Quest to Attest 2014 Stage 1 Meaningful Use. Brett M. Paepke, OD Advisor, Stage 1 Meaningful Use

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2 Quest to Attest 2014 Stage 1 Meaningful Use Brett M. Paepke, OD Advisor, Stage 1 Meaningful Use

3 Goals Discussion of MU and the Incentive Program Analysis of Stage 1 Objectives Summary of RevolutionEHR Support Q&A

4 Introduction Meaningful Use will not happen without planning Schedule staff meetings period to start date entire staff input and education important consider action plans so each staff member knows what is expected of them

5 Support

6 Quest to Attest Facebook group Support

7 Ask About Meaningful Use Support

8 What is Meaningful Use? The use of certified EHR technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and families Improve care coordination and public health Maintain privacy and security of patient health information

9 Incentive Program Incentive payment based on 75% of Medicare allowable charges for year Total Payment First Year of MU 2011 $18,000 $12,000 $8,000 $4,000 $2,000 $44, $18,000 $12,000 $8,000 $4,000 $2,000 $44, $15,000 $12,000 $8,000 $4,000 $39, $12,000 $8,000 $4,000 $24, Penalty Penalty $0

10 Stages of MU 3 Stages of Meaningful Use Stage 1 - Data Capture and Sharing Stage 2 - Advanced Clinical Processes Stage 3 - Improved Outcomes

11 Stages of MU First Year of MU

12 Registration Each provider needs to register for Incentive program Not required to declare Start or End dates EHR Certification Number needs to be generated Registration guidance document on INSIGHT

13 Period of MU in 2014 Everyone will have a 90 day reporting period Providers in Year 1 of Stage 1 can choose any 90 consecutive days Providers in Year 2 of Stage 1 must choose a calendar quarter Providers in first year of Stage 1 need to complete 90 days and attestation by October 1, 2014 to avoid penalty in 2015 July 3, 2014 is last start date to avoid penalty Earliest target start date: April 1, 2014

14 Attestation The process by which you tell CMS how you did Can happen anytime after you complete your 90 days deadline is February 28, 2015 Preparation MU and CQM scorecards in RevolutionEHR CMS Attestation calculator / practice site

15 2014 Changes New Core objective: Patient Electronic Access Replaces/combines two objectives: Core 12: e-copy of Health Information Menu 5: Provide Timely Access to Health Information Can no longer exclude from Menu objectives Clinical Quality Measures removed from Core Now a fundamental part of being a Meaningful User Must report on 9 (vs. 6 in previous years)

16 Stage 1 Objectives 13 Core objectives (all required) eliminated/removed from original 15: E-copy of Health Info (old Core 12) Test of Electronic Exchange (old Core 14) Clinical Quality Measures (old Core 10) 9 Menu objectives (report on 5) exclusions for Public Health Submission objectives do not count toward your 5 removed from original 10: Provide Timely Access to Health Information (old Menu 5) 64 Clinical Quality Measures (report on 9) electronic submission of CQMs if beyond year 1 of MU

17 Core 1: CPOE Computerized Provider Order Entry How many of the med Rx s you wrote during the reporting period did you record as structured data in the EHR? if you use RxNT for all Rx s, you ll achieve 100% if not, provider must manually track Rx s written Exclusion available for providers who write less than 100 orders during the reporting period. >30% of med orders

18 Core 2: Drug Interaction Checks Drug-drug and drug allergy checks must be enabled for entire reporting period actual use of checks not required for Stage 1 Interaction checks available through RxNT Available for entire period

19 Core 3: Maintain Problem List Problem = Diagnosis Need at least one ICD-9 code in Diagnosis History or No Known Active Diagnoses box checked >80% of unique patients

20 Core 4: e-prescribing Generate and transmit prescriptions electronically How many of your med Rx s during the reporting period did you send electronically? Exclusions available: write fewer than 100 Rx s during reporting period no pharmacy within 10 miles that accepts e-rx s RxNT is the integrated e-rx partner >40% Rx s sent electronically

21 Core 5: Medication List Need at least one FDA medication in medication list or No Known Active Medications box checked General medication categories do not count. >80% of unique patients

22 Core 6: Med Allergy List Need at least one medication allergy in allergy list or No Known Medication Allergies box checked Other allergies do not count. >80% of unique patients

23 Core 7: Record Demographics Must have all five demographic categories documented: Date of Birth Gender Preferred Language Race Ethnicity >50% of unique patients

24 Core 8: Vital Signs Document a standard set of patient vital signs: Blood Pressure on patients 3+ Height Weight Depending on scope of care, a provider can: capture all 3 capture only height/weight capture only blood pressure capture none and exclude fully from objective >50% of unique patients

25 Core 9: Smoking Status Smoking status needs to be documented for patients age 13+ >50% of unique patients age 13+

26 Core 10: Clinical Decision Support EHR technology is expected to create a clinical decision support alert based on demographics, diagnoses, medication list, and lab test results. Two steps to enable CDS Setup rule(s) Add CDS screen to encounters Excellent video summary of setup process on INSIGHT. Process is identical to setting up Patient Education rules. at least 1 rule in place for entire period

27 Core 11: Patient Electronic Access New Core objective for 2014 Combines/replaces: Core 12: e-copy of Health Information Menu 5: Provide Timely Access to Information Must provide patients access to RevolutionPHR Access = When a patient possesses all of the necessary information needed to view, download, or transmit their information Provide >50% of unique patients with online access to health info within 4 business days

28 Core 12: Clinical Summaries Clinical summaries are specific to an encounter display list of medications, med allergies, diagnoses, and lab results Must be provided to patient within 3 business days Generate document as PDF and deliver delivery can be via print, media device, or PHR is not acceptable form of delivery Provided for >50% of all visits within 3 business days

29 Core 13: Protect Electronic Health Information Providers must conduct a security risk assessment (SRA) in accordance with HIPAA standards and implement security updates as necessary Failure to perform an appropriate SRA in the most common reason for MU audit failure Wisconsin Health Information Technology Extension Center (WHITEC) for more info on SRA assistance: Conduct or review a SRA and implement security updates as necessary

30 Menu Objectives Drug Formulary Checks Clinical Lab Test Results Patient Lists Patient Reminders Patient-Specific Education Resources Medication Reconciliation Transition of Care Summary Immunization Registries Data Submission Syndromic Surveillance Public Health Objectives Must attest to 5 of the 9 objectives

31 Menu 1: Drug Formulary Checks Must have ability to check at least 1 medication formulary Drug formulary checks must be enabled for the entire reporting period Formulary checks are part of RxNT Enabled for entire reporting period

32 Menu 2: Clinical Lab Test Results Clinical lab tests (i.e., hematology) that can be identified with a LOINC code should have the order and results logged provided they can be documented as positive/negative or in a numerical format. If you do not order lab tests, do not plan to attest to this objective >40% of lab test results are recorded

33 Menu 3: Patient Lists The ability to mine patient data is expected to improve quality of care, research, and patient outreach Lists can be created within Reports > Patients > Patient Search RevolutionEHR tracks lists based on ICD-9 codes Generate at least 1 list during period

34 Menu 4: Patient Reminders RevolutionEHR will automatically track reminders sent through the envelope icon within Appointment Details Scorecard looks at unique patients seen during the reporting period age 5 or 65 to see how many had an reminder sent to them Other methods of reminders are allowed and will require good documentation for reporting purposes Recall cards Telephone calls 3rd party systems reminder sent to >20% of patients age 5 or younger or 65 or older

35 Menu 5: Patient-Specific Education Resources Delivery of education material should be based on diagnosis, medication, med allergies, or lab results Only need to deliver materials to a patient once for credit Education resources don t need to come out of EHR. Setup of Patient Education is the same as Clinical Decision Support Excellent video walk-through on INSIGHT >10% of unique patients

36 Menu 6: Medication Reconciliation When a patient is referred into the practice, the patient s med list can be compared to the med list in RevolutionEHR to create one correct, consolidate list. Two steps: Click Transition of Care box on RFV Click Medication Reconciliation Performed on Medications screen >50% of patients referred into practice have medication reconciliation performed

37 Menu 7: Transition of Care Summary Pertains to patients sent out of the practice for care/consult 3 steps: Log referral under Show More > Referrals Print a Record Summary as requested by Provider. Forward summary along with other documents to consulting provider. Click the Document Provided checkbox Summary provided for >50% of referrals out

38 Menu 8 & 9: Public Health Submissions Menu objectives 8 and 9 are the two public health objectives that require a provider to submit information regarding: Immunization Status (Menu 8) Syndromic Surveillance (Menu 9) Since virtually no ODs perform immunizations or make syndromic diagnosis, an exclusion from either objective is expected Must report on one of the two unless you can exclude from both

39 Clinical Quality Measures No longer part of Core objectives. Instead, it is now a fundamental part of being a Meaningful User Must report a total of 9 Clinical Quality Measures (CQMs) that cover at least 3 of the National Quality Strategy measurement domains : Patient and family engagement Patient safety Care coordination Population and public health Efficient use of health care resources Clinical process / effectiveness

40 Clinical Quality Measures Providers in Year 1 of MU will submit CQM data through attestation system Providers in Year 2 of MU will submit CQM data electronically submission will occur between 1/1/15 and 2/28/15 Providers beyond Year 1 will be able to submit a full year of CQM data for PQRS reporting full year of CQM data required for PQRS reporting even though period of MU in 2014 is 90 days

41 Check scorecard frequently over 90 day period Everyday for 2 weeks Weekly at weeks 3 and 4 If after one month you are on track, check every other week With two weeks to go, begin to check daily again MU Scorecard

42 Clinical Quality Measures Scorecard

43 Summary What will you report on during attestation for 2014? 13 Core objectives 5 Menu objectives You must report on one of the two public health submission objectives unless you can exclude from both (New for 2014) - No penalty for skipping public health objective reporting if you can exclude from both, but it will not count toward your 5 Exclusions not acceptable for other Menu items 9 Clinical Quality Measures Scores are not important for Stage 1 Tracked automatically Specifics available on INSIGHT

44 Summary All providers have a 90 day reporting period in 2014 Providers in Year 1 of Stage 1 can choose any 90 consecutive days Providers in Year 2 of Stage 1 must choose a calendar quarter Can register and complete attestation anytime up to and including February 28, 2015

45 Questions? Brett M. Paepke, OD Advisor, Stage 1 Meaningful Use

46

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