christopher geer, mba meaningful use project manager unity health system [email protected]
TRANSCRIPT
Christopher Geer, MBAMeaningful Use Project Manager
Unity Health [email protected]
The Health Information Technology for Economic and Clinical Health (HITECH) Act
Enacted as part of the American Recovery and Reinvestment Act of 2009
Promotes the adoption and meaningful use of health information technology.
http://www.recovery.gov/About/Pages/The_Act.aspx
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2
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First Payment Year
Payment Year
2011 2012 2013 2014 2015 2016 2017
2011Stage 1 (100%)
Stage 1 (75%)
Stage 1 (50%)
Stage 2 (25%) Stage 2 Stage 3 Stage 3
2012 Stage 1 (100%)
Stage 1 (75%)
Stage 2 (50%)
Stage 2 (25%) Stage 3 Stage 3
2013 Stage 1 (100%)
Stage 1 (75%)
Stage 2 (50%)
Stage 2 (25%) Stage 3
2014 Stage 1 (75%)
Stage 1 (50%)
Stage 2 (25%) Stage 2
2015 Stage 1 Stage 1 Stage 2
2016 Stage 1 Stage 1
“If there will be a stage 4 of Meaningful Use, we expect to update this table in the rulemaking stage 3” – CMS, Stage 2 NPRM
http://onc-chpl.force.com/ehrcert
Is your vendor certified?
Dually-eligible Hospitals can
participate in both programs
Dually-eligible providers must pick 1 program
Medicaid Program Medicare Program
Administered by the State Administered by Federal Government
No payment reductions Payment reductions begin in 2015
Adopt, Implement, Upgrade option for 1st year
Must demonstrate MU in year 1
Maximum EP incentive $63,750Maximum incentive $44,000 for EP’s
(10% bonus for EP’s in HPSAs)
Fixed incentive over 6 years (EP) and 4 years (EH) in NYS (may vary by
state)
EP incentive paid over 5 years based on 75% of net allowable charges
Require 30% (EP) and 10%(EH) minimum Medicaid volume
No minimum volume threshold
Can skip years once starting Must be done in consecutive years
Medicaid EP’s30% Medicaid Volume Required
Medicare EP’sNo Volume Requirement
Physicians Doctor of Medicine or Osteopathy
DentistsDoctor of Oral Surgery or Dental
Medicine
Certified Nurse Midwife Doctor of Podiatric Medicine
Nurse Practitioner Doctor of Optometry
Physician Assistant* Chiropractor
*Must be practicing in a Rural Health Center or Federally Qualified Health Center led by a PA.
•Must render <90% of services in an Inpatient Acute or Emergency Setting
Subsection (d) hospitals or Critical Access Hospitals in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS)
Eligible Hospital Stage 1 Stage 2
Core 14 16
Menu 10 4
Menu Required 5 2
Eligible Professional
Stage 1 Stage 2
Core 15 17
Menu 10 5
Menu Required 5 3
Yes / No Attestation
Percentage-Based Measure• Numerator / Denominator = Requirement• Possible Denominators: Unique Patients Transitions of Care Orders
There are exclusions for many of the objectives
STAGE 1EP: CORE EH: CORE
PROPOSED STAGE 2 EP: CORE EH: CORE
Requirement: 30%
Numerator: At least 1 medication order
Denominator: Unique patients with at least 1 medication in their med list
Requirement: 60 %
Numerator: Total orders entered using CPOE
Denominator: Total medication, lab, and radiology orders
Objective : Use CPOE for orders entered
STAGE 1 EP: MENU EH: MENU
PROPOSED STAGE 2 CONSOLIDATED
Enable drug formulary checks Consolidated into the eRx objective
Objective: Implement drug-formulary checks
STAGE 1 EP: CORE EH: N/A
PROPOSED STAGE 2 EP: CORE EH: MENU
Requirement: 40%
Numerator: E-prescriptions
Denominator: Prescriptions written
Requirement: EP: 65% EH: 10%
Numerator: E-prescriptions
Denominator: Prescriptions written (EH: Discharge Prescriptions)
Must be checked against at least 1 formulary
Objective: Generate and transmit permissible prescriptions electronically (eRx).
STAGE 1EP: MENU EH: MENU
PROPOSED STAGE 2 EP: CORE EH: CORE
Requirement: 10%
Numerator: Number of patients who are provided patient education specific resources
Denominator: Unique patients
Requirement: 10%
Numerator: Number of patients who are provided patient education specific resources
Denominator: EH: Unique patientsEP: Office Visits
Objective: Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.
STAGE 1EP: MENU EH: MENU
PROPOSED STAGE 2 EP: CORE EH: CORE
Requirement: 50%
Numerator: Patients where medication reconciliation was performed.
Denominator: Transitions of care
Requirement: 65%
Numerator: Patients where medication reconciliation was performed.
Denominator: Transitions of care
Objective: The EP or EH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation
STAGE 1EP: MENU EH: N/A
PROPOSED STAGE 2 EP: CORE EH: N/A
Requirement: 20%
Numerator: Patients who were sent reminders
Denominator: Number of unique patients 65 years old or older or 5 years older or younger.
Requirement: 10%
Numerator: Patients who were sent reminders
Denominator: Unique patients
Objective: Send reminders to patients per patient preference for preventive/follow-up care.
STAGE 1EP: CORE EH: CORE
PROPOSED STAGE 2 EP: CORE EH: CORE
Requirement: 50%
Numerator: Number of patients will all elements captured
Denominator: Unique patients
Race/Ethnicity Standard: OMB Standards
Requirement: 80 %
Numerator: Number of patients will all elements captured
Denominator: Unique patients
Race/Ethnicity Standard: OMB Standards
Objective : Record the following demographics: preferred language, gender, race and ethnicity, date of birth, and date and preliminary cause of death in the event of mortality in the eligible hospital or CAH
http://www.whitehouse.gov/omb/fedreg_1997standards/
STAGE 1EP: CORE EH: CORE
PROPOSED STAGE 2 CONSOLIDATED
Requirement: 80%
Numerator: Unique patients with at least 1 recorded problem, medication, medication allergy, or an indication of none.
Denominator: Unique patients
Consolidated into the requirements for other objectives
Objectives : Maintain an up-to-date problem list, medication list, and medication allergy list
STAGE 1EP: CORE EH: CORE
PROPOSED STAGE 2 EP: CORE EH: CORE
Requirement: 50%
Numerator: Number of patients with all elements captured
Denominator: Unique patients
Requirement: 80 %
Change BMI to age 3, and eliminate height/weight age restriction
Numerator: Number of patients will all elements captured
Denominator: Unique patients
Objective: Record and chart height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 - 20 years, including BMI
STAGE 1EP: CORE EH: CORE
PROPOSED STAGE 2 EP: CORE EH: CORE
Requirement: 50%
Numerator: Number of unique patients with smoking status captured
Denominator: Unique patients
Requirement: 80 %
Numerator: Number of unique patients with smoking status captured
Denominator: Unique patients
Objective: Record smoking status for patients 13 years old or older
STAGE 1EP: MENU EH: MENU
PROPOSED STAGE 2 EP: CORE EH: CORE
Generate 1 list Generate 1 list
Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach
STAGE 1EP: CORE EH: CORE
PROPOSED STAGE 2 REMOVED AS AN OBJECTIVE
Submit quality measures Still required to submit to be considered a meaningful user
Electronic Submission
Objective : Report quality measure to CMS or the states
STAGE 1EP: CORE EH: CORE
PROPOSED STAGE 2 EP: CORE EH: CORE
1 Rule 5 Rules related to the improvement of selected quality measures
Drug-Drug / Drug Allergy Checks included as part of this objective
Objective : Implement clinical decision support rules related to specialty or high clinical priority
STAGE 1 EP: CORE EH: CORE
PROPOSED STAGE 2 CONSOLIDATED
Enable drug-drug / drug-allergy checks
Consolidated into the Clinical Decision Support Objective
Enable drug-drug / drug-allergy checks
Objective : Implement drug-drug and drug-allergy checks
STAGE 1EP: CORE EH: CORE
PROPOSED STAGE 2 EP: CORE EH: CORE
Perform Security Risk Assessment
Perform Security Risk Assessment
Objective: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities
STAGE 1EP: N/A EH: MENU
PROPOSED STAGE 2 EP: N/A EH: MENU
Requirement: 50%
Numerator: Number of patients where an indication of an advance directive is entered
Denominator: Unique patients
Requirement: 50%
Numerator: Number of patients where an indication of an advance directive is entered
Denominator: Unique patients
Objective: Record whether a patient 65 years old or older has an advanced directive as structured data
STAGE 1EP: MENU EH: MENU
PROPOSED STAGE 2 EP: CORE EH: CORE
Requirement: 40%
Numerator: Lab orders received electronically
Denominator: Lab orders
Requirement: 55%
Numerator: Lab orders received electronically
Denominator: Lab orders
Objective: Incorporate clinical lab-test results into EHR as structured data
STAGE 1EP: N/A EH: N/A
PROPOSED STAGE 2 EP: CORE EH: N/A
New with for stage 2 Requirement: 10%
Numerator: The number of patients who send a secure message to the provider
Denominator: Unique patients
Objective: Use secure electronic messaging to communicate with patients on relevant health information.
STAGE 1EP: N/A EH: N/A
PROPOSED STAGE 2 EP: MENU EH: MENU
New with for stage 2 Requirement: • 40% images captured• 10% submitted to another
provider of care
Numerator: Results accessible through the EHR
Denominator: Number of scans and tests whose result is one or more image ordered
Objective: Imaging results and information are accessible through CertifiedEHR Technology.
STAGE 1EP: N/A EH: N/A
PROPOSED STAGE 2 EP: N/A EH: MENU
New with for stage 2 Requirement: 10%
Numerator: The number of orders tracked using eMAR.
Denominator: Medication orders
Objective: Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).
STAGE 1EP: N/A EH: N/A
PROPOSED STAGE 2 EP: MENU EH: MENU
New with for stage 2 Requirement: 20%
Numerator: Patients with structured data entry for one or more first-degree relatives.
Denominator: Unique Patients
Objective Record patient family health history as structured data
STAGE 1EP: CORE EH: N/A
PROPOSED STAGE 2 EP: CORE EH: N/A
Requirement: 50%
Numerator: Patients provided a clinical summary within 3 business days
Denominator: Unique Patients
Requirement: 50%
Numerator: Patients provided a clinical summary within 24 hours
Denominator: Unique Patients
Expanded requirements
Objective Provide clinical summaries for patients for each office visit
STAGE 1EP: CORE EH: CORE
PROPOSED STAGE 2 CONSOLIDATED
Performed one test Consolidated into the summary of care objective
Objective: Capability to exchange key clinical information, among providers of care and patient authorized entities electronically
STAGE 1EP: MENU EH: MENU
PROPOSED STAGE 2 EP: CORE EH: CORE
Requirement: 50%
Numerator: Number of patients where a summary of care was provided
Denominator: Number of transitions of care
Requirement: • 60% Paper or electronic• 10% electronically
Numerator: Number of patients where a summary of care was provided
Denominator: Number of transitions of care
Objective: The EP or EH who transitions their patient to another setting of care should provide summary care record for each transition of care or referral
STAGE 1EP: CORE EH: CORE
PROPOSED STAGE 2 CONSOLIDATED
Requirement: 50%
Numerator: Number of patients receiving their record electronically within 3 business days
Denominator: patient requests for an e-copy
At a minimum: must include Problems, medications, medication allergies, and diagnostic test results
Consolidated into the view, download, transmit objective.
Objective: Provide patients with an electronic copy of their health information upon request
STAGE 1EP: N/A EH: CORE
PROPOSED STAGE 2 CONSOLIDATED
Requirement: 50%
Numerator: Number of patients receiving their instructions electronically
Denominator: patient requests for an e-discharge instructions
Consolidated into the view, download, transmit objective.
Objective: Provide patients with an electronic copy of their health information upon request
STAGE 1EP: MENU EH: N/A
PROPOSED STAGE 2 CONSOLIDATED
Requirement: 10%
Numerator: Number of patients who have their record displayed online
Denominator: Unique patients
At a minimum: must include Problems, medications, medication allergies, and diagnostic test results
Consolidated into the view, download, transmit objective.
Objective: Provide patients with timely electronic access to their health information within four business days of the information being available to the EP
EP:• Must provide information online in 4 business days• 50% of unique patients are provided their health information online• 10% of patients must access that information
Standards
Patient Name Provider name, practice Problem List
SNOMED CT Procedures
ICD-10, CPT-4 Laboratory test results
LOINC Medication list
Medication Allergy List Vital Signs Smoking Status Demographic Information Care plan field, including goals
and instructions Additional known care team
members
EP:• Must provide information online within 36 hours of discharge• 50% of unique patients are provided their health information online• 10% of patients must access that information
Standards
Admit and discharge date/place
Reason for hospitalization Providers of care Problem List
SNOMED CT Relevant past diagnosis Laboratory test results
LOINC
Medication list Medication Allergy List Vitals at discharge Demographic Information Care transition plan Discharge Instructions