E Z BIS ELECTRONIC HEALTH RECORDS

E Z BIS ELECTRONIC HEALTH RECORDS CERTIFICATION AND THE HITECH INCENTIVE PROGRAM The Incentives On July 13, 2010, the U.S. Department of Health and Human Services finalized the Electronic Health Record Incentive Program, otherwise known as the Meaningful Use rule. The rule establishes incentives for health care providers to obtain and use certified electronic health records (EHR) technology. The incentive amounts are based on allowable charges submitted to Medicare and Medicaid. E Z BIS believes that the overwhelming majority of eligible providers (EPs) will qualify under the Medicare program. Medicaid qualification is much more difficult for most providers, with a requirement of a minimum of 30% Medicaid patient volume. The Medicare program allows for a maximum possible incentive payment amount of $44,000, over five years. The incentives are intended to help health care providers offset a portion of the cost of purchasing, implementing and using certified EHR technology. Incentive payments can begin as early as April of 2011. However, providers who begin using certified as late as 2012 are eligible to receive the entire maximum payment amount. The following chart shows the timetable for the five payment years: EHR Adoption Year 2011 2012 2013 2014 2015 2016 Maximum Incentive s Adopt in 2011 $ 18,000 $ 12,000 $ 8,000 $ 4,000 $ 2,000 $ 44,000 Adopt in 2012 $ 18,000 $ 12,000 $ 8,000 $ 4,000 $ 2,000 $ 44,000 Adopt in 2013 $ 15,000 $ 12,000 $ 8,000 $ 4,000 $ 39,000 Adopt in 2014 $ 12,000 $ 8,000 $ 4,000 $ 24,000 The amount of incentive for each year is based on the allowable Medicare charges submitted in the previous year. Eligible providers who become meaningful users of certified EHRs in 2011 or 2012 are paid 75% of the allowed Medicare charges during the payment year, with a maximum of $18,000 for the first payment year, $12,000 for the second payment year, $8,000 for the third payment year, $4,000 for the fourth payment year and $2,000 for the fifth and final payment year. Providers who adopt and use certified software after 2012 qualify for a lesser maximum amount. What is Certified Electronic Health Records Technology? To qualify for incentive payments, eligible providers must obtain electronic health records technology that has been certified to meet the requirements established in the Standards, Implementation Specifications and Certification Criteria for Electronic Health Record Technology rule. Software certification is performed by an Authorized Certification and Testing Body, or ONC-ATCB. EHR 1

technology can be certified either as a Complete EHR, or certified as one or more EHR Modules. It is permissible for an eligible provider to use a combination of more than one EHR module, from more than one vendor, to meet the requirements to prove Meaningful Use of certified EHR technology. It is expected that the EHR systems will begin to be certified by ONC-ATCBs in the fall of 2010. What is Meaningful Use? To qualify for the HITECH incentives, eligible providers must not only obtain certified EHR technology, but must become meaningful users of that technology. Meaningful Use can be defined as using certified EHR technology to meet a number of pre-determined objectives, working toward the following goals: To improve the quality, safety, and efficiency of care while reducing disparities; To engage patients and families in their care; To promote public and population health; To improve care coordination; and To promote the privacy and security of EHRs. Over the five payment years of the incentive program, the Meaningful Use objectives will be phasedin over three stages. Eligible providers must meet the objectives in each of the three stages in order to continue to receive incentive payments. Stage 1 sets the baseline for electronic data capture and information sharing. Stage 2 (estimated for 2013) and Stage 3 (estimated for 2015) will continue to expand on this baseline and be will be further developed through future rule making. It should be emphasized that the key to receiving incentive payments is not in obtaining certified EHR technology, but in meeting the objectives necessary to demonstrate Meaningful Use of that technology. Stage 1 (2011-2012) consists of 25 objectives, divided into two broad categories of the Core Set and the Menu Set. The core set is made up of 15 objectives that must be met by all eligible providers. The Menu Set consists of 10 additional objectives. Providers can choose five of the ten objectives to meet the Meaningful Use requirements for Stage 1. The remaining five objectives will be deferred to Stage 2. In all, providers must achieve 20 out of 25 objectives in order to qualify for the incentives in Stage 1. Each objective has specific measures for meeting the objectives in order to prove Meaningful Use. Stages 2 and 3 of the incentive program for the years 2013-2015 will require providers to achieve any of the Menu Set objectives that were deferred from Stage 1, introduce additional new objectives and will raise the bar for meeting the objectives introduced in Stage 1 by increasing the measurement minimums. The Meaningful Use rule provides for exclusions to some of the objectives in both the Core Set and the Menu Set, due to the fact that some objectives are not applicable to some providers due to scope of practice, patient population or other circumstances. "For example, chiropractors do not have prescribing authority and thus may not make use of an EHR technology s e-prescribing function and rheumatologists may not require information on vital signs." When exclusions apply, the number of objectives required in the 2

Core Set or in the Menu Set is reduced by the number of objectives for which the provider has obtained exclusions. Core Set of Objectives for Eligible Providers (Medicare program) Required for all eligible providers 1 Meaningful Use Objective Use computerized order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines More than 30% of unique patients with at least one medication in their medication list Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period 2 3 Implement drug-drug and drug-allergy interaction checks Generate and transmit permissible prescriptions electronically (erx) The eligible provider (EP) has enabled this functionality for the entire EHR reporting period More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period 4 5 6 7 8 Record Demographics Preferred language Gender Race Ethnicity Date of birth Maintain an up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Height Weight Blood pressure Calculate and display body mass index (BMI) Plot and display growth charts for children 2-20 years, including BMI More than 50% of all unique patients seen by the EP have demographics recorded as structured data 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 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 More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data For more than 50% of all unique patients age 2 and over seen by the EP, height, weight and blood pressure are recorded as structured data Exclusion: Any EP who either see no patients 2 years or older, or who believes that all three vital signs 3

Meaningful Use Objective of height, weight, and blood pressure of their patients have no relevance to their scope of practice 9 Record smoking status for patients 13 years old or older More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data Exclusion: Any EP who sees no patients 13 years or older 10 11 12 Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance that rule Report ambulatory clinical quality measures to CMS Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request. Implement one clinical decision support rule Successfully report to CMS, ambulatory clinical quality measures selected by CMS in the manner specified by CMS More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 days Exclusion: Any EP that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period 13 Provide clinical summaries for patients for each office visit Clinical summaries provided to patients for more than 50% of all office visits within 3 business days Exclusion: Any EP who has no office visits during the EHR reporting period 14 15 Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, diagnostic test results) among providers of care and patient authorized entities electronically Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information Conduct or review a security risk analysis in accordance with the requirements under the HIPAA Security Rule and implement security updates as necessary and correct identified security deficiencies as part of its risk management process 4

Menu Set of Objectives for Eligible Providers (Medicare program) Five required for Stage 1, five may be deferred to Stage 2 1 2 Meaningful Use Objective Implement drug-formulary checks Incorporate clinical lab-test results into EHR as structured data The EP has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period More than 40 percent of all clinical lab tests 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 Exclusion: An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period 3 4 Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach Send reminders to patients per patient preference for preventive/follow-up care Generate at least one report listing patients of the EP with a specific condition More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period Exclusion: An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology 5 Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP At least 10 percent of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP's discretion to withhold certain information Exclusion: Any EP that neither orders nor creates any of the following information during the reporting period: lab test results, problem list, medication list, or medication allergy list. 6 7 Use certified EHR technology to identify patientspecific education resources and provide those resources to the patient if appropriate The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation More than 10 percent of all unique patients seen by the EP are provided patient-specific education resources The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP Exclusion: An EP who was not the recipient of any transitions of care during the EHR reporting period 8 The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more 5

Meaningful Use Objective summary care record for each transition of care or referral than 50 percent of transitions of care and referrals Exclusion: An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period 9 Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice 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) Exclusion: An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically 10 Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice 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) Exclusion: An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically E Z BIS Certification E Z BIS believes than many of the goals of the HITECH incentive program are worthy and well intended. There is much potential benefit for health care providers in embracing electronic health record technology to standardize health information data formats and to easily exchange health records between providers of care, patients and health agencies. However, our opinion is that many of the specific objectives that have been laid out in the Meaningful Use rule do not provide benefit to many health care providers. Some requirements for proving Meaningful Use will cause doctors and staff members to spend valuable time obtaining, recording and reporting data and performing tasks that do not help to improve patient care. Not all providers qualify for the incentives. Those that do not treat Medicare patients, do not bill Medicare directly and certain health care specialists, such as physical therapists, cannot receive funds under the Medicare incentive plan. To qualify for incentives under Medicaid, 30% of a provider's patient population must be Medicaid patients. For those providers who do qualify to receive incentive payments and who do choose to achieve Meaningful Use, E Z BIS is certified as a Complete EHR and provides the needed 6

capabilities to achieve the meaningful use objectives. Our certification was completed on February 25, 2011 by The Drummond Group, an ONC Authorized Certification and Testing Body. E Z BIS certified EHR technology is available for eligible providers to meet the meaningful use objectives for the 2011 payment year and which will allow E Z BIS users to achieve Meaningful Use and receive the maximum incentive payments for which they qualify, up to $44,000. We currently provide all functionality that is necessary to meet the requirements for Stage 1, and we will also re-certify the software for the additional requirements for Stages 2 and 3. Because we believe that many providers will either choose not to attempt to meet the Meaningful Use objectives, or because they simply do not qualify for the program, E Z BIS offers the certified component as an optional add-on for our E Z BIS Electronic Health Records software, which already gives providers the ability to maintain complete patient health information, perform exams, record x-ray findings and impressions, quickly and easily enter daily progress notes and produce professional-looking, complete documentation. This approach gives E Z BIS users the option to choose the software that best meets their own needs. E Z BIS has been developing and providing electronic health records software for greater than thirty-one years. We plan to continue to create software that helps providers to improve office efficiency so that doctors and therapists can maximize their time for patient care. We also embrace the goals of the Electronic Health Record Incentive Program and are committed to providing certified technology for achieving Meaningful Use. This Complete EHR is 2011/2012 compliant and has been certified by Drummond Group, an ONC-ATCB approved to certify any complete or modular EHR both ambulatory and inpatient, in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. E-Z BIS, Inc. completed EHR certification on February 25, 2011 for E-Z BIS Office v8.2. Certification ID: 02252011-1071-6. Clinical Quality s tested: NQF0013, NQF0024, NQF0028, NQF0038, NQF0041, NQF0052, NQF0056, NQF0061, NQF0421. Additional software used: Emdeon Clinician (erx module) 7