New Jersey physicians who currently use EHRs in their practices and another 10 percent who plan to use EHRs in the next two years. This data comes from an optional questionnaire attached to the biannual re-licensing of 33,840 physicians in mid-2011. The EHR use reported is higher than what was learned from a 2009-10 national survey, when 16 percent of New Jersey physicians were shown to be using a basic EHR system. About 13,400 physicians did not answer the questions about EHRs. The good news is there is an upward trend. We will be focusing on additional strategies in the next couple of months to further help physicians and other providers to be eligible for the incentive funds. Health information technology makes it possible for healthcare providers to better manage patient care through secure use and sharing of health information. NJ-HITEC, which was awarded $23 million in federal funds, helps physicians assess their EHR needs, choose a vendor, review workflows, and make sure physicians are taking the correct steps to fulfill the Meaningful Use requirements needed to qualify to receive EHR incentives. NJ-HITEC has been recognized as a national leader for its expertise in helping physicians achieve Meaningful Use. NJ-HITEC is working with physician associations and organizations, hospitals, and New Jersey Medicaid to reach out to physicians and other qualified professionals.

2. Establishing Health Information Organizations 16

Physician Advocate ✦ Winter 2011


Five groups of hospitals, physicians, Federally Qualified Healthcare Centers (FQHCs), and other healthcare providers came together to form the State’s five regional health information organizations (HIOs). The HIOs allow health data to be gathered confidentially and securely from all the patient’s providers, and then shared among those physicians, hospitals, pharmacies, labs and community healthcare providers within the HIO’s membership who are treating the patient for the benefit of the patient. These are the five existing HIOs, and the counties they serve: Health Information Organization

Counties Served

Camden Coalition

Camden County

Health-e-cITi-NJ

Passaic, Essex, and Hudson Counties

Jersey Health Connect

Bergen, Hunterdon, Middlesex, Morris, Somerset, Sussex, Union, and Warren Counties

Trenton HIE

Mercer County

MOHIE

Monmouth and Ocean Counties

3. Connecting through a Statewide/Nationwide Exchange The New Jersey Health Information Network (NJHIN) will be established to facilitate data exchange among the HIOs operating in the State, allow HIOs to access state data sources such as Medicaid and immunization registry information, and provide a gateway to connect to other states via the Nationwide Health Information Network (NwHIN).

Use Cases Under the direction of the NJ Health IT Coordinator, a subcommittee has drafted five use cases, which are the technical details needed to exchange different types of health information among providers: 1. Medication History: Patient medication history will be made available for Emergency Department admissions. 2. Public Health Immunization Data: State immunization registry information will be available directly to a physician EHR. 3. Lab and Radiology Results: Reports, not images, will be available to EHRs. 4. Emergency Department/Acute Discharge Summary: Transfer of patient information in form of discharge summary to after an Emergency Room visit or hospital discharge summary to a patient’s primary care or specialist physician. 5. Transition of Care-Referral Information: To enhance communication and care coordination with primary care physician or specialist.

Three National Priorities for Exchanging Information The New Jersey Coordinator’s Office is also working on three priorities set nationally to increase the chances for physicians to achieve Meaningful Use:

“The goal is to have everyone in New Jersey and across the country have his or her own electronic health records by 2014.”

1. E-Prescribing: In order to ensure that physicians can perform ePrescribing, the ONC has asked the state programs to work to get all pharmacies to accept ePrescriptions. In August 2011, 91 percent of pharmacies actively accepted ePrecriptions, up from 2008 when 72 percent of pharmacies in New Jersey accepted ePrescriptions. This is in line with national trends according to Surescripts. 2. Receipt of structured lab results: Labs are being approached to facilitate the delivery of reports via the HIOs to hospital and physician members.

3. Sharing patient care summaries across unaffiliated organizations: The coordinator’s office is working on an avenue for physician offices and hospitals to share patient information when those different organizations are not part of the same structure.

Privacy and Security The privacy and security safeguards established to protect paper-based health information also apply to electronic health records. In fact the HITECH Act has stepped up the HIPAA measures by requiring providers to perform an annual risk analysis of their security arrangements, and correct any problems they encounter in order to achieve Meaningful Use. Continued on page 18 17

The Medical Society of New Jersey, established 1766 ✦ “Leaders in healthcare, leaders in life”


Turning Paper Into Electronic Health Records in New Jersey: View from the NJ Health IT Coordinator’s Office Continued from page 17

Statement of Ownership, Management, and Circulation Required by 39 U.S.C. 3685 1. Title of Publication: Physician Advocate 2. Publication No.: 1555-5054 3. Date of Filing: October 21, 2011 4. Frequency of Issue: Quarterly. 5. No. of Issues Published Annually: Four

Looking Ahead Physicians, along with other health professionals, play a critical role in transforming the paper world of healthcare into the electronic world we have learned to expect in the other areas of our life. As the State Coordinator, I stand in awe and appreciation for all the work physicians, hospitals, and their health IT colleagues have done within their organizations and outside of their organizations to achieve our goals for using health IT to help transform healthcare.

Resources These are resources on the Web that can assist physicians in learning, adopting and complying with Meaningful Use of EHRs. New Jersey Health IT Coordinator’s Office: www.nj.gov/njhit NJ-HITEC: www.njhitec.org NJ Medicaid EHR Incentive Program: www.nj.gov/njhit/ehr NJ Medicaid EHR Incentive Application/Attesting: www.njmmis.com

6. Annual Subscription Price: $35 7. Complete Mailing Address of Known Office of Publication: Medical Society of New Jersey 2 Princess Road, Lawrenceville, Mercer County, NJ 08648 8. Complete Mailing Address of the Headquarters of General Business Office of the Publisher: 2 Princess Road, Lawrenceville, Mercer County, NJ 08648 9. Names and addresses of publisher, editor, and managing editor: Publisher: Medical Society of New Jersey, 2 Princess Road, Lawrenceville, NJ 08648. Editor: Daniel Klim, 2 Princess Road, Lawrenceville, NJ 08648 10. Owner (if owned by a corporation, its name and address must be stated and also immediately there under the names and addresses of stockholders owning or holding 1% or more of total amount of stock. If not owned by a corporation, the names and addresses of the individual owners must be given. If owned by a partnership or other unincorporated firm, its name and address, as well as that of each individual must be given. If the publication is published by a nonprofit organization, its name and address must be stated): Medical Society of New Jersey, 2 Princess Road, Lawrenceville, NJ 08648 11. Known bondholders, mortgagees, and other security holders owning or holding 1% or more of total amount of bonds, mortagages, or other securities: None (a nonprofit corporation of New Jersey). 12. For completion by nonprofit organizations authorized to mail at special rates (dmm Section 423.12 only). The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes have not changed during preceding 12 months.

HIOs

15. Extent and Nature of Circulation

AVERAGE NO. COPIES EACH ISSUE DURING PRECEDING 12 MONTHS

a. Total number of copies (net press run)

Jersey Health Connect: www.jerseyhealthconnect.org Health-e-cITi-NJ: www.healtheciti.net Camden: www.camdenhealth.org/programs/health-information-exchange

ACTUAL NO. OF COPIES OF SINGLE ISSUE PUBLISHED NEAREST TO FILING DATE

6,125

6,500 4,674

Office of National Coordinator for Health IT (policy and technical site): http://healthit.hhs.gov

b. Paid circulation (by mail and outside the mail) 5,042 1. and 2. Paid/Requested Mail Subscriptions Stated on Form 3541 3. Paid distribution outside the mails including sales through dealers and carriers, street vendors, counter sales, and other paid distribution outside USPS® — 4. Paid distribution by other Classes Mailed through the USPS —

Health IT (physician and consumer site): www.healthit.gov

c. Total paid distribution (sum of 15b (1), (2), (3) & (4)

4,674

Centers for Medicare and Medicaid Services EHR Incentives Program: www.cms.gov/EHRIncentivePrograms

d. Free or nominal rate distribution (by mail and outside the mail)

Trenton Health Team: www.trentonnj.org/Cit-eAccess/news/index.cfm?NID=21238&TID=55&jump2=0 MOHIE: Web site not yet established

e. Total free or nominal rate distribution (sum of 15d (1), (2), (3) and (4)

Author Bio:

f. Total free distribution (sum of 15c and 15e)

Colleen Woods was appointed by Governor Chris Christie as New Jersey Health IT Coordinator in July 2010 and works in the Governor’s Office. Previously Woods served as the Chief Information Officer for the New Jersey Department of Human Services.

5,042

— —

5,042

4,674

g. Copies not distributed (see instructions to Publishers #4 (page #3)

1,083

1,826

h. Total (sum of 15f and g)

6,125

6,500

i. Percent paid (15c divided by 15f times 100)

100%

100%

13. I certify that the statements made by me above are correct and complete. (signed) Art Weigold

18

Physician Advocate ✦ Winter 2011


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I hereby release, and hold harmless from any liability or loss, the County Medical Society and Medical Society of New Jersey, their officers, agents, employees, & members for acts performed in good faith & without malice in connection with evaluating any application & my credentials & qualifications, & hereby release from any liability any & all individuals & organizations, who, in good faith & without malice, provide information to the above named organizations, or to their authorized representatives, concerning my professional competence, ethical conduct, character & other qualifications for membership. Furthermore, I attest to the accuracy of information supplied on this application & understand that falsification of any information may result in denial or revocation of membership. Applicant's signature: ___________________________________________________ Date: ______________________________ $10 of the annual msnj dues goes toward publication of Physician Advocate. 19

The Medical Society of New Jersey, established 1766 ✦ “Leaders in healthcare, leaders in life”


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Physician Advocate âœŚ Winter 2011


  

 

 

  









 


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Winter 2011  

Volume 7, Issue 3

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