Stage 1 Meaningful Use for Specialists. NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene

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1 Stage 1 Meaningful Use for Specialists NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene 1

2 Today s Agenda Meaningful Use Overview Meaningful Use Measures Resources Primary Care Information Project 2

3 Overview of Meaningful Use The American Recovery and Reinvestment Act (ARRA) authorizes CMS to offer financial incentives to physician & hospital providers who demonstrate meaningful use of an electronic health record (EHR). Meaningful Use is using a certified EHR technology to: 1) Improve quality, safety, efficiency, and reduce health disparities 2) Engage patients and families in their care 3) Improve care coordination 4) Improve population and public health 5) All the while maintaining privacy & security 3

4 Meaningful Use Stages Each stage gets progressively harder to drive toward the ultimate goal Three Stages of Meaningful Use Improved quality of care Stage 3 Stage 2 Stage 1 4

5 Meaningful Use Eligibility 5

6 Today s Agenda Meaningful Use Overview Meaningful Use Measures Resources Primary Care Information Project 6

7 Overview of Stage 1 Meaningful Use Measures Meaningful Use Objective Measures are divided into 3 sets: 1. Core: has 13 measures; must do all Clinical Quality Measures: must report 3 core/alternate and 3 specialty 3. Menu: has 10 measures; must choose 5, at least 1 public health measure **Specialists working in Multiple Practices: MU Data for measures should be added together 7

8 Stage 1 Meaningful Use Objectives 13 Core Measures 6 Clinical Quality Measures* 5 Menu Measures Stage 1 Meaningful Use * CQM requirement for

9 Stage 1 Meaningful Use CORE Measures 13 Core Measures 6 Clinical Quality Measures 5 Menu Measures Stage 1 Meaningful Use Must meet 13 out of 13 9

10 Core Measures All providers have to either meet or qualify for an exclusion to every core measure Exclusions are not based on specialty, but rather on unique criteria for each exclusion There is no blanket exclusion for any type of EP, specialists must individually evaluate whether they meet the exclusion criteria for each applicable objective 10

11 CORE measures without Exclusions # Objective Measure Threshold Exclusions Core 2 Implement drug-drug and drug-allergy interaction checks. The EP has enabled this functionality for the entire EHR reporting period. Yes/No No Exclusions Core 3 Maintain an up-to-date problem list of current and active diagnoses. Unique patients seen by the EP that have at least one entry or indication that no problems are known for the patient recorded as structured data. 80% No Exclusion Core 5 Maintain active medication list. Unique patients seen by the EP that have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. 80% No Exclusion Core 6 Maintain active medication allergy list. Unique patients seen by the EP that have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. 80% No Exclusion 11

12 CORE measures without Exclusions # Objective Measure Threshold Exclusions Core 7 Record all of the following demographics: (a) preferred language, (b) gender, (c) race, (d) ethnicity, (e) date of birth. Unique patients seen by the EP that have demographics recorded as structured data. 50% No Exclusions Core 11 Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Implement one clinical decision support rule. Yes/No No Exclusions Core 15 Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of risk management process. Yes/No No Exclusions 12

13 CORE measures with Exclusions # Objective Measure Threshold Exclusions Core 1 Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. Unique patients with at least one medication in their medication list seen by the EP that have at least one medication order entered using CPOE OR 30% Any EP who writes < 100 prescriptions during the EHR reporting period. Number of medication orders created entered using CPOE during the EHR reporting period Core 4 Generate and transmit permissible prescriptions electronically (erx). Permissible prescriptions written by the EP that are transmitted electronically using certified EHR technology 40% Any EP who writes < 100 prescriptions during the EHR reporting period. 13

14 CORE measures with Exclusions # Objective Measure Threshold Exclusions Core 8 Record and chart changes in the following vital signs: (a) height, (b) weight, (c) blood pressure, (d) calculate and display body mass index, (e) plot and display growth charts for children 2-20 years, including BMI. Unique patients age 2 and over seen by the EP, that have height, weight, and blood pressure recorded as structured data. OR Unique patients age 3 and over seen by the EP, that have height, weight, and blood pressure recorded as structured data. 50% Any EP who 1. Sees no patients 2 or 3 years and older 2. Believes that all three vital signs of ht, wt, and bp have no relevance to their scope of practice. 3. Believes that ht and wt are relevant but bp is not, is excluded from recording bp. 4. Believes that bp is relevant to their scope of practice, but ht and wt are not, is excluded from recording ht and wt Core 9 Record smoking status for patients 13 years old or older. Unique patients 13 years old or older seen by the EP that have smoking status recorded as structured data. 50% Any EP who sees no patients 13 years or older. 14

15 CORE measures with Exclusions # Objective Measure Threshold Exclusions Core 12 Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication list, medication allergies) upon request. Patients who request an electronic copy of their health information that are provided it within3 business days. 50% Any EP that has no requests from patients or their agents for an electronic copy of patient health information during EHR reporting period. Core 13 Provide clinical summaries for patients for each office visit. Clinical summaries provided to patients with office visits within 3 business days. 50% Any EP who has no office visits during the EHR reporting period. 15

16 Stage 1 Meaningful Use Clinical Quality Measures 13 Core Measures 6 Clinical Quality Measures* 5 Menu Measures Stage 1 Meaningful Use Must report 3 core/alt and 3 specialty for

17 Clinical Quality Measures All providers must report on clinical quality measures (CQMs) in order to demonstrate meaningful use. Specialists are not excluded from this requirement CMS suggests that specialists pick quality measures that are relevant to their practices and clinical workflow If none of the CQMs are applicable to the provider's scope of practice, the EHR should generate zero values Zeros are an acceptable value for the CQM denominator, numerator, and exclusion fields during attestation Starting 2014, all providers are required to report 9 out of 64 total CQMs Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html 17

18 Clinical Quality Measures - must report 3 Core Measures Alternate Core Measures 18

19 Specialty Clinical Quality Measures must report 3 of 38 Diabetes 0055 Diabetes: Eye Exam 0056 Diabetes: Foot Exam 0059 Diabetes Control: Hemoglobin A1c >9.0% 0061 Diabetes: Controlling High Blood Pressure 0064 Diabetes: LDL Management & Control 0088 Diabetic Retinopathy: Macular Edema 0089 Diabetes Management: Retinopathy Screening 0575 Diabetes Control: Hemoglobin A1c <8.0% Prevention 0012 Prenatal Care: Screening for HIV 0014 Prenatal Care: Anti-D Immune Globulin 0031 Breast Cancer Screening 0032 Cervical Cancer Screening 0033 Chlamydia Screening for Women 0034 Colorectal Cancer Screening 0041 Influenza Immunization 0043 Pneumonia Vaccination Status for Older Adults Appropriate Use 0002 Children With Pharyngitis-Appropriate Testing 0052 Low Back Pain: Use of Imaging Studies 0389 Prostrate Cancer: Avoidance of Overuse of Bone Scan for Low Risk Patients Dependence 0004 Alcohol and Drug Dependence Cardiovascular 0013 Hypertension: Blood Pressure Measurement 0067 Antiplatelet Therapy 0070 Coronary Artery Disease: Beta Blocker Therapy Post Myocardial Infarction 0074 Coronary Artery Disease: Lipid Lowering Therapy 0081 Heart Failure: ACE/ ARB Therapy For LVSD (LVEF <40%) 0083 Heart Failure: Beta Blocker for LVSD 0084 Heart Failure: Warfarin Therapy 0068 Ischemic Vascular Disease: Aspirin or other Anti-thrombotic 0075 IVD: Complete Lipid Panel and LDL Control 0073 Blood Pressure Management: Ischemic Vascular Disease Asthma 0001 Asthma Assessment 0036 Use of Appropriate Medications for Asthma 0047 Asthma- Pharmacologic Therapy Tobacco 0027 Tobacco Use Cessation 0028 Preventive Care: Tobacco Use Assessment and Cessation Depression 0105 Anti-Depression Management Oncology 0387 Hormonal Therapy for Stage IC-IIIC Estrogen Receptor / Progesterone Receptor (ER/PR) Positive Breast Cancer 0385 Chemotherapy for Stage III Colon Cancer Patients 19

20 Stage 1 Meaningful Use MENU Measures 13 Core Measures 6 Clinical Quality Measures 5 Menu Measures Stage 1 Meaningful Use 1 of 5 must be a Public Health Measure 20

21 Menu Measures If the specialist qualifies for all of the exclusions for each of the menu objectives, then select any five menu objectives during attestation and claim the exclusion for each If specialists do not qualify for all of the exclusions to the menu objectives, they should select ones they can report 21

22 Public Health Measures # Objective Measure Threshold Exclusions Menu 9 Capability to submit electronic data to immunization registries or immunization information systems. Perform at least one test of certified EHR technology s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically) Yes/No Any EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically. Menu 10 Capability to submit electronic syndromic surveillance data to public health agencies. Perform at least one test of certified EHR technology s capacity to provide electronic syndromic surveillance data to public health agencies and follow up submission if the test is successful (unless none of the public health agencies to which the EP submits such information has the capacity to receive the information electronically). Yes/No No public health agencies to which the EP submits such information has the capacity to receive the information electronically. 22

23 System Capabilities # Objective Measure Threshold Exclusions Menu 1 Implement drug formulary checks. The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period. Yes/No Any EP who writes fewer than 100 prescriptions during the EHR reporting period. Menu 3 Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Generate at least one report listing patients of the EP with a specific condition. Yes/No No Exclusions 23

24 Collect Structured Data # Objective Measure Threshold Exclusions Menu 2 Incorporate clinical lab test results into EHR as structured data. Clinical lab test results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format that are incorporated in certified EHR technology as structured data. 40% An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period. 24

25 Patient Engagement # Objective Measure Threshold Exclusions Menu 6 Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. Unique patients seen by the EP that are provided patientspecific education resources. 10% No Exclusions Menu 4 Send patient reminders per patient preference for preventive/follow-up care Patients 65 years or older or 5 years or younger that were sent an appropriate reminder during EHR reporting period. 20% Any EP who has no patients 65 years or older or 5 years or younger with records maintained using certified EHR technology. Menu 5 Provide patients with timely electronic access to their health information (including lab results, problem list, medication list, and allergies) within 4 business days of the information being available to the EP. Unique patients seen by the EP that are provided timely electronic access to their health information subject to the EP s discretion to withhold certain information. 10% Any EP that neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list during the EHR reporting period. 25

26 Care Coordination # Objective Measure Threshold Exclusions Menu 7 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. EP performs medication reconciliation for transitions of care in which the patient is transitioned into the care of the EP. 50% An EP who was not the recipient of any transitions of care during the EHR reporting period. Menu 8 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. The EP who transitions or refers their patient to another setting of care or provider of care that provides a summary of care record for those transitions of care and referrals. 50% An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period. 26

27 Meaningful Use is a Team Sport 27

28 Example of MU workflow 28

29 Today s Agenda Meaningful Use Overview Meaningful Use Measures Resources Primary Care Information Project 29

30 Resources Contact your Clinical Quality Specialist NYC REACH Resource Library Primary Care Information Project 30

31 Additional Resources CMS: Cardiology: Cardiosource.org Health IT Resources (from American College of Cardiology; includes information on EHRs and MU) ARRA Health IT Provisions - Frequently Asked Questions (from American College of Cardiology) Surgery: What surgeons should know about Meaningful Use of electronic health records (PDF from American College of Surgeons) Dermatology: Understanding meaningful use (fact sheet from American Academy of Dermatology) Pediatrics: Meaningful Use Overview - Child Health Informatics Center (resource from American Academy of Pediatrics) Radiology: 10 Steps to Meaningful Use (resource from American College of Radiology) 31

32 Thank You, From the PCIP & NYC REACH Teams 32