Meaningful Use. Michael L. Brody, DPM FACFAOM CCHIT Ambulatory Workgroup HITSP Physician Perspective Technical Committee NYeHC

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1 Meaningful Use Michael L. Brody, DPM FACFAOM CCHIT Ambulatory Workgroup HITSP Physician Perspective Technical Committee NYeHC

2 What is Meaningful Use? Meaningful use is a term defined by CMS and describes the use of HIT that furthers the goals of information exchange among health care professionals

3 A bit of history In 2008 The National Quality Forum released a report titled National Priorities and Goals which were used to create the framework for Meaningful Use

4 And those Priorities are: Patient Engagement Reduction or Racial Disparities Improved Safety Increased Efficacy Coordination of Care Improved Population Health

5 And that means That eventually your EHR records will be connected to the EHR records of all other doctors and hospitals and every physician will have all medical information they require to make the best decision for each patient in their care.

6 The Incentive To prime the pump, the federal government is providing incentive money to physicians who adopt EHR software in a meaningful manner.

7 How Much Adopt in 2011 you can recieve up to $44,000 Adopt in 2012 you can receive up to $44,000 Adopt in 2013 you can receive up to $39,000 Adopt in 2014 you can recieve up to $24,000

8 And this is... For each physician using certified software in a meaningful manner.

9 A practice of 10 doctors Can receive up to $440,000 in incentive funds

10 If a doctor works for you You have the right to require by contract that your employees assign their incentive payment to you if they are using EHR software that you pay for.

11 A doctor who works for you Is NOT required to assign their incentive payment to you, in addition if they work for you part time and for another physician part time. They CAN NOT have Medicare SPLIT the incentive payment between two employers. The check has to be issued as a single WHOLE payment.

12 The Contract Therefore the contract you have with your employees is very important. Make sure both you and your employees understand the contract.

13 Who Doctors, including Doctors of Podiatric Medicine can receive incentive payments. Nurses are NOT eligible for incentive payments.

14 The Ultimate Goal The ultimate vision is one in which all patients are fully engaged in their health care, providers have real time access to ALL medical information and tools to ensure the quality and safety of the care provided while also affording improved access and elimination of health care disparities

15 Privacy and Security Additional areas that relate to privacy and security have been added to the definition of Meaningful Use

16 Housekeeping There are two incentive programs, the Medicare Program which I have been discussing and the Medicaid Program. In order to be eligible for the Medicaid Program, your practice must be 30% Medicaid. Since that does not fit most Podiatric Practices that I am aware of I have excluded it from this presentation.

17 In order to receive this incentive You must use software that has been certified to meet Meaningful Use

18 And... You need to use the software in a Meaningful Manner. Over the next set of slides I will discuss each of the things that YOU must do when using the software in order to use it in a Meaningful Manner

19 Subject to Change The final definiton of Meaningful Use is due out this month. The information in this lecture is based upon the 'Interim Final Rule' which was published earlier this year.

20 CPOE- Computerized Physician Order Entry A Physician (not a staff member) must directly enter orders in the computer for Medications Laboratory Orders Radiology / Imaging Services Referrals

21 CPOE Threshold 80% of all orders for these services must be entered DIRECTLY by the physician into the computer system

22 Clinical Decision Support - Drugs The system must be able to electronically generate and indicate alerts for drug-drug and drug- allergy interactions. The system must be able to check a new prescription against those in a patients formulary The system must track and record the number of alerts that you respond to.

23 What you have to do Most of this Measure is handled automatically by the software. When you are shown an alert you can decide whether or not to act on it. You will have to enter into the computer whether or not you acted on the alert for tracking purposes.

24 Maintain an Active Problem List Utilizing ICD-9 Codes you will have to keep track of all active problems for a patient. You will need to deactivate a problem when it is resolved, and add new problems as they occur.

25 Threshold At least 80% of the patients you have seen since implementing EHR must have an up to date problem list in the computer.

26 Electronic Prescribing The system will be required to have the capability to send electronic Prescriptions

27 Threshold You will have to send at least 75% of your prescriptions electronically

28 Medication List You will have to keep track of all active medications for a patient. You will need to deactivate a medication when it is D/C'd, and the system should automatically add new medications to the list when they are entered as a new Prescription.

29 Threshold At least 80% of the patients seen must have either a medication list or must be marked as not currently taking any medications.

30 Note Keeping this medication list up to date is important because that list will be used to check for potential drug drug interactions. (Remember that from a few slides ago).

31 Allergy List You will have to keep track of all active allergies for a patient. You will need to deactivate an allergy when it resolves.

32 Threshold At least 80% of the patients seen must have either an allergy list or must be marked as not currently having any allergies.

33 Note Keeping this allergy list up to date is important because that list will be used to check for potential drug allergy interactions. (Remember that from a few slides ago).

34 Collect Patient Demographics In addition to the demographic information that you have historically taken Name Date of Birth Address Gender Insurance Info

35 New Demographic Information You will need to collect additional demographic info Patient Preferences Race Ethnicity

36 Threshold At least 80% of the patients seen must have all required demographic information entered into the computer system

37 Vital Signs You will need to collect vital signs including: Height Weight Blood Pressure Pulse

38 Threshold At least 80% of the patients seen must have all required vital signs entered into the computer system. The system will also calculate BMI (Body Mass Index) for you from this information.

39 Smoking Status You will be required to collect the Smoking Status for patients over 13 years of age.

40 Threshold At least 80% of the patients seen must have their smoking status entered into the computer system

41 Lab Results Lab Results will need to be entered into the database for analysis and graphing purposes. This means you will need to get the results electronically from the lab and the program will read the electronic results and put them in the database for you. This is already built into the software.

42 Threshold At least 50% of all lab results must be stored in the database as discreet data. Notice this threshold is lower because not all labs are currently able to send you results electronically.

43 Patient Lists You will need to generate lists of patients by problem and USE that list. For example print out a list of all patients with diabetes and use it for recalls.

44 Threshold Print out a list at least once. (now that was easy)

45 Quality Reporting The system will need to be able to collect quality measure information.

46 Electronic Claims Submission At least 80% of your medical claims must be submitted electronically.

47 Electronic Copy of Patient Records You need to be able to create an electronic copy of the patients records including: Problem List Test Results Medication List Allergy List And Procedure History

48 Threshold At least 80% of all patients who request a copy of their records must receive it within 48 hours.

49 Summary of Care When you generate a referral it must include a summary of care to send to the receiving provider

50 Threshold 80% of referrals must include a summary of care

51 Patient having electronic access to their Health Information The patients must have online access to their health information

52 Threshold There is no threshold for this measure

53 Patient Reminders Remember Patient Reminders from the Demographics Section. This is where the patient tells you things like: You can leave a message on my machine You can not leave a message with my husband /wife etc

54 And how do we use that info Contacting a patient you will need to take that information into account. When calling to report lab results When calling to confirm an appointment When contacting a patient for any reason.

55 Threshold You must have log contact for at least 50% of your patients as per their stated preferences

56 Clinical Decision Support At least 5 clinical decision rules specific to Podiatry (well the rule says Specialty Specific) must be implemented

57 For Example Have a pop up that alerts you when a diabetic patient comes in if they have not had a neurologic exam in the last 12 months.

58 Insurance Eligibility The system must check the insurance eligibility for your patients

59 Threshold Insurance eligibility needs to be checked for 80% of the patients who you have seen

60 PHR (Personal Health Record) This is a form of a PHR. You do not have to provide this, they can use Microsoft, Google or some other service but if you do not provide it you will need to send the info to those PHR providers

61 Patient Clinical Summary You need to be able to provide a summary of care for each office visit to the patient either electronically or in a printout. The summary will include Test Results Current Medications Current Allergies Current Problem List Services Provided at that visit

62 Threshold The summary must be provided to at least 80% of patients seen

63 Exchange Clinical Information Electronically be able to send clinical information to and receive clinical information from other providers.

64 Threshold Once during the year you need to test this capability against a 'test' system. You will actually need to be doing this some time after 2013.

65 Medication Reconcillation At least once a year, and ever time you write a new prescription you will need to review the list of medications a patient is taking with the patient and update the list as appropriate.

66 Threshold Medication Reconciliation must be completed on at least 80% of patients seen.

67 Immunization Registries If there is an Immunization Registry in your state you need to be able to report to that registry. Your software takes care of this for you.

68 Bio Surveillance If there is an Syndromic Registry in your state you need to be able to report to that registry. Your software takes care of this for you.

69 Patient Record Security Your software must have security built into it and...

70 Security You are required to have a HIPAA Security Manual and Plan in place in your office.

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