Meaningful Use Stages 1 & 2

Meaningful Use Stages 1 & 2 Making Sure You Get the Most Out of Your EHR Tracy McDonald Medicaid EHR Incentive Program Coordinator

Agenda Meaningful Use Stages & Incentive Program Timing 2014 Changes to Stage 1 Stage 2 s New Core, Menu Set and Quality Objectives 2015 Payment Adjustments Timeline

Stages of Meaningful Use Stage 1 Stage 2 Stage 3 Data Capture and Sharing Capturing health information in a standardized format Track key clinical conditions Communication of information for care coordination processes Report Quality Measures & public health information Patient and family engagement Advanced Processes More rigorous health information exchange (HIE) Increased requirements for e-prescribing, demographics and vital signs Electronic transmission of patient care summaries More patient-controlled data Improved Outcomes Improving quality, safety, and efficiency Decision support for national high-priority conditions Patient access to selfmanagement tools Access to comprehensive patient data through patientcentered HIE Improving population health Adapted from HealthIT.gov 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 3

First Program Year Meaningful Use Timing Incentive Payment Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2011 1 1 1 2* 2 3 3 TBD TBD TBD TBD 2012 1 1 2* 2 3 3 TBD TBD TBD TBD 2013 1 1* 2 2 3 3 TBD TBD TBD 2014 1* 1 2 2 3 3 TBD TBD 2015 1 1 2 2 3 3 TBD 2016 1 1 2 2 3 3 2017 1 1 2 2 3 * 90-day EHR Reporting Period for all Stages of MU in 2014 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 4

Incentive Payments for EPs - Medicare Calendar Year 2011 $18,000 CY2011 CY2012 CY2013 CY2014 2015 and beyond 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000-1% 2015 $2,000 $4,000 $8,000 $8,000-2% 2016 $2,000 $4,000 $4,000-3% 2017 2018-4% -5% TOTAL $44,000 $44,000 $39,000 $24,000 0 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution

Incentive Payments for EPs - Medicaid Calendar Year 2011 $21,250 CY2011 CY2012 CY2013 CY2014 CY2015 CY2016 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution

Stage 1 & Stage 2 Meaningful Use

Meaningful Use More than just Incentive $$ Continuous Quality Improvement Patient and Family Engagement Check in / Check out Patient Intake / Rooming Provider Visit Orders / Point of Care Admin Privacy and Security 8

Meaningful Use Definitions Objective Description of the Meaningful Use goal Measure The level at which the EH or EP will demonstrate they met the objective Core Core objectives are required Menu Set Menu set objectives are required; however, the EH or EP can choose which objectives on which to report * These are changes as of this presentation final changes from CMS are expected this Fall.

2014 Stage 1 to Stage 2 Overview Stage 1 Stage 2 13 Core Objectives 5 of 9 Menu Objectives 17 Core Objectives 3 of 6 Menu Objectives 9 Total Quality Measures 9 Total Quality Measures 27 Total 29 Total

Stage 1 Changes* Menu Set Objectives EPs will have to report on 5 of 9 What does this mean? Menu Objective: Timely access to health information has been incorporated into a new Core Measure for 2014 Exclusion for Menu Set Objectives Measures with exclusions will no longer count toward the 5 required menu set objectives What does this mean? If you take an exclusion, you must report on all other menu set measures (FAQ10162) * These are changes as of this presentation final changes from CMS are expected this Fall.

Stage 1 Changes* Quality Measures EPs & EHs will need to report on additional CQMs that fall into at least 3 domains Electronic Copy of and Electronic Access to Health Information These two measures will be eliminated and replaced in both Stage 1 and Stage 2 Record Vital Signs The exclusions have been modified and divided The objective has been clarified * These are changes as of this presentation final changes from CMS are expected this Fall.

Meaningful Use - Core Objectives

Stage 2 Core Objectives Measure Increases EP Objective Previous Measure New Measure Workflow E-Prescribing 40% 50% Orders / Points of Care Record Demographics Record Smoking Status Decision Rule(s) 50% 80% Check in / Check out 50% 80% Patient Intake / Rooming 1 5 Provider Visit Summaries 50% / 3 days 50% / 1 day Check in / Check out Protect Electronic Health Information Yes Yes Annually!! 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Stage 2 Core Objectives Menu to Core EP Objective Previous Measure New Measure Patient Lists Yes Yes Menu to CORE Patient-Specific Education Resources Medication Reconciliation Lab-Test Results 10% 10% Menu to CORE Workflow Administration Orders / Points of Care 50% 50% - Menu to CORE Provider Visit 40% 55% - Menu to CORE Administration 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

CPOE for Medication, Laboratory and Radiology Orders Stage 1 = Medication orders entered directly by a licensed health care professional 30% of all medication orders Stage 2 = Medication, laboratory and radiology orders entered directly by a licensed health care professional 60% of all medication orders 30% of all laboratory orders 30% of all radiology orders Orders / Point of Care Check in / Check out Patient Intake / Rooming Patient Exam Administration 16

CPOE for Medication, Laboratory and Radiology Orders Notes from CMS: Electronic transmittal of the medication order is not a requirement for meeting the measure of this objective CPOE is the entry of the order into the patient's EHR that uses a specific function of CEHRT - it is not how that order is filled or otherwise carried out Any licensed health care professional and credentialed medical assistants can enter orders into the medical record for purposes of including the order in the numerator of the CPOE objective Credentialing of the MA must come from an organization other than the employing organization Orders / Point of Care Check in / Check out Patient Intake / Rooming Patient Exam Administration 17

Record Vital Statistics Stage 1 2013 = Record and chart vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for 2-20 years, including BMI 50% of all unique patients Stage 2 = Record and chart changes in the following vital signs: Height/length & weight (no age limit) Blood pressure (age 3 and older) BMI (no age limit) Growth charts, including BMI (age 0-20) 80% of all unique patients Stage 1 2014 Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 18

Record Vital Statistics Notes from CMS: The exclusions are extensive; research them if you do not think they pertain to your scope of practice Height, weight and blood pressure do not have to be updated by the EP at every patient encounter At least once during the EHR Reporting Period EP can make the determination Information can be entered in a number of ways: Directly by EP Designated individual from EP s staff Data transfer from another provider electronically HIE Data entered directly through a patient portal Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 19

Patient Electronic Access Stage 1 = Provide patients with an electronic copy of their health information (50% within 3 days), AND Stage 1 = Provide patients with timely electronic access to their health information (MENU SET, 10% within 4 days) Stage 2 = 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 Measure 1 = More than 50% of all unique patients are Stage 1 2014 provided timely online access to their health information Measure 2 = More than 5% of all unique patients view, download or transmit to a third party their health information Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 20

Patient Electronic Access Notes from CMS: CMS has a list of the information that must be made available online Any information that is prohibited by any federal, state or local law does not need to be included Any information that the provider believes could cause substantial harm to the patient does not need to be included Transmission any means of electronic transmission including, but not limited to SMTP, FTP, REST, SOAP Physical electronic media (USB, CD, etc.) does not qualify Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 21

Preventive Care / Patient Reminders Stage 1 = MENU SET Send reminders to patients per patient preference for preventive/follow-up care More than 20% of all unique patients 65 or older or 5 years or younger Stage 2 = Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients reminders per patient preference More than 10% of all unique patients who have had 2 or more office visits with the EP within the 24 months prior to the EHR Reporting period were sent a reminder Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 22

Preventive Care / Patient Reminders Notes from CMS Patient Preference = includes, but not limited to mail, phone or secure messaging Must follow HIPAA guidance 45 CFR 164.522(b) If a patient declines to provide their preferred method, the provider may select one for them The reminder must be for preventive/follow-up care that the patients isn t already scheduled to receive Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 23

Summary of Care / Transitions of Care Stage 1 = 4 Measures Drug-Drug and Drug-Allergy Interaction Checks Problem Lists Active Medication List Active Medication Allergy List Stage 2 = 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 a summary care record for each transition of care or referral This is a 3-part measure Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 24

Summary of Care / Transitions of Care Summary of Care Measures 1 & 2 must both be met Measure 1: EP who transitions or refers patients provides a summary of care record for more than 50% of transitions of care and referrals Measure 2: EP who transitions or refers patients provides a summary of care record for more than 10% of such transitions and referrals with (a) electronically transmitted using the CEHRT to a recipient, or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a ehealthexchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the ehealthexchange Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 25

Summary of Care / Transitions of Care Summary of Care Measure 3 must have one of the following criteria met Conducts one or more successful electronic exchanges of a summary of care document, as part of which is counted in Measure 2 The sending and receiving EHRs must be different Conducts one or more successful test with the CMS designated test EHR during the EHR reporting period CMS is setting up a dummy site for this exchange so that the EP may meet the measure Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 26

Summary of Care / Transitions of Care Items that need to be included in a summary of care record: Patient Name Referring or transitioning provider s name & contact Procedures Encounter diagnosis Immunizations Laboratory test results Vital signs (height, weight, blood pressure, BMI Smoking status Functional status Demographic information Care plan field, including goals and instructions Care team Reason for referral Current problem list Current medication list Current medication allergy list CMS Tip sheet has definitions for the numerators / denominators, along with other tips (7 pages) Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 27

Immunization Registries Data Submission Stage 1 = MENU SET Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice Yes/No Measure Stage 2 = Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or Immunization Information System for the entire EHR reporting period Yes/No Measure Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 28

Immunization Registries Data Submission Tips from CMS: There are 4 different exclusions for this measure, so review the CMS tip sheet CMS envisions setting up a centralized repository for this information sent to public health; however, if they do not and the EP is expected to work directly with their PHA Same situation as Stage 1 If an EP has had successful ongoing submission on a 2011 CEHRT, they may continue to do so to meet Stage 2 for as long as the HL7 2.3.1 continues to be accepted by IIS You may want to speak directly with CMS about this if applicable since you need a 2014 CEHRT for other measures Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 29

New! - Use Secure Electronic Messaging Stage 2 = Use secure electronic messaging to communicate with patients on relevant health information Secure message sent to more than 5% of unique patients CMS Tips: Secure Message = any electronic communication between a provider and patient that ensures only those parties can access the communication Email, electronic messaging function of a PHR, online patient portal would qualify The EP is not expected to respond to the electronic messages and may have a staff member respond Check in / Check out Patient Intake / Rooming Patient Exam Orders / Point of Care Administration 30

Meaningful Use Menu Set Objectives

Menu Set Objectives Stage 2 has a total of 6 Menu Set Objectives EPs must report on 3 of 6 Of the 6, 5 are brand new measures 3 of the objectives address capturing information as structured data 3 of the objectives are public health focused 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Menu Set Objectives Structured Data Electronic Notes New! Record electronic notes in patient records (created, edited and signed by EP) 30% of unique patients Imaging results - New! Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through the CEHRT 10% Family Health History - New! Record patient family health history as structure data 20%; first-degree relatives 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Menu Set Objectives Public Health Syndromic Surveillance Data Submission Updated! Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period Report Cancer Cases - New! Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period Report Specific Cases - New! Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Meaningful Use Quality Measures

What s new for 2014? All Meaningful Use attestations will submit their CQMs in accordance with the 2014 changes Yes, even Stage 1 Stage 2 CQMs must cover at least 3 of the 6 National Quality Strategy domains EPs now report on 9 total CQMs Medicare must be submitted electronically Medicaid the state will submit them for you Recorded webinar with more detail at www.corhio.org 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 36

What s new for 2014? Six Domains Patient Safety Patient & Family Engagement Care Coordination Make care safer by reducing harm in the delivery of care Ensure that each person and family are engaged as partners in their care Promote effective communication and coordination of care Population & Public Health Efficient Use of Health Care Resources Processes / Effectiveness Work with communities to promote wide use of best practices to enable healthy living Make quality care more affordable for individuals, families, employers and governments by developing and spreading new health care delivery models Improve quality, safety and efficiency; reduce health disparities 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 37

2014 Adult Recommended CQMs CQM Number CQM Title Domain NQF 0018 NQF 0022 NQF 0028 NQF 0052 NQF 0418 NQF 0419 NQF 0421 Controlling High Blood Pressure Use of High-Risk Medications in the Elderly Tobacco Use: Screening and Cessation Intervention Use of Imaging Studies for Low Back Pain Screening for Depression and Follow-up Plan Documentation of Current Medications in the Medical Record Body Mass Index (BMI) Screening and Follow-up Process / Effectiveness Patient Safety Population/Public Health Efficient Use of Healthcare Resources Population/Public Health Patient Safety Population/Public Health NQF TBD Receipt of Specialist Report Care Coordination NQF TBD Functional Status Assessment for Complex Chronic Conditions Patient and Family Engagement 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 38

2014 Pediatric Recommended CQMs CQM Number CQM Title Domain NQF 0002 NQF 0024 Appropriate Testing for Children with Pharyngitis Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution Efficient Use of Healthcare Resources Population/Public Health NQF 0033 Chlamydia Screening for Women Population/Public Health NQF 0036 Use of Appropriate Medications for Asthma Process/Effectiveness NQF 0038 Childhood Immunization Status Population/Public Health NQF 0069 NQF 0108 NQF 0418 NQF TBD Appropriate Treatment for Children with Upper Respiratory Infection ADHD: Follow-up Care for Children Prescribed ADHD Medication Screening for Depression and Follow-up Plan Children who have Dental Decay or Cavities Efficient Use of Healthcare Resources Process/Effectiveness Population/Public Health Process/Effectiveness 39

Payment Adjustments

2015 Payment Adjustments EPs and EHs that are not meaningful users, bill Medicare and are eligible for the EHR Incentive Program could be affected Attested to MU in 2011 or 2012 EPs CY2013 full year EHs FFY2013 full year Attested to MU year 1 in 2013 EPs CY2013 90 days EHs FFY2013 90 days Attesting to MU year 1 in 2014 EPs EHs Oct 1, 2014 90 days Jul 1, 2014 90 days 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 41

2015 Payment Adjustments EPs and EHs must demonstrate MU each year in order to avoid payment adjustments If you are participating in the Medicaid EHR Incentive Program, you can still incur penalties if you see Medicare patients If you skip a year in the Medicaid EHR Incentive Program, you will still incur penalties if you have already attested to MU at least once There are hardship exceptions for both EPs and EHs which can be reviewed on CMS website or CMS can be contacted directly 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 42

Helpful Links CMS Stage 2 Toolkit: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Stage_2.html CMS Quality Measures page: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Quality Measures.html CORHIO s Meaningful Use Page: FAQs Webinars Quick Reference & User Guides Medicaid Workbooks for Attestation http://www.corhio.org/ehrs-meaningful-use.aspx 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Contact Information Tracy McDonald Medicaid EHR Incentive Program Coordinator MedicaidEHR@corhio.org Phone: 720.285.3232 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved