achieving meaningful use - himss chapter · 2016-04-13 · overall agenda •“achieving...
TRANSCRIPT
Meaningful Use
Gerry Blass, President, ComplyAssistant
Nabil Rab, President, NARBC
Portia Towns, Project Manager, North Shore LIJ Hospital
October 10, 2014
Overall Agenda
• “Achieving Meaningful Use Stage 2 for Eligible Providers”
• “Educating the staff on Meaningful Use Deployment”
• “What You Need to Know to Be Prepared for HIPAA-HITECH and MU Audits from CMS and the OCR”
Achieving Meaningful Use Stage 2 for Eligible Providers
Nabil Rab
Nabil A Rab Business Consulting (NARBC)
October 10, 2014
Learning Objectives • Meaningful Use Overview
• Objective Measures by System Functionality
• Quality Measures
• Discuss changes between Stage 1 and Stage 2
• Flexibility Rule
• Stage 2 Risks
Meaningful Use – Background
• $27 billion government program that incentivizes “meaningful use” of EHR (Electronic Health Records)
• Created by the HITECH Act (Health Information Technology for Economic and Clinical Health), a part of ARRA (American Recovery and Reinvestment Act) of 2009
Who is eligible for incentives?
• Eligible Hospitals: – Acute care hospitals with at least 10% Medicaid
patient volume and/or participate in the Inpatient Prospective Payment System (IPPS = Medicare)
• Eligible Providers: – providers who bill more than 10% services outside
of ED or Inpatient setting
– Criterion for determining Medicaid vs Medicare: at least 30% patient volume is Medicaid, otherwise provider will attest Medicare
Meaningful Use – Eligible Hospitals
• Eligible for $2 - $6 million incentive per year depending on number of discharges (formula created by CMS)
• Hospital must attest to meeting “Objectives” and “Quality Measures”: – Core Objectives
– Menu Objectives
– Quality Measures
• Objectives Requirements vary between Stages 1 and 2
Meaningful Use EH Stages
# of Core Objectives
# of Menu Objectives
# of Menu Objectives to choose from
EH Stage 1 11 5 10
EH Stage 2 16 3 6
# of Quality Measures
# of Measures # of EHR Supported Measures
EH Stages 1 and 2 16 29 ?
Meaningful Use – Eligible Providers
• Medicaid providers
– Eligible for $63,750 over 6 years
• Medicare providers
– Eligible for $44,000 over 5 years if started in 2011
– Eligible for $24,000 over 3 years if starting in 2014
• Eligible Providers who do not adopt an EHR by 2014 will be penalized (decreased Medicare payments)*
Meaningful Use EP Stages
# of Core Objectives
# of Menu Objectives
# of Menu Objectives to choose from
EP Stage 1 13 5 9
EP Stage 2 17 3 6
# of Quality Measures
# of CMS Measures # of EHR Supported Measures
EP Stages 1 and 2 9 64 ?
Thinking about Objectives by
• Electronic Health Record
– Interfaces
– Patient Portal
– HIE/HISP
– Public Health
– Practice Management System
– Protect Health Information
Electronic Health Record
1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
2. Record and chart changes in the following vital signs: height/length and weight (no age limit) blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI.
3. Record smoking status for patients 13 years old or older. 4. Use clinical decision support to improve performance on
high-priority health conditions.
Electronic Health Record cont.
5. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
6. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference.
7. Record electronic notes in patient records. 8. Record patient family health history as structured data. 9. 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.
Interfaces
10.Incorporate clinical lab-test results into Certified EHR Technology as structured data.
11.Generate and transmit permissible prescriptions electronically (eRx).
12.Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT.
Patient Portal
13.Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP.
14.Use secure electronic messaging to communicate with patients on relevant health information.
Patient Portal + EHR
15.Provide clinical summaries for patients for each office visit.
16.Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.
HIE/HISP
17.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 a summary care record for each transition of care or referral.
Public Health
18. Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice.
19. Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice.
20. Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice.
21. Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.
Practice Management
22.Record the following demographics: preferred language, sex, race, ethnicity, date of birth.
Protect Health Information
23.Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.
Quality Measure Overview
• Clinical quality measures, or CQMs, are tools that help measure and track the quality of health care services provided by eligible professionals, eligible hospitals and critical access hospitals (CAHs) within our health care system.
• Eligible professionals who are attesting for 2014 clinical quality measures (CQMs) will need to report 9 measures
National Quality Strategy Domains
New requirement in 2014 that the quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains:
• Patient and Family Engagement
• Patient Safety
• Care Coordination
• Population/Public Health
• Efficient Use of Healthcare Resources
• Clinical Process/Effectiveness
Using CPOE (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines
More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE
Now includes laboratory and radiology orders with a threshold of 30%. Counts orders instead of patients. Threshold increased from 30% to 60% for medication orders.
Transmitting e-prescriptions (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Generate and transmit permissible prescriptions electronically (eRx)
More than 50 percent of all permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using Certified EHR Technology.
Threshold increased from 40% to 50%. EP exclusion if no pharmacy at organization, AND none within 10 miles of EP's practice that accept eRx.
Recording Demographics (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Record demographics Preferred language Gender Race Ethnicity Date of birth
More than 80% of all unique patients seen by the EP have demographics recorded as structured data
Threshold increased from 50% to 80%.
Recording/charting changes in vital signs (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Record and chart changes in vital signs: • Height/Length • Weight • Blood pressure (age 3 and over) • Calculate and display BMI • Plot and display growth charts for children 0-20 years, including BMI
More than 80 percent of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height/length and weight (for all ages) recorded as structured data.
Threshold increased from 50% to 80%. Changed age requirements. EP exclusion if height/length and weight or BP are not relevant to EP's scope of practice.
Recording smoking status for patients 13 years old or older (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
More than 80% of all unique patients 13 years old or older seen by the EP have smoking status
Record smoking status for patients 13 years old or older
Threshold increased from 50% to 80%
Using clinical decision support to improve performance (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Use clinical decision support to improve performance on high-priority health conditions.
1. Implement 5 clinical decision support interventions related to 4 or more clinical quality measures, if applicable, at a relevant point in patient care for the entire EHR reporting period.
2. The EP, eligible hospital, or CAH has enabled the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period
Clinical decision support requirements increased from 1 to 5. Also includes requirement for the interventions to be related to four or more quality measures.
Provide patients with an electronic copy of their health information (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP.
1. More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP's discretion to withhold certain information. 2. More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.
Added a requirement for 5% of patients to view, download, or transmit health information to a third party.
Provide clinical summaries for patients for each office visit (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Provide clinical summaries for patients for each office visit.
Clinical summaries provided to patients within 1 business day for more than 50 percent of office visits.
Time period for providing a summary decreased from 3 business days to 1 business day. No change to threshold.
Protect Health Information (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Protect electronic health information created or maintained by the certified EHR technology (CEHRT) through the implementation of appropriate technical capabilities.
Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs.
must also address the encryption/security of data at rest
Incorporate clinical lab-test results into EHR as structured data (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Incorporate clinical lab-test results into EHR as structured data.
More than 55 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative affirmation or numerical format are incorporated in Certified EHR Technology as structured data.
Threshold increased from 40% to 55%.
Generate lists of patients by specific conditions research or outreach (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
Generate at least one report listing patients of the EP with a specific condition.
Moved from Menu to Core.
Send reminders to patients (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminder, per patient preference.
More than 10 percent of all unique patients who have had two or more office visits with the EP within the 24 months prior to the beginning of the EHR reporting period were sent a reminder, per patient preference.
Moved from Menu to Core. Denominator changed to remove age range, increase the number of office visits, and limit time range to begin 2 years before the reporting period. Numerator now requires the message to be sent per patient preference. Threshold lowered from 20% to 10%.
Use EHR to identify patient-specific education resources (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate
More than 10% of all unique patients seen by the EP are provided patient-specific education resources
Moved from Menu to Core. No change to threshold, but education resources must be identified by the EHR. Denominator counts office visits instead of unique patients.
Perform Medication Reconciliation (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
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
The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP
Moved from Menu to Core. No change to threshold
Transition of Care to outside EHR (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
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 summary care record for each transition of care or referral.
1. The EP that transitions or refers a patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. 2. The EP that transitions or refers a patient to another setting of care or provider of care provides a summary of care record for more than 10% of such transitions and referrals
No change to threshold. Added a requirement to electronically transmit the summary of care to a recipient or transmit the summary or care via NwHIN Exchange. Added a requirement to electronically exchange the summary of care with an organization with a different EHR vendor, or, conduct a successful test with the CMS test EHR.
Submit e lectronic data to immunization registry (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice
Successful ongoing submission of electronic immunization data from Certified EHR Technology to an immunization registry or immunization information system for the entire EHR reporting period.
Moved from Menu to Core. Now requires ongoing submission and not simply a test.
Patients send electronic messages to provider via EHR (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Use secure electronic messaging to communicate with patients on relevant health information.
A secure message was sent using the electronic messaging function of Certified EHR Technology by more than 5 percent of unique patients seen during the EHR reporting period.
New to Stage 2.
Capability to submit electronic syndromic data (Core)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice.
Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period.
Now requires ongoing submission and not simply a test.
Record Electronic Notes (menu)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Record electronic notes in patient records
Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of unique patients
New to Stage 2 Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of unique patients
Record patient family health history as structured data (menu)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Record patient family health history as structured data.
More than 20 percent of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives.
New to Stage 2
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through Certified EHR Technology.
More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through Certified EHR Technology.
New to Stage 2.
Imaging tests are accessible via EHR (menu)
Capability to report cancer cases to a public health registry (menu)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice.
Successful ongoing submission of cancer case information from Certified EHR Technology to a cancer registry for the entire EHR reporting period.
New to Stage 2
Capability to identify/report to specific cases to another registry (menu)
Stage 2 Objective Stage 2 Measure Changes from Stage 1
Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.
Successful ongoing submission of specific case information from Certified EHR Technology to a specialized registry for the entire EHR reporting period.
New to Stage 2
CMS 2014 CEHRT Flexibility
Per cms.gov: • In August 2014, CMS released a final rule that grants flexibility to
providers who are unable to fully implement 2014 Edition CEHRT for an EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability.
• Providers scheduled to demonstrate Stage 2 of meaningful use for an EHR reporting period in 2014 that have not fully implemented 2014 Edition CEHRT can: – Demonstrate 2013 Stage 1 objectives and 2013 CQMs with 2011
Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT – Demonstrate 2014 Stage 1 objectives and 2014 CQMs with 2014
Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT – Demonstrate Stage 2 objectives and 2014 CQMs with 2014 Edition
CEHRT or a combination of 2011 and 2014 Edition CEHRT
Stage 2 Risks
• Send Patient Reminders
• Patients view, download, or transmit health information
• Use secure electronic messaging to communicate with patients on relevant health information
QUESTIONS?
