MEETING MEANINGFUL USE IN MICROMD -STAGE TWO- Presented by: Anna Mrvelj EMR Training Specialist

MEETING MEANINGFUL USE IN MICROMD -STAGE TWO- Presented by: Anna Mrvelj EMR Training Specialist 1

Proposed Rule On April 15, 2015 CMS Issued a new proposal rule for the Medicare and Medicaid EHR Incentive Programs. The rule is open for public comment until June 15, 2015 at 5:00PM. 2

Proposed Rule The following is a summary of how the proposed rule will affect Stage Two Meaningful Use in 2015. This is based on our interpretation of the rule. We strongly encourage you to read the proposal in its entirety and to follow and make comments prior to the June 15 th deadline. 3

Proposed Rule Summary This proposed rule would change the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program EHR reporting period in 2015 to a 90-day period aligned with the calendar year, and also would align the EHR reporting period in 2016 with the calendar year. In addition, this proposed rule would modify the patient action measures in the Stage 2 objectives related to patient engagement. Finally, it would streamline the program by removing reporting requirements on measures which have become redundant, duplicative, or topped out through advancements in EHR function and provider performance for Stage 1 and Stage 2 of the Medicare and Medicaid EHR Incentive Programs. 4

Proposed Rule Reporting in 2015 and 2016 2015 Only- Stage 1 providers only may use alternate exclusions and specifications In 2016, all EPs will report on 9 objectives 2 public health measures Modifications to patient action and public health objectives 5

Stage 2 Meaningful Use in 2015 2017 with proposed rule To qualify for Stage 2, a provider must meet: 9 core objectives 1 public health objective (2 measure options) Reporting on Clinical Quality Measures: Beginning in 2014, the reporting of CQMs changed for all providers. All EPs will report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2. In 2014 and beyond, EPs will report on 9 CQMs from a list of 64. There is also a new requirement that the quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains. The 6 NQS domains are: 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 6

Stage 2 Meaningful Use in 2015 2017 with proposed rule For an EHR reporting period in 2015, and for providers demonstrating meaningful use for the first time in 2016, the proposed rule is that providers may Attest to any continuous 90-day period of CQM data during the calendar year through the Medicare EHR Incentive Program registration and attestation site; or Electronically report CQM data using the established methods for electronic reporting. For 2016 and subsequent years, providers beyond their first year of meaningful use may attest to one full calendar year of CQM data or they may electronically report their CQM data using the established methods for electronic reporting outlined in section II.C. of the proposed rule. 7

Stage 2 Meaningful Use in 2015 2017 with proposed rule CORE OBJECTIVES CORE 1 CORE 2 CORE 3 OBJECTIVE MEASURE COMMENTS AND CHANGES WITH PROPOSED RULE Use computerized More than 60% of medication orders, 30% of laboratory provider order entry orders, and 30% of radiology orders created by the EP (CPOE) for medication during the EHR reporting period are recorded using orders CPOE. Generate and Transmit Prescriptions Electronically NOTE: Combined with measure to Implement drug formulary checks Record Patient Demographics NULL Exclusion: Any EP who writes fewer than 100 prescriptions during the reporting period. Any EP who writes fewer than 100 lab orders during the reporting period. Any EP who writes fewer than 100 radiology orders during the EHR reporting period. More than 50% of all permissible prescriptions, or all prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period, OR any EP who 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. More than 80% of all unique patients seen by the EP have demographics recorded as structured data. Represents a patient being seen to qualify to be counted on the report. The new measure is based on the total number of medication, lab, and radiology orders created during the EHR reporting period. Order status change from requested will be relevant. All permissible prescriptions written during the reporting period will be counted. Problem List Entries must be present (either problem list or an indication of no problem) Formulary panel must be activated (box UNCHECKED in user preferences to allow formulary panel to populate) In EMR, record demographics, including Preferred language, Gender, Race, Ethnicity and Date of Birth. MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS 8

Stage 2 Meaningful Use in 2015 2017 with proposed rule CORE 4 Record and Chart Changes in Vital Signs NULL More than 80% of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data. Exclusions: Any EP who: 1. Sees no patients 3 years or older. 2. Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice. 3. Believes that height and weight are relevant to their scope of practice, but BP is not. 4. Believes that blood pressure is relevant to their scope of practice, but height and weight are not. In EMR encounter record and chart changes in vital signs: Patient must have at least one encounter during reporting period with vital signs documented, including height, weight, and BP in accordance with measure requirement Calculate and display BMI on 80% of patients regardless of age. Plot and display growth charts for patients 0 20 years of age, including BMI. Scope of Practice must be set in EMR Manager MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS CORE 5 CORE 6 y/n Smoking Status for Patients 13 years of age and older NULL Use Clinical Decision Support to improve highpriority health conditions. Combined with drug/drug and drug/allergy interaction checking More than 80% of patients 13 years and older recorded has smoking status recorded Exclusion: Any EP who sees no patients 13 years or older. Successful implementation of five Clinical Decision Support Rules and functionality enabled for the entire reporting period for drug drug and drug allergy interaction checks Habit List Entries must be present to represent the smoking status: There are a total of eight statuses to choose from. MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS Patient must have at least one encounter during the reporting period Four of the five interventions must directly correspond with the Clinical Quality Measures practice will be reporting on. 9

Stage 2 Meaningful Use in 2015 2017 with proposed rule CORE 7 Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP. 7a: More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information 7b: More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) will view, download, or transmit to a third party their health information. CHANGE TO: At least one patient seen by the EP during the EHR reporting period (or their authorized representatives) views, downloads, or transmits his or her health information to a third party. Exclusions: Provider who neither orders or creates any of the information listed for inclusion as part of both measures OR If a provider conducts 50% or more of his/her encounters in a county that does not have 50% or more of its housing units with 3 Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period Patient must have at least one encounter during the reporting period to be counted Use of Secure Chart (MicroMD patient portal) required CCR/CCD/CDA must be published to Portal, with patient accessing and either viewing, downloading, or transmitting to a third party Portal updates on Desktop Navigator will be relevant CIN Direct Mail required to transmit CORE 8 Provide Patient with Clinical Summary for Each Visit NULL More than 50% of patients are given a Clinical Summary (Patient Care Plan) within one business day MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS 10

Stage 2 Meaningful Use in 2015 2017 with proposed rule CORE 9 y/n Protect Electronic Health Information Protect electronic health information created or maintained by CEHRT through implementation of appropriate technical capabilities Practice should conduct or review security risk analysis and implement security updates as necessary to correct identified deficiencies CORE 10 Include Lab Test Results in EHR NULL More than 55% of all clinical lab tests ordered by the EP during the HER reporting period whose results are either +/ or numerical format are incorporated in CEHRT as structured data Exclusion: Any EP who orders no lab tests whose results are either in a +/ or numeric format during the EHR reporting period. While MicroMD EMR is only a part of the required security risk analysis, it is important to note that all software security requirements have been demonstrated successfully during the certification process. It is recommended that each practice would validate that each of the items below are reviewed for proper setup in their practice: Authentication: Verifying that the person seeking access to the electronic health information is the one authorized to do so. Access Control: An ability to create, activate and deactivate users as well as to assign access levels within the software Emergency Access: An ability to allow certain users to Break the Glass and obtain access to charts that they would be otherwise restricted from seeing. Automatic Log Off: An automatic function that will terminate an electronic session that has been inactive for a predetermined amount of time. Audit Log: An ability to produce audit logs of access to patient health information. Integrity and Encryption: An ability to encrypt data based on specified standards with assurance that the data has not been altered in the process Patients must have at least one encounter during the reporting period in order to be counted Results must be manually entered as structured data or imported utilizing a lab interface. Scanned results will not be calculated. MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS 11

Stage 2 Meaningful Use in 2015 2017 with proposed rule CORE 11 y/n CORE 12 Generate Lists of Patients by a specific condition. NULL Send reminders to patients for preventative and follow up care NULL Successful generation of one list of patients by a specific condition to use for quality improvement, reduction in disparities, research, and/or outreach. Use EHR to send reminders to more than 10% 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, per patient preference. Exclusion: Any EP who has had no office visits in the 24 months before the EHR reporting period. Report generated from Administrative Panel > Patient Recall MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS MEET CRITERIA AS EITHER REDUNDANT, DUPLICATIVE, OR TOPPED OUT WITH NEW PARTICIPANTS CORE 13 Provide Patient Specific Education Provide patient specific education resources identified by CEHRT for more than 10% 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. Patient must have an encounter during the reporting period to be counted. Can print educational material from within encounter or from chart, as long as patient had an office visit during the reporting period. 12

Stage 2 Meaningful Use in 2015 2017 with proposed rule CORE 14 Medication Reconciliation Between Care Settings Perform medication reconciliation for more than 50% of patients transitioned to the care of the Eligible Provider. Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period. Use of Transition of Care IN is relevant. Use of Import CCR/CCD on Transition of Care In to import data into chart is relevant (Medications, Problem List, and Allergies) CORE 15 Provide Summary of Care for patients transitioned or referred Combined with the following measures: Maintain an up to date Problem list Maintain an up to date Medication list Maintain an up to date Allergy list Core 15a: An EP who transitions or refers their patients to another setting of care or provider should provide a summary of care record for more than 50% of transitions of care and referrals. 15a ONLY NULL Core 15b: The EP who transitions or refers their patients to another setting of care or provider or care provides a summary of care for more than 10% of such transitions or referrals electronically. Exclusion: Any provider who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period. Patient must have at least one completed encounter during reporting period. In MicroMD EMR, Transition of Care OUT will be used to satisfy measure. A Transition of Care (OUT) may be created on the desktop or in patient s Workflow Communicator. Additionally, Referrals Orders allow users a link to Transition of Care from within the order. 15b requires use of Direct Mail Messaging within the EMR. Surescripts CIN will have relevance. CORE 16 Immunization Registry See Public Health Proposal below 13

Stage 2 Meaningful Use in 2015 2017 with proposed rule CORE 17 Secure Electronic Messaging A secure message was sent using the electronic messaging function of CEHRT by more than 5% of unique patients seen by the EP during the EHR reporting period. PROPOSED CHANGE: During the EHR reporting period, the capability for patients to send and receive a secure electronic message with the provider was fully enabled. Patient Portal (MicroMD Secure Chart) will be required 14

Stage 2 Meaningful Use in 2015 2017 with proposed rule PUBLIC HEALTH OBJECTIVE (2 MEASURE OPTIONS) ALL OTHER MENU ITEMS NOW NULL OBJECTIVE MEASURE COMMENTS AND CHANGES WITH PROPOSED RULE PUBLIC HEALTH OBJECTIVE EPS WOULD BE REQUIRED TO CHOOSE FROM MEASURES 1 THROUGH 5 (BELOW) AND WOULD BE REQUIRED TO SUCCESSFULLY ATTEST TO ANY COMBINATION OF TWO MEASURES: REPORTING MAX 1) IMMUNIZATION REGISTRY MAX 1 2) SYNDROMIC SURVEILLANCE REPORTING MAX 1 3) CASE REPORTING MAX 1 REPORTABLE CONDITIONS AS DEFINED BY STATE, TERRITORIAL AND LOCAL PHA S 4) PUBLIC HEALTH REPORTING MAX 3 SPECIALIZED REGISTRY OTHER THAN CANCER REGISTRY 5) CLINICAL DATA REPORT REGISTRY MAX 3 INFORMATION ABOUT THE HEALTH STATUS OF PATIENT AND HEALDCARE THEY RECEIVE OVER VARYING PERIODS OF TIME (Max=Maximum times measure can count towards objective for EP) Exclusions: 1) The EP is not in a category of providers that collect ambulatory 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 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 data; 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. PUBLIC HEALTH REPORTING OBJECTIVES WITH MULTIPLE OPTIONS. MUST SHOW ACTIVE ENGAGEMENT BY ONE OF THE FOLLOWING: COMPLETED REGISTRATION TO SUBMIT DATA WITHIN 60 DAYS AFTER START OF REPORTING PERIOD TESTING AND VALIDATION THE EP IS IN THE PROCESS OF TESTING AND VALIDATION OF THE ELECTRONIC SUBMISSION OF DATA. PROVIDERS MUST RESPOND TO REQUESTS FROM THE PHA OR, WHERE APPLICABLE, THE CDR WITHIN 30 DAYS; FAILURE TO RESPOND TWICE WITHIN AN EHR REPORTING PERIOD WOULD RESULT IN THAT PROVIDER NOT MEETING THE MEASURE. PRODUCTION STAGE THE EP HAS COMPLETED TESTING AND VALIDATION OF THE ELECTRONIC SUBMISSION AND IS ELECTRONICALLY SUBMITTING PRODUCTION DATA TO THE PHA OR CDR. 15

A look at Stage 3 Meaningful Use For New Participants In 2015, propose allowing providers to attest to an EHR reporting period of any continuous 90-day period within calendar year In 2016, first-time participants may use EHR reporting period of any continuous 90-day period between January 1, 2016 and December 31, 2016 All returning participants must use EHR reporting period of full calendar year (January 1, 2015 through December 31, 2016) In 2017, all providers, both new or existing, must use EHR reporting period of one full calendar year as defined in Stage 3 proposed rule 16

A look at Stage 3 Meaningful Use Objective Measure(s) Retained Stage 2 Objectives with small modification Protect Electronic Health Information: Conduct or review a security risk analysis including addressing the encryption/security of data stored in CEHRT, and implement security updates as necessary and correct identified security deficiencies as part of the EP s risk management process. Electronic Prescribing (erx): More than 80% of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Clinical Decision Support: EP s must satisfy both measures in order to meet the objective: Measure 1: Implement at least 5 CDS interventions tied to clinical quality measures or key high-priority health conditions. Measure 2: Enable and implement the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Computerized Provider Order Entry (CPOE): More than 80% of medication, 60% of laboratory, and 60% of diagnostic imaging orders are recorded using CPOE. EPs must meet all 3 measures. 17

A look at Stage 3 Meaningful Use Objective Measure(s) Patient Electronic Access to Health Information: EPs must satisfy both measures in order to meet the objective. Measure 1: More than 80% of all unique patients seen by the EP or discharged from the hospital during the EHR reporting period are provided access to new information within 24 hours of its availability to the EP, subject to the provider's discretion to withhold certain information. Measure 2: Use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to 35% of patients. 18

A look at Stage 3 Meaningful Use Objective Measure(s) Coordination of Care through Patient Engagement: EPs must attest to 3 measures, but meet 2 out of 3 thresholds: Measure 1: More than 25% of all unique patients (or authorized representatives) under the care of the EP during the EHR reporting period (1) view, (2) download, or(3) transmit to a third party their health information. Or enable Application Program Interface (API) and meet Measure 1 of Patient Electronic Access Objective. Measure 2: EP communicate with patients electronically through secure messaging for 35% of patients encountered during the reporting period. In patient-to-provider communication, provider must respond to patient to receive credit under this objective. Communicate means when a provider sends a message to patients OR when a patient sends a message to the provider and the provider responds. Measure 3: EP must use health information received electronically from a non-physician source for 15% of patients encountered by EP in the reporting period and must use health information received from a patient or from the patient s caregiver for 5% of patients encountered by the EP in the reporting period. 19

A look at Stage 3 Meaningful Use Objective Measure(s) Health Information Exchange: EPs must attest to 3 measures, but meet 2 out of 3 thresholds: Measure 1 The EP that transitions or refers their patient to another setting of care or to another provider of care creates and exchanges an electronic summary of care record for 50% of such transitions of care and referrals. The electronic summary of care must be sent in accordance with the standards for transitions of care set by ONC. Measure 2 The EP must receive, request or query for a patient s electronic summary of care record that has been created by another setting of care or provider of care for 40% of all new patient encounters during the reporting period. The electronic summary of care must be accessed in accordance with the standards for transitions of care set by ONC. Measure 3 Clinical Information Reconciliation (CIR) Providers perform clinical information reconciliation for more than 80% (percent will be the same as Measure 1) of transitions of care in which the patient is transitioned into the care of the EP. Provider may choose to reconcile 2 out of 3 of the following: meds, problems, and allergies. 20

A look at Stage 3 Meaningful Use Objective Measure(s) Public Health Reporting Providers must report data on an ongoing basis to established public health registries. Immunization, syndromic surveillance, ELR, specialized (PDMP, cancer, etc.) EP Objective: Report 3 measures from #1-5 Measure 1-Immunization Registry Reporting Measure 2- Syndromic Surveillance Reporting Measure 3- Case Reporting Measure 4- Public Health Registry Reporting* Measure 5- Clinical Data Registry Reporting** *Providers may choose to report to more than one public health registry to meet the number of measures. *Providers may choose to report to more than one clinical data registry to meet the number of measures required to meet the objective. 21

2015 Clinical Quality Measure Calculations Manual. This helpful reference manual can be found by going to the lounge at www.micromd.com http://www.micromd.net/documentation/ Meaningful%20Use/Clinical%20Quality% 20Measure%20Calculations%202015%20 MicroMD%2010.0-1.pdf 22

23

CMS Website For specific details regarding the incentive programs, such as registration, attestation processes, MU requirements and EMR certification, visit the CMS EHR Incentive Program website: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/i ndex.html?redirect=/ehrincentiveprograms/ 24

Federal Registry For information on the proposed rule initiated 4/10/15 Modifications to Meaningful Use in 2015 through 2017: https://www.federalregister.gov/articles/2015/04 /15/2015-08514/medicare-and-medicaidprograms-electronic-health-record-incentiveprogram-modifications-to 25

THANK YOU FOR YOUR KIND ATTENTION! 26