OCTOBER 19, 2018 PROMOTING INTEROPERABILITY- UPDATES ANNUAL MEETING 2018

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1 OCTOBER 19, 2018 PROMOTING INTEROPERABILITY- UPDATES ANNUAL MEETING 2018

2 AGENDA The MU name change changes-our focus is on the nuances and workflow changes Is it time for an EHR optimization review? AGENDA

3 NAME CHANGE Meaningful use is now and Promoting Interoperability Synchronizes this with the Quality Payment Program-MIPS NAME CHANGE

4 JANUARY 1, 2015 EDITION MUST BE USED ARE YOU READY? 2015 EDITION The reporting period is a minimum of a 90 day continuous period in the calendar year for the 6 general measures

5 In addition to the 6 PI measures there continues an ecqm requirement For Electronic Clinical Quality Measuresrequired to only select one calendar year quarter and at least 4 self selected measures The 16 measures will be reduced by 8 on 2020

6 -Stage 3 Patient Electronic Access to Health Information This is measure 3 and includes both the timely access to health information and patient education The change is how access is provided

7 -Stage 3 For more than 50 percent of all unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) The patient (or the patient authorized representative) is provided timely access to view online, download, and transmit his or her health information; and

8 -Stage 3 The eligible hospitals or CAH ensures the patient s health information is available for the patient (or patient authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the application programming interfaces (API) in the eligible hospitals or CAHs certified electronic health record technology (CEHRT).

9 API A set of programming protocols established for multiple purposes. APIs may be enabled by an eligible hospital or CAH to provide the patient with access to their health information through a thirdparty application with more flexibility than is often found in many current patient portals.

10 Provide Access When a patient possesses all of the necessary information needed to view, download, or transmit their information. This could include providing patients with instructions on how to access their health information, the website address they must visit for online access, a unique and registered username or password, instructions on how to create a login, or any other instructions, tools, or materials that patients need in order to view, download, or transmit their information.

11 Does your EHR still require patients to be ed, invited, and registered before they access the portal and are counted in the 50%? Or does it generate a portal record that is available once registered? The latter is optimum to reaching 50%

12 Eligible hospitals or CAHs may not prohibit patients from using any application, including third-party applications, which meet the technical specifications of the API, including the security requirements of the API. Eligible hospitals or CAHs are expected to provide patients with detailed instructions on how to authenticate their access through the API and provide the patient with supplemental information on available applications that leverage the API.

13 Similar to how eligible hospitals or CAHs support patient access to View, Download, Transmit capabilities, eligible hospitals or CAHs should continue to have identity verification processes to ensure that a patient using an application, which is leveraging the API, is provided access to their health information.

14 Eligible hospitals or CAHs should also be aware that while meaningful use is limited to the capabilities of CEHRT to provide online access, there may be patients who cannot access their EHRs electronically because of a disability. Eligible hospitals or CAHs who are covered by civil rights laws must provide individuals with disabilities equal access to information and appropriate auxiliary aids and services as provided in the applicable statutes and regulations.

15 This means that use of the API must incorporate identity verification and security And the same is required for general portal or view/download and transfer Are the systems in place sufficient? Such as two factor authentication? What happens if your is spoofed or phished and a hacker sees invites to patients?

16 The disability requirement will require specific policies and procedures and some awareness at discharge or soon after If a patient elects to "opt out" of participation, that patient must still be included in the denominator. Do you have a process for opt-out of this type pf participation? Is it the same as for CORHIO/QHN?

17 Health Information Exchange..provide a summary of care record when transitioning or referring their patient to another setting of care, receives or retrieves a summary of care record upon the receipt of a transition or referral or upon the first patient encounter with a new patient, and incorporates summary of care information from other providers into their electronic health record (EHR) using the functions of certified EHR technology (CEHRT).

18 Eligible hospitals or CAHs must attest to all three measures on the next slides and must meet the thresholds for at least two measures to meet the objective.

19 Send a Summary of Care For more than 10 percent of transitions of care and referrals, the eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care: (1)Creates a summary of care record using CEHRT; and (2)Electronically exchanges the summary of care record.

20 Request/Accept Summary of Care For more than 10 percent of transitions or referrals received and patient encounters in which the eligible hospital or CAH has never before encountered the patient, the eligible hospital or CAH incorporates into the patient s EHR an electronic summary of care document.

21 Clinical Information Reconciliation For more than 50 percent of transitions or referrals received and patient encounters in which the eligible hospital or CAH has never before encountered the patient, the eligible hospital or CAH performs a clinical information reconciliation.

22 The eligible hospital or CAH must implement clinical information reconciliation for the following three clinical information sets: (1)Medication. Review of the patient s medication, including the name, dosage, frequency, and route of each medication. (2) Medication allergy. Review of the patient s known medication allergies. (3) Current Problem list. Review of the patient s current and active diagnoses.

23 An eligible hospital or CAH may exclude from the measure for whom the total of transitions or referrals received and patient encounters in which the eligible hospital or CAH has never before encountered the patient, is fewer than 100 during the PI reporting period is excluded from this measure.

24 The Summary of Care Patient name Demographic information (preferred language, sex, race, ethnicity, date of birth) Smoking status Current problem list (eligible hospitals or CAHs may also include historical problems at their discretion)* Current medication list* Current medication allergy list* Laboratory test(s) Laboratory value(s)/result(s)

25 The Summary of Care Vital signs (height, weight, blood pressure, BMI) Procedures Care team member(s) (including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider)* Immunizations Unique device identifier(s) for a patient s implantable device(s) Care plan, including goals, health concerns, and assessment and plan of treatment Encounter diagnosis Functional status, including activities of daily living, cognitive and disability status Discharge instructions (eligible hospital and CAH only)

26 Nuances Non-medical staff may conduct reconciliation under the direction of the eligible hospital or CAH so long as the provider or other credentialed medical staff is responsible and accountable for review of the information and for the assessment of and action on any relevant CDS.

27 Nuances An eligible hospital or CAH must verify that the fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information known by the eligible hospital or CAH as of the time of generating the summary of care document or include a notation of no current problem, medication and/or medication allergies. How will you do this?

28 Nuances For Stage 3, CMS is NOT continuing the policy of allowing a third party to convert the summary of care record transmission to fax as it does not drive toward the overall goal of sending, receiving or retrieving an electronic summary of care document for this objective.

29 Nuances Will your CEHRT correctly identify and count new patients in for the clinical reconciliation measure?

30 Nuances For the purposes of defining the cases in the denominator for Accept/Request Summary of Care, what constitutes unavailable and, therefore, may be excluded from the denominator, will be that an eligible hospital or CAH

31 Requested an electronic summary of care be sent and did not receive it and The eligible hospital or CAH either: Queried at least one external source via health information exchange (HIE) functionality and did not locate a summary of care for the patient, or the eligible hospital or CAH does not have access to HIE functionality to support such a query CORHIO to the rescue!

32 EHR REVIEW MU has created a tail wagging the dog scenario Doing things for MU/PI and not true meaningful use? EHR REVIEW And what is that?

33 EHR REVIEW improved charting faster, easier, better improved referrals care coordination population health, clinical decision support, chronic care management EHR REVIEW And what about social determinants of care and patient generated information

34 EHR REVIEW Workflows such as: 1. maintaining a data repository 2. supporting patient triage 3. Care coordination to incorporate social determinants of care which will drive new data sources (input) and data disclosures (output) 4. Remote diagnostic monitoring 5. True patient engagement EHR REVIEW

35 Is it time to Analyze and redo workflows Look at workflow and use of the system to support patient centered medical home models Re-engage clinical practice and guidelines More importantly re-engage the entire team of stakeholders EHR REVIEW

36 Summary Moving to Stage 3 requires strategic planning EHR REVIEW Questions? Remember our Consortium webinars