01-10c - introduction to healthcare and public health in the us - unit 10 - meaningful use of health...

Introduction to Healthcare and Public Health in the US

Meaningful Use of Health Information Technology

Lecture c

This material (Comp1_Unit10c) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number

IU24OC000015.

Meaningful Use (MU) of Health Information Technology

Learning Objectives• Define meaningful use of health information technology in the

context of the Health Information Technology for Economic and Clinical Health (HITECH) Act (Lecture a)

• Describe the major goals of meaningful use (Lecture a)• Define the criteria for Stages 1 and 2 of meaningful use for

eligible professionals and eligible hospitals (Lecture b)• Describe the standards specified for Stages 1 and 2 of

meaningful use, including those devoted to privacy and security (Lecture c)

• Define the clinical quality measures (CQMs) for the meaningful use program (Lecture c)

2Health IT Workforce Curriculum Version 3.0/Spring 2012

Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology

Lecture c

HITECH, ARRA and Achieving Meaningful Use

• Standards• Privacy and security• Clinical quality measures (CQMs)



Lecture c

Standards for Stages 1 and 2

10.21 Chart: Metzger, 2012



Lecture c

Standards for Stages 1 and 2 (continued)




Lecture c

Additional Standards For Stage 2• Amendments – to support HIPAA compliance, EHR must accept

patient-supplied information in both free text and scanned format and append/amend it to EHR

• Encryption of data on end-user devices – any electronic health information on end-user devices must encrypt such information once it is no longer being actively used

• View, download and transmit to third party – EHR must be able to• Transmit ambulatory and inpatient summary to a third party• Include “patient accessible log” to track use of the view,

download, and transmit capabilities and make that information available to the patient

• Cancer case information and transmission to cancer registries – EHR must have capability to identify and report cancer cases to a state cancer registry (except where prohibited by law) (menu option for EPs)



Lecture c

Additional Standards For Stage 2 (continued)

• Transitions of care – EHR must be able to• Receive, display and incorporate transition of care/referral summaries• Create and transmit transition of care/referral summaries

• CQMs – three new criteria• Electronic data capture and export – EHR must be able to record data

that would be required in order to calculate CQMs, and export the data in the event that an EP, EH, or CAH chooses to use a different certified EHR module to perform the calculation of CQM results

• Electronic data import and calculation – EHR technology must be able to electronically import all of the data elements necessary to calculate CQMs for which it is to be certified

• Electronic submission of CQM data to CMS – EHR must be able to create for electronic transmission CQM results in a data file defined by CMS, i.e., put CQM results into an XML data file and be able to send it



Lecture c

Stage 2 Requirements For Summary Care Record

• Patient name and demographic information including preferred language (ISO 639-2 alpha-3), sex, race/ethnicity (OMB Ethnicity) and date of birth

• Vital signs including height, weight, blood pressure, and smoking status (SNOMED CT)

• Encounter diagnosis (SNOMED CT or ICD-10-CM)• Procedures (SNOMED CT)• Medications (RxNorm) and medication allergies (RxNorm)• Laboratory test results (LOINC)• Immunizations (CVX)• Functional status including activities of daily living, cognitive and disability

status• Care plan field including goals and instructions• Care team including primary care provider of record• Reason for referral and referring provider’s name and office contact

information (for providers)• Discharge instructions (for hospitals)



Lecture c

Required Privacy and Security Standards for Meaningful Use

• Encryption/decryption– Any approved algorithm in FIPS 140-2– HIE requires encryption and integrity-protected link

• Record actions– Date, time, patient, and user recorded for creation, modification,

access, and deletion• Verification of no alteration in transit

– SHA-1 algorithm or stronger, as specified in FIPS 180-3• Record TPO disclosures

– Date, time, patient, and user recorded for HIPAA-allowed activities(from Geek Doctor: geekdoctor.blogspot.com)



Lecture c

Clinical Quality Measures Stage 1

• EPs must report on– 3 core measures

• Can substitute alternate core measures if denominator of any core measure is 0

– 3 of 38 additional measures• EHs must report on 15 measures• CMS aiming to align all quality reporting

programs, i.e., PQRS, e-Rx, HQA, etc.



Lecture c

Eligible Professionals Core Clinical Quality Measures




Lecture c

Eligible ProfessionalsAlternate Core Clinical Quality

Measures




Lecture c

Eligible Professionals Additional Clinical Quality Measures (1-12)

• Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment

• Appropriate Testing for Children with Pharyngitis• Asthma Assessment• Asthma Pharmacologic Therapy• Breast Cancer Screening• Cervical Cancer Screening• Chlamydia Screening for Women• Colorectal Cancer Screening• Controlling High Blood Pressure• Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with

Prior Myocardial Infarction (MI)• Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol• Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for

Patients with CAD



Lecture c


• Diabetes: Blood Pressure Management• Diabetes: Eye Exam• Diabetes: Foot Exam• Diabetes: Hemoglobin A1c Control (<8.0%)• Diabetes: Hemoglobin A1c Poor Control• Diabetes: Low Density Lipoprotein (LDL) Management and Control• Diabetes: Urine Screening• Diabetic Retinopathy: Communication with the Physician Managing Ongoing

Diabetes Care• Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema

and Level of Severity of Retinopathy• Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin

Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)• Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction

(LVSD)• Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation



Lecture c


• Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement

• Ischemic Vascular Disease (IVD): Blood Pressure Management• Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control• Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic• Low Back Pain: Use of Imaging Studies• Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone

Receptor (ER/PR) Positive Breast Cancer• Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients• Pneumonia Vaccination Status for Older Adults• Prenatal Care: Anti-D Immune Globulin• Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)• Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation• Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer

Patients• Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco

Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies

• Use of Appropriate Medications for Asthma



Lecture c

Eligible Hospitals Clinical Quality Measures

• Anticoagulation overlap therapy• Emergency Department Throughput – admitted patients – Admission decision time to ED

departure time for admitted patients• Emergency Department Throughput – admitted patients – Median time from ED arrival to ED

departure for admitted patients• Incidence of potentially preventable venous thromboembolism • Intensive Care Unit venous thromboembolism prophylaxis• Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2• Ischemic or hemorrhagic stroke – Rehabilitation assessment• Ischemic or hemorrhagic stroke – Stroke education• Ischemic stroke – Anticoagulation for atrial fibrillation/flutter• Ischemic stroke – Discharge on anti-thrombotics• Ischemic stroke – Discharge on statins• Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom onset• Platelet monitoring on unfractionated heparin• Venous thromboembolism discharge instructions• Venous thromboembolism prophylaxis within 24 hours of arrival



Lecture c

Clinical Quality Measures – Starting In 2014 For All Stages




Lecture c

National Quality Strategy Domains

• Patient and Family Engagement• Patient Safety• Care Coordination• Population and Public Health• Efficient Use of Healthcare Resources• Clinical Processes/Effectiveness



Lecture c

Results of Stage 1 Adoption Through August, 2012




Lecture c

Informatics Now Lives In A HITECH World

• Although not all of biomedical and health informatics, HITECH and MU are now the major drivers

• HITECH brings use of EHRs, quality reporting, etc. to mainstream of healthcare

• Leading to better ways to learn about MU? (Courtesy of Ross Martin, MD, formerly of ONC)– http://www.youtube.com/watch?v=Gv1s8fM3mMk– http://vimeo.com/20923483



Lecture c


Summary – Lecture c• In addition to meaningful use objectives required of

eligible professionals and hospitals, there are various standards for structure of the data and its security

• The clinical quality measures for meaningful use must be reported to receive the incentive payments, and the new measures that will be unveiled in 2014 will be required of all eligible professionals and hospitals no matter the current stage



Lecture c


Summary• The HITECH Act of ARRA legislated incentives

for the “meaningful use” (MU) of health IT• MU means that criteria for use of IT are tied

back to goals of the health care system• These criteria are met by eligible professionals

and eligible hospitals to receive incentive payments for use of EHRs



Lecture c

Meaningful Use of Health Information Technology References – Lecture c

References Blumenthal, D. (2010). Launching HITECH. New England Journal of Medicine, 362, 382-385. Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic health records.

New England Journal of Medicine, 363, 501-504. Metzger, J. and Rhoads, J. (2012). Summary of Key Provisions in Final Rule for Stage 2 HITECH

Meaningful Use. Falls Church, VA, Computer Sciences Corp. http://assets1.csc.com/health_services/downloads/CSC_Key_Provisions_of_Final_Rule_for_Stage_2.pdf.

Charts, Tables, Figures 10.21 – 10.27 Charts: Metzger, J. and Rhoads, J. (2012). Summary of Key Provisions in Final Rule

for Stage 2 HITECH Meaningful Use. Falls Church, VA, Computer Sciences Corp. http://assets1.csc.com/health_services/downloads/CSC_Key_Provisions_of_Final_Rule_for_Stage_2.pdf. (By Permission)



Lecture c

http://assets1.csc.com/health_services/downloads/CSC_Key_Provisions_of_Final_Rule_for_Stage_2.pdf




01-10c - introduction to healthcare and public health in the us - unit 10 - meaningful use of health...

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