CiMH 15 th Annual Information Management Conference Meaningful Use: Incentives, Standards, and Aspirational Goals Michael R. Lardieri, LCSW AVP Strategic Program Development North Shore LIJ Health System Mlardieri@nshs.edu
What is in the Rule Payment for MU Stage 2 2014 Edition is the Floor Changes to Stage 1 of meaningful use Stage 2 of meaningful use New clinical quality measures New clinical quality measure reporting mechanisms Payment adjustments and hardships Medicaid program changes Slide 2 of 109
Payment for MU For Medicaid EPs: Annual Incentive Payment by Stage of Meaningful Use YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 YEAR 6 (AIU) $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 Maximum incentive amount is $63,750. Payments are made over 6 years and do not have to be consecutive. *2016 is the last year that Medicaid EPs can begin participation in the program. Slide 3 of 109
What requirements do you have to meet? To receive an EHR incentive payment in the Medicaid EHR Incentive Program, providers have to meet certain requirements. First year of participation: In their first year of participation, providers can Adopt, Implement, Upgrade to, or demonstrate meaningful use of certified EHR technology. Second year and subsequent years of participation: In their second year of participation and subsequent participation years, providers must show that they are using their EHRs in a meaningful way by meeting thresholds for a number of objectives. Slide 4 of 109
What kind of EHR do you need? Certified Electronic Health Record Technology (CEHRT) Certified to the 2014 Edition Found on ONC Certified Health IT Product List (CHPL) Web site http://oncchpl.force.com/ehrcert?q=chpl Cannot use 2011 Certified Technology Slide 5 of 109
What Providers are Eligible? The following are considered eligible professionals who can participate in the Medicaid EHR Incentive Program: Physicians (primarily doctors of medicine and doctors of osteopathy) Nurse practitioners Certified nurse-midwives Dentists Physician assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. Slide 6 of 109
Eligibility To qualify for participation in the Medicaid EHR Incentive Program, an eligible professional must also meet one of the following criteria: Have a minimum 30% Medicaid patient volume* Have a minimum 20% Medicaid patient volume, and be a pediatrician* Practice predominantly in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) and have a minimum 30% patient volume attributable to needy individuals *Children s Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria * Uninsured patients, those served at no cost or on a sliding fee scale do count towards 30% threshold Slide 7 of 109
CMS has developed a web tool that can help you determine whether or not you are eligible to participate in the EHR Incentive Programs. Click on the image to the right to try out the tool on our website. https://www.cms.gov/regulations-and-guidance/ Legislation/EHRIncentivePrograms/Eligibility.html Slide 8 of 109
What are the requirements? Eligible professionals have to meet the following measures in order to receive a meaningful use incentive payment under 2014* Stage 1: 13 CORE OBJECTIVES These are objectives that everyone who participates in the program must meet. Some of the core objectives have exclusions that could exempt you from having to meet them, but many of them do not. You have to report on all 13 core objectives and meet the thresholds established by those objectives. 9 MENU OBJECTIVES You only have to report on 5 out of the 9 available menu objectives, including at least one public health-related objective. You can choose objectives that make sense for your workflow or practice. Again, some of these objectives have exclusions that could exempt you from having to meet them. Slide 9 of 109
What are the requirements? Under Stage 2, EPs will have to meet 17 core objectives and 3 out of 6 menu objectives. Keep in mind that states can seek prior approval from CMS to require that up to 4 public healthrelated menu objectives be core objectives for their Medicaid eligible professionals. Slide 10 of 109
What are the Stage 1 requirements? In addition to meeting the thresholds for the 13 core and 5 menu objectives, all eligible professionals have to report on Clinical Quality Measures, also known as CQMs. There are no thresholds to meet for Clinical Quality Measures you simply report the data exactly as it is calculated by your certified EHR. 13 Core Measures Meaningful Use + 5 Menu Measures + 9 = M U CQMs Meaningful Use Slide 11 of 109
Stage 1 meaningful use: 13 core objectives Below are the 13 core objectives that every eligible professional must meet in order to receive an EHR Incentive Payment. 1. Computerized provider order entry (CPOE) 2. Drug-drug and drug-allergy checks 3. Maintain an up-to-date problem list of current and active diagnoses 4. E-Prescribing (erx) 5. Maintain active medication list 6. Maintain active medication allergy list 7. Record demographics 8. Record and chart changes in vital signs 9. Record smoking status for patients 13 years or older 10. Implement clinical decision support 11. Provide patients with the ability to view, download, or transmit their health information online 12. Provide clinical summaries for patients for each office visit 13. Protect electronic health information Slide 12 of 109
Stage 1 meaningful use: 13 core objectives Over the next 13 pages, we ll take a quick look at each of these core objectives so that you can see at a glance: What the objective requires What you have to do to meet the required threshold What exclusions exist for the objective There are many details about meeting these objectives. CMS provides Meaningful Use Specification Sheets [http://www.cms.gov/ Regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads//EPMU-TOC.pdf], which give in-depth information on each of the core objectives, including how to calculate numerators and denominators, definitions of important terms, and additional information about achieving the objectives. Slide 13 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 1. Computerized provider order entry (CPOE) What the Measure Requires More than 30% of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. What That Means for You For at least 30% of your patients that have a medication listed in the EHR, you or a licensed staff person will have to use the EHR s CPOE module to enter medication orders. Are You Excluded from Having to Do This? You can be excluded from meeting this objective if you write fewer than 100 prescriptions during the reporting period. Optional alternate: More than 30% of your medication orders during the reporting period are recorded using CPOE. Slide 14 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 2. Drug-drug and drug-allergy checks What the Measure Requires EP has enabled this functionality for the entire EHR reporting period. What That Means for You Certified EHR comes with the ability to automatically check for potentially adverse drug-drug or drug-allergy interactions. You have to turn this functionality on and keep it on. Are You Excluded from Having to Do This? There is no exclusion for this objective. Everyone has to meet it. Slide 15 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 3. Maintain an up-to-date problem list of current and active diagnoses What the Measure Requires More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data. What That Means for You More than 80% of your patients have to have an entry in the EHR about current diagnoses either actual problems or just an indication that there are no problems right now. Are You Excluded from Having to Do This? There is no exclusion for this objective. Everyone has to meet it. Slide 16 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 4. E-Prescribing (erx) What the Measure Requires More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. What That Means for You More than 40% of the prescriptions you write have to be sent electronically not by phone and not by fax using your certified EHR. Are You Excluded from Having to Do This? You can be excluded from meeting this objective if you write fewer than 100 prescriptions during the reporting period. You can be excluded from meeting this objective if there is not a pharmacy within your organization and there are no pharmacies that accept electronic prescriptions within 10 miles of your practice location at the start of your EHR reporting period. Slide 17 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 5. Maintain active medication list What the Measure Requires More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. What That Means for You More than 80% of your patients have to have an entry in the EHR about medications either medications they are currently taking or just an indication that they aren t taking any medications right now. Are You Excluded from Having to Do This? There is no exclusion for this objective. Everyone has to meet it. Slide 18 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 6. Maintain active medication allergy list What the Measure Requires More than 80% of of all all unique patients seen by the EP have at have least at one least entry one or entry an indication or an indication that no that problems no are problems known are for known the patient for recorded the patient as recorded structured as data. structured data. What That Means for You More than 80% of your patients have to have an entry in the EHR about current diagnoses either actual problems or just an indication that there are no problems right now. Are You Excluded from Having to Do This? There is no exclusion for this objective. Everyone has to meet it. Slide 19 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 7. Record demographics What the Measure Requires More than 50% of all unique patients seen by the EP have demographics recorded as structured data. What That Means for You For more than half of your patients you have to record the following in the EHR: Preferred language Gender Race Ethnicity Date of Birth Are You Excluded from Having to Do This? There is no exclusion for this objective. Everyone has to meet it. Slide 20 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 8. Record and chart changes in vital signs What the Measure Requires Required: For more than 50% 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. What That Means for You For more than half of your patients, you have to record the following in the EHR: Height Weight Blood pressure (for patients age 3 and over only) Calculate and display body mass index (BMI) Plot and display growth charts for children 0-20 years, including BMI A certified EHR will chart changes in those vital signs for you. Are You Excluded from Having to Do This? You can be excluded from this objective for either of these reasons: 1. If you see no patients 3 years or older, you are excluded from recording blood pressure; 2. If you believe that all three vital signs of height, weight, and blood pressure have no relevance to your scope of practice you are excluded from recording them; 3. If you believe that height and weight are relevant to your scope of practice, but blood pressure is not, you are excluded from recording blood pressure; or 4. If you believe that blood pressure is relevant to your scope of practice, but height and weight are not, you are excluded from recording height and weight. Slide 21 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 9. Record smoking status for patients 13 years or older What the Measure Requires More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. What That Means for You Smoking status is recorded in the EHR for over half of your patients that are over the age of 13. Are You Excluded from Having to Do This? You can be excluded from meeting this objective if you don t see any patients who are 13 years or older. Slide 22 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 10. Implement clinical decision support What the Measure Requires Implement one clinical decision support rule. What That Means for You Certified EHRs have the ability to program clinical decision support that can trigger alerts or clinical information for providers when they encounter patients with certain diagnoses or treatments. You should implement one of these rules that makes sense for your medical practice. Are You Excluded from Having to Do This? There is no exclusion for this objective. Everyone has to meet it. Slide 23 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 11. Provide patients with an electronic copy of their health information What the Measure Requires More than 50% of all patients are provided the ability to view, download, or transmit their health information online within 4 business days after it is available. What That Means for You You must provide patients the ability to view, download, or transmit their health information (including diagnostic test results, problem lists, medication allergies) online in a timely fashion for over half of all patients. Are You Excluded from Having to Do This? There is no exclusion for this objective. Everyone has to meet it. Slide 24 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 12. Provide clinical summaries for patients for each office visit What the Measure Requires Clinical summaries provided to patients for more than 50% of all office visits within 3 business days. What That Means for You For more than half of your office visits, patients receive a clinical summary within 3 days of the visit. Are You Excluded from Having to Do This? If you do not conduct any office visits, you can be excluded from meeting this objective. Slide 25 of 109
STAGE 1 MEANINGFUL USE: 13 CORE OBJECTIVES 13. Protect electronic health information What the Measure Requires Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. What That Means for You You have to meet the same HIPAA requirements for protecting patient information in your EHR as you do for paper records. To do this, you must conduct a security review of your system and correct any problems that could make patient information vulnerable. Are You Excluded from Having to Do This? There is no exclusion for this objective. Everyone has to meet it. Slide 26 of 109
Stage 1 meaningful use: 9 menu objectives Now that we ve seen all of the core objectives that you have to meet, let s look at the 10 menu objectives. You have to report on 5 of these 9 menu objectives At least one of the 5 you report on must be a Public Health objective CMS provides Meaningful Use Specification Sheets [http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads//EP-MU- TOC.pdf], which give in-depth information on each of the menu objectives, including how to calculate numerators and denominators, definitions of important terms, and additional information about achieving the objectives. Slide 27 of 109
Stage 1 public health objectives When selecting your 5 menu objectives, at least one must come from the Public Health list, which consists of the following: Submit electronic data to immunization registries OR Submit electronic syndromic surveillance data to public health agencies Slide 28 of 109
STAGE 1 MENU OBJECTIVES 1. Submit electronic data to immunization registries What the Measure Requires Performed 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) except where prohibited. What That Means for You Your EHR comes equipped with the ability to electronically send immunization data. You have to test your EHR s ability to electronically transmit that information to a public health registry. Even if the test fails, you have successfully met this objective. Are You Excluded from Having to Do This? You could be excluded from meeting this objective for either of these reasons: You don t administer immunizations There s no immunization registry to which you can send information It is prohibited Slide 29 of 109
STAGE 1 MENU OBJECTIVES 2. Submit electronic syndromic surveillance data to public health agencies What the Measure Requires Performed 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 an EP submits such information has the capacity to receive the information electronically) except where prohibited. What That Means for You Your EHR comes equipped with the ability to electronically send syndromic surveillance data (e.g., influenza population data). You have to test your EHR s ability to electronically transmit that information to a public health agency. Even if the test fails, you have successfully met this objective. Are You Excluded from Having to Do This? You could be excluded from meeting this objective for either of these reasons: You don t collect any reportable syndromic data during the EHR reporting period There s no immunization registry to which you can send information It is prohibited Slide 30 of 109
Other stage 1 menu objectives After you have selected a public health objective, you still have to choose 4 more menu objectives to report. You can select any 4 from the list below or you could report on both public health objectives and choose 3 from the list below: 3. Drug formulary checks 4. Incorporate clinical lab-test results 5. Generate lists of patients by specific conditions 6. Send reminders to patients for preventive/follow-up care 7. Patient-specific education resources 8. Medication reconciliation 9. Summary of care record for transitions of care Slide 31 of 109
STAGE 1 MENU OBJECTIVES 3. Drug formulary checks What the Measure Requires EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period. What That Means for You Your certified EHR has the ability to check potential medication orders against a drug formulary. If you choose this objective, then you need to enable the formulary check for the entire reporting period. Are You Excluded from Having to Do This? You can be excluded from meeting this objective if you write fewer than 100 prescriptions during the reporting period. Slide 32 of 109
STAGE 1 MENU OBJECTIVES 4. Incorporate clinical lab-test results What the Measure Requires More than 40% of all clinical lab test results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. What That Means for You Results from over 40% of lab tests ordered during the reporting period are recorded in the EHR as long as the tests yield a number or a positive/ negative response. Other test results do not count toward this objective. Are You Excluded from Having to Do This? You can be excluded from meeting this objective if you did not order any lab tests during the reporting period or if none of the results from the tests you ordered came back as a number or as a positive/negative response. Slide 33 of 109
STAGE 1 MENU OBJECTIVES 5. Generate lists of patients by specific conditions What the Measure Requires Generate at least one report listing patients of the EP with a specific condition. What That Means for You You can decide what condition is clinically relevant or useful to your practice, then generate a report from your certified EHR of patients with that condition. Are You Excluded from Having to Do This? There is no exclusion for this objective if you select it. Slide 34 of 109
STAGE 1 MENU OBJECTIVES 6. Send reminders to patients for preventive /follow -up care What the Measure Requires More than 20% of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. What That Means for You Over 20% of patients in these age ranges must be sent preventive or follow-up care reminders. The information in the reminder and how the reminder is sent (e.g., mail, email, telephone) is up to you. Are You Excluded from Having to Do This? You can be excluded from meeting this objective if you have no patients 65 years or older or 5 years old or younger whose information is in your certified EHR. Slide 35 of 109
STAGE 1 MENU OBJECTIVES 7. Patient-specific education resources What the Measure Requires More than 10% of all unique patients seen by the EP are provided patient-specific education resources. What That Means for You For over 10% of your patients, you use your certified EHR s ability to recommend educational resources to your patients. Your EHR is certified with the ability to make these recommendations based on patient-specific variables, such as chronic condition (e.g., diabetes). Are You Excluded from Having to Do This? There is no exclusion for this objective if you select it. Slide 36 of 109
STAGE 1 MENU OBJECTIVES 8. Medication reconciliation What the Measure Requires EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP. What That Means for You For over half the patients who see you after receiving care from another provider, you should update medication information by comparing the patient s medical record to an external list of medications obtained from a patient, hospital, or other provider. Are You Excluded from Having to Do This? You can be excluded from meeting this objective if you did not see any patients after they received care from another provider. Slide 37 of 109
STAGE 1 MENU OBJECTIVES 9. Summary of care record for transitions of care What the Measure Requires EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals. What That Means for You You send either an electronic or paper summary of care document that is generated by your certified EHR for over half of the patients you refer to another provider or transfer to another setting for care (e.g., nursing home). Are You Excluded from Having to Do This? You can be excluded from meeting this objective if you don t refer any patients or transfer any patients to another setting for care during the reporting period. Slide 38 of 109
What if none of the Stage 1 menu objective s are relevant? It s rare, but it s possible that none of the menu objectives are applicable to your scope of practice. If that is the case for you and you qualify for all of the exclusions for each of the menu objectives, then you can select 5 menu objectives and claim the exclusion for each. However, if you do not qualify for all of the exclusions to the menu objectives, you should go back and select menu objectives on which you can report. Slide 39 of 109
Clinical quality measures Clinical quality measures do not have thresholds that you have to meet you simply have to report data on them. You don t have to do any calculations for the clinical quality measures. Your certified EHR will produce a report with clinical quality measure data, and you must enter that data exactly as your certified EHR produced it. Slide 40 of 109
Clinical quality measures The number of CQMs providers need to report in 2014 differs from previous years. Beginning in 2014, you must select and report 9 of a possible list of 64 approved CQMs 2011 through 2013: 6 of a possible 44 measures 3 required core measures or 3 alternate core, as necessary 3 of 38 additional measures In 2014 and beyond: 9 of a possible 64 measures Slide 41 of 109
9 recommended measures for adult populations Adult Recommended Core Measures Controlling High Blood Pressure Use of High-Risk Medications in the Elderly Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Use of Imaging Studies for Low Back Pain Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan Documentation of Current Medications in the Medical Record Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Closing the referral loop: Receipt of specialist report Functional status assessment for complex chronic conditions Slide 42 of 109
9 recommended measures for pediatric populations Pediatric Recommended Core Measures Appropriate Testing for Children with Pharyngitis Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Chlamydia Screening for Women Use of Appropriate Medications for Asthma Childhood Immunization Status Appropriate Treatment for Children with Upper Respiratory Infection (URI) ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan Children who have dental decay or cavities Slide 43 of 109
2014 CQM Domains 2014 CQM Domains 1. Patients and Family Engagement CQMs 2014 and Beyond 2. Patient Safety 3. Care Coordination 4. Population/Public Health b Choose from at least 3 different domains 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness 44
RESOURCES Resources library Topic Resource Description Certified EHR Technology CPHL Certified EHR List Webpage maintained by ONC that provides a comprehensive listing of complete EHRs and EHR modules Eligibility Eligibility Flow Chart Demonstrates the functionality of the online module for eligible professionals registering for the EHR incentive program Eligibility Widget Helps eligible professionals determine their eligibility for the Medicare and Medicaid EHR Incentive Programs Meaningful Use Clinical Quality Measures - Web page CMS web page that provides information on CQM requirements for meeting meaningful use Core and Menu Measures for Eligible Professionals with FAQs Guide to Clinical Quality Measures Other CMS Programs erx Incentive Program Homepage Physician Quality Reporting System (PQRS) Homepage Helps eligible professionals understand the core and menu measures needed to attest for meaningful use with FAQs included A guide to help eligible professionals understand clinical quality measures CMS webpage that provides information on the MIPPA e-prescribing incentive program CMS webpage that provides information on the PQRS and how to participate in it 45
Resources library Topic Resource Description Overview Introduction to the Medicare EHR Incentive Program for Eligible Professionals An overview of the Medicare EHR Incentive Program for eligible professionals EHR Incentive Program Timeline Key dates of the Medicare and Medicaid EHR Incentive Programs My EHR Participation Timeline Interactive timeline to determine which year eligible professionals will demonstrate each statge of meaningful use. Medicaid State Information Webpage listing which states have already begun participation in the Medicaid EHR Incentive Program State Contact Information for Medicaid EHR Incentive Program Provides contact information for each state s EHR Incentive Program Registration Registration, Attestation and PECOS Checklist Medicaid EHR Incentive Program Registration User Guide Medicare and Medicaid EHR Incentive Program Webinar for Eligible Professionals A checklist of steps providers need to take before they can register, attest, or enroll in PECOS A guide to help eligible professionals register online for EHR Incentive Program Video explaining step by step instructions for how to register for the EHR Incentive Program 46
Stage 2 Meaningful Use Slide 47 of 109
Meaningful Use: Changes from Stage 1 to Stage 2 Eligible Professionals 17 core objectives 3 of 6 menu objectives 20 total objectives Stage 2 Slide 48 of 109
2014 Edition > Half of Outpatient Encounters at least No Changes 50% of EP outpatient encounters must occur at locations equipped with certified EHR technology. > Measure compliance = objective compliance > Denominators based on outpatient locations equipped with CEHRT and include all such encounters or only those for patients whose records are in CEHRT depending on the measure. Slide 49 of 109
2014 Changes 1. EHRs Meeting ONC 2014 Standards starting in 2014, all EHR Incentive Programs participants will have to adopt certified EHR technology that meets ONC s Standards & Certification Criteria 2014 Final Rule 2. Reporting Period Reduced to Three Months to allow providers time to adopt 2014 certified EHR technology and prepare for Stage 2, all participants will have a three-month reporting period in 2014. Slide 50 of 109
Stage 2 EP Core Objectives EPs must meet all 17 core objectives: Core Objective Measure 1. CPOE Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology 2. E-Rx E-Rx for more than 50% 3. Demographics Record demographics for more than 80% 4. Vital Signs Record vital signs for more than 80% 5. Smoking Status Record smoking status for more than 80% 6. Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy 7. Labs Incorporate lab results for more than 55% 8. Patient List Generate patient list by specific condition 9. Preventive Reminders Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years Slide 51 of 109
Stage 2 EP Core Objectives EPs must meet all 17 core objectives: Core Objective 10. Patient Access Measure Provide online access to health information for more than 50% with more than 5% actually accessing 11. Visit Summaries Provide office visit summaries for more than 50% of office visits 12. Education Resources Use EHR to identify and provide education resources more than 10% 13. Secure Messages More than 5% of patients send secure messages to their EP 14. Rx Reconciliation Medication reconciliation at more than 50% of transitions of care 15. Summary of Care Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR 16. Immunizations Successful ongoing transmission of immunization data 17. Security Analysis Conduct or review security analysis and incorporate in risk management process Slide 52 of 109
Stage 2 EP Menu Objectives EPs must select 3 out of the 6: Menu Objective 1. Imaging Results Measure More than 20% of imaging results are accessible through Certified EHR Technology 2. Family History Record family health history for more than 20% 3. Syndromic Surveillance Successful ongoing transmission of syndromic surveillance data 4. Cancer Successful ongoing transmission of cancer case information 5. Specialized Registry Successful ongoing transmission of data to a specialized registry 6. Progress Notes Enter an electronic progress note for more than 30% of unique patients Slide 53 of 109
Closer Look at Stage 2: Patient Engagement Patient engagement engagement is an important focus of Stage 2. Requirements for Patient Action: More than 5% of patients must send secure messages to their EP More than 5% of patients must access their health information online EXCULSIONS CMS is introducing exclusions based on broadband availability in the provider s county. Slide 54 of 109
Closer Look at Stage 2: Electronic Exchange Stage 2 focuses on actual use cases of electronic information exchange: Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals. The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals. At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR. Slide 55 of 109
Changes to Stage 1: CPOE Current Stage 1 Measure New Stage 1 Option Denominator= Unique patient with at least one medication in their medication list Denominator= Number of orders during the EHR Reporting Period This optional CPOE denominator is available in 2013 and beyond for Stage 1 Slide 56 of 109
Changes to Stage 1: Vital Signs Current Stage 1 Measure New Stage 1 Measure Age Limits= Age 2 for Blood Pressure & Height/ Weight Age Limits= Age 3 for Blood Pressure, No age limit for Height/ Weight Exclusion= All three elements not relevant to scope of practice Exclusion= Blood pressure to be separated from height /weight The vital signs changes are optional in 2013, but required starting in 2014 Slide 57 of 109
Changes to Stage 1: Testing of HIE Current Stage 1 Measure Stage 1 Measure Removed One test of electronic transmission of key clinical information Requirement removed effective 2013 The removal of this measure is effective starting in 2013 Slide 58 of 109
Changes to Stage 1: E-Copy & Online Access Current Stage 1 Objective New Stage 1 Objective Objective= Provide patients with e-copy of health information upon request Provide electronic access to health information Objective= Provide patients the ability to view online, download and transmit their health information The measure of the new objective is 50% of patients have access to their information; there is no requirement that 5% of patients do access their information for Stage 1. The change in objective takes effect in 2014 to coincide with the 2014 certification and standards criteria Slide 59 of 109
Changes to Stage 1: Public Health Objectives Current Stage 1 Objectives New Stage 1 Addition Immunizations Reportable Labs Addition of except where prohibited to all three objectives Syndromic Surveillance This addition is for clarity purposes and does not change the Stage 1 measure for these objectives. Slide 60 of 109
Clinical Quality Measures Slide 61 of 109
Alignment Among Programs 2014 represents CMS s commitment to aligning quality measurement and reporting among programs, including Hospital Inpatient Quality Reporting Program, PQRS, CHIPRA, and ACO Programs Hospital Inpatient Quality Reporting Program PQRS CHIPRA ACO Slide 62 of 109
CQMs in 2014 and Beyond A complete list of 2014 CQMs and their associated National Quality Strategy domains will be posted on the CMS EHR Incentive Programs website (www.cms.gov/ehrincentiveprograms) in the future. CMS will also post a recommended core set of CQMs for EPs that focus on high-priority health conditions. Slide 63 of 109
https://www.cms.gov/medicare/quality-initiatives-patient- Assessment-Instruments/QualityMeasures/Downloads/Eligible- Providers-2014-Proposed-EHR-Incentive-Program-CQM.pdf
New Certification Criteria Ambulatory & Inpatient Inpatient Only Ambulatory Only Electronic Notes Electronic medication administration record Secure messaging Image results erx (for discharge) Cancer case information Family Health History Amendments View, Download, & Transmit to 3rd party Auto numerator recording Non-%-based measure use report Safety-enhanced design Quality management system Data Portability Transmission of electronic lab tests and values/results to ambulatory providers Transmission to cancer registries Slide 65 of 109
Revised Certification Drug-drug, drug-allergy interaction checks Criteria Ambulatory & Inpatient Vital signs, body mass index, and growth charts erx Ambulatory Only Demographics CQMs (3 criteria) Clinical summaries Clinical information reconciliation Incorporate lab tests and values/results Transmission to cancer registries Problem list Clinical decision support Drug-formulary checks TOC receive, display, and incorporate toc/referral summaries Patient list creation Smoking status Transmission to Immunization Registries End-user device encryption Auditable events and tamperresistance Audit report(s) TOC create and transmit toc/referral summaries Patient-specific education resources Automated measure calculation Transmission to public health agencies syndromic surveillance Inpatient Only Transmission of reportable lab tests and values/results Slide 66 of 109
Unchanged Certification Criteria Ambulatory & Inpatient CPOE Medication list Medication allergy list Authentication, access control, & authorization Integrity Incorporate lab test results (inpatient only) Vital signs, body mass index, and growth charts Patient lists Advance directives Immunization information Automatic log-off Emergency access Accounting of disclosures Smoking status Drug-formulary checks Patient reminders Reportable laboratory tests and Public health surveillance values/results These certification criteria would be eligible for gap certification Slide 67 of 109
2014 Edition CEHRT Easy as 1, 2, 3 + C* What varies is the quantity of EHR technology certified to the 2014 Edition EHR certification criteria that would be necessary to be used to meet MU EP/EH/CAH would only need to have EHR technology with capabilities certified for the MU menu set objectives & measures for the stage of MU they seek to achieve. Base HER 1 EP/EH/CAH would need to have EHR technology with capabilities certified for the MU core set objectives & measures for the stage of MU they seek to achieve unless the EP/EH/CAH can meet an exclusion. EP/EH/CAH must have EHR technology with capabilities certified to meet the Base EHR definition. Slide 68 of 109
Two Types of Certifications Issued Complete EHR or EHR Module 1 2 3 4 Universe of EHR technology capabilities (e.g., all of what XYZ s EHR technology includes) 2014Ed Complete EHR definition Supports MUS1 or MUS2 achievement Certified to all 2014Ed cert. criteria for setting EHR Module certified to quantity of 2014Ed necessary to support MUS1 Inner square = EHR Module certified to quantity of 2014Ed less than MUS1 (or MUS2) Outer square = EHR Module certified to quantity of2014ed necessary to support MUS2 5 Base EHR definition = certified EHR Module 6 EHR Module certified to less than Base EHR definition Point to remember: Certification s scope does NOT address all capabilities included in EHR technology 2014 Edition Scope Stops Here Slide 69 of 109
2014 Edition EHR Certification Criteria Mapped to the 2014 CEHRT Definition for EHs & CAHs Seeking to Achieve MU Stage 2 in and sfter CY 2014 2014 Certification Criteria associated with MU Core Stage 2: Drug-drug, drug-allergy interaction checks (170.314(a)(2)) Vital signs, BMI, & growth charts (170.314(a)(4)) Smoking status (170.314(a)(11)) Patient list creation (170.314(a)(14)) Patient-specific education resources (170.314(a)(15)) emar (170.314(a)(16)) Clinical information reconciliation (170.314(b)(4)) Incorporate lab tests & values/results (170.314(b)(5)) View, download, & transmit to 3rd Party (170.314(e)(1)) Immunization information (170.314(f)(1)) Transmission to immunization registries (170.314(f)(2)) Transmission to PH agencies syndromic surveillance (170.314(f)(3)) Transmission of reportable lab tests & values/results (170.314(f)(4)) * optional 2014 ed. certification criteria for which certification may be required: > Automated numerator recording (170.314(g)(1)) > Automated measure calculation (170.314(g)(2)) > Safety-enhanced design (170.314(g)(3)) > Quality management system (170.314(g)(4)) 2014 Certification Criteria associated with a Base EHR: > CPOE (170.314(a)(1)) > Demographics (170.314(a)(3)) > Problem list (170.314(a)(5)) > Medication list (170.314(a)(6)) > Medication allergy list (170.314(a)(7)) > Clinical decision support (170.314(a)(8)) > Transitions of care (170.314(b)(1) & (2)) > Data portability (170.314(b)(7)) > Clinical quality measures (170.314(c)(1) - (3)) > Privacy and Security CC: o Authentication, access control, authorization (170.314(d)(1)) o Auditable events & tamper resistance (170.314(d)(2)) o Audit report(s) (170.314(d)(3)) o Amendments (170.314(d)(4)) o Automatic log-off (170.314(d)(5)) o Emergency access (170.314(d)(6)) o End-user device encryption (170.314(d)(7)) o Integrity (170.314(d)(8)) o Accounting of disclosures* (170.314(d)(9)) 2014 Certification Criteria associated with MU Menu Stage 2: > Electronic notes (170.314(a)(9)) > Drug-formulary checks (170.314(a)(10)) > Image results (170.314(a)(12)) > Family health history (170.314(a)(13)) > Advance directives (170.314(a)(17)) > erx (170.314(b)(3)) > Transmission of e-lab tests & values/results to providers (170.314(b)(6)) Slide 70 of 109
Stage 1 3 Trajectory Stage 1 Data capturing and sharing Stage 2 Advanced clinical processes Stage 3 Improved outcomes Slide 71 of 109
Stage 3 NPRM Requirements 72
Goals of Proposed Provisions 1 Provide a flexible, clear framework to simplify the meaningful use program and reduce provider burden 2 Ensure future sustainability of Medicare and Medicaid EHR Incentive Programs 3 Advance the use of health IT to promote health information exchange and improved outcomes for patients Slide 73 of 109
Stage 3 NPRM Streamlines Programs Streamlining Synchronizing on single stage and single reporting period Slide 74 of 109
Stage 3 NPRM Streamlines Programs Streamlining Reducing burden by removing objectives that are: Redundant to other more advanced measures being retained Duplicative of other measures using same certified EHR technology function Topped out and have reached high performance Slide 75 of 109
Stage 3 NPRM Streamlines Programs Streamlining 8 advanced use objectives
Stage 3 NPRM Improves Outcomes Stage 3 NPRM focuses on objectives which support advanced use of EHR technology and quality improvement Health information exchange objectives improve outcomes by: Ensuring providers caring for same patient are sharing info with one another Providing patients with easy access to health info Fostering data collection in sharable format across multiple health care organizations Supporting learning health system through sharing of common clinical dataset and expanding types of registries to which hospitals and providers can report Slide 77 of 109
Stage 3 NPRM Increases Interoperability Stage 3 NPRM increases interoperability by: Simplifying requirements to focus on objectives supporting advanced use of health IT Requiring providers to report on 2 of 3 HIE measures Requiring Stage 3 in 2018 for all to increase scale of participation and support growth in HIE and patient engagement infrastructure Slide 78 of 109
Stage 3 NPRM Provides Flexibility The Stage 3 proposed rule makes the meaningful use program more flexible: Have option to report on Stage 3 criteria in 2017 Required to report on Stage 3 beginning in 2018 regardless of prior participation/stage of meaningful use Slide 79 of 109
Stage 3 NPRM Provides Flexibility The Stage 3 proposed rule makes the meaningful use program more flexible: Simplifying meaningful use objectives and measures and allowing flexible measures for: health information exchange consumer engagement public health reporting Providing enhanced flexibility and options for public health reporting Slide 80 of 109
Stage 3 Requirements, Objectives & Measures 81
Reporting Period Full calendar year reporting period beginning in 2017 CQM reporting in coordination with quality reporting programs Slide 82 of 109
Stage 3 Proposed Objectives 1. Protect Electronic Health Information 2. Electronic Prescribing (erx) 3. Clinical Decision Support 4. Computerized Provider Order Entry (CPOE) 5. Patient Electronic Access to Health Information 6. Coordination of Care through Patient Engagement 7. Health Information Exchange 8. Public Health Reporting Slide 83 of 109
Retained Stage 2 objectives with small modifications 84
Objective Protect Electronic Health Information Electronic Prescribing (erx) Measure(s) 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, EH s, or CAH's risk management process. EP Measure: 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. EH/CAH Measure: More than 25% of hospital discharge medication orders for permissible prescriptions (for new, changed, and refilled prescriptions) are queried for a drug formulary and transmitted electronically using CEHRT. Clinical Decision Support EPs, EHs, and CAHs must satisfy both measures in order to meet the objective: Computerized Provider Order Entry (CPOE) 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 drugdrug and drug- allergy interaction checks for the entire EHR reporting period. More than 80% of medication, 60% of laboratory, and 60% of diagnostic imaging orders are recorded using CPOE. EPs, eligible hospital, or CAH must meet all 3 measures. 85
Objectives with more expanded scope: 1. Patient Electronic Access to Health Information 2. Coordination of Care through Patient Engagement 3. Health Information Exchange 4. Public Health Reporting Slide 86 of 109
Objective Patient Electronic Access to Health Information Measure(s) EPs/EHs/CAHs 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/EH/CAH, subject to the provider's discretion to withhold certain information. Measure 2 Use clinically relevant information from CEHRT to identify patientspecific educational resources and provide electronic access to those materials to 35% of patients. 87
Objective Coordination of Care through Patient Engagement Measure(s) EPs/EHs/CAHs 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/EH/CAH during the EHR reporting period (1) view, (2) download, or (3) transmit to a third party their health information. Or enable API and meet Measure 1 of Patient Electronic Access Objective. Measure 2 EP/EH/CAHs 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/EH/CAH must use health information received electronically from a non-physician source for 15% of patients encountered by EP/EH/CAH 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/EH/CAH in the reporting period. 88
Objective Health Information Exchange Measure(s) EPs/EHs/CAHs must attest to 3 measures, but meet 2 out of 3 thresholds: Measure 1 The EP/EH/CAH 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/EH/CAH 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/EH/CAH. Provider may choose to reconcile 2 out of 3 of the following: meds, problems, and allergies. 89
Objective Public Health Reporting Measure(s) Providers must report data on an ongoing basis to established public health registries. Registry options: Immunization, syndromic surveillance, ELR, specialized (PDMP, cancer, etc.) EP Objective: Report 3 measures from #1-5 EH/CAHs Objective: Report 4 measures from #1-6 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** Measure 6- Electronic Reportable Laboratory Results *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. 90
Modifications for meaningful use in 2015-2017 91
Goals of Proposed Provisions 1 Align with Stage 3 proposed rule to achieve overall goals of programs 2 Synchronize reporting period objectives and measures to reduce burden 3 Continue to support advanced use of health IT to improve outcomes for patients Slide 92 of 109