Meaningful Use
Indiana Association for Health Care Quality,
May 2013
What’s all this Meaningful Use stuff?
The Compelling Why…..of HITECH
Why does America need to
modernize using Health IT?
What is America doing to modernize its
Healthcare System through Health IT?
• Enable providers to securely
Showing
Outcomes
and efficiently exchange
patient health information.
Engaging
• Give providers the right
Consumers
information, at the right time
Promoting
to offer their patients the
Exchange
right care.
Keeping
• Give consumers tools to
Protecting Patients
Safe
know their health information
Privacy
Accelerating
and
so that they can improve
Meaningful
Security
their health.
Use
• Foundational to building a
truly 21st century health
system where we pay for the
right care, not just
Source:
2012
more care.
Doug Fridsma, MD, Chief Science Officer,
Director, Office of Science & Technology,
ONC
3
2009 Hitech Act-ARRA
 The Hitech Act of the American Recovery & Reinvestment Act (ARRA)
was signed into law by President Obama in Feb. 2009
“It's an investment that will take the long overdue step of computerizing America's
medical records, to reduce the duplication and waste that costs
billions of healthcare dollars and medical errors that cost thousands of lives
each year. ... We have done more in 30 days to advance the cause of healthcare reform than this country has done in an entire decade.“
February 17, 2009
 Appointed the Center for Medicare & Medicaid (CMS) to govern the
clinical side of the program
 The Office of the National Coordinator (ONC)
governs the technical side: certification of
the EHR at the code level.
 Both sets of guidelines must be met to qualify for MU
 Stage One Guidelines: Released July 2010.
 Stage Two Guidelines: Preliminary Release
Feb. 2012, Final Release: Aug, 2012
2009 Hitech Act-ARRA
 Three progressive stages of “meaningful use” over next 5+
years
– Stage 1: Capture and track basic data, communication and
coordination, sets stage for electronic quality reporting
– Stage 2: Quality improvement at the point of care, clinical
data exchange
– Stage 3: Advanced clinical decision support to promote
safety, quality and efficiency (e.g. national high priority
conditions, patient access to self‐management tools,
comprehensive patient data and improving population
health)
 Medicare $$ Incentives: payment for “Meaningful Use”(MU) of
an electronic health record (EHR)-by Hospital or Physician
 Medicaid $$ Incentives: Demonstrate “AIU” -Adoption,
Implementation, Upgrade (first year only), or “Meaningful Use”
Eligibility
 Medicare Fee for Service, Medicare Advantage and
Medicaid providers
 Eligible Professionals (EP) include: Doctors of Medicine or
Osteopathy, Dentists, Podiatrists, Optometrists and
Chiropractors. Medicaid also includes NPs, Certified Nurse
Midwives & PAs.
 Hospital based EPs are not included (90% or > services
are provided on an Inpatient or ED setting).
 Eligible Hospitals include: Acute Care Hospitals and
Critical Access Hospitals, including Emergency
Departments(pts being admitted or in an extended
Observation status).
The Carrot….
•Eligible Providers:
•Medicare Incentives: ~$44K/eligible provider/5 years
•Medicaid Incentives: ~$64K/eligible provider/6 years
…….and the Stick
•Hospitals: Incentive calculated based on cost reporting to CMS
•After 2015, Medicare penalties for Hospitals and EPs
Health Outcomes Priorities
• Improve quality, safety, efficiency
and reduce health disparities
• Engage patients and families in their
health care
• Improve care coordination
• Improve population & public health
• Ensure adequate privacy and security
protection of personal health information
Final Rulings-Stage 1
 Stage 1:
 1st Submission-90 days of data
 2nd submission-12 consecutive
months
 Mandatory Core Measures-15 for
Eligible Providers, 14 for Hospitals
 Menu Set-10 to choose from; 5 deferred
until Stage II.
 Total reporting requirements:
 Eligible Providers: report on 20 of 25
MU Measures.
 Hospitals: report on 19 of 24 MU
Measures.
Stage 1 Core Measures-Mandatory
CPOE-1 med order
>30%
Hospital & Provider
ePrescribing-I med order
>40%
Provider
ON
Hospital & Provider
Problem List
>80%
Hospital & Provider
Medication List
>80%
Hospital & Provider
Medication Allergy
>80%
Hospital & Provider
Vital Signs: Ht, Wt, BP, >2yo
>50%
Hospital & Provider
Smoking Status, 13yo
>50%
Hospital & Provider
Demographic Data
>50%
Hospital & Provider
Drug/Drug, Drug/Allergy Checks
Stage 1 Core Measures-Mandatory
eCopy of Record, w/in 3 days
>50%
Hospital & Provider
Clinical Decision Support Rule
1
Hospital & Provider
E-Copy of Discharge Instruction
>50%
Hospital
Provide Clinic Summary
>50%
Provider
Information Exchange
1 test
Hospital & Provider
Protect Pt Info, Security Analysis
Conduct Hospital & Provider
Quality Measures: VTE, Stroke, ED
15
Hospital
Quality Measures: 3 core/3 menu +
38 options
6
Provider
Stage 1 Menu Measures-5 Optional
Incorporate Clinical Lab Results
Patient List
>40%
Hospital & Provider
1
Hospital & Provider
Patient Reminders
>20%
Provider
Pt Access to Information: 4days
>10%
Provider
ID Patient Education Needs
>10%
Hospital & Provider
Medication Reconciliation
>50%
Hospital & Provider
On
Hospital & Provider
Transfer Summaries
>50%
Hospital & Provider
Record Advanced Directives
>50%
Hospital
Drug Formulary Checks
Submit Syndromic Data to SDOH
Test
Hospital & Provider
Submit Lab Data to SDOH
Test
Hospital
Submit Immunizations to SDOH
Test
Hospital & Provider
What’s Coming with Stage 2?
• Goes into effect October 1, 2013.
• Thresholds and complexity increases
• Second year added to stage 2 with a
90 day quarterly measurement period;
no change in payment model
• 2015 Payment adjustments confirmed
(complete attestation by Oct 2014 to
avoid penalties)
• Hospitals-Report on 19 out of 22 measures
EPs-Report on 20 out of 23 measures
What’s Coming with Stage 2?
• Focus on Patient Engagement-Portal
access; view, download or transmit
• Exclusions will not count toward Menu
Items
• Batch reporting for EPs
• CPOE changes in denominator,
addition of radiology and labs
• Addition of electronic notes, capturing
care team, functional and cognitive
status in the summary or care.
• Better Alignment of Quality measures against other
CMS requirements: ACO, PQRS, CHIPRA etc
The Details
Core Objective
Labs
Measure
Hospital/Provider
Use of CPOE for >60% of medications, 30%
Hospital/Provider
of Laboratory and 30% of radiology
E-Prescribing for >50%
Provider
Record demographics for >80%
Hospital/Provider
Record Vital Signs for >80%
Hospital/Provider
Record Smoking Status for >80%
Hospital/Provider
Implement 5 clinical decision support
Hospital/Provider
interventions + drug/drug and drug/allergy
Incorporate lab results for >55%
Hospital/Provider
Patient Lists
Generate patient lists by specific condition
Hospital/Provider
Preventive Reminders
Use the EHR to identify and provide
reminders for preventive/follow-up care for
>10% of pts with 2 or more office visits in
last 2 years.
Provider
CPOE
e-Prescribing
Demographics
Vital Signs
Smoking Status
Interventions
The Details
Core Objective
eMar
Measure
Implement eMar and use for > 10% of
medication orders (bar code med admin)
Hospital/Provider
Hospital
Patient Access
Provide online access to health information for
> 50% with >5% actually accessing
Hospital/Provider
Visit Summaries
Provide office visit summars for >50% of office
visits
Provider
Education Resources
Use the EHR to identify and provide education
resources for >10% of the patients
Hospital/Provider
Secure Messages
Meds Reconciliation
Summary of Care
>5% of patients send secure messages to the
EP
Medication Reconciliation is completed at >
50% of the transitions of care
Provide Summary of Care Document for >50%
of the transitions of care and referrals with 10%
sent electronically and at least 1 sent to
recipient with a different EHR vendor
Provider
Hospital/Provider
Hospital/Provider
The Details
Core Objective
Measure
Immunizations
Successful ongoing transmission of
immunization data
Hospital/Provider
Ongoing submission of reportable lab
results
Hospital
Ongoing submission of electronic
syndromic surveillance data
Hospital
Conduct or review security analysis and
incorporate risk management process
Hospital/Provider
Labs
Syndromic Surveillance
Security Analysis
Hospital/Provider
The Details
MENU Objective
Hospital/Provider
Family History
Measure
Enter an electronic progress note for >30% of
unique patients
>10% of discharge medication orders are
e-prescribed
>20% of imaging results are accessible through
the certified EHR
Record family health history for >20%
Advanced Directives
Record AD for >50% of patients 65yo or older
Hospital
Labs
Provide structured lab results to EPs for >20%
Hospital
Progress Notes
E-Prescribing
Imaging Results
Syndromic Surveillance
Cancer Registry
Specialized Registry
Ongoing submission of electronic syndromic
surveillance data
Successful ongoing transmission of cancer case
information
Successful ongoing transmission of data to a
specialized registry
Hospital/Provider
Hospital
Hospital/Provider
Hospital/Provider
Provider
Provider
Provider
Other Related Initiatives;
Similar…..but not quite!
• ICD-9 vs ICD-10
-DEADLINE OCTOBER 2014
-Dx Codes: from 14,315 to 69,099 (483%)
-Px Codes: from 3,838 to 71,957 (1875%)
Angioplasty-Moving from 1 code to 854 codes based
on site, device & approach!
• Value Based Purchasing
• Medical Home
• Impact of Hospital Acquired Conditions
• Payment cuts for readmissions
• PQRI
• ePrescribing
• Bundled payments
• Quality Bonus Payments for Medicare Advantage
• Accountable Care Organization Mandates……..
Take Home Concepts
 Meaningful Use and EHR adoption is a clinical
care initiative supported by IT, not an IT
program. It will forever change how we provide
service to our patients.
 Our success or failure will depend in great part
on our ability to define and standardize our best
practice clinical workflows throughout our
system.
 Physician and clinical operation’s leadership will
be crucial in each clinic’s, service line’s and
facility’s success or failure.
Resources
• CMS Attestation resources (including Calculator) available at:
http://www.cms.gov/EHRIncentivePrograms/32_Attestation.asp#TopOf
Page
• Beginners guide for MU at:
https://www.cms.gov/EHRIncentivePrograms/Downloads/Beginners_G
uide.pdf
• http://www.cms.gov/EHRIncentivePrograms
• http://healthit.hhs.gov
• www.himss.org/economicstimulus
• http://www.himss.org/ASP/topics_meaningfuluse.asp
• Payment Webpage:
https://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp#TopOfP
age
So, in a nutshell………
Thank You
Kathy Mathena, MSN, RN
Executive Director, Clinical Information
Systems
KMathena@iuhealth.org
Office: 317-963-7854