Agenda. What is Meaningful Use? Stage 2 - Meaningful Use Core Set. Stage 2 - Menu Set. Clinical Quality Measures (CQM) Clinical Considerations

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1 AQAF Health Information Technology Forum Meaningful Use Stage 2 Clinical Considerations Marla Clinkscales & Mike Bice Alabama Regional Extension Center (ALREC) August 13,

2 Agenda What is Meaningful Use? Stage 2 - Meaningful Use Core Set Stage 2 - Menu Set Clinical Quality Measures (CQM) Clinical Considerations What can your REC team do for you? Questions, Contact Information and Resources - 1 -

3 What is Meaningful Use? The Recovery Act specifies the 3 stages of Meaningful Use: I. Use of certified EHR in a meaningful manner (e.g., e-prescribing) II. Use of certified EHR technology for electronic exchange of health information to improve quality of health care III. Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary But What we have learned is that Meaningful Use is simply a measure of EHR adoption and a by-product of a good EHR implementation Meaningful Use Happens 2

4 Each Stage of Meaningful Use provides a foundation for future growth and functionality Stage 3 Promote improvements in quality, safety and efficiency Decision support for national high-priority conditions Patient access to self-management tools Access to comprehensive patient data Improving population health Stage 2 Expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible Applying the criteria more broadly to both the inpatient and outpatient hospital settings Stage 1 Electronically capture health information in a structured format Use captured information to communicate that information for care coordination Implement clinical decision support tools Report clinical quality measures and public health information - 3 -

5 Agenda What is Meaningful Use? Stage 2 Meaningful Use Core Set Stage 2 - Menu Set Clinical Quality Measures (CQM) Clinical Considerations What can your REC team do for you? Questions, Contact Information and Resources - 4 -

6 Meaningful Use Stage 2 objectives and standards correlate with health related goals s relate to health related goals 17 Core s Providers must meet all standards unless an exception applies. 6 Menu s Providers must select 3 menu objectives. Blue Background White Background CORE objectives MENU objectives - 5 -

7 Stage 2 Meaningful Use s The List! Core Set: Must Do All 17 Menu Set: Must Do 3 of 6* Record demographics Smoking status Vital signs Clinical summary to patient Protect health information CPOE (meds, labs, imaging) e-prescribing + Formulary Checks Drug-drug -allergy checks and 5 CDS Rules Incorporate clinical labs results Medication reconciliation Generate patient list Patient reminders Patient-specific education Submit to immunization registry esummary for transitions to provider View Download and Transmit ephi Secure electronic messaging Submit electronic syndromic surveillance data Imaging results access Family history Electronic progress notes Report to cancer registries Report to specialty registry * Exceptions for menu items do not count towards the total. You must use a different menu item if possible. Clinical Quality Measures to CMS - 6 -

8 Core 1 Record Demographics Improve quality, safety, efficiency and reduce health disparities Record demographics: preferred language, sex, race, ethnicity, date of birth More than 80% of all unique patients seen by the EP have demographics recorded as structured data Numerator Denominator Population Exclusion Criteria The number of patients in the denominator who have all the elements of demographics (or a specific exclusion if the patient declined to provide one or more elements) recorded as structured data. Number of unique patients seen by the EP during the EHR reporting period. All Unique Patients. None - 7 -

9 Core 2 Smoking Status Improve quality, safety, efficiency and reduce health disparities Record smoking status for patients 13 years old or older More than 80% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data Numerator Denominator Population Exclusion Criteria The number of patients in the denominator with smoking status recorded as structured data. Number of unique patients age 13 or older seen by the EP during the EHR reporting period. Patients whose Records are Maintained in the EHR. EPs who see no patients 13 years or older - 8 -

10 Core 3 Vital Signs Improve quality, safety, efficiency and reduce health disparities Record and chart changes in vital signs: Height/length, Weight, Blood pressure (age 3 and over), Calculate and display BMI. Plot and display growth charts for patients 0-20 years More than 80% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and height/length and weight (for all ages) recorded as structured data Numerator Denominator Population Exclusion Criteria Any EP who believes that all Number of patients in the Number of unique 3 vital signs, or BP or Ht/Wt denominator who have at Patients whose patients seen by have no relevance to their least one entry of their records are the EP during the scope of practice. Any EP Ht/length and Wt (all ages) maintained in the EHR reporting with no patients 3 or older and/or BP (ages 3 and over) EHR. period is excluded from reporting recorded as structured data BP - 9 -

11 Core 4 Clinical Summary to Patient Engage patients and families in their health care Provide clinical summaries for patients for each office visit Clinical summaries provided to patients for more than 50% of all office visits within 1 business day Numerator Denominator Population Exclusion Criteria Number of office visits in the denominator where the patient or a patient-authorized representative is provided a clinical summary of their visit within 1 business day. Number of office visits conducted by the EP during the EHR reporting period. Patients whose Records are Maintained in the EHR. EPs who have no office visits during the EHR reporting period

12 Core 5 Protect Health Information Ensure adequate privacy and security protections for personal health information Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Conduct or review a security risk analysis per 45 CFR (a)(1) and implement security updates as necessary including addressing the encryption/security of data at rest in accordance with requirements under 45 CFR (a)(2)(iv) and 45 CFR (d)(3) and correct identified security deficiencies as part of its risk management process Requires only Yes/ No Attestation X Exclusion Criteria None

13 Core 6 CPOE (meds, labs, imaging) Improve quality, safety, efficiency and reduce health disparities Use CPOE for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local and professional guidelines More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE 3 Numerators 3 Denominators Population Exclusion Criteria Number of orders Patientswhose created for each of records are medication, maintained in laboratory and the EHR radiology. The number of orders in the denominator for each of medication,laboratory and radiology that have been entered using CPOE. If an EP writes fewer than one hundred orders for anyone of the three order types, then the exclusion applies to that order type only

14 Core 7 e-prescribing + Formulary Checks Improve quality, safety, efficiency and reduce health disparities Generate and transmit permissible prescriptions electronically (erx) More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Numerator Denominator Population Exclusion Criteria The number of prescriptions in the denominator generated and queried for a drug formulary and eprescribed Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or Number of prescriptions written for drugs requiring a prescription in order to bedispensed during the EHR reporting period. Patients whose Records are Maintained in the EHR. Does not apply to any EP who writesfewer than 100 prescriptions during the reporting periodordoes not have a pharmacy within their organization and no pharmacy accepts electronic prescriptions within 10 miles at the start of the reporting period

15 Core 8 Drug-drug allergy checks and 5 CDS Rules Improve quality, safety, efficiency and reduce health disparities Use clinical decision support to improve performance on highpriority health conditions Measure 1: Implement 5 clinical decision support (CDS) interventions Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entre EHR reporting period Requires only Yes/ No Attestation Exclusion Criteria X No exclusions. CDS interventions must be related to 4 or more Clinical Quality Measures

16 Core 9 Incorporate Clinical Lab Results Improve quality, safety, efficiency and reduce health disparities Incorporate clinical lab test results into certified EHR technology as structured data Morethan 55% of all clinical lab tests results ordered by the during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data Numerator Denominator Population Exclusion Criteria The number of lab test Number of lab tests results whose results are ordered during the EHR expressed in a positive or reporting period by the negative affirmation or as a EP whose results are number which are expressed in a positive incorporated as structured or negative affirmation data. or as a number. Patients whose Records are Maintained in the EHR. If an EP orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period

17 Core 10 Medication Reconciliation Improve care coordination The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP Numerator Denominator Population Exclusion Criteria Number of transitions of care during the EHR Patients whose reporting period for Records are which the EP was the maintained in receiving party of the the EHR. transition. The number of transitions of care in the denominator where medication reconciliation was performed. Any EP who was not the recipient of any transitions of care during the EHR reporting period

18 Core 11 Generate Patient List Improve quality, safety, efficiency and reduce health disparities Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach Generate at least one report listing patients of the EP with a specific condition Requires only Yes/ No Attestation Exclusion Criteria X None

19 Core 12 Patient Reminders Improve quality, safety, efficiency and reduce health disparities Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminder, per patient preference More than 10% of all unique patients who have had 2 office visits with the EP within the 24 months prior to the beginning of the EHR reporting period were sent a reminder, per patient preference Numerator Denominator Population Exclusion Criteria Number of unique Number of patients in the patients who have had denominator who were Any EP who has had no two or more office visits Patients whose sent a reminder per office visits in the 24 with the EP in the 24 Records are patient preference when months before the EHR months prior to the Maintained in the EHR. available during the EHR reporting period. beginning of the EHR reporting period. reporting period

20 Core 13 Patient- Specific Education Engage patients and families in their health care Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate More than 10% of all unique patients seen by the EP are provided patient-specific education resources Numerator Denominator Population Exclusion Criteria Number of patients in the denominator who are provided patient education specific resources. Number of unique patients seen by the EP during the EHR reporting period. All Unique Patients. AnyEP who has no office visits during the reporting period

21 Core 14 Submit to Immunization Registry Improve population and public health Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice Successful ongoing submission of electronic immunization data from Certified EHR Technology to an immunization registry or immunization information system for the entire EHR reporting period Yes/ No Attestation X Exclusion Criteria 1) EPdoes not administer any of the immunizations to any of the populations for which data is collected by their immunization registry /system, or 2) No immunization registry /system is capable of accepting the specific standards required at the start of their EHR reporting period, or 3) no immunization registry provides timely info on capability to receive immunization data, or 4) no immunization registry /system that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs

22 Core 15 esummary for Transitions to Provider Improve care coordination The EP who transitions their patient to another setting or provider should provide summary of care record for each transition of care or referral Measure 1: The EP that transitions or refers their patient to another setting or provider supplies a summary of care record for more than 50 percent of transitions of care and referrals. Numerator Denominator Population Exclusion Criteria Number of transitions of care and referrals Patients whose during the EHR Records are reporting period for maintained in which the EP was the the EHR. transferring or referring provider. The number of transitions of care and referrals in the denominator where a summary of care record was provided. Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from both measures

23 Core 15 esummary for Transitions to Provider (continued) Improve care coordination The EP who transitions their patient to another setting or provider should provide summary of care record for each transition of care or referral Measure 2: The EP that transitions or refers their patient to another setting or provider transmits a summary of care electronically for 10 percent of transitions and referrals. Numerator Denominator Population Exclusion Criteria Number of The number of transitions of care and transitions of referrals in the denominator where a Any EP who transfers a care and summary of care record was a) Patients patient to another setting or referrals during electronically transmitted to a recipient whose refers a patient to another the reporting using CEHRT or b) where the recipient Records are provider less than 100times period for which receives the summary of care record via Maintained during the EHR reporting the EP was the exchange facilitated by an organization in the EHR. period is excluded from transferring or that is a NwHIN Exchange participant or in both measures. referring a consistent manner provider

24 Core 15 esummary for Transitions to Provider (continued) Improve care coordination The EP who transitions their patient to another setting or provider should supply summary of care record for each transition of care or referral Measure 3: Perform at least one instance of exchange with a provider using EHR technology designed by a different EHR vendor or with a CMSdesignated test EHR Requires only Yes/ No Attestation Exclusion Criteria x None

25 Core 16 View Download and Transmit ephi Engage patients and families in their health care Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP Measure 1: More than 50 percent of all unique patients seen by the EP are provided online access to their health information with the EPs discretion to withhold certain information Numerator Denominator Population Exclusion Criteria The number of patients in the denominator who have timely (within 4 business days after the information is available to the EP) online access to their health information. Number of unique patients seen by the EP during the EHR reporting period. All Unique Patients. Any EP who neither orders nor creates any of the information listed for inclusion as part of this measure, except for "Patient name" and "Provider's name and office contact information," may exclude both measures

26 Core 16 View Download and Transmit ephi (Continued) Engage patients and families in their health care Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP Measure 2: More than 5 percent of all unique patients seen by the EP (or their authorized representatives) view, download, or transmit to a third party, their health information Numerator Denominator Population Exclusion Criteria Number of unique patients seen by the EP during the EHR reporting period. The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient's health information. All Unique Patients. Any EP that conducts 50% or more of his or her patient encounters in a county that does not have 50% or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude only the second measure

27 Core 17 Secure Electronic Messaging Engage patients and families in their health care Use secure electronic messaging to communicate with patients on relevant health information A secure message is sent using the electronic messaging function of Certified EHR Technology by more than 5 percent of unique patients seen during the EHR reporting period Numerator Denominator Population Exclusion Criteria The number of patients or patient-authorized representatives in the denominator who send a secure electronic message to the EP using the electronic messaging function of CEHRT during reporting period Number of unique patients seen by the EP during the EHR reporting period. Unique Patients Any EP who has no office visits during reporting period, or who conducts 50% or more of his / her patient encounters in a county that does not have 50% or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period

28 Agenda What is Meaningful Use? Stage 2 - Meaningful Use Core Set Stage 2 - Menu Set Clinical Quality Measures (CQM) Clinical Considerations What can your REC team do for you? Questions, Contact Information and Resources

29 Menu Submit Electronic Syndromic surveillance Data Improve population and public health Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period Yes/ No Attestation X Exclusion Criteria (1) the EP is not in a category of providers thatcollect ambulatory syndromic surveillance information on their patients during the EHR reporting period; or (2) the EPoperates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specificstandards required by CEHRT at the start of their EHR reporting period; (4) the EP operates in a jurisdiction where no public health agency provides informationtimely on capability to receive syndromic surveillance data; or (5) the EPoperates in a jurisdiction for which no public health agency that is capable of accepting thespecific standards required by CEHRT at the start of their EHR reporting period can enrolladditional EPs,

30 Menu Imaging Results Access Improve quality, safety, efficiency and reduce health disparities Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through Certified EHR Technology More than 10 percent of all tests whose result is an image ordered by the during the EHR reporting period are accessible through Certified EHR Technology Numerator Denominator Population Exclusion Criteria The number of results in the denominator that are accessible through CEHRT. Number of tests whose result is one or more images ordered by the during the EHR reporting period. Patientswhose records are maintained in the EHR Any EP who orders less than 100 tests whose result is an image during the EHR reporting period or any EP who has no access to electronic imaging results at the start of the EHR reporting period

31 Menu Family History Improve quality, safety, efficiency and reduce health disparities Record patient family health history as structured data More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives Numerator Denominator Population Exclusion Criteria The number of patients in the denominator with a structured data entry for one or more first-degree relatives. Number of unique patients seen by the EP during the EHR reporting period. Unique Patients EP who has no office visits during the EHR reporting period

32 Menu Electronic Progress Notes Improve quality, safety, efficiency and reduce health disparities Record electronic notes in patient records Enter at least one electronic progress note created, edited and signed by the EP for more than 30 percent of unique patients with at least one office visit during the EHR reporting period Numerator Denominator Population Exclusion Criteria The number electronic progress note created, edited and signed by an eligible professional UniquePatients with at least one office visit during the reporting period All Unique Patients EP who has no office visits during the EHR reporting period

33 Menu Report to Cancer Registries Improve population and public health Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period Yes/ No Attestation X Exclusion Criteria Any EP that meets at least 1 of the following criteria may be excluded: (1) The EP does not diagnose or directly treat cancer; (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 for CEHRT at the beginning of their EHR reporting period or (3) the EP operates in a jurisdiction where no PHA provides information timely on capability to receive electronic cancer case information

34 Menu Report to Specialty Registry Improve population and public health Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. Successful ongoing submission of specific case information from Certified EHR Technology to a specialized registry for the entire EHR reporting period Yes/ No Attestation X Exclusion Criteria Any EP that meets at least 1 of the following criteria may be excluded : (1) The EP does not diagnose or directly treat any disease associated with a specialized registry sponsored by a national specialty society for which the EP is eligible, or the public health agencies in their jurisdiction; (2) the EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period. or (3) the EP operates in a jurisdiction where no public health agency or national specialty society for which the EP is eligible provides information timely on capability to receive information into their specialized registries

35 Agenda What is Meaningful Use? Stage 2 Meaningful Use Core Set Stage 2 - Menu Set Clinical Quality Measures (CQM) Clinical Considerations What can your REC team do for you? Questions, Contact Information and Resources

36 Clinical Quality Measures-Stage 2 The Recovery Act specifies the 3 components of Meaningful Use: Use of certified EHR in a meaningful manner (e.g. e-prescribing) Use of certified EHR technology for electronic exchange of health information to improve quality of health care Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary New CQMs in certified EHRs Removed as a Core but required to demonstrate Meaningful Use Must report CQM data electronically to CMS (Medicare), or to state (Medicaid) 2014 CQM reporting period is the entire year or optional 3 month period identical to the reporting period for meaningful use Beyond 2014 the reporting period for CQMs will be the entire calendar year Submission period must be within 2 months following the reporting period 35

37 How CQMs are changing What you did Historical data based on claims collected post visit with time delay What you are doing Current data incorporating erx, orders and some test results What you should do Clinical Decision Support based on real time ICD/CPT data, erx, results, and approved protocols EHR Implementation and Adoption

38 Stage 2 framework for the reporting of CQM Submit 9 of 64 CQMs from at least 3 of 6 National Quality domains: (includes adult and pediatric recommended core CQMs) Population & Public Health Care Coordination Patient Safety Clinical Process Efficiency Patient & Family Engagement

39 Agenda What is Meaningful Use? Stage 2 Meaningful Use Core Set Stage 2 - Menu Set Clinical Quality Measures (CQM) Clinical Considerations What can your REC team do for you? Questions, Contact Information and Resources

40 Clinical Considerations Dates to Remember June 30 Last DOS for 10 G8553 on any paid Medicare claims to avoid possible erx Penalty June 30 October 3 December 31 Deadline to submit G-Code Hardship Last DOS to use as start date for 90 day MU reporting period Last DOS for 25 G8553 paid applicable Medicare claims during calendar year to possibly qualify for erx incentive or offset erx penalty December 31 Last DOS for 2013 PQRS reporting period to avoid the PQRS penalty (levied in 2015) December 31 Last DOS for 2013 MU reporting period

41 Clinical Considerations Stage 2 Requirements Vendor Performance Radiology Viewing Trading Brands

42 Clinical Considerations Risk Analysis & Security IT System Complexity Internal Enforcement Drawing The Line Between Mitigate & Accept Risk Audits

43 Clinical Considerations ICD-10 Financial Clinic EHR System Clearing House Payor Systems

44 Clinical Considerations Technology Expense versus Revenues Staffing IT Vendor Fee Schedule, Incentives, Bonuses

45 Clinical Considerations Other Future of Medicine Participate or Retire

46 Agenda What is Meaningful Use? Stage 2 Meaningful Use Core Set Stage 2 - Menu Set Clinical Quality Measures (CQM) Clinical Considerations What can your REC team do for you? Questions, Contact Information and Resources

47 REC staff have a broad experience base and access to national learning collaborative and tools Required REC Direct Assistance Services Education and outreach Vendor selection and group purchasing Implementation and project management Practice and workflow redesign including: - Sharing of best practices from the National Learning Consortium - Sharing of privacy and security best practices - Functional interoperability and health information exchange - Progress towards meaningful use Local workforce support 46

48 Agenda What is Meaningful Use? Stage 2 Meaningful Use Core Set Stage 2 - Menu Set Clinical Quality Measures (CQM Clinical Considerations What can your REC team do for you? Questions, Contact Information and Resources

49 Resources Get information, tip sheets and more at CMS official website for the EHR incentive programs: Learn about certification and certified EHRs, as well as other ONC programs designed to support providers as they make the transition: 48

50 Keys to Success - Stage 2 Care team based approach to maximize data entry into EHR Preparation for LOINC, SNOMED and ICD10 terminology Preparation for increased objective thresholds Maximize point of care documentation to leverage EHR functionality (alerts, reminders, CDS) and provide real-time medical summary Establish external connectivity through results interface and Health Information Exchange (HIE) Receive structured data through HL7 interface and CCD exchange Establish online patient access and communication (Patient Portal) for access to clinical information and secure messaging Opportunity to have patient input of social and family HX 49

51 Contact Information Marla Clinkscales, CPC, CPC-I Mike Bice, Manager 50

52 Questions? 51

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