Meaningful Use - Modified Stage 2 Brett Paepke, OD David Wolfson Marni Anderson
Wait! Where did Stage 1 and Stage 2 go? Traditional stages eliminated in late 2015 in order to: 1. reduce reporting requirements 2. align reporting periods with calendar year 3. modify patient engagement measures
Traditional Stages of MU First Year of MU Stage of Meaningful Use 2011 2012 2013 2014 2015 2016 2017 2011 1 1 1 2 2 2 3 2012 1 1 2 2 2 3 2013 1 1 2 2 3 2014 1 1 2 2 2015 1 1 2 2016 1 1
New Stages of MU First Year of Meaningful Use Stage of Meaningful Use 2016 2017 2018 2011 Modified Stage 2 Modified Stage 2 or Stage 3 Stage 3 2012 Modified Stage 2 Modified Stage 2 or Stage 3 Stage 3 2013 Modified Stage 2 Modified Stage 2 or Stage 3 Stage 3 2014 Modified Stage 2 Modified Stage 2 or Stage 3 Stage 3 2015 Modified Stage 2 Modified Stage 2 or Stage 3 Stage 3 2016 Modified Stage 2 Modified Stage 2 or Stage 3 Stage 3
Reporting Periods 2016 proposal on table for 90 days for all EPs in 2016 at present: any 90 consecutive days for new EPs full calendar year for all others 2017+ full calendar year (???) for all Medicare EPs (including new EPs) MU replaced by Advancing Care information in MIPS
Core 1 - CPOE Core 2 - erx Core 3 - Demographics Protect Patient Health Information Core 4 - Vital Signs Clinical Core 5 - Smoking Decision Status Support Core 6 - Clinical Decision Support Computerized Core 7 - Incorporate Clinical Provider Lab-Test Results Order Entry Core 8 - Patient Lists Electronic Core 9 - Preventative Prescribing Care Core 10 - Patient Electronic Access Health Information Exchange Core 11 - Clinical Summaries Core 12 - Patient Specific Educational Resources Patient Specific Education Core 13 - Medication Reconciliation Core 14 - Summary of Care Medication Reconciliation Core 15 - Immunization Registries Data Submission Patient Electronic Access Core 16 - Protect Electronic Health Information Core 17 - Secure Electronic Messaging Secure Menu 1 - Syndromic Electronic Surveillance Messaging Menu 2 - Electronic Notes Public Menu 3 - Imaging Health Results Reporting Menu 4 - Family Health History Menu 5 - Report Cancer Cases Menu 6 - Report Specific Cases Modified Stage 2 Reorganization
Protect Patient Health Information Proposed Objective Protect patient health information created or maintained by the CEHRT through the implementation of appropriate technical capabilities. Proposed Measure Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of data stored in Certified EHR Technology in accordance with requirements in 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the EP s risk management process Exclusions None
SRA can be performed anytime during the calendar year as long as it is completed by the day of attestation. Failure to perform SRA remains the #1 reason for audit failure Essentials of the Security Risk Analysis webinar with MetaStar
Clinical Decision Support Proposed Objective Use clinical decision support to improve performance on high-priority health conditions Proposed Measures 1. Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period 2. The EP has enabled and implemented the functionality for drug-drug and drug allergy interaction checks for the entire EHR reporting period Exclusions Any EP who writes fewer than 100 medication orders during the EHR reporting period can exclude from measure 2
Clinical Decision Support CDS - Rules CDS - Interaction Checks
Computerized Provider Order Entry Proposed Objective Use computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines 1. More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry Proposed Measures 2. More than 30 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry 3. More than 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using computerized provider order entry Exclusions Alternate Specifications for EPs due for Stage 1 in 2016 Any EP who writes fewer than 100 medication, laboratory, or diagnostic imaging orders during the EHR reporting period can exclude from that measure Proposed Measure: More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry Providers due for Stage 1 in 2016 can exclude from measures 2 and 3 as they do not exist in Stage 1
Computerized Provider Order Entry Scoring for Labs and Radiology controlled by Orders - Medical:
Electronic Prescribing Proposed Objective Generate and transmit permissible prescriptions electronically (erx) Proposed Measure More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using Certified EHR Technology 1. Any EP who writes fewer than 100 permissible prescriptions during the EHR reporting period Exclusions 2. An EP who does not have a pharmacy within his or her organization and does not have a pharmacy that accepts electronic prescriptions within 10 miles of the EP's practice location at the start of his or her EHR reporting period
Health Information Exchange Proposed Objective The EP who transitions their patient to another setting of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral The EP that transitions or refers their patient to another setting of care or provider of care: Proposed Measure 1. uses CEHRT to create a summary of care record 2. electronically transmits the summary to a receiving provider for more than 10 percent of transitions of care and referrals Exclusions Any EP who refers a patient to another provider less than 100 times during the EHR reporting period
Health Information Exchange
Patient-Specific Education Proposed Objective Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient Proposed Measure Patient-specific education resources identified by Certified EHR Technology are provided to more than 10 percent of all unique patients seen by the EP during the EHR reporting period Exclusions Any EP who has no office visits during the EHR reporting period
Patient-Specific Education 1 2
Medication Reconciliation Proposed Objective The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation Proposed Measure The EP performs medication reconciliation for more than 50 percent of encounters with new patients and inbound transitions of care. Exclusions Any EP who saw no new patients and was not the recipient of any transitions of care during the EHR reporting period
Medication Reconciliation What if my patient tells me they aren t taking medications? What if all my patients are kids and don t take meds? = Travel to a different country Travel to a new provider When a new patient enters the practice, there s an expectation that we use an official, standardized document to coordinate their care
Medication Reconciliation Denominator all new patients automatically included inbound referrals need TOC Document Received box checked Numerator number of patients in denominator who have Medication reconciliation performed box checked
Patient Electronic Access Proposed Objective Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP An EP must meet both measures: Proposed Measures 1. More than 50 percent 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 2. At least one patient seen by the EP during the EHR reporting period (or their authorized representatives) views, downloads, or transmits his or her health information to a third party Any EP who: 1. Neither orders nor creates any of the information listed for inclusion as part of the measures; or Exclusions 2. Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period (www.broadbandmap.gov). (for 2nd measure only)
Patient Electronic Access Measure 1 establish PHR credentials sign encounter within 4 business days Measure 2 promote use of the PHR to have patients View, Download, or Transmit their information V/D/T links available in About Me or Appointments area of PHR
Secure Electronic Messaging Proposed Objective Use secure electronic messaging to communicate with patients on relevant health information Proposed Measure For at least 1 patient seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the EHR reporting period. Any EP who: 1. has no office visits during the EHR reporting period, or Exclusions 2. conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period (www.broadbandmap.gov)
Secure Electronic Messaging
Public Health Reporting Proposed Objective The EP is in active engagement with a PHA or CDR to submit electronic public health data in a meaningful way using certified EHR technology, except where prohibited, and in accordance with applicable law and practice Proposed Measures There are a total of 3 possible measures for this objective. EPs are required to choose from measures 1 through 3, and are required to successfully attest to active engagement with any combination of two measures Exclusions 3 available for each measure + broad availability for Syndromic Surveillance and Specialized Registry Reporting
Public Health Reporting What is Active Engagement? The EP is moving toward the submission of real patient data. This can be demonstrated 1 of 3 ways: 1. Completed registration with a registry within 60 days after the start of reporting period 2. Testing of data submission process initiated 3. Actively submitting patient data
Public Health Reporting Exclusions Do not count as satisfying a measure i.e. EP can exclude from Immunization Registry Reporting on grounds that they didn t perform any immunizations during reporting period but it will not count as 1 of the 2 measures they need to meet. Alternate exclusions possible for Syndromic Surveillance and Specialized Registry Reporting if you attest to fact that you did not plan to participate in the previous Stage 2 menu measure CMS FAQ 14397: https://goo.gl/otwncg 2016 Bottom Line: you ll either fully exclude, or exclude from Immunizations and Syndromic Surveillance but claim engagement with a Specialized Registry like AOA MORE
Summary Reporting periods 2016: any 90 consecutive days for new EPs, full year for all others proposal on table for 90 days for all EPs. Continue as originally scheduled until finalized 2017: full year (???) for all EPs (including new EPs) in Advancing Care Information MU in 2016 involves 10 objectives Key Info V/D/T Actual Use still at at least 1 patient Secure Messaging now measures messages you send to unique patients. Need to send a message to at least 1 Broad exclusions from Public Health Reporting still possible Providers in first year of MU in 2016 should try to complete attestation prior to October 1 to avoid a 3% penalty in 2017
Next 4:30 to 5:30 PM Peer to Peer Roundtable Discussions