The CLINICAL LABORATORY and Meaningful Use Stage 2. Clinical Lab Test Results and Reportable Lab Results March 2014

Transcription

1 The CLINICAL LABORATORY and Meaningful Use Stage 2 Clinical Lab Test Results and Reportable Lab Results March 2014

2 Presenters Karen Romancito & Leslie White National RPMS Lab Consultants Office of Information Technology Indian Health Service 2

3 Objectives for Laboratory Review EHR and MU requirements. Recognize changes in Clinical Indication (SNOMED codes). Review different displays of Microbiology Interim reports. 3

4 How Did We Get Here? ONC: The Office of the National Coordinator for Health Information Technology issued the Interim Final Rule. This rule calls for our industry to standardize the way in which EHR information is exchanged between organizations, and sets forth criteria required for an EHR technology to be certified. ONC = do this and you will be certified. CMS: The Centers for Medicare and Medicaid Services define and specify the objectives for meeting Meaningful Use (MU) of EHR technology. CMS = how to do this and here are the objectives. 4

5 Important Terms EP - Eligible Professional Provider EH - Eligible Hospital CAH- Critical Access Hospitals CEHRT Certified Electronic Health Record Technology 5

6 Certification Requirements for Lab - Stage 1 Menu Set Measures: Clinical Lab Test Results (EP/EH): More than 40 percent of all lab test results ordered by the EP or by an authorized provider of the EH for patients admitted to its inpatient or emergency department during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in CEHRT. Reportable Lab Results (EH): Performed at least one test of CEHRT s capacity to provide electronic submission or reportable lab results to public health agencies and follow up submission if the test is successful. (Yes/No) 6

7 Lab Package Stage 1 Lab Package LR 5.2v Patch 1027 (release 2010) MU1 LOINC codes : LOINC (Logical Observation Identifiers Names and Codes ). A certified EHR is capable of receiving a message with LOINC from lab. The EHR retains & uses the LOINC to populate a patient summary record. This sets the stage for MU Stage 2. MU1 SNOMED Codes: SNOMED (Systematized Nomenclature of Medicine Clinical Terms) will accelerate the adoption and use of clinical decision support used in conjunction with LOINC and other vocabulary standards. 7

8 Ready for Meaningful Use Stage 2 and LABORATORY 8

9 Certification Requirements for Lab Stage 2 Core Objective & Measure: CPOE (a)(1) standard - Computerized provider order entry 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. Definition of terms: Laboratory Order Order for any service provided by a laboratory that could not be provided by a non-laboratory. 9

10 Stage 2 Core Objective & Measure: CPOE Objective (EP/EH): 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 (EP/EH): More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP or authorized providers of the EH s/cah s inpatient or emergency department during the EHR reporting period are recorded using CPOE. Exclusion (EP): Any EP who writes fewer than 100 medication, radiology, or laboratory orders during the EHR reporting period. 10

11 Stage 2 Attestation Requirement CPOE Measure: Laboratory DENOMINATOR: Number of laboratory orders created by the EP or authorized providers in the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period. NUMERATOR: The number of orders in the denominator recorded using CPOE. THRESHOLD: The resulting percentage must be more than 30 percent in order for an EP, eligible hospital or CAH to meet this measure. EXCLUSION: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period. 11

12 Certification Requirements for Lab Stage 2 Core Objective & Measure: LRI (b)(5)(A) standard Incorporate laboratory tests and values/results Objective (EP/EH): Incorporate clinical lab-test results into certified EHR technology (Certified EHR Technology) as structured data. Comparing to Stage 1 for Clinical Lab Test Results Clinical Lab Test Results (EP/EH): More than 40 percent of all lab test results ordered by the EP or by an authorized provider of the EH for patients admitted to its inpatient or emergency department during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in CEHRT. 12

13 Stage 2 Core Objective & Measure: LRI Measure (EP/EH): More than 55 percent of all clinical lab tests results ordered by the EP or authorized providers of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period whose results are either in a positive/negative affirmation or numerical format are incorporated in Certified EHR Technology as structured data. Exclusion (EP): Any EP who orders no lab tests where results are either in a positive/negative affirmation or numeric format during the EHR reporting period. 13

14 Stage 2 - Attestation Requirements LRI Measure: Laboratory DENOMINATOR (EP/EH): Number of lab tests ordered during the EHR reporting period by the EP or by authorized providers of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) whose results are expressed in a positive or negative affirmation or as a number. NUMERATOR (EP/EH): Number of lab test results which are expressed in a positive or negative affirmation or as a numeric result which are incorporated in CEHRT as structured data. THRESHOLD (EP/EH): The resulting percentage must be more than 55 percent in order for an EP, eligible hospital or CAH to meet this measure. EXCLUSION (EP): Any EP who orders no lab tests where results are either in a positive/negative affirmation or numeric format during the EHR reporting period. 14

15 Certification Requirements for Lab Stage 2 Core Objective & Measure: ELR (f)(4) standard Electronic Reportable Laboratory Results Inpatient setting only transmission of reportable laboratory tests and values/results. EHR technology must be able to electronically create reportable laboratory tests and values/results for electronic transmission in accordance with HL (g), SNOMED (a)(3), and LOINC (c )(2) standards. Definition of Terms: 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. Public Health Agency = IHS Division of Epidemiology and Disease Prevention 15

16 Stage 2 Core Objective & Measure: ELR Objective (EH): Capability to submit electronic reportable laboratory results to public health agencies, where except where prohibited, and in accordance with applicable law and practice. Measure (EH): Successful ongoing submission of electronic reportable laboratory results from Certified EHR Technology to a public health agency for the entire EHR reporting period. Exclusion (EH): Any eligible hospital or CAH that meets one or more of the following criteria: A. Operates in a jurisdiction for which no public health agency is capable of receiving electronic reportable laboratory results in the specific standards required for Certified EHR Technology at the start of their EHR reporting period. B. Operates in a jurisdiction for which no public health agency provides information timely on capability to receive electronic reportable laboratory results. C. Operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by Certified EHR Technology at the start of their EHR reporting period can enroll additional eligible hospitals or CAHs. 16

17 Stage 2 Measure ELR Attestation Requirements YES/NO Eligible hospitals or CAHS Additional Information In determining whether the public health agency has the capacity, CMS anticipates developing a centralized repository for this information, including a deadline for the public health agency to submit information. If the public health agency fails to provide information to this centralized repository by the deadline, the provider could claim the exclusion. In the event, that we are unable to develop a centralized repository, providers will make the determination of public health agency capacity by working directly with the public health agency as in currently the case for Stage 1 of meaningful use. 17

18 Lab Reporting submit electronic reportable laboratory results to public health agencies Install PCC Reports (APCL) Version 3.0 Patch 27. Regular data exports sent to the IHS Division of Epidemiology and Disease Prevention (DEDP) (Sites) Sign up to receive an export file receipt notification. A copy of the confirmation export file receipt will serve as the attestation of this measure for MU. 18

19 Lab Patch Meaningful Use Stage 2 Lab Package LR 5.2v Patch 1033 (Release May 2014) 19

20 End Users What will Lab see in RPMS with the MU2 Patch? 1. SNOMED Code Clinical Indication entry Multipurpose Accessioning Add tests to a given Accession 2. Microbiology Reporting Format options 3. The BLRTASKS routine has been modified and a new option (BLRSCRNTASKS) has been created so that a user can select the option and interactively determine if the main RPMS Lab tasks have been tasked. 20

21 End Users What will Lab see in RPMS with the MU2 Patch? LAB MENU Select item #2 Accession Multipurpose Accessioning Keystrokes 21

22 What will Lab see with the MU2 Patch? POV entry is free text (No Codes/Numbers) text opens BLR SNOMED SELECT S for Select (appropriate SNOMED code) and indicate corresponding number left of SNOMED (1-16) If not displayed, enter key for Next Screen for additional SNOMED codes. 22

23 What will Lab see with MU2 Patch? Lab testing scenario: a test (reflex) is added to the original testing accession number. SNOMED code entry is required for add on test. For each test/panel added- Free Text opens BLR SNOMED SELECT. Previously utilized SNOMED Code is used for Add On test. 23

24 What will Lab see with the MU2 Patch? What staff need to know when adding a test accession but realize the addition is an error. Next Screen will prompt user to Create New Listing An ^ and/or Y(es) will delete the incorrect addition. 24

25 Additional Microbiology Reporting Option LAB (LB) > BLR > IHSM (IHS Lab Micro Report) 25

26 Additional Microbiology Reporting Option LAB(LB) > BLR > LRAS (Accession IHS Lab Micro Report) 26

27 LAB shortcut to the BLRSCRNTASK LAB (LB) > BLR > LABT This Report is NOT designed to be printed, but does provide the lab with the ability to show crucial lab tasks TASKMAN statuses. 27

28 Next Display how the new Clinical Indication will appear in the EHR. 28

29 Creating a Lab Order using EHR (Patient, Visit, Location Selected) 29

30 No Active Problem List Found 30

31 Creating a Lab Order for a Patient with an Active Problem List 31

32 Sample of the Lab Order Accessioned in the Lab Package in RPMS 32

33 QUESTIONS AND DISCUSSION 33