understanding meaningful use stage 2 plotts-stage 2 mu(final).pdf · stage 2 goals from onc &...

Miranda Ladue, Manager, Product ManagementAdam Plotts, Manager, Product Management

Understanding Meaningful Use Stage 2

Copyright © 2011 Allscripts Healthcare Solutions, Inc.

Agenda

• Review MU Timeline

• MU 2 Overview

• Review of major changes

• EEHR Timeline & Proposed Functionality

• Q&A

| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health

• Review MU Timeline

• MU 2 Overview

• Review of major changes

• EEHR Timeline & Proposed Functionality

• Q&A

2

Stage of MU by first payment yearFirst Payment

Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

2011 1 1 1 2 2 3 3 TBD TBD TBD TBD

2012 1 1 2 2 3 3 TBD TBD TBD TBD

2013 1 1 2 2 3 3 TBD TBD TBD

2014 1 1 2 2 3 3 TBD TBD

2015 1 1 2 2 3 3 TBD

2016 1 1 2 2 3 3


2016 1 1 2 2 3 3

2017 1 1 2 2 3

3

“If there will be a Stage 4 of meaningful use, we expect to update this table in the

rulemaking for Stage 3.”

NOTE: Medicare penalties we begin being assess 2015 for EP not attesting

Reporting periodsProviderType

ReportingPeriod Year 1 Submission Period Year 1

SubsequentReporting Periods

Subsequent SubmissionPeriods

EP 90 days Anytime immediate following theend of the 90-day reportingperiod, but no later than February28 of the following calendar year.

1 calendar year(January 1 -December 31)

2 months following theend of the EHR reportingperiod (January 1 -February 28)

EligibleHospital /CAH

90 days Anytime immediatefollowing the end of the 90-dayreporting period, but no later thanNovember 30 of the followingfiscal year.

1 fiscal year(October1 -September30)

2 months following theend of the EHR reportingperiod (October 1 -November 30)


EligibleHospital /CAH

Anytime immediatefollowing the end of the 90-dayreporting period, but no later thanNovember 30 of the followingfiscal year.

1 fiscal year(October1 -September30)

2 months following theend of the EHR reportingperiod (October 1 -November 30)

4

If you begin program participation in 2014, the 90 continues days of demonstrating

MU must conclude three months prior to the end of the year.

Q4

Proposed Stage 2Ruling60 Day Comment Period

5Road to Meaningful Use Stage 2

Q1

Stage 2 RulingHITPC Recommendationson Stage 2

Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

20122012 20132013 20142014

Q3 Q4

20112011

Proposed Stage 2Reporting Period(For Stage 1 2011/2012Reporting)


Stage 2 RulingHITPC Recommendationson Stage 2 Proposed Stage 2

Reporting Period(For Stage 1 2011/2012Reporting)

Ambulatory Considerations

2• Clinical Decision Support• Patient Portal Requirements• Emphasis on information exchange• Stretch of MU Stage 1 Goals

Clinical QualityMeasures

Stage 1 - 44Stage 2 – 125*

Road to Meaningful Use Stage 2Allscripts comments on NPRM

https://clientconnect.allscripts.com/groups/arrapractices/blog/2012/04/25/allscripts-guidance-for-mu-stage-2-comments


Allscripts comments on NPRM

https://clientconnect.allscripts.com/groups/arrapractices/blog/2012/04/25/allscripts-guidance-for-mu-stage-2-comments

6

Key themes

• Continuing the drive to value-driven healthcare

• Raising the bar on most measures

• Adding new administrative & clinical measures

• Special emphasis on information exchange

• Clinical measures

• Administrative measures

• More flexibility and options, including changes for 2013

• Special emphasis on penalties, reviews and appeals


• Continuing the drive to value-driven healthcare

• Raising the bar on most measures

• Adding new administrative & clinical measures

• Special emphasis on information exchange

• Clinical measures

• Administrative measures

• More flexibility and options, including changes for 2013

• Special emphasis on penalties, reviews and appeals

7

• Registries

• Attestation

Summary of Major Provisions

Stage 1 Stage 2EP Measures 15 core, 5 of 10 menu 17 core, 3 of 5 menu

EH Measures 14 core, 5 of 10 menu 16 core, 2 of 4 menu

| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health 8

EP CQM 6 CQMs out of 46 12 CQMs out of 125

EH CQM 6 CQMs out of 46 24 CQMs out of 49

Stage 2 goals from ONC & CMS

• Expand upon the Stage 1 criteria

• Encourage the use of Health IT for continuous quality improvement at the point of

care

• Encourage the exchange of information in the most structured format possible

• Stage 2 MU criteria include rigorous HIEs

• Demand requirements for ePrescribing

• Incorporate structured laboratory results

• Electronically transmit patient care summaries to support transitions in care across

unaffiliated providers, settings and EHR systems

• Information follows the patient (Stage 3 also)

• Nearly every optional Stage 1objective to be required in Stage 2


• Expand upon the Stage 1 criteria

• Encourage the use of Health IT for continuous quality improvement at the point of

care

• Encourage the exchange of information in the most structured format possible

• Stage 2 MU criteria include rigorous HIEs

• Demand requirements for ePrescribing

• Incorporate structured laboratory results

• Electronically transmit patient care summaries to support transitions in care across

unaffiliated providers, settings and EHR systems

• Information follows the patient (Stage 3 also)

• Nearly every optional Stage 1objective to be required in Stage 2

9

Stage 2 State Flexibility with IR/SS

• States will have the flexibility with the public health measures in

Stage 2 similar to that of Stage 1

• True for Medicare and Medicaid participation

• States may also specify the means of transmission of the data

or otherwise change the public health measure


• States will have the flexibility with the public health measures in

Stage 2 similar to that of Stage 1

• True for Medicare and Medicaid participation

• States may also specify the means of transmission of the data

or otherwise change the public health measure

10

Stage 2 Exclusion Criteria

• Allowances for exclusions would change for both Stages 1 & 2

beginning in 2014

• At that point, should focus solely on those objectives they can

meet rather than those for which they have exclusion

• Exclusions just for EPs who are unable to meet certain objectives because

of scope of practice

• New exclusion criteria when necessary for new objectives will be added

as needed

• Almost every menu objective in Stage 2 will be core in Stage 3


• Allowances for exclusions would change for both Stages 1 & 2

beginning in 2014

• At that point, should focus solely on those objectives they can

meet rather than those for which they have exclusion

• Exclusions just for EPs who are unable to meet certain objectives because

of scope of practice

• New exclusion criteria when necessary for new objectives will be added

as needed

• Almost every menu objective in Stage 2 will be core in Stage 3

11

Stage 2 Multiple Practices/Locations

• EP must still have 50% or more of outpatient encounters at a

practice/location or practices/locations equipped with Certified EHR

Technology – can be fulfilled in a single or multiple locations.

• Starting in 2013, will no longer allow the practice of creating a

record in one location with no EHR and then later entering information

in a practice location with a certified EHR

• Do not have to include patients in reporting denominators that are

seen at practices/locations that are not equipped with Certified EHR

Technology as long as the EP clears the 50% threshold described

above


• EP must still have 50% or more of outpatient encounters at a

practice/location or practices/locations equipped with Certified EHR

Technology – can be fulfilled in a single or multiple locations.

• Starting in 2013, will no longer allow the practice of creating a

record in one location with no EHR and then later entering information

in a practice location with a certified EHR

• Do not have to include patients in reporting denominators that are

seen at practices/locations that are not equipped with Certified EHR

Technology as long as the EP clears the 50% threshold described

above

12

Stage 2 Denominators

• Include all patients in the denominators of all of the measures (except

those not seen at a location with a certified EHR)

• Create a uniform set of denominators

• Proposed denominators for EPs• Unique patients seen by the EP during the EHR reporting period (stratified

by age or previous office visit)

• Number of orders (medication, labs, radiology)

• Office visits, and

• Transitions of care/referrals.


• Include all patients in the denominators of all of the measures (except

those not seen at a location with a certified EHR)

• Create a uniform set of denominators

• Proposed denominators for EPs• Unique patients seen by the EP during the EHR reporting period (stratified

by age or previous office visit)

• Number of orders (medication, labs, radiology)

• Office visits, and

• Transitions of care/referrals.

13

What Measures Are NotChanging…. Much?


What Measures Are NotChanging…. Much?

14

Common themes of small changes

• Increase of thresholds

• More stringent parameters

• Movement of Menu to Core


Increase of ThresholdseRx• Stage 1: More than 40% must be transmitted electronically• Stage 2: More than 65% are compared to at least one drug formulary and

transmitted electronically

Record patient demographics• More than 50% of patient demographic data must be recorded as structured data.• More than 80% of all unique patients have demographics recorded as structured

data.

Record vital signs and chart changes• More than 50% of patients >2 years old must have height, weight and blood

pressure recorded as structured data• More than 80% of patients >3 years old must have blood pressure measured and

all patients have height and weight recorded as structured data.


eRx• Stage 1: More than 40% must be transmitted electronically• Stage 2: More than 65% are compared to at least one drug formulary and

transmitted electronically

Record patient demographics• More than 50% of patient demographic data must be recorded as structured data.• More than 80% of all unique patients have demographics recorded as structured

data.

Record vital signs and chart changes• More than 50% of patients >2 years old must have height, weight and blood

pressure recorded as structured data• More than 80% of patients >3 years old must have blood pressure measured and

all patients have height and weight recorded as structured data.

16

Increase of ThresholdsRecord smoking status• More than 50% of patients age 13 or older have smoking status recorded as

structured data• More than 80% of patients age 13 or older have smoking status recorded as

structured data

Lab results• More than 40% of clinical lab results are in positive/negative or numerical format

and stored as structured data• Move to core requirement. More than 55% of all clinical lab tests are incorporated

as structured data.


Record smoking status• More than 50% of patients age 13 or older have smoking status recorded as

structured data• More than 80% of patients age 13 or older have smoking status recorded as

structured data

Lab results• More than 40% of clinical lab results are in positive/negative or numerical format

and stored as structured data• Move to core requirement. More than 55% of all clinical lab tests are incorporated

as structured data.

17

More Stringent Parameters

Provide patients with clinical summaries for each office visit

• Provide clinical summaries for more than 50% of all visits within 3 business days

• Provide clinical summaries for more than 50% of all visits within 24 hours

Privacy and Security

• Conduct a security risk analysis, implement security updates and correct identified issues

• Conduct a security risk analysis, implement security updates and correct identified issues,

including data at rest.


Provide patients with clinical summaries for each office visit

• Provide clinical summaries for more than 50% of all visits within 3 business days

• Provide clinical summaries for more than 50% of all visits within 24 hours

Privacy and Security

• Conduct a security risk analysis, implement security updates and correct identified issues

• Conduct a security risk analysis, implement security updates and correct identified issues,

including data at rest.

18

Move to Core from MenuLab results

• More than 40% of clinical lab results are in positive/negative or numerical formatand stored as structured data

• Move to core requirement. More than 55% of all clinical lab tests are incorporatedas structured data.

Generate list of patients by specific condition

• Move to core requirement.

Send reminders to patients per patient preference

• More than 20% of patients aged 65 or older or 5 or younger must be sentappropriate reminders.

• Move to core requirement. More than 10% of all unique patients who had a visitwithin past 24 months were sent a reminder, per patient preference.


Lab results

• More than 40% of clinical lab results are in positive/negative or numerical formatand stored as structured data

• Move to core requirement. More than 55% of all clinical lab tests are incorporatedas structured data.

Generate list of patients by specific condition


Send reminders to patients per patient preference

• More than 20% of patients aged 65 or older or 5 or younger must be sentappropriate reminders.

• Move to core requirement. More than 10% of all unique patients who had a visitwithin past 24 months were sent a reminder, per patient preference.

19

Move to Core from MenuPatient-specific education resources

• More than 10% of patients are provided patient-specific education resources.


Perform medication reconciliation

• Perform med reconciliation for more than 50% of transitions of care

• Move to core requirement. Perform medication reconciliation for more than 65% of

transitions of care.

Submission of electronic immunization data

• Must perform at least one test of data submission and follow-up submission to

immunization registries.

• Move to core requirement. Successful ongoing submission of electronic

immunization data to a registry or reporting system for entire EHR reporting period.| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health

Patient-specific education resources

• More than 10% of patients are provided patient-specific education resources.


Perform medication reconciliation

• Perform med reconciliation for more than 50% of transitions of care

• Move to core requirement. Perform medication reconciliation for more than 65% of

transitions of care.

Submission of electronic immunization data

• Must perform at least one test of data submission and follow-up submission to

immunization registries.

• Move to core requirement. Successful ongoing submission of electronic

immunization data to a registry or reporting system for entire EHR reporting period.20

What Measures Should You BeThinking About?


What Measures Should You BeThinking About?

21

Areas of major change

• CPOE

• Secured Messaging

• Patient Access: View, Download, Transmit

• Transitions of Care

• Clinical Decision Support


• CPOE

• Secured Messaging

• Patient Access: View, Download, Transmit

• Transitions of Care

• Clinical Decision Support

22

CPOE

• More than 60% of meds, lab, and rad orders created

by the EP during the reporting period use CPOE

= 60%

Cor

e

# of orders in the denominator recorded usingCPOE


= 60%

23

Cor

e

Exclusion: Any EP who fewer of 100 meds, labs, and radiology orders COMBINED

# of med, rad, and lab orders created by the EPduring the reporting period

# of orders in the denominator recorded usingCPOE

CPOE EP Requirements

• Further defining CPOE

• CPOE should be used the first time the order becomes part of the record,

before any action can be taken on the order

• removing the possibility that a record of the order could be created prior to CPOE

• This means that the originating provider (whose judgment creates the

order) must personally use the CPOE function or verbally communicate

the order to someone else who will use the CPOE function

• Provider is responsible for including the orders in their

denominators if they are not recorded using CPOE


• Further defining CPOE

• CPOE should be used the first time the order becomes part of the record,

before any action can be taken on the order

• removing the possibility that a record of the order could be created prior to CPOE

• This means that the originating provider (whose judgment creates the

order) must personally use the CPOE function or verbally communicate

the order to someone else who will use the CPOE function

• Provider is responsible for including the orders in their

denominators if they are not recorded using CPOE

24

Patient Access

• 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

• 2 Report Calculations

Cor

e

Report #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


= 65%

25

Cor

e

Exclusion: Next slide

#of unique patients seen by the EP during thereporting period

# of patients in the den. who have timely (within 4business days after the information is available tothe EP) online access to their health information

online

Report #1

Patient Access

= 10%Cor

e

# of unique patients (or their authorizedrepresentatives) in the den. who have viewedonline or downloaded or transmitted to a third

party the patient's health information

Report #2


= 10%

26

Cor

e

Exclusion: Any EP who neither orders nor creates any of the information listed for inclusion aspart of this measure may exclude both measures.

Any EP that conducts 50% or more of his or her patient encounters in a county that does nothave 50 percent or more of its housing units with 4Mbps broadband availability according to thelatest information available from the FCC on the first day of the reporting period may excludeonly the second measure.

#of unique patients seen by the EP during thereporting period

Patient Access EP Requirements

• Patients must be able to access this information on demand

• This includes that patients with disabilities need equal access

• Its not just about the patient, but also their authorized representatives that

can access their health info

• Patients have to grant access to those representatives with the exception of minors

• Still uses the same business day logic as in stage 1

• Reporting

• A patient who views their info online, downloads it from the internet, or uses the

internet to transmit it to a third party would count for the numerator

• New exclusions about the counties without high-speed internet


• Patients must be able to access this information on demand

• This includes that patients with disabilities need equal access

• Its not just about the patient, but also their authorized representatives that

can access their health info

• Patients have to grant access to those representatives with the exception of minors

• Still uses the same business day logic as in stage 1

• Reporting

• A patient who views their info online, downloads it from the internet, or uses the

internet to transmit it to a third party would count for the numerator

• New exclusions about the counties without high-speed internet

27

Patient Access EP Requirements• The following information must be made available within 4 days of the info being available to the EP:

• Patient name

• Provider's name and office contact information

• Problem list

• Procedures

• Laboratory test results

• Medication list

• Medication allergy list

• Vital signs (height, weight, blood pressure, BMI, growth charts*)

• Smoking status

• Demographic information (preferred language, gender, race, ethnicity, date of birth)

• Care plan field, including goals* and instructions

• Any additional known care team members* beyond the referring or transitioning provider and the receiving

provider.

• Provider needs to be able to not send specific information when needed at the provider’s discretion


• The following information must be made available within 4 days of the info being available to the EP:

• Patient name

• Provider's name and office contact information

• Problem list

• Procedures


• Medication list

• Medication allergy list

• Vital signs (height, weight, blood pressure, BMI, growth charts*)

• Smoking status

• Demographic information (preferred language, gender, race, ethnicity, date of birth)

• Care plan field, including goals* and instructions

• Any additional known care team members* beyond the referring or transitioning provider and the receiving

provider.

• Provider needs to be able to not send specific information when needed at the provider’s discretion

28

Secured Messaging

• Use secure electronic messaging to communicate with

patients on relevant health information

= 10%

Cor

e # of patients in the den. who send a secureelectronic message to the EP using the electronicmessaging function of CEHRT during the reporting

period.


= 10%

29

Cor

e

Exclusion: Any EP who has no office visits during the reporting period

# of unique patients seen by the EP during thereporting period

# of patients in the den. who send a secureelectronic message to the EP using the electronicmessaging function of CEHRT during the reporting

period.

Secured Messaging EP Requirements

• Secure Message must contain relevant health info

• Secure Messaging can occur through:

• Email with necessary safeguards

• Patient portals

• PHR

• Stand along messaging applications

• Patient must take action for provider to meet this measure

• CMS wants comments about behavioral health


• Secure Message must contain relevant health info

• Secure Messaging can occur through:

• Email with necessary safeguards

• Patient portals

• PHR

• Stand along messaging applications

• Patient must take action for provider to meet this measure

• CMS wants comments about behavioral health

30

Transitions of Care (TOC) Calculation

• 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


= 65%

Cor

e

Report #1


• 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


= 65%

31

Cor

e

Exclusion: Any EP who neither transfers a patient to another setting nor refers a patient to another providerduring the EHR reporting period is excluded from both measures.

# of TOC and referrals during the reporting periodfor which the EP was the transferring or referringprovider

# of TOC and referrals in the denominator wherea summary of care record was provided

Report #1

Transitions of Care (TOC) Calculation

= 10%Cor

e

# of TOC & referrals in the denominator where asummary of care record was electronically

transmitted using CEHRT to a recipient with no orgaffiliation and using a different CEHRT vendor than

the sender

Report #2


= 10%

32

Cor

e

Exclusion: Any EP who neither transfers a patient to another setting nor refers a patient to another providerduring the EHR reporting period is excluded from both measures.

# of TOC and referrals during the reporting periodfor which the EP was the transferring or referring

provider

# of TOC & referrals in the denominator where asummary of care record was electronically

transmitted using CEHRT to a recipient with no orgaffiliation and using a different CEHRT vendor than

the sender

Clinical Decisions Support (CDS)

• Use clinical decision support to improve

performance on high-priority health

conditions

Cor

e

Threshold


• Use clinical decision support to improve

performance on high-priority health

conditions

33

Cor

e

Exclusion: None

5 Clinical Decision Support + DUR AlertThreshold

CDS EP Requirements

• User must use 5 Clinical Decision Support rules and they must be

related to 5 or more Quality Measures

• Related = intent is to improve performance of the Clinical Quality

Measure

• User does not need to show improvement in the Quality Measure.

• If user doesn't have an applicable CQM, they can choose to do another

related to patient care

• User must have enabled DUR interactions for the entire

reporting period


• User must use 5 Clinical Decision Support rules and they must be

related to 5 or more Quality Measures

• Related = intent is to improve performance of the Clinical Quality

Measure

• User does not need to show improvement in the Quality Measure.

• If user doesn't have an applicable CQM, they can choose to do another

related to patient care

• User must have enabled DUR interactions for the entire

reporting period

34

CDS EP Requirements

• Intervention must be done at a relevant point of time in the

workflow, before action is taken on the patient

• ex. create a trigger that prompts the provider to ask about influenza

immunization when a patient is 50 years or older.


• Intervention must be done at a relevant point of time in the

workflow, before action is taken on the patient

• ex. create a trigger that prompts the provider to ask about influenza

immunization when a patient is 50 years or older.

35

TOC Reporting Considerations

• Exchange Key Clinical Information from Stage 1 was combined into

this measure

• Combined Maintain Active Med List, Problem List, and Med Allergy

list into this measure

• EP must verify med/prob/allergies and they cannot be blank

• Denominator –

• If the referral is sent to a provider has access to the system, the referral

does not count in the denominator

• Sending Electronically: USB, CD, Fax does not count


• Exchange Key Clinical Information from Stage 1 was combined into

this measure

• Combined Maintain Active Med List, Problem List, and Med Allergy

list into this measure

• EP must verify med/prob/allergies and they cannot be blank

• Denominator –

• If the referral is sent to a provider has access to the system, the referral

does not count in the denominator

• Sending Electronically: USB, CD, Fax does not count

36

TOC Workflow RequirementsSummary of Care Document must contain the following (if available on the patient)• Patient name

• Referring or transitioning provider's name and

office contact information (EP only)

• Procedures

• Relevant past diagnoses


• Vital signs (height, weight, blood pressure, BMI,

growth charts)

• Smoking status

• Demographic information (preferred language,

gender, race, ethnicity, date of birth)

• Any additional known care team members

beyond the referring or transitioning provider

and the receiving provider

• Care plan field, including goals and instructions

• Care Plan is defined as the management actions

for various conditions, problems, and issue

• Care Plan = Problem (focus) + Goal (Target

outcome) + Instructions given to patient

• Goal is defined as target or measure to be achieved in the

process of patient care (expected outcome)

• An up-to-date problem list of current and active

diagnoses

• An active medication list

• An active medication allergy list


• Patient name

• Referring or transitioning provider's name and

office contact information (EP only)

• Procedures

• Relevant past diagnoses


• Vital signs (height, weight, blood pressure, BMI,

growth charts)

• Smoking status

• Demographic information (preferred language,

gender, race, ethnicity, date of birth)

• Any additional known care team members

beyond the referring or transitioning provider

and the receiving provider

• Care plan field, including goals and instructions

• Care Plan is defined as the management actions

for various conditions, problems, and issue

• Care Plan = Problem (focus) + Goal (Target

outcome) + Instructions given to patient

• Goal is defined as target or measure to be achieved in the

process of patient care (expected outcome)

• An up-to-date problem list of current and active

diagnoses

• An active medication list

• An active medication allergy list

37

Stage 2 Reporting - EPs

• Report 12 CQMs from a menu of 125

• Includes most of the current 44

• Must include at least 1 CQM from each of the 6 domains

• All begin in 2014 for both Stage 1 and Stage 2

• Examples of new measures

• pediatric, obstetric, behavioral/mental health, HIV medical visits,

antiretroviral therapy, oral health – many geared towards Medicaid

providers


• Report 12 CQMs from a menu of 125

• Includes most of the current 44

• Must include at least 1 CQM from each of the 6 domains

• All begin in 2014 for both Stage 1 and Stage 2

• Examples of new measures

• pediatric, obstetric, behavioral/mental health, HIV medical visits,

antiretroviral therapy, oral health – many geared towards Medicaid

providers

39

Stage 2 Reporting - EPs

• Online submission via XML files

• May submit as an individual or group

• Possible aggregation of performance here (!) unlike the batch reporting with the measures,

which must remain individual

• Can only be done beginning in second year of MU

• Three group options:

• Different NPIs / one TIN: all members of group must report all CQMs as a group

• Different NPIs / one TIN, participating in the Medicare Shared Savings Program and

Pioneer ACO model who use Certified EHR to submit ACO measures: all measures must be

extracted by the Certified EHR

• Medicare EPs who satisfactorily report PQRS CQMs using Certified EHR Technology


• Online submission via XML files

• May submit as an individual or group

• Possible aggregation of performance here (!) unlike the batch reporting with the measures,

which must remain individual

• Can only be done beginning in second year of MU

• Three group options:

• Different NPIs / one TIN: all members of group must report all CQMs as a group

• Different NPIs / one TIN, participating in the Medicare Shared Savings Program and

Pioneer ACO model who use Certified EHR to submit ACO measures: all measures must be

extracted by the Certified EHR

• Medicare EPs who satisfactorily report PQRS CQMs using Certified EHR Technology

40

CQM reporting options (2014)• Option 1a:

• 12 measures, including at least 1 from each of 6 domains (NPRM Table

8)

• Option 1b:

• 11 “core” measures (NPRM Table 6) + 1 “menu” measure (NPRM Table

8)

• Option 2:

• Successfully report through PQRS

• Must continue to comply with PQRS as it evolves


• Option 1a:

• 12 measures, including at least 1 from each of 6 domains (NPRM Table

8)

• Option 1b:

• 11 “core” measures (NPRM Table 6) + 1 “menu” measure (NPRM Table

8)

• Option 2:

• Successfully report through PQRS

• Must continue to comply with PQRS as it evolves

41

ONC will finalize Option 1a or 1b

11.3

New FeaturesUsability & VOC

ImprovementsDUR EnhancementsClinical Item Contention

(also in 11.2.3)Patient EducationConnected CommunityEnhanced Community

PortalADX Integration 1.0MaintenancePerformance & Technology

Enhancements

43Enterprise EHR Roadmap

Q2 2012 Q3 2012Q1 2012 Q4 2012 Q1 2013 Q2 2013

New FeaturesPatient GoalsPatient Care teamClinical Decision SupportPop. Health ImprovementsOrders Usability ImprovementsConnected CommunityPatient Portal ImprovementsReferral ImprovementsRegulatoryMeaningful Use Stage 2Quality Measure SupportSureScripts NCPDP 10.6 STDEPCS & Pharm Directory 4.4

11.4.1


Q2 2012 Q3 2012Q1 2012

Innovation Projects (Wombat, New Note, Humedica, App Store, Voice Enablement)

Focus of 11.4 & 11.4.1Improved Usability whilemeeting regulatory req’s

Focus of 11.4 & 11.4.1Improved Usability whilemeeting regulatory req’s

Q4 2012 Q1 2013 Q2 2013

New FeaturesEmail Distribution of scheduled

reportsNew filter optionsMulti-Organization SupportQuality Measure Drill DownMaintenanceUsability Defects

Stimulus Reporting 2.0 11.4

New FeaturesProblem Usability ImprovementsMy Priority Problem ListsProblem ImpressionConnected CommunityADX integration 1.5Patient Portal Costume FormsRegulatoryICD-10 Support

Questions


Appendix


Requirement Stage 1 Standard Stage 2 Standard1 CPOE More than 30% of patients with at least one

medication must have at least onemedication ordered via CPOE

More than 60% of medication, labs, andradiology orders are recorded usingCPOE. No requirement to orderelectronically.

2 eRx More than 40% must be transmittedelectronically

More than 65% are compared to at leastone drug formulary and transmittedelectronically

3 Record patient demographics More than 50% of patient demographicdata must be recorded as structured data.

More than 80% of all unique patients havedemographics recorded as structured data.

Improving Quality, Safety, Efficiency...


3 Record patient demographics More than 50% of patient demographicdata must be recorded as structured data.

More than 80% of all unique patients havedemographics recorded as structured data.

4 Record vital signs and chart changes More than 50% of patients >2 years oldmust have height, weight and bloodpressure recorded as structured data

More than 80% of patients >3 years old musthave blood pressure measured and allpatients have height and weight recorded asstructured data.

5 Record smoking status More than 50% of patients age 13 or olderhave smoking status recorded asstructured data

More than 80% of patients age 13 or olderhave smoking status recorded as structureddata

6 Clinical Decision Support Implement one clinical decision supportrule and track compliance with that rule

Implement five clinical decision supportrules related to 5 or more clinical qualitymeasuresAndImplement drug-drug and drug-allergyinteraction checks

Requirement Stage 1 Standard Stage 2 Standard7 Lab results More than 40% of clinical lab results are in

positive/negative or numerical format andstored as structured data

Move to core requirement. More than55% of all clinical lab tests are incorporatedas structured data.

8 Generate list of patients by specificcondition for use in qualityimprovement, reduction ofdisparities, research or outreach.

Generate one list of patients with a specificcondition.

Move to core requirement.

9 Send reminders to patients perpatient preference for preventativeand follow up care

More than 20% of patients aged 65 orolder or 5 or younger must be sentappropriate reminders.

Move to core requirement. More than10% of all unique patients who had a visitwithin past 24 months were sent areminder, per patient preference.

Improving Quality, Safety, Efficiency...


9 Send reminders to patients perpatient preference for preventativeand follow up care

More than 20% of patients aged 65 orolder or 5 or younger must be sentappropriate reminders.

Move to core requirement. More than10% of all unique patients who had a visitwithin past 24 months were sent areminder, per patient preference.

M1 Imaging results. New measure. More than 40% of all scansand tests ordered by EP are accessiblethrough the certified EHR.

M2 Record patient family health historyas structured data

New measure. More than 20% of all uniquepatients have a structured data entry for oneor more first-degree relatives.

Requirement Stage 1 Standard Stage 2 Standard10 Provide patients with ability to view

online, download & transmit theirhealth information.

New Requirement. 50% of all uniquepatients provided online access to theirhealth information within 4 business daysafter it is available to the EP (subject to EPdiscretion)AndMore than 10% unique patients view,download, or transmit their info to a thirdparty.

11 Provide patients with clinicalsummaries for each office visit

Provide clinical summaries for more than50% of all visits within 3 business days

Provide clinical summaries for more than50% of all visits within 24 hours

Engage Patients & Families


Provide patients with clinicalsummaries for each office visit

Provide clinical summaries for more than50% of all visits within 3 business days

Provide clinical summaries for more than50% of all visits within 24 hours

12 Use EHR technology to identifypatient-specific education resourcesas provide to patients asappropriate.

More than 10% of patients are providedpatient-specific education resources.

Move to core requirement.

13 Use secure electronic messaging. New requirement. A secure message wassent using the Certified EHR by more than10% of unique patients seen.

Requirement Stage 1 Standard Stage 2 Standard14 Perform medication reconciliation Perform med reconciliation for more than

50% of transitions of careMove to core requirement. Performmedication reconciliation for more than 65%of transitions of care.

15 Provide summary of care record forpatients referred or transitioned toanother provider.

Summary of care records are provided forat least 50% of patient transitions orreferrals.

Move to core.1. provide a summary of care for 65% of

transitions or referrals;and

2. transmit summary of care record to arecipient with no organizationalaffiliation and who uses a differentcertified technology vendor than thesender for more than 10% oftransitions or referrals.

Improve Care Coordination


Move to core.1. provide a summary of care for 65% of

transitions or referrals;and

2. transmit summary of care record to arecipient with no organizationalaffiliation and who uses a differentcertified technology vendor than thesender for more than 10% oftransitions or referrals.

Requirement Stage 1 Standard Stage 2 Standard24 Submission of electronic

immunization dataMust perform at least one test of datasubmission and follow-up submission toimmunization registries.

Move to core requirement. Successfulongoing submission of electronicimmunization data to a registry or reportingsystem for entire EHR reporting period.

M3 Syndromic surveillance data topublic health agencies

Must perform at least one test of datasubmission and follow-up submission topublic health agencies for syndromicsurveillance.

Successful ongoing submission ofelectronic immunization data to a publichealth agency for entire EHR reportingperiod.

M4 Report cancer cases to cancerregistry

New measure. Successful ongoingsubmission of cancer case information to acancer registry for entire EHR reportingperiod.

Improve Population & Public Health


Report cancer cases to cancerregistry

New measure. Successful ongoingsubmission of cancer case information to acancer registry for entire EHR reportingperiod.

M5 Report specific cases tospecialized, non-cancer registry

New measure. Successful ongoingsubmission of specific case information to aspecialized, non-cancer registry for entireEHR reporting period.

Requirement Stage 1 Standard Stage 2 Standard25 Privacy and Security Conduct a security risk analysis, implement

security updates and correct identifiedissues

Conduct a security risk analysis, implementsecurity updates and correct identifiedissues, including data at rest.

Ensure Adequate Privacy


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