Incorporating Meaningful Use in the Specialty Practice April 10 th 2012 12:00pm 1:00 pm Thank you for joining us. The webinar will begin shortly. If you experience technical difficulties at any time, please contact 1-888-259-8414 Housekeeping How to participate You can join the audio for today s conference by selecting Use Mic & Speakers Or, to join by phone, select Use Telephone in your Audio window. See example Submit your text t question using the Questions pane -0- -1-1
General Information 1.0 AMA PRA Category 1 Credits (Risk Management) Online evaluation and CME certificate PowerPoint slides available for download You will also receive this information in a reminder email, following the webinar Questions during the webinar may be typed into the questions box on the right side of your screen Questions will be answered at the end of the presentation For help with technical difficulties, call 1-888-259-8414 Faculty Introductions Presenter Moderator Jeff Loughlin, MHA Project Director jloughlin@maehc.org Christina Moran, MPH Strategy Consultant cmoran@maehc.org -2- -3-2
Faculty Disclosures The following faculty has indicated their financial interests and/or relationships with commercial manufacturers as follows: Jeff Loughlin, MHA, N/A Christina Moran, MPH N/A Activity planners of today s webinar have nothing to disclose. MAEHC Mission: Facilitate Universal EHR Adoption Company launched September 2004 Non-profit registered in the Commonwealth of Massachusetts CEO on board January 2005 Backed by broad array of 34 non-profit MA health care stakeholders -4- -5-3
MAeHC Selected Three Pilot Sites From 35 Applicants: Brockton, Newburyport, North Adams Provided EHRs to ~600 clinicians practicing in over 200 office locations Created health information exchanges connecting the physicians with each other and with the hospitals Created a quality data center to extract clinical data from EHRs to evaluate effectiveness and measure performance Since the pilot program, MAeHC has expanded its experience base and involvement in a variety of projects 300 Physician EHR implementation Beth Israel Deaconess Physician Organization (BIDPO) Community-wide EHR Implementation, HIE, and Quality Data Center Large Healthcare Foundation HEAL 5 New York New York State Department of Health and New York ehealth Collaborative (NYeC) HEAL 10 New York Adirondack Region Medical Home Pilot State-level HIE technical services vendor procurement Missouri HIO State t Level Health Information Exchange Strategic t and Operational Plan Development New Hampshire Regional Extension Center planning, deployment, and operations New York, Massachusetts, Rhode Island, New Hampshire www.maehc.org -6- -7-4
Polling Questions Please note that we will be conducting a few polls during today s webinar. At various points during the presentation, you will be asked a brief question regarding HIT and EHR use. At the appropriate time, a screen will pop-up on your computer. Please select the appropriate response and click Submit. Goals and Objectives Goal: To educate providers who are planning to use Electronic Health Records (EHRs) to incorporate the objectives of Meaningful Use into their daily office routines Objective: For providers to understand how to use the required functionality within their EHR to achieve meaningful use, the specific standards required for compliance, and how the objectives can easily be incorporated into the basic workflow of a specialty office visit -8- -9-5
Agenda American Recovery and Reinvestment Act Funding (ARRA) Medicare and Medicaid Incentive Programs What is Meaningful Use? Meaningful Use in Practice Clinical Quality Measures (CQM) Health Information Exchange (HIE) Putting The Pieces Together Questions, Contact Information and Resources American Recovery and Reinvestment Act -10- -11-6
Estimated ARRA Funding for HIT and HIE 35 $30B 30 25 $1.1B $1.2B Medicaid id 90/10 funds Health information exchanges Regional health IT extension centers 20 15 $28B Direct payments to individual providers 10 Health Information Technology for Economic and Clinical Health (HITECH) 5 0 Agenda American Recovery and Reinvestment Act Funding (ARRA) Medicare and Medicaid Incentive Programs What is Meaningful Use? Meaningful Use in Practice Clinical Quality Measures (CQM) Health Information Exchange (HIE) Putting The Pieces Together Questions, Contact Information and Resources -12- -13-7
Comparison of Medicare and Medicaid Incentive Programs Medicare Maximum incentive $44,000 ($48,000 in HPSA) $63,750 Medicaid Payment calculation Eligibility 75% of submitted allowable charges in a year, up to cap Any ambulatory Eligible Professional doing Medicare business Flat payment to cover allowable costs, up to cap Any ambulatory Eligible Professional doing Medicaid business Limitations on eligibility No mid-levels 30% of services must be Medicaid; 20% for peds Penalties Qualifying period Qualifying logistics Penalties for non-compliance starting in 2015 Any 90 continuous days between Jan 1 2011 and Dec 31 2011 Attestation to CMS of all requirements, including submission of quality measure numerators and denominators for selected core measures; electronic submission of quality measures starting in 2012 (if available by CMS) NPs, NMWs qualify; PAs only in Rural Health Clinics No penalties Any 90 continuous days between Jan 1 2011 and Dec 31 2011 Attestation to state Medicaid of all requirements, including submission of quality measure numerators and denominators for selected core measures; electronic submission of quality measures starting in 2012 (if available by CMS) Agenda American Recovery and Reinvestment Act Funding (ARRA) Medicare and Medicaid Incentive Programs What is Meaningful Use? Meaningful Use in Practice Clinical Quality Measures (CQM) Health Information Exchange (HIE) Putting The Pieces Together Questions, Contact Information and Resources -14- -15-8
What is Meaningful Use The Recovery Act specifies the 3 components of Meaningful Use: Use of certified EHR in a meaningful manner (e.g., e-prescribing) Use of certified EHR technology for electronic exchange of health information to improve quality of health care Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary http://onc-chpl.force.com/ehrcert Meaningful Use has five health related goals Improve quality, safety, efficiency and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information -16- -17-9
Meaningful Use objectives and standards correlate with health related goals Objectives relate to health related goals Objective 15 Core Objectives Standard Providers must meet all standards unless an exception applies. Objective 10 Menu Objectives Standard Providers may defer up to 5 items for Stage 1. One menu item selected must be related to public health reporting. Exclusions are provided to account for specialties and variations in practice settings Meaningful Use objectives and standards will change over time, focusing today on structured data and exchange Stage 2 2014 Stage 3 2015 Stage 1 2011-13 Data capture and sharing Advanced clinical processes Improved outcomes Better clinical outcomes Improved population health outcomes Increased transparency and efficiency Empowered individuals More robust research data on health system -Standards will be become higher in Stage 2-3 - Menu items will become Core objectives -18- -19-10
Medicare EP Meaningful Use Qualifying Periods and Payment Schedule Calendar Year First Qualifying Year Annual Incentive 2011 2012 2013 2014 2015 2016 Total 2011 $18,000 $12,000 $8,000 $4,000 $2,000 $44,000 2012 $18,000 $12,000 $8,000 $4,000 $2,000 $44,000 2013 $15,000 $12,000 $8,000 $4,000 $39,000 2014 $12,000 $8,000 $4,000 $24,000 2015+ $0 $0 $0 Meaningful Use: Stage 1 Stage 2 Stage 3 Agenda American Recovery and Reinvestment Act Funding (ARRA) Medicare and Medicaid Incentive Programs What is Meaningful Use? Meaningful Use in Practice Clinical Quality Measures (CQM) Health Information Exchange (HIE) Putting The Pieces Together Questions, Contact Information and Resources -20- -21-11
Polling Question Before we beginning discussing the details of Meaningful Use, I would like to ask the audience about your use of Certified EHR Technology: A. I use an EHR but it is not certified by ONC for MU B. I use an ONC Certified EHR C. I am planning to implement an EHR soon D. None of the above Meaningful Use is distributed throughout the clinical office visit correlating to the health related goals CPOE Rx Drug-Drug *Formulary eprescribe Demographics Problems Medications Rx Allergy Vitals Smoking CDS CQM *elabs *Dx List *Reminders Pt. ecopy Clinical Summary *Pt. eaccess *Education HIE Capable *Rx Reconcile *Referral summary *Immunizations *Syndromic Data Privacy & Security Improve quality, safety, efficiency and reduce health disparities Engage patients and families in their health care ` Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information * Menu Items -22- -23-12
Re-organizing Meaningful Use tasks can follow patient flow *Dx List *Reminders Demographics Vitals Smoking Rx Allergy *Rx Reconcile CPOE Rx Drug-Drug *Formulary eprescribe Problems Medications CDS *elabs Pt. ecopy Clinical Summary *Pt. eaccess *Education CQM HIE Capable *Referral summary *Immunizations *Syndromic Data Privacy & Security ` * Menu Items Pre-Visit Registration Patient Intake Provider Visit Check-Out Post Visit CMS FAQ #10151 If an eligible professional (EP) is unable to meet the measure of a Meaningful Use objective because it is outside of the scope of his or her practice, will the EP be excluded from meeting the measure of that objective under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs? - - - - - - - - Some Meaningful Use objectives provide exclusions and others do not. Exclusions are available only when our regulations specifically provide for an exclusion. EPs may be excluded from meeting an objective if they meet the circumstances of the exclusion. If an EP is unable to meet a Meaningful Use objective for which h no exclusion is available, then that EP would not be able to successfully demonstrate Meaningful Use and would not receive incentive payments under the Medicare and Medicaid EHR Incentive Programs. https://questions.cms.hhs.gov/app/answers/detail/a_id/10151-24- -25-13
How is meaningful use different for specialists? It is not! The objectives may appear to have a Primary Care focus, but are required for all providers unless they qualify for an exclusion to an objective. Many exclusions may apply to the practice, but clear policies i must be documented, i.e.. Vital signs not taken. Must have a detailed understanding of how your EHR vendor is calculating the denominator, i.e.. Office Visits, Office Procedures, SOAP note or OP note? For example, Clinical Summaries are only required for E&M services, not procedural services. Often you can manipulate the reports based on visit type or document type to exclude certain visits it or procedures. Key data elements can be collected and entered by support staff so leveraging their skill sets and time is critical as you develop your workflow. Meaningful Use is built into the major common components of patient visit flow and at the point of care in the clinical office Pre-Visit Registration Patient Intake Provider Visit Check-Out Post Visit Privacy & Security -26- -27-14
Patient receives notification as a reminder of visit or clinical need Pre-Visit Registration Patient Intake Provider Visit Check-Out Post Visit Privacy & Security Office staff generates report and reminder letters for patients with upcoming appointments and procedures Pre-Visit Send patient reminder letters for visit or procedure Send reminder letter to target population by diagnosis Examples only -28- -29-15
Pre-Visit tasks meet two Menu objectives (I) Improve quality, safety, efficiency and reduce health disparities ective Obj Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach ndard Sta Generate at least one report listing patients of the EP with a specific condition Requires only Yes / No Attestation Exclusion Criteria X None http://healthcare.nist.gov/docs/170.302.i_generatepatientlists_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/3_patient_lists.pd Pre-Visit tasks meet two Menu objectives (II) Improve quality, safety, efficiency and reduce health disparities ective Obj Send reminders to patients per patient preference for preventive/ follow up care ndard Sta 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 Numerator Denominator Population Exclusion Criteria The number of patients inthe denominator who were sent the appropriate reminder. Number of unique patients 65 years old or older or 5 years older or younger. Patients whose Records are Maintained in the EHR. If an EP has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology http://healthcare.nist.gov/docs/170.304.d_generatepatientreminders_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/4_patient_reminders.pdf -30- -31-16
Patient arrives at clinical practice for services Pre-Visit Registration Patient Intake Provider Visit Check-Out Post Visit Privacy & Security Front desk staff verify and update Patient s demographics and billing information Date of birth Gender Registration Preferred language Ethnicity Race Contact Information & Preferences Mailing, Voicemail, Patient Portal access -32- -33-17
Registration function meets one Core objective Improve quality, safety, efficiency and reduce health disparities Ob bjective Record demographics: preferred language, gender, race, ethnicity, date of birth Sta andard More than 50% of all unique patients seen by the EP have demographicsrecorded recorded as structured data Numerator Denominator Population Exclusion Criteria The number of patients in the denominator who have all the elements of Number of unique demographics (or a specific exclusion if patients seen by the All Unique the patient declined to provide one or EP during the EHR Patients. None more elements) recorded as structured reporting period. data. http://healthcare.nist.gov/docs/170.306.b_recorddemographicsip_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/7_record_demographics.pdf Registration function meets one Core objective Improve quality, safety, efficiency and reduce health disparities Ob bjective Record demographics: preferred language, gender, race, ethnicity, date of birth Sta andard More than 50% of all unique patients seen by the EP have demographicsrecorded recorded as structured data Race Categories: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Ethnicity Categories: Hispanic or Latino Not Hispanic or Latino *Patients can refuse to report -34- -35-18
Patient moves to the clinical area to prepare for provider visit or procedure Pre-Visit Registration Patient Intake Provider Visit Check-Out Post Visit Privacy & Security Polling Question Before discussing the overview of the Patient Intake, I would like to ask the audience a question: Do you currently utilize a Technician, Medical Assistant, LPN, or RN to assist in the clinical visit? Yes, No -36- -37-19
Medical assistants update Patient s vital signs in structured data fields and review or update her medical summary information Record blood pressure Record height, weight, calculate BMI Patient Intake Plot and display growth chart (age appropriate) Record or review smoking status Verify, update allergy list, or NKDA Verify, update current medications, or annotate none If Vital Signs are clinically relevant or appropriate Patient Intake meets four Core objectives (I) Improve quality, safety, efficiency and reduce health disparities Obje ective Maintain active medication list Stan ndard More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data Numerator Denominator Population Exclusion Criteria The number of patients in the Number of unique denominator who have a medication (or patients seen by the All Unique an indication that the patient is not None EP during the EHR Patients. currently prescribed any medication) reporting period. recorded as structured data. http://healthcare.nist.gov/docs/170.302.d_medicationlist_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/5_active_medication_list.pdf -38- -39-20
Patient Intake meets four Core objectives(ii) Improve quality, safety, efficiency and reduce health disparities Obje ective Maintain active medication allergy list Stan ndard More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data Numerator Denominator Population Exclusion Criteria The number of unique patients in the denominator who have at least one entry Number of unique (or an indication that the patient has no patients seen by the All Unique known medication allergies NKDA) EP during the EHR Patients. None recorded as structured data in their reporting period. medication allergy list. http://healthcare.nist.gov/docs/170.302.e_allergylist_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/6_medication_allergy_list.pdf Patient Intake meets four Core objectives (III) Improve quality, safety, efficiency and reduce health disparities ective Obj Record and chart changes in vital signs: Height, Weight, Blood pressure, Calculate Cl lt and display BMI, Plot and display growth charts for children 2 20 years, including BMI ndard Sta For more than 50% of all unique patients age 2 and over seen by the EP height, ht weight ihtand blood pressure are recorded as structured data Numerator Denominator Population Exclusion Criteria The number of patients in Number of unique Any EP who either see no patients 2 the denominator who have Patients whose patients t age 2 or over years or older, or who bli believes that t all at least one entry of their records are seen by the EP during three vital signs of height, weight, and height, weight and blood maintained in the EHR reporting blood pressure of their patients have pressure are recorded as the EHR. period. no relevance to their scope of practice structure data. -40- -41-21
Patient Intake meets four Core objectives (IIIa) Improve quality, safety, efficiency and reduce health disparities ective Obj Record and chart changes in vital signs: Height, Weight, Blood pressure, Calculate Cl lt and display BMI, Plot and display growth charts for children 2 20 years, including BMI ndard Sta For more than 50% of all unique patients age 2 and over seen by the EP height, ht weight ihtand blood pressure are recorded as structured data http://healthcare.nist.gov/docs/170.302.f.1_vitalsigns_v1.0.pdf http://healthcare.nist.gov/docs/170.302.f.2_bmi_v1.0.pdf http://healthcare.nist.gov/docs/170.302.f.3_growthcharts_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/8%20record%20vital%20signs%202011.pdf Patient Intake meets four Core objectives (IV) Improve quality, safety, efficiency and reduce health disparities jective Obj Record smoking status for patients 13 years old or older Sta andard More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data Numerator Denominator Population Exclusion Criteria Number of unique The number of patients in Patients whose patients age 13 or older the denominator with Records are EPs who see no patients 13 years or seen by the EP during smoking status tt recorded ddas Miti Maintained din older the EHR reporting structured data. the EHR. period. http://healthcare.nist.gov/docs/170.302.g_smokingstatus_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/9_record_smoking_status.pdf -42- -43-22
Patient Intake meets four Core objectives (IVa) Improve quality, safety, efficiency and reduce health disparities bjective O Record smoking status for patients 13 years old or older tandard S More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data Smoking status types must include: current every day smoker current some day smoker former smoker never smoker smoker current status unknown unknown if ever smoked Patient Intake meets one Menu objective Improve care coordination Ob bjective 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 tandard St 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 Numerator Denominator Population Exclusion Criteria Number of transitions The number of transitions of care during the EHR Patients whose of care in the denominator If an EP was not on the receiving end reporting period for Records are where medication i of any transition ii of care during the which the EP was the Maintained in reconciliation was EHR reporting period receiving party of the the EHR. performed. transition. http://healthcare.nist.gov/docs/170.302.j_%20medicationreconciliation_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/7_medication_reconciliation.pdf -44- -45-23
Patient Intake meets one Menu objective Improve care coordination Ob bjective 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 tandard St 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 Transition of Care The movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long term care, home health, rehabilitation facility) to another. Provider and Patient interact at point of care Pre-Visit Registration Patient Intake Provider Visit Check-Out Post Visit Privacy & Security -46- -47-24
Provider conducts patient consult or procedure Provider documents consult or procedure Provider Visit Provider determines problem or diagnosis Update patient problem list, or document none The use of templates can increase speed, efficiency and accuracy but is not required for MU. The use of dictation, voice recognition or free text is possible, but you may lose the ability to use Evaluation and Management (E&M) coders. Provider assessment meets one Core objective Improve quality, safety, efficiency and reduce health disparities Obje ective Maintain an up to date problem list of current and active diagnoses Stan ndard More than 80% of all unique patients seen by the EP have at least one entry, or an indication that no problems are known for the patient, recorded as structured data Numerator Denominator Population Exclusion Criteria The number of patients in the Number of unique denominator who have at least one entry patients seen by the All Unique or an indication that no problems are None EP during the EHR Patients. known for the patient recorded as reporting period. structured data in their problem list. http://healthcare.nist.gov/docs/170.302.c_problemlist_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/3_maintain_problem_listep.pdf -48- -49-25
Provider determines Patient s care plan Reviews alerts, reminders, quality indicators Provider Visit Uses diagnosis based order sets or clinical decision tools Use EHR to order and transmit lab request A lab interface is not required for Stage 1 but facilitates the ability to comply with CQM, results management and patient engagement Provider care plan meets one Core objective Improve quality, safety, efficiency and reduce health disparities jective Obj Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule Sta andard Implement one clinical decision support rule Requires only Yes / No Attestation Exclusion Criteria X None http://healthcare.nist.gov/docs/170.304.e_clinicaldecisionsupportamb_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/11_clinical_decision_support_rule.pdf -50- -51-26
Provider care plan meets one Menu objective Improve quality, safety, efficiency and reduce health disparities Objective Incorporate clinical lab test results into certified EHR technology as structured data Standard More than 40% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data Numerator Denominator Population Exclusion Criteria The number of lab test Number of lab tests results whose results are ordered during the EHR Patients whose If an EP orders no lab tests whose expressed in a positive or reporting period by the Records are results are either in a negative affirmation or as a EP whose results are Maintained in positive/negative or numeric format number which are expressed in a positive the EHR. during the EHR reporting period incorporated as structured or negative affirmation data. or as a number. http://healthcare.nist.gov/docs/170.302.h_incorplabtest_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/2_clinical_lab_test_results.pdf Provider selects and prescribes medication as needed Review drug-to-drug and drug-to-allergy interactions Provider Visit Review patient s insurance formulary Use EHR to generate prescription and transmit to pharmacy Formulary checking is not required for Stage 1 but may have direct financial impact on the patient based upon the medications selected by provider -52- -53-27
Using EHR medication management and eprescribing meets three Core objectives (I) Improve quality, safety, efficiency and reduce health disparities Obje ective Use CPOE for medication orders directly entered by any licensed healthcare h professional who can enter orders into the medical record per state, local and professional guidelines Stan ndard More than 30% of unique patients with at least one medication i in their medication i list seen by the EP have at least one medication order entered using CPOE Numerator Denominator Population Exclusion Criteria The number of patients Number of unique Patients whose in the denominator patients with at least If an EP s writes fewer than one hundred records are that have at least one one medication i in prescriptions i during the EHR reporting maintained in medication order their medication list period the EHR. entered using CPOE. seen by the EP. http://healthcare.nist.gov/docs/170.306.a_cpoeip_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/2_clinical_lab_test_results.pdf -54- Using EHR medication management and eprescribing meets three Core objectives (II) Improve quality, safety, efficiency and reduce health disparities Obje ective Implement drug drug and drugallergy interaction checks Stan ndard The EP has enabled this functionality for the entire EHR reporting period Requires only Yes / No Attestation Exclusion Criteria X None http://healthcare.nist.gov/docs/170.302.a_drugdrugdrugallergy_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/2_drug_interaction_checksep.pdf -55-28
Using EHR medication management and eprescribing meets three Core objectives (III) Improve quality, safety, efficiency and reduce health disparities jective Obj Generate and transmit permissible prescriptions electronically (erx) Sta andard More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology Numerator Denominator Population Exclusion Criteria The number of Number of prescriptions written prescriptions in the for drugs requiring a Patients whose This objective and associated measure do denominator prescription in order Records are not apply to any EP who writes fewer than generated and to be dispensed other Maintained in one hundred prescriptions during the EHR transmitted than controlled the EHR. reporting period. electronically. substances during the EHR reporting period. http://healthcare.nist.gov/docs/170.304.b_exchangeprescriptioninformation_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/4_e-prescribing.pdf Using EHR medication management and eprescribing meets one Menu objective Improve quality, safety, efficiency and reduce health disparities Obje ective Implement drug formulary checks Stan ndard The EP has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period Requires only Yes / No Attestation Exclusion Criteria X Any EP who writes fewer than one hundred prescriptions during the EHR reporting period should be excluded from this objective and associated measure. http://healthcare.nist.gov/docs/170.302.b_drugformularychecks_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/1_drug_formulary_checks.pdf -56- -57-29
Patient completes clinical visit Pre-Visit Registration Patient Intake Provider Visit Check-Out Post Visit Privacy & Security Patient receives information before leaving the practice Patient provided with educational information Patient provided with clinical summary Check-Out Patient provided with CD of medical information if requested Clinical information and results are sent to Patient Portal Generating educational material through the EHR is a menu item but makes it easier to keep up-to-date information. Patient Portal is not required for Stage 1 but facilitates patient engagement and communication -58- -59-30
Check-Out process meets two Core objectives (I) Engage patients and families in their health care Objective Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request Standard More than 50% of all patients of the EP who request an electronic copy of their health information are providedit it within 3 business days Numerator Denominator Population Exclusion Criteria The number of patients The number of patients in of the EP who request If the EP has no requests from the denominator who an electronic copy of Patients whose patients or their agents for an receive an electronic copy their electronic health Records are electronic copy of patient health of their electronic health information four Maintained in information during the EHR information within three business days prior to the EHR. reporting period business days. the end of the EHR reporting period. http://healthcare.nist.gov/docs/170.304.f_electroniccopyofhealthinformation_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/12_electronic_copy_of_health_information.pdf Check-Out process meets two Core objectives (II) Engage patients and families in their health care Ob bjective Provide clinical summaries for patients for each office visit tandard St Clinical summaries provided to patients for more than 50% of all office visits within 3 business days Numerator Denominator Population Exclusion Criteria Number of patients in the Number of unique Patients whose denominator who are patients seen by the EP Records are EPs who have no office visits during provided a clinical during the EHR Maintained in the EHR reporting period summary of their visit reporting period. the EHR. within three business days. http://healthcare.nist.gov/docs/170.304.h_clinicalsummaries_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/13_clinical_summaries.pdf -60- -61-31
Check-Out process meets two Core objectives (IIa) Engage patients and families in their health care Obje ective Provide clinical summaries for patients for each office visit Stan ndard Clinical summaries provided to patients for more than 50% of all office visits i within 3 business days Clinical summaries include, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list. Check-Out process meets two Core objectives (IIa) Engage patients and families in their health care Obje ective Provide clinical summaries for patients for each office visit Stan ndard Clinical summaries provided to patients for more than 50% of all office visits i within 3 business days Office visits include separate, billable encounters that result from evaluation and management services provided to the patient and include: (1) Concurrent care or transfer of care visits, (2) Consultant visits, or (3) Prolonged Physician Service without Direct (Face To Face) Patient Contact (tele health). A consultant visit occurs when a provider is asked to render an expert opinion/service for a specific condition or problem by a referring provider. -62- -63-32
Check-Out process meets two Menu objectives (I) Engage patients and families in their health care Objective Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP Standard More than 10% of all unique patients seen by the EP are provided timely electronic access to their health information subject to the EP s discretion to withhold certain information Numerator Denominator Population Exclusion Criteria The number of patients in the denominator who have If an EP neither orders nor creates timely (available to the Number of unique any of the information listed in the patient within four business days of being updated in the certified EHR technology) electronic access to their health information online. patients seen by the EP during the EHR reporting period. All Unique Patients. ONC finalrule 45 CFR 170.304(g) and therefore included in the minimum data for this objective during the EHR reporting period http://healthcare.nist.gov/docs/170.304.f_electroniccopyofhealthinformation_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/5_patient_electronic_access.pdf Check-Out process meets two Menu objectives (II) Engage patients and families in their health care Obje ective Use certified EHR technology to identify patient specific education resources and provide those resources to the patient if appropriate Stan ndard More than 10% of all unique patients seen by the EP are provided d patient specific ifi education resources Numerator Denominator Population Exclusion Criteria Number of patients in the denominator who are Number of unique patients seen by the EP provided patient education during the EHR specific resources. reporting period. All Unique Patients. None http://healthcare.nist.gov/docs/170.302.m_educationresources_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/6_patient-specific_education_resources.pdf -64- -65-33
Provider has completed visit and all test results and quality indicators are complete Pre-Visit Registration Patient Intake Provider Visit Check-Out Post Visit Privacy & Security Consult note sent back to referring provider and key elements of structured data transmitted externally Consult note and medical summary sent to referring provider Clinical quality measures are transmitted to CMS Post Visit Immunization information is sent to State Registry Syndromic data is sent to Public Health organizations CQM do not have to be sent electronically today Stage 1 requires only one public health reporting menu item Immunizations or Syndromic data -66- -67-34
Post visit exchange of data meets one Core objective Improve care coordination Ob bjective Capability to exchange key clinical information (for example, problemlist list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically Sta andard Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information Requires only Yes / No Attestation Exclusion Criteria X None http://healthcare.nist.gov/docs/170.306.f_exchangeclinicalinfosummaryrecordip_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/14_electronic_exchange_of_clinical_information.pdf Post visit exchange of data meets one Menu objective Improve care coordination Objective The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral Standard The EP who transitions or refers 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 Numerator Denominator Population Exclusion Criteria Number of transitions The number of transitions of care and referrals Patients whose If an EP does not transfer a patient of care and referrals in the during the EHR Records are to another setting or refer a patient denominator where a reporting period for Maintained in to another provider during the EHR summary of care record which the EP was the the EHR. reporting period was provided. transferring or referring provider. http://healthcare.nist.gov/docs/170.304.i_exchangeclinicalinforpatientsummaryrecordamb_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/8_transition_of_care_summary.pdf -68- -69-35
Post visit reporting and submission of CQM and public health data meet one Core objective Improve quality, safety, efficiency and reduce health disparities Ob bjective Report ambulatory clinical quality measures to CMS or the States: Core: Hypertension, Tobacco Use Assessment & Cessation Intervention, Adult Weight Screening (NQF 13, 28, 421 or PQRI 128) Menu: Must choose 3 measures to report tandard St For 2011, provide aggregate numerator, denominator, and exclusions through attestation as discussed in section II(A)(3) of this final rule. For 2012, electronically submit the clinical quality measures. Requires only Yes / No Attestation Exclusion Criteria X None http://healthcare.nist.gov/docs/170.304.j_calcsubmitclinqualitymeasures_v1.0.pdf http://healthcare.nist.gov/docs/170.306.i_calcsubmitclinqualitymeasures_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/10_clinical_quality_measures.pdf Post visit reporting and submission of CQM and public health data meets two Menu objectives Improve population and public health jective Obj Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice Sta andard 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 Requires only Yes / No Attestation Exclusion Criteria X EPs that have not given any immunizations during the EHR reporting period are excluded from this measure. http://healthcare.nist.gov/docs/170.302.k_immunizations_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/9_immunization_registries_data_submission.pdf -70- -71-36
Post visit reporting and submission of CQM and public health data meets two Menu objectives Improve population and public health Ob bjective Capability to submit electronic Syndromic surveillance data to public health agenciesand and actual submission in accordance with applicable law and+c17 practice Sta andard Performed at least one test of certified EHR technology's capacity to provide electronic Syndromic surveillance data to public health agencies and follow up submission if the test is successful Requires only Yes / No Attestation Exclusion Criteria X If an EP does not collect any reportable syndromic information on their patients during the EHR reporting period, then they are excluded from this measure. http://healthcare.nist.gov/docs/170.302.l_publichealthsurveillance_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/10_syndromic_%20surveillance_data_submissionep.pdf Polling Question Before discussing the risk assessment portion, I would like to ask the audience a question: Do you currently use complexpasswordsaspasswords a requirement for your staff logins? Yes, No -72- -73-37
Promoting the privacy & security of EHRs by incorporating practice policies, procedures, and password management underlies each step in the patient and visit flow Pre-Visit Registration Patient Intake Provider Visit Check-Out Post Visit Privacy & Security Conduct periodic risk assessment and risk mitigation and ensure written policies are in place Physical security of hardware and devices Privacy & Security Password management and role-based security access Portable and mobile device policies Data encryption and network security HIPAA compliance -74- -75-38
Conducting periodic risk analysis and risk mitigation meets one Core objective Ensure adequate privacy and security protections for personal health information tive Object Protect electronic health information created tdor maintained by the certified EHR technology through the implementation of appropriate technical capabilities ard Stand Conduct or review a security risk ikanalysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process Requires only Yes / No Attestation Exclusion Criteria X None Conducting periodic risk analysis and risk mitigation meets one Core objective Ensure adequate privacy and security protections for personal health information Obje ective Protect electronic health information created or maintained i dby the certified EHR technology through the implementation of appropriate technical capabilities Stan ndard 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 process http://healthcare.nist.gov/docs/170.302.u_generalencryption_v1.0.pdf http://healthcare.nist.gov/docs/170.302.v_encryptionhie_v1.0.pdf http://healthcare.nist.gov/docs/170.302.o_accesscontrol_v1.0.pdf http://healthcare.nist.gov/docs/170.302.t_authentication_v1.0.pdf t v1 0 pdf http://healthcare.nist.gov/docs/170.302.q_automaticlogoff_v1.0.pdf http://www.cms.gov/ehrincentiveprograms/downloads/15_core_protectelectronichealthinformation.pdf -76- -77-39
Meaningful Use is built into the major components of patient visit flow and at the point of care in the clinical practice Pre-Visit Registration Patient Intake Provider Visit Check-Out Post Visit Privacy & Security Using basic EHR functionality and performing common tasks can meet objectives for 15 Core and 10 Menu items Agenda American Recovery and Reinvestment Act Funding (ARRA) Medicare and Medicaid Incentive Programs What is Meaningful Use? Meaningful Use in Practice Clinical Quality Measures (CQM) Health Information Exchange (HIE) Putting The Pieces Together Questions, Contact Information and Resources -78- -79-40
Polling Question Before discussing the Clinical Quality Measures, I would like to ask the audience a question: Do you currently participateinin another qualityinitiativeinitiative or payor program that requires you to submit quality measures or data? i.e. PQRS? Yes, No CQM concerns CMS has acknowledged that the CQM reporting requirement in Stage 1 is no more than that a reporting requirement meant to get physicians comfortable with the process of reporting. CMS is under no illusions that the data collected will be meaningful as a measure of the level or quality of care being provided. Many physicians will be reporting on problems for which they are not treating the patients, which means that measure numerators will be zero (or very low) and that duplicate data will be submitted by different physicians for the same patients for the same conditions, which will result in an underestimation of the true care being delivered. In some cases, providers may be submitting data for CQMs that are not directly tied to their specialty or focus of care. -80- -81-41
CQM today is based on current standards NQF, PQRI Population may be all patients, patients seen, or unique patients http://www.ama-assn.org/ama1/pub/upload/mm/399/ehr-clinical-quality-measures.pdf Future framework for the reporting of CQM The intention is to broaden the scope of reporting to address a wider spectrum of factors affecting care and to accommodate all types of providers. All providers will find measures relevant to their specialty in the core set as well as in each of the domains -82- -83-42
Key to CQM success today Code and document completely; missing values or missing information = lower performance Information should be kept as structured data in searchable/sortable fields rather than free-text Establish workflows and maximize staff capabilities to enter data elements, i.e. support staff can enter problems, medications, allergies and history Patient/Medical/System reasons for exclusions should be documented and coded; helps to improve scores by legitimately reducing the denominator Agenda American Recovery and Reinvestment Act Funding (ARRA) Medicare and Medicaid Incentive Programs What is Meaningful Use? Meaningful Use in Practice Clinical Quality Measures (CQM) Health Information Exchange (HIE) Putting The Pieces Together Questions, Contact Information and Resources -84- -85-43
Meaningful Use and Health Information Exchange (HIE) Meaningful Use objectives requiring health exchange 2011 Lab results delivery Prescribing Health summaries for continuity of care Increases volume of transactions that are most commonly happening today Lab to provider Quality & immunization reporting, if Provider to pharmacy available Summary of care record is new process step 2014 2015 Registry and public health reporting Claims and eligibility checking Electronic ordering Receive public health alerts Home monitoring Populate PHRs Access comprehensive data from all available sources Experience of care reporting Medical device interoperability Substantially steps up exchange Provider to lab Pharmacy to provider Office to hospital & vice versa Office to office Hospital/office to public health & vice versa Hospital to patient t Office to patient & vice versa Hospital/office to reporting entities Starts to envision routine availability of relatively rich exchange transactions Anyone to anyone Patient to reporting entities Agenda American Recovery and Reinvestment Act Funding (ARRA) Medicare and Medicaid Incentive Programs What is Meaningful Use? Meaningful Use in Practice Clinical Quality Measures (CQM) Health Information Exchange (HIE) Putting The Pieces Together Questions, Contact Information and Resources -86- -87-44
HITECH how the pieces fit together Regional Extension Centers Workforce Training Medicare and Medicaid Incentives and Penalties State Grants for Health Information Exchange Standards & Certification Framework Privacy & Security Framework ADOPTION MEANINGFUL USE EXCHANGE Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery 88 Agenda American Recovery and Reinvestment Act Funding Medicare and Medicaid Incentive Programs Meaningful Use Meaningful Use in the Medical Practice ARRA Health Information Exchange (HIE) Putting The Pieces Together Questions, Contact Information and Resources -88- -89-45
Resources Get information, tip sheets and more at CMS official website for the EHR incentive programs: http://www.cms.gov/ehrincentiveprograms For questions about the Meaningful Use objectives and how to comply with the standards: https://questions.cms.gov/ Learn about certification and certified EHRs, as well as other ONC programs designed to support providers as they make the transition: http://healthit.hhs.govhhs For additional information about MAeHC and access to additional presentations and services: http://www.maehc.org Questions? Presenter Moderator Jeff Loughlin, MHA Project Director jloughlin@maehc.org www.maehc.org Christina Moran, MPH Strategy Consultant cmoran@maehc.org www.maehc.org -90- -91-46
Evaluation, CME Credit & Resource Information To complete your evaluation, please visit: http://www.massmed.org/mu2012eval After completing the evaluation, you will be directed to the MMS CME Certificate portal. Enter the CME Activity Code: EHR041012 Enter your FIRST and LAST name. To access today s presentation and other resources, visit http://www.massmed.org/mu2012presentation Questions regarding CME certificates and/or presentations, contact MMS Continuing Education at 800-322-2303, x7306 or email mmscmecertification@mms.org -92-47