CARE COORDINATION: TAKING IT TO THE NEXT LEVEL Focus On Stage 2 Meaningful Use Requirements
What We Have Planned How we got here Overview of the path to Meaningful Use Stage 2 Review changes from to Stage 2 Identify Stage 2 Objectives that Improve Care Coordination Review Project Plan for Stage 2
How we got here: History of LPHI Health IT Programs in SBHCs School Health Connection Robert Wood Johnson Foundation 2007-2010 Goals: Procurement and Implementation of a common EHR for metro New Orleans SBHCs W.K. Kellogg Foundation 2010-2013 Goals: Aid in the recovery of school health programs post-katrina. GE Foundation 2011-2013 Goals: Develop and implement sustainability plans for Orleans SBHCs.
How we got here: History of LPHI Health IT Programs in SBHCs Regional Extension Center, LHIT Resource Center REC Est. 2010 Expansion of SBHC partnerships throughout the state of Louisiana. Goals: Provide TA for eligible providers towards achieving Meaningful Use. Assist with vendor selection and contracting. Assist with workflow improvement and provide on-site support.
Meaningful Use Overview Stage 2 Date Capture and Sharing Stage 3 Advanced Clinical Processes Improved Outcomes
Meaningful Use Overview STAGE 1 13 core objectives 5 of 9 menu objectives 18 total objectives STAGE 2 17 core objectives 3 of 6 menu objectives 20 total objectives https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/stage1changestipsheet.pdf
Stage 2
Stage 2: Where you need to be HIT Provides the framework to provide the Stage 2 Stage 2 Stage 3 organized management of health information. x 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 $21,250 A/I/U 90-Day 90-Day TBD TBD TBD TBD $21,250 A/I/U 90-Day 90-Day Stage 2 Stage 2 Stage 3 TBD TBD TBD TBD $21,250 A/I/U 90-Day Stage 2 Stage 2 Stage 3 TBD TBD TBD $21,250 A/I/U 90-Day Stage 2 Stage 2 Stage 3 TBD TBD $21,250 A/I/U 90-Day Stage 2 Stage 2 Stage 3 TBD $21,250 A/I/U 90-Day Stage 2 Stage 2 Stage 3
Measure CPOE E-Prescribe Demographics - preferred language, sex, race, ethnicity, date of birth Stage 2 Core Objectives Must Meet all 17 Measures What Changed? Threshold bumped up from 30% to 60%. Adds lab and radiology orders Threshold bumped up from 40% to 50%. Prescriptions need to be compared to at least one formulary. Threshold bumped up from 50% to 80%. Vitals Threshold bumped up from 50% to 80%. Smoking status for patients 13 years old or older Threshold bumped up from 50% to 80%. CDS Provide patients the ability to view online, download and transmit their health information Clinical Summaries Protect electronic health information created or maintained by the Certified EHR Technology Changed from one CDS intervention to five which are related to 4 or more clinical quality measures; drug-drug and drug-allergy interaction checks were moved here. Patients are provided timely online access to their health information and 5% must view, download, or transmit to a third party their health information. Same threshold but must be provided within one business day, not three. No Major changes Lab Test Moved from Menu set to Core. Threshold bumped up from 40% to 55% Generate lists of patients by specific conditions Patient Reminders Education Resources Medication Reconciliation Summary of Care Record Immunization Registry Secure electronic messaging Moved from Menu set to Core. Moved from Menu set to Core. Threshold bumped down from 20% to 10%. No age limit; Reminders are for preventive/follow-up care; Moved from Menu set to Core. Moved from Menu set to Core. Moved from Menu set to Core. Adds electronic transmission requirement for 10% of TOC. One test transmission with a recipient on a different EHR vendor. Successful ongoing submission of electronic immunization data NEW - Send message to more than 5% of unique patients
Stage 2 Menu Set Objectives Pick 3of 6 Measure Syndromic Surveillance (Public Health) Record electronic notes in patient records. Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. Record patient family health history as structured data. What s New? Successful ongoing submission NEW Enter at least one electronic progress note for more than 30% of unique patients NEW More than 10% of all scans and tests whose result is an image are incorporated into or accessible in the EHR NEW Enter family health history for more than 20% of unique patients Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. NEW Successful ongoing submission NEW Successful ongoing submission
Stage 2 Clinical Quality Measures No longer a core MU objective All providers regardless of or Stage 2 will report on 2014 CQMs Report on 9 of 64 CQMs from at least three National Quality Strategy Domains Patient and Family Engagement, Patient Safety, Care Coordination, Population/Public Health, Efficient Use of Healthcare Resources, Clinical Process/Effectiveness
Pediatric Recommended CQMs Effective Use of Healthcare Resources: Pharyngitis Testing, Upper Respiratory Infection Treatment Public/Population Health: Weight Assessment/Nutrition Counseling, Chlamydia Screening (16-24 years), Immunization Status (2 Years), Preventative Care/Screening for Clinical Depression (12 and older) Clinical Process/Effectiveness: Asthma Medications, ADHD F/U care (6-12 years), Children who have dental decay or cavities
Other CQMs Public/Population Health: Preventative Care and Screening - Influenza Immunization Care coordination: Closing the Referral Loop - receipt of specialist report Clinical Process/Effectiveness: Hemoglobin A1c Test for Pediatric Patients
Stage 2: Focus on Care Coordination Care coordination in the primary care practice involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care. The main goal of care coordination is to meet patients' needs and preferences in the delivery of high-quality, high-value health care. This means that the patient's needs and preferences are known and communicated at the right time to the right people, and that this information is used to guide the delivery of safe, appropriate, and effective care. - AHRQ
Care Coordination MU Objectives http://www.healthit.gov/providersprofessionals/step-5-achievemeaningful-use-stage-2
Medication Reconciliation (50%) Denominator: Number of transitions of care during the EHR reporting period for which the EP was the receiving party Numerator: The number of transitions of care in the denominator where medication reconciliation was performed
Medication Reconciliation IMPORTANT NOTES: This includes first encounters with a new patient Electronic exchange is not a requirement Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period
Medication Reconciliation Why does this improve care coordination? Accurate and complete medication information Prevent adverse drug events Reduce medication errors
Summary of Care Record Measure 1 of 3: Provide Summary of Care Record (50%) Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider Numerator: The number of transitions of care or referrals in the denominator where a summary of care record was provided
Summary of Care Record Measure 2 of 3: Electronically Transmit Summary of Care Record (10%) Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider Numerator: The number of transitions of care or referrals in the denominator where a summary of care record was a) electronically transmitted using CEHRT or b)where the recipient receives the summary of care recorded via exchange
Summary of Care Record Measure 3 of 3: Electronically Transmit Summary of Care Record to another EHR vendor (YES/NO) EP attests YES to one of the two criteria: 1. Conducts one or more successful electronic exchanges of a summary of care document with a recipient who has EHR technology that was developed designed by a different EHR technology developer 2. Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period.
Summary of Care Record IMPORTANT NOTES: Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from all three measures
Summary of Care Record Why does this improve care coordination? Provides essential health information to the receiving care team Coordinates care between locations or within the same location
What else can be considered Care Coordination?
Additional Care Coordination Objectives E-Prescribe Clinical Summaries Reduce errors Patient access to health info. Refill Requests Smoking Status Patient Lists Care Manager F/U care, counselling, selfmanagement CDS Patient Reminders Includes reminders for referrals/activities Protocols, Order Sets, Alerts Online view, download, transmit Patient access to health info. Electronic Messaging Communicate with patients about health information Imaging Result Complete patient information
MU Stage 2 Project Plan Stage 2 measure education EHR upgrade training Upgrade EHR to 2014 version Review EHR MU Stage 2 Workflows Implement the patient portal Register Patients Send reminders, education, and clinical summaries to the portal Communicate with patients via messaging
MU Stage 2 Project Plan Cont d Enter lab results as structured data Identify relevant CQMs and build or implement CDS around them Scan in images Send letter of intent to state registry
Stage 2 Resources Overview: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf Comparison to : http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTab lesforep.pdf Deep Dive into Measures: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_EP_SpecSheets. zip
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