Keeping Pace with Meaningful Use and EHR Technology

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1 Keeping Pace with Meaningful Use and EHR Technology Paul Kleeberg, M.D., FAACP, FHIMSS CMIO Stratis Health Joe Wivoda, M.S. CIO & REACH HIT Consultant National Rural Health Resource Center REACH - Achieving - Achieving meaningful meaningful use of your use EHR of your EHR

2 Objectives Understand the changes to Meaningful Use in 2014 Learn about some ways you can keep up with the changes How can you prepare for Meaningful Use Stage 2, Stage 3, ICD-10, Health Reform, and the proposed rules 2

3 How do you keep up? What should drive your HIT efforts? Meaningful Use requirements and the government? Your EHR vendor? Your physicians? Your staff? Your patients! Health reform! 3

4 Strategic Thinking "We need to achieve MU so we can get the incentive" CPOE requirement, taken literally, will create two processes "We need to be prepared for health reform" Likely that you will easily achieve MU, be better prepared for payment reform, provide better patient care, etc 4

5 Basic Assumptions about the Future Payment rates: decline Quality and efficiency: rewarded Readmissions and low quality: penalized Population health: important

6 ACOs Rapid growth August 2012: 154 July 2013: 259 January 2014: 606 Both hospital and physician lead Medicare and private insurance models Some are based in rural

7 Focus on Value Patient Value = Quality Cost Accountable Care = a mechanism to Patient monetize value by increasing quality and reducing Value cost =

8 What Hospitals and Clinics Can Do Now to be Prepared for Health Reform How do you do ANY of this without HIT? Improve/document efficiency and quality Partner with referral partners Improve care coordination Prepare for population health management Consider participation in an ACO, a medical home or other value-based models

9 Implementation Framework Implementation phases linked to evolution of payment system incentives over time Current State Phase I Phase II Phase III Phase IV Initiative I Operating Efficiencies Implementation HIT & Workflow Redesign Initiative II Align Primary Care Network Implementation Planning Align Primary Care Network Implementation Information Exchange Initiative III Rationalize Service Network Strategy Rationalize Service Network Implementation Planning Rationalize Service Network Implementation Initiative IV Population Based Payment System Conceptual Plan Population Based Payment System Strategy Population Based Payment System Implementation Planning Population Based Payment System Implementation

10 HIT Will Be Increasingly Important Meaningful Use is just the start Health Reform will require Robust information exchange between referral partners Real-time Clinical Quality Measures Best practice Clinical Decision Support and Clinical Workflows Registries Population Health Management Patient engagement in their health care HIT will continue to be a central competency for any healthcare organization! 10

11 11

12 Items of Particular Focus Patient Engagement MU Stage 2 requires 5% of patients view, download, and transmit their information Consider patient s families and caregivers Clinical Quality Measures More than just pushing the button Will require significant process improvement ICD-10 Don t forget about this, and its impact on your system/processes/reports (it s more than training!) Transitions of Care 12

13 Transitions of Care: Measure 1 The eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. Note: The word electronic is not used here 13

14 Transitions of Care: Measure 2 The eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network. Note: Another setting of care or provider of care includes lots of things 14

15 Transitions of Care: Measure 3 The eligible hospital or CAH must satisfy one of the two following criteria: Conducts one or more successful electronic exchanges of a summary of care document, which is counted in "measure 2" (for eligible hospitals and CAHs the measure at 495.6(l)(11)(ii)(B)) with a recipient who has EHR technology that was designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR (b)(2); or Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period. Note: Can t just exchange within your network if they are all using the same EHR 15

16 Outline The proposed rules Exceptions Certification tools Getting help 16

17 Seems like CMS heard us CMS & ONC announced a Notice of Proposed Rulemaking (NPRM) on May 20, 2014 to relax requirements to utilize 2014 Edition Certified EHR Technology (CEHRT) Enables flexibility and decision making whether you have implemented 2014 Edition CEHRT or not! Can use either 2014 CEHRT or 2011 CEHRT Can attest to 2013 Stage 1 or 2014 Stage 1 or 2 (depending on your readiness) 17

18 2014 CEHRT NPRM CMS definition of implemented from NPRM: A provider s ability to fully implement all of the functionality of 2014 Edition CEHRT may be limited by the availability and timing of product installation, deployment of new processes and workflows, and employee training. 18

19 19

20 Timeline before & after NPRM: Stage 2 in 2014 original requirement 2 years of Stage days Stage 1 Full Year Stage 1 1 Quarter Stage 2 on 2014 Edition Full Year Stage 2 Full Year Stage 3 If NPRM is adopted: days Stage 1 *2 years min. on each Stage of MU Full Year Stage 1 1 Quarter Stage 1: 2013 Measures on 2011 Edition OR 2014 Stage 1 Measures on 2014 Edition OR 1 Quarter Stage 2 on 2014 Edition Full Year Stage 2 2 or 3 years of Stage 2 Full Year Stage 2 20

21 Timeline before & after NPRM: Stage 1 in 2014 original requirement 2 years of Stage days Stage 1 1 Quarter Stage 1 on 2014 Edition Full Year Stage 2 Full Year Stage 2 Full Year Stage 3 If NPRM is adopted: days Stage 1 *2 years min. on each Stage of MU 1 Quarter Stage 1 on 2014 Edition OR 2013 Stage 1 on 2011 Edition Full Year Stage 2 Full Year Stage 2 2 years of Stage 2 Full Year Stage 3 21

22 This NPRM is just Proposed Rule is not final Public comment period from May 23 rd July 22 nd Ambiguities? Ask for clarification in your comments Likely to become final Really only delays stage 2 and 2014 CEHRT for 3 months is a full year with 2014 CEHRT! 22

23 Decisions The Final Rule not likely to be out until Sept EHs/CAHs This is after the start of Q4 FY 2014 (July Sept.) Must be using 2014 Edition CEHRT on Oct 1, 2014 EPs This is close to the start of Q4 of CY2014 (Oct Dec) (Must be using 2014 Edition CEHRT by Jan 1,

24 Outline The proposed rules Exceptions Certification tools Getting help 24

25 Applying for Hardship Exceptions If an EP is granted a hardship exception No penalty is applied for 1 year but the incentive $$ are forfeited and the EP moves forward on their MU timeline 25

26 New 2014 EHR Hardship Exception Issued March 2014 by CMS [If] you are unable to implement the 2014 Edition of Certified Electronic Health Record Technology (CEHRT) in time to successfully demonstrate meaningful use for the 2014 reporting year, you may be eligible for a hardship exception from the applicable Medicare payment adjustment CMS info sheet for EPs: Guidance/Legislation/EHRIncentivePrograms/Downloads/C EHRT2014_HEGuidance_EPs.pdf 26

27 Outline The proposed rules Exceptions Certification tools Getting help 27

28 ONC Certified EHR Products List 28

29 Add your products to the cart 29

30 Percent of Criteria met in your cart 30

31 The Criteria Included 31

32 Quality Measures Included 32

33 Outline The proposed rules Exceptions Certification tools Getting help 33

34 How to get help 34

35 35

36 36

37 Meaningful Use Specification Sheets The authoritative source on MU Criteria Downloadable PDF index that links to the Stage 2 Criteria: EP: Guidance/Legislation/EHRIncentivePrograms/Downloa ds/stage2_meaningfulusespecsheet_tablecontents_ EPs.pdf EH/CAH: Guidance/Legislation/EHRIncentivePrograms/Downloa ds/stage2_meaningfulusespecsheet_tablecontents_ EligibleHospitals_CAHs.pdf Updated by CMS to account for any corrections or changes Includes relevant certification criteria 37

38 CMS Resources: CMS Help desk (888) Meaningful Use: Meaningful Use Stage 1 Criteria Specifications MU-TOC.pdf CAH_MU-TOC.pdf CMS Stage 2 web page (with information on revised Stage 1 as well as Stage 2): Guidance/Legislation/EHRIncentivePrograms/Stage_2.html Quality Measure Specifications on the CMS web site: Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMe asures.html 38

39 Other Resources: ONC-ACB Certified EHRs and what modules they are certified for: Office of the National Coordinator Health IT site: Regional Extension Assistance Center for Health Information Technology (REACH) Stratis Health HIT Toolkits for hospitals, clinics, home health, nursing homes and chiropractic Minnesota Department of Health Info Sheet on Public Reporting Measures: 39

40 Key Health Alliance Stratis Health, National Rural Health Resource Center, and The College of St. Scholastica. REACH is a project federally funded through the Office of the National Coordinator, Department of Health and Human Services (grant number EP-HIT ). 40

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