Achieving Meaningful Use Stage II Electronic Patient Access Requirements Dennis Mihale MD MBA Chief Medical Officer CareSync Amy Gleason RN BSN Chief Operating Officer CareSync CPT codes, descriptions and material only are Copyright 2012 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in applicable FARS/DFARS restrictions to government use. 10/28/14 2014 CareSync 1 Learning Objectives Develop strategies to meet Meaningful Use Stage 2 electronic patient access requirements Compare the effectiveness of different types of social media with patients Engage patients in practice technologies 10/28/14 2014 CareSync 2 Problem Statement Meaningful Use Stage II has 17 Core Objectives, all of which must be met. You do not get to pick and choose. Some of them seem almost impossible to meet. You are being asked to get someone else (the patient) to do something. No matter whose fault it is, the physician will pay the price. Mobile computing/technology may provide a priceless tool to improve patient and family engagement and help meet MU II. 10/28/14 2014 CareSync 3 1
Topics Covered Review Meaningful Use Stage II Identify the Most Difficult Terms Understand Impact of Patient Engagement on MU II Understand how technology impacts MU II Determine how to leverage technology for MU II 10/28/14 2014 CareSync 4 Meaningful Use Stage II Core Use CPOE for meds, labs and radiology orders Electronic Prescriptions Record demographics: language, sex, race, ethnicity, DOB Record Vita Signs Height and Weight (all ages) and Blood Pressure (Age 3 and over) Document BMI (all ages) and Display Growth Charts (Ages 0 to 20) Record smoking status (Ages 13 and over) Use Clinical Decision Support: improve performance (high priority) 10/28/14 2014 CareSync 5 Meaningful Use Stage II Core Provide patients the ability to view, download and transmit health information within 4 days of availability to physician: Portal 5% must use this ability or send secure message Provide clinical summaries for patients for each office visit Protect Electronic Health Information: Certified EHR/Tech Capabilities Incorporate Clinical Lab-Test Results: Certified EHR Technology Generate Lists of Patients by specific conditions to use: pop. health Quality improvement, reduction of disparities, research or outreach 10/28/14 2014 CareSync 6 2
Meaningful Use Send Reminders for preventive/follow up care: Identify which patients and use patient preferred method Certified EHR Technology: identify/provide patient specific education Medication Reconciliation: EP receives patient from another setting/provider Summary record for each transition of care or referral Able to submit electronic data to immunization registries Use Secure Electronic Messaging: communicate with patients 10/28/14 2014 CareSync 7 Challenging Core Objectives in MU II Provide patients the ability to view, download and transmit health information within 4 days of availability to physician: Portal 5% must use this ability or send secure message Use Secure Electronic Messaging: communicate with patients Send Reminders for preventive/follow up care: Identify which patients and use patient preferred method Medication Reconciliation: EP receives patient from another provider 10/28/14 2014 CareSync 8 Meaningful Use (MU) Audits Only 13% of physicians say their EHR can support 14 of 17 core Stage II objectives (CDC Report). Healthcare IT News Jan 22, 2014 Meaningful Use is an All or Nothing deal: If one component of the attestation is faulty, the provider must return all of the money. No partial credit. Fierce EMR 10/17/13 If, based on an audit, a provider is found to not be eligible for an EHR incentive payment, the payment will be recouped. CMS.GOV https://questions.cms.gov/faq.php?faqid=7711 (See handout) 10/28/14 2014 CareSync 9 3
Meaningful Use (MU) Audits CMS Recoups All Meaningful Use Money From Providers if Audits Turn Up Errors: AIS Health (from Health Business Daily) 9/16/13 It appears hospitals and physicians will have to give back their entire Meaningful Use incentive payment if CMS auditors find any errors. So far, more clients than not are having audit findings and owing money. EHR continually updates system: no proof patient received info at DC. You get no credit for getting 90%. You owe all the money back. FierceEMR, 10/1/13 It is not the 1% or 2% reduction in payment that scares me. Dennis P.H. Mihale, MD 10/28/14 2014 CareSync 10 RFI for Meaningful Use (MU) Audits EHR Meaningful Use Incentive Payment Program Audits Apr 10, 2014 Solicitation Number: HHSM-500-2012-00042G THIS NOTICE IS FOR INFORMATION PURPOSES ONLY This work (HITECH Audit Support) is being done as a modification to an existing contract, GS-23F-0133M/ HHSM-500-2012-00042G that was awarded to FIGLIOZZI AND COMPANY. This contract was competitively awarded on April 16, 2012 Figliozzi: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_AuditGuidan ce.pdf 10/28/14 2014 CareSync 11 RFI for Meaningful Use (MU) Audits The Office of the National Coordinator for Health Information Technology (ONC), along with CMS, has identified criteria to define meaningful use of EHR s. Early stages: users attest that they are meaningful users of EHRs Upon attestation, eligible to receive an incentive payment CMS Office of Financial Management is responsible for auditing components of the HITECH program Oversees the audit process and the contractor Monitoring control process to ensure users are in compliance with regulations eligible to participate in the program. CMS Management will evaluate the evidence in order to make a final determination of each meaningful EHR user s eligibility. 10/28/14 2014 CareSync 12 4
Mobile Health Computing Exchange of information to and from provider before, during, and after the point of care Patient activities between visits can be reported as they happen Helps identify missing diagnosis and also helps identify co-morbidities: but only if the patient can participate 10/28/14 2014 CareSync 13 Mobile Computing Smartphone app use (not browser use) exceeded PC use for the first time in January 2014 (CNN Money, Feb 2014) Smartphones are widely used by all age groups and income levels (Pew Research Internet Project, January 2014) 58% of American adults have a smart phone Medicaid/Medicare members use smart phones and tablets 47% with household incomes <30K/year 44% high school grad or less Race/Ethnicity: White: 53% African-American: 59% Hispanic: 61% Seniors (65 or older) 27% own tablet or e-reader 18% own a smartphone 10/28/14 2014 CareSync 14 Mobile Computing Overview Mobile computing enables all healthcare stakeholders to actively interact with patients, their family, and caregivers on an easy to manage and understand, structured, cost-efficient, and patient-centric platform. Mobile computing improves physician care management, increases member interaction with their own healthcare without being intrusive, and helps health plans better understand utilization, care spend, provider & patient interaction, and overall care protocols. 10/28/14 2014 CareSync 15 5
Patient/Family Engagement Through Mobile Patient and family engagement is the most important asset in health care (IOM: Partnering with Patients, 2/25/13 Workshop) Families and caregivers have access to mobile applications even when away from the patient Wearable and mobile integrations capture contemporaneous data usually not available to the provider Outcomes increased when provider has access to the data between visits Patient satisfaction is increased with access to data between visits Mobile is the new way to take notes and provide helpful information at the visit/point of care 10/28/14 2014 CareSync 16 Challenging Core Objectives in MU II Provide patients the ability to view, download and transmit health information within 4 days of availability to physician: Portal 5% must use this ability or send secure message Use Secure Electronic Messaging: communicate with patients Send Reminders for preventive/follow up care: Identify which patients and use patient preferred method Medication Reconciliation: Eligible provider (EP) receives patient from another provider 10/28/14 2014 CareSync 17 View, Download and Transmit 5% must use this ability or send secure messages How do you get patients to come to portal and retrieve data? Do it at the office (point of care) as they check out. Send emails with links back to your portal Send alerts (texts/sms) to the patient s phone Let them schedule visits online via their phone For every test, lab or study alert: come to secure portal Allow third parties, approved by the patient, to do it for them 10/28/14 2014 CareSync 18 6
Secure Electronic Messaging Do it at the office (point of care) as they check out Send secure emails with links back to your portal Send alerts (texts/sms) to the patient s phone For every test, lab or study alert: come to secure portal Send reminders for appointment 10/28/14 2014 CareSync 19 Send Reminders for Care Use patient preferred method What if preferred method is mobile? Paper is easy and e-mail is not much harder? Mobile means texts, security and messaging. There are trustworthy vendors to help. Build interface from EHR to Mobile Platform (solution). Meet MU Core Objective AND Make Patients Happy 10/28/14 2014 CareSync 20 Medication Reconciliation Eligible Provider receives patient from another provider Let s ask the patient to help! Why not ask the family to help, too? What is the patient really taking? What have they stopped taking? What are they taking that neither doctor prescribed? 10/28/14 2014 CareSync 21 7
Patient Engagement Pilot 10/28/14 2014 CareSync 22 Patient Engagement Pilot Pilot Task List 1. Demo technology to staff. 2. Implementation manager discusses and clarifies pilot goals and timeline. 3. Identify patients/caregivers to target for pilot. 4. Create & send on-boarding materials (email, mail, and print) to selected patients/caregivers, introducing them to technology. 5. Train staff on technology. 6. Invite patients/caregivers to begin using technology. 10/28/14 2014 CareSync 23 Patient Engagement Pilot Pilot Task List (cont.) 7. Patient/Caregiver receives personalized phone introduction. 8. Technology specialists assist patients/caregivers in using system. 9. Information Technology (IT) specialists help patients get started: the hard part. 10. Follow up with patients to ensure they are comfortable with new technology. 11. Team reviews project to ensure technology is driving MU compliance. 12. Patient/Caregiver receives ongoing training and encouragement. 13. Team meets to discuss lessons learned. 10/28/14 2014 CareSync 24 8
Pilot Results Size of test group Adoption rate Staff Patients Caregivers/Family 10/28/14 2014 CareSync 25 Pilot Results (cont.) Lessons learned Training Ongoing support Feedback from Staff Feedback from Patients 10/28/14 2014 CareSync 26 Questions? 10/28/14 2014 CareSync 27 9
REFERENCES Almost every Reference you Need http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Stage_2.html Stage 2 Audit Programs http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Audi tguidance.pdf 10/28/14 2014 CareSync 28 Appendix 10/28/14 2014 CareSync 29 CC 1: CPOE for Med, Lab & Radiology Orders Definition: Computerized Provider Order entry (CPOE) is the provider s use of a computer assistance to directly enter medical orders Objective: Use CPO to enter medication, lab and radiology orders Measure: > 60% meds, > 30% lab and > 30% radiology orders created using CPOE Exclusion: Provider writing < 100 med, lab or radiology orders during EMR reporting period 10/28/14 2014 CareSync 30 10
CC 2: Electronic Prescriptions Definition: Permissible prescriptions are those not restricted due to controlled substance schedules II-IV Objective: Generate and transmit permissible prescriptions electronically erx Measure: > 50% of all permissible prescriptions or all prescriptions are queried for drug formulary and transmitted electronically using CEHRT Exclusion 1: EP writing < 100 permissible prescriptions Exclusion 2: No pharmacy accepts erx within 10 miles 10/28/14 2014 CareSync 31 CC 3: Record Demographics Definition: Preferred language patient choice Unique patient only counts once in denominator Objective: Record preferred language, sex, race, ethnicity, date of birth Measure: > 80% of all unique patients seen by EP have structured demographics recorded Exclusion: NONE 10/28/14 2014 CareSync 32 CC 4: Record Vital Signs Definition: Unique patient counted once Objective: Record height/length and weight; BP (> 3); BMI; growth charts for patients 0 20 Measure: > 80% of unique patients have BP (Age >3) AND/OR height/weight recorded Exclusion 1: All patients < 3 BP excluded Exclusion 2: Believes 3 VS have no relevance Exclusion 3: Believes BP not relevant Excluded Exclusion 4: Believes height/weight not relevant 10/28/14 2014 CareSync 33 11
CC 5: Record Smoking Status Definition: Unique patient counts once Objective: Record smoking status for patients 13 years or older Measure: > 80% unique patients have smoking status recorded Exclusion: All patients seen or admitted < 13 10/28/14 2014 CareSync 34 CC 6: Use Clinical Decision Support Clinical Decision Support is HIT functionality that provides information, filtered and organized, to enhance health care Objective: Use clinical decision support to improve performance on high priority health conditions Measure 1: Use five (5) clinical decision support interventions for 4 or more quality measures Measure 2: EP has implemented functionality for drugdrug and drug-allergy interactive checks Exclusion Measure2: EP writes < 100 medication orders 10/28/14 2014 CareSync 35 CC 7: View, Download and Transmit Objective: Provide patients the ability to view online, download and transmit their information within 4 business days (M-F) of information being available to the EP. Measure 1: > 50% of patients provided timely, within 4 days, online access to their information Measure 2: > 5% of patients view, download or transmit to a 3 rd party their information Exclusion 1: EP who does not create any info Exclusion 2: EP in county with <50% broadband 10/28/14 2014 CareSync 36 12
CC 8: Provide Clinical Summaries Clinical Summary: After visit summary providing patient with relevant and actionable information Objective: Provide clinical summaries for each office visit Measure: clinical summaries for > 50% of office visits within one business day Exclusion: Provider with no office visits 10/28/14 2014 CareSync 37 CC 9: Protect Electronic Health Information Attestation: EP must attest YES to conducting or reviewing security risk analysis and implementing security updates as needed to meet this measure Objective: Protect EHI created or maintained by certified EHR technology (CEHRT) through implementation of appropriate technical capabilities Measure: Conduct or review a security risk analysis in accordance with 45 CFR 164.308 (a) 1, including addressing encryption/security of data stored in CEHRT Exclusion: NONE 10/28/14 2014 CareSync 38 CC 10: Incorporate Clinical Results Attestation Requirements: Allow limiting measure of objective to labs ordered for patients with records maintained using CEHRT Objective: Incorporate clinical lab-test results into CEHRT as structured data Measure: > 55% of all clinical lab-test results ordered, with positive/negative or numerical format are incorporated into CEHRT as structured data Exclusion: No lab-tests ordered or results are not in a positive/negative or numerical format 10/28/14 2014 CareSync 39 13
CC 11: Generate Patient Lists by Condition Specific Conditions: 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: NONE 10/28/14 2014 CareSync 40 CC 12: Send Reminders for Preventive Care Definition: Patient preference is the reminder communication method patient s prefer for Objective: Use clinically relevant information to identify patients to receive reminders for preventive/follow up care and use patient preference Measure: > 10% patients with 2 or more office visits within 24 preceding months are sent reminder Exclusion: No office visits preceding 24 months 10/28/14 2014 CareSync 41 CC 13: Certified EMR Technology Patient Specific Education Resources Identified by CEHRT: Resources identified through logic built into CEHRT which evaluates information about patients and suggests education resources of value to the patients Objective: Use clinically relevant information from CEHRT to identify patient specific education resources and provide these resources to the patient Measure: > 10% of patients with office visits are provided patient specific education resources Exclusion: EP with no office visits 10/28/14 2014 CareSync 42 14
CC 14: Medication Reconciliation Definition: Identify the most accurate list of all meds the patient is taking: name, dosage, frequency and route. Compare external list to medical record list Objective: Perform med reconciliation on patients received from another setting or provider Measure: med reconciliation for > 50% transitions of care Exclusion: No transitions of care during EMR reporting period 10/28/14 2014 CareSync 43 CC 15: Summary for Transition of Care Transition of Care (TOC): Movement of a patient from one setting of care to another. Objective: Provide summary of care record (see definition) for each transition of care or referral Measure 1: Summary record for > 50% TOC Measure 2: Summary record sent electronically via CEHRT or via exchange (ONC) > 10% TOC Measure 3: Conducts one or more successful electronic exchanges with recipient who has CEHRT different from senders CEHRT OR conducts successful test with CMS designated EHR Exclusion: EP with < 100 transfers or referrals 10/28/14 2014 CareSync 44 CC 16: Submit to Immunization Registries Objective: Ability to submit electronic data to immunization registries or information systems Measure: Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or information system Exclusion 1: EP does not administer immunizations for which data collected by immunization registry Exclusion 2: Immunization registry able to accept data Exclusion 3: Immunization registry not timely Exclusion 4: Exclusion 2 but can enroll additional EP s 10/28/14 2014 CareSync 45 15
CC 17: Secure Electronic Messaging Definition: Any electronic communication between a provider and patient that ensures only those parties cab access the information. Objective: Use electronic messaging to communicate with parties on relevant health issues Measure: Secure message sent by > 5% od patients using CEHRT messaging function Exclusion: No office visits or EP conducts > 50% of patient encounters in county with < 50% of households with 3Mbps broadband availability 10/28/14 2014 CareSync 46 Achieving Meaningful Use Patient Electronic Access Requirements Thank you Dennis Mihale MD MBA CMO CareSync dennis.mihale@caresync.com Amy Gleason RN BSN Chief Operating Officer CareSync 10/28/14 2014 CareSync 47 16