Understanding Meaningful Use
Review of Stage 1 and Stage 2
Presented by: Allison Bryan MS, CHES
December 7, 2012
Purdue Research Foundation 2012
Meaningful Use
• Financial incentives for the “meaningful
use” of certified EHR technology to
improve patient care
• Providers have to meet thresholds for
certain objectives
– Required core objectives
– Choice of menu objectives
• Meaningful use must be demonstrated for
all patients, not just Medicare or Medicaid
subscribers
Purdue Research Foundation 2012
Meaningful Use Stages
Stage 2
Stage 1
Report and
Exchange
Information
Stage 3 and
Beyond…
Leverage
Information for
Improved
Patient Care
Capture
Information
Purdue Research Foundation 2012
Purdue Research Foundation 2012
Purdue Research Foundation 2012
Policy Priority
Stage 1 Objectives
Measure
Maintain active medication allergy list
Improving
quality, safety,
efficiency and
reducing
health
disparities
(cont.)
80%+ of
patients
Record and chart changes in selected vital signs
50%+
(height, weight, BP, BMI, growth charts (2-20 of patients
yrs.)
Record smoking status for patients 13 years old
50%+
or older
of patients
Implement one clinical decision support rule
along with the ability to track compliance that
rule
Report ambulatory quality measures to CMS or
the States
1 rule
Aggregate
numerator/
denominator
Purdue Research Foundation 2012
Policy Priority
Engage patients
and families in
their healthcare
Stage 1 Objectives
Measure
Provide patients with an electronic copy of
50%+ of all
their health information (including diagnostic
patients who
test results, problem list, medication lists, and
request
medication allergies) upon request, within 3
days of request
Provide clinical summaries to patients for each 50%+ of all
office visit within 3 days of visit
office visits
Improve Care
Coordination
Ensure adequate
security and
privacy
provisions for
personal health
information
Capability to exchange key clinical information
(for example problem list, medication lists,
medication allergies, diagnostic test results)
among providers of care and patient
authorized entities electronically
Protect electronic health information created
or maintained by certified EHR technology
through the implementation of appropriate
technical capabilities.
1 test of
capability
Conduct or
review a
security risk
analysis
Purdue Research Foundation 2012
Security
Providers fined $100,00 for Internet
privacy violations
o 2 physician cardiology practice
 The physician practice was posting clinical and surgical
appointments for its patients on an Internet-based calendar that
was publicly accessible
 OCR findings:
 Few policies and procedures to comply with the HIPAA Privacy and
Security Rules
 Limited safeguards in place to protect ePHI
 Outcome:
 $100,000 penalty
 Required to adopt a Corrective Action Plan
Purdue Research Foundation 2012
Security
Massachusetts provider settles HIPAA
case for $1.5 million
o 300 Physician Eye and Ear Institute
 Result of a theft of an unencrypted personal laptop containing
ePHI of patients and research subjects
 OCR findings:



No thorough analysis of the risk to the confidentiality of ePHI
maintained on portable devices
Did not Implement security measures sufficient to ensure the
confidentiality of ePHI
Did not implement policies and procedures to restrict access to
ePHI to authorized users of portable devices
 Outcome:


$1.5 million penalty
Required to adopt a Corrective Action Plan
Purdue Research Foundation 2012
Menu Set
Policy
Priority
Improving
quality,
safety,
efficiency and
reducing
health
disparities
Stage 1 Objectives
Measure
Implement drug formulary
checks
Functionality
enabled
Incorporate clinical lab test results into certified
EHR technology as structured data
40%+ of all
clinical lab tests
ordered
Generate lists of patients by specific conditions
to
use for quality improvement, reduction of
disparities, research or outreach
At least 1 report
of patients with
condition
Send reminders to patients 65 years or older of
5 years or younger per patient preference for
preventive/ follow up care
20%+
of patients
Purdue Research Foundation 2012
Policy
Priority
Engage
patients and
families in
their
healthcare
Improve Care
Coordination
Stage 1 Objectives
Measure
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
10%+ of
patients
Use certified EHR technology to identify patientspecific
education resources and provide those resources
to the patient if appropriate
10%+
of patients
Purdue Research Foundation 2012
Policy
Priority
Improve care
coordination
Improve
population
health
Stage 1 Objectives
Measure
Perform Medication Reconciliation when the EP or 50%+ of care
eligible hospital receives a patient from another
transitions to
setting of care or provider of care
EP
Provide summary of care record for each
50%+ of care
transition of a patient to another setting of care or transitions
provider of care or referral to another provider of
from EP
care
Capability to submit electronic data to
immunization registries
At least 1 test
or Immunization Information Systems and actual
submission in accordance with applicable law and
practice
Capability to submit electronic syndromic
surveillance data to
public health agencies and actual submission in
accordance with applicable law and practice
At least 1 test
Purdue Research Foundation 2012
Progress to Date
• Incentives according to CMS:
– More than 110,000 Eligible Professionals
have received incentive payments from the
Medicare and Medicaid EHR Incentive
Programs
– From May 2011 to July 31, 2012, more than
$3.6 billion in Medicare payments
– From January 2011 to August 31, 2012, more
than $3.3 billion in Medicaid payments
• Release of Stage 2 Meaningful Use
– Begins 2014
Purdue Research Foundation 2012
Meaningful Use: Stage 2
•
Secure Messaging (Core)
– Use secure electronic messaging to communicate with patients
on relevant health information
– Threshold: greater than 5%
– 2 exclusions apply
•
Timely Online Access: View, Transmit or Download (Core)
– 2 portions, must achieve both for Meaningful Use
– Timely Online Access
• Measure: 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
or 36 hours after discharge from an inpatient or emergency
department of an EH or CAH
• Threshold: greater than 50%
– View Transmit or Download
• Measure: Number of unique patients seen by the EP during
the reporting period (or authorized representative), who
view, download, or transmit health information.
• Threshold: greater than 5%
– 1 exclusion applies to each portion
Purdue Research Foundation 2012
Meaningful Use: Stage 2
• Imaging Results (Menu)
– Imaging results consisting of the image itself and any
explanation or other accompanying information are
accessible through CEHRT.
– Threshold: The resulting percentage must be more than 10
percent in order to meet this measure.
– 2 exclusions apply
• Family History (Menu)
– More than 20% of all unique patients seen by the EP during
the EHR reporting periods have a structured data entry for
one or more first-degree relatives
– 1 exclusion applies
Purdue Research Foundation 2012
Meaningful Use: Stage 2
• Cancer Registry (Menu)
– Successful ongoing submission of cancer case information
from CEHRT to a public health central cancer registry for the
entire EHR reporting period.
– No threshold, pass/fail
– 4 exclusions apply
• Specialized Registry (Menu)
– Successful ongoing submission of specific case information
from CEHRT to a specialized registry for the entire EHR
reporting period
– No threshold, pass/fail
– 4 exclusions apply
Purdue Research Foundation 2012
Summary
• Meaningful Use is here to stay
• Advanced stages become more
challenging
• Resources are available
– Allison Bryan
• 765-496-9791
• abryan@purdue.edu
Purdue Research Foundation 2012