Vermont Information

Technology Leaders, Inc.

Meaningful Use Webinar Series

March 5, 12, and 19, 2014

12:00pm – 1:00pm

2014 Meaningful Use Webinar Series

• March 5: PREPARING FOR STAGE 2 MEANINGFUL USE Now that you've achieved Stage 1 of Meaningful Use, it's time to start preparing for the additional requirements of Stage 2. In this webinar, VITL eHealth Specialist Jennifer Morgan will provide an in-depth look at the core and menu objectives for Stage 2, including the higher thresholds that must be met, and the new objectives which emphasize health information exchange between providers to improve patient care coordination.

• March 12: IMPLEMENTING A SUCCESSFUL PATIENT PORTAL Under Stage 2 of meaningful use, patients must be given online access to their health information. There is also a minimum threshold of 5 percent of patients using health IT to access their information. In this webinar, VITL eHealth Specialist Ann Guilmette will provide strategies and advice for successfully implementing a patient portal, along with tips for getting patients involved in using it.

• March 19: CHANGES IN STAGE 1 MEANINGFUL USE FOR 2014 If you are an eligible professional considering joining the EHR Incentive Program, or if you are already in the program and are working toward achieving Stage 1 of meaningful use, this webinar will be particularly helpful. VITL eHealth Specialist Suzanne McEachron will discuss changes in Stage 1 requirements and important dates to keep in mind for participating during 2014. The webinar will also cover the 2014 changes in clinical quality measure reporting for all providers, regardless of whether they are in Stage 1 or Stage 2.

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Before We Get Started

• You may interact with the presenters at anytime

– Type your question into the questions box

– Today’s panelists will send an answer

– Selected questions will be discussed further in a Q&A session at the end of the presentation

• Slides and video recording will be posted later today at www.vitl.net/muwebinars

• Keep the conversation going during and after the webinar ends on Twitter - #VITLmu

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Vermont Information

Technology Leaders, Inc.

CHANGES IN STAGE 1 MEANINGFUL USE FOR 2014

March 19, 2014

Presented by Suzanne McEachron

• Review of 2014 MU Stage 1 Requirements

• Detailed Changes for 2014

• 2014 Incentive & Penalties Timelines

• MU Additional Resources

• Time for Questions and Answers

Today’s Agenda

• 2014 Certified EHR Technology (CEHRT) MUST be used for ENTIRE EHR reporting period

• REGARDLESS of your Meaningful Use Stage

• Obtain your 2014 CEHRT number from the CHPL website: http://oncchpl.force.com/ehrcert

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2014 CEHRT REQUIRED

2014 MU Stage 1 Overview

• 13 REQUIRED Core Measures

• 5 out of 9 REQUIRED Menu Measures

• 9 Clinical Quality Measures

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2014 Eligible Professional Core Objectives

Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local and professional guidelines. > 30% (*2013*)

Implement drug-drug and drug-allergy interaction checks.

Maintain an up-to-date problem list of current and active diagnoses. > 80%

Generate and transmit permissible prescriptions electronically > 40% (*2013*)

Maintain active medication list. > 80%

Maintain active medication allergy list. > 80%

Record the following demographics: preferred language, sex, race, ethnicity, and date of birth >50%

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2014 Eligible Professional Core Objectives (cont.)

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 BMI; and plot and display growth charts for patients 0-20 years, including BMI. > 50% (*2013* and **2014**)

Record smoking status for patients 13 years old or older. > 50%

Implement one relevant clinical decision support rule

Provide patients the ability to view, download and transmit their health information within 4 business days of the information being available to the EP. > 50% (**2014**)

Provide clinical summaries for patients for each office visit. > 50%

Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

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2014 Eligible Provider Menu Objectives

Implement drug formulary checks.

Incorporate clinical lab test results into EHRR as structured data. > 40%

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

Send appropriate reminders to patients (age 65 and older or age 5 and under) per patient preference. > 20%

Use CEHRT to identify patient-specific education resources and provide those resources to patient if appropriate. > 10%

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2014 Eligible Provider Menu Objectives (cont.)

EP who receives a patient from another setting of care or provider of care or believes an encounter id relevant should perform medication reconciliations. > 50%

EP who transitions their patients 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. > 50%

Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. (*2013*)

Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. (*2013*)

2013 Stage 1 Changes

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CPOE for Medication Orders

EP may choose “Original” measure: More than 30% of all unique patients with at least 1 medication order in their medication list seen by the EP have at least one medication order entered using CPOE

OR “Alternate Measure”

More than 30% of medication orders created by the EP during the EHR reporting period are recorded using CPOE

NOTE: “Alternate” Measure will become REQUIRED in Stage 2

Changes Effective in 2013

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Changes Effective in 2013

Electronic Prescribing

Exclusion was added in 2013:

Any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice location at the start of his/her EHR reporting period

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Changes Effective in 2014

Record and Chart Changes in Vital Signs More than 50% of all unique patient seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data.

Exclusions for Vital Signs measure

An EP may select any of the following reasons for excluding part or all of the vital signs measure:

• Sees no patients 3 years or older (excluded from recording blood pressure)

• Believes that all three vital signs have no relevance to their scope of practice

• Believes that height and weight are relevant to their scope of practice, but blood pressure is not (excluded from recording blood pressure)

• Believes that blood pressure is relevant to their scope of practice, but height and weight are not (excluded from recording height and weight)

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Changes Effective in 2014

Objective: Provide patients the ability to view online, download, and transmit their health information within 4 business days of their information being available to the EP

Measure: > 50% 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.

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New Core Measure in 2014

The following information must be made available electronically: • Patient name

• Provider’s name and office contact information

• Current and past problem list

• Procedures

• Lab test results

• Current medication list and medication history

• Current medication allergy list and medication allergy history

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

• Smoking status

• Demographic information

• Care plan field(s) including goals and instructions

• Any known care team members including the PCP of record

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2014 Objective – View, Download, and Transmit

Exclusions:

• Any EP who neither orders nor creates any of the information listed for inclusion except for Patient Name and office contact information may exclude measure

• Any EP that conducts > 50% of patient encounters in a county with < 50% of its housing units with 3Mbps broadband availability…

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2014 View, Download, and Transmit (cont.)

2014 Changes to Clinical Quality Measures (CQMs)

EPs must report on 9 of the 64 approved CQMs

CMS has recommended core CQMs

• 9 CQMs for adult populations

• 9 CQMs for pediatric populations

• NQF 0018 strongly encouraged (controlling high blood pressure)

Selected CQMs must cover at least 3 of the 6 National Quality Strategy domains

EPs have capability to choose CQMs relevant to their practice

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DOMAINS for CQMs

Patient and Family Engagement

Patient Safety

Care Coordination Population/Public Health

Efficient Use of Healthcare Resources

Clinical Processes/Effectiveness

Reporting of Clinical Quality Measures (CQMs) in 2014

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Category Year Time Period

Data Level

Payer Submission Type

Reporting Schema

Medicaid Year 1 or Year 2

90 days Aggregate All Attestation 9 CQMs

Medicare Year 1 90 days Aggregate All Attestation 9 CQMs

Medicare Year 2 / Option 1

Calendar quarter

Aggregate All Electronic 9 CQMs

Medicare Year 2 / Option 2

Calendar Year

Patient Medicare Electronic PQRS reporting using CEHRT

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Provider Type Year Reporting Period Submission Period

Medicare EP 1 90 consecutive days Anytime immediately following the 90 day reporting period, but no later than 2/28/2015

Medicare EP 2 Calendar year quarter: January 1-March 31 April 1 – June 30 July 1-September 30 October 1-Decmeber 31

Anytime immediately following the calendar quarter reporting period, but no later than 2/28/2015

Medicaid 1 or 2 90 consecutive days

Anytime immediately following the 90 day reporting period, but no later than 2/28/2015

2014 STAGE 1 REPORTING AND ATTESTATION TIME FRAMES

CMS Payment Adjustment Timelines

• If you began in 2011 or 2012… If you first demonstrated meaningful use in 2011 or 2012, you must demonstrate meaningful use for a full year in 2013 to avoid the payment adjustment in 2015.

• If you began in 2013… If you first demonstrated meaningful use last year, you needed to demonstrate meaningful use for a 90-day reporting period to avoid the payment adjustment in 2015.

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CMS Payment Adjustment Timelines (cont.)

• If you plan to begin in 2014… If you first demonstrate meaningful use in 2014, you must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid the payment adjustment in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and eligible professionals must attest to meaningful use no later than October 1, 2014, to avoid the payment adjustment.

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Hardship Exceptions

• Infrastructure: Eligible professionals must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).

• New Eligible Professionals: Newly practicing eligible professionals who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. Thus eligible professionals who begin practice in calendar year 2015 would receive an exception to the penalties in 2015 and 2016, but would have to begin demonstrating meaningful use in calendar year 2016 to avoid payment adjustments in 2017.

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Hardship Exceptions (cont.) • Unforeseen Circumstances: Examples may include a natural disaster

or other unforeseeable barrier.

• Patient Interaction: Lack of face-to-face or telemedicine interaction with patients or lack of follow-up need with patients

• Practice at Multiple Locations: Lack of control over availability of CEHRT for more than 50% of patient encounters

• 2014 EHR Vendor Issues: The eligible professional’s EHR vendor was unable to obtain 2014 certification or the eligible professional was unable to implement meaningful use due to 2014 EHR certification delays.

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MU Additional Resources

ONC CHPL website

MU1 and MU2 Comparison Table for EPs

CMS CQM Measures

CMS Hardship Exceptions Tipsheet

MU Stage 1 Tipsheet

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Free Help With Meaningful Use

• Meaningful use assistance is available for all Vermont eligible professionals at no charge through a statewide grant to VITL

• Take advantage of our custom support plans and onsite assistance

• eHealth Specialists are located around Vermont to better assist you

• Call VITL at 802-223-4100 or visit our website www.vitl.net to get started

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Thank You!

Replays of this webinar will be posted within 24 hours to:

www.vitl.net/muwebinars

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