Program Year 2014 Stage 2 Meaningful Use for EPs

Transcription

1 Program Year 2014 Stage 2 Meaningful Use for EPs Valorie A. Vigil, Staff Manager Idalia Lechuga-Tena, Communications Manager New Mexico Human Services Department Medical Assistance Division Systems Bureau NM Medicaid EHR Incentive Program

2 This Webinar will cover the Stage 2 Objectives and Measures We will walk through the Objectives and Measures as they will appear in the NM State Level Registry Only providers who have attested to two years of Stage 1 MU are eligible to attest to Stage 2 MU Under the CMS 2014 CEHRT Flexibility Rule, providers will only be able to attest to AIU if they have fully implemented 2014 Edition CEHRT 2

3 Before attesting in the NM State Level Registry, providers are strongly encouraged to attend the webinar: Program Year 2014 CMS 2014 CEHRT Flexibility Rule & NM State Level Registry Changes Or view the webinar slides on the State EHR Website under the General Information tab: 3

4 NEW EHR FINAL RULE It is critical that providers know the CEHRT Edition, Vendor Name and Product Version they are using for the 90-day EHR Reporting Period Work with your Vendor and IT Staff to determine the above Go to the ONC website to get correct EHR CEHRT number: 4

5 2014 CEHRT FLEXIBILITY = NM SLR CHANGES Log into PY 2014 Attestation in the NM SLR Type in ONC CEHRT Number Provider will get a Set of Attestation Options based on the CERHT Edition associated with the number Choose from MU Options Available Only 2014 CEHRT Edition will have the Option for AIU or Stage 2 MU 5

6 2014 CEHRT FLEXIBILITY = NM SLR CHANGES The NM SLR will Determine the Set of Measures Based on the Following: 2014 CEHRT No. Characters 3-5 are 14E Combo 2011/2014 CEHRT No. Characters 3-5 are H CEHRT No. If Characters 3-5 are any Combination other than 14E or H13 6

7 The CEHRT number you have entered results in an option for MU Stage 2 Objectives and Measures *Only providers that could not fully implement 2014 Edition CEHRT for the EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability 7

8 NM State Level Registry Screen when you login If Invalid CEHRT ID is entered, the SLR will display the following error message: You have entered a number that does not match the EHR Certification ID format from the ONC CHPL. Please check the number to ensure it is correct. No attestation record is created and the provider may not continue until a valid number has been entered. 8

9 NM State Level Registry Screen when you login Entering a 2014 CEHRT Edition Number allows 3 options; When Option 2 (second box) is selected, the SLR will create a set of Stage 1 or Stage 2 objectives, measures and CQMs based on the provider s prior attestations. 9

10 NM State Level Registry Screen when you login Once an option is selected, a confirmation screen will display the CEHRT Edition, MU Stage and Year (MU criteria) chosen. When continue is clicked, the set of measures is locked in and cannot be changed without deleting the attestation and starting over. 10

11 Patient Volume Requirements Step 2 in the State Level Registry EPs need a minimum 30% Medicaid PV for all patient encounters over a continuous 90- day Representative Period. EPs may choose a 90-day Representative Period from either: the prior calendar year, OR the preceding 12 months from date of attestation 11

12 ONC CEHRT Number After login to PY 2014 Attestation Step 3 in the SLR Must have ONC CEHRT # each Payment Year First Payment Year: Attach documentation a vendor contract or paid invoice on SLR Step 3 Subsequent Payment Years: If ONC CEHRT # changes from prior year (new version of EHR), attach vendor documentation a vendor contract or paid invoice on SLR Step 3 PY 2014: Attach screenshot on SLR Step 3 12

13 IMPORTANT TO REMEMBER The same product and version may be listed under one or more of the Edition tabs However, the CEHRT number will be different under each Edition as shown on your left Again, please verify with your Vendor which CEHRT number should be used 13

14 NM State Level Registry Dashboard All MU data is input at Step 3. Attestation of EHR EHR Certification No. EHR Reporting Period MU General Requirements MU All Core & Menu Objectives & Measures; all CQMs 14

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16 SLR will populate the CEHRT # that was entered at login. Attach ONC screenshot of CEHRT # and updated vendor documents. 16

17 If the CEHRT # is changed on Step 3 to a different CEHRT Edition # that does not match the CEHRT # entered at the beginning of the attestation, you will get an error message as shown to the right. NOTE: If the CEHRT Edition # entered at login is incorrect, the 2014 attestation will have to be deleted and the provider will have to start over. 17

18 MU Two General Requirements At least 80% of unique patients must have their records in a certified EHR during the EHR reporting period Unique Patients = Number of patients seen in the EHR reporting period. Patients seen more than once count only once in the denominator. For EPs who practice at multiple sites, at least 50% of total patient encounters during the EHR reporting period must be at location(s) with certified EHR technology As long as an EP has certified EHR available for 50% or more of their patient encounters during the EHR reporting period, the EP only has to include those encounters where certified EHR is available at the start of the EHR reporting period. 18

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21 Option for a different CQMs EHR Reporting Period. 21

22 2014 Stage 2 Reporting Requirements Eligible Professionals Meaningful Use 20 Objectives CORE 17 Objectives MENU 3 of 6 Objectives Clinical Quality Measures 9 Objectives 9 CQMs total out of 64 9 adult 9 pediatric Any 9 22

23 Stage 2 Objectives and Measures 2014 is the first year an EP can attest to Stage 2 MU if the EP has already attested to two years of Stage 1 MU Some Objectives have more than one Measure Stage 2 Measures have higher thresholds than Stage 1 Immunization Measure moves to the Core set 23

24 2014 Stage 2 Core Set Core Objectives: Must meet measures for all 17 Core Objectives or meet an exclusion 13 of the Core Objectives have percentage-based measures that require a numerator and a denominator 4 of the Core Objectives have Y/N responses did you perform the action required in the measure? 4 of the Core Objectives have multiple measures 14 of the Core Objectives have exclusion criteria 24

25 2014 Stage 2 Menu Set Menu Measures: Must meet 3 out of 6 Menu Objectives without an exclusion, or must attest to all 6 with some exclusions criteria. 3 of the Menu Objectives have percentage-based measures that require a numerator and a denominator 3 of the Menu Objectives have Y/N responses did you perform the action required in the measure? 6 of the Menu Objectives have exclusion criteria 25

26 2014 CQMs Must report on 9 CQMs instead of 6 and choose from: 9 CQMs for adult populations; OR 9 CQMs for pediatric populations; OR 9 CQMs total from a list of 64 9 CQMs must be from 3 of 6 NQS key health care policy domains 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population/Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness Data must be reported directly from information generated by CEHRT 26

27 Measure Types Percentage-based Measures Have a Numerator and Denominator Yes/No Measures Some measures have exclusions 27

28 Exclusions Based on all patients seen during the EHR reporting period not just those whose records are maintained in CEHRT True even if the measure for the objective has the option to choose only records maintained in the CEHRT A Yes answer to a Core Measure exclusion meets the measure A No answer to an exclusion means the EP has to meet the required threshold for percentage-based measures or say Yes to taking the required action on a Yes/No measure If no exclusion criteria is offered, the EP must meet the measure There are no exclusions based on provider type 28

29 Text Boxes in the NM SLR Require valid information be input Some are free text must type something in Some are dropdown menus Some measures have more than one text box 29

30 Selection Pages & Detail Pages in the NM SLR Each group of measures includes a Selection Page which provides a place to access or select the measures. Each measure within a group also includes a Detail Page where you input the data. Use the Save & Continue button on each measure Detail Page to move into the next measure requiring input, or to the next Selection Page. Navigation Menu is on left-hand side of each page. 30

31 Navigation Menu The left-hand Navigation Menu will contain page titles that serve as links associated with the MU pages. The majority of MU pages are collected in four or five subgroups. Clicking the name of a subgroup or clicking the expand icon ( ) will reveal all the pages in the subgroup, all of which must be completed by the user. Once all the pages in a navigation group have been completed, and all have passed their validation criteria, then the subgroup will receive a completed icon ( ). Clicking the collapse icon ( ) will hide the title of the individual pages in a subgroup. 31

32 NM Medicaid EHR Incentive Payment Program Stage 2 MU for EPs 2014 Core Objectives 32

33 Skip the Import Screen and Click on MU Core Objectives 33

34 NM Medicaid EHR Incentive Payment Program S2 MU for EPs 2014 Core Objectives 34

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36 NM Medicaid EHR Incentive Payment Program S2 MU for EPs 2014 Core Objectives 36

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38 Definitions Core Objective 1 CPOE Computerized Provider Order Entry (CPOE) A provider's use of computer assistance to directly enter medical orders (for example, medications, consultations with other providers, laboratory services, imaging studies, and other auxiliary services) from a computer or mobile device. Laboratory and radiology orders are included as part of Stage 2 for CPOE: Laboratory Order Order for any service provided by a laboratory that could not be provided by a non-laboratory. Laboratory A facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered laboratories. Radiology Order Order for any imaging services that uses electronic product radiation. The EP can include orders for other types of imaging services that do not rely on electronic product radiation in this definition as long the policy is consistent across all patient and for the entire EHR reporting period. 38

39 Definitions Continued Core Objective 1 CPOE Electronic Product Radiation Any ionizing or nonionizing electromagnetic or particulate radiation, or [a]ny sonic, infrasonic, or ultrasonic wave that is emitted from an electronic product as the result of the operation of an electronic circuit in such product. Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. Objective: 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. Measure More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE. Exclusion Any EP who writes fewer than 100 medication, radiology, or laboratory orders during the EHR reporting period. 39

40 Additional Information Core Objective 1 CPOE The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology (CEHRT). The CPOE function must be used to create the first record of the order that becomes part of the patient's medical record and before any action can be taken on the order to count in the numerator. However, in some situations it may be impossible or inadvisable to wait to initiate an intervention until a record of the order has been created. For example, situations where an intervention is identified and immediately initiated by the provider, or initiated immediately after a verbal order by the ordering provider to a licensed healthcare professional under his/her direct supervision. Therefore in these situations, so long as the order is entered using CPOE by a licensed healthcare professional or certified medical assistant to create the first record of that order as it becomes part of the patient s medical record, these orders would count in the numerator of the CPOE measure. Any licensed healthcare professionals and credentialed medical assistants, can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local and professional guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. Electronic transmittal of the medication order is not a requirement for meeting the measure of this objective. CPOE is the entry of the order into the patient's EHR that uses a specific function of CEHRT. It is not how that order is filled or otherwise carried out. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (a)(1). 40

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43 Definitions: Core Objective 2 e-prescribing (erx) Permissible Prescriptions The concept of only permissible prescriptions refers to the current restrictions established by the Department of Justice on electronic prescribing for controlled substances in Schedule II-V. (The substances in Schedule II-V can be found at ). Any prescription not subject to these restrictions would be permissible. Prescription The authorization by an EP to a pharmacist to dispense a drug that the pharmacist would not dispense to the patient without such authorization. Objective: Generate and transmit permissible prescriptions electronically (erx). Measure: More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Exclusions: Any EP who: (1) Writes fewer than 100 permissible prescriptions during the EHR reporting period. (2) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period. 43

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45 Core Objective 3 Record Demographics Definitions: Preferred Language The language by which the patient prefers to communicate. Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Objective: Record the following demographics: preferred language, sex, race, ethnicity, date of birth. Measure: More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data. Exclusion: No exclusion. 45

46 Core Objective 3 Record Demographics Attestation Requirements: DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: The number of patients in the denominator who have all the elements of demographics (or a specific notation if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data. THRESHOLD: The resulting percentage must be more than 80 percent in order for an EP to meet this measure. Additional Information If a patient declines to provide all or part of the demographic information, or if capturing a patient s ethnicity or race is prohibited by state law, such a notation entered as structured data would count as an entry for purposes of meeting the measure. In regards to patients who do not know their ethnicity, EPs should treat these patients the same way as patients who decline to provide race or ethnicity identify in the patient record that the patient declined to provide this information. EPs are not required to communicate with the patient in his or her preferred language in order to meet the measure of this objective. The term gender in the Stage 1 objective is replaced with the term sex for Stage 2. 46

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52 Core Objective 4 Record Vital Signs Definitions: Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Objective: Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. 52

53 Core Objective 4 Record Vital Signs Measure: More than 80 percent of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data. Exclusion: Any EP who: (1) Sees no patients 3 years or older is excluded from recording blood pressure. (2) Believes that all 3 vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them. (3) Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure. (4) Believes that blood pressure is relevant to their scope of practice, but height/length and weight are not, is excluded from recording height/length and weight. 53

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56 Definitions: Core Objective 5 Record Smoking Status Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Objective: Record smoking status for patients 13 years old or older. Measure: More than 80 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Exclusion: Any EP that neither sees nor admits any patients 13 years old or older. 56

57 NOTE: You must attest YES to meet the attestation requirements 57

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60 Core Objective 6 Clinical Decision Support Rule Definitions: Clinical Decision Support HIT functionality that builds upon the foundation of an EHR to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care. Objective: Use clinical decision support to improve performance on high-priority health conditions. 60

61 Measure: Core Objective 6 Clinical Decision Support Rule Measure 1: Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions. Must attest YES to this measure or EP will not meet Meaningful Use. If none of the CQMs are applicable to an EP's scope of practice, the EP should implement CDS interventions that he or she believes will drive improvements in the delivery of care for the high-priority health conditions relevant to their patient population. CMS will not issue additional guidance on the selection of appropriate clinical decision support rules for Stage 2 Meaningful Use. This determination is best left to the EP taking into account their workflow, patient population, and quality improvement efforts. Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Exclusion: For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period. 61

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64 Objective: Core Objective 7 Clinical Lab-Test Results Incorporate clinical lab-test results into Certified EHR Technology (CEHRT) as structured data Measure: More than 55 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data Exclusion: Any EP who orders no lab tests where results are either in a positive/negative affirmation or numeric format during the EHR reporting period. 64

65 Core Objective 7 Clinical Lab-Test Results Additional Information: The structured data for the numeric/quantitative test results may include positive or negative affirmations and/or numerical format that would include a reference range of numeric results and/or ratios. Structured data does not need to be electronically exchanged in order to qualify for the measure of this objective. The EP is not limited to only counting structured data received via electronic exchange, but may count in the numerator all structured data entered through manual entry through typing, option selecting, scanning, or other means. Lab results are not limited to any specific type of laboratory or to any specific type of lab test. The Medicare and Medicaid EHR Incentive Programs do not specify the use of code set standards in meeting the measure for this objective. However, the Office of the National Coordinator for Health Information Technology (ONC) has adopted Logical Observation Identifiers Names and Codes (LOINC ) version 2.27, when such codes were received within an electronic transaction from a laboratory, for the entry of structured data for this measure and made this a requirement for EHR technology to be certified. Provided the lab result is recorded as structured data and uses the standards above, there does not need to be an explicit linking between the lab result and the order placed by the physician in order to be counted in the numerator. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (b)(5). 65

66 NOTE: You must attest YES to meet the attestation requirements 66

67 Definitions: Core Objective 8 Patient Lists Specific Conditions Those conditions listed in the active patient problem list. Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Measure: Generate at least one report listing patients of the EP with a specific condition. Exclusion: No exclusion. Attestation Requirements: Eligible professionals (EPs) must attest YES to having generated at least one report listing patients of the EP with a specific condition to meet this measure. 67

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70 Definitions: Core Objective 9 Preventive Care Patient Preference The method of communication that patients prefer to receive their reminders such as (but not limited to) by mail, by phone or by secure messaging. Active Patients Patients with at least two office visits in the last 24 months. Objective: Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference. Measure: More than 10 percent of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available. Exclusion: Any EP who has had no office visits in the 24 months before the EHR reporting period. 70

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74 Definitions: Core Objective 10 Patient Electronic Access Access When a patient possesses all of the necessary information needed to view, download, or transmit their information. This could include providing patients with instructions on how to access their health information, the website address they must visit for online access, a unique and registered username or password, instructions on how to create a login, or any other instructions, tools, or materials that patients need in order to view, download, or transmit their information. View The patient (or authorized representative) accessing their health information online. Transmission Any means of electronic transmission according to any transport standard(s) (SMTP, FTP, REST, SOAP, etc.). However, the relocation of physical electronic media (for example, USB, CD) does not qualify as transmission although the movement of the information from online to the physical electronic media will be a download. Business Days Business days are defined as Monday through Friday excluding federal or state holidays on which the EP or their respective administrative staffs are unavailable. Diagnostic Test Results All data needed to diagnose and treat disease. Examples include, but are not limited to, blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, and pulmonary function tests. 74

75 Objective: Core Objective 10 Patient Electronic Access Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. Measure: Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information, with the ability to view, download, and transmit to a third party. Measure 2: More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information. Exclusion: Any EP who: (1) Neither orders nor creates any of the information listed for inclusion as part of both measures, except for "Patient name" and "Provider's name and office contact information, may exclude both measures. (2) Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude only the second measure. 75

76 Additional Information: Core Objective 10 Patient Electronic Access The following information must be made available online: Patient name, provider's name and office contact information, current and past problem list, procedures. laboratory test results, current medication list and medication history, current medication allergy list and medication allergy history, vital signs (height, weight, blood pressure, BMI, growth charts), smoking status, demographic information (preferred language, sex, race, ethnicity, date of birth), care plan field(s), including goals and instructions, and any known care team members including the primary care provider (PCP) of record unless the information is not available in certified EHR technology (CEHRT), is restricted from disclosure due to any federal, state or local law regarding the privacy of a person s health information, including variations due to the age of the patient or the provider believes that substantial harm may arise from disclosing particular health information in this manner. Replaces the Stage 1 core objective for EPs of "Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request" and the Stage 1 menu objective for EPs of "Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP." Both of the measures for this objective must be met using CEHRT. 76

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79 Definitions: Core Objective 11 Clinical Summaries Clinical Summary An after-visit summary that provides a patient with relevant and actionable information and instructions containing in no particular order: Patient name. Date and location of the visit. Current problem list. Current medication allergy list. Laboratory test results. Clinical instructions. Referrals to other providers. Smoking status. Provider's name and office contact information. Reason for the office visit. Current medication list. Procedures performed during the visit. List of diagnostic tests pending. Future appointments. Future scheduled tests. Recommended patient decision aids (if applicable to the visit). Care plan field(s), including goals and instructions. Demographic information maintained within certified electronic health record technology (CEHRT) (sex, race, ethnicity, date of birth, preferred language). Immunizations or medications administered during the visit. Vital signs taken during the visit (or other recent vital signs). 79

80 Definitions Continued: Core Objective 11 Clinical Summaries Office Visit Office visits include separate, billable encounters that result from evaluation and management services provided to the patient and include: (1) Concurrent care or transfer of care visits, (2) Consultant visits, or (3) Prolonged Physician Service without Direct (Face-To-Face) Patient Contact (tele-health). A consultant visit occurs when a provider is asked to render an expert opinion/service for a specific condition or problem by a referring provider. Objective: Provide clinical summaries for patients for each office visit. Measure: Clinical summaries provided to patients or patient-authorized representatives within one business day for more than 50 percent of office visits. Exclusion: Any EP who has no office visits during the EHR reporting period. 80

81 Additional Information: Core Objective 11 Clinical Summaries The provision of the clinical summary is limited to the information contained within CEHRT. The clinical summary can be provided through a PHR, patient portal on the web site, secure , electronic media such as CD or USB fob, or printed copy. If the EP chooses an electronic media, they would be required to provide the patient a paper copy upon request. They may also default to providing paper copies, in which case an electronic form of the EP s choice would need to be provided upon request. Providers may not charge patients a fee to provide this information. When a patient visit lasts several days or a patient is seen by multiple EPs, a single clinical summary at the end of the visit should be counted only once in both the numerator and denominator. In the event that a clinical summary is offered to and subsequently declined by the patient, that patient may still be included in the numerator of the measure. In circumstances where there is no information available to populate one or more of the fields previously listed, either because the EP can be excluded from recording such information (for example, vital signs) or because there is no information to record (for example, no medication allergies or laboratory tests), an indication that the information is not available in the clinical summary would meet the measure of this objective. 81

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84 Core Objective 12 Patient-Specific Education Resources Definitions: Patient-Specific Education Resources identified by Certified EHR Technology Resources or a topic area of resources identified through logic built into certified EHR technology which evaluates information about the patient and suggests education resources that would be of value to the patient. Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Objective: Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. Measure: Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period. Exclusion: Any EP who has no office visits during the EHR reporting period. 84

85 Core Objective 12 Patient-Specific Education Resources Additional Information: Unique patients with office visits means that to count in the denominator a patient must be seen by the EP for one or more office visits during the EHR reporting period, but if a patient seen by the EP more than once during the EHR reporting period, the patient only counts once in the denominator. Education resources or materials do not have to be stored within or generated by the certified EHR. However, the provider should utilize certified EHR technology (CEHRT) in a manner where the technology suggests patient-specific educational resources based on the information stored in the CEHRT. The provider can make a final decision on whether the education resource is useful and relevant to a specific patient. While CEHRT must be used to identify patient-specific education resources, these resources or materials do not have to be stored within or generated by the CEHRT. Certified EHR technology is certified to use the patient's problem list, medication list, or laboratory test results to identify the patient-specific educational resources. The EP may use these elements or additional elements within CEHRT to identify educational resources specific to patients' needs. The EP can then provide these educational resources to patients in a useful format for the patient (such as, electronic copy, printed copy, electronic link to source materials, through a patient portal or PHR). If resources or topic area of resources are not identified by CEHRT and provided to the patient then it will not count in the numerator. The education resources will need to be provided prior to the calculation and subsequent attestation to meaningful use. 85

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88 Definitions: Core Objective 13 Use Secure Electronic Messaging Secure Message Any electronic communication between a provider and patient that ensures only those parties can access the communication. This electronic message could be or the electronic messaging function of a PHR, an online patient portal, or any other electronic means. Objective: Use secure electronic messaging to communicate with patients on relevant health information. Measure: A secure message was sent using the electronic messaging function of CEHRT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period. Exclusion: Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. 88

89 Core Objective 13 Use Secure Electronic Messaging Attestation Requirements: DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: The number of patients or patient-authorized representatives in the denominator who send a secure electronic message to the EP that is received using the electronic messaging function of CEHRT during the EHR reporting period. THRESHOLD: The resulting percentage must be more than 5 percent in order for an EP to meet this measure. EXCLUSION: Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. Additional Information: There is not an expectation that the EP must personally respond to electronic messages to the patient. 89

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92 Definitions: Core Objective 14 Medication Reconciliation Medication Reconciliation The process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider. Relevant Encounter An encounter during which the EP performs a medication reconciliation due to new medication or long gaps in time between patient encounters or for other reasons determined appropriate by the EP. Essentially an encounter is relevant if the EP judges it to be so. (Note: Relevant encounters are not included in the numerator and denominator of the measure for this objective.) Transition of Care The movement of a patient from one clinical setting (inpatient, outpatient, physician office, home health, rehab, long-term care facility, etc.) to another or from one EP to another. At a minimum, transitions of care include first encounters with a new patient and encounters with existing patients where a summary of care record (of any type) is provided to the receiving provider. The summary of care record can be provided either by the patient or by the referring/transiting provider or institution. Objective: 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. Measure: The EP who performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period. 92

93 Core Objective 14 Medication Reconciliation Additional Information: Only patients whose records are maintained using certified EHR technology must be included in the denominator for transitions of care. In the case of reconciliation following transition of care, the receiving EP should conduct the medication reconciliation. The electronic exchange of information is not a requirement for medication reconciliation. The measure of this objective does not dictate what information must be included in medication reconciliation. Information included in the process of medication reconciliation is appropriately determined by the provider and patient. 93

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99 Definitions: Core Objective 15 Summary of Care Transition of Care 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. At a minimum this includes all transitions of care and referrals that are ordered by the EP. Summary of Care Record A summary of care record must include the following elements: Patient name Smoking status Reason for referral Procedures Encounter diagnosis Current medication list Immunizations Laboratory test results Current medication allergy list Vital signs (height, weight, blood pressure, BMI). 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. Referring or transitioning provider's name and office contact information (EP only). Current problem list (EPs may also include historical problems at their discretion). 99

100 Definitions Continued: Core Objective 15 Summary of Care Problem List At a minimum a list of current, active and historical diagnoses. We do not limit the EP to just including diagnoses on the problem list. Active/current medication list A list of medications that a given patient is currently taking. Active/current medication allergy list A list of medications to which a given patient has known allergies. Allergy An exaggerated immune response or reaction to substances that are generally not harmful. Care Plan The structure used to define the management actions for the various conditions, problems, or issues. A care plan must include at a minimum the following components: problem (the focus of the care plan), goal (the target outcome) and any instructions that the provider has given to the patient. A goal is a defined target or measure to be achieved in the process of patient care (an expected outcome). 100

101 Core Objective 15 Summary of Care Objective: The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. Measure: EPs must satisfy both of the following measures in order to meet the objective: Measure 1: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. Measure 2: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent 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 a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN. Measure 3: An EP must satisfy one of the 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 45 CFR (b)(2). Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period. Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from all three measures. 101

102 Additional Information: Core Objective 15 Summary of Care Only patients whose records are maintained using certified EHR technology must be included in the denominator for transitions of care. The EP that transfers or refers the patient to another setting of care or provider should provide the summary of care document. It is for this provider that has the most recent information on the patient that may be crucial to the provider to whom the patient is transferred or referred. The EP can send an electronic or paper copy of the summary care record directly to the next provider or can provide it to the patient to deliver to the next provider, if the patient can reasonably expected to do so and meet Measure 1. If the provider to whom the referral is made or to whom the patient is transitioned to has access to the medical record maintained by the referring provider then the summary of care record would not need to be provided, and that patient must not be included in the denominator for transitions of care. To count in the numerator of any measure, the EP must verify these three fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information known by the EP or hospital as of the time of generating the summary of care document. To count in the numerator of measure 2, the summary of care record must be received by the provider to whom the sending provider is referring or transferring the patient. 102

103 Additional Information: Core Objective 15 Summary of Care To count in the numerator of measure 2, one of the following three transmission approaches must be used: Use of the transport standard capability required for certification. As required by ONC to meet the CEHRT definition, every EP, eligible hospital, and CAH, must have EHR technology that is capable of electronically transmitting a summary care record for transitions of care and referrals according to the primary Direct Project specification (the Applicability Statement for Secure Health Transport). Thus, EPs, eligible hospitals, or CAHs that electronically transmit summary care records using their CEHRT s Direct capability (natively or combined with an intermediary) would be able to count all such electronic transmissions in their numerator. Use of the SOAP-based optional transport standard capability permitted for certification. As part of certification, ONC permits EHR technology developers to voluntarily seek certification for their EHR technology s capability to perform SOAP-based electronic transmissions. EHR technology developers who take this approach would enable their customers to also use this approach to meet the measure. Thus, EPs, eligible hospitals, or CAHs that electronically transmit summary care records using their CEHRT s SOAP-based capability (natively or combined with an intermediary) would be able to count all of those transmissions in their numerator. Use of CEHRT to create a summary care record in accordance with the required standard (i.e., Consolidated CDA as specified in 45 CFR (b)(2)), and the electronic transmission is accomplished through the use of an ehealth Exchange participant who enables the electronic transmission of the summary care record to its intended recipient. Thus, EPs, eligible hospitals, or CAHs who create standardized summary care records using their CEHRT and then use an ehealth Exchange participant to electronically transmit the summary care record would be able to count all of those transmissions in their numerator. 103

104 Core Objective 15 Summary of Care CMS 2014 Flexibility Rule Limited Exception: The Flexibility Rule allows providers who cannot meet the Stage 2 Summary of Care measures to attest to Stage 1 Meaningful Use using the 2014 Edition criteria if the following applies. Provider cannot meet the Stage 2 Summary of Care Measures due to the recipient Summary of Care transmittal being impacted by a 2014 CEHRT issue. The sending provider may experience significant difficulty meeting the 10% threshold for electronic transmissions, despite the referring provider s ability to send the electronic document if the intermediary or recipient of the transmission or referral is experiencing delays in the ability to fully implement 2014 Edition CEHRT. The Referring Provider under this circumstance may attest to the 2014 Stage 1 Objectives and Measures for the EHR Reporting Period in The Referring Provider must retain documentation demonstrating that s/he was unable to meet the 10% threshold to Provide and Electronic Summary of Care document for a Transition or Referral because the Intermediary or Recipient of the Transmission or Referral is experiencing delays in the ability to Fully Implement 2014 Edition CEHRT. 104

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109 Core Objective 16 Immunization Registries Data Submission Objective: Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or immunization information system for the entire EHR reporting period. Exclusions: Any EP that meets one or more of the following criteria may be excluded from this objective: (1) the EP does not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction's immunization registry or immunization information system during the EHR reporting period; (2) the EP operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for CEHRT at the start of their EHR reporting period; (3) the EP operates in a jurisdiction where no immunization registry or immunization information system provides information timely on capability to receive immunization data; or (4) the EP operates in a jurisdiction for which no immunization registry or immunization information system that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs. 109

110 Core Objective 16 Immunization Registries Data Submission Additional Information: The second exclusion does not apply if an entity designated by the immunization registry or immunization information system can receive electronic immunization data submissions. For example, if the immunization registry cannot accept the data directly or in the standards required by CEHRT, but if it has designated a Health Information Exchange to do so on their behalf and the Health Information Exchange is capable of accepting the information in the standards required by CEHRT, the provider could not claim the second exclusion. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (f)(1) and (f)(2). However, if EPs prior to CY 2014 have achieved successful ongoing submission using EHR technology certified to the 2011 Edition EHR certification criteria (HL only), it is acceptable to continue this ongoing submission and meet the Stage 2 measure for as long as HL continues to be accepted by the immunizations information system or immunization registry. 110

111 NOTE: You must attest YES to meet the attestation requirements 111

112 Core Objective 17 Protect Electronic Health Information Objective: Protect electronic health information created or maintained by the certified EHR technology (CEHRT) through the implementation of appropriate technical capabilities. Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR (a)(2)(iv) and 45 CFR (d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs. Exclusion: No exclusion. 112

113 Core Objective 17 Protect Electronic Health Information Additional Information: EPs must conduct or review a security risk analysis of CEHRT including addressing encryption/security of data, and implement updates as necessary at least once prior to the end of the EHR reporting period and attest to that conduct or review. The testing could occur prior to the beginning of the first EHR reporting period. However, a new review would have to occur for each subsequent reporting period. The parameters of the security risk analysis are defined 45 CFR (a)(1) which was created by the HIPAA Security Rule. Meaningful use does not impose new or expanded requirements on the HIPAA Security Rule nor does it require specific use of every certification and standard that is included in certification of EHR technology. More information on the HIPAA Security Rule can be found at 113

114 Core Objective 17 Protect Electronic Health Information Additional Information: An EP who is reporting for a 90-day EHR Reporting Period in 2014 may complete the security risk analysis requirements outside of the this 90-day period as long as it is completed between January 1 st of the EHR reporting year and no later than the date the eligible professional submits the attestation for that reporting period. If the EP attests in the grace period, the security analysis must be performed by December 31, For more information, read the updated FAQ at 114

115 Core Objective 17 Protect Electronic Health Information Attestation Attach Supporting Documentation Providers should attach supporting documentation in the NM State Level Registry at the time of Attestation, including any of the following: Copy of the security risk analysis or subsequent review Letter from provider/practice summarizing results of security risk analysis or subsequent review; note any actions that were taken or will be taken to address any security issues identified Letter from contractor who performed the security risk analysis or subsequent review summarizing results; note any actions that were taken or will be taken to address any security issues identified 115

116 2014 Reporting Requirements Eligible Professionals Meaningful Use 20 Objectives CORE 17 Objectives MENU 3 of 6 Objectives Clinical Quality Measures 9 Objectives 9 CQMs total out of 64 9 adult 9 pediatric Any 9 New Mexico Human Services Department 116

117 NM Medicaid EHR Incentive Payment Program S2 MU for EPs 2014 Menu Objectives 117

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123 On-Boarding Status Attach NM DOH screenshot OR DOH dated within 60 days prior to start of EHR Reporting Period 123

124 Menu Objective 1 Syndromic Surveillance Data Submission Definition: Public Health Agency An entity under the jurisdiction of the U.S. Department of Health and Human Services, tribal organization, State level and/or city/county level administration that serves a public health function. Objective: Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period. Exclusion: Any EP that meets one or more of the following criteria may be excluded from this objective: (1) the EP is not in a category of providers that collect ambulatory syndromic surveillance information on their patients during the EHR reporting period; (2) the EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period; (3) the EP operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; or (4) the EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs. 124

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126 Definition: Menu Objective 2 Electronic Notes Electronic Notes Defined as electronic progress notes. CMS will rely on providers own determinations and guidelines defining when progress notes are necessary to communicate individual patient circumstances and for coordination with previous documentation of patient observations, treatments and/or results in the electronic health record. Objective: Record electronic notes in patient records. Measure:. Enter at least one electronic progress note created, edited and signed by an EP for more than 30 percent of unique patients with at least one office visit during the EHR reporting period. The text of the electronic note must be text searchable and may contain drawings and other content Exclusion: Any EP who has no office visits during the EHR reporting period. 126

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128 Definition: Menu Objective 3 Imaging Results Imaging The description of radiology services from the Stage 2 CPOE objective is the minimum description of imaging. We describe radiologic services as any imaging service that uses electronic product radiation. Electronic product radiation is defined at 21 CFR as: "any ionizing or nonionizing electromagnetic or particulate radiation, or [a]ny sonic, infrasonic, or ultrasonic wave that is emitted from an electronic product as the result of the operation of an electronic circuit in such product." If the provider desires to include other types of imaging services that do not rely on electronic product radiation they may do so as long as the policy is consistent across all patients and for the entire EHR reporting period. Accessible through Either incorporation of the image and accompanying information into CEHRT or an indication in CEHRT that the image and accompanying information are available for a giving patient in another technology and a link to that image and accompanying information. Incorporation of the Image The image and accompanying information is stored by the CEHRT. A Link to the Image and Accompanying Information A link to where the image and accompanying information is stored is available in CEHRT. This link must conform to the certification requirements associated with this objective in the ONC final rule published elsewhere in this issue of the Federal Register. No Access None of the imaging providers used by the EP provide electronic images and any explanation or other accompanying information that are accessible through their CEHRT at the start of the EHR reporting period. 128

129 Objective: Menu Objective 3 Imaging Results Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. Measure: More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT. Exclusion: Any EP who orders less than 100 tests whose result is an image during the EHR reporting period; or any EP who has no access to electronic imaging results at the start of the EHR reporting period. 129

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131 Definition: Menu Objective 4 Family Health History First Degree Relative A family member who shares about 50 percent of their genes with a particular individual in a family. First degree relatives include parents, offspring, and siblings. Objective: Record patient family health history as structured data. Measure:. More than 20 percent of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives. Exclusion: Any EP who has no office visits during the EHR reporting period. 131

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135 Menu Objective 5 Report Cancer Cases Objective: Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period. Exclusion: Any EP that meets at least 1 of the following criteria may be excluded from this objective: (1) The EP does not diagnose or directly treat cancer; (2) The EP operates in a jurisdiction for which no public health agency is capable of receiving electronic cancer case information in the specific standards required for CEHRT at the beginning of their EHR reporting period; (3) The EP operates in a jurisdiction where no PHA provides information timely on capability to receive electronic cancer case information; or (4) The EP operates in a jurisdiction for which no public health agency that is capable of receiving electronic cancer case information in the specific standards required for CEHRT at the beginning of their EHR reporting period can enroll additional EPs. 135

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139 Menu Objective 6 Specialized Registry Objective: Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period. EPs must attest YES to successfully submitting specific case information from CEHRT to a specialized registry for the entire reporting period to meet this measure. Ongoing submission was already achieved for an EHR reporting period in a prior year and continues throughout the current EHR reporting period. Registration with the PHA or other body to whom the information is being submitted of intent to initiate ongoing submission was made by the deadline (within 60 days of the start of the EHR reporting period) and ongoing submission was achieved. Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is still engaged in testing and validation of ongoing electronic submission. Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is awaiting invitation to begin testing and validation. 139

140 Exclusions: Menu Objective 6 Specialized Registry Any EP that meets at least 1 of the following criteria may be excluded from this objective: (1) The EP does not diagnose or directly treat any disease associated with a specialized registry sponsored by a national specialty society for which the EP is eligible, or the public health agencies in their jurisdiction; (2) The EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period; (3) The EP operates in a jurisdiction where no public health agency or national specialty society for which the EP is eligible provides information timely on capability to receive information into their specialized registries; or (4) The EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible that is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period can enroll additional EPs. 140

141 Definition of Terms Menu Objective 6 Specialized Registry Specialized Registry Sponsored by national specialty societies and specialized registries maintained by public health agencies. Additional Information: The specialized registry cannot be duplicative of any of the other registries included in other meaningful use objectives and measures. This means that an EP cannot meet the immunization, syndromic surveillance or cancer objectives and this objective by reporting to the same registry. In determining whether an EP meets the first exclusion, the registries in question are those sponsored by the public health agencies with jurisdiction over the area where the EP practices and national medical societies covering the EP s scope of practice. Attestation: Attach Supporting Documentation: If attesting to a specialized registry sponsored by a national specialty society, attach a letter from the specialty society stating that the data was received by them, that the data was transmitted from the provider s/practice s CEHRT, and on what date the transmission occurred. 141

142 2014 Stage 2 Reporting Requirements Eligible Professionals Meaningful Use 20 Objectives CORE 17 Objectives MENU 3 of 6 Objectives Clinical Quality Measures 9 Objectives 9 CQMs total out of 64 9 adult 9 pediatric Any 9 142

143 NM Medicaid EHR Incentive Payment Program S2 MU for EPs 2014 CQMs 143

144 Clinical Quality Measures Specific to Medical Conditions Help evaluate how a particular medical condition is treated 144

145 4 Components of CQMs Initial Patient Population: The group of patients the performance measure is designed to address. Example: All patients 65 years and older. Denominator: A subset of the initial patient population; in some measures the denominator may be the same as the initial patient population. Example: All patients 65 years and older with diabetes. Numerator: A subset of the denominator for whom a process or outcome of care occurs. Example: Patients who had a diabetic foot exam. Exclusions: The mechanism used to exclude patients from the denominator of a performance measure when a therapy or service would not be appropriate in instances for which the patient otherwise meets the denominator criteria. Example: A patient with bilateral lower extremity amputation is excluded from a measure of foot exams. 145

146 Report on 9 out of 64 CQMs May choose from: 9 CQMs for adult populations; OR 9 CQMs for pediatric populations; OR 9 CQMs total from a list of 64 Data must be reported directly from information generated by CEHRT 9 CQMs should be individually certified by the ONC Report on 9 CQMs with a denominator greater than zero; attach a copy of CEHRT report including CQM data 9 CQMs must be from 3 of 6 NQS key health care policy domains 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population/Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness 146

147 Electronic CQMs are optional for 2014 Skip Import Screen and Click on CQMs 147

148 Electronic CQMs are optional for 2014 Skip Import 148

149 9 Adult Core CQMs 2014 Edition Stage 1 Only 1. Questionnaire (1 of 9): Controlling High Blood Pressure 2. Questionnaire (2 of 9): Use of High-Risk Medications in the Elderly 3. Questionnaire (3 of 9): Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 4. Questionnaire (4 of 9): Use of Imaging Studies for Low Back Pain 5. Questionnaire (5 of 9): Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan 6. Questionnaire (6 of 9): Documentation of Current Medications in the Medical Record 7. Questionnaire (7 of 9): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up 8. Questionnaire (8 of 9): Closing the referral loop: receipt of specialist report 9. Questionnaire (9 of 9): Functional status assessment for complex chronic conditions 149

150 New Mexico Human Services Department 150

151 9 Pediatric Core CQMs 2014 Edition Stage 1 Only 1. Questionnaire (1 of 9): Appropriate Testing for Children with Pharyngitis 2. Questionnaire (2 of 9): Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 3. Questionnaire (3 of 9): Chlamydia Screening for Women 4. Questionnaire (4 of 9): Use of Appropriate Medications for Asthma 5. Questionnaire (5 of 9): Childhood Immunization Status 6. Questionnaire (6 of 9): Appropriate Treatment for Children with Upper Respiratory Infection (URI) 7. Questionnaire (7 of 9): ADHD: Follow-Up Care for Children Prescribed Attention- Deficit/Hyperactivity Disorder (ADHD) Medication 8. Questionnaire (8 of 9): Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan 9. Questionnaire (9 of 9): Children who have dental decay or cavities 151

152 SELECTION ERROR MESSAGES 2014 Edition Stage 1 Only If you select less than 9 CQMs, when you hit Save & Continue, you will get the following error message at the bottom of the selection page: If you select less than 3 domains, when you hit Save & Continue, you will get the following error message at the bottom of the selection page: 152

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162 CMS Links Stage 2 MU Stage 2 MU Guidance/Legislation/EHRIncentivePrograms/Stage_2.html Table: Core & Menu Set Objectives Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Mean ingfulusespecsheet_tablecontents_eps.pdf Core and Menu Set Zip File: at bottom of Stage 2 MU Page 2014 Clinical Quality Measures Page Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeas ures.html 162

163 CMS EHR Final Rules Links EHR Final Rule EHR Stage 2 Final Rule CMS 2014 CEHRT Flexibility Rule - September

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165 Attestation Step 4 in the SLR: Print the attestation agreement. Attestation must be signed and dated by the Eligible Professional (EP). A practice representative or MU/EHR coordinator cannot sign on behalf of the EP. Upload the signed and dated attestation agreement on Step 4. Step 5 in the SLR : Submit the signed and dated agreement electronically. Make a copy of the original agreement for your records for audit purposes. Mail the original signed and dated attestation to the address on the agreement. The Prepayment review process will begin upon receipt of the agreement.. 165

166 Save All Documentation for 6 Years You will be asked to attach during attestation, or later submit, documentation supporting the data from any of the sources used in the Meaningful Use attestation process. It is the responsibility of the individual eligible professional to retain all supporting documents, reports and other information used in the attestation process for a period of six years. This is true even if EPs enrolled in the EHR program through the Group Administrator function or if EPs change practice locations. Work with your EHR vendor to fully understand the capabilities of your certified EHR technology. For example, if you were randomly audited eight months after Meaningful Use attestation, could your certified EHR produce the identical report for the 90-day EHR reporting period you used for Meaningful Use attestation? If not, keep an electronic file copy or a hard copy of the report used for your attestation. 166

167 Group Administrator Webinar Group Administrator is a must use function for any practice or clinic: whose EPs choose to use Group Patient Volume as proxy for the EPs in the group; and/or will have one representative entering data in the NM SLR on behalf of two or more EPs. Group Administrator is the only approved method by the NM Medicaid EHR Incentive Program for someone other than the eligible professional to enter the data for attestation. Contact Idalia.Lechuga-Tena@state.nm.us to schedule a webinar demonstration customized to your practice or clinic;

168 New Mexico Program Contacts Program Registration: Call Option 6, then 2 EHRPROGRAMNM@xerox.com Policy Questions: Staff Manager EHR Incentives Program Phone: ehr.incentives@state.nm.us 168

169 QUESTIONS??? 169

170 THANK YOU! 170