2011 1 Objectiv 2011 1 Measur 2013 Objectiv 2013 Measur Objectiv care procs outcom Measur Improve Provide Report quality all Additional Achieve Clinical Use CPOE for all 10% of all orders Use CPOE for all Use CPOE for quality, accs to orders 2 (any type) directly measur to orders order typ quality reports minimal outcome safety, comprehe entered by CMS including: using HIT- levels of measur efficienc nsive authorizing provider o % diabetics Use evidence- Use evidence- enabled NQF- (TBD) y, and patient (e.g., MD, DO, RN, with A1c based order sets based order sets endorsed on quality, [OP, IP] reduce health PA, NP) through under control quality safety, and health data for CPOE 2 [EP] Record clinical measur [EP, efficiency Efficiency dispariti patient s o % documentation in IP] measur measur health care team Use evidencebased order sets and CPOE Apply clinical decision support at the point of care Implement drugdrug, drug-allergy, drug-formulary checks Maintain an up-todate problem list of current and active diagnos based on ICD-9 or SNOMED Generate and transmit permissible prcriptions Implement drugdrug, drug-allergy, drug-formulary checks Maintain an up-todate problem list of current and active diagnos based on ICD-9 or SNOMED hypertensive patients with BP under control [EP] o % of patients with LDL under control [EP] o % of smokers offered smoking csation counseling Manage chronic using patient lists and decision support Provide clinical decision support at the point of care EHR Generate and transmit permissible discharge prcriptions electronically Manage chronic using patient lists and decision support Provide clinical decision support at the point of care % of all orders entered by physicians through CPOE Potentially preventable Emergency Department Visits and Hospitalizations [IP] Inappropriate Implement clinical decision support for national high priority Medical device interoperability Multimedia support (e.g., x-rays) (TBD) [OP, IP] Safety measur (TBD) [OP, IP] 1 The HIT Committee recommends that incentiv be paid according to an adoption year timeframe rather than a calendar year timeframe. Under this scenario, qualifying for the first-year incentive payment would be asssed using the 2011 Measur. The payment rate and phaseout of payments would follow the calendar dat in the statute, but qualifying for incentiv would use the adoption-year approach. 2 CPOE requir computer-based entry by providers of orders (medication, laboratory, procedure, diagnostic imaging, immunization, referral) but electronic interfac to receiving entiti are not required in 3 2011 Race and ethnicity cod should follow federal guidelin (see Census Bureau) 1
2 2011 1 Objectiv 2011 1 Measur 2013 Objectiv use of imaging electronically (erx) (e.g., reminders, (e.g., reminders, Generate % of patients with recorded alerts) alerts) (e.g., MRI for lists of Maintain active Maintain active BMI [EP] acute low back patients medication list medication list Specialists report to Specialists report to pain) who need % eligible relevant external relevant external care and Maintain active Maintain active surgical disease (e.g., disease (e.g., Other efficiency use them medication allergy medication allergy patients who cardiology, thoracic cardiology, thoracic measur to reach list list receive VTE surgery, cancer) or surgery, cancer) or (TBD) out to prophylaxis [IP] device registri, device registri patients Record Record approved by CMS (e.g., demographics: demographics: % of orders reminders o preferred o preferred (for Conduct closed, care language language medications, loop medication instruction o insurance type o insurance type, lab tts, management, s, etc.) o gender o race 3 o gender o race 3 procedur, radiology, and including emar and computer-assisted Report to o ethnicity o ethnicity referrals) administration patient entered directly registri Record advance Record advance by physicians for quality directiv directiv through CPOE m ent, public reporting, etc. risk Record vital signs: o weight o weight medications o height Record vital signs: o height o blood prsure o blood prsure (Re: Beers Calculate and Calculate and criteria) in the display: display: elderly o BMI o BMI % of patients 2013 Measur Objectiv care procs outcom Measur
3 2011 1 Objectiv 2011 1 Measur 2013 Objectiv Record smoking Record smoking over 50 with status status annual Incorporate lab-tt rults into EHR as structured data Incorporate lab-tt rults into EHR as structured data colorectal cancer screenings [EP] 2013 Measur Objectiv care procs outcom Measur Generate lists of patients by specific to use for quality ment, Generate lists of patients by specific % of femal over 50 receiving annual mammogram [EP] reduction of dispariti, and outreach % patients at high-risk for cardiac events Report ambulatory quality measur to CMS Report hospital quality measur to CMS on aspirin prophylaxis [EP] Send reminders to patients per patient preference for preventive/ follow up care Implement one clinical decision rule Implement one clinical decision rule % of patients who received flu vaccine [EP] % lab rults incorporated into EHR in
2011 1 Objectiv 2011 1 Measur 2013 Objectiv relevant to specialty or high clinical priority related to a high priority hospital condition coded format Document a progrs note for each encounter Check insurance eligibility electronically from public and private payers, where possible Submit claims electronically to public and private payers. Check insurance eligibility electronically from public and private payers, where possible Submit claims electronically to public and private payers. Stratify reports by gender, insurance type, primary language, race ethnicity [EP, IP] % of all medications, entered into EHR as generic, when generic options exist in the relevant drug class 2013 Measur Objectiv care procs outcom Measur % of orders for high-cost imaging servic with specific structured indications recorded [EP, 4
2011 1 Objectiv 2011 1 Measur 2013 Objectiv IP] 2013 Measur Objectiv care procs outcom Measur % claims submitted electronically to all payers % patient encounters with insurance eligibility confirmed [EP, IP] Engage Provide Provide patients Provide patients % of all Accs for all Accs for all % of patients Patients have NPP patients patients with an electronic with an electronic patients with patients to PHR patients to PHR with full accs accs to quality and and copy of their health copy of their health accs to populated in real populated in real to PHR self- measur famili famili with timely accs to data, knowledg e, and tools to make informed information (including lab rults, problem list, medication lists, allergi) upon requt 4 Provide patients information (including lab rults, problem list, medication lists, allergi, discharge summary, procedur), upon requt 4 Provide patients personal health information electronically % of all patients with accs to patient-specific educational time with health data Offer secure patient-provider msaging capability Provide accs to 4 Electronic accs to and copi of may be provided by a number of secure electronic methods (e.g., PHR, patient portal, CD, USB drive) time with patient health data Provide accs to populated in real time with EHR data [OP, IP] Additional patient accs and experience reports using NQF-endorsed management tools Electronic reporting on experience of care, related to patient and family engagem ent [OP, IP] 5
6 2011 1 Objectiv 2011 1 Measur 2013 Objectiv decisions with timely with an electronic rourc [EP, patient-specific patient-specific HIT-enabled and to electronic accs to copy of their IP] educational educational quality manage their health discharge rourc in rourc in measur [EP, their information instructions and % of common primary common primary IP] health (including lab procedur at time encounters for languag languag rults, problem list, medication lists, allergi) 4 of discharge, upon requt 4 which clinical summari were provided 2013 Measur Objectiv % of patients with accs to secure patient Provide accs to Provide accs to Record patient Record patient preferenc (e.g., preferenc (e.g., [EP] preferred preferred msaging [EP] communication communication patient-specific patient-specific media, advance media, advance % of education rourc education rourc directive, health directive, health educational care proxi, care proxi, content in Provide clinical treatment options) treatment options) common summari for primary patients for each Documentation of Documentation of languag [EP, encounter family medical family medical IP] history, in history, in compliance with compliance with % of GINA GINA all patients with preferenc Upload data from recorded [IP] home monitoring device % of transitions where summary care record is shared Implemented care procs outcom Measur
2011 1 Objectiv 2011 1 Measur 2013 Objectiv 2013 Measur Objectiv care procs outcom Measur ability to incorporate data uploaded from home monitoring devic [EP] Improve Exchange Capability to Capability to Report 30-day Retrieve and act on Retrieve and act on Accs to Accs Aggregate care meaningf exchange key exchange key readmission electronic electronic comprehensive comprehensi clinical coordina ul clinical clinical information clinical information rate [IP] prcription fill data prcription fill data patient data ve patient summarie tion informatio n among profsion al health care team (e.g., problem list, medication list, allergi, tt rults), among providers of care and patient authorized entiti electronically 5 Perform medication reconciliation at relevant encounters and each transition of care 6 (e.g., discharge summary, procedur, problem list, medication list, allergi, tt rults), among providers of care and patient authorized entiti electronically 5 Perform medication reconciliation at relevant encounters and each transition of care 6 % of encounters where med reconciliation was performed Implemented ability to exchange health information with external clinical entity (specifically labs, care Produce and share an electronic summary care record for every transition in care (place of service, consults, discharge) Perform medication reconciliation at each transition of care from one health care setting to another Produce and share an electronic summary care record for every transition in care (place of service, consults, discharge) Perform medication reconciliation at each transition of care from one health care setting to another from all available sourc 10 % reduction in 30-day readmission rat for 2013 compared to 2012 Improvement in NQF-endorsed measur of care coordination. data from all available sourc s from multiple sourc available to authorize d users [OP, IP] NQFendorsed Care Coordinati on Measur (TBD) 5 information exchange capability and demonstrated exchange to be specified by Information Exchange Work Group of HIT Committee. 6 Transition of care defined as moving from one health care setting or provider to another 7
2011 1 Objectiv 2011 1 Measur 2013 Objectiv summary and medication lists) 2013 Measur Objectiv care procs outcom Measur % of transitions in care for which summary care record is shared (e.g., electronic, paper, e-fax) Improve Communi Capability to submit Capability to submit Reportup-to- Receive Receive % of patients for Use of HITpopulati cate with electronic data to electronic data to date status for immunization immunization whom an epidemiologi enabled on and public immunization immunization childhood histori and histori and asssment of c data population public health registri and actual registri and actual immunizations recommendations recommendations immunization measur health agenci submission where required and accepted. 7 submission where required and accepted. 7 [EP] 7 from immunization registri 7 from immunization registri 7 need and status has been completed Automated real-time surveillance % of patients for % reportable HITlab rults Receive health Receive health during the visit (adverse enabled Capability to Capability to submitted alerts from public alerts from public [EP] 7 events, near surveillan provide electronic provide electronic electronically health agenci health agenci miss, ce syndromic submission of [IP] disease measure surveillance data to reportable lab Provide sufficiently Provide sufficiently whom a public outbreaks, [OP, IP] public health rults to public anonymized anonymized health alert bioterrorism agenci and actual health agenci and electronic syndrome electronic syndrome should have [OP, IP] 7 Applicability to Medicare versus Medicaid meaningful use is to be determined 8
2011 1 Objectiv 2011 1 Measur 2013 Objectiv 2013 Measur Objectiv care procs outcom transmission actual submission surveillance data to surveillance data to triggered and Clinical according to where it can be public health public health audit evidence dashboards applicable law and received. agenci with agenci with that a trigger practice capacity to link to capacity to link to appeared Dynamic and Capability to personal identifiers personal identifiers during the Ad hoc provide electronic encounter quality syndromic reports surveillance data to public health agenci and actual transmission according to applicable law and practice Measur adequat privacy HIPAA Privacy and HIPAA Privacy and compliance de-identified data summarized or patients, on patients, e and Security Rul 8, 9 Security Rule 8, 9 with HIPAA when reporting data de-identified requt, with on privacy security Privacy and for population data when an requt, and protection Security Rul health purpos reporting data accounting of with a security s for Compliance with fair Compliance with fair (e.g., public health, for health treatment, timely protectio confidenti data sharing data sharing quality reporting, purpos (e.g., payment, and accountin ns for al practic set forth in practic set forth in Conduct or and rearch), public health, health care g of personal informatio the Nationwide the Nationwide update a where appropriate, quality operations disclosure health n through Privacy and Privacy and security risk so that important reporting, and disclosur s for informati operating Security Framework Security Framework asssment information is rearch), treatment, 8 The HIT Committee recommends that CMS withhold meaningful use payment for any entity until any confirmed HIPAA privacy or security violation has been rolved 9 The HIT Committee recommends that state Medicaid administrators withhold meaningful use payment for any entity until any confirmed state privacy or security violation has been rolved 9
10 on polici, procedure s, and technologi and complianc e with applicable law. 2011 1 Objectiv 2011 1 Measur 2013 Objectiv and implement available with security minimal privacy risk. updat as necsary 2013 Measur Objectiv care procs outcom where appropriate, so that important information is available with minimal privacy risk. Protect sensitive health information to minimize reluctance of patient to seek care because of privacy Incorporat e and utilize tech- nology to segment sensitive data Provide concerns. transpare ncy of data sharing to patient. Measur payment, and health care operation s, in complianc e with applicable law.