Meaningful Use Stage 1 & 2
Helping Colorado Providers Achieve Meaningful
Use
Tracy Rue
Senior Consultant, Colorado Regional Extension Center
Agenda
•
•
•
•
•
Three Stages of Meaningful Use
Stage 1 & 2 Timing
Regional Extension Center
Objectives Comparing Stages 1 & 2
Clinical Quality Measures Stages 1 & 2
© 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved
Meaningful Use: Laying the
Foundation for Future Advances
Meaningful Use Stage 3:
Fully integrated systems, reductions in
errors & duplications, improved cost
effectiveness, better coordinated care
Stage 3: Home is Built
Meaningful Use Stage 2:
Exchanging clinical data with other
sources, tracking clinical outcomes,
targeted patient-care initiatives,
patient access to self-management
tools
Stage 2: Walls & Windows
Stage 2: Walls & Windows
Meaningful Use Stage 1:
Using electronic systems, structured data,
point-of-care protocols, improved care
coordination, security protocols & HIPAA
standards in place
© 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved
Meaningful Use Timing
Incentive Payment Year
First Program 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
2013
2014
2015
2016
2017
1
1
2*
2
3
3
TBD TBD TBD TBD
1
1*
2
2
3
3
TBD TBD TBD
1*
1
2
2
3
3
TBD TBD
1
1
2
2
3
3
TBD
1
1
2
2
3
3
1
1
2
2
3
*3-month quarter EHR reporting period for Medicare and continuous 90day reporting for Medicaid EPs.
4
Colorado Regional
Extension Center
MU
• Colorado REC’s mission is to provide the training and
support services necessary for primary care providers in
small practices, Rural Hospitals and Critical Access
Hospitals to achieve Stage 1 Meaningful Use
Adopt EHR
Select &
Implement EHR
Determine HIT & EHR
Readiness
• CORHIO has partnered with six healthcare organizations across
Colorado to work with 2,295 providers and 33 rural and critical
access hospitals to achieve the goals of the grant
SUCCESS!
• 97% of participating providers have
gone live on their EHR and 42% have
reached Meaningful Use
• 85% of participating Rural and Critical
Access hospitals have gone live and
67% have reached Meaningful Use
5
The EHR Incentive Programs
What is the EHR
Incentive Program?
• HITECH Act of 2009/American Recovery &
Reinvestment Act
– Meaningful Use of Certified Electronic Health
Records Technology (CEHRT)
• Three Stages (currently in Stage 1)
• Two programs:
– Medicare
» Opened in 2011 for Meaningful Use demonstration
» Eligible Professionals, Eligible Hospitals and Critical Access Hospitals
– Medicaid
» Opened in 2012 for Adopt, Implement or Upgrade of a CEHRT
» Opened in 2013 for Meaningful Use
» Eligible Professionals, Eligible Hospitals and Critical Access Hospitals
Who is Eligible for Medicare
EHR Incentives?
Eligible Providers - Medicare
Eligible Professionals (EPs)*
Doctor of Medicine or Osteopathy
Doctor of Dental Surgery or Dental Medicine
Doctor of Podiatric Medicine
Doctor of Ophthalmology
Chiropractor
To qualify for an incentive payment under the Medicare EHR Incentive
Program, an eligible professional must:
• Bill Medicare FFS “straight Medicare”
• Medicare Provider in good-standing
Hospital-based providers are not eligible for incentive payments.
An eligible professional is considered hospital-based if 90% or more of his or her
services are performed in a hospital inpatient (Place of Service code 21) or emergency
room (Place of Service code 23) setting.
8
Incentive Payments for
Medicare EPs
Medicare Incentive is 75% of total allowed charges, based on a
calendar year
•
Calendar
Year
CY 2011
2011
$18,000
2012
$12,000
$18,000
2013
$8,000
$12,000
$15,000
2014
$4,000
$8,000
$12,000
$12,000
2015
$2,000
$4,000
$8,000
$8,000
-1%
$2,000
$4,000
$4,000
-2%
2016
CY 2012
CY 2013
CY 2014
CY 2015
and later
2017
-3%
2018
-4%
2019
-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
Who is Eligible for Medicaid
EHR Incentives?
Eligible Providers - Medicaid
Eligible Professionals (EPs)*
Physicians
Nurse Practitioners (NPs)
Certified Nurse-Midwives (CNMs)
Dentists
Physician Assistants (PAs) who lead a FQHC or RHC
To qualify for an incentive payment under the Medicaid EHR Incentive Program,
an eligible professional must meet one of the following criteria:
• Have a minimum 30% Medicaid patient volume*
• Have a minimum 20% Medicaid patient volume and is a pediatrician*
• Practice predominantly in a Federally Qualified Health Center or Rural Health Center and
have a minimum 30% patient volume attributable to needy individuals
• Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid
patient volume criteria
Hospital-based providers are not eligible for incentive payments.
An eligible professional is considered hospital-based if 90% or more of his or her services are
performed in a hospital inpatient (Place of Service code 21) or emergency room
(Place of Service code 23) setting.
10
Incentive Payments for
Medicaid EPs
•
Medicaid EPs can start receiving payments any time from CY 2011
through 2016, and there is no penalty for starting later
– Payments based on participation year, so EPs can have gaps in meeting Meaningful
Use requirements and still receive max $
•
No Medicaid payment reductions for not meeting Meaningful Use
Calendar
Year
CY 2011
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
TOTAL
$63,750
CY 2012
$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$63,750
CY 2013
$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$63,750
CY 2014
$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$63,750
CY 2015
$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$63,750
CY2016
$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$63,750
© 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution
Stage 1 & Stage 2
Meaningful Use
Definitions
• Structured Data (Discrete Data)
– Data that is identifiable because it is organized in a
structure………(i.e.. ICD-9, SNOMED)
• Denominator (MU)
– Example: The number of Unique Patients seen within the
reporting period
• Numerator (MU)
– Example: The number of times the Meaningful Use
Objective was met
• Unique Patient
– A Unique patient means that even if a patient is seen
multiple times during the reporting period they are only
counted once.
Stage 2 Goals & Intentions
• Alignment of Clinical Quality Measures with
other reporting programs
• Improving Patient Care with new objectives to
improve patient care through better clinical decision
support, care coordination and patient engagement
• Rigorous expectations for HIE through increased
emphasis on exchanging clinical summary documents
to improve care coordination, public health reporting
and importing lab results in a structured manner
Stage 1 to Stage 2 Overview
Stage 2
Stage 1
Eligible Professionals
15 Core
5 of 10 Menu
20 total objectives
Eligible Professionals
17 Core
3 of 6 Menu
20 total objectives
Eligible Hospitals and CAHs
14 Core
5 of 10 Menu
19 total objectives
Eligible Hospitals and CAHs
16 Core
3 of 6 Menu
19 total objectives
Adapted from HealthIT.gov
What are the Requirements of
Stage 2 Meaningful Use?
• Core Objectives
• Menu Set Objectives
• Clinical Quality Measures
Meaningful Use - Core Objectives
Patient Check In & Out
Stage 1 Objective
Stage 1 Measure
Stage 2 Objective
Stage 2 Measure
Record
demographics
• Race
• Ethnicity
• Preferred
Language
• DOB
•
> 50% of all
unique patients
Record
demographics
•
> 80% of all unique
patients
Provide clinical
summaries for patients
for each office visit
> 50% of all office
visits within 3
business days
Provide clinical
summaries for
patients for each
office visit
> 50% of all office
visits within ONE
business day
Rooming Patient
Stage 1 Objective
Stage 1 Measure
Stage 2 Objective
Stage 2 Measure
Maintain active
medication list
> 80% of all
unique patients
No longer a separate
objective for Stage 2
Incorporated into
Transitions of Care
Maintain active
medication allergy list
> 80% of all
unique patients
No longer a separate
objective for Stage 2
Incorporated into
Transitions of Care
Record and chart
changes in vital signs:
•
Height, Weight, BP,
BMI
•
> 50% of
all unique patients age
Record and chart
changes in vital signs
> 80% of all unique
patients
2 and older
3 years and older
BP and Height and
Weight can be reported
separately.
•
Record smoking status
for patients 13 years
or older
> 50% of all
unique patients 13
years or older
Record smoking status
for patients 13 years
or older
> 80% of all unique
patients
Patient Exam
Stage 1 Objective
Stage 1 Measure
Stage 2 Objective
Stage 2 Measure
Maintain an up-todate
problem list
> 80% of all
unique patients seen
No longer a
separate
objective for
Stage 2
Incorporated
into Transitions
of Care
Implement one
clinical
decision support
rule relevant to
specialty
Implement one
clinical
decision support
rule
Use clinical decision
support to improve
performance on
high-priority health
conditions
Implement 5 clinical
decision support
interventions
Report CQMs
Report 6 CQMs
No longer a separate
objective
CQMs submitted
electronically to
CMS
Patient Exam
Stage 1 Objective
Medication
Reconciliation
Stage 1 Measure
>50% of patients
who transitioned
into the care of
the EP
Stage 1 Menu
Set
Stage 2 Objective
Medication
Reconciliation
Stage 2 Measure
50% of transitions
of care in which
the patient is
transitioned into
the care of the EP
Orders and Point of Care
Stage 1 Objective
Stage 1 Measure
Stage 2 Objective
Stage 2 Measure
Use CPOE for
medication orders
> 30% of
unique patients
Use computerized
provider order entry
(CPOE) for
medication,
laboratory and
radiology orders
> 60% of
Medication
> 30% of laboratory
> 30% of radiology
orders
Implement drugdrug and drugallergy interaction
checks
The EP has enabled
this functionality for
the entire EHR
reporting period
No longer a
separate
objective for
Stage 2
Incorporated into
the Stage
2 Clinical
Decision Support
measure
Orders and Point of Care
Stage 1 Objective
Generate and transmit
permissible
prescriptions
electronically (eRx)
Stage 1 Measure
> 40% of all
permissible
prescriptions
Use certified EHR
> 10% of all
technology to identify
unique
patient-specific
education resources and Stage 1 Menu Set
provide those resources
to the patient if
appropriate
Stage 2 Objective
Generate and
transmit
permissible
prescriptions
electronically (eRx)
Stage 2 Measure
> 50% of all
permissible
prescriptions
Patient-specific
Use certified EHR
education resources
technology to
identified by
identify patientspecific education CEHRT provided to
patients for more
resources and
than 10% of all
provide those
unique patients seen
resources to the
patient if appropriate by EP during the
EHR reporting
period
Orders and Point of Care
Stage 1 Objective
Stage 1 Measure
Stage 2 Objective
Implement drugformulary checks
Enabled
functionality
No longer a separate
objective for Stage 2
Stage 1 Menu Set
Stage 2 Measure
Incorporated into
the e- Prescribing
measure for Stage 2
Clinical Administration
Stage 1 Objective
Stage 1 Measure
Stage 2 Objective
Stage 2 Measure
Give patients
electronic copy of
their health
information
(including
diagnostic test
results, problem list,
medication lists,
medication
allergies) upon
request
> 50% of all
patients of the EP
who request an
electronic copy of
their health
information are
provided it within 3
business days
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
> 50% of all
unique patients seen by
the EP within 4
business days after the
information is available
have online access to
their health
information
> 5% of all unique
patients seen by the
EP (or their
authorized
representatives)
view,
download or
transmit their
health information
to a third party
Clinical Administration
Stage 1 Objective
Stage 1 Measure
Stage 2 Objective
Stage 2 Measure
Capability to
exchange key clinical
information
Performed at least
one test
Eliminated from
Stage 1 in 2013
No longer an
objective for Stage 2
Eliminated
from Stage 1 in 2013
No longer a measure
for Stage 2
Incorporate clinical
lab test results into
certified EHR
technology as
structured data
> 40%
Stage 1 Menu Set
Incorporate clinical
lab test results into
certified EHR
technology as
structured data
> 55%
Clinical Administration
Stage 1 Objective
Stage 1 Measure
Stage 2 Objective
Stage 2 Measure
Generate lists of
Generate at least one Generate lists of patients Generate at least one
patients by specific
report listing patients of by specific conditions to report listing patients of
conditions to use for
use for quality
the EP with a specific
the EP with a specific
quality improvement,
improvement, reduction
condition
condition
reduction of disparities,
of disparities, research,
Stage 1 Menu Set
research or outreach
or outreach
Send reminders to
patients per patient
preference for
preventive/follow-up
care
> 20% of all
unique patients 65 years
or older or 5 years old
Stage 1 Menu Set
Use clinically relevant
information to identify >10% of all patients with
two or more office visits
patients who should
in the last 2 years
receive reminders for
preventive/follow-up
care
Clinical Administration
Stage 1 Objective
Provide patients with
timely electronic
access to their health
information
Stage 1 Measure
Stage 2 Objective
Stage 2 Measure
Eliminated
Eliminated from
> 10% of all unique
from Stage 1 in 2014
Stage 1 in 2014
patients seen by the
No longer an
No longer a
EP are provided
timely (available to objective for Stage 2 measure for Stage 2
the patient within
four business days of
being updated in the
certified EHR
technology)
Stage 1 Menu Set
Clinical Administration
Stage 1 Objective
Stage 1 Measure
The EP who
transitions
their patient to
another setting of
care should provide
summary of care
record for each
transition of care or
referral
>50% of transitions
of care and referrals
Stage 1 Menu
Stage 2 Objective
Stage 2 Measure
The EP who
>50% of transitions of
transitions
care
>10% electronically
their patient to
This measure combines
another setting of
Stage 1 core items –
care should provide
problem list, active
summary of care
medication list and
record for each
transition of care or active medication allergy
list - to emphasize
referral
increased data exchange
Clinical Administration
Stage 1 Objective
Stage 1 Measure
Capability to submit
electronic data to
immunization registries
or Immunization
Information Systems and
actual submission except
where prohibited and in
accordance with
applicable law and
practice
Performed at least
one test
NEW
Stage 1 Menu
NEW
Stage 2 Objective
Capability to submit
electronic data to
immunization registries
or Immunization
Information Systems and
actual submission except
where prohibited and in
accordance with
applicable law
Use secure electronic
messaging to
communicate with
Patients
Stage 2 Measure
Successful ongoing
submission of
electronic
immunization data
> 5% of patients
communicate
electronically with their
provider (s)
Administration
Stage 1 Objective
Stage 1 Measure
Stage 2 Objective
Stage 2 Measure
Protect electronic
Conduct or review a
Protect electronic
Conduct or review a
health
health information security risk analysis
security risk analysis
created or maintained
information created
and
by the certified EHR
or maintained by the encryption/security of
technology through
certified EHR
data at rest
the implementation
technology through
of appropriate
the implementation
technical capabilities
of appropriate
technical capabilities
Meaningful Use –
Menu Set Objectives
Stage 2 Menu Set
(EPs must select 3 of 6)
Stage 1 Objective
Stage 1 Measure
Stage 2 Objective
Capability to submit
Performed at least
Capability to submit
electronic syndromic
one test of certified EHR
electronic syndromic
surveillance data to
technology's capacity to
surveillance data to
public health agencies
provide electronic
public health agencies
and actual submission
syndromic surveillance
and actual submission
except where prohibited
data to public health
except where prohibited
and in accordance with
agencies
and in accordance with
applicable law and
applicable law and
practice
practice
NEW
NEW
Record electronic notes
in patient records
Stage 2 Measure
Successful ongoing
submission
of electronic syndromic
surveillance data
Enter at least one
electronic progress note
created, edited and
signed by an EP for more
than 30% of unique
patients
Stage 2 Menu Set
Stage 1 Objective
NEW
NEW
Stage 1 Measure
NEW
NEW
Stage 2 Objective
Stage 2 Measure
Imaging results
consisting of the image
itself and any
explanation or other
accompanying
information are
accessible through
CEHRT
More than 10% of all
scans and
tests whose result is an
image ordered by the EP
for patients seen during
the EHR reporting
period are incorporated
into or accessible
through CEHRT
Record patient family
health history as
structured data
>20% of all unique
have a structured data
entry for one or more
first-degree relatives
Stage 2 Menu Set
Stage 1 Objective
NEW
NEW
Stage 1 Measure
NEW
NEW
Stage 2 Objective
Stage 2 Measure
Capability to identify and
report cancer cases to a
state cancer registry,
except where prohibited,
and in accordance with
applicable law and
practice
Successful ongoing
submission
of cancer case
information from
CEHRT to a cancer
registry for the entire
EHR reporting period
Capability to identify and
Successful ongoing
submission
report specific cases to a
specialized registry
of specific case
(other than a cancer
information from
registry), except where
CEHRT to a
prohibited, and in
specialized registry
accordance with
for the entire EHR
applicable law and
reporting period
practice
Clinical Quality Measure Requirements
for Stage 1
Meet 6 total Clinical Quality Measures
–3 core or alternate core, and
–3 out of 38 from alternate set
Most Electronic Health Record systems only report
on the minimum 9 Clinical Quality Measures.
Which Clinical Quality Measures can your system report?
http://onc-chpl.force.com/ehrcert/chplhome
Clinical Quality Measures
Stage 1
Must Choose 3
Core Set
Alternate Set
1. Hypertension: Blood Pressure
Measurement
4. Weight Assessment and Counseling for
Children and Adolescents
2. Preventive Care and Screening
Measure Pairs: a) Tobacco Use
Assessment, b) Tobacco Cessation
Intervention
5. Preventive Care and Screening;
Influenza Immunization for Patients 50
Years Old or Older
3. Adult Weight Screening and
Follow-up
6. Childhood Immunization Status
Additional CQMs
38 Additional CQMs
• Must choose 3 of the additional 38 CQMs
Clinical Quality Measures
Stage 2
• Submission of CQMs electronically (starting in 2014)
• Alignment with existing quality programs
• Providers must select from 3 of the 6 HHS National Quality Strategy domains:
1.
2.
3.
4.
5.
6.
Patient and Family Engagement
Patient Safety
Care Coordination
Population and Public Health
Efficient Use of Healthcare Resources
Clinical Processes/Effectiveness
Provider
2014 and Beyond*
Eligible Providers
Complete 9 out of 64
*Regardless of the stage of meaningful use, all providers will complete this number of CQMs in 2014
Adapted from HealthIT.gov
Helpful Links
CMS Registration:
https://ehrincentives.cms.gov/hitech/login.action
Colorado Registration & Attestation System (CO R&A):
http://co.arraincentive.com/
Certified Health IT Product List (CHPL ID):
http://oncchpl.force.com/ehrcert?q=chpl
Colorado Regional Extension Center
http://www.corhio.org/
© 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved
Contact Information
Tracy Rue
Senior Consultant, Colorado Regional Extension Center
true@corhio.org
Phone: 720.285.3234
2/19/2013
© 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved