Meaningful Use: Stage 1 and 2 Hospitals (EH) and Providers (EP) Lindsey Mongold, MHA HIT Practice Advisor Oklahoma Foundation for Medical Quality

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1 Meaningful Use: Stage 1 and 2 Hospitals (EH) and Providers (EP) Lindsey Mongold, MHA HIT Practice Advisor Oklahoma Foundation for Medical Quality

2 Meaningful Use Stage 1 Focuses on Functional & Interoperability Measures Health Outcomes Policy Priorities: Improve quality, safety, efficiency and reduce disparities Engage patients and families in their healthcare Improve care coordination Improve population and public health 2

3 Meaningful Use Stage 2 Meaningful Use released August 23 rd 2012 The Focus: Increase health information exchange between providers Promote patient engagement by giving patients secure online access to their health information 3

4 Changes to Stage 1 Meaningful Use 4

5 Changes to Stage 1 MU o Computerized Provider Order Entry (CPOE): EH and EP Current measure is based on the number of unique patients with a medication in their medication list that was entered using CPOE Alternate measure is based on the total number of medication orders created during the EHR reporting period 2013 NOTE- Alternate measure will be required for Stage 2 5

6 Changes to Stage 1 MU o erx: EP only Addition of an additional exclusion Any EP who does not have a pharmacy within their organization and there are no pharmacies that accept erx within 10 miles of the EP s practice location 2013 onward (Required) o Electronic Exchange of Key Clinical Information: EH and EP Objective is no longer required 2013 Onward (Required) 6

7 o Vitals Signs Changes to Stage 1 MU Addition of alternative age limitations: EH and EP Height & weight No age limit Blood Pressure Only (Optional); 2014 Onward (Required) Addition of alternative exclusions: EP only EP sees no patients 3 and over EP believes ht. & wt. are not relevant EP believes BP is not relevant 2013 Only (Optional); 2014 Onward (Required) 7

8 Changes to Stage 1 MU o Public Health Objectives: EH and EP Addition of except where prohibited to the objective regulation text The intent is to encourage hospitals to submit public health data therefore, if providers are authorized to submit data they should do so even if it is not required by law or practice 2013 Onward (Required) 8

9 Changes to Stage 1 MU o Exclusions For Menu Objectives: EH and EP A Hospital cannot select a menu objective and claim an exclusion for it if there are other menu objectives they can meet Will not be penalized for selecting a menu objective and claiming exclusion if they would also qualify for the exclusions for all the remaining menu objectives 2014 Onward (Required) 9

10 Clinical Quality Measures (CQM) o Change from Stage 1 to Stage 2: EH and EP CQMs are no longer a Meaningful Use core objective CQMs have been incorporated into the definition of being a Meaningful User of certified EHR technology CQMs must be reported electronically to CMS 10

11 CQMs for Eligible Hospitals EHs and CAHs must report on 16 out of 29 total CQMs Selected CQMs must cover at least 3 National Quality Strategy domains Hospitals will electronically report their CQMs in the QRDA Category I format through the infrastructure similar to the EHR Reporting Pilot for hospitals 11

12 CQMs for Eligible Professional EPs will submit 9 CQMs from at least 3 of the National Quality Strategy domains Potential list of 29 CQMs across 6 domains Data must be sent electronically via a CMSdesignated transmission method EPs participating in PQRS One submission will give you credit for both PQRS and the Medicare EHR Incentive Program 12

13 Stage 1 vs. Stage 2 (Eligible Hospitals) Stage 1 Stage 2 24 Objectives EHs 14 Core (CQM included) 10 Menu (Choose 5) 19 Total 22 Objectives EHs 16 Core (CQM not included) 6 Menu (Choose 3) CQM 19 Total 13

14 Stage 1 vs. Stage 2 (Eligible Providers) Stage 1 25 Objectives EPs 15 Core (CQM included) 10 Menu (Choose 5) 20 Total Stage 2 23 Objectives EPs 17 Core (CQM not included) 6 Menu (Choose 3) CQM 20 Total 14

15 Core Objectives 15

16 Stage 2 EH Core Objectives CPOE (Computerized Physician Order Entry) Record demographics Record vital signs Record smoking status Implement 5 Clinical Decision Support (CDS) rules Structured lab results Generate lists of patients by condition emar Provide online access to health info Provide patient education resources Medication reconciliation Provide summary of care record Submit electronic data to immunization registry Submit reportable lab results to public health agencies Submit syndromic surveillance data to public health agencies Protect electronic health info 16

17 Stage 2 EP Core Objectives CPOE (Computerized Physician Order Entry) erx Record demographics Record vital signs Record smoking status Implement 5 Clinical Decision Support (CDS) rules Structured lab results Generate lists of patients by condition Reminders for preventative/follow-up care Provide online access to health info Provide clinical visit summaries Provide patient education resources Secure messaging with patients Medication reconciliation Provide summary of care document Submit electronic data to immunization registry Conduct security risk analysis 17

18 Core Objectives o CPOE: EH and EP Medication, laboratory & radiology orders Threshold 60% for meds; 30% for lab & radiology o erx: EP only Threshold 50% of all permissible Rx Implement at least 1 drug formulary 18

19 Core Objectives Demographics: EH Preferred language, Sex, Race, Ethnicity, DOB, Date & Preliminary cause of death Threshold 80% of all unique patients Demographics: EP Preferred language, Sex, Race, Ethnicity, DOB Threshold 80% of all unique patients 19

20 Core Objectives o Record and chart changes in vital signs: EH and EP Height/length, Weight, BP (age 3+), Calculate and display BMI, Plot and display growth charts for patients 0-20 years Threshold 80% of unique patients o Record smoking status: EH and EP Threshold 80% of unique patients 13 years old + o Use clinical decision support: EH and EP Implement 5 CDS interventions related to 4 or more CQMs Enabled drug-drug & drug-allergy interactions 20

21 Core Objectives o Lab test results: EH and EP Threshold 55% of all tests ordered are recorded as structured data o Generate list of patients by specific condition: EH and EP Generate at least 1 report o emar: EH only Threshold 10% of medication orders are tracked using emar 21

22 Core Objectives o Reminders for preventative/follow-up care: EP only More than 10% of all unique patients who have had an office visit in the past 24 months prior to the beginning of the reporting period were sent a reminder, per patient preference 22

23 Core Objectives o Provide patients the ability to view online, download, and transmit their health info within 36 hours after discharge from the hospital: EH only More than 50% of all unique patients have timely online access More than 5% of unique patients view, download, or transmit to a 3 rd party their health info 23

24 Core Objectives o Provide patients the ability to view online, download, and transmit their health info within 4 business days of the info being available to the EP: EP only More than 50% of all unique patients have timely electronic access More than 5% of unique patients view, download, or transmit to a 3 rd party their health info 24

25 Core Objectives o Provide clinical summaries for each office visit: EP only Clinical summary provided within 1 business day for more than 50% of office visits Summary must include: Patient name, Provider s name and contact info, Date and location of visit, Reason for office visit, Current problem list and any updates, Current medication list and any updates, Current medication allergy list and any updates, Procedures preformed during the visit, Immunizations or medications administered during the visit, Vital signs and any updates, Laboratory test results, List of diagnostic tests pending, Clinical instructions, Future appointments, Referrals to other providers, Future scheduled tests, Demographics maintained by EP, Smoking status, Care plan field including goals and instructions, Recommended patient decision aids 25

26 Core Objectives o Patient education resources: EH and EP Use certified EHR to identify patient-specific education resources and provide to the patient Threshold 10% of unique patients o Use secure electronic messaging to communicate with patients on relevant health information: EP only Send a secure message using electronic messaging function of certified EHR technology to more than 5% of unique patients 26

27 Core Objectives o Medication reconciliation: EH only Threshold 50% of transitions of care, in which the patient is admitted to the EH s or CAH s inpatient or ED. o Medication reconciliation: EP only Perform med reconciliation when receiving a patient from another setting of care Threshold 50% of transitions of care, where patient was transitioned into the care of the EP 27

28 Core Objectives o Summary of care record: EH only Provide summary of care for more than 50% of transitions of care and referrals Provide summary of care for more than 10% of such transitions and referrals either A. electronically transmitted using CEHRT to a recipient B. via exchange through NwHIN Exchange participant or in a manner consistent with ONC governance mechanism 28

29 Core Objectives o Summary of care record: EP only Provide summary of care for more than 50% of transitions of care and referrals Provide summary of care for more than 10% of such transitions and referrals either A) electronically transmitted using CEHRT to a recipient B) via exchange through NwHIN Exchange participant or in a manner consistent with ONC governance mechanism Must satisfy one of the two following criteria: A) Exchange of summary with a recipient who uses a different EHR vendor B) Conduct one or more successful tests with the CMS designated test EHR 29

30 Core Objectives o Public Health Objectives: EH only Immunization Data Reportable lab results Syndromic Surveillance Data Oklahoma providers can register here: OSDH Meaningful Use Submission of Public Health Measures 30

31 Core Objectives o Public Health Objective Immunization Data: EP only Successful ongoing submission of electronic immunization data to an immunization registry Oklahoma providers can register here: OSDH Meaningful Use Immunization Message Submission 31

32 Core Objectives o Protect electronic health information: EH and EP Conduct or review a security risk analysis Implement security updates as necessary Address encryption/security of data at rest 32

33 Why Security & Privacy Risk Analysis? Required for Meaningful Use Primary tenet for HIPAA (1996) and HITECH (2009) Used to determine which safeguards and technologies will best protect the confidentiality, integrity, and availability of e-phi- Electronic Protected Health Information Risk analysis is the first step in an organization s Security Rule compliance efforts 33

34 Why Security & Privacy Risk Analysis? Because patients trust you with their health information Your Organization, NOT your EHR vendor, is responsible for taking the steps necessary to protect the confidentiality, integrity, and availability of health information in your EHR and comply with HIPAA Rules and CMS Meaningful Use requirements 34

35 Specifics for Meaningful Use Provider/Hospital is responsible for obtaining a compliant risk analysis for each reporting period Results of the Risk Analysis must be kept as part of the Meaningful Use Attestation Provider/Hospital is responsible for any identified deficiencies, inventory, as well as ongoing mitigation Have to address your findings (risks) with proper documentation 35

36 Risk Assessment 1 Review Existing Security of PHI 5 Monitor Results Mitigate Security Risks Security Risk Analysis Process Identify Threats and Vulnerabilities Assess Risks for Likelihood and Impact

37 Menu Objectives 37

38 Stage 2 EH Menu Objectives Electronic progress notes erx Imaging results accessible through CEHRT Record family health history Advanced directives Provide structured lab results to EPs 38

39 Stage 2 EP Menu Objectives Imaging results accessible through EHR Record family health history Record electronic notes in patient records Submit electronic syndromic surveillance data to public health agencies Identify and report cancer cases to cancer registry Identify and report specific cases to a specialized registry (other than cancer) 39

40 Menu Objectives o Record electronic notes in patient records: EH and EP Enter at least one electronic progress note created, edited, and signed by an EP Threshold: 30% Electronic notes must be text searchable (i.e. No scanned progress notes) 40

41 Menu Objectives o Imaging results and information: EH and EP More than 10% of all tests are accessible through the EHR o Record patient family health history: EH and EP More than 20% of all unique patients have a structured data entry for one or more first-degree relatives 41

42 Menu Objectives o Advanced Directives: EH only Threshold 50% of all unique patients 65+ admitted to the EH or CAH s inpatient department have an indication of an advanced directive status recorded as structured data o Provide structured lab results to ambulatory providers: EH only Threshold 20% EHs and CAHs must send structured electronic clinical lab results to the ordering provider 42

43 Menu Objectives o erx: EH only Threshold 10% of discharge medication orders are compared to at least 1 drug formulary and transmitted electronically 43

44 Menu Objectives o Electronic Syndromic Surveillance Data: EP only Capability to submit public health agencies o Identify and Report Cancer Cases: EP only Capability to report to public health central cancer registry o Specialized Registry: EP only Capability to identify and report specific cases to a specialized registry (other than a cancer registry) 44

45 We are Here to HELP! 45

46 OFMQHIT Expertise ARRA Incentive and Eligibility Review Meaningful Use Assessment and Gap Analysis Practice & Workflow Assessment and Design EHR Vendor Selection & Optimization Project Planning & Vendor Oversight HIPAA Security and Privacy Preparedness Post Go-Live Practice Assessment & EHR Optimization IT Security and Privacy Review & Assessment

47 Questions? Lindsey Mongold, MHA

48 CME Statement This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Oklahoma State Medical Association (OSMA). The Oklahoma Foundation for Medical Quality (OFMQ) is accredited by the OSMA to provide continuing medical education for physicians. OFMQ designates this live activity for a maximum of 3 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. The OFMQ CME Coordinator has reviewed all speaker information and resolved all conflicts of interest, if applicable. The CME Committee/OFMQ staff has no financial relationships to disclose. 48

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