Meaningful Use Stage 2: Summary of Proposed Rule for Eligible Professionals (EPs) Wyatt Packer HIT Regional Extension Center (REC) HealthInsight

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1 Meaningful Use Stage 2: Summary of Proposed Rule for Eligible Professionals (EPs) Wyatt Packer HIT Regional Extension Center (REC) HealthInsight

2 Notice of Proposed Rule Making (NPRM) Stage 2 proposed rule released March 7 60-day comment period ends May 6 Final rule expected Summer 2012

3 Conceptual Approach to Meaningful Use Stage 3 Stage 1 Stage 2 Data capture and sharing Advanced clinical processes Improved outcomes 3

4 Stages of Meaningful Use 1 st Year Stage of Meaningful Use TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD

5 Total Objectives Stage 1 Stage 2 Eligible Professionals Eligible Professionals 15 core objectives 17 core objectives 5 of 10 menu objectives 3 of 5 menu objectives 20 total objectives 20 total objectives 5

6 Changes to Existing Measures 6

7 Computerized Physician Order Entry (CPOE) More than 30% of patients have a CPOE medication order if they have any med orders More than 60% of medication, laboratory and radiology orders entered using CPOE Exclusion: Any EP who writes fewer than 100 medication, laboratory and radiology orders during the EHR reporting period

8 e-prescribing More than 40% of prescriptions for eligible providers Required for EP - More than 65% of prescriptions for eligible providers Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period or does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 25 miles of the EP's practice location at the start of his/her EHR reporting period.

9 Demographics Recorded (race, ethnicity, pref. language) More than 50% of patients More than 80% of patients

10 Vital Signs Recorded More than 50% of patients over 2 Split vitals: BP is more than 80% of patients over 3; Height/Weight is more than 80% of all patients Exclusion: Any EP who sees no patients 3 years or older is excluded from recording blood pressure.

11 Smoking Status Recorded More than 50% of patients over 13 More than 80% of patients over 13 Exclusion: Any EP that neither sees nor admits any patients 13 years old or older.

12 Clinical Decision Support Implement 1 clinical decision support intervention Implement 5 intervention rules + drug/drug and drug/allergy

13 Visit Summaries More than 50% of office visits within three business days Policy: An EP can choose whether to offer the summary electronically or on paper by default, but at the patient's request must make the other form available. Provide summary for more than 50% of office visits within 24 hours, includes a list of required elements, some of which are newly proposed, such as: demographic info, smoking status, care plan field with goals and instructions, recommended patient decision aids, if applicable. Maintain policy from Stage 1 on electronic vs. paper summary. Exclusion: Any EP who has no office visits during the EHR reporting period

14 Conduct Security Analysis Conduct or review security analysis Expanded to include encryption of data at rest

15 e-copy & e-access Patient Health Information e-copy: Required, more than 50% of patients who request it e-access: Menu option, more than 10% of patients Replaced by dual requirement: 1) more than 50% of patients have online access within 4 business days and, 2) more than 10% of patients have used the capability to view (access), download or transmit to a 3rd party their information Exclusion: Any EP who neither orders nor creates any of the information listed for inclusion as part of this measure may exclude both measures. Any EP that conducts 50 percent or more of his or her patient encounters in a county with low broadband levels* may exclude only the second measure.

16 Lab Results as Structured Data Menu option, more than 40% of lab results Required, for more than 55% of lab results Exclusion: Any EP who orders no lab tests whose results are either in a positive/ negative or numeric format during the EHR reporting period.

17 Generate List of Patients by Specific Condition Menu option, one list Required, one list

18 Send Reminders for Preventive, Follow-up Care Menu option; more than 20% of patients under 5 or over 65 Required, 10% of all patients seen in the last 24 months Exclusion: Any EP who has had no office visits in the 24 months before the EHR reporting period.

19 Patient Specific Education Materials Provided Menu option, more than 10% of patients Required, more than 10% of all patients. EHR needs to be used to ID materials, can be stored elsewhere Exclusion: Any EP who has no office visits during the EHR reporting period

20 Medication Reconciliation Menu option, performed for more than 50% of transitions of care visits (incoming) Required, more than 65% of transitions of care visits (incoming) Exclusion: Any EP who was not the recipient of any transitions of care (in-coming) during the EHR reporting period.

21 Summary of Care Record Transmitted to Provider Menu option, performed for more than 50% of transitions (can be on paper) Replaced by dual requirement: 1) for more than 65% of care transitions (outgoing) and referrals; 2) must be electronic for 10% (further explanation of electronic : transmit a summary of care record using Certified EHR Technology to a recipient with no organizational affiliation and using a different Certified EHR Technology vendor than the sender for more than 10% of transitions of care and referrals) Exclusion: Any EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period is excluded from both measures.

22 Submit Immunization Data to Registry Menu option, perform one test Required, successful ongoing submission of data Exclusions: Any EP that meets one or more of the following criteria may be excluded from this objective: (1) the EP does not administer any of the immunizations to any of the populations for which data is collected by the jurisdiction's immunization registry or immunization information system during the EHR reporting period; or (2) the EP operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required at the start of their EHR reporting period.

23 Submit Syndromic Surveillance Data Menu option, perform one test Menu option for EPs, successful ongoing submission of data Exclusions: Any EP that meets one or more of the following criteria may be excluded from this objective: (1) the EP is not in a category of providers that collect ambulatory syndromic surveillance information on their patients during the EHR reporting period; or (2) the EP operates in a jurisdiction for which no public health agency is capable of accepting the specific standards required or receiving electronic syndromic surveillance data in the specific standards required by ONC.

24 New Measures 24

25 Secure Messaging No requirement More than 10 % of patients have sent at least one message to EP. Exclusion: Any EP who has no office visits during the EHR reporting period

26 Ability to View Images No requirement Menu option: more than 40% of all imaging results are accessible through EHR Exclusion: Any EP who does not perform diagnostic interpretation of scans or tests whose result is an image during the EHR reporting period.

27 Family History No requirement Menu option: more than 20% of patients have family history recorded as structured data Exclusion: Any EP who has no office visits during the EHR reporting period.

28 Submit Information to Cancer Registries No requirement Menu option: successful ongoing submission to cancer registry Exclusions: Any EP that meets at least 1 of the following criteria may be excluded from this objective: (1) The EP does not diagnose or directly treat cancer; or (2) the EP operates in a jurisdiction for which no public health agency is capable of receiving electronic cancer case information in the specific standards required under Stage 2 at the beginning of their EHR reporting period.

29 Submit Information to Specialized Registries No requirement Menu option: successful ongoing submission to specialized registry Exclusions: Any EP that meets at least 1of the following criteria may be excluded from this objective: (1) The EP does not diagnose or directly treat any disease associated with a specialized registry; or (2) the EP operates in a jurisdiction for which no registry is capable of receiving electronic specific case information in the specific standards required under Stage 2 at the beginning of their EHR reporting period.

30 Removed or No Longer Stand-alone 30

31 Report Clinical Quality Measures Core requirement with specified measures 15 measures for hospitals, 6 for EPs CQMs are no longer a meaningful use core objective, but reporting CQMs is still a requirement for meaningful use 24 measures for hospitals, 12 for EPs, submit electronically (final measures with final rule, but expect additional measures targeted to pediatrics, oral health, obstetrics, and behavioral health) Option to submit once for both MU and PQRS

32 Drug-drug and Drug-allergy Checking Enabled No longer a stand-alone measure now combined as part of clinical decision support

33 Drug Formulary Checking Menu option No longer a stand-alone measure Incorporated as a requirement for e-rx

34 Electronically Exchange Patient Information Perform one test Replaced by specific requirement for transitions in care

35 Maintain Medication List, Problem List, & Med Allergy List More than 80% of patients have an entry or indication of none No longer stand-alone measures, must be included in the electronic record for patient access and transmitted at transitions in care.

36 Other Areas Covered in the Proposed Rule 36

37 Care Plan Definition e-copy/e-access, Visit Summaries, Summary of Care Record We propose to describe a care plan as the structure used to define the management actions for the various conditions, problems, or issues. For purposes of meaningful use measurement, we propose that a care plan must include at a minimum the following components: problem (the focus of the care plan), goal (the target outcome) and any instructions that the provider has given to the patient. A goal is a defined target or measure to be achieved in the process of patient care (an expected outcome). We encourage EPs to develop the most robust care plan that is warranted by the situation. We also welcome comments on both our description of a care plan and whether a description is necessary for purpose of meaningful use.

38 Hardship Exemptions for Payment Adjustments Proposed Exemptions for payment adjustments (penalties) on an application basis: Insufficient internet access two years prior to the adjustment year Newly practicing EPs for two years Extreme circumstances such as unexpected closures, natural disaster, EHR vendor going out of business, etc. Applications need to be submitted no later than July 1 of year before the payment adjustment Other Possible Exemption Discussed in NPRM Combination of 3 barriers would constitute a significant hardship: o Lack of direct interaction with patients o Lack of need for follow-up care for patients o Lack of control over the availability of Certified EHR Technology Discussion as to whether any specialty may nearly uniformly face all 3 barriers

39 Medicaid-specific Changes Expanded definition of a Medicaid encounter: To include any encounter with an individual receiving medical assistance under 1905(b), including Medicaid expansion populations To permit inclusion of patients on panels seen within 24 months instead of just 12 To permit patient volume to be calculated from the most recent 12 months, instead of on the CY To include zero-pay Medicaid claims

40 REC Tools & Services Resources on our website - EHR Adoption & Implementation Tools Meaningful Use Education & Tools Seminars and presentations Direct technical assistance available 40

41 Questions? For additional information, contact us: HealthInsight s Regional Extension Center (800) This material was prepared by HealthInsight as part of our work as the Regional Extension Center for Nevada and Utah, under grant #90RC0033/01 from the Office of the National Coordinator, Department of Health and Human Services. 41

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