EHR Meaningful Use 2014 (Stage 1 & 2) DR Reporting Strategies

EHR Meaningful Use 2014 (Stage 1 & 2) DR Reporting Strategies International MUSE Conference 2013 Educational Session: #1179 Date: Friday May 31 at 3:30 pm Presenter: Glen D Abate

Session Agenda CMS EHR Incentive Program specification versions Issues facing fiscal 2014, Stage 1 attestations (yes, for those who have not yet attested twice, the Stage 1 specifications have changed significantly) Sort discussion of MEDITECH Best Practices in 2014 Overview of what is carried forward and what changed from Stage 1 and what is new in Stage 2 Review of new core objectives and how to achieve them with new MEDITECH functionality Identify and discuss the significant changes to existing core objectives and menu set objectives that are now core objectives Review of new menu set objectives Discuss notable changes and additions to clinical quality measures Review of value sets standard and how they are handled in the MEDITECH environment

Who Can Benefit from the Topics in this Presentation? All EH, CAH that plan to participate in the Medicare and Medicaid CMS EHR incentive program Healthcare organizations who plan to implement and attest with the MEDITECH certified SQL scripts on their own Healthcare organizations who plan to implement the MEDITECH certified scripts with assistance from a vendor Healthcare organizations who plan to use a third party application to attest Anyone who is interested in assuring EHR Meaningful Use Performance measures are accurately extracted from their MEDITECH Data Repository application (regardless of methodology)

Where Does Stage 2 Documentation Live? http://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/stage_2.html Primary Resources CMS Web Site MEDITECH Web site MEDITECH Applications MEDITECH DR

Versions are Year-Based, not Stage-Based 2011 Specs 2014 Specs Do not confuse 2014 specification version with Stage 2

For EH and CAHs Attesting for Stage 1 in 2014 Use of 90 day period for initial or second Stage 1 attestation Changes to the EH Stage 1 meaningful use objectives effective Oct. 1, 2013 Will longer be permitted to count an exclusion toward the minimum of 5 menu objectives CPOE (CM-1) denominator can be count of patients or by orders Changes to age criteria for BP, height & weight for vital signs (CM-7) Electronic exchange of key clinical information will no longer be required for Stage 1 (MSM-9) Clinical quality measures as a core measure (CM-9) is removed because it was originally put in place by the CMS dept. of redundancy dept. Patient access core objectives (CM-11, provide patients with an electronic copy of their health information; CM-12, provide patients with an electronic copy of their discharge instructions) are replaced with CM-6 objective provide patients the ability to view online, download and transmit information about a hospital admission Clinical quality measures will be reported using the new 2014 criteria

What s new with Stage 2? Stage 2 retains the core and menu structure for meaningful use objectives Some Stage 1 objectives were combined or eliminated Most of the Stage 1 objectives are now core objectives under the Stage 2 criteria For many of these objectives, the threshold that EH and CAH must meet for the objective has been raised New objectives are also introduced for Stage 2, mostly as menu set objectives Many of the Stage 2 objectives have exclusions that allow EH and CAH to achieve meaningful use without having to meet objectives outside of their normal scope of clinical practice (examples: eliminate CPOE for providers with less than 100 orders; no emar requirement if census less than 10, etc.) For Stage 2, 19 total objectives (16 core and 3 menu set) objectives must be met (note, this is the same total as Stage 1) Stage 2 EH and CAH Clinical Quality Measures were expanded from 15 of 15, to 16 of 29

Core / Menu Set Objective Relationship 2011 Specific Menu Set Objectives Example: MSM-3 Incorporate Structured Lab Results in EHR (40% threshold) General Core Objectives Example: CM-13: Capable of Exchanging key Clinical Info with Entities (Y/N self attest) 2014 New Core Objectives Becomes: CM-8 Incorporate Structured Lab Results in EHR (55% threshold) New Menu Set Objective Becomes: MSM-5: Generate and Transmit Rx on Discharge (10% threshold)

What are 2014 Best Practices? MEDITECH Best Practices documentation provides the roadmap for implementing application changes to capture key measure data

New or Significantly Modified Core Objective Measures CM-1: 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. CM-6: Provide patients the ability to view online, download, and transmit information about a hospital admission (CMS sees this a modification to CM11) CM-16: Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (emar)

Computerize Provider Order Entry (CM-1) Count orders NOT patients (optional for FY13) Includes Laboratory and Radiology orders as well as Pharmacy orders Any provider who writes fewer than 100 medication orders during the EHR reporting period Like all core objectives, must select either Observation Services (POS 21 & 22) or All ED (POS 21 & 23) method for identifying patient population

Patients can View Online, Download, and Transmit Information (CM-6) Achieved using the MEDITECH Patient Health and Consumer Portal

View Online, Download or Transmit Meets CCD Requirements for Electronic Transmission Options required to meet CM-6

Portal Summary Activity in Data is Available in Data Repository for Stage 2 Core Reports Can identify if a patient viewed his/her information via the MEDIECH Patient Health and Consumer Portal Action captured Time used to confirm within 36 hours of discharge

New emar / BMV Requirement (CM-16) Must have MEDITECH emar and BMV components implemented, preferably in all units The objective measure count of medications ordered, not administered All mediation administration (for a given Rx Order) must have both patient and medication scanned for pharmacy order to qualify for the numerator

Core Measures with Minor / No Modifications --- Performance Measures --- CM-2: (Prev. CM-6) Record all of the following demographics: preferred language, sex, race, ethnicity, date of birth, date and preliminary cause of death in the event of mortality in the eligible hospital or CAH CM-3: (Prev. CM-7) 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. CM-4: (Prev. CM-8) Record smoking status for patients 13 years old or older --- Self Attestation --- CM-5: (Prev. CM-10) Use clinical decision support to improve performance on high-priority health conditions CM-7: (Prev. CM-14) Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.

Menu Set Objective Measures (3 of 6) --- New --- MSM-2: Record electronic notes in patient records MSM-3: Imaging results accessible through CEHRT MSM-4: Record patient family health history MSM-5: Generate and transmit permissible discharge prescriptions electronically MSM-6: Provide structured electronic lab results to ambulatory providers --- Retained --- MSM-1: (Prev. MSM-2) Record whether a patient 65 years old or older has an advance directive (50% threshold, no change)

Record Electronic Notes in Record (MSM-2) Patient considered include inpatients and ED patients (POS 21 or 23) To qualify, at least one electronic progress note from an authorized provider must be recorded CMS will rely on providers own determinations and guidelines defining when progress notes are necessary Progress note text must be searchable Threshold is 30%

Imaging Results Accessible (MSM-3) Images must be accessible through Certified EHR Technology Patient considered include inpatients and ED patients (POS 21 or 23) Radiologic services are any imaging service that uses electronic product radiation Storing the images natively in Certified EHR Technology is one way to make them accessible through Certified EHR Technology, but there are many other ways and native storage is not required by the objective and measure Threshold is 10%

Record Patient Family Health History (MSM-4) Patient considered include inpatients and ED patients (POS 21 or 23) Family means member who shares about 50% of their genes with a patient Structured data entry is required "unknown is considered a valid response for a patient and qualifies Threshold is 20%

Generate and Transmit Permissible Discharge Prescriptions Electronically (MSM-5) Patient considered include discharged inpatients (POS 21) Medication orders for permissible prescriptions (for new, changed, and refilled prescriptions) are considered Order must be transmitted electronically EH and CAH are excluded if no internal pharmacy or pharmacy that can accept electronic prescriptions located within 10 miles Threshold is 10%

Provide Structured Electronic Lab Results to Ambulatory Providers (MSM-6) Not patient base count electronic lab orders received Order must be electronically transmitted from the ordering provider to the hospital lab Laboratory results include MEDITECH Anatomical Pathology, Blood Bank, Laboratory, Microbiology, Oncology Data includes procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body Threshold is 20%

Stage 2 Clinical Quality Measures There is still much Stage 2 CQM work to be done

Clinical Quality Measures (What s New) Beginning in 2014, CQM data must be submitted electronically to CMS All Stage 1 CQMs have been updated based on advances in technology, comments from stakeholders, changes by measure developers, and CMS s standards Introduction of a new emeasureid (e.g., ED-1 is CME emeasureid of 55, NQF #495, Version 2) New specifications define consistent relative timing across measures (huge improvement over HiTSP TN906) CMS has specified (and required) the use of Quality Data Model (QDM) value sets. This results in the MEDITECH Intelligent Medical Objects requirement (IMO) 16 of 29 CQMs must be reported Eligible hospitals, and CAHs must select CQMs that cover at least three of these six domain (Patient and Family Engagement, Patient Safety, Care Coordination, Population and Public Health, Efficient Use of Healthcare Resources, Clinical Processes/Effectiveness)

Stage 2 Reporting Options

CQM Reporting Authority 2013 & Beyond Eligible hospitals, and CAHs participating only in a Medicaid EHR Incentive Program will submit their CQM data directly to their State Each State is responsible for sharing the details on the process for electronic reporting with its provider community Subject to CMS s prior approval, the process and the timeline are within the States purview

Stage 2 CQM Resources http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM_ResourceTable_2012_10.pdf This well hidden web page is the key to understanding the details of Stage 2 CQMs

Emergency Department CQMs ED-1: (emeasure ID=55) Emergency Department Throughput Median time from ED arrival to ED departure for admitted ED patients ED-2: (emeasure ID=111) Emergency Department Throughput admitted patients Admit decision time to ED departure time for admitted patients ED-3: (emeasure ID=32) Median time from ED arrival to ED departure for discharged ED patients

Venous Thromboembolism (VTE) CQMs VTE-1: (emeasure ID=108) Venous Thromboembolism (VTE) VTE Prophylaxis for non-icu inpatients VTE-2: (emeasure ID=190) Intensive Care Unit (ICU) VTE prophylaxis VTE-3: (emeasure ID=73) VTE Patients with Anticoagulation Overlap Therapy VTE-4: (emeasure ID=109) VTE Patients Receiving Unfractionated Heparin (UFH) with Dosages/Platelet Count Monitoring by Protocol (or Nomogram) VTE-5: (emeasure ID=110) VTE discharge instructions VTE-6: (emeasure ID=113) Incidence of potentially preventable VTE

Stroke CQMs Stroke-2: (emeasure ID=104) Ischemic stroke Discharged on antithrombotic therapy Stroke-3: (emeasure ID=75) Ischemic stroke Anticoagulation Therapy for Atrial Fibrillation/Flutter Stroke-4: (emeasure ID=91) Ischemic stroke Thrombolytic Therapy Stroke-5: (emeasure ID=72) Ischemic stroke Antithrombotic therapy by end of hospital day two Stroke-6: (emeasure ID=105) Ischemic stroke Discharged on Statin Medication Stroke-8: (emeasure ID=107) Ischemic or hemorrhagic stroke Stroke education Stroke-10: (emeasure ID=102) Ischemic or hemorrhagic stroke Assessed for Rehabilitation

Acute Myocardial Infarction (AMI) CQMs AMI-2: (emeasure ID=100) Aspirin Prescribed at Discharge for AMI AMI-7a: (emeasure ID=60) Fibrinolytic Therapy Received Within 30 minutes of Hospital Arrival AMI-8a: (emeasure ID=53) Primary PCI Received Within 90 Minutes of Hospital Arrival AMI-10: (emeasure ID=30) Statin Prescribed at Discharge

Surgical Care Improvement Project (SCIP) CQMs SCIP-INF-1: (emeasure ID=171) Prophylactic Antibiotic Received within 1 Hour Prior to Surgical Incision SCIP-INF-2: (emeasure ID=172) Prophylactic Antibiotic Selection for Surgical Patients SCIP-INF-9: (emeasure ID=178) Urinary catheter removed on Postoperative Day 1 (POD1) or Postoperative Day 2 (POD2) with day of surgery being day zero

Other New Stage 2 CQMs PC-01: (emeasure ID=113) Patient Care PN-6: (emeasure ID=188) Pneumonia HMPC: (emeasure ID=26) Home Management Plan (emeasure ID=9) Exclusive Breast Feeding (emeasure ID=185) Health Term Newborn EHDI-1a: (emeasure ID=31) Early Hearing Detection and Intervention

Standard Value Sets and Stage 2 National Library of Medicine and contains the value sets for each of 29 ecqms for eligible hospitals for 2014 In MAGIC/ CS 5.66 MEDITECH (and presumably M-AT 6.07), 46 dictionaries are added or modified with link to IMO using new Nomenclature ID field to manage the cross-walk between MEDITECH Dictionaries and standard value set Impacts dictionaries in BBK, LAB, MIC, PTH, MIS, OE, NUR, RAD, RXM, SCH

MAGIC 5.66 IMO Main Menu Initialize and maintain MEDITECH IMO crosswalk MIS dictionaries with IMO crosswalk

MIS Nomenclature Map Lookup Consolidated crosswalk list MEDITECH Locations MEDITECH Problem List

Modification to MIS Query Dictionary Construction of MEDITECH MIS Query crosswalk to IMO NomenclatureID

Location Dictionary With Nomenclature Map Construction of MEDITECH MIS Location crosswalk to IMO NomenclatureID

Free License from Value Set Authority Access to all of the Value Sets used in Stage 2 CQM and by IMO

Educational Session Summary 2014 version is not the same as Stage 2 CMS Documentation has been drastically improved for 2014 MEDITECH Best Practices will be available soon and are critical to implementing core and menu set objectives and clinical quality measures accurately Most menu set objectives in Stage 1 have become core objectives in Stage 2; most core objectives have seen their thresholds rise Five new menu set objectives have been added for Stage 2 Clinical quality measures have been expanded from 15 to 29, though onl6 16, from 3 of 6 healthcare domains must be addressed CQMs require standard value sets necessitating IMO crosswalk mappings

Discussion, Questions & Answers