CHCANYS NYS HCCN ecw Webinar Meaningful Use, V10 and UDS January 30, 2013 Stephanie Rose, Project Director Desiree Railine, HIT Implementation Specialist/Trainer
Agenda Meaningful Use Stage 1 2014 Review Stage 1 2014 to Stage 2 Comparison V10 Upgrade UDS 2013 Highlights HEALTH CENTER NETWORK OF NEW YORK 2
Stage 1 2014 HEALTH CENTER NETWORK OF NEW YORK 3
Overview of 2014 Changes Eligible Providers must use 2014 certified EHR technology for Stage 1 and 2 2014 only Reporting period 90 days for all participants regardless of stage or payment year Changes in Objectives Elimination of Menu Exclusions Electronic Copy of Health Information Electronic Access to Health Information Clinical Quality Measures HEALTH CENTER NETWORK OF NEW YORK 4
Certification Change All EHR Incentive Programs participants must adopt certified EHR technology that meets ONC s Standards & Certification Criteria 2014 Final Rule. You will need to upgrade to the 2014 certified version of eclinicalworks (V10.x) regardless of the stage you are working on. HEALTH CENTER NETWORK OF NEW YORK 5
2014 Special Reporting Year To accommodate the upgrade to the 2014 certified version for all vendors and participants, CMS has reduced the reporting requirement to 90 days for 2014 for all participants regardless of stage or payment year. HEALTH CENTER NETWORK OF NEW YORK 6
2014 Menu Measure Change Elimination of reporting menu measures that are excluded or have no denominator Providers must still attest to 5 menu measures Beginning in 2014 you can no longer count a menu objective that has an exclusion towards the 5 required if there are other menu objectives you can meet. HEALTH CENTER NETWORK OF NEW YORK 7
Menu Measure Example Menu Measure Numerator Denominator Benchmark Metric 2013 Use 2014 Use Lab 0 0 40% Excl Yes No Pt Reminders 8 100 20% 0.08 No No Portal 2 100 10% 0.02 No No Education 0 100 10% 0 No No Med Rec 0 0 50% Excl Yes No Trans of Care Summary 0 0 50% Excl Yes No Drug formulary checks Attestation Yes Yes Yes The provider will need to meet two additional measures in 2014 that are not excluded. List of Patients Attestation Yes Yes Yes Immunization Registry Attestation Yes Yes Yes Syndromic Registry Attestation Excl Yes No HEALTH CENTER NETWORK OF NEW YORK 8
Electronic Access CMS combined the original Core objective to provide patients an electronic copy of their health information upon request and the Menu objective for electronic access into one Core objective. Expanded requirements HEALTH CENTER NETWORK OF NEW YORK 9
Electronic Copy of Health Information Upon Request New Stage 1 2014 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. New Stage 1 2014 Core Measure: More than 50% of all unique patients seen by the provider during the reporting period have on line access to their health information within 4 business days after it is available subject to the provider s discretion to withhold certain information. HEALTH CENTER NETWORK OF NEW YORK 10
13 Core Measures (2 of 15 eliminated in 2014) HEALTH CENTER NETWORK OF NEW YORK 11
5 out of 9 Menu Measures (1 out of 10 eliminated in 2014) HEALTH CENTER NETWORK OF NEW YORK 13
HEALTH CENTER NETWORK OF NEW YORK 14
2014 Clinical Quality Measures Must report using the new 2014 criteria Must report on 9 out of 64 measures Recommended Core Quality Measures are encouraged but not required 9 for Adult 9 for Pediatrics Selected CQMs must cover at least 3 of the National Quality Strategy domains HEALTH CENTER NETWORK OF NEW YORK 15
CQM Domains Patient and Family Engagement Patient Safety Care Coordination Population/Public Health Efficient Use of Healthcare Resources Clinical Process/Effectiveness HEALTH CENTER NETWORK OF NEW YORK 16
Core Adult CQM HEALTH CENTER NETWORK OF NEW YORK 17
Pediatric CQM HEALTH CENTER NETWORK OF NEW YORK 18
Questions on Stage 1 2014
Stage 2 Requirements 17 Core Objectives 7 moved from Menu; 1 new all more demanding 3 Menu Objectives Select from 6; 5 new 9 Clinical Quality Measures HEALTH CENTER NETWORK OF NEW YORK 20
Meaningful Use Stage 1 2014 to Stage 2 Comparison http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2 CompTablesforEP.pdf
17 Core Measures
Stage 2 Core Stage 2 Measure Objective C1 CPOE > 60% of medication, > 30% lab and > 30% radiology orders C2* eprescribe/formulary > 50% of permissible prescriptions are queried for a drug formulary and sent electronically C3 Demographics > 80% of patients (language, sex, race, ethnicity, DOB) C4* Vitals > 80% of patients (BP/HT/WT) C5 Smoking Status > 80% of patients C6 CDSS 5 CDSS implemented related to >4 CQM C7 Online Information > 50% of patients are provided timely online access to their health information AND > 5% of patients view, download, or transmit their health information C8 Clinical Summaries > 50% of office visits C9 Protect Health Information Risk Assessment and Encryption/Security of Data at rest C10 Lab Test Results > 55% of lab tests are recorded as structured data (positive/negative/numerical) C11 Patient List Generate at least one report per provider for a specific condition C12 Patient Reminders > 10% of patients per patient preference (all ages) C13 Patient Education > 10% of patients (identified by CEHR) C14 Medication Reconciliation > 50% of patients C15 Transition of Care > 50% of transitions of care/referrals AND > 10% are sent electronically AND Test exchange of summary of care with a different vendor or ONC Test System C16 Immunization Registry Ongoing Submissions for the reporting period C17 Secure Electronic Messaging > 5% of patients send a secure message
CPOE HEALTH CENTER NETWORK OF NEW YORK 24
Drug Drug & Drug Allergy Interaction Eliminated/Moved HEALTH CENTER NETWORK OF NEW YORK 25
eprescribing HEALTH CENTER NETWORK OF NEW YORK 26
Demographics HEALTH CENTER NETWORK OF NEW YORK 27
Problem List HEALTH CENTER NETWORK OF NEW YORK 28
Active Medication List HEALTH CENTER NETWORK OF NEW YORK 29
Medication Allergy HEALTH CENTER NETWORK OF NEW YORK 30
Vitals HEALTH CENTER NETWORK OF NEW YORK 31
Smoking Status HEALTH CENTER NETWORK OF NEW YORK 32
Clinical Decision Support
Clinical Quality Reporting Eliminated from Core 34
Electronic Copy Upon Request becomes Ability to view online, download & transmit 35
Clinical Summaries 36
Exchange Clinical Information Eliminated 37
Risk Assessment 38
Drug Formulary Checking Combined with eprescribing 39
Lab Results 40
List of Patients 41
Timely Electronic Access becomes Ability to view online, download & transmit 42
Patient Reminders 43
Patient Education 44
Medication Reconciliation 45
Summary of Care for Referrals: Part 1 46
Summary of Care for Referrals: Part 2 The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for > 10% of such transitions and referrals either: a) electronically transmitted to a recipient using CEHRT or b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner consistent with an ONC-established governance mechanism to facilitate exchange. 47
Summary of Care for Referrals: Part 3 The EP who transitions or refers their patient to another setting of care or provider of care must either a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender's, or b) conduct one or more successful tests with the CMS-designated test EHR during the EHR reporting period 48
Immunization Registry 49
Secure Messaging 50
3 out of 6 Menu Measures
Stage 2 Menu Measures Must select 3 out of 6 Stage 2 Measure Objective M1 Syndromic Surveillance Ongoing Submissions for the reporting period from CEHRT M2 Electronic Notes > 30% of patients M3 Imaging Results > 10% of imaging results accessible through CEHRT M4 Family Health History > 20% of patients M5 Cancer Registry Ongoing Submissions for the reporting period from CEHRT M6 Specialized Registry Ongoing Submissions for the reporting period from CEHRT 52
Syndromic Surveillance Registry 53
Electronic Progress Note 54
Image Results Accessible Through the CEHR 55
Family Health History 56
State Cancer Registry 57
Specialized Registry 58
Questions on Stage 2 59
V10 Upgrade
V10 Upgrade Resources 1. Go to the ecw Support Portal and download/read the V10 documentation 2. Listen to the V10 webinars and videos
Plan Ahead This is a substantial upgrade and it will take time to configure plus implement new features and workflows ecw has recommended a 90 day implementation cycle if you are implementing new features Submit ticket to install in your test environment (must be 64 bit) Read and watch videos IT Impact may require hardware and software upgrades to meet the specs Determine when you would like to upgrade consider UDS reports, MU submission, ICD10 and other projects HEALTH CENTER NETWORK OF NEW YORK 62
V10 Feature Highlights V10 has over 500 new enhancements ONC 2014 Certified Edition required to meet Stage 1 2014 and Stage 2 (certification number CC 2014 955447 1. ) Structured Family History (Stage 2) search by ICD9 and stores the linked SNOWMED code Immunization Enhancements CDSS ability to customize Clinical Rules Engine Patient Race Multi Select Patient s Preferred Language Community mapping to ISO standard Structured data enhancement Order Set enhancements Flow Sheet enhancements Document enhancement Progress Note Enhancement Much more HEALTH CENTER NETWORK OF NEW YORK 63
Meaningful Use Features Licensed Healthcare professional or Credentialed Medical Assistant Flag for Staff Members HEALTH CENTER NETWORK OF NEW YORK 64
Meaningful Use Features Race can now select multiple race Enable feature by item key 1643_IOAOO through support HEALTH CENTER NETWORK OF NEW YORK 65
Meaningful Use Features Attribute Codes for DI and Procedures HEALTH CENTER NETWORK OF NEW YORK 66
Meaningful Use Features Language ISO mapping Community Mapping If the language you create is not part of the standard list, a red exclamation point will show Can also set a language as a favorite Item key 1646_IOAOO HEALTH CENTER NETWORK OF NEW YORK 67
Meaningful Use Features Circle of Care Care team HEALTH CENTER NETWORK OF NEW YORK 68
Meaningful Use Features Visit Summary enhancements (web view and Decline button) Item key 1651_IOAOO for the Web View Item key 0987_UK for Decline in print options Show associated assessments from education in Print Visit Summary Lab Requisition Number for Electronic Lab or DI Results Item key 1146_DMK HEALTH CENTER NETWORK OF NEW YORK 69
Immunization Enhancements CVX Codes are mandatory Therapeutic Injections added (available from hub and right chart panel) New Modern View shows vaccines in an editable grid Immunization Schedule based on CVX codes Immunization Admin code enhancement PPD flag option PPD reading fields Immunization given by displays in progress note Immunization Lot enhancement HEALTH CENTER NETWORK OF NEW YORK 70
HEALTH CENTER NETWORK OF NEW YORK 71
Family History Enhancements Customize columns add ICD codes to the grid Feature enabled by Item Key 1683_AOOA Stage 2 Menu HEALTH CENTER NETWORK OF NEW YORK 72
Pause for questions HEALTH CENTER NETWORK OF NEW YORK 73
UDS 2013 Highlights
ecw UDS Resources ecw Support Portal/ Health Center Link Download and read documentation Listen to UDS recorded Webinars (mandatory) ecw UDS Patch for ebo reporting HEALTH CENTER NETWORK OF NEW YORK 75
ecw Patch Installed only after you watch all of the videos The patch will add medication groupings to your system You will need to add the groupings manually to any custom medications HEALTH CENTER NETWORK OF NEW YORK 76
ecw Changes Moved from the report console to ebo starting with this year Log into ebo to access Choice of using claims or encounters for encounter pool. Only support using one method. No Preset mapping on UDS Console Use preset of prompts for each ebo report using action icon HEALTH CENTER NETWORK OF NEW YORK 77
UDS Due Dates and Revisions UDS Reports may be submitted after January 1, 2014 and are initially due no later than February 15, 2014. Between February 15th and March 31st health centers work with their UDS Reviewer to identify and correct possible errors. Final corrected submissions are due by March 31st and changes after this date are not accepted. To request assistance at any time, please contact the UDS Support Center at 1 866 UDS HELP. HEALTH CENTER NETWORK OF NEW YORK 78
Access ecw ebo UDS Reports
HEALTH CENTER NETWORK OF NEW YORK 80
ecw Mapping HEALTH CENTER NETWORK OF NEW YORK 81
Decision Run ecw reports by Encounter or by Claim ebo reports require that you select only one method Review the grid in the ecw Manual (page 11) to determine which method to use Encounter based requires Visit Types to be set up Encounters counted based on resource provider on appointment ICD9, CPT codes from progress note Encounters based on charges, payments and other financial transactions Claims based Encounters are based on claims Insurance reported as of last claim Encounter counted based on last resource provider on the claim HEALTH CENTER NETWORK OF NEW YORK 82
ecw ebo Report Mapping Community Mapping Counseling for Nutrition and Physical Activity for children BMI Management Follow Up for adults Smoking Structured data Asthma Smart Form Rx Groups Structured data migrant, seasonal, homeless UDS Report mapping Providers/Resources Insurance/Insurance Group Immunization Adjustments HEALTH CENTER NETWORK OF NEW YORK 83
Important Demographic Fields It is important that your staff complete this information. Zip Code Gender Date of Birth Additional Information Screen Sliding Fee/Income information Race, ethnicity, language Additional Information Structured Data tab Veterans status Migrant/Seasonal worker status homeless status, public housing status Information for patients served best in a language other then English. HEALTH CENTER NETWORK OF NEW YORK 84
2013 Changes to UDS Cervical Cancer Screening Childhood Immunization Patient by Zip Code Insurance Age Ranges HEALTH CENTER NETWORK OF NEW YORK 85
Cervical Cancer Screening Compliant Women age 24 64 with a Pap test every 3 years Women age 30 64 with a Pap test every 5 years if accompanied by an HPV test (Added in 2013) Denominator: Number of all female patients age 24 64 years of age during the measurement year who had at least one medical visit during the reporting year, or a sample of these women. No Change to Table 6B HEALTH CENTER NETWORK OF NEW YORK 86
HPV High Risk lab Associate the appropriate LOINC code to the lab attribute Select the HPV High Risk lab, and then click the Attribute Codes button Click on Update LOINC Add the appropriate LOINC code if it is not already mapped HEALTH CENTER NETWORK OF NEW YORK 87
Exclusion for Hysterectomy Record in Surgical History Utilize browse button Add to Hysterectomy browse if not available HEALTH CENTER NETWORK OF NEW YORK 88
Cervical Cancer Screening Table 6 B HEALTH CENTER NETWORK OF NEW YORK 89
Asthma no change Use the Asthma Smart form to record severity, structured data, ICD9 code 493.x or Category II codes. Map smart form in Community Mapping to HPI Structured data Asthma must be in the problem list HEALTH CENTER NETWORK OF NEW YORK 90
Immunizations Table 6B Key Changes Removed Hepatitis A, Rotavirus, and Influenza immunizations from the immunization test battery Revised the time frame for immunization completion from by age 2 to by age 3 HEALTH CENTER NETWORK OF NEW YORK 91
Patient Zip Codes by Insurance Source Health centers must report the number of patients served by the most recent ZIP code. Breaks down each zip code by Uninsured, Medicaid, Medicare or Private insurance Utilize either insurance or insurance group Not mapped = private insurance If residence is not known or for whom a proxy is not available, residence should be reported as Unknown ZIP codes with ten or fewer patients may be aggregated and reported in an Other category Medical insurance status must be obtained for all persons counted by the health center regardless of what services are provided. HEALTH CENTER NETWORK OF NEW YORK 92
Table 4 Selected Patient Characteristics Revised age range for insurance Changed age categories from 0 19 years and 20 years and older to match the census categories 0 17 years and 18 years and older HEALTH CENTER NETWORK OF NEW YORK 93
Patients by Zip Code Table
New! NYS-HCCN Ask the Experts Forum http://www.chcanys.org/index.php?src=forum 1. If you do not have an account, the link will take you to the login screen so you can create an account. 2. Choose the options for NYS-HCCN members only 3. You will need to wait for an email from the CHCANYS system administrator approving your account before you ll be able to log in for the first time. 4. When you get a confirmation, return to this link to log in. Posting a Question 1. Click on a relevant category, e.g., Meaningful Use Data Capture for eclinical Works 2. Click the New Topic button in the top right, type a question (message body optional) and submit the form. a. The question will appear on the list of questions for your selected category.
We appreciate your feedback! Please take survey using the link below HTTPS://WWW.SURVEYMONKEY.COM/S/8KPPWN2 HEALTH CENTER NETWORK OF NEW YORK 96
Resources CMS Website www.cms.gov HealthIT.Gov www.healthit.gov CHPL Certification http://oncchpl.force.com/ehrcert?q=chpl ecw Support Portal UDS 2013 Pal http://bphc.hrsa.gov/policiesregulations/policies/pal201302.html HRSA UDS 2013 Manual http://bphc.hrsa.gov/healthcenterdatastatistics/reporting/2013udsreport.pdf HEALTH CENTER NETWORK OF NEW YORK 97