GE Healthcare Meaningful Use 2014 Prep: Core Part 1 Ramsey Antoun, Training Operations Coordinator December 12, 2013
2013 General Electric Company All rights reserved. This does not constitute a representation or warranty or documentation regarding the product or service featured. All illustrations are provided as fictional examples only. Your product features and configuration may be different than those shown. Information contained herein is proprietary to GE. No part of this publication may be reproduced for any purpose without written permission of GE. DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY REMAIN AT GE S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY CLEARANCE. Customer is responsible for understanding and meeting the requirements of achieving meaningful use through use of HHS certified EHR technology and associated standards. Customer is responsible for understanding applicable GE documentation regarding Meaningful Use functionality and reporting specifications, and for using that information to confirm the accuracy of meaningful use attestation. Customer is responsible for ensuring an accurate attestation is made and GE does not guarantee incentive payments. Use of the product does not ensure customer will be eligible to receive payments. * GE, the GE Monogram, Centricity and imagination at work are trademarks of General Electric Company. General Electric Company, by and through its GE Healthcare division. 2
Centricity Practice Solution 12.0 Complete EHR Certification Information: Centricity Practice Solution v12.0 was certified as a Complete EHR for Ambulatory on 11/27/2013 [CHPL Product ID: CC- 2014-704359-1] including the following Clinical Quality Measures (CMS 69, 117, 125, 126, 138, 147, 148, 165, 166), and used the following additional software during testing (Required: Centricity eprescribing, Centricity Clinical Messenger, Centricity Patient Portal, Centricity Clinical Gateway or the Qvera Interface Engine; Used for demonstration: Micromedex CareNotes Patient Education Resources, Micromedex Clinical Knowledge Suite). The certification includes all required certification criteria, plus Accounting of Disclosures and SOAP protocols for Transition of Care. This complete EHR is ONC 2014 Edition compliant and has been certified by the Certification Commission for Health Information Technology (CCHIT ), an ONC-ACB, in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services. Transparency for Complete EHR There may be one-time costs to support installation and implementation of certified capabilities for all measures. There may be annual support and/or maintenance costs associated with certified capabilities for all measures. There may be one-time interface configuration costs associated with the following measures: Image Results (170.314.a.12); Transitions of Care / referral summaries (170.314.b.1-2); Incorporate Laboratory Tests and Values/Results (170.314.b.5); Clinical Quality Measures (170.314.c.1-3); Transmission to Immunization Registries and Public Health Agencies - Syndromic Surveillance (170.314.f.2-3); Transmission to Cancer Registries (170.314.f.5-6); Automated Measure Calculation (170.314.g.2); and Report Specific Cases to Specialized Registry. There may be annual or monthly subscription costs through third-party partners associated with the following measures: Clinical Decision Support (170.314.a.8) and Patient-Specific Education Resources (170.314.a.15). There may be a one-time configuration cost for reporting on all measures. There may be additional costs for state or local transmission methods for public health measures. Customers may choose to incur additional one-time costs to customize clinical content. Customers may choose to incur additional transmission costs associated with the following measures: Transitions of Care / referral summaries (170.314.b.1-2) CCHIT is a registered mark of the Certification Commission for Health Information Technology. 3
Centricity EMR 9.8 Complete EHR Certification Information: Centricity EMR 9.8 was certified as a Complete EHR for Ambulatory on 11/27/2013 [CHPL Product ID: CC-2014-704359-2] including the following Clinical Quality Measures (CMS 69, 117, 125, 126, 138, 147, 148, 165, 166), and used the following additional software during testing (Required: Centricity eprescribing, Centricity Clinical Messenger or Secure Messenger for POL-CEMR, Centricity Patient Portal or Patient Online, Centricity Clinical Gateway or the Qvera Interface Engine; Used for demonstration: Micromedex CareNotes Patient Education Resources, Micromedex Clinical Knowledge Suite). The certification includes all required certification criteria, plus Accounting of Disclosures and SOAP protocols for Transition of Care. This complete EHR is ONC 2014 Edition compliant and has been certified by the Certification Commission for Health Information Technology (CCHIT ), an ONC-ACB, in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services. Transparency for Complete EHR There may be one-time costs to support installation and implementation of certified capabilities for all measures. There may be annual support and/or maintenance costs associated with certified capabilities for all measures. There may be one-time interface configuration costs associated with the following measures: Demographics (170.314.a.3); Image Results (170.314.a.12); Transitions of Care / referral summaries (170.314.b.1-2); Incorporate Laboratory Tests and Values/Results (170.314.b.5); Clinical Quality Measures (170.314.c.1-3); Transmission to Immunization Registries and Public Health Agencies - Syndromic Surveillance (170.314.f.2-3); Transmission to Cancer Registries (170.314.f.5-6); Automated Measure Calculation (170.314.g.2); and Report Specific Cases to Specialized Registry. There may be annual or monthly subscription costs through third-party partners associated with the following measures: Clinical Decision Support (170.314.a.8) and Patient-Specific Education Resources (170.314.a.15). There may be a one-time configuration cost for reporting on all measures. There may be additional costs for state or local transmission methods for public health measures. Customers may choose to incur additional one-time costs to customize clinical content. Customers may choose to incur additional transmission costs associated with the following measures: Transitions of Care / referral summaries (170.314.b.1-2) CCHIT is a registered mark of the Certification Commission for Health Information Technology. 4
Agenda Meaningful Use requirements overview Stage 2 Core measures 1-5 Measure Detail Workflow Impact Application Changes/Configuration Exclusions and References Q&A 5
Meaningful Use Requirements Overview
Timing & Requirements Medicare Incentive Program *3 months must be on the calendar quarter, not just 90 consecutive days. **Proposed delay of Stage 3 to 2017 announced by CMS Source: http://cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Participation-Timeline.html 7
Timing & Requirements Medicare Incentive Program Reporting\Attestation Deadlines for 2014 Stage/Year Reporting Period Complete Submission By Stage 1/Year 1 Any 90 Consecutive Day Period. *October 1 st, 2014 All others Any Calendar Quarter 2 months following the reporting year. *October 1 st 2014 deadline to avoid 2015 penalties. Otherwise 2 months following the reporting year (receive incentive but incur penalties). 8
Timing & Requirements Medicaid Incentive Program (If Adopting, Implementing, or Upgrading in first year) *For Medicaid, at the discretion of the state, reporting period can be any three month period, not just a calendar quarter. **Proposed delay of Stage 3 to 2017 announced by CMS Source: http://cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Participation-Timeline.html 9
Stage 1 It s important to note that Stage 1 requirements change in 2014 The following slides will help distinguish the requirements for Stage 1 2013 vs. Stage 1 2014 AND Stage 2 10
Stage 1 If you are on Stage 1 in 2013, these are your requirements: Certified EHR Technology Functional Measures Clinical Quality Measures CQM Reporting Method CPS v9.5 or higher and relied-upon products CEMR v9.5 or higher and relied-upon products 14 Core Select 5 of 10 Menu (at least one must be a Public Health measure) 3 Core/3 Alternate Core 3 Additional (From 44 defined in the MU 2011 Edition) Crystal Reports; and/or MQIC
Stage 1 Functional Measures (2013) Core: Computerized Provider Order Entry Drug-Drug and Drug-Allergy checks eprescribing Record Demographics Problem List Medication List Medication Allergy List Vital Signs Smoking Status Clinical Decision Support Report Clinical Quality Measures Electronic Health Information Clinical Visit Summaries Electronic Exchange of Health Information Protect Electronic Health Information Menu: Drug Formulary checks Incorporate Laboratory Test Results Patient Lists Patient Reminders Timely Electronic Access to Health Information Patient-specific Education Medication Reconciliation Transition of Care Clinical Summary Immunization Registries (PH) Syndromic Surveillance (PH) Measure: >30% of patients with a Med had one entered as CPOE Enabled for entire reporting period >40% of permissible prescriptions are transmitted electronically >50% of Unique patients Seen have recorded as structured data >80% of Unique patients Seen have an entry >80% of Unique patients Seen have an entry >80% of Unique patients Seen have an entry >50% of Unique patients 2 or older have recorded as structured data >50% of Unique patients 13 or older have recorded as structured data Implemented at least one CDS rule Report 6 Clinical Quality Measures to CMS >50% of Unique patients requesting have copy within 3 business days >50% of patients provided CVS within 3 business days Conduct on test during reporting period Conduct/Review security risk analysis; corrected deficiencies Enabled for entire reporting period; access to at least one formulary >40% of Lab results (+/-, n) are recorded as structured data Generated at least one report for patients w/specific condition >20% of patients 65 up, 5 or younger were sent appropriate reminders >10% of Unique patients Seen have available within 4 business days >10% of Unique patients Seen provided patient-specific education >50% of received transitions of care >50% of Referrals provided a summary of care Performed at least one successful test Performed at least one successful test
Stage 1 If you are on Stage 1 in 2014, these are your requirements: Certified EHR Technology Functional Measures Clinical Quality Measures CQM Reporting Method CPS v12 and relied-upon products CEMR v9.8 and relied-upon products 13 Core (CQM removed as its own measure) Select 5 of 9 Menu (at least one must be a Public Health measure) 9 (From 64 defined in the MU 2014 Edition, and must include measures from at least 3 of the National Quality Strategy domains) Note: 32 of the 44 MU 2011 Edition were retained in the MU 2014 Edition Clinical Quality Reporting (CQR) only
Stage 1 Functional Measures (2014) New for 2014 Changed, Stage 1 Combined, Stage 1 Core: Computerized Provider Order Entry Drug-Drug and Drug-Allergy checks eprescribing Record Demographics Problem List Medication List Medication Allergy List Vital Signs Smoking Status Clinical Decision Support Report Clinical Quality Measures Electronic Health Information Clinical Visit Summaries Protect Electronic Health Information View, Download, and Transmit Menu: Drug Formulary checks Incorporate Laboratory Test Results Patient Lists Patient Reminders Timely Electronic Access to Health Information Patient-specific Education Medication Reconciliation Transition of Care Clinical Summary Immunization Registries (PH) Syndromic Surveillance (PH) Measure: >30% of Unique patients with a Med order, had one entered as CPOE Alternate: >30% of all Med orders are entered as CPOE Enabled for entire reporting period >40% of permissible prescriptions are transmitted electronically >50% of Unique patients Seen have recorded as structured data >80% of Unique patients Seen have an entry >80% of Unique patients Seen have an entry >80% of Unique patients Seen have an entry >50% of Unique patients 3 or older have BP, all patients have Ht/Wt >50% of Unique patients 13 or older have recorded as structured data Implemented at least one CDS rule Removed as a separate requirement (redundant) >50% of Unique patients requesting have copy within 3 business days >50% of patients provided CVS within 3 business days Conduct/Review security risk analysis; corrected deficiencies >50% of Unique patients Seen have available within 4 business days Enabled for entire reporting period; access to at least one formulary >40% of Lab results (+/-, n) are recorded as structured data Generated at least one report for patients w/specific condition >20% of patients 65 up, 5 or younger were sent appropriate reminders >10% of Unique patients Seen have available within 4 business days >10% of Unique patients Seen provided patient-specific education >50% of received transitions of care >50% of Referrals provided a summary of care Performed at least one successful test Performed at least one successful test
Stage 2 If you are on Stage 2 in 2014, these are your requirements: Certified EHR Technology Functional Measures Clinical Quality Measures CQM Reporting Method CPS v12 and relied-upon products CEMR v9.8 and relied-upon products 17 Core (22 individual data points) Select 3 of 6 Menu 9 (From 64 defined in the MU 2014 Edition, and must include measures from at least 3 of the National Quality Strategy domains) Clinical Quality Reporting (CQR) only
Software - versions appropriate for Meaningful Use in 2014 MUST HAVE from GE Healthcare or your VAR: Centricity Practice Solution 12 OR Centricity EMR 9.8 Advanced eprescribing 3.5 Centricity Clinical Messenger 6.4 OR (QIE 2.0 + HISP) [Not required for MU1. We recommend both for MU2.] Access to Clinical Quality Reporting 1.0 QIE 2.0 [may be supplemented by Centricity Clinical Gateway 9.2.0 ] MUST HAVE appropriate certified version (may be from other vendors): Certified tools for View Download and Transmit + Secure Messaging MU Requirements Such as: Centricity Patient Portal 6.4 OR (Centricity Patient Online 13.03 +Secure Messenger for CEMR-PoL 13.0.3) And an info-button enabled version of patient education materials such as: Truven's Micromedex Carenotes Patient Education Resources 5.27.0 Optional software: An info-button enabled version of clinician referential information such as Truven's Micromedex Clinical Knowledge Suite 5.27.0 Note change NOTE: Centricity Clinical Messenger is also known as Centricity Integrated Secure Messaging 16
Stage 2 Functional Measures (2014)
Stage 1 to 2 (2014) Comparison 18
Removed as separate requirements for Stage 2 Implement drug-drug and drug-allergy interaction checks incorporated into the Clinical Decision Support measure Maintain active problem, medication, and allergy lists incorporated into the Summary of Care (TOC) measure Report CQMs to CMS or state No longer a separate Core objective, but providers must still submit CQMs to CMS or the states in order to achieve MU. 19
Stage 2 CORE Measures 1-5 and Related Functionality Changes
CORE Measure 1 - CPOE Changed in Stage 2: Measure More than 60 percent of medication (changed from 30% in Stage 1), 30 percent of laboratory (new), and 30 percent of radiology orders (new) created by the EP during the EHR reporting period are recorded using CPOE. Workflow The person entering the order has to be either Licensed or Credentialed (and set up as so in Administration see configuration changes) as long as local, state, and professional laws and policies allow them to enter orders. (Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant.) Configuration See next slide Product and Service Used to Meet Criteria: CPS 12/CEMR 9.8
CORE Measure 1 - CPOE Configuration Changes Administration: Added radio buttons to classify Orders as Laboratory, Radiology, or Other Administration: Added area to indicate if a user is an Eligible Professional (EP) Indicate user s reporting stage and year. Indicate user is Licensed Healthcare Professional (for CPOE) 22
CORE Measure 1 - CPOE Changed in Stage 2: Workflow Use the Medication Administration HTML form to document and count medications administered in the office. Administered medications are now treated as separate clinical list items. Provider can first document the request, then another user can document the administration. NOTE: This change also applies for Stage 1 2014 23
CORE Measure 1 - CPOE Changed in Stage 2: Configuration Changes Medications must be configured for use in the Medication Administration form by populating the Administered Medication Custom Lists located in the Administration (CPS) or Settings (C-EMR) module.
CORE Measure 1 - CPOE Addtl. Configuration/Workflow Changes Indicate drug category (Drug vs. Non-Drug) *Only medications listed as Drug will be counted for MU NOTE: This change also applies for Stage 1 2014 25
CORE Measure 1 - CPOE Configuration NEW DATA SYMBOLS MEL_Add_MedAdministration MEL_Update_MedAdministration MEL_Get_MedAdministration MEL_Add_MedAdminRequest MEL_Update_MedAdminRequest MEL_Get_MedAdminRequest. 26
CORE Measure 1 - CPOE Exclusions: Any EP who writes fewer than 100 medication, radiology, or laboratory orders during the EHR reporting period. Additional Info: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_1_ CPOE_MedicationOrders.pdf 27
CORE Measure 2 - eprescribing Changed in Stage 2: Measure Change from 40% to >50% of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using certified EHR technology. Workflow Requirement to now review and confirm new or refilled prescriptions before they are sent. (See screenshot on next page) Configuration No changes Product and Service Used to Meet Criteria: CPS 12/CEMR 9.8 (Included Advanced eprescribing 3.5) 28
CORE Measure 2 - eprescribing Workflow New review/confirm screen for electronic prescriptions. (Displays automatically when signing/sending an electronic Rx)
CORE Measure 2 - eprescribing Exclusions: Any EP who: (1) Writes fewer than 100 permissible prescriptions during the EHR reporting period. (2) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period. Additional Info: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_2_ eprescribing.pdf 30
CORE Measure 3 -Record Demographics Changed in Stage 2: Measure Change from 50% of Unique Patients, to 80% of unique patients have Demographics recorded as structured data (Race, Ethnicity, Gender, Language, DOB). Workflow Upgrade customers may need to alter how they currently set up race and ethnicity to meet requirements. (See configuration changes) User can select up to 2 races for a patient now a list box in Registration. Multiracial no longer acceptable. State Prohibited or Declined also available. Many standard languages available out of the box. Configuration See next slide Product and Service Used to Meet Criteria: CPS 12/CEMR 9.8 For CPS EMR module or CEMR: Demographics interface
CORE Measure 3 -Record Demographics Changed in Stage 2: Acceptable values for Race (per CMS): Available as out-of-thebox values in CPS12/EMR 9.8: Acceptable values for Ethnicity (per CMS): Available as out-of-thebox values in CPS12/EMR 9.8: 32
CORE Measure 3 - Record Demographics Configuration Changes Administration: Now a Race Subcategory option in Administration. Government required Race options cannot be altered, but subcategories can mapped to Race categories. Administration: Now an Ethnicity Subcategory option in Administration. Ethnicity options cannot be altered, but subcategories can be mapped to Ethnicity categories.
CORE Measure 3 Record Demographics Exclusions: None Additional Info: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_3_ RecordingDemographics.pdf 34
CORE Measure 4 - Vital Signs Changed in Stage 2: Measure Changed from BP, Height and Weight for >50% of unique patients age 2 and over, to BP for >80% of unique patients age 3 and over, and Height/Weight for >80% of unique patients of all ages. Workflow Requirement to plot and display growth charts for children changed from 2-20 years, to 0-20 years. Height, Weight, and BP now constrained to numeric-only values. Configuration Only numeric values accepted for vital signs. If customers use custom content for Vitals, may need to constrain Ht, Wt, and BP fields to accept only positive integers. 35 Product and Service Used to Meet Criteria: CPS 12/CEMR 9.8
CORE Measure 4 Vital Signs Exclusions: Any EP who: (1) Sees no patients 3 years or older is excluded from recording blood pressure. (2) Believes that all 3 vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them. (3) Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure. (4) Believes that blood pressure is relevant to their scope of practice, but height/length and weight are not, is excluded from recording height/length and weight. Additional Info: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_4_ RecordVitalSigns.pdf
CORE Measure 5 - Smoking Status Changed in Stage 2: Measure Change from >50% to >80% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Workflow - No changes Configuration Update clinical content to contain the additional requirements/granularity for identifying smoking status: (Updated Risk- Factors-CCC, FH-SH-CCC, and other CCC forms included in release) Current every day smoker Current Heavy tobacco smoker Current Light tobacco smoker Current some day smoker Former smoker Never smoker Smoker, current status unknown Unknown if ever smoked 37 Product and Service Used to Meet Criteria: CPS 12/CEMR 9.8
CORE Measure 5 Smoking Status Exclusions: Any EP that neither sees nor admits any patients 13 years old or older. Additional Info: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_5_ RecordSmokingStatus.pdf 38
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