Burning Issues Health Information Exchange Webinar Series Session 2: HIE for Meaningful Use Stage 2 Summary of Care Record for Transitions of Care

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1 Burning Issues Health Information Exchange Webinar Series Session 2: HIE for Meaningful Use Stage 2 Summary of Care Record for Transitions of Care Joe Kalaidis, Health IT Consultant Regional Extension Assistance Center for HIT (REACH) July 23, 2014 BI We b inar He alth In fo rmation Exch an ge Series Se ssio n 2 : HIE for Me anin gful Use Stage 2 Su mmary o f C are Re co rd for Tran sitio ns of Care REACH - Achieving - Achieving meaningful meaningful use of your use EHR of your EHR

2 BI Radio Upcoming Webinars: Health Information Exchange 3 part series Session 1 HIE and Interoperability Overview Session 2 Summary of Care Record for Transitions of Care Session 3 Providing Patients with Ability to View- Download-Transmit Their Health Information July 30th, Wednesday / 12:00-1:00pm Registration: ents/onstage/g.php?t=a&d=

3 Acknowledgement for Resources Elisabeth Myers CMS Paul Tuten - ONC Cindy Grolla, Northfield Hospital & Clinics Phil Deering, Reid Haase, Joe Wivoda REACH Greg Linden Stratis Health 2014 Minnesota e-health Summit 3

4 Agenda for today Stage 2 Requirements for Summary of Care Record at Transitions of Care Measure 1: Summary of Care Record Measure 2: Sent Electronically Measure 3: to a Recipient with Different CEHRT Process Flow Real-World Example Challenges Making it Work for You Q & A 4

5 Why Summary of Care Record? Purpose: Ensure provider who transitions a patient to someone else s care gives receiving provider most up-todate information available For Positive Outcomes For Avoiding Negative Outcomes (patient safety) Why Summary of Care Record 3 REACH - Achieving - Achieving meaningful meaningful use of your use EHR of your EHR

6 CMS EP Core #15 CMS EH Core #12 Transfer of Care / Referral Stage 1 (Menu) Measure >50% of referrals and transitions of care Denominator Care transitions Exclusion EP: Does not refer or transition EH: None Stage 2 (Core) Measure >50% of referrals and transitions of care >10% sent electronically One or more sent electronically to: A different provider with a different EMR The CMS designated test EHR Denominator Care transitions Exclusion EP: <100 transfers/referrals during the EHR reporting period EH: None 6

7 Summary of Care Record (SoC) for Referrals and Transitions of Care What s New in Stage 2? Electronic requirement is new in Stage 2 Unfamiliar terminology Multiple options on how to do it (Maybe) multiple options on who you can use to do it Multiple Moving Parts 7

8 Summary of Care Objective Measures SoC Objective EP who transitions patient to another setting of care or provider of care or refers patient to another provider of care should provide summary care record for each transition of care or referral EPs must satisfy both of the following measures in order to meet the objective: Measure 1: EP who transitions or refers patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals Measure 2: EP who transitions or refers patient to another setting of care or provider of care provides a summary of care record for more than 10% 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 an NwHIN Exchange (now called ehealth Exchange) participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN Measure 3 :EP must satisfy one of following criteria: Conducts one or more successful electronic exchanges of a summary of care document, as part of which is counted in "measure 2 (for Eps the measure at 495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender's EHR technology certified to 45CFR (b)(2) Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period Exclusion EP who transfers a patient to another setting or refers a patient to another provider lesst han 100 times during EHR reporting period is excluded

9 Let s Take the Measure Apart Measure 1 Summary of Care Record for >50% of referrals and transitions of care SoC can be done electronically or on paper SoC can be handed to patient if there is a reasonable expectation it will get to recipient 9

10 Let s Take the Measure Apart - Measure 2 >10% of SoCs electronically, either: Transmitted using Certified EHR Technology (CEHRT) to a recipient, or; Where the recipient receives the SoC via exchange facilitated by an organization that is an ehealth Exchange (formerly called NwHIN or HealtheWay) participant 10

11 Information Requirements Requirements for for Summary of Care Record SoC Record Certified EHR Technology Enter information into certified EHR technology Patient name Referring/transitioning provider s name & office contact information (EP only) Procedure Encounter diagnosis Immunizations Laboratory test results Vital signs (height, weight, blood pressure, BMI) Smoking Status Functional Status, including activities of daily living, cognitive and disability status Demographic information (preferred language, sex, race, ethnicity, date of birth) Care plan field, including goals and instructions Care team including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider Reason for referral Current problem list (EPs may also include historical problems at their discretion) ** Current medication list ** Current allergy list ** ** required Withhold any information provider determines could cause possible harm Verify presence of elements; Problem List, Medication List, and Medication Allergy List Create C-CDA (Consolidated Clinical Document Architecture) Provide summary of care record when patient is transferred to another setting of care or referred to another provider REACH - Achieving - Achieving meaningful meaningful use of your use EHR of your EHR

12 Clinical Document Architecture (CDA) & Consolidated-CDA (C-CDA) Overview Clinical Document Architecture (CDA) is the base standard for building electronic clinical documents Templates provide the building blocks for clinical documents Consolidated Clinical Document Architecture (C-CDA) includes nine document types, one of which is an updated version of the Continuity of Care Document (CCD) To help simplify implementations, commonly used templates were harmonized from existing CDA implementation guides and consolidated into a single implementation guide the C-CDA Implementation Guide (IG) (07/2012)

13 2014 Edition CEHRT Requirements Achieved using C-CDA CDA standardizes the expression of clinical concepts which can be used/re-used Templates are used to specify the packaging for those clinical concepts Sets of CDA templates (including CCD) are arranged to create a purpose-specific clinical document 2014 Ed. CEHRT adds data requirements, which can be layered on top of C-CDA document templates by the EP or EH/CAH to achieve compliance MU2 NOTE: No single C-CDA document template contains all of the data requirements to sufficiently meet all 2014 Ed. CEHRT requirements C-CDA & MU2 guidelines must be implemented together.

14 Measure 2 Sending the Summary of Care Record How to identify the recipient? Recipient needs a Direct address From a directory available within the CEHRT From a directory available from your HISP What if you don t see the recipient in the directory? Contact them and ask if they have one If not, ask them to get one through their vendor or a HISP Recipients don t have to have CEHRT to receive your SoC and have it count for MU 14

15 Measure 2 Sending the Electronic Summary of Care Record How do you actually send the SoC? Ask your EHR vendor Adapt your workflow How is the numerator calculated for MU? Needs confirmation of receipt in order to count Ask your EHR vendor (is there a common theme here?) Ask your Health Information Service Provider (HISP) 15

16 Transmit Summary Care Record Using CEHRT Direct (Required) Example 1 Transmit Provider Summary A Care Record Using CEHRT Direct (Required) Direct (SMTP + S/MIME) Represents Certified EHR Technology or CEHRT Provider B Example 2 Provider A <Data> HISP Provider B Any Edge Transmission Protocol Direct (SMTP + S/MIME) Provider A EHR Affiliated HISP Provider B Example 3 <Data> Any Edge Transmission Protocol Direct (SMTP + S/MIME)

17 Transmit Summary Care Record Using CEHRT SOAP +XDR/XDM (Option) Represents Certified EHR Technology or CEHRT Example 1 1. EHR generates CCDA 2. EHR (certified to include optional SOAP + XDR/XDM Transmit Summary Care Record transport) sends message to Provider B using SOAP + XDR/XDM Provider A SOAP + XDR/XDM Using CEHRT SOAP +XDR/XDM (Option) Provider B Example 2 1. EHR generates CCDA 2.EHR (certified to include optional SOAP + XDR/XDM transport) sends message to Provider B (via HISP) using SOAP + XDR/XDM 3.HISP/HIE repackages content and sends to Provider B Provider A SOAP + XDR/XDM HISP/HIE Provider B Example 2 demonstrates how CEHRT may be used to integrate with other HISPs, ehealth Exchange participants, or HIEs offering query-based exchange.

18 Transmit Summary Care Record Using ehealth Exchange Participant Example 1 ehealth Exchange Transmit Example Summary Care Record 1.EHR generates CCDA 2.EHR sends CCDA to ehealth Exchange Participant 3.eHealthExchange Participant sends to Provider B Provider A ehealth Exchange Participant (formerly NwHIN Exchange) Using ehealth Exchange Participant Provider B CEHRT An ehealth Exchange Participant does not have to be certified in order for Provider A s transmissions to count for MU. However, Provider A must still use CEHRT to generate a standard summary record in accordance with the CCDA.

19 Transmi t Summary Care Record Using Connect Pul l or Query I nf rastruct ure Transmit Summary Care Record Using Connect Pull or Query Infrastructure Provider 1 Provider 2 Provider 3 Provider 4 HISP/HIE Providers #1-4 (1) have CEHRT, and (2) use the CEHRT s transport capability (Direct or SOAP) to send a C-CDA to a HISP/HIE that enables the C-CDA they ve sent the HISP/HIE to be subsequently pulled by Provider #5 using the Connect model. Provider 5

20 Measure 2 Sending the Summary of Care Record All 2014 CEHRT must be certified for Direct How is yours certified? With or without relied on software? HISP = Health Information Service Provider Ask your EHR vendor Go to the CHPL 20

21 CHPL: Is your EHR capable of SRE 21

22 An EHR vendor could 1 Be a Health Information Service Provider (HISP) 2 Partner with a HISP 3 Enable clients to be a self-service HISP SOAP + XDR/XDM Regardless of the option(s) they select, they need to ensure that they, their partner(s), and/or their client(s) are capable of doing what s required to successfully engage in Direct exchange. 22

23 CEHRT Certification Vendor Product Direct + XDR/XDM SOAP + XDR/XDM HISP Allscripts Enterprise EMR Yes Yes MedAllies Direct Allscripts Professional No Yes MedAllies Direct Amazing Charts Amazing Charts No No Updox Direct Cerner Powerchart No No Cerner Direct CPSI CPSI No Yes InPriva Direct Core Services eclinicalworks eclinicalworks No No E-MDs E-MDs Chart No No Updox Direct Epic EpicCare Yes Yes Epic (for CareEverywhere) GE Healthcare Centricity Practice Solution No Yes Centricity Clinical Messenger or Qvera HIE or any HISP Greenway PrimeSuite No No Updox Direct Greenway Vitera No No Kryptiq HISP Greenway SuccessEHS No No Data Motion for Direct 23

24 CEHRT Certification Vendor Product Direct + XDR/XDM Healthcare Mgt Systems (HMS) SOAP + XDR/XDM HISP HMS No No Secure Exchange for Direct Healthland Centriq No No Updox Direct Healthland Classic No No Updox Direct McKesson Paragon No No Med3000 InteGreat EMR No No MedFusion? Meditech Meditech Yes Yes NextGen NextGen EMR No No Practice Fusion Practice Fusion No No Updox Direct 24

25 Health Information Service Providers (HISPs) North Dakota Health Information Network: NDHIN Minnesota: Community Health Information Collaborative (CHIC) IOD Emdeon Surescripts Sandlot Solutions Eldermark Exchange Applications pending: MedAllies RelayHealth Others coming? Other HISPs as specified by your CEHRT 25

26 Measure 2 Also Can Be Met where the recipient receives the SoC via exchange facilitated by an organization that is an ehealth Exchange participant The national health information super-highway This works no matter how the EHR is certified Who are ehealth Exchange participants? Allina CHIC Fairview Health Services Essentia Health Health Partners-Park Nicollet Health Services Other provider organizations in process? 26

27 Let s Take the Measure Apart - Measure 3 Must satisfy one of the two following criteria: Conducts one or more successful electronic exchanges of a SoC with a recipient who has different EHR technology So Epic-to-Epic does not count! Or conducts one or more successful tests with a test EHR identified by the CMS Randomizer McKesson Meditech ipatientcare 27

28 Summary of Care Example - outbound Patient Health Summary = Summary of Care Record Hospital Unit Secretary completes an assessment at the time of Discharge to identify disposition and F/U plan (updates Transition of Care numerator for measure 1) 28

29 Summary of Care Example - outbound Select the Send DIRECT Message menu item Enter information on the DIRECT message screen and select ok to send the message 29

30 Summary of Care Example - inbound Select the Process DIRECT Messages menu item Select the DIRECT ID inbox 30

31 Summary of Care Example - inbound Select the message and Import CCD 31

32 Summary of Care Example - inbound View the CCD and if you are going to import the CCD do a Patient Search in the Name field, then IMPORT 32

33 Summary of Care Example - inbound CCD flows to Reports module and to the patient s EMR 33

34 Summary of Care Example - Calculating the Numerator for Transitions of Care Third-party application (2014-certified) Spreadsheet report contains detail if needed Separate views for Measure 1 and Measure 2 Use this information for MU attestation and retain for possible audit 34

35 Challenges Interoperability Layers Technical Transmitting the data Hardware, software, networks Semantic Communicating the meaning of the data Data content, terminologies and structure Process Best practices on the use of data People interacting with the system Workflow, user roles, etc.

36 Semantic Interoperability 36

37 Easier Said than Done 37

38 Counting Transitions of Care Counting Transitions of Care When reporting on the Summary of Care objective, which transitions would count toward the numerator of the measures? A transition of care is defined as the movement of a patient from one setting of care (hospital, ambulatory, primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. To count toward the Summary of Care objective, the transition or referral must take place between providers with different billing identities such as a different National Provider Identifier (NPI) or hospital CMS Certification Number (CCN). For Measure 1: include the transitions of care in which a summary of care document was provided to the recipient of the transition or referral by any means. For Measure 2: include the transitions of care in which a summary of care document was transmitted electronically using a Certified EHR Technology (CEHRT) to the recipient, or via exchange facilitated by an organization that is an ehealth Exchange participant. If the receiving provider already has access to the CEHRT of the initiating provider of the transition or referral, simply accessing the patient s health information does not count toward meeting this objective. However, if the initiating provider also sends a summary of care document, this transition can be included in the denominator and the numerator as long as it is counted consistently across the organization and across both measures if: For Measure 1, a summary of care document is also provided by any means. For Measure 2, a summary of care document is provided using the same technical standards used if the receiving provider did not have access to the CEHRT, For Measure 3: a single summary of care document sent to a provider using a different EHR and EHR Vendor or a test with the CMS and ONC Randomizer test system would meet the measure. REACH - Achieving - Achieving meaningful meaningful use of your use EHR of your EHR

39 Challenges Building the SoC and workflow to capture all data elements What is a Transition of Care and when can it count? How is it counted in your CEHRT or HISP? How to send the SoC 39

40 People Process Technology Communicate: Making It All Work With your patients With your trading partners (referrals) With your vendor(s) 40

41 Questions? Q&A Joe Kalaidis Key Health Alliance Stratis Health, 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. 41