The Georgia Health Information Technology Extension Center (GA-HITEC) is Georgia's only federally endorsed health information technology center focused on providing technical assistance to providers and hospitals throughout the entire Electronic Health Record (EHR) implementation process and beyond, including assistance with the reporting required to qualify for and receive EHR Incentive Program payments from the federal Centers for Medicare and Medicaid Services (CMS). GA-HITEC's leaders use their expertise to assist practices and hospitals with improving the quality of care for patients and maximizing overall productivity through the meaningful use of EHR systems. Through its work in the HIT arena, GA-HITEC launched Georgia Health Connect (GaHC), a regional health information exchange connecting practices and small hospitals in rural and under resourced areas with disparate EHR systems to the state health information network—a task that would be otherwise difficult to achieve.
Dominic Mack, M.D., a practicing family physician who is co-director of the National Center for Primary Care and an associate professor at the Morehouse School of Medicine in Atlanta, currently serves as the executive director of GA-HITEC and Georgia Health Connect. He has spent many years practicing family medicine in underserved communities of Georgia. Dr. Mack recently spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the current efforts of GA-HITEC and GaHC to help support practicing physicians in Georgia who are delivering care to underserved and indigent communities in Georgia, as they move to fulfill the requirements of the MIPS (Merit-based Incentive Payment System) system under the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law. Below are excerpts from their recent interview.
Tell me a bit more about the mission of the National Center for Primary Care?
We’re a research, educational, training, and resource center for health equity. We do a lot of health equity big-data research, and help provide implementation programs to help support the primary care system, for underserved communities. We are here to advance health equity. Our focus is underserved communities, especially rural communities.
Is the National Center’s focus statewide, or national?
No, the Center’s focus is national. We do a good bit of our work in the Southeast. We have a number of federally focused programs, some of them as broad as 18 states in breadth. Most of the HIT work has been within the state of Georgia.
And we’ve been working with Liaison [the Alpharetta, Ga.-based Liaison Technologies, Inc.] to help implement HIE [health information exchange] in smaller practices and hospitals to serve underserved and under-resourced communities in both urban and rural areas. With MACRA, we’re moving forward to improve quality improvement programs that help them to meet those initiatives. With HIE, we’re looking at analytics that can help them evaluate how they’re performing in relation to the MACRA measures. With regard to GA-HITEC, we’re actually a sub-recipient of federal funding to help smaller practices in Georgia, so we’ll be working with that program. GMCS is the QIO for the state of Georgia. Georgia Medical Care Foundation. They are the QIO for Georgia. They received about $11 million to manage the implementation of this QPP program that CMs is doing in NC, SC, GA, and FL. We are their partner in Georgia. QPP. QPP is MIPS—the Quality Payment Program.
When did this work to help physicians in practice prepare for work with QPP, begin?
It began in March.
And what are you doing, at a very basic level?
We’re providing technical assistance to small practices. In the state of Georgia, there are over 6,000 providers in practices of fewer than 15 providers. We will be working with GMCS to help those 6,000 providers to implement QPP/MIPS over the next four years.
What are the key components of that?
Quality improvement. That area encompasses Advancing Care Information (ACI), which deals with HIT and HIE. We’ll be focusing on ACI and clinical practice improvement with GCMS.
How are you going to be helping them do this?
So for ACI measures, which replace the meaningful use measures, we’ll be helping them to upgrade the technology, improving the functionality, and improving workflows within their practice, for better health information exchange. They have to improve the functionality of the EHR. The EHR is going to have to be more encompassing and to more comprehensively capture patient data, so that it can be analyzed and reported within their record on behalf of patients.
Is there 100 percent adoption of EHRs on the part of physicians in Georgia now?
No, we have about 80 percent adoption right now.
And, per the remaining 20 percent who haven’t yet adopted, you’ll be helping them implement EHRs, correct?
Yes, and the Medicaid program’s meaningful use program is continuing. We’re working with the State of Georgia Department of Community Health—CMS has continued to provide funding to help Medicaid-participating physicians to complete adoption. And the ones who do, with Georgia Health Connect—what we do is not a direct objective of the MACRA program with GMCS; but because we’re an HIE, as Georgia Health Connect, we’re able to help providers connect with information exchange. And that’s what we’re doing with Liaison; we formed our HIE in 2015.
How many physicians and hospitals have been connected live so far through Georgia Health Connect?
We don’t have any hospitals right now; we have about 45 physicians. It’s still in its early stages. We are live with those 45 doctors, and we are connected to the Georgia statewide HIE—GaHC.
What is it that Liaison is helping you to do?
Liaison is providing our technology backbone. We’re not a technology organization; we do the ideation and the customer-facing work. But the connectivity, the service and the maintenance, are provided by Liaison. We started working with them in 2014.
How big are you hoping that GHC will become?
I do hope it becomes big. By the end of this year, we’re hoping to get up to a couple of hundred providers, and then over the next five years, we’d like to get a couple of thousand providers, and some hospitals, on board as well.
What will the biggest challenges be for doctors to get up to speed to gather, analyze, and report their data to the QPP/MIPS?
The smaller the practice, the more difficult it’s going to be. One of the largest barriers will be not just implementing an EHR system, but getting an EHR system that performs in a manner that allows them to obtain the information, analyze the information, and report on the information, effectively. A lot of doctors are doing good work, but now you have to show that you’re doing good work. And taking that next step is a big issue. And it takes personnel to improve your workflows within your practice. And so to improve your patient engagement and your workflows—you do need a staff. You may need to upgrade your staff, for example, to support the different components of the PCMH [patient-centered medical home] model. So getting the additional resources to support changes to your workflow and improve your technology, will be one of the biggest problems.
Do you think most Georgia physicians will be able to ramp up to the mandates in 2018?
They’ve changed a little of it; 2018 is still relatively simple. It’s in 2019 and 2020 that things ramp up.
And are doctors ready for the demands of 2019 and 2020?
Today? No. Probably up to 40 percent of providers really don’t know too much about the program. And on a basic level, there’s a need for awareness, and getting the physicians to report this year. They’re hoping to encourage people to report on all the measures, just to get ready. But I’ve seen articles saying, you just need to report on one measure this year. But doing so wouldn’t help me prepare for next year. So as of today, no, they’re not ready.
Do you think that CMS’s expectations of Georgia physicians are too rigorous, or not?
Let me just leave it at, ‘aggressive.’ We’ve been happy to be on board and to work with CMS on this. The good thing is that they are involved with us with communities that are saying they need more help. But it is definitely aggressive. That’s not just coming from me, but from other physicians. They’ve been inundated with multiple programs, and smaller practices just don’t know how they’re going to meet the requirements. That’s why we’re glad to be involved. And hopefully, we can help them to be successful.
What would CIOs and CMIOs of hospitals and health systems with which some physicians in practice are affiliated, be thinking about right now?
The smaller and rural hospitals are just trying to survive; they’re doing all they can with the resources they have, to help the practices. With the larger health systems, of course, they’ve been buying up practices, and connecting them with their health systems. What I would say to CIOs and CMIOs on behalf of these small practices, is that I would hope that they develop programs that allow the practices to stay in practice. Part of the CMS program is trying to push practices into APMs [advanced alternative payment models]. There are a lot of small businesspeople who want to stay in business. In that context, I’m so glad that they’re talking about these virtual groups in the MIPS program, and I don’t know if they’ve got the definition of that nailed down, but I like the idea of them coming together in groups of 10 or more, so that they can report together. And I’d like for those practices to remain viable and independent.
Is there anything you’d like to add?
We’re just trying to advance the creation of health equity. We just want to make it an equitable playing field for all patients. We try to support the practices that are serving patients. And for us, the technology innovation that’s happened has actually widened the technology gap, so we’re trying to make sure the smaller practices can make use of the same level of technology available to larger practices. And Liaison has been a great partner in that.