mmsiv - incorporating meaningful use in the specialty ...€¦ · qualifyinglogistics attestation...

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April 10th 201212:00pm – 1:00 pm

Incorporating Meaningful Use in the Specialty Practice

- 0 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

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How to participate

Housekeeping

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• Or, to join by phone, select “Use Telephone” in your Audio window. See exampleS b it t t ti i th


• Submit your text question using the Questions pane

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General Information

• 1.0 AMA PRA Category 1 Credits™ (Risk Management)g y ( g )• Online evaluation and CME certificate• PowerPoint slides available for download• You will also receive this information in a reminder email,

following the webinar• Questions during the webinar may be typed into the

“questions” box on the right side of your screen• Questions will be answered at the end of the presentation


Questions will be answered at the end of the presentation• For help with technical difficulties, call 1-888-259-8414

Faculty Introductions

ModeratorPresenter

Jeff Loughlin, MHA Christina Moran, MPH


Massachusetts eHealth CollaborativeProject Director

[email protected]

,Massachusetts eHealth Collaborative

Strategy [email protected]

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Faculty Disclosures

The following faculty has indicated their financial interests and/or g yrelationships with commercial manufacturers as follows:

Jeff Loughlin, MHA, N/AChristina Moran, MPH N/A

Activity planners of today’s webinar have nothing to disclose.


MAEHC Mission: Facilitate Universal EHR Adoption

• Company launched September 2004

–Non-profit registered in the Commonwealth of Massachusetts

• CEO on board January 2005


• Backed by broad array of 34 non-profit MA health care stakeholders

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MAeHC Selected Three Pilot Sites From 35 Applicants: Brockton, Newburyport, North Adams

• Provided EHRs to ~600 clinicians practicing in over 200 office locations


office locations

• Created health information exchanges connecting the physicians with each other and with the hospitals

• Created a quality data center to extract clinical data from EHRs to evaluate effectiveness and measure performance

Since the pilot program, MAeHC has expanded its experience base and involvement in a variety of projects

300 Physician EHR implementation – Beth Israel Deaconess Physician Organization (BIDPO)

Community wide EHR Implementation HIE and Quality Data Center LargeCommunity-wide EHR Implementation, HIE, and Quality Data Center – Large Healthcare Foundation

HEAL 5 New York – New York State Department of Health and New York eHealthCollaborative (NYeC)

HEAL 10 New York – Adirondack Region Medical Home Pilot

State-level HIE technical services vendor procurement – Missouri HIO

St t L l H lth I f ti E h St t i d O ti l Pl


State Level Health Information Exchange Strategic and Operational Plan Development – New Hampshire

Regional Extension Center planning, deployment, and operations – New York, Massachusetts, Rhode Island, New Hampshire

www.maehc.org

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Polling Questions

Please note that we will be conducting a few polls during today’s webinar.

At various points during the presentation, you will be asked a brief question regarding HIT and EHR use.

At the appropriate time, a screen will pop-up on your computer.

Please select the appropriate response and click Submit.


Goals and Objectives

Goal:

To educate providers who are planning to use Electronic Health Records (EHRs) to incorporate the objectives of Meaningful Use into their daily office routines

Objective:

For providers to understand how to use the required functionality


within their EHR to achieve meaningful use, the specific standards required for compliance, and how the objectives can easily be incorporated into the basic workflow of a specialty office visit

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Agenda

American Recovery and Reinvestment Act Funding (ARRA)

Medicare and Medicaid Incentive Programs

What is Meaningful Use?What is Meaningful Use?

Meaningful Use in Practice

Clinical Quality Measures (CQM)

Health Information Exchange (HIE)

P tti Th Pi T th


Putting The Pieces Together

Questions, Contact Information and Resources

American Recovery and Reinvestment Act


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Estimated ARRA Funding for HIT and HIE

$30B35

$ M di id 90/10 f d

Direct payments to individual providers15

20

25

30

$28B

$1.2B

$1.1B Medicaid 90/10 fundsHealth information exchangesRegional health IT extension centers


0

5

10 Health Information Technology for Economic and Clinical Health(HITECH)

Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Agenda







P tti Th Pi T th




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Comparison of Medicare and Medicaid Incentive Programs

Medicare MedicaidMaximum incentive $44,000 ($48,000 in HPSA) $63,750

Payment calculation 75% of submitted allowable charges in a year, up to cap

Flat payment to cover allowable costs, up to cap

Eligibility Any ambulatory Eligible Professional doing Medicare business

Any ambulatory Eligible Professional doing Medicaid business

Limitations on eligibility No mid-levels 30% of services must be Medicaid; 20% for peds

NPs, NMWs qualify; PAs only in Rural Health Clinics

Penalties Penalties for non-compliance starting in 2015

No penalties

Qualifying period Any 90 continuous days between Jan 1 2011 and Dec 31 2011

Any 90 continuous days between Jan 1 2011 and Dec 31 2011


Qualifying logistics Attestation to CMS of all requirements, including submission of quality measure numerators and denominators for selected core measures; electronic submission of quality measures starting in 2012 (if available by CMS)

Attestation to state Medicaid of all requirements, including submission of quality measure numerators and denominators for selected core measures; electronic submission of quality measures starting in 2012 (if available by CMS)

AgendaAmerican Recovery and Reinvestment Act Funding (ARRA)


What is Meaningful Use?







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What is Meaningful Use

The Recovery Act specifies the 3 components of Meaningful Use:

• Use of certified EHR in a meaningful manner (e g e prescribing)• Use of certified EHR in a meaningful manner (e.g., e-prescribing)

• Use of certified EHR technology for electronic exchange of health information to improve quality of health care

• Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary


http://onc-chpl.force.com/ehrcert

Meaningful Use has five health related goals

Improve quality safety efficiency and reduce health disparitiesImprove quality, safety, efficiency and reduce health disparities

Engage patients and families in their health care

Improve care coordination

Improve population and public health


Ensure adequate privacy and security protections for personal health information

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Objectives relate to health related goals

Meaningful Use objectives and standards correlate with health related goals

Objective 15 Core Objectives

Standard Providers must meet all

standards unless an exception applies.

Ob

ject

ive 10 Menu Objectives

Sta

ndar

d Providers may defer up to 5 items for Stage 1. One menu item selected must be related to public health reporting


O S to public health reporting.

Exclusions are provided to account for specialties and variations in practice settings

Meaningful Use objectives and standards will change over time, focusing today on structured data and exchange

Stage 32015

Advanced clinical processes

Improved outcomes

Stage 12011-13

Stage 22014

Better clinical outcomes


Data capture and sharing

Improved population health outcomes Increased transparency and efficiency Empowered individuals More robust research data on health system

-Standards will be become higher in Stage 2-3- Menu items will become Core objectives

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Medicare EP Meaningful Use Qualifying Periods and Payment Schedule

Calendar YearAnnual Incentive

Calendar Year2011 2012 2013 2014 2015 2016 Total

First Qualifying

Year

2011 $18,000 $12,000 $8,000 $4,000 $2,000 $44,000

2012 $18,000 $12,000 $8,000 $4,000 $2,000 $44,000

2013 $15,000 $12,000 $8,000 $4,000 $39,000

2014 $12,000 $8,000 $4,000 $24,000

2015+ $0 $0 $0


Meaningful Use: Stage 1 Stage 2 Stage 3

Agenda







P tti Th Pi T th




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Polling Question

Before we beginning discussing the details of Meaningful Use, I would like to ask the audience about your use of Certified EHR Technology:

A I use an EHR but it is not certified by ONC for MUA. I use an EHR but it is not certified by ONC for MU

B. I use an ONC Certified EHR

C. I am planning to implement an EHR soon

D. None of the above


__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Meaningful Use is distributed throughout the clinical office visit correlating to the health related goals

CPOE RxDrug-Drug *FormularyePrescribe

DemographicsProblems _______________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ProblemsMedications

Rx AllergyVitals

SmokingCDSCQM

*eLabs*Dx List

*RemindersPt. eCopy

Clinical Summary*Pt. eAccess `

Improve quality, safety, efficiency and reduce health disparities



_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

*EducationHIE Capable

*Rx Reconcile*Referral summary

*Immunizations*Syndromic Data

Privacy & Security

* Menu Items




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_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Re-organizing Meaningful Use tasks can follow patient flow

*Dx List*Reminders

DemographicsVitals

SmokingRx Allergy

*Rx Reconcile ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CPOE RxDrug-Drug*FormularyePrescribeProblems

MedicationsCDS

*eLabsPt. eCopy

Clinical Summary*Pt. eAccess

*EducationCQM

`


___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Pre-Visit Registration Patient Intake

Provider Visit Check-Out Post Visit

CQMHIE Capable

*Referral summary*Immunizations

*Syndromic DataPrivacy & Security

* Menu Items

CMS FAQ #10151

If an eligible professional (EP) is unable to meet the measure of a Meaningful Use

objective because it is outside of the scope of his or her practice, will the EP be

excluded from meeting the measure of that objective under the Medicare and g j

Medicaid Electronic Health Record (EHR) Incentive Programs?

- - - - - - - -

Some Meaningful Use objectives provide exclusions and others do not. Exclusions

are available only when our regulations specifically provide for an exclusion. EPs

may be excluded from meeting an objective if they meet the circumstances of the

l i If EP i bl t t M i f l U bj ti f hi h


exclusion. If an EP is unable to meet a Meaningful Use objective for which no

exclusion is available, then that EP would not be able to successfully demonstrate

Meaningful Use and would not receive incentive payments under the Medicare and

Medicaid EHR Incentive Programs.

https://questions.cms.hhs.gov/app/answers/detail/a_id/10151

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How is meaningful use different for specialists?

• It is not! The objectives may appear to have a Primary Care focus, but are required for all providers unless they qualify for an exclusion to an objective.

M l i l t th ti b t l li i t b• Many exclusions may apply to the practice, but clear policies must be documented, i.e.. Vital signs not taken.

• Must have a detailed understanding of how your EHR vendor is calculating the denominator, i.e.. Office Visits, Office Procedures, SOAP note or OP note? For example, Clinical Summaries are only required for E&M services, not procedural services.

• Often you can manipulate the reports based on visit type or document type to l d t i i it d


exclude certain visits or procedures.

• Key data elements can be collected and entered by support staff so leveraging their skill sets and time is critical as you develop your workflow.

Meaningful Use is built into the major common components of patient visit flow and at the point of care in the clinical office



Privacy & Security


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Patient receives notification as a reminder of visit or clinical need



Privacy & Security


Office staff generates report and reminder letters for patients with upcoming appointments and procedures

Pre-Visit

Send patient reminder letters for visit or procedure

Send reminder letter to target population by diagnosis


Examples only

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Pre-Visit tasks meet two Menu objectives (I)

ective Generate lists of patients by

specific conditions to use for lit i t

ndard Generate at least one report

listing patients of the EP with a ifi diti

Obj quality improvement,

reduction of disparities, research or outreach

Sta specific condition

Requires only Yes / No Attestation Exclusion Criteria


X None

http://healthcare.nist.gov/docs/170.302.i_GeneratePatientLists_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/3_Patient_Lists.pd


Pre-Visit tasks meet two Menu objectives (II)

ective Send reminders to patients per

patient preference for ti / f ll

ndard More than 20% of all unique

patients 65 years or older or 5 ld t

Obj preventive/ follow up care

Sta years old or younger were sent

an appropriate reminder during the EHR reporting period

Numerator Denominator Population Exclusion Criteria

The number of patientsin the denominator who

Number of unique patients 65 years old or

Patients whose Records are

If an EP has no patients 65 years old or older or 5 years old or younger


in the denominator who were sent the

appropriate reminder.

patients 65 years old or older or 5 years older

or younger.

Records are Maintained in

the EHR.

or older or 5 years old or younger with records maintained using

certified EHR technology

http://healthcare.nist.gov/docs/170.304.d_GeneratePatientReminders_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/4_Patient_Reminders.pdf

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Patient arrives at clinical practice for services



Privacy & Security


Front desk staff verify and update Patient’s demographics and billing information

Date of birth

Gender

Preferred language

Ethnicity

Race

Contact Information & Preferences

Registration


Contact Information & Preferences

Mailing, Voicemail, Patient Portal access

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Registration function meets one Core objective

bjective Record demographics:

preferred language, gender, race ethnicity date of birth an

dard More than 50% of all unique

patients seen by the EP have demographics recorded as

Numerator Denominator Population Exclusion CriteriaThe number of patients in the

denominator who have all the elements of demographics (or a specific exclusion if

Number of unique patients seen by the All Unique

N

Ob race, ethnicity, date of birth

Sta demographics recorded as

structured data


g p ( pthe patient declined to provide one or more elements) recorded as structured

data.

p yEP during the EHR reporting period.

qPatients.

None

http://healthcare.nist.gov/docs/170.306.b_RecordDemographicsIP_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/7_Record_Demographics.pdf


Registration function meets one Core objective

bjective Record demographics:

preferred language, gender, race ethnicity date of birth an

dard More than 50% of all unique

patients seen by the EP have demographics recorded as

Ob race, ethnicity, date of birth

Sta demographics recorded as

structured data

Race Categories:

American Indian or Alaska Native

Asian

Ethnicity Categories:

Hispanic or Latino


Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Not Hispanic or Latino

*Patients can refuse to report

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Patient moves to the clinical area to prepare for provider visit or procedure



Privacy & Security


Polling Question

Before discussing the overview of the Patient Intake, I would like to ask the audience a question:

Do you currently utilize a Technician Medical Assistant LPN or RN to assist in theDo you currently utilize a Technician, Medical Assistant, LPN, or RN to assist in the clinical visit?

Yes, No


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Medical assistants update Patient’s vital signs in structured data fields and review or update her medical summary information

Record blood pressure

Record height, weight, calculate BMI

Plot and display growth chart (age appropriate)

Record or review smoking status

Patient Intake


Verify, update allergy list, or NKDA

Verify, update current medications, or annotate “none”

If Vital Signs are clinically relevant or appropriate


Patient Intake meets four Core objectives (I)

ective Maintain active medication list


patients seen by the EP have at


The number of patients in the denominator who have a medication (or


Obje

Stan least one entry (or an indication

that the patient is not currently prescribed any medication) recorded as structured data


an indication that the patient is not currently prescribed any medication)

recorded as structured data.

patients seen by the EP during the EHR reporting period.

All Unique Patients.

None

http://healthcare.nist.gov/docs/170.302.d_medicationlist_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/5_Active_Medication_List.pdf

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Patient Intake meets four Core objectives(II)

ective Maintain active medication

allergy list


patients seen by the EP have at

Numerator Denominator Population Exclusion CriteriaThe number of unique patients in the

denominator who have at least one entry Number of unique

Obje

Stan least one entry (or an

indication that the patient has no known medication allergies) recorded as structured data


(or an indication that the patient has no known medication allergies ‐ NKDA) recorded as structured data in their

medication allergy list.



None

http://healthcare.nist.gov/docs/170.302.e_allergylist_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/6_Medication_Allergy_List.pdf


Patient Intake meets four Core objectives (III)

ective Record and chart changes in

vital signs: Height, Weight, Bl d C l l t d

ndard For more than 50% of all unique

patients age 2 and over seen by th EP h i ht i ht d bl d

Numerator Denominator Population Exclusion CriteriaThe number of patients in the denominator who have

Number of unique ti t 2

Patients whose Any EP who either see no patients 2

ld h b li th t ll

Obj Blood pressure, Calculate and

display BMI, Plot and display growth charts for children 2‐20 years, including BMI

Sta the EP height, weight and blood

pressure are recorded as structured data


at least one entry of their height, weight and blood pressure are recorded as

structure data.

patients age 2 or over seen by the EP during the EHR reporting

period.

records are maintained in

the EHR.

years or older, or who believes that allthree vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice

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Patient Intake meets four Core objectives (IIIa)

ective Record and chart changes in

vital signs: Height, Weight, Bl d C l l t d

ndard For more than 50% of all unique

patients age 2 and over seen by th EP h i ht i ht d bl d

Obj Blood pressure, Calculate and

display BMI, Plot and display growth charts for children 2‐20 years, including BMI

Sta the EP height, weight and blood

pressure are recorded as structured data

http://healthcare.nist.gov/docs/170.302.f.1_vitalsigns_v1.0.pdf


http://healthcare.nist.gov/docs/170.302.f.2_BMI_v1.0.pdf

http://healthcare.nist.gov/docs/170.302.f.3_growthcharts_v1.0.pdf

http://www.cms.gov/EHRIncentivePrograms/Downloads/8%20Record%20Vital%20Signs%202011.pdf


Patient Intake meets four Core objectives (IV)

jective Record smoking status for

patients 13 years old or older

andard More than 50% of all unique

patients 13 years old or older seen by the EP have smoking


The number of patients in the denominator with ki t t d d

Number of unique patients age 13 or older seen by the EP during

Patients whose Records are M i t i d i

EPs who see no patients 13 years or ld

Obj

Sta seen by the EP have smoking

status recorded as structured data


smoking status recorded as structured data.

y gthe EHR reporting

period.

Maintained in the EHR.

older

http://healthcare.nist.gov/docs/170.302.g_smokingstatus_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/9_Record_Smoking_Status.pdf

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Patient Intake meets four Core objectives (IVa)

bjective Record smoking status for

patients 13 years old or older

tandard More than 50% of all unique

patients 13 years old or older seen by the EP have smoking

O S status recorded as structured data

Smoking status types must include:

current every day smoker

current some day smoker

former smoker


never smoker

smoker

current status unknown

unknown if ever smoked


Patient Intake meets one Menu objective

bjec

tive The EP who receives a patient

from another setting of care or provider of care or believes an ta

ndar

d The EP performs medication reconciliation for more than 50% of transitions of care in


The number of transitions of care in the denominator

h di i

Number of transitions of care during the EHR reporting period for


If an EP was not on the receiving end f i i f d i h

Ob

encounter is relevant should perform medication reconciliation

St

which the patient is transitioned into the care of the EP


where medication reconciliation was

performed.

reporting period for which the EP was the receiving party of the

transition.


the EHR.

of any transition of care during the EHR reporting period

http://healthcare.nist.gov/docs/170.302.j_%20MedicationReconciliation_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/7_Medication_Reconciliation.pdf

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Patient Intake meets one Menu objective

bjec

tive The EP who receives a patient

from another setting of care or provider of care or believes an ta

ndar

d The EP performs medication reconciliation for more than 50% of transitions of care in

Ob

encounter is relevant should perform medication reconciliation

St

which the patient is transitioned into the care of the EP

Transition of Care – The movement of a patient from one setting of care


(hospital, ambulatory primary care practice, ambulatory specialty care

practice, long‐term care, home health, rehabilitation facility) to another.

Provider and Patient interact at point of care



Privacy & Security


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Provider conducts patient consult or procedure

Provider documents consult or procedure

Provider determines problem or diagnosis

Update patient problem list, or document “none”

Provider Visit


The use of templates can increase speed, efficiency and accuracy but is not required for MU. The use of dictation, voice recognition or free text is possible, but you may lose the ability to use Evaluation and Management (E&M) coders.


Provider assessment meets one Core objective

ectiv

e Maintain an up‐to‐date problem list of current and

i di ndar

d More than 80% of all unique patients seen by the EP have

l


The number of patients in the denominator who have at least one entry


Obj

e active diagnoses

Sta

n at least one entry, or an indication that no problems are known for the patient, recorded as structured data


or an indication that no problems are known for the patient recorded as structured data in their problem list.



None

http://healthcare.nist.gov/docs/170.302.c_problemlist_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/3_Maintain_Problem_ListEP.pdf

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Provider determines Patient’s care plan

Reviews alerts, reminders, quality indicators

Uses diagnosis based order sets or clinical decision tools

Use EHR to order and transmit lab request

Provider Visit


A lab interface is not required for Stage 1 but facilitates the ability to comply with CQM, results management and patient engagement


Provider care plan meets one Core objective

jective Implement one clinical

decision support rule relevant to specialty or high clinical an

dard Implement one clinical

decision support rule

Obj to specialty or high clinical

priority along with the ability to track compliance with that rule

Sta


X None


http://healthcare.nist.gov/docs/170.304.e_ClinicalDecisionSupportAmb_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/11_Clinical_Decision_Support_Rule.pdf

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Provider care plan meets one Menu objective

Objective Incorporate clinical lab test

results into certified EHR technology as structured data

Standard More than 40% of all clinical lab

tests results ordered by the EP during the EHR reporting period

Numerator Denominator Population Exclusion CriteriaThe number of lab test results whose results are expressed in a positive or

Number of lab tests ordered during the EHR reporting period by the

Patients whose If an EP orders no lab tests whose

O S whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data


expressed in a positive or negative affirmation or as a

number which are incorporated as structured

data.

reporting period by the EP whose results are expressed in a positive or negative affirmation

or as a number.


the EHR.

results are either in a positive/negative or numeric format during the EHR reporting period

http://healthcare.nist.gov/docs/170.302.h_IncorpLabTest_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/2_Clinical_Lab_Test_Results.pdf

Provider selects and prescribes medication as needed

Review drug-to-drug and drug-to-allergy interactions

Review patient’s insurance formulary

Use EHR to generate prescription and transmit to pharmacy

Provider Visit


Formulary checking is not required for Stage 1 but may have direct financial impact on the patient based upon the medications selected by provider

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Using EHR medication management and ePrescribing meets three Core objectives (I)

ective Use CPOE for medication orders

directly entered by any licensed h l h f i l h

ndard More than 30% of unique

patients with at least one di i i h i di i

Obje healthcare professional who can

enter orders into the medical record per state, local and professional guidelines

Stan medication in their medication

list seen by the EP have at least one medication order entered using CPOE


The number of patientsin the denominator h h l

Number of unique patients with at least

di i i

Patients whose records are

If an EP’s writes fewer than one hundred i i d i h EHR i


that have at least one medication order

entered using CPOE.

one medication in their medication list

seen by the EP.

records are maintained in

the EHR.

prescriptions during the EHR reporting period

http://healthcare.nist.gov/docs/170.306.a_CPOEIP_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/2_Clinical_Lab_Test_Results.pdf


Using EHR medication management and ePrescribing meets three Core objectives (II)

ective Implement drug‐drug and drug‐

allergy interaction checks

ndard The EP has enabled this

functionality for the entire EHR i i d

Obje

Stan reporting period


X None


X None

http://healthcare.nist.gov/docs/170.302.a_DrugDrugDrugAllergy_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/2_Drug_Interaction_ChecksEP.pdf

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Using EHR medication management and ePrescribing meets three Core objectives (III)

jective Generate and transmit

permissible prescriptions electronically (eRx) an

dard More than 40% of all

permissible prescriptions written by the EP are


The number of prescriptions in the

d i t

Number of prescriptions written for drugs requiring a

i ti i dPatients whose R d

This objective and associated measure do t l t EP h it f th

Obj electronically (eRx)

Sta written by the EP are

transmitted electronically using certified EHR technology


denominator generated and transmitted electronically.

prescription in order to be dispensed other

than controlled substances during the EHR reporting period.


the EHR.

not apply to any EP who writes fewer than one hundred prescriptions during the EHR

reporting period.

http://healthcare.nist.gov/docs/170.304.b_ExchangePrescriptionInformation_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/4_e-prescribing.pdf


Using EHR medication management and ePrescribing meets one Menu objective

ective Implement drug formulary

checks

ndard The EP has enabled this

functionality and has access


X

Any EP who writes fewer than one hundred prescriptions during the EHR reporting period

Obje

Stan

yto at least one internal or external drug formulary for the entire EHR reporting period


Xshould be excluded from this objective and

associated measure.

http://healthcare.nist.gov/docs/170.302.b_DrugFormularyChecks_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/1_Drug_Formulary_Checks.pdf

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Patient completes clinical visit



Privacy & Security


Patient receives information before leaving the practice

Patient provided with educational information

Patient provided with clinical summary

Patient provided with CD of medical information if requested

Clinical information and results are sent to Patient Portal

Check-Out


• Generating educational material through the EHR is a menu item but makes it easier to keep up-to-date information.

• Patient Portal is not required for Stage 1 but facilitates patient engagement and communication

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Check-Out process meets two Core objectives (I)

Objective Provide patients with an

electronic copy of their health information (including diagnostic test results problem St

andard More than 50% of all patients

of the EP who request an electronic copy of their health information are provided it


The number of patients in the denominator who

receive an electronic copy

The number of patients of the EP who request an electronic copy of their electronic health


If the EP has no requests from patients or their agents for an

O diagnostic test results, problem list, medication lists, medication allergies), upon request

information are provided it within 3 business days


receive an electronic copy of their electronic health information within three

business days.

their electronic health information four

business days prior to the end of the EHR reporting period.


the EHR.

electronic copy of patient health information during the EHR

reporting period

http://healthcare.nist.gov/docs/170.304.f_ElectronicCopyOfHealthInformation_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/12_Electronic_Copy_of_Health_Information.pdf


Check-Out process meets two Core objectives (II)

bjective Provide clinical summaries for

patients for each office visit

tandard Clinical summaries provided to

patients for more than 50% of all office visits within 3 business


Number of patients in the denominator who are provided a clinical

Number of unique patients seen by the EP

Patients whose Records are EPs who have no office visits during

Ob St days


provided a clinical summary of their visit

within three business days.

during the EHR reporting period.

Maintained in the EHR.

the EHR reporting period

http://healthcare.nist.gov/docs/170.304.h_ClinicalSummaries_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/13_Clinical_Summaries.pdf

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Check-Out process meets two Core objectives (IIa)

ective Provide clinical summaries for


ndard Clinical summaries provided to

patients for more than 50% of ll ffi i i i hi 3 b i

Obje

Stan all office visits within 3 business

days

Clinical summaries include, at a d l


minimum, diagnostic test results, problem list, medication list, and medication allergy list.


Check-Out process meets two Core objectives (IIa)

ective Provide clinical summaries for


ndard Clinical summaries provided to

patients for more than 50% of ll ffi i i i hi 3 b i

Obje

Stan all office visits within 3 business

days

Office visits include separate, billable encounters that result from evaluation and management services provided to the patient and include: (1) Concurrent care or transfer of care visits (2) Consultant visits or (3) Prolonged Physician Service


transfer of care visits, (2) Consultant visits, or (3) Prolonged Physician Service without Direct (Face‐To‐Face) Patient Contact (tele‐health). A consultant visit occurs when a provider is asked to render an expert opinion/service for a specific condition or problem by a referring provider.

33


Check-Out process meets two Menu objectives (I)

Objective Provide patients with timely

electronic access to their health information (including lab results, problem list, medication lists, St

andard More than 10% of all unique

patients seen by the EP are provided timely electronic access to their health information

Numerator Denominator Population Exclusion CriteriaThe number of patients in the denominator who have timely (available to the patient within four

Number of unique patients seen by the EP All Unique

If an EP neither orders nor creates any of the information listed in the ONC final rule 45 CFR 170 304(g)

medication allergies) within four business days of the information being available to the EP

subject to the EP’s discretion to withhold certain information


business days of being updated in the certified

EHR technology) electronic access to their health information online.



ONC final rule 45 CFR 170.304(g) and therefore included in the

minimum data for this objective during the EHR reporting period

http://healthcare.nist.gov/docs/170.304.f_ElectronicCopyOfHealthInformation_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/5_Patient_Electronic_Access.pdf


Check-Out process meets two Menu objectives (II)

ective Use certified EHR technology to

identify patient‐specific d i d


patients seen by the EP are id d i ifi


Number of patients in the denominator who are

Number of unique patients seen by the EP All Unique

N

Obje education resources and

provide those resources to the patient if appropriate

Stan provided patient‐specific

education resources


provided patient education specific resources.

p yduring the EHR reporting period.

qPatients.

None

http://healthcare.nist.gov/docs/170.302.m_EducationResources_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/6_Patient-Specific_Education_Resources.pdf

34

Provider has completed visit and all test results and quality indicators are complete



Privacy & Security


Consult note sent back to referring provider and key elements of structured data transmitted externally

Consult note and medical summary sent to referring provider

Clinical quality measures are transmitted to CMS

Immunization information is sent to State Registry

Syndromic data is sent to Public Health organizations

Post Visit


• CQM do not have to be sent electronically today

• Stage 1 requires only one public health reporting menu item – Immunizations or Syndromic data

35


Post visit exchange of data meets one Core objective

bjective Capability to exchange key

clinical information (for example problem list an

dard Performed at least one test of

certified EHR technology's capacity to electronically

Ob example, problem list,

medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically

Sta capacity to electronically

exchange key clinical information



X None

http://healthcare.nist.gov/docs/170.306.f_ExchangeClinicalinfoSummaryRecordIP_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/14_Electronic_Exchange_of_Clinical_Information.pdf


Post visit exchange of data meets one Menu objective

Objective The EP who transitions their

patient to another setting of care or provider of care or refers their patient to another provider St

andard The EP who transitions or refers

their patient to another setting of care or provider of care provides a summary of care


The number of transitions of care and referrals in the

Number of transitions of care and referrals

during the EHR Patients whose Records are

If an EP does not transfer a patient to another setting or refer a patient

their patient to another provider of care should provide summary of care record for each transition of care or referral

provides a summary of care record for more than 50% of transitions of care and referrals


denominator where a summary of care record

was provided.

reporting period for which the EP was the transferring or referring

provider.


the EHR.

to another setting or refer a patient to another provider during the EHR

reporting period

http://healthcare.nist.gov/docs/170.304.i_ExchangeClinicalinforPatientSummaryRecordAmb_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/8_Transition_of_Care_Summary.pdf

36


Post visit reporting and submission of CQM and public health data meet one Core objective

bjective Report ambulatory clinical quality

measures to CMS or the States: Core: Hypertension, Tobacco Use ta

ndard For 2011, provide aggregate

numerator, denominator, and exclusions through attestation as

Ob yp ,

Assessment & Cessation Intervention, Adult Weight Screening (NQF 13, 28, 421 or PQRI 128) Menu: Must choose 3 measures to report

St

gdiscussed in section II(A)(3) of this final rule. For 2012, electronically submit the clinical quality measures.



X None

http://healthcare.nist.gov/docs/170.304.j_CalcSubmitClinQualityMeasures_v1.0.pdfhttp://healthcare.nist.gov/docs/170.306.i_CalcSubmitClinQualityMeasures_v1.0.pdf

http://www.cms.gov/EHRIncentivePrograms/Downloads/10_Clinical_Quality_Measures.pdf


Post visit reporting and submission of CQM and public health data meets two Menu objectives

jective Capability to submit electronic

data to immunization registries or Immunization Information an


certified EHR technology's capacity to submit electronic

Obj or Immunization Information

Systems and actual submission in accordance with applicable law and practice

Sta capacity to submit electronic

data to immunization registries and follow up submission if the test is successful


EPs that have not given any immunizations


XEPs that have not given any immunizations

during the EHR reporting period are excluded from this measure.

http://healthcare.nist.gov/docs/170.302.k_Immunizations_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/9_Immunization_Registries_Data_Submission.pdf

37


Post visit reporting and submission of CQM and public health data meets two Menu objectives

bjective Capability to submit electronic

Syndromic surveillance data to public health agencies and an


certified EHR technology's capacity to provide electronic

Ob public health agencies and

actual submission in accordance with applicable law and+C17 practice

Sta capacity to provide electronic

Syndromic surveillance data to public health agencies and follow‐up submission if the test is successful


If an EP does not collect any reportable


X

y psyndromic information on their patients

during the EHR reporting period, then they are excluded from this measure.

http://healthcare.nist.gov/docs/170.302.l_PublicHealthSurveillance_v1.0.pdfhttp://www.cms.gov/EHRIncentivePrograms/Downloads/10_Syndromic_%20Surveillance_Data_SubmissionEP.pdf

Polling Question

Before discussing the risk assessment portion, I would like to ask the audience a question:

Do you currently use complex passwords as a requirement for your staff logins?Do you currently use complex passwords as a requirement for your staff logins?

Yes, No


38

Promoting the privacy & security of EHRs by incorporating practice policies, procedures, and password management

underlies each step in the patient and visit flow



Privacy & Security


Conduct periodic risk assessment and risk mitigation and ensure written policies are in place

Physical security of hardware and devices

Password management and role-based security access

Portable and mobile device policies

Data encryption and network security

Privacy&

Security


HIPAA compliance

39


Conducting periodic risk analysis and risk mitigation meets one Core objective

tive Protect electronic health

i f ti t d

ard Conduct or review a security

i k l i 45 CFR

Object information created or

maintained by the certified EHR technology through the implementation of appropriate technical capabilities

Stand risk analysis per 45 CFR

164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process



X None


Conducting periodic risk analysis and risk mitigation meets one Core objective

ective Protect electronic health

information created or i i d b h ifi d

ndard Conduct or review a security

risk analysis per 45 CFR 164 308 ( )(1) d i l

Obje maintained by the certified

EHR technology through the implementation of appropriate technical capabilities

Stan 164.308 (a)(1) and implement

security updates as necessary and correct identified security deficiencies as part of its risk management process

http://healthcare.nist.gov/docs/170.302.u_GeneralEncryption_v1.0.pdfhttp://healthcare.nist.gov/docs/170.302.v_EncryptionHIE_v1.0.pdfhttp://healthcare.nist.gov/docs/170.302.o_AccessControl_v1.0.pdfhttp://healthcare nist gov/docs/170 302 t Authentication v1 0 pdf


http://healthcare.nist.gov/docs/170.302.t_Authentication_v1.0.pdfhttp://healthcare.nist.gov/docs/170.302.q_AutomaticLogOff_v1.0.pdf

http://www.cms.gov/EHRIncentivePrograms/Downloads/15_Core_ProtectElectronicHealthInformation.pdf

40

Meaningful Use is built into the major components of patient visit flow and at the point of care in the clinical practice



Privacy & Security


Using basic EHR functionality and performing common tasks can meet objectives for 15 Core and 10 Menu items










41

Polling Question

Before discussing the Clinical Quality Measures, I would like to ask the audience a question:

Do you currently participate in another quality initiative or payor program thatDo you currently participate in another quality initiative or payor program that requires you to submit quality measures or data? i.e. PQRS?

Yes, No


CQM concerns

• CMS has acknowledged that the CQM reporting requirement in Stage 1 is no more than that—a reporting requirement meant to get physicians comfortable with the process of reportingcomfortable with the process of reporting.

• CMS is under no illusions that the data collected will be meaningful as a measure of the level or quality of care being provided.

• Many physicians will be reporting on problems for which they are not treating the patients, which means that measure numerators will be zero (or very low) and that duplicate data will be submitted by different physicians for the same patients for the same conditions which will result in an


the same patients for the same conditions, which will result in an underestimation of the true care being delivered.

• In some cases, providers may be submitting data for CQMs that are not directly tied to their specialty or focus of care.


42

CQM today is based on current standards – NQF, PQRI


http://www.ama-assn.org/ama1/pub/upload/mm/399/ehr-clinical-quality-measures.pdf

Population may be all patients, patients seen, or unique patients

Future framework for the reporting of CQM


The intention is to broaden the scope of reporting to address a wider spectrum of factors affecting care and to accommodate all types of providers. All providers will find measures relevant to their specialty in the core set as well as in each of the domains

43

Key to CQM success today

• Code and document completely; missing values or missing information = lower performance

• Information should be kept as structured data in searchable/sortable fields rather than free-text

• Establish workflows and maximize staff capabilities to enter data elements, i.e. support staff can enter problems, medications, allergies and history

• Patient/Medical/System reasons for exclusions should be documented and


• Patient/Medical/System reasons for exclusions should be documented and coded; helps to improve scores by legitimately reducing the denominator











44

• Lab results delivery

• Prescribing

• Health summaries for continuity of care2011

Increases volume of transactions that are most commonly happening today– Lab to provider

Meaningful Use objectives requiring health exchange

Meaningful Use and Health Information Exchange (HIE)

• Health summaries for continuity of care

• Quality & immunization reporting, if available

2011 Lab to provider– Provider to pharmacySummary of care record is new process step

• Registry and public health reporting

• Claims and eligibility checking

• Electronic ordering

• Receive public health alerts

• Home monitoring

2014

Substantially steps up exchange– Provider to lab– Pharmacy to provider– Office to hospital & vice versa– Office to office– Hospital/office to public health & vice versa

H it l t ti t


Home monitoring

• Populate PHRs– Hospital to patient– Office to patient & vice versa– Hospital/office to reporting entities

• Access comprehensive data from all available sources

• Experience of care reporting

• Medical device interoperability

2015Starts to envision routine availability of relatively rich exchange transactions– “Anyone to anyone”– Patient to reporting entities










45

ADOPTIONRegional Extension Centers

HITECH – how the pieces fit together

Medicare and Medicaid Incentives and Penalties

Improved Individual &Population HealthOutcomes

IncreasedTransparency &Efficiency

ImprovedAbility to Study &

ADOPTIONWorkforce Training

MEANINGFUL USE


Ability to Study &Improve Care Delivery

EXCHANGE

State Grants forHealth Information Exchange

Standards & Certification Framework

Privacy & Security Framework

88

AgendaAmerican Recovery and Reinvestment Act Funding


Meaningful UseMeaningful Use

Meaningful Use in the Medical Practice

ARRA – Health Information Exchange (HIE)




46

Resources

Get information, tip sheets and more at CMS’ official website for the EHR incentive programs:http://www.cms.gov/EHRIncentivePrograms

For questions about the Meaningful Use objectives and how to comply with the standards:https://questions.cms.gov/

Learn about certification and certified EHRs, as well as other ONC programs designed to support providers as they make the transition:http://healthit hhs gov


http://healthit.hhs.gov

For additional information about MAeHC and access to additional presentations and services:http://www.maehc.org

Questions?

ModeratorPresenter

Jeff Loughlin, MHA Christina Moran MPH


Jeff Loughlin, MHAMassachusetts eHealth Collaborative

Project [email protected]

www.maehc.org

Christina Moran, MPHMassachusetts eHealth Collaborative

Strategy [email protected]

www.maehc.org

47

Evaluation, CME Credit & Resource Information

To complete your evaluation, please visit: http://www.massmed.org/MU2012evalAfter completing the evaluation you will be directed to the MMS CMEAfter completing the evaluation, you will be directed to the MMS CME Certificate portal.

• Enter the CME Activity Code: EHR041012

• Enter your FIRST and LAST name.

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