Meaningful Use and Lab Related Requirements

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1 Meaningful Use and Lab Related Requirements ONC State HIE / NILA Workgroup August 20, 2013

2 What is an EHR? Electronic Health Record Information system used by healthcare providers to store and manage patient medical histories Supports electronic ordering (prescriptions, lab, etc.) Electronic Patient Chart Collect Patient Information Display Test Results Allow Computerized Provider Order Entry (lab, pharmacy, etc.) Help Make Treatment Decisions

3 EHR and Labs Physicians looking to integrate lab workflow and structured results into EHR Uni-directional interface Results only Orders entered manually or via other entry system Bi-directional interface Orders generated electronically in EHR Results received electronically EHR integration is a competitive issue for labs.

4 HITECH Act HITECH = Health Information Technology for Economic and Clinical Health Act $19.2 Billion in stimulus funds to increase the meaningful use of EHR s by physicians and hospitals Encourage adoption of Information Technology as a way to improve care and reduce cost of Healthcare

5 Stimulus Details Stimulus $ in form of additional Medicare and Medicaid payments Incentives available Max $44,000/provider over 5 years (MC) Max $63,000/provider over 6 years (MD) Penalties starting in 2015 for late adopters of EHR. Providers must prove Meaningful Use of EHR in order to receive stimulus $ Labs not eligible for stimulus $

6 What is Meaningful Use (MU)? Use EHR in meaningful manner Computerized Order Entry Incorporate Structured Lab Result Data eprescribe Document patient encounters Lots more Health Information Exchange Providers Patients Report Clinical Quality Measures

7 What is Health Information Exchange (HIE) and the States Role Office of the National Coordinator for Health Information Technology (ONC) State Health Information Exchange (HIE) Cooperative Agreement program ARRA/HITECH Grants provided to 50 states and 6 territories to build out the infrastructure within their state to facilitate the exchange of data among providers and assist them in achieving meaningful use. Priorities within the Cooperative Agreement Program included enabling e-prescribing, care summary exchange and lab interoperability. State grantees are working with all labs (national, regional, hospital and independent) to encourage connectivity with providers and public health authorities.

8 Conceptual Approach to Meaningful Use Meaningful Use In Three Stages

9 Meaningful Use Update Increasingly demanding criteria released in Stages Stage 1 Final Rule published in July 2010 Stage 2 Final Rule published in September, 2012 Mandates Lab-related functionality Stage 3 in Draft 2 Sets of MU Criteria Eligible Providers (EP) Eligible Hospitals (EH)

10 MU Stage 1: Core Set Objectives 15 Core Objectives (Must be met): 1. Computerized physician order entry (CPOE) 2. E-Prescribing (erx) 3. Report ambulatory clinical quality measures to CMS/States 4. Implement one clinical decision support rule 5. Provide patients with an electronic copy of their health information, upon request 6. Provide clinical summaries for patients for each office visit 7. Drug-drug and drug-allergy interaction checks 8. Record demographics 9. Maintain an up-to-date problem list of current and active diagnoses 10. Maintain active medication list 11. Maintain active medication allergy list 12. Record and chart changes in vital signs 13. Record smoking status for patients 13 years or older 14. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically 15. Protect electronic health information

11 MU: Menu Set Objectives * Choose 5 of 10 Objectives from list: 1. Drug-formulary checks 2. Incorporate clinical lab test results as structured data 3. Generate lists of patients by specific conditions 4. Send reminders to patients per patient preference for preventive/follow up care 5. Provide patients with timely electronic access to their health information 6. Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate 7. Medication reconciliation 8. Summary of care record for each transition of care/referrals 9. Capability to submit electronic data to immunization registries/systems * 10. Capability to provide electronic syndromic surveillance data to public health agencies * * At least 1 public health objective must be selected

12 MU Stage 2 Eligible Providers 17 Core Objectives (Must be met): 1. Use computerized provider order entry (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. 2. Generate and transmit permissible prescriptions electronically (erx). 3. Record the following demographics: preferred language, sex, race, ethnicity, date of birth. 4. Record and chart changes in specific vital signs. 5. Record smoking status for patients 13 years old or older. 6. Use clinical decision support to improve performance on high-priority health conditions. 7. Provide patients the ability to view online, download and transmit their health information. 8. Provide clinical summaries for patients for each office visit. 9. Protect electronic health information created or maintained by the Certified EHR Technology. 10. Incorporate clinical lab-test results into Certified EHR Technology as structured data. 11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. 12. Identify & send patients reminders for preventive/follow-up care. 13. Identify patient-specific education resources and provide those resources to the patient. 14. 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. 15. Provide a summary care record for each transition of care or referral. 16. Submit electronic data to immunization registries or immunization information systems. 17. Use secure electronic messaging to communicate with patients on relevant health information.

13 MU Stage 2 Lab Related

14 MU Stage 2 Eligible Hospitals Menu Objective (Optional) Provide structured electronic lab results to ambulatory providers for 20% of orders received. Additional competitive pressure on commercial labs to provide the same level of structured electronic results.

15 Thank You

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