The idea of Meaningful Use was developed by the National Quality Forum (NQF) in an effort to create a set of national priorities that would help healthcare performance-improvement efforts. In 008 the NQF released a report which identified the areas they felt needed to be improved. Their ideas included many obvious areas such as: improved population health, coordination of care, improved safety, increased efficiency, reduction of racial disparities, and patient engagement. Privacy and security were later added to this list. These ideals were used as a framework framework to determine the Meaningful Use of EMR/EHRs. In 009 the American Recovery and Reinvestment Act (ARRA) added to Meaningful Use by focusing on preserving and improving the affordability of health care as well as less medically-relevant provisions such as modernizing the nation's infrastructure, enhancing energy independence, providing tax relief, and expanding educational opportunities. The HITECH Act addressed the ARRA's focus on affordable healthcare, and specifically outlines the promotion of Health Information Technology (HIT), HIT testing, grants and loans funding and demonstration programs, privacy, and provisions for monetary incentives through Medicaid and Medicare. If you are still reading this, chances are you are already familiar with Meaningful Use Stage criteria and timeline as well as the concept of core and menu objectives that the Centers for Medicare & Medicaid Services (CMS) introduced. Basically Stage objectives require that Eligible Professionals (EPs) 5 core objectives, 5 out of the 0 menu objectives plus a total of 6 Clinical Quality Measures (CQMs). For Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs) the requirement is 4 core objectives, 5 out of 0 menu objectives and 5 CQMs. / 5
This proposed new standards for Stage maintain the existing structure and specifies that EPs must meet (or qualify for an exclusion to) 7 core objectives and of 6 menu objectives. EHs and CAHs must meet or qualify for an exclusion to 6 core objectives and of 6 menu objectives as summarized here: EPs Stage Two Stage One Core Objectives 7 / 5
5 Menu Objectives /6 5/0 CQM Alternative #, from each domain core plus additional CQM Alternative # / 5
Physician Quality Reporting System Program EH/CAH Core Objectives 6 4 Menu Objectives /6 5/0 4 / 5
CQM Alternative # 4, from each domain 5 core CQM Alternative # Hospital Inpatient Quality Reporting Program Nearly every objective considered optional for Stage will be required in Stage and thresholds and exclusions of all measures have been reevaluated. Specific submission of clinical quality measures (CQMs) that align with pre-existing national quality programs will be required in 04. New objectives are proposed, some of which are part of the Stage core set and others would make up the Stage menu set. 5 / 5
Stage meaningful use requirements include rigorous expectations for health information exchange and more demanding e-prescribing, incorporation of structured laboratory results, and transmission of patient care summaries across unaffiliated providers, settings, and EHR systems. Specifically, Stage meaningful use criteria encourage the use of Healthcare IT for continuous quality improvement at the point of care, exchange of information in structured format, and patient engagement. With this new regulation, CMS has proposed changes to the timeline as well as an extension beyond 04. Stage requires changes to both technology and workflow that cannot be expected to be completed in the time between publication of the final rule and the start of the EHR reporting periods. Consequently, CMS is proposing a year extension of Stage of meaningful use for providers who successfully demonstrated meaningful use for 0. The new timeline is reflected in the table below. First Payment Year Stage of Meaningful Use 0 6 / 5
0 0 04 05 06 07 08 09 00 0 0 7 / 5
0 8 / 5
0 9 / 5
0 / 5
04 / 5
05 / 5
06 / 5
07 4 / 5
Just as federal officials have finalized standards for Stage of the Meaningful Use incentive program for adoption of EHRs, an advisory committee is already hard at work planning for the third and final stage of this $7 billion initiative. The same ideals of increased care and efficiency that were the basis for the development of stages and will also apply to the drafting of the stage criteria for Meaningful Use. In the months and years ahead there will be much public discussion on this topic and CoreTech will be here to keep you informed of the latest. ~ Steve Barnes 5 / 5