Are you ready? Meaningful Use Stage 2 HIT Summit July 26, 2014

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1 Are you ready? Meaningful Use Stage 2 HIT Summit July 26, 2014

2 Meaningful Use Stage 2 Are you Ready? Speakers: Robyn Polinar, BA, MBA, AMB & Community EMR Supervisor Hawai i Pacific Health Nadine Owen, BS,CHTS-IS, CHTS-IM, Health IT Consultant Hawaii Health Information Exchange No other relevant financial disclosures

3 Presentation Outline: Overview of Stage 2 Meaningful Use Brief Overview of Meaningful Use Overview of Stage 2 MU Objectives, What s New? What CMS says vs What it Means Top Challenges Patient Access & Engagement Electronic Exchange: Transition of Care Public Health Reporting: Immunization Registry Electronic Reporting: CQMs Payment Adjustments and Hardship Exemptions Notice of Proposed Ruling extending Stage 1 Q & A

4

5 Staying the Course Transforming Health Care with Health IT

6 Stage 2 of Meaningful Use Overview What s New?

7 No Changes: Eligible Professionals Medicare Doctor of medicine or osteopathy Doctor of oral surgery or dental medicine Doctor of podiatric medicine Doctor of optometry Chiropractor Medicaid Physicians Dentists Certified nursemidwives Nurse practitioners Physician assistants (if practicing in an FQHC or RHC lead by a PA)

8 Stage 2 Follows Same Format as Stage 1

9 Do I need to Upgrade my EHR? YES - For Stage 1 and Stage 2 All EPs 2014 Certified EHR Technology All MU Stages All years Both Programs

10 Special Reporting Period in 2014 Medicare EPs Stage 1 Year 1 Beyond Stage 1 Year 1 Any continuous 90 days 3 month reporting period Fixed to the quarter Jan 1 March 31 April 1 June 30 July 1 Sept 30 Oct 1 Dec 31 Medicaid eligible professionals can select any 90 day reporting period that falls within the 2014 calendar year.

11 Medicare EPs This is a timeline of participation and payments by stage of MU

12 Medicaid EPs This is a timeline of participation and payments of MU Year 2013 $21,250 Annual Incentive Payments for Medicaid EPs who Adopt In: $8,500 $21, $8,500 $8,500 $21, $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8, $8,500 $8, $8,500 TOTAL $63,750 $63,750 $63,750 $63,750

13 Meaningful Use Stage 2 Core Objectives Overview

14 Overview 2014 Changes Stage 1 and Stage Clinical Quality Measures 64 CQMs in Stage 2 final rule CQM reporting no longer core objective but required for MU 9 Recommended CQMs Reported electronically for those in year 2 and beyond of MU

15 What CMS Says vs What It Means vs We want YOU to meet MU

16 Stage 2 of Meaningful Use What CMS Says vs What It Means CORE MEASURES

17 Meaningful Use Stage 2 Core Objectives Computerized Provider Order Entry (CPOE) for Medication, Laboratory, and Radiology Orders OBJECTIVE MEASURE CHANGE FROM STAGE 1 1 CPOE > 60% of medications, > 30% of laboratory & > 30% of radiology orders 30% to 60% for medication orders. Option to count orders instead of unique patients. Credentialed MA can enter order.

18 Meaningful Use Stage 2 Core Objectives E-Prescribing & Record Demographics OBJECTIVE MEASURE CHANGE FROM STAGE 1 2 erx > 50% of permissible or all Rxs compared to drug formulary and transmitted electronically 3 Demographics > 80% of all unique patients Excl: None 40% to 50%. Formulary was a Stage 1 Menu measure 50% to 80%.

19 Meaningful Use Stage 2 Core Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 4 Vital Signs > 80% of all unique patients age 3: blood pressure all ages: height and weight 50% to 80%. Increase in required age for BP. Separate exclusions. 5 Smoking Status > 80% of all unique patients 13 years old 50% to 80%.

20 Meaningful Use Stage 2 Core Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 6 Clinical Decision Support 1. 5 CDS interventions tied to four or more CQMs 2. Drug-drug and drugallergy interaction checks function enabled for the entire EHR reporting period. 1 to 5 CDS. Includes drugdrug and drugallergy checks.

21 Meaningful Use Stage 2 Core Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 7 Patient Access to Health Information 1. > 50% of all unique patients seen are provided timely online access to their health information (within 4 business days after the information is available to the EP) 2. > 5% access (view, download, or transmit) health information Online access was menu; 10% to 50% E-copy by request in Stage 1 Requires patient action

22 What Does This Mean Patient Electronic Access

23 Meaningful Use Stage 2 Core Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 8 Clinical Summaries > 50% of office visits within 1 business day 3 to 1 business day 9 Protect electronic health information Conduct risk analysis including addressing encryption of data at rest No change; Referred to HIPAA security rule.

24 What Does This Mean Clinical Summaries Provide patients with relevant info/instructions: Patient Name Provider Name and contact info Date & Location of Visit Reason for Visit Current Problem List Current Medication List Current Medication Allergy List Procedures Performed during Visit Immunizations/Medications given at Visit Lab Tests Results Clinical Instructions Future Appointments Referrals to Others Future Scheduled Tests Demographic info from CEHRT Smoking Status Care Plan Patient Decision Aids (if applicable)

25 What Does This Mean Clinical Summaries Acceptable forms of summary distribution: Printed copy Patient Portal Secure Electronic media (CD or USB drive) If an EP believes that substantial harm may arise from the disclosure of particular information, an EP may choose to withhold that particular information from the clinical summary Do not need to send test results that have not been reviewed by provider

26 What Does This Mean Protect Electronic Health Information CMS Tip Sheet on Conducting a Privacy & Security Risk Assessment Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_Update d pdf New SRA (Security Risk Assessment) Tool

27 Meaningful Use Stage 2 Core Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 10 Labs > 55% of lab tests in EHR as structured data 40% to 55% Stage 1 Menu measure 11 Patient Lists Generate one list by condition Excl: None Stage 1 Menu measure

28 Meaningful Use Stage 2 Core Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 12 Preventive Reminders 13 Education Resources > 10% of patients seen 2 times in past 24 months sent a reminder, per patient preference when available. > 10% of patients provided patient specific education resources identified by EHR Stage 1 Menu measure 20% for patients age 65 or age 5 in Stage 1 Stage 1 Menu measure

29 Meaningful Use Stage 2 Core Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 14 Medication reconciliation The EP must perform a medication reconciliation for more than 50% of transitions of care. Stage 1 Menu measure

30 Meaningful Use Stage 2 Core Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 15 Transition of Care 1. Summary of care record for > 50% of transitions and/or referrals to another provider or setting 2. > 10% sent electronically 3. 1 record sent to a provider with different EHR vendor or to CMS test EHR Combines Stage 1 core objectives: maintaining an up-todate problem list, an active medication list, and an active medication allergy list. Stage 1 Menu measure

31 What s in a Summary of Care Record? * These fields cannot be blank. Patient Name Smoking Status Provider Name and Office Contact Information Demographics: DOB, Race, Ethnicity, Sex, Preferred Language Problem list* Medications* Medication Allergies* Care Team Information ( PCP and other known care team members) Encounter diagnosis Vital signs: BP, Height, Weight, BMI Procedures Care Planning: Goals and Clinical Instructions Laboratory Test Results Immunizations Functional Status (ADL, cognitive and disability status) Reason for referral

32 What Does This Mean Transition of Care

33 Meaningful Use Stage 2 Core Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 16 Immunizations Successful ongoing submission of electronic immunization data 17 Secure Messaging > 5% of unique patients send an electronic message to EP Ongoing submission required rather than a test Menu measure NEW MEASURE

34 Stage 2 of Meaningful Use What CMS Says vs What It Means MENU MEASURES

35 Meaningful Use Stage 2 Menu Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 1 Capability to submit electronic syndromic surveillance data Successful ongoing submission of electronic surveillance data from CEHRT to a public health agency for entire reporting period No change

36 Meaningful Use Stage 2 Menu Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 2 Progress Notes 3 Imaging Results > 30% of patients have an electronic progress note created, edited, signed by EP. Excl: None Provide access to images through EHR for >10% of tests NEW MEASURE NEW MEASURE 4 Family History > 20% of patients seen have a structured data entry for one or more first-degree relatives. NEW MEASURE

37 Meaningful Use Stage 2 Menu Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 5 Capability to identify and report cancer cases to a State cancer registry Successful ongoing submission of cancer case information from CEHRT to a cancer registry for the entire reporting period NEW MEASURE

38 Meaningful Use Stage 2 Menu Objectives OBJECTIVE MEASURE CHANGE FROM STAGE 1 6 Capability to identify and report specific cases to a specialized registry (other than a cancer registry) Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire reporting period NEW MEASURE

39 Stage 2 of Meaningful Use What CMS Says vs What It Means CLINICAL QUALITY MEASURES

40 CQM Reporting in 2014 Prior to 2014 Beginning in 2014 Report 6 out of 44 3 core or alt core 3 menu Report 9 out of 64 CQMs Cover at least 3of 6 domains Recommended core CQMs: 9 for adults 9 for pediatric

41 CQM Reporting in 2014 Required to demonstrate MU Based on Reporting Year not Stage of MU Electronic Reporting to CMS (Medicare - second year and beyond) Quarterly reporting data (Medicare second year and beyond) Medicaid providers: report to their state For the Medicaid EHR Incentive Program, the method of reporting CQMs for EPs and eligible hospitals will continue to be at the state's discretion subject to our prior approval, as established in the Stage 2 final rule

42 TOP CHALLENGES of Stage 2 Patient Access & Engagement Electronic Exchange: Transition of Care Public Health Reporting: Immunization Registry Electronic Reporting: CQMs

43 Top Challenges of Stage 2: PATIENT ACCESS & ENGAGEMENT: Requirements for Patient Action: More than 5% of patients must access their health information online More than 5% of patients must send secure messages to their EP TRANSITIONS OF CARE: Requirements for Transitions of Care: More than 50% of transitions of care and referrals include a summary of care document. More than 10% of transitions of care and referrals involves a summary of care document that is electronically transmitted. At least one summary of care document sent electronically to recipient with different EHR vendor.

44 Top Challenges of Stage 2: PUBLIC HEALTH REPORTING: Requirements for Public Health Reporting Immunization Registry: Ongoing feed to state s immunization registry Interface demands/insufficient staff to handle demands Current integration processes not scaleable ELECTRONIC REPORTING OF CQMs: Requirements for ELECTRONIC REPORTING OF CQMs: Direct from 2014 CEHRT QCDR (Qualified Clinical Data Registry) vendor Attend MU Challenges in Molokai room at 1:45-3:15pm for detailed information and discussion on this topic. Powerpoint will be available at

45 Payment Adjustments & Hardship Exceptions

46 Medicare Payment Adjustments Starts in 2015 If you did not attest for 2013 or by Oct 1, 2014 if you are attesting to MU for first time Demonstrate MU every year EPs must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.

47 Medicare Payment Adjustments

48 How to Avoid Payment Adjustments in 2015: Attested to MU for 2013 If attesting to MU in 2014 for the first time: Attest to MU by October 1, 2014 Begin reporting period by July 1, 2014

49 Hardship Exemptions for 2016 Infrastructure lack of broadband New EP Unforeseen Circumstances e.g. natural disasters Lack of face-to-face or follow up Providers at Multiple locations Vendor s 2014 Edition of CEHRT not available Must apply July 2, 2014 July 1, 2015 Exemptions granted by CMS

50 What is NPRM? A Notice of Proposed Rule Making is a federal procedure that agencies use to announce changes to agency rules (CMS in this case) and to allow, typically, a 60 day comment period follow by a 30 day response period after which time the changes are adopted in their proposed form or modified based on public comment. Announced May 20, 2014 Public comment period: May 23-July 22, 2014

51

52

53 NPRM provides relief for those who may not be able to achieve Stage 2 if you are struggling with: Transitions of Care / Summary of Care document...or related HIE exchange of the summary of care Patient Portal issues...especially 5% of patients viewing / downloading /transmitting their information CPOE: added labs and radiology orders

54 NPRM Some important considerations: NPRM does NOT provide relief based on budgetary/ monetary/affordability issues surrounding 2014 CEHRT Medicaid ONLY: You must Adopt, Implement or Upgrade to a 2014 CEHRT if you are starting the MU program in It is NOT acceptable to do AIU in 2014 using 2011 Edition CEHRT Remember: Jan. 1, 2015 is the first day when you must be up and running with 2014 Edition CEHRT Must attest that you are unable to fully implement 2014 Edition CEHRT because of issues related to 2014 Edition CEHRT availability delays when they attest to the meaningful use objectives and measures.

55 Links and References CMS: Guidance/Legislation/EHRIncentivePrograms/index.html Stage 2 Toolkit: Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Toolkit_EHR_0313.pdf CQMs: Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html Final Rule: ONC: 2014 Edition S&CC final rule Payment adjustments: Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipShe etforep.pdf NPRM:

56 Questions???

57 Mahalo! Hawaii Health Information Exchange (808)

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