Meaningful Use:
Managing Stage 2 and Beyond
John Valutkevich
Senior Supervisor
Electronic Health Records and Federal Health Initiatives
Lisa Palmer,
Senior Specialist for Federal Health Initiatives
MEDITECH Ambulatory
• Review of Systems:
○ Industry Stats
○ MEDITECH Stats
• Chronic Conditions Continue from Stage 1
• Prognosis - Stage 2 and Stage 3
• Plan of Action
Review of Systems
Industry Demands Facing Health Care
This Year:
•
•
•
•
•
•
Meaningful Use demands
Healthcare Reform
Payment Reform
ICD-10 (delayed again)
5010
ACO’s and PCMH’s
Stage 1 Meaningful Use Summary
To qualify for incentives, grants, or funding, users
must demonstrate meaningful use of the EHR system.
• Focus is deployment/adoption of
Advanced Clinical Systems
• Electronic exchange of information
• Report on Meaningful Use Metrics
and Clinical Quality Measures
• Complete EHR or EHR Modules must
be "certified"
Review of Systems
Review of Systems
Review of Systems
Certification Status: Stage 1
Visit our certification page for updates and instructions on obtaining
your CMS Certification Numbers
Review of Systems
Preparing for Stage 2 Certification:
Eligible Hospitals
Review of Systems
Preparing for Stage 2 Certification:
Eligible Professionals
Review of Systems
Why New Releases ?
Privacy & Security Requirements
• Standardized Encryption of all connections to
SSL/TLS
• Encryption of Downloads (CD, USB)
• Enhanced Patient Centric Audit Logs in MIS
• Increased Security Requirements in Stage 2
Visit: MEDITECH Systems Support
Review of Systems
Why New Releases ?
Increased Standardization with Nomenclature
• Increased use of SNOMED-CT For Problem List
• Mapping to Tests and Results: LOINC and SNOMED
• SNOMED-CT for Nursing Terms, Orders
• Standards for Medications, Allergies and Reactions
Improvements to mapping standards
Review of Systems
Why New Releases?
Improvements to Usability
• Enhanced Problem List Functionality
• Improved Workflow for Medication Reconciliation
• Patient and Clinician Discharge Processes
• Robust CCD Enhancements
• Ambulatory Checkout Process
• Ambulatory Patient Education
Increasing Clinician and
Physician User Satisfaction
Chronic Conditions of Stage 1 Continue
Chronic Conditions Stage 1
Computerized Provider Order Entry
• Physician Adoption Historically is Slow
• CMS Interpretations:
• Licensed Professional
• Must use CDS at time of order entry
• Requiring only 1 Med - raises patient
safety issues and disjointed care
• Acute, ED or Both calculation
MEDITECH certified CPOE solution resides within PCM and EDM for
Acute and AOM/RXM for Ambulatory providers.
Chronic Conditions Stage 1
Reporting Requirements: Eligible Hospitals
Utilization of Your EHR
• EHR Utilization Metrics (i.e. 30% CPOE utilization)
• 14 Required Functional Measures and 10 Menu Items
• Utilization Reports are NPR and Report Designer for 90
days reporting
• Longer reporting period (365 days) may require
Data Repository for increased data retention
Chronic Conditions Stage 1
Reporting Requirements: Eligible Hospitals
Clinical Quality Measures - The Big Gotcha!!
15 Quality Measures for Stage 1:
• ED Throughput
• Stroke
• VTE
• Clinical Quality Measure Reports calculated from Data Repository
• DR customers receive Quality Measures Report SQL Templates
• For 2011 and 2012 - CMS requires attestation only – capability of your
certified EHR to report the measures
• Performance and Outcomes are not measured
Chronic Conditions Stage 1
Reporting Requirements: Eligible Professionals
Utilization of Your EHR
•EHR Utilization Metrics (i.e. 30% CPOE utilization)
•15 Required Core Measures and 10 Menu Items
•Standard System Utilization Reports
provided for Core and Menu set items
Chronic Conditions Stage 1
Reporting Requirements: Eligible Professionals
Clinical Quality Measures - The Big Gotcha!!
•44 Clinical Quality Measures for Stage 1
•3 Core/3 Alternate Core Measures
•3 Additional Measures
• Use of MPM Clinical Reporting tool for quality reporting
• For 2011 and 2012 - CMS requires attestation only – capability of your
certified EHR to report the measures
• Performance and Outcomes are not measured
Chronic Conditions Stage 1
Clinical Quality Reports …
… became as big an impact as CPOE !
• Required vocabularies not used widely in EHRs:
(SNOMED CT, RxNorm, CVX)
• Over 500 data elements in the 15 measures
• Data capture must be in discrete fields
• Impact on workflow for clinicians
• Specification was incomplete and not maintained
• Review of Best Practices is Critical
Chronic Conditions Stage 1
Interoperability Requirements
Stage 1 - Just A Test! But with Whom?
Infrastructure lacking - exchange standards not defined
•CCD: Capability to exchange key clinical information among
providers - regardless of the transport – standard has to be a CCD
•Public Health Reporting Interfaces
Must choose 1 Public Health Objective to Demonstrate - (but
own them all)
• Capability to submit electronic data to immunization registries
• Capability to provide electronic submission of reportable lab
results to public health agencies
• Capability to provide electronic syndromic surveillance data to
public health agencies
Chronic Conditions Stage 1
CMS Clarifications
FAQ Mechanism to clarify or re-write legislation
• Wording in Final Rule – ambiguous and left open to
much interpretation
• Many, many “clarifications” from CMS and ONC –
sometimes changing the ruling
• What will be involved in an Audit?
Prognosis:
Stage 2 and Beyond
Timeframe for Stage 2
• HIT Policy Panel submitted recommendations to
ONC – July 7, 2011
• Associated standards for Stage 2 Measures
submitted September 28, 2011
• CMS and ONC issued Notice of Proposed
Rulemaking (NPRM) February 23, 2012
• CMS and ONC will then issue the final rule in
middle of 2012
• Certification for Stage 2 in Fall 2012
Prognosis Stage 2 and Beyond
Stage 2 Delay Start For Early Attesters
Stage 2 Eligible Hospitals
•
•
•
•
16 CORE objectives – choose 2 of 4 menu items
All menu items in Stage 1 become core
Most Stage 1 thresholds increase in Stage 2
Several new measures:
-Clinician Notes (Physcian, PA, NP)
-eMar in at least one unit
-Record care plan goals and patient
instructions
-Record health care team members
-Address encryption of data at rest
-Inclusion of Direct Protocol
-Reporting
-Additional interoperability
requirements (orders and results)
-e-Prescribing
-Patient Portal – discharge
instructions and visit information
-Ability to view images in EHR for
40% orders
Stage 2 Providers
•17 CORE Objectives - choose 3 of 5 menu items
•All menu items in Stage 1 become core
•Stage 1 thresholds increase in Stage 2
•Several new measures:
-Patients are offered secure, online messaging
-Patient Portal – view and download, transfer health information
-Record Advance Directives
-Increased clinical decision support rules
-Record health care team members
-Record Care Plan Goals and Patient Instructions
-Submit Reportable Cancer Conditions
-Ability to view images in EHR for 40% orders
Prognosis Stage 2 and Beyond
The Future: Focus is on Patient and
Consumer Engagement … (PCMH’s, ACO’s)
Prognosis Stage 2 and Beyond
EH & EP Stage 2 - You will need a Patient Portal
Prognosis Stage 2 and Beyond
EP Stage 2 – Secure Patient Messaging
Stage 2 – You will need to implement e-Prescribing
• Integrated into MEDITECH’s PCM,
EDM and PCS/Nursing Suites
○ Includes:
•
•
•
•
Access to medication histories
Updates patients' records
Check benefits while ordering
Communicate orders to retail
and mail order pharmacies
• Standards-based NCPDP
Script interfaces
• DrFirst as transaction clearinghouse
*Eligible Professionals: Continue eRx
measure from Stage 1 with increased
threshold from 40% to 50%
Prognosis Stage 2 and Beyond
EH Stage 2 – You will need to implement the
Electronic Medication Administration Record
Prognosis Stage 2 and Beyond
EH & EP Stage 2: You will need to
implement “Electronic Notes”
Prognosis Stage 2 and Beyond
Stage 2: Clinical Quality Measures
• Data needed to be captured in discrete
fields
• Increase use of standard nomenclature
• Subscription to IMO for vocabulary
mapping
• Best Practices for Workflow Guidance
in development
• Physician groups of a certain size can
report quality data for their groups
Prognosis Stage 2 and Beyond
Stage 2 Quality Reporting – 113 Proposed Measures for
Hospitals and Providers
Stage 2 and Beyond:
• Over 130 Proposed Quality Measures
• Over 65,000 Data Elements mapped to standard nomenclature
Prognosis Stage 2 and Beyond
Increased Interoperability: Order and Results exchanged
electronically
Prognosis Stage 2 and Beyond
Increased Interoperability: Electronically Transmit a summary
of care record
• “Electronic Exchange of Summary Care Documents to a
recipient with no organizational affiliation and a different
certified EHR technology vendor for more than 10% of
transitions of care and referrals”
Stage 2 – new Exchange Requirements
• Discharge Summaries
• CCD’s
• Referral
• Consolidated CDA
• SOAP transport option to Direct
Plan of Action: Meaningful Use Stage 2 and Beyond
Plan of Action
MEDITECH: A Dedicated Meaningful Use Team
• ARRA Leadership - weekly meetings - VPs and
Management
• Certified EHR Technology
• Customer Implementation and Support Best Practices
• Integrated Collaboration –
Cross-division Meaningful Use Task Force
• Industry Expertise and Leadership
• Customer Outreach, Focus Groups and Advisory
Activities
Plan of Action
YOU: A Dedicated Meaningful Use Team
• ARRA Leadership Team - establish weekly
meetings
• Educate, Educate, Educate – Staff, Board,
Community
• Prepare for increased Quality Measures –
do you need a “Quality Officer”?
• Stay tuned in to meditech.com and lssdata.com –
ARRA pages
Meaningful Use Resources
A Step By Step to the Guides
• Begin with MEDITECH
○ Eligible Hospitals
○ Eligible Professionals
• Certified Product Listing
• Registration for Incentive Programs
• CMS FAQ Pages
• ONC FAQ Pages