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Meaningful Use Workgroup. Stage 3 Update Paul Tang, Chair George Hripcsak, Co-Chair. January 16, 2014. Improving quality of care and safety: Stage 3 Priorities. Stage 3 Functional Objectives. MU Outcome Goals. Stage 1 + 2 Functional Objectives. Stage 3 Functionality Goals. CDS - PowerPoint PPT Presentation

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PowerPoint Presentation

Stage 3 Update

Paul Tang, ChairGeorge Hripcsak, Co-Chair

Meaningful Use WorkgroupJanuary 16, 2014Improving quality of care and safety:Stage 3 Priorities1Stage 3 Functional ObjectivesCDSStructured dataCare planningRemindersImagingFamily historyElectronic notesHospital labsSafetyeMAROrder trackingUDI Med adherenceMU Outcome GoalsPatients receive evidence-based carePatients are not harmed by their carePatients do not receive inappropriate careStage 1 + 2 Functional ObjectivesCPOECDSStructured data :DemographicsProblem, Med, Allergy listsVitals, smoking statusLab resultsImagingFamily historyProgress notesSafetyeRx, drug interaction, drug-allergy checkseMARRed: Changes to objectiveBlue: Newly introducedStage 3 Functionality GoalsAll relevant data accessible through EHRCDS supports timely, effective, safe, efficient care and preventionCDS helps avoid inappropriate care1Improving quality of care and safety:Clinical decision support (CDS)2Functionality Needed to Achieve GoalsCore: EPs/EHs demonstrate use of multiple CDS interventions that apply to quality measures in at least 4 of the 6 National Quality Strategy priorities. Recommended intervention areas:Preventive careChronic disease management (e.g., diabetes, coronary artery disease) Appropriateness of lab and radiology orders (e.g., medical appropriateness, cost-effectiveness)Advanced medication-related decision support* (e.g., renal drug dosing, condition-specific recommendations). Improving the accuracy/completeness of the problem list, medication list, drug allergiesDrug-drug and drug-allergy interaction checksStage 3 Functionality GoalsAll relevant data accessible through EHRCDS supports timely, effective, safe, efficient care and preventionCDS helps avoid inappropriate care2Improving quality of care and safety:Care Planning3Functionality Needed to Achieve GoalsCore for EHs, introduce as Menu for EPsRecord whether a patient 65 years old or older has an advance directive Threshold: Medium Certification Criteria: CEHRT has the functionality to store the document in the record or include more information about the document (e.g., link to document or instructions regarding where to find the document or where to find more information about it).Stage 3 Functionality GoalsAll relevant data accessible through EHRCDS supports timely, effective, safe, efficient care and preventionCDS helps avoid inappropriate care3Improving quality of care and safety:eMAR4Functionality Needed to Achieve GoalsCore: EHs automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR)Threshold: MediumCertification criteria: CEHRT provides the ability to track mismatches between the order and what was administered to use for quality improvement Stage 3 Functionality GoalsAll relevant data accessible through EHRCDS supports timely, effective, safe, efficient care and preventionCDS helps avoid inappropriate care4Improving quality of care and safety:Imaging5Functionality Needed to Achieve GoalsFor both EPs (menu) and EHs (core) imaging results should be included in the EHR. Access to the images themselves should be available through the EHR. Threshold: LowCEHRT should have ability to deliver a patient friendly description of the result from the provider to the patient Stage 3 Functionality GoalsAll relevant data accessible through EHRCDS supports timely, effective, safe, efficient care and preventionCDS helps avoid inappropriate care5Improving quality of care and safety:Electronic Notes6Functionality Needed to Achieve GoalsCore: EPs record an electronic progress note, authored by theeligible professional. Electronic progress notes (excluding the discharge summary) should be created, edited, and signed by an authorized provider of the EH or CAH (Core)Notes must be text-searchableNon-searchable scanned notes do not qualify but this does not mean that all of the content has to be character text. Drawings and other content can be included with text notes under this measureThreshold: LowCertification Criteria: Provide functionality analogous to track changes in Microsoft Word. Help reader assess accuracy and find relevant changes by making the originating source of sections of clinical documents transparent.Default view of documents in the medical record and those transmitted to other EHRs is a "clean copy" (i.e. not showing tracked changes). The reader can easily click a button and view the tracked-changes version.Stage 3 Functionality GoalsAll relevant data accessible through EHRCDS supports timely, effective, safe, efficient care and preventionCDS helps avoid inappropriate care6Improving quality of care and safety:Order Tracking7Functionality Needed to Achieve Goals*NEW* Menu - Eligible Professionals Results of consult requests are returned to the ordering providerCertification requirements:CEHRT provides ability to:Identify abnormal tests as indicated in the lab result messageIndicate a due date for orders when entering the orderNotify ordering provider when results are available or not completed by a certain timeRecord date and time that results are reviewed and by whomThreshold: Low Stage 3 Functionality GoalsAll relevant data accessible through EHRCDS supports timely, effective, safe, efficient care and preventionCDS helps avoid inappropriate care7Improving quality of care and safety:Unique Device Identifer8Functionality Needed to Achieve Goals*NEW* Eligible providers and hospitals should record the FDA Unique Device Identifier (UDI) when patients have devices implanted for each newly implanted deviceThreshold: HighStage 3 Functionality GoalsAll relevant data accessible through EHRCDS supports timely, effective, safe, efficient care and preventionCDS helps avoid inappropriate care8Improving quality of care and safety:Medication adherence9Functionality Needed to Achieve Goals*NEW* Certification Criteria CEHRT has the ability to:Access medication fill information from PBMAccess PDMP data in a streamlined way (e.g., sign-in to PDMP system)Provide patients with the ability to share their adherence history (using structured questionnaire)

Stage 3 Functionality GoalsAll relevant data accessible through EHRCDS supports timely, effective, safe, efficient care and preventionCDS helps avoid inappropriate care9Engaging patients and families in their care:Stage 3 Priorities10Stage 3 Functional ObjectivesView, download, transmitAmendmentsPatient Generated Health DataClinical summaryPatient-specific educational resourcesSecure messagingMU Outcome GoalsPatients understand their disease and treatmentsPatients participate in shared decision makingPatient preferences honored across care teams Stage 1 + 2 Functional ObjectivesView, download, transmitClinical summaryPatient-specific educational resourcesSecure messagingRed: Changes to objectiveBlue: Newly introducedStage 3 Functionality GoalsEnabling active participation by patients and families to improve health and care Provide ability to contribute information in the record, including patient reported outcomes (PRO)Patient preferences recorded and used10Engaging patients and families in their care:View, Download, Transmit11Functionality Needed to Achieve GoalsEligible Professionals/Eligible Hospitals provide patients with the ability to view online, download, and transmit (VDT) their health information within 24 hours if generated during the course of a visit and ensure the functionality is in use by patients.Threshold for availability: High (i.e., the functionality is available to the majority of patients; it does not require patients to view information online, if they chose not to)Threshold for use: lowLabs or other types of information not generated within the course of the visit should be made available to patients within four (4) business days of information becoming availableAdd family history to data available through VDT Mobile access to VDT is encouraged as an essential way to reach underserved populations.Stage 3 Functionality GoalsEnabling active participation by patients and families to improve health and care Provide ability to contribute information in the record, including patient reported outcomes (PRO)Patient preferences recorded and used11Engaging patients and families in their care:Amendments12Functionality Needed to Achieve Goals*NEW* Certification Criteria only: Provide patients with an easy way to request an amendment to their record online (e.g., offer corrections, additions, or updates to the record) Stage 3 Functionality GoalsEnabling active participation by patients and families to improve health and care Provide ability to contribute information in the record, including patient reported outcomes (PRO)Patient preferences recorded and used12Engaging patients and families in their care:Patient Generated Health Data13Functionality Needed to Achieve Goals*NEW* Menu Eligible Providers and Hospitals Providers accept electronically submitted patient-generated health information through structured or semi-structured questionnaires (e.g., screening questionnaires, intake forms, risk assessment, functional status) or secure messaging. (NB: an organization that accepts patient-generated information using interfaces to remote devices may count that as patient-generated health information.) Low threshold Stage 3 Functionality GoalsEnabling active participation by patients and families to improve health and care Provide ability to contribute information in the record, including patient reported outcomes (PRO)Patient preferences recorded and used13Engaging patients and families in their care:Visit Summary/Clinical Summary14Functionality Needed to Achieve GoalsEPs provide office-visit summaries to patients or patient-authorized representatives with relevant, actionable information, and instructions pertaining to the visit in the form/media preferred by the patie

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