Community Health Centers. May 6, 2010

Transcription

1 Community Health Centers May 6, 2010

2 Agenda Overview MeHI s Goals and Strategies Health Information Exchange Regional Extension Center Chapter 305 State and Federal Relationship Meaningful Use Eligibility and Payments Next Steps Questions Appendix: Stage 1 Criteria for Meaningful Use 2

3 3 Overview

4 Massachusetts e-health Institute Established with Vision of EHR and HIE Adoption by 2015 Massachusetts e-health Institute (MeHI) established within the Massachusetts Technology Collaborative through Chapter 305 of the Acts of 2008 Mission to promote implementation of Electronic Health Records in all provider settings as part of an interoperable Health Information Exchange State appropriated $15M for 2009: annual funding subject to appropriation through 2014 Development of six-year Plan for statewide deployment of electronic health records and health information exchange Use of Implementation and Optimization Organizations to assist in the execution of the plan through community engagement, technology selection, project management, training etc. Health IT efforts in Commonwealth support healthcare reform Leveraging state-wide efforts including Massachusetts e-health Collaborative, Massachusetts Health Data Consortium, NEHEN, Masspro, Eastern MA H/C Initiative, CHAPS, SafeHealth, etc. 4

5 History of HIE in Massachusetts The key drivers of success in current Massachusetts HIE activities include a high level of collaboration and coordination among entities, the willingness of the private sector to fund these activities, and the depth and breadth of HIE expertise within the state MHDC founded to collect, analyze and disseminate healthcare information 1995 MHQP was established to drive improvement 2003 SAFE Health established 2004 MAeHC established to bring together healthcare stakeholders to create an EHR system 2006 EMHI founded by group of hospitals, health plans and universities 2009 NEHEN Merged With MA SHARE 2010 MeHI designated as Statewide HIE 1972 MLCHC was established to represent and serve the needs of the state s 52 community health centers 1985 Masspro, the designated QIO was established 1998 NEHEN established 2003 MA SHARE established 2008 MeHI established by Chapter SAFEHealth Go Live 2010 MeHI s updated plan following the passage of HITECH 5

6 ARRA/HITECH Opportunities HITECH Statewide HIE with collaborative governance and sustainable funding model: funded for $10.6M for Massachusetts (MEHI) HITECH Regional Extension Center to support implementation of electronic health record systems in physician offices: funded for $13.4M for Massachusetts (MeHI) for two years with additional $1M Additional opportunities for Massachusetts include: Health IT Community College/Education Grant: Total of $36M Awarded to 5 regional recipients to establish a multi-institutional consortium within each designated region. Will include a total of 70 community colleges, with on Massachusetts community college included. ARRA: Beacon Community Cooperative Agreement grant: $10-$20M Four Applicants from Massachusetts ARRA: Strategic Health IT Advanced Research Project (SHARP): $15M Advance the sophistication, development and deployment of security and privacy for Health IT Three Major Environments: EHR, HIE and Telemedicene (TEL) with PHRs Twelve universities including Harvard University and University of Massachusetts Amherst 6

7 HITECH Total Provider Adoption Value Assumes all eligible entities receive maximum incentives Hospitals: $ 412 M Medicare Incentives Medicaid Incentives Physicians: $ 755 M CHCs: $ M Total Incentives for Meaningful Use: $1.20 Billion (2-3 years) 7

8 8 MeHI s Goals and Strategies

9 MA Health IT Strategic Plan Overview: Goals 1. Improve access to comprehensive, coordinated, person-focused health care through widespread provider adoption and meaningful use of certified EHRs. 2. Demonstrably improve the quality and safety of health care across all providers through Health IT that enables better coordinated care, provides useful evidence-based decision support applications, and can report data elements to support quality measurement. 3. Slow the growth of health care spending through efficiencies realized from the use of Health IT. 4. Improve the health of the Commonwealth s population through public health programs, research and quality improvement efforts, enabled through an efficient, reliable and secure health information exchange processes. 9

10 MA Health IT Strategic Plan Overview: Strategies Strategy 1: Establish Multi-Stakeholder Governance. Strategy 2: Establish a Privacy Framework to Guide the Development of a Secure Health IT Environment. Strategy 3: Implement Interoperable Health Records in all Clinical Settings and Assure They Are Used to Optimize Care. Strategy 4: Develop and Implement a Statewide Health Information Exchange (HIE) Infrastructure to Support Care Coordination, Patient Engagement and Population Health. Strategy 5: Create a Local Workforce to Support Health IT Related Initiatives. Strategy 6: Monitor Success. 10

11 Massachusetts ehealth Institute (MeHI) as REC Serves as Regional Extension Center (targeting 2500 priority providers) Provides staff support as necessary (including practice liaison/ project manager) to serve as point of contact with providers and coordinate IOO services Provides additional services to providers (for additional cost) Supports a loan program for priority providers who receive REC assistance Developing a certification program for Implementation and Optimizations Organizations (IOO) and Electronic Health Records (EHR) vendors 11

12 12 Health Information Exchange

13 Health Information Exchange Guiding Principles Patient-centric: The HIE will enable better longitudinal, cross-organizational care for every individual in Massachusetts and provide access to and use of health information for those individuals. Adoptability: The HIE will conform to all applicable state and federal laws, standards, policies and regulations. Adaptability: The HIE will be able to be modified and expanded to integrate new components, services, interfaces and features, as needed to accommodate more users, systems or networks. Maintainability: The standards and requirements for participating in the HIE will be as simple as possible to allow greater participation throughout the community. Systems Integration: HIE adapters and connection mechanisms will be defined and developed for all HIE participants. Extensibility and Scalability: HIE functionality will be added or updated with minimum impact to existing functions and ensure that the infrastructure is scalable. Data Aggregation: Information will be collected, transmitted and aggregated in standard, secure formats. 13

14 Health Information Exchange (HIE) in Massachusetts The future of HIE for Massachusetts includes services, such as advanced patient-centric and population health-focused services that meet the broader needs of Massachusetts citizens. With an HIE that enables and facilitates the exchange of clinical and administrative data, a patient s care will be better coordinated, and their providers and insurance company will be able to make better, more informed and faster decisions about care. 14

15 Health Information Exchange (HIE) Access to Patient Information Residents will have the ability to share medical records with their caregivers through HIE. To protect consumers health related information from unauthorized access, appropriate processes will be in place. The Commonwealth s privacy and security framework will focus on the following key areas: Compliance with and development and coordination of policies and standards Policy to respond to and mitigate breaches of information, quickly and transparently Development of secure Health Information Exchange Technology Process for Certification Consent Management 15

16 16 Regional Extension Center

17 Massachusetts ehealth Institute (MeHI) as REC Sustaining the REC is critical to the Commonwealth s strategy for accelerating Health IT implementation for all providers. Federal REC funding will begin phasing out after two years and will end after four years. As the REC becomes operational and increasingly robust, MeHI plans to supplement the projected federal subsidies with revenue from the certification/qualification programs. 17

18 Building an Effective Regional Extension Center (REC) Program for the Commonwealth As the REC, MeHI s primary purpose is to provide federally subsidized direct support to the preferred priority primary care providers (PPPCP), of which 2,500 providers will be eligible. Preferred priority primary care providers include: Primary care providers in individual and small practices (less than 10) Public and critical access hospitals FQCHC s, community health centers and rural health clinics Other settings that serve uninsured, underinsured and medically underserved populations. Applied for supplemental funding for 11 Critical Access Hospitals. For a modest fee, all providers in the Commonwealth will be able to use the portfolio of services, best practices, and preferred vendor relations of the REC, examples include the following: Certification from Board of Registration in Medicine (for licensure renewal) and Medicaid (to certify meaningful use, so provider can collect incentive payments) to integrate with the statewide Health Information Exchange. REC business model must be approved by the Health IT Council and MTC Board of Directors. 18

19 MeHI REC Service Area Total Physicians: 20,000 Total Population 6,497,697* Total PCPs: 7800 Total Priority PCPs: 6700 Total Priority PCPs Served by REC Total Patients served 3,750,000** 97% Population Insured 19 Non Priority Providers committed Critical Access Hospitals *Population as of 2008 **Patients served calculated at estimated 1,500 patients per Priority PCP

20 Proposed MeHI Value-Added Services Improve access to comprehensive, coordinated, person-focused health care through widespread provider adoption and meaningful use of certified EHRs REC MeHI Clinical Relationship Manager MeHI Clinical Relationship Manager REC Provided Education REC and Meaningful Use 101 HIE 101 Advanced Compliance MeHI will provide Value-Added Services for all participating REC providers. INITIAL SERVICES Provide education including REC program overview and State and Federal HIT Programs. Promote financing alternatives such as a Loan Program. Certify and negotiate standard relationships with IOOs. Evaluate and structure arrangements with EHR and other vendors. Consolidate and aggregate practices by geography and timeframe for more efficient implementation. Supply readiness assessment tool for provider prequalification. Establish standardized contract provisions. ONGOING SERVICES Communicate to Providers and Consumers for Targeting, Education and Outreach. Coordinate Community of Practice (CoP). Certify all Medicaid providers for Centers for Medicare & Medicaid Services (CMS) Meaningful Use Incentives. Provide ongoing education and support for Federal and State HIT compliance including Meaningful Use, HIPAA, HIE, Chapter 305, Quality Improvement Coaching and Privacy and Security. 20

21 Potential Future REC Value-Added Services MeHI will provide Value-Added Services for all participating REC providers. Leverage Computerized Physician Order Entry (CPOE) expertise. Link with Massachusetts Broadband Institute (MBI) for broadband infrastructure for underserved areas. Collaborate with Department of Public Health on Quality Improvement Coaching in practices. Partner with the Patient Centered Medical Home program and emerging Integrated Care Delivery Organizations. 21

22 Implementation Optimization Organizations (IOO) Certification of IOOs MeHI will conduct a thorough review of IOOs to assess their technical and financial capabilities. The Request for Qualification (RFQ) was issued in March 2010, and MeHI expects to finalize the list of Certified IOOs by May The REC will use certified IOOs to support deployment of EHRs and establishment of state-wide HIE through the following services: Contract with providers for clinical and technical implementation Provide full range of implementation services thru to meaningful use Implement and recommend providers as compliant with Chapter 305 and eligible for participation in state-wide HIE 22

23 Electronic Health Record (EHR) Qualification of EHR Implementations Prior to HIE connectivity, MeHI will develop a program to ensure that each implementation is completed in a manner that meets or exceed the Commonwealth s standards, which included the following: Readiness criteria to pre-qualify providers for EHR adoption and implementation. Qualification criteria for EHR implementations Certification standards and process for all Medicaid providers All payers in the Commonwealth will adopt a single set of Federal standards for eligibility and claims payment processes, which will be incorporated into certified EHRs. 23

24 Stakeholder Roles, Responsibilities and Services MeHI/REC Recruit providers into program Certify and recertify IOOs for program including a code of conduct Execute agreements with vendors to provide products and services at preferred pricing Provide financing alternatives, integrate and coordinate Medicaid incentive payments Consolidate and Aggregate providers by geography and timeframe PMO oversight of projects and vendors IOO Contract with providers for clinical and technical implementation Provide full range of implementation services thru to meaningful use Implement and recommend providers as compliant with Chapter 305 and eligible for participation in state-wide HIE Providers Contract with REC Contract with IOO for full implementation package Contract with participating vendors for provision of products and services at preferred prices Participate in required orientation programs Vendors Contract directly with providers. Provide products and services directly to providers pursuant to terms negotiated with MeHI/REC Could include EHR/PMS, Hardware, Software or Connectivity vendors 24 24

25 REC Baseline Assumptions MeHI REC is responsible to support providers to achieve and sustain Meaningful Use and other Federal and State HIT compliance requirements. 20,000 total providers Baseline goal for REC for 2 year period: 2,500 priority primary care providers 800 non priority providers (Primary Care and Specialists) Receive $5,000 in direct assistance per priority provider (total of $12.5M) Pass incentives to the IOOs to cover the basic services for the priority providers Charge Initial REC Participation fee until Meaningful Use is achieved Charge a Post-Meaningful Use REC Membership fee Value of Services exceeds participation and membership fees 25

26 Medicaid Baseline Assumptions 4,000 estimated Medicaid eligible providers MeHI will be the certification body for State Medicaid (MassHealth) Certification is annual process Certification is required in order to receive Medicaid incentive payments and optimal reimbursement 26

27 27 Chapter 305

28 Relationship of Chapter 305 and HITECH Act Same goal: healthcare system where all providers use EHRs as part of a comprehensive, interoperable HIE. Chapter 305 requirements: All Massachusetts providers will be using EHRs by January 1, 2015 as part of an interoperable Health Information Exchange. Massachusetts Board of Registration of Medicine will require that all physicians demonstrate proficiency in the use of EHRs. HITECH Act provides financial incentives for providers to install EHRs and demonstrate meaningful use - commencing

29 Chapter 305 Impact Assumptions REC will certify Massachusetts physicians to assure that they meet Chapter 305 requirements A certificate will be issued by the REC to satisfy Chapter 305 compliance and will be required by Board of Registration in Medicine for licensure As a benefit of the REC program, all members will receive their Chapter 305 certificate upon compliance Exception clauses will be developed in conjunction with the Board of Registration in Medicine 29

30 30 State and Federal Relationship

31 MeHI and Medicaid Collaboration MeHI and Medicaid (MassHealth) are currently collaborating to ensure the objectives of each entity are in alignment, which includes the following: State Health IT Strategic Plan and Chapter 305 objectives are tightly aligned with CMS Medicaid Health IT incentives. Medicaid Health IT funding is provided towards achieving the adoption and meaningful use goals of Chapter 305 and the HITECH. Advance the adoption and meaningful use of Health IT, which is critical for the support of the statewide, all payer PCMH initiative. Align MeHI s focus of IOO support for Primary Care Providers, Nurse Practitioners and Community Health Centers with the Commonwealth s commitment to support and enhance primary care, as MeHI IOO certification will be instrumental in encouraging rapid adoption of Health IT by MassHealth providers. 31

32 32 Governance Structure and Elements of Public/Private Collaboration

33 Office of National Coordinator (ONC) Responsibilities Serves as principal advisor to the Secretary of HHS on the development, application, and use of health information technology Coordinates HHS health information technology policies and programs internally and with other relevant executive branch agencies Develops, maintains and directs the implementation of HHS strategic plan to guide the nationwide implementation of interoperable health information technology in both the public and private health care sectors, to the extent permitted by law Provides comments and advice at the request of Office of Management and Budget (OMB) regarding specific Federal health information technology programs. 33

34 34 Meaningful Use

35 35 Meaningful Use

36 Stage 1 of Meaningful Use Electronic capturing of health information in a coded format Use health information to track key clinical conditions and communicate that information for care coordination purposes, whether that information is structured or unstructured, but in structured format whenever feasible Consistent with other provisions of Medicare and Medicaid law, implement clinical decision support tools to facilitate disease and medication management Report clinical quality measures and public health information 36

37 Stage 2 of Meaningful Use Expand upon Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible Electronic transmission of orders entered using computerized provider order entry (CPOE) Electronic transmission of diagnostic test results May consider applying the criteria more broadly to both the inpatient and outpatient hospital settings 37

38 Stage 3 of Meaningful Use Promote improvements in quality, safety and efficiency focusing on Decision support for national high priority conditions Patient access to self management tools Access to comprehensive patient data Improving population health 38

39 39 Eligibility and Payments

40 Medicaid Provider Eligibility Non Hospital Based: Physicians, Dentists, Certified Nurse Mid-Wives, Nurse Practitioners and Physician Assistants practicing at a FQHC or RHC led by a Physician Assistant All eligible professionals (EP) must meet their respective annual Medicaid Patient Volume Thresholds Non Pediatric EPs must meet a 30% or more annual Medicaid Patient Volume Threshold Pediatric EPs must meet a 20% or more annual Medicaid Patient Volume Threshold EPs practicing predominately at an FQHC or RHC must meet 30% or more annual Needy Individual Patient Volume Threshold Hospital Based EP equals 90% or more of their allowed professional services provided in the ER, inpatient or outpatient hospital using Medicaid claims and encounter data for the full year prior to the payment year. 40

41 Receiving Medicaid Incentive Payments (EP) An EP may only receive an incentive payment from either Medicare or Medicaid, but not both. Medicaid EP may receive an incentive payment from only one state in a payment year. The Medicaid EP s incentive payments are subject to the following: First year payment may not exceed 85% of maximum threshold of $25K, which equals $21,250. Subsequent annual payment may not exceed 85% of the maximum threshold of $10K, which equals $8,500. Payments after the first year may continue for a maximum of 5 years. Medicaid EPs may participate for a total of 6 years and may not begin receiving payment any later than CY In no case will the maximum incentive over a 6-year period exceed $63,

42 Receiving Medicaid Incentive Payments (EP) 42 Calendar Year 2011 $21, $8,500 $21, $8,500 $8,500 $21, $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8, $8,500 $8, Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 For a Medicaid EP who is a pediatrician who is between 20-30% of the annual Medicaid Patient Threshold: Maximum payment in the first year is further reduced to 2/3rds, which equals $14,167. Maximum payment in subsequent years is further reduced to 2/3rds, which equals $5,667. In no case will the maximum incentive payment to a pediatrician under this limitation exceed $42,500 over a 6-year period.

43 Receiving Medicare Incentive Payments (EP) Calendar Year Adoption Year $18, $12,000 $18, $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12, $2,000 $4,000 $8,000 $8,000 $ $2,000 $4,000 $4,000 $0 Total $44,000 $44,000 $39,000 $24,000 $0 Medicare Maximum Reimbursement is based on adoption of Meaningful Use 43

44 Required Activities to Receive Payments First Year: Medicaid EP demonstrates that during the EHR reporting period it has adopted, implemented or upgraded a certified EHR technology. Subsequent Payment Years: In the second, third, fourth, fifth and sixth payment years, the Medicaid EP must demonstrate that during the EHR reporting period for the applicable payment year it is a meaningful EHR user. 44

45 Medicare vs. Medicaid Incentive Payment Programs Medicare Feds will implement (will be an option nationally). Fee Schedule reductions begin in 2015 for providers that are not meaningful users. Must be a meaningful user in Year 1. Maximum incentive is $44,000 for EPs. Meaningful use definition will be common for Medicare. Medicare Advantage EPs have special eligibility accommodations Last year an EP may initiate program is 2014; last payment in program is Payment adjustments begin in Only physicians, subsection (d) hospitals and CAHs. Medicaid Voluntary for States to implement (may not be an option in every State). No Medicaid fee schedule restrictions. Adopt/implement/upgrade option for 1 st participation year. Maximum incentive is $63,750 for EPs. States can adopt a more rigorous definition (based on common definition). Medicaid managed care providers must meet regular eligibility requirements. Last year an EP may initiate program is 2016; last payment in program is types of EPs, 3 types of hospitals 45

46 Meaningful Use Provider Impact Physician/Other Eligible Professional Medicare Incentives Provides financial incentives for physicians and other eligible professionals beginning in January The incentives paid over five years begin to decrease after 2012, if meaningful use is not achieved. By 2015, eligible providers that have not achieved meaningful use will be penalized through a decrease in Medicare reimbursements. Physicians and other eligible professionals cannot receive both Medicare and Medicaid incentives. 46

47 Meaningful Use Provider Impact (cont d) Physician/Other Eligible Professional Medicaid Incentives Provides up to $63,750 to support the purchase of an EHR and/or to partially cover the upfront costs of implementation, with some portion of that incentive potentially available to providers in advance of meaningful use. While these incentives are more generous than those provided through Medicare, they are available only to those providers serving a specified percentage of Medicaid patients (20-30% of their total patient population, depending on provider type). Physicians and other eligible professionals cannot receive both Medicare and Medicaid incentives. 47

48 48 Federal Funding of MeHI will bring resources to community health centers and primary care providers to help them achieve meaningful use of Electronic Health Records. State health information technology efforts are focused on preparing for and maximizing the return on CMS incentives for all health care providers in the Commonwealth.

49 49 Questions

50 50 Appendix: Stage 1 Criteria for Meaningful Use

51 Health Outcomes Policy Priority - Improving Quality, Safety, Efficiency and Reducing Health Disparities Stage 1 Objectives Care Goals Eligible Professionals Hospitals Stage 1 Measures Provide access to comprehensive patient health data for patient's health care team Use evidence-based order sets and CPOE Apply clinical decision support at the point of care Generate lists of patients who need care and use them to reach out to patients Report information for quality improvement and public reporting Use CPOE Implement drug-drug, drugallergy, drug-formulary checks Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT Generate and transmit permissible prescriptions electronically (erx) Use of CPOE for orders (any type) directly entered by authorizing provider (for example, MD, DO, RN, PA, NP) Implement drug-drug, drugallergy, drug-formulary checks Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT For EPs, CPOE is used for at least 80% of all orders For eligible hospitals, CPOE is used for 10% of all orders. The EP/eligible hospital has enabled this functionality At least 80% of all unique patients seen by the EP or admitted to the eligible hospital have at least one entry or an indication of none recorded as structured data At least 75% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology Maintain active medication list Maintain active medication list At least 80% of all unique patients seen by the EP or admitted to the eligible hospital have at least one entry (or an indication of none if the patient is not currently prescribed any medication) recorded as structured data Maintain active medication allergy list Maintain active medication allergy list At least 80% of all unique patients seen, by the EP or admitted to the eligible hospital have at least one entry or (an indication of none if the patient has no medication allergies) recorded as structured data 51

52 Health Outcomes Policy Priority - Improving Quality, Safety, Efficiency and Reducing Health Disparities (cont d) Stage 1 Objectives Care Goals Eligible Professionals Hospitals Stage 1 Measures Record demographics preferred language insurance type gender race ethnicity date of birth Record and chart changes in vital signs: height weight blood pressure Calculate and display: BMI Plot and display growth charts for children 2-20 years, including BMI. Record smoking status for patients 13 years old or older Incorporate clinical lab-test results into EHR as structured data Generate lists of patients by specific conditions to use for quality improvement, education of disparities, and outreach Record demographics preferred language insurance type gender race ethnicity date of birth date and cause of death in the event of mortality Record and chart changes in vital signs: height weight blood pressure Calculate and display: BMI Plot and display growth charts for children 2-20 years, including BMI. Record smoking status for patients 13 years old or older Incorporate clinical lab-test results into EHR as structured data Generate lists of patients by specific conditions to use for quality improvement, education of disparities, and outreach At least 80% of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data For at least 80% of all unique patients age 2 and over seen by the EP or admitted to eligible hospital, record blood pressure and BMI; additionally plot growth chart for children age 2-20 At least 80% of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospital have smoking status recorded At least 50% of all clinical lab tests ordered whose results are in a positive/negative or numerical format are incorporated in certified EHR technology as structured data Generate at least one report listing patients of the EP or eligible hospital with a specific condition. 52

53 Health Outcomes Policy Priority - Improving Quality, Safety, Efficiency and Reducing Health Disparities (cont d) Stage 1 Objectives Care Goals Eligible Professionals Hospitals Stage 1 Measures Report ambulatory quality measures to CMS or the States Send reminders to patients per patient preference for preventive/ follow up care Report hospital quality measures to CMS or the States For 2011, provide aggregate numerator and denominator through attestation as discussed in section II(A)(3) of this proposed rule For 2012, electronically submit the measures as discussed in section II(A)(3) of this proposed rule Reminder sent to at least 50% of all unique patients seen by the EP that are age 50 or over Implement 5 clinical decision support rules relevant to specialty or high clinical priority, including diagnostic test ordering, along with the ability to track compliance with those rules Implement 5 clinical decision support rules related to a high priority hospital condition, including diagnostic test ordering, along with the ability to track compliance with those rules Implement 5 clinical decision support rules relevant to the clinical quality metrics the EP/Eligible Hospital is responsible for as described further in section II(A)(3). Check insurance eligibility electronically from public and private payers Check insurance eligibility electronically from public and private payers Insurance eligibility checked electronically for at least 80% of all unique patients seen by the EP or admitted to the eligible hospital Submit claims electronically to public and private payers. Submit claims electronically to public and private payers. At least 80% of all claims filed electronically by the EP or the eligible hospital 53

54 Health Outcomes Policy Priority Engage Patients and Families in their Health Care Stage 1 Objectives Care Goals Eligible Professionals Hospitals Stage 1 Measures Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, allergies), upon request Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, allergies, discharge summary, procedures), upon request At least 80% of all patients who request an electronic copy of their health information are provided it within 48 hours Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request At least 80% of all patients who are discharged from an eligible hospital and who request an electronic copy of their discharge instructions and procedures are provided it Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) within 96 hours of the information being available to the EP At least 10% of all unique patients seen by the EP are provided timely electronic access to their health information Provide clinical summaries for patients for each office visit Clinical summaries are provided for at least 80% of all office visits 54

55 Health Outcomes Policy Priority - Improve Care Coordination Stage 1 Objectives Care Goals Eligible Professionals Hospitals Stage 1 Measures Exchange meaningful clinical information among professional health care team Capability to exchange key clinical information (for example, problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronically Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronically Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information Perform medication reconciliation at relevant encounters and each transition of care Perform medication reconciliation at relevant encounters and each transition of care Perform medication reconciliation for at least 80% of relevant encounters and transitions of care Provide summary care record for each transition of care and referral Provide summary care record for each transition of care and referral Provide summary of care record for at least 80% of transitions of care and referrals 55

56 Health Outcomes Policy Priority Improve Population and Public Health Stage 1 Objectives Care Goals Eligible Professionals Hospitals Stage 1 Measures Communicate with public health agencies Capability to submit electronic data to immunization registries and actual submission where required and accepted Capability to submit electronic data to immunization registries and actual submission where required and accepted Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries Capability to provide electronic submission of reportable lab results (as required by state or local law) to public health agencies and actual submission where it can be received Performed at least one test of the EHR system's capacity to provide electronic submission of reportable lab results to public health agencies (unless none of the public health agencies to which eligible hospital submits such information have the capacity to receive the information electronically) Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically) 56

57 Health Outcomes Policy Priority Ensure Adequate Privacy and Security Protections for Personal Health Information Stage 1 Objectives Care Goals Eligible Professionals Hospitals Stage 1 Measures Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Conduct or review a security risk analysis per 45 CFR (a)(1) and implement security updates as necessary Provide transparency of data sharing to patient. 57