New York State-Health Centered Controlled Network (NYS HCCN) Webinar #5 Meaningful Use: Looking Ahead to Stage 2 and CPS 12 December 10, 2013 Ekem Merchant-Bleiberg, Director of Implementation Services
Welcome & Introductions Participants Presenters How to Participate Learning Objectives
How to Participate Today Open and close your Panel View, Select, and Test your audio Submit text questions Raise your hand Q&A addressed throughout the session
Learning Objectives Compare & Contrast Meaningful Use Stage 1 & Stage 2 Review key components of Centricity Practice Solution 12
Definition of Meaningful Use Use of ONC-HIT Certified Electronic Health Records (EHR) Electronic Exchange of Health Information Quality Reporting
An Overview CONTRASTING STAGE 1 MEANINGFUL USE TO STAGE 2
Stage 2 Meaningful Use Overview Stage 2 Meaningful Use (S2MU) Final Rule was published on August 23, 2012. Beginning in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 for 2 or 3 years will need to meet S2MU criteria.
What is in the Rule Changes to Stage 1 of Meaningful Use Stage 2 of Meaningful Use New clinical quality measures (CQMs) New CQM reporting mechanisms Medicaid program changes
S2MU Change in Total Objectives Required Stage 1 MU Eligible Professionals Stage 2 MU Eligible Providers 15 core objectives 17 core objectives 5 of 10 menu objectives 3 of 6 menu objectives 20 total objectives 20 total objectives 10
How to Get to S2MU 17 Core Objectives 3 of 6 Menu Objectives 9 Clinical Quality Measures Meaningful Use 11
Key Changes to Stage 1 Meaningful Use Menu Objective Exclusion While you can continue to claim exclusions if applicable for menu objectives, starting in 2014 these exclusions will no longer count towards the number of menu objectives needed.
Medicaid Eligibility Changes The definition of what constitutes a Medicaid patient encounter has changed. A Medicaid encounter now includes anyone enrolled in a Medicaid program, including: Medicaid expansion encounters (excluding stand alone Title 21) Zero-pay claims 13
2014 Changes Reporting Period Reduced to Three Months to allow providers time to adopt 2014 certified EHR technology and prepare for Stage 2, all participants will have a three-month reporting period in 2014. All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a threemonth EHR reporting period. 14
2014 Changes For Medicaid providers only eligible to receive Medicaid EHR incentives, the 3-month reporting period is not fixed, where providers do not have the same alignment needs. CMS is permitting this one-time three-month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems. 15
Stage 2: Batch Reporting Stage 2 MU rules allows for batch reporting: Starting in 2014, groups will be allowed to submit attestation information for all of their individual EPs in one file for upload to the Attestation System, rather than having each EP individually enter data.
Alignment Among Programs 2014 represents CMS s commitment to aligning quality measurement and reporting among programs, including Hospital Inpatient Quality Reporting Program, PQRS, CHIPRA, and ACO Programs. ACO Hospital Inpatient Quality Reporting Program PQRS CHIPRA
A LOOK AT THE OBJECTIVES
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Use of computerized provider order entry More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. More than 60% of medication, 30% of laboratory and 30% of radiology orders created by the EP during the reporting period are recorded using CPOE. Revised Threshold Revised Requirement Clinician Action: Put down the script pads 19
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Generate and transmit permissible prescriptions electronically (erx) More than 40% of all prescriptions written are transmitted electronically using certified EHR technology (CEHRT). More than 50% of all permissible prescriptions or all prescriptions written by the EP and queried for a drug formulary and transmitted electronically using CEHRT. Increased Threshold Revised Requirement Clinician Action: Put down the script pad & use EHR for formulary checking 20
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Record the following demographic s: Preferred language Gender Race Ethnicity Date of birth More than 50% of all unique patients seen by the EP have demographics recorded as structured data. More than 80% of all unique patients seen by the EP during the EHR reporting period have demographics recorded as structured data. Increased Threshold Clinician Action: Workflow to communicate updates/errors to registration staff 21
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Record and chart changes in the following vital signs: Height/length and weight Blood pressure Calculate and display BMI Plot and display growth charts for patients 0-20 years (incl. BMI) More than 50% of all unique patients age 2 and over seen by the EP height, weight and blood pressure are recorded as structured data. More than 80% of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height/length and weight (for all ages) recorded as structured data. Increased Threshold Revised Requirement Clinician Action: Enable easy data entry; Training and reinforcement for Intake process 22
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Use clinically relevant information to identify patients who should receive reminders for preventive/followup care and send these patients the reminder, per patient preference More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. More than 10% of all unique patients who have had two or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available. Menu to Core Decreased Threshold Clinician Action: prioritize recalls, develop Workflow, and train staff 23
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change 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 More than 10% of all unique patients seen by the EP are provided timely electronic access to their health information. More than 50% of all unique patients seen by the EP are provided timely electronic access to their health information. More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download or transmit to a third party their health information. Menu to Core Revised Requirement 24
What PHI should be available? ANSWER: PHI that empowers patients to maintain their health and well-being, or to manage their chronic conditions ESSENTIAL: Diagnostic test results Current Problem List Current Medication List Medication Allergies
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Provide clinical summaries for patients for each office visit Clinical summaries provided to patients for more than 50% of all office visits within 3 business days. Clinical summaries provided to patients within 1 business day for more than 50% of office visits. Revised Requirement Clinician Action: Real Time documentation and order entry 26
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Use CEHRT to identify patientspecific education resources and provide those resources to the patient More than 10% of all unique patients seen by the EP during the EHR reporting period are provided patient-specific education resources. Patient-specific education resources identified by CEHRT are provided to patients for more than 10% of all office visits by the EP. Menu to Core Revised Requirement Clinician Action: Identify which handouts are best & reinforce workflow 27
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Use secure electronic messaging to communicate with patients on relevant health information N/A A secure message was sent using the electronic messaging function of CEHRT by more than 5% of unique patients seen by the EP during the EHR reporting period. New Requirement Clinician Action: Adopt Patient Portal or Secure Online Messaging technology and use it 28
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change 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 The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP. The EP performs medication reconciliation for more than 65% of transitions of care in which the patient is transitioned into the care of the EP. Increased Threshold Menu to Core 29
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change The EP who transitions their patient to another setting of care or provider 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 who transitions their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals. The EP who transitions their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals. 10% of such transitions or referrals are electronically transmitted. One or more successful exchanges of a summary of care document with a recipient on a different EHR technology. Menu to Core Revised Requirement 30
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice Performed at least one test of certified EHR technology s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless the immunization registries do not have the capacity to receive the information electronically). Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or immunization information system for the entire EHR reporting period. Revised Requirement Menu to Core 31
EP Core Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Protect electronic health information created or maintained by the CEHRT through the implementati on of appropriate technical capabilities Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management. Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 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 provider s risk management process. Revised Requirement 32
MENU SET REQUIREMENTS
EP Menu Set Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT N/A More than 10% of all tests whose result is one or more images ordered by an EP during the EHR reporting period are accessible through CEHRT. New Requirement 34
EP Menu Set Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Record patient family health history as structured data N/A More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives. New Requirement 35
EP Menu Set Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Record electronic notes in patient records N/A Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of unique patients with at least one visit during the EHR reporting period. Electronic progress notes must be textsearchable. New Requirement 36
EP Menu Set Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice N/A Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period. New Requirement 37
EP Menu Set Requirements Objective Stage 1 MU Stage 2 MU Summary of Change Capability to identify and report cancer cases to a State cancer registry, except where prohibited, and in accordance with applicable law and practice N/A Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period. New Requirement 38
EP Menu Set Requirements Objective Stage 1 MU Stage 2 MU Summary of Change 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 N/A Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period. New Requirement 39
CLINICAL QUALITY MEASURES
How do CQMs relate to the CMS Incentive Programs? Although reporting CQMs is no longer a core objective of the EHR Incentive Programs, all providers are required to report on CQMs in order to demonstrate Meaningful Use. In 2014 and beyond, reporting programs (i.e., PQRS, erx reporting) will be streamlined in order to reduce provider burden.
Domains of Quality Measures Patient and Family Engagement. Greater involvement of patients and families in decision making, self care, activation, and understanding of their health condition and its effective management Patient Safety. Processes that would reduce harm to patients and reduce burden of illness. enable longitudinal assessment of condition-specific, patientfocused episodes of care. Care Coordination. Measures that demonstrate appropriate and timely sharing of information and coordination of clinical and preventive services among health professionals in the care team and with patients, caregivers Population and Public Health. Measures that reflect the use of clinical and preventive services and achieve improvements in the health of the population served especially focused on the leading causes of mortality. Efficient Use of Healthcare Resources. Emphasize the use of evidence to best manage high priority conditions and determine appropriate use of healthcare resources. Clinical Processes/Effectiveness. Reflect clinical care processes closely linked to outcomes based on evidence and practice guidelines.
Clinical Quality Measures Provider Prior to 2014 2014 and Beyond* EPs Complete 6 out of 44: 3 core or 3 alt. core + 3 menu Complete 9 out of 64 Choose at least 1 measure in 3 NQS domains Recommended core CQMs include: 9 CQMs for the adult population 9 CQMs for the pediatric population Prioritize NQS domains
2014 CQM Reporting For 2014, CMS is not requiring the submission of a core set of CQMs. There are two recommended core sets of CQMs, one for adults and one for children. Eligible professionals should report from the recommended core set to the extent those CQMs are applicable to your scope of practice and patient population
2014 CQM Reporting Alignment includes: Choosing the same measures for different program measure sets Coordinating quality measurement stakeholder involvement efforts and opportunities for public input Identifying ways to minimize multiple submission requirements and mechanisms
Reporting CQMs in 2014 and Beyond Beginning in 2014, Medicaid providers will electronically report their CQM data to their state.
CPS 12
Centricity Practice Solution v12 Capture Patient Data Use Advanced Clinical Functions Capture Data Report for Meaningful Use Engage Patients Coordinate Patient Care Manage patient populations Patient Care Use clinical functions Manage Patient Populations Report for Meaningful Use Coordinate patient care Engage patients
CPS v12 Measure Support Stage 1 Problem List Medication List Medication Allergy List Drug Formulary checks
CPS v12 Measure Support Stage 1 & 2 Computerized Provider Order Entry Drug-Drug and Drug- Allergy checks eprescribing Record Demographics Vital Signs Smoking Status Clinical Decision Support Clinical Visit Summaries View, Download, and Transmit Incorporate Laboratory Test Results Patient Lists Patient Reminders Patient-Specific Education Medication Reconciliation Transition of Care Clinical Summary Immunization Registries Syndromic Surveillance Secure Messaging (Patient to Provider) Protect Electronic Health Information
CPS v12 Measure Support Stage 2 Electronic Notes View Imaging Results Record Family Health History
CPS 12 NEW FUNCTIONALITY
Capture Patient Data Record Patient Demographics Patient Race ( up to 2) Record Patient Smoking Record Patient Vital Signs Record Patient Family History
Use Advanced Clinical Functions Computerized Provider Order Entry Classify orders as Laboratory, Radiology, or Other Support Credentialed Medical Assistants Record Administered Medications Record requests for medications administered to the patient during the visit Track medications administered to a patient during the visit in a new structured format
Clinical Visit Summary Engage Patients Provide Patient Specific Education Provide patient-specific education using the HL7 v3 standard Context Aware Knowledge Retrieval Application (Infobutton) Retrieve context-sensitive information for patients as well as referential information for the clinician Supports supplier-agnostic educational content Communicate with Patients Online Secure Messaging Vendor Agnostic Portal
Coordinate Patient Care Reconcile Clinical Information Reconcile problems, medications, and allergies from external sources Identify encounters as a Transition of Care Transition of Care documentation Create a summary document to send to another provider when transitioning care Transition of care documentation integrated with the orders workflow Customize patient content in the transition of care summary Send transition of care summaries through Centricity Clinical Messenger
Coordinate Patient Care Immunization Management Preload Submit to Registries Create Patient Care Plans
Manage Patient Populations Send Patient Reminders for Follow Up or Preventative Care
CPS 12 NAVIGATION
CPS 12 New Navigation Customize Website Links New Navigation Tools Access Chart Desktop, Patient Charts, Chart Reporting, and LinkLogic through new navigation structure Navigation Administration Module Access the Administration module through a new navigation structure Manage application constants grouped by financial, clinical, and main application functions
CLINICAL QUALITY MEASURES
Clinical Quality Measures Track physician progress towards Clinical Quality Measures and Functional Measures for Meaningful Use 2014 Stage 1 and Stage 2 Access to the reporting dashboard is set up online, outside of the application. Users can configure the application to display the reporting dashboard. Review unmet measures to find patient data that can be updated to meet thresholds Meaningful Use Functional Measure checklist encounter form to help physicians update all of the data required for Meaningful Use while their patient is still with the physician Customize Value Sets for Reporting
Questions & Thoughts