Event Name: Meaningful Use Updates: Stage 2 and Stage 3 Event Date: July 8, 2016 Event Time: 12:30-1:00pm ET

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1 Event Name: Meaningful Use Updates: Stage 2 and Stage 3 Event Date: July 8, 2016 Event Time: 12:30-1:00pm ET Please stand by for realtime captions. Good afternoon. This is Nancy Kelly. We will get started in a few minutes. Good afternoon. This is John from the New England QIO. Thank you for joining us for the meaningful use updates Stage 2, Stage 3. This call is being recorded. The recording and the presentation slides will be available following the presentation. All participants who are registered will receive an how to access the information. Phone lines will be on mute during the presentation. Questions will be taken at the end. I would like to introduce our presenter, Julia Moore. Through her work she assists primary care providers in achieving meaningful use and applying for EHR incentive programs. I will now turn the presentation over to Julia. Thank you for joining. We will skim over a few repetitive measures that have not changed. First, we will take a polling question. Please indicate the setting in which you provide healthcare. We have results from our polling. We have a mix of participants from hospital, primary care and specialties. The proposed rule for Stage 2 will affect 2015 through If passed all providers have a 90 day reporting period regardless of stage. For 2016, new participants can still use that 90 day reporting period. All else will use full reporting periods. And 2017, everyone will be on a full-year reporting period with the exception of new Medicaid providers. The reporting period is based on a calendar year. We will continue to use the 2014 addition EHR. Here is an image of what stage you have the choice of being on depending on when you began the meaningful use program. This highlights the biggest changes to Stage 2. They will eliminate distinctions between core and menu measures. They were all essentially core measures. You must meet all of them and was a qualified for exclusion. There will be nine of these that are still meant to be in stage one. There are exclusions that will point out. The remove many measures they felt were redundant.

2 There are no changes to CQM. There will be 9 and three domains. Rather than having 5% accessing portal you only need one patient. That makes it simpler. For the secure electronic messaging it's no longer percentage-based measured. It will be a yes or no question. The public health measures will be consolidated into one objective with different options. Here is the list of the removed measures. You no longer report on these. Providers are still expected to be doing these things. It will not be part of the attestation process. Recording demographics, vital signs, lab results et cetera. We have CBOE patient electronic access, patient education, medication reconciliation, summary of care, secure messaging and public health reporting. You can see on the left is the proposed Stage 2 measure. On the right is a for those providers still on stage I. We have this limited exception where they may claim exclusions for measures they may not have encountered had the proposed rule not past. No changes for CP OE. Without the proposed rule 60% of mad, 30% of radiology are recorded using CPOE. No change with prescriptions. Clinical decision support implement five related to four or MCQMs. Patient electronic access: this is one of the big changes. You still need to provide 50% of patients access to health information. Only one patient has to view, download or transmit that information rather than 5%. Protect electronic health information has no change. Continued to conduct. Patient education provides patient education to at least 10%. The medical records, no change. Perform reconciliation for 50%. Summary of care: the morally no change. When you are the recipient, you create that summary of care record for at least 10%. Messaging: have the capability for your patience to send and receive a secure message. You don't have to prove threshold of patients using that measure. You have multiple options. On Stage 2, you must choose two of the five. Stage I you select one. We have standard options, case reporting and clinical case reporting. This is to give providers more options of public health reporting that they can participate in. Attestation changes: Medicare providers cannot attest prior to January 1 prior to January 1, 2016 for the 2015 reporting period. They are providing an option for providers eligible for Medicare and Medicaid programs who do not meet Medicaid

3 patient requirements. They can attest through the RNA system to avoid Medicare payment adjustment. They will not receive incentive payment. We have our next polling question. Please indicate if you will be submitting directly from EHR. If submitting through different means or not submitting for 2015, please indicate this. Can we see the results of the poll? Most are using EHR direct or direct submission vendors. Moving on to Stage 3 proposed rule. Program changes has an optional participation in 2017 if you are ready. In 2018, all providers will be reporting on same definition of meaningful use regardless of prior participation. Medicare program participants must participate in full year regardless of stage first-year Medicaid program participants can still use a 90 day reporting period. From you must use the 2014 addition at a minimum. You can no longer use You may upgrade to the 2015 addition prior to By 2018, you must use the 2015 addition. There will be one set of objectives. No core, no menu. Protect, ARS, clinical decision, CP OE, electronic access, coordination of care, health information exchange, public health clinical data registry reporting. At the bottom of each slide you will see the changes pointed out in the color red. Changes have clarified the language to clear up confusion. It includes administrative safeguards. Timing has been clarified as well. Electronic describing: no change. The threshold has been increased until 80%. Clinical decision support: no change. Implement five decision-support rules. Computerized provider order entry: not a big change here. Thresholds have increased. Med orders are 80%. Lap 60%, imaging 60%. Formally in stage II we were saying at least 60% of radiology orders. It is extended to diagnostic imaging orders to include additional methods. Patient electronic access. This has had a few changes. Thresholds have increased to 80%. The patient wait time has decreased. Patient is provided health information within 24 hours. There is in addition of APIs. You can provide access to view online,

4 download or transmit their health information through portal or ONC certified API. The second part incorporates the education resources through the portal or API. This is a new measure. They call it coronation of care. Use communication functions to engage with patients about the patients care. All three must be attested to. They only have to meet the threshold for two of the three measures. The first measure is that 25% are actively engaged with the EHR. They can do this by viewing, downloading or transmitting their health information. At least 35% use secure message process or in response to a secure message sent by the patient. The patient or provider can send the response. Third, patient generated health data is incorporated into the EHR for at least 15%. Providers will have to attest to all three but only meet the threshold for two. Similarly, attest to all three but meet the denominator for just two. Retrieve the summary of care record upon first patient encounter and then incorporate information into their EHR using EHR technology. At least 50% the provider that traditions creates a summary of care record using the EHR and electronically exchange is the summary of care record. At least 40% of transitions received and patient encounters where never before encountered, the provider incorporates an electronic summary of care document other than that providers EHR system. At least 80% received in which the provider has never accounted the patient, the provide a reconciliation including medication, medication allergy and review. We have the public health and clinical data reporting. Stage III expands the options. There are three options. First, register to submit data. Next, testing and validation. Third, production. It depends on the registry you are using and what stage they are accepting. In Connecticut, we have the meaningful use state testing portal registry. You can only use it to send test messages. You can you choose from these five measures. You need to choose at least three. The first to our immunization registration. Case reporting, public health and clinical data registry reporting. CQM reporting requirements for 2017 will be addressed in the Medicare physician fee rulemaking. The goal is to further align duplicate reporting. Reporting can be electronic which is preferred or attestation. EHR will be required. That's all I have. That was a lot of information. We will now look at questions. If anybody has questions, type them into the chat window. Will slides be available?

5 After the presentation we will post them on the website. We have an extended deck with more material as well. What is the frequency for standard security risk assessment? Providers must conduct upon installation of EHR or upon upgrade to new version. Initial security risk analysis and testing may occur prior to beginning of first EHR reporting period. In subsequent years [ Indiscernible ] AHR -- EHR and to make updates as necessary but once per reporting period. Is there an idea of what proposed rules will be approved? The comment period finished a few weeks ago. Comments are being reviewed. If I had to make an educated guess, I would say within a month. We will have that information as soon as we know it. If providers communicate via secure messaging, does that satisfied the measure? It has to be with a patient. They can be a response to a patient. It can't be provider to provider. Is there a penalty for not doing a security risk analysis? There is not a particular penalty but you will not satisfy the meaningful use if you do not. We would like to open the phones for questions. Press Star 6 to unmute. For the public health measure, can you go over registry if we don't have. It will be similar to the current rule you are expected to submit depending on your state registry. Pertaining to your access or you meet the exclusion for enough, yes, you can claim exclusion. If a provider is excluded in a public health options are they required to take on other measures? If there are others that you can submit to, you are expected to do so. If they don't exist, you can't. More are going to start popping up if this proposed rule passes. In Connecticut, we don't have a lot of options. There will have to be in order to make this measure meaningful.

6 50% of all patients seen during reporting must be signed up? They don't have to be signed up. Is still the same as in stage I. They have to be provided access so that they have all information necessary to sign up if they choose. It means they have the URL and possibly a code to sign up that they received from the practice. Medicare providers can't attest to January Does that mean we are reporting for fourth quarter 2015? Because the proposed rule hasn't passed we will probably be doing fourth-quarter. That would make sense. If you happen to meet all measures at a different time, -- any other questions? Thank you for participating. When you close the webinar, the evaluation will pop up. Please fill this out. If you don't have time to fill the evaluation now or you are sharing your computer, you will receive an with a link for the evaluation and event site tomorrow morning. The presentation will be posted on the event webpage along with the recording. And we are providing a webinar shortly after the final rule becomes official. We expect the rule to be in place in August and the webinar will be provided sometime in September. Thank you for attending, and have a great day. [Event Concluded]

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