2015 User Conference
Meaningful Use Overview (State of Affairs)
April 23, 2015
Presented by:
Peter Minio
Product Manager, Pediatric and Primary Care Solutions
Co-Presenter:
Cindy Malek
Training Specialist
General Session
Learning Objectives
▪ Overview of the EHR Incentive Program.
▪ Understanding of Meaningful Use stages and
which one applies to you.
▪ Know the reporting criteria.
▪ Executive summary on proposed rule for
Stage 3.
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Incentive Payment Calendar
Source: www.cms.gov
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Who is Eligible?
Under the Medicaid EHR Incentive Program
●
Physicians
●
Nurse practitioner
●
Physician Assistant (PA) who furnishes services in a FQHC or Rural
Health Clinic that is led by a PA
●
Other (Certified nurse-midwives, Dentists)
Do I qualify:
●
Have a minimum 30% Medicaid patient volume
●
Have a minimum 20% Medicaid patient volume, and is a pediatrician
NOTE: Medicaid patient volume includes individuals enrolled in Medicaid
managed care organizations, prepaid inpatient health plans, prepaid
ambulatory health plans, and Medicaid medical home programs or Primary
Care Case Management. Children's Health Insurance Program (CHIP)
patients do not count toward the threshold.
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Meaningful Use Stages
A Conceptual Approach to Meaningful Use
Source: www.cms.gov/EHRIncentivePrograms/
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Your Path to $63,750
Source: www.cms.gov
First year demonstrating Meaningful Use (Stage 1),
reporting period is 90 days.
All other years of participation, the reporting period is a
full calendar year (Jan 1 - Dec 31).
Source: www.cms.gov
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Stages: Proposed Rules
● Proposed on April 10th with a 60-day public
comment period.
● All Eligible Providers (EPs) will report on Modified
Stage 2 criteria effective immediately.
● Stage 3 criteria will be optional in 2017, but required
in 2018.
Source: www.cms.gov
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A little bit about AIU
Adopt: Acquire or install certified EHR
technology (CEHRT). Required evidence varies
by state (e.g, evidence of installation).
Implement: Begin using CEHRT (e.g., training
or initial data entry).
Upgrade: Update existing software (e.g.,
upgrade to CEHRT from a non-certified product).
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Stage 1
Source: www.cms.gov
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Stage 1: Core Measures
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Stage 1: Menu Measures
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Stage 2
Source: www.cms.gov
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Stage 2: Core Measures
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Stage 2: Menu Measures
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QIC
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Clinical Quality Measures (CQMs)
● Both MU stages share the same set of CQMs.
● Providers must select 9 CQMs from at least 3 of 6
National Quality Strategy (NQS) domains:
○ Patient and Family Engagement
○ Patient Safety
○ Care Coordination
○ Population and Public Health
○ Efficient Use of Health Care Resources
○ Clinical Processes/Effectiveness
●OP 14 is certified for 23 CQMs across 5 domains
and it includes all 9 core pediatric measures.
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OP 14 Certified CQMs
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Things to Remember about CQMs
Source: www.cms.gov
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Affecting CQMs Has Changed
● Before OP prescribed a
workflow to affect each certified
CQM.
Use of Appropriate Medications for Asthma
(p. 4 of 10)
● CQMs are now affected by a
myriad of chart elements and
complex calculations.
Source: http://ushik.ahrq.gov/
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CQM Library
How to obtain complete library of CQMs?
○ Register for a license to the Unified Medical Language System
(UMLS) at https://uts.nlm.nih.gov//license.html
○ Log in at http://ushik.ahrq.gov
Source: www.ushik.ahrq.gov
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Population Health Management Engine
Source: www.projectpophealth.org
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Reporting Period
●90-day reporting period for an EPs first year
demonstrating Meaningful Use.
●Full calendar year (Jan. 1 - Dec. 31) each
subsequent year.
●Providers must use 2014 Certified EHR Technology
(CEHRT) starting in 2015.
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Reporting Period: Proposed Rule
● Full year reporting period with several exceptions:
○ 90-day reporting period in 2015
○ In 2016 all new EPs may use a 90-day period.
○ Medicaid EPs will still be allowed to use a 90-day
reporting period.
● For 2015 ONLY: The Flexibility in Health IT
Reporting (Flex-IT) Act of 2014 (H.R. 5481)
proposed by Congresswoman Renee Ellmers of
North Carolina would allow for a 90 day reporting
periods.
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Attestation
● Participation in the Medicaid EHR Program means
you will need to submit your attestation each year
through your state.
○ More information:
■
■
■
State Contacts (e.g., attestation websites):
https://www.cms.gov/apps/files/statecontacts.pdf
Regional Extension Centers (RECs):
http://www.healthit.gov/providers-professionals/regionalextension-centers-recs
OP’s certification:
http://officepracticum.com/about/ratings-awardsaccreditations/
●After each calendar year ends, the states have a tail
period for EPs to complete their attestations (typically
60-120 days).
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Proposed Rules
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Stage 2 - Proposed Rule
●Proposed on April 10 with a 60-day public comment
period.
●Effective immediately for all EPs.
●Redundant, duplicative, or topped-out measures are
removed.
●There is no more distinction between Core and
Menu objectives with 9 remaining measures plus one
public health measure.
○ Exemption: With the remaining measures, EPs who would
have attested to Stage 1 in 2015 will be allowed to meet the
lesser of the requirements between what was defined as
2014 Stage 1 and Stage 2.
●OP 14 and OP 15 certifications will be valid through
December 31, 2017.
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Stage 2 - Proposed Rule
●Measures removed:
○
○
○
○
○
○
○
○
○
○
○
○
○
○
Problem List
Medication Allergies
Medication List
Record demographics
Record vital signs
Record smoking status
Clinical Summaries
Structured lab results
Patient List
Patient Reminders
Summary of Care
Electronic Notes
Imaging Results
Family Health History
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Stage 2 - Proposed Rule
●Remaining Objectives
○
○
○
○
CPOE
ePrescribing with formulary checking
Clinical Decision Support (CDS)
Patient Access
■ VDT threshold dropped from 5% to >=1 patient
○
○
○
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Protect Electronic Health Information (attest only)
Patient Specific Education
Medication Reconciliation
Summary of Care (outbound referral) - electronic
transmission can be DIRECT or HIE.
○ Secure Messaging ch- changed to functionality fully enabled
with no minimum threshold percentage.
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Stage 2 - Proposed Rule
●Remaining Objectives
○ Public Health Reporting - All public health measures have
been consolidated into on objective, and EPs must report
“active engagement” (rather than “ongoing submission”) for
any 2 of the following 5 (in 2015 only, EPs who would have
been Stage 1 may report 1 of 5):
■
■
■
■
Immunization Registry
Syndromic Surveillance
Case Reporting
Public Health Registry Reporting (may claim up to 3 of this
type, other than IIS)
■ Clinical (non-Public Health Agency) Data Registry Reporting
(may claim up to 3 of this type)
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Stage 3 - Proposed Rule
● Proposed to be optional in 2017, but required for all
providers starting in 2018
● Eight objectives:
○
○
○
○
○
○
○
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Protect Patient Health Information
Electronic Prescribing (eRx)
Clinical Decision Support (CDS)
Computerized Provider Order Entry (CPOE)
Patient Electronic Access to Health Information
Coordination of Care through Patient Engagement
Health Information Exchange (HIE)
Public Health and Clinical Data Registry Reporting
● Public comment due by May 29, 2015.
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Protect Patient Health Information
● Objective: Protect electronic protected health
information (ePHI) created or maintained by CEHRT
through the implementation of appropriate technical,
administrative, and physical safeguards.
● Measure:
○ Conduct or review a security risk analysis upon install or
upgrade to new Edition of CEHRT.
■ Perform risk analysis annually in subsequent years.
○ Address the security (including encryption) of data stored in
EHR.
○ Implement security updates as necessary, and correct
identified security deficiencies as part of the provider's risk
management process.
○ The practice must implement appropriate technical,
administrative, and physical safeguards.
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Electronic Prescribing (eRx)
● Objective: Generate and transmit permissible
prescriptions electronically.
● Measure:
○ More than 80 percent of all permissible prescriptions written
by the EP are queried for a drug formulary and transmitted
electronically.
■ Inclusion of controlled substances optional.
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Clinical Decision Support
● Objective: Implement clinical decision support
(CDS) interventions focused on improving
performance on high-priority health conditions.
● Measures:
○ Implement five CDS interventions related to four or more
CQMs at a relevant point in patient care for the entire EHR
reporting period.
■ If four CQMs are not related to scope of practice or
patient population, the clinical decision support
interventions must be related to high-priority health
conditions.
○ Implement drug-drug and drug-allergy interaction checks for
the entire EHR reporting period.
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Computerized Provider Order Entry (CPOE)
● Objective: Use CPOE for medication, laboratory,
and diagnostic imaging orders directly entered by any
licensed healthcare professional, credentialed
medical assistant, or a medical staff member
credentialed to and performing the equivalent duties
of a credentialed medical assistant; who can enter
orders into the medical record per state, local, and
professional guidelines.
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Computerized Provider Order Entry (CPOE)
● Measures:
○ More than 80 percent of medication orders created by the
EP during the EHR reporting period are recorded using
CPOE
○ More than 60 percent of laboratory orders created by the EP
during the EHR reporting period are recorded using CPOE
○ More than 60 percent of diagnostic imaging orders created
by the EP during the EHR reporting period are recorded
using CPOE.
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Patient Electronic Access
● Objective: Provide access for patients to view
online, download, and transmit their health
information, or retrieve their health information
through an API, within 24 hours of its availability.
● Measures:
○ For more than 80% of all unique patients seen by the EP:
■ The patient (or authorized representative) is provided
access to view online, download, and transmit their
health information within 24 hours; or
○ Provide access to clinically relevant patient-specific
educational resources to more than 35% of unique patients
seen.
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Coordination of Care
● Objective: Use communications functions of CEHRT
to engage with patients or their authorized
representatives about the patient’s care.
● Measures:
○ More than 25% of unique patients seen during reporting
period view, download or transmit their health information to
a third party.
○ Send a secure message or respond to a secure message for
more than 35% of all unique patients seen.
○ Patient-generated health data or data from a non-clinical
setting (e.g., Nutrition, PT) is incorporated into the CEHRT
for more than 15% of unique patients seen.
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Health Information Exchange (HIE)
● Objective: Provide a summary of care record when
transitioning or referring patients to another care
setting, retrieve a summary of care record upon the
first encounter with a new patient, and incorporate
summary of care information from other providers into
the EHR.
● Measures: Choose 2 of 3.
○ Create a summary of care record and electronically
exchange it for more than 50% of transitions of care and
referrals.
○ Incorporate patient information into the EHR from an
electronic summary of care document for more than 40% of
transitions or referrals received.
○ Perform a clinical information reconciliation (medications,
medication allergies, problems)for more than 80% of new
patient encounters.
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Public Health and Clinical Data Reporting
● Objective: Active engagement to submit public health
data in a meaningful way using CEHRT.
○ Active engagement means the provider is in the process of
moving towards sending production data.
■ Completed registration to submit.
■ Testing and validation.
■ Production.
●Measures: Choose any combination of three.
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Source: HIMSS
Questions
?
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We want your feedback!
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