meaningful use overview

Christopher Geer, MBAMeaningful Use Project Manager

Unity Health [email protected]

The Health Information Technology for Economic and Clinical Health (HITECH) Act

Enacted as part of the American Recovery and Reinvestment Act of 2009

Promotes the adoption and meaningful use of health information technology.

http://www.recovery.gov/About/Pages/The_Act.aspx

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First Payment Year

Payment Year

2011 2012 2013 2014 2015 2016 2017

2011Stage 1 (100%)

Stage 1 (75%)

Stage 1 (50%)

Stage 2 (25%) Stage 2 Stage 3 Stage 3

2012 Stage 1 (100%)

Stage 1 (75%)

Stage 2 (50%)

Stage 2 (25%) Stage 3 Stage 3

2013 Stage 1 (100%)

Stage 1 (75%)

Stage 2 (50%)

Stage 2 (25%) Stage 3

2014 Stage 1 (75%)

Stage 1 (50%)

Stage 2 (25%) Stage 2

2015 Stage 1 Stage 1 Stage 2

2016 Stage 1 Stage 1

“If there will be a stage 4 of Meaningful Use, we expect to update this table in the rulemaking stage 3” – CMS, Stage 2 NPRM

http://onc-chpl.force.com/ehrcert

Is your vendor certified?

Dually-eligible Hospitals can

participate in both programs

Dually-eligible providers must pick 1 program

Medicaid Program Medicare Program

Administered by the State Administered by Federal Government

No payment reductions Payment reductions begin in 2015

Adopt, Implement, Upgrade option for 1st year

Must demonstrate MU in year 1

Maximum EP incentive $63,750Maximum incentive $44,000 for EP’s

(10% bonus for EP’s in HPSAs)

Fixed incentive over 6 years (EP) and 4 years (EH) in NYS (may vary by

state)

EP incentive paid over 5 years based on 75% of net allowable charges

Require 30% (EP) and 10%(EH) minimum Medicaid volume

No minimum volume threshold

Can skip years once starting Must be done in consecutive years

Medicaid EP’s30% Medicaid Volume Required

Medicare EP’sNo Volume Requirement

Physicians Doctor of Medicine or Osteopathy

DentistsDoctor of Oral Surgery or Dental

Medicine

Certified Nurse Midwife Doctor of Podiatric Medicine

Nurse Practitioner Doctor of Optometry

Physician Assistant* Chiropractor

*Must be practicing in a Rural Health Center or Federally Qualified Health Center led by a PA.

•Must render <90% of services in an Inpatient Acute or Emergency Setting

Subsection (d) hospitals or Critical Access Hospitals in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS)

Eligible Hospital Stage 1 Stage 2

Core 14 16

Menu 10 4

Menu Required 5 2

Eligible Professional

Stage 1 Stage 2

Core 15 17

Menu 10 5

Menu Required 5 3

Yes / No Attestation

Percentage-Based Measure• Numerator / Denominator = Requirement• Possible Denominators: Unique Patients Transitions of Care Orders

There are exclusions for many of the objectives

STAGE 1EP: CORE EH: CORE

PROPOSED STAGE 2 EP: CORE EH: CORE

Requirement: 30%

Numerator: At least 1 medication order

Denominator: Unique patients with at least 1 medication in their med list

Requirement: 60 %

Numerator: Total orders entered using CPOE

Denominator: Total medication, lab, and radiology orders

Objective : Use CPOE for orders entered

STAGE 1 EP: MENU EH: MENU

PROPOSED STAGE 2 CONSOLIDATED

Enable drug formulary checks Consolidated into the eRx objective

Objective: Implement drug-formulary checks

STAGE 1 EP: CORE EH: N/A

PROPOSED STAGE 2 EP: CORE EH: MENU

Requirement: 40%

Numerator: E-prescriptions

Denominator: Prescriptions written

Requirement: EP: 65% EH: 10%

Numerator: E-prescriptions

Denominator: Prescriptions written (EH: Discharge Prescriptions)

Must be checked against at least 1 formulary

Objective: Generate and transmit permissible prescriptions electronically (eRx).

STAGE 1EP: MENU EH: MENU


Requirement: 10%

Numerator: Number of patients who are provided patient education specific resources

Denominator: Unique patients

Requirement: 10%

Numerator: Number of patients who are provided patient education specific resources

Denominator: EH: Unique patientsEP: Office Visits

Objective: Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.



Requirement: 50%

Numerator: Patients where medication reconciliation was performed.

Denominator: Transitions of care

Requirement: 65%

Numerator: Patients where medication reconciliation was performed.

Denominator: Transitions of care

Objective: The EP or EH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation

STAGE 1EP: MENU EH: N/A

PROPOSED STAGE 2 EP: CORE EH: N/A

Requirement: 20%

Numerator: Patients who were sent reminders

Denominator: Number of unique patients 65 years old or older or 5 years older or younger.

Requirement: 10%

Numerator: Patients who were sent reminders


Objective: Send reminders to patients per patient preference for preventive/follow-up care.



Requirement: 50%

Numerator: Number of patients will all elements captured


Race/Ethnicity Standard: OMB Standards

Requirement: 80 %



Race/Ethnicity Standard: OMB Standards

Objective : Record the following demographics: preferred language, gender, race and ethnicity, date of birth, and date and preliminary cause of death in the event of mortality in the eligible hospital or CAH

http://www.whitehouse.gov/omb/fedreg_1997standards/



Requirement: 80%

Numerator: Unique patients with at least 1 recorded problem, medication, medication allergy, or an indication of none.


Consolidated into the requirements for other objectives

Objectives : Maintain an up-to-date problem list, medication list, and medication allergy list



Requirement: 50%

Numerator: Number of patients with all elements captured


Requirement: 80 %

Change BMI to age 3, and eliminate height/weight age restriction



Objective: Record and chart height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 - 20 years, including BMI



Requirement: 50%

Numerator: Number of unique patients with smoking status captured


Requirement: 80 %

Numerator: Number of unique patients with smoking status captured


Objective: Record smoking status for patients 13 years old or older



Generate 1 list Generate 1 list

Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach


PROPOSED STAGE 2 REMOVED AS AN OBJECTIVE

Submit quality measures Still required to submit to be considered a meaningful user

Electronic Submission

Objective : Report quality measure to CMS or the states



1 Rule 5 Rules related to the improvement of selected quality measures

Drug-Drug / Drug Allergy Checks included as part of this objective

Objective : Implement clinical decision support rules related to specialty or high clinical priority

STAGE 1 EP: CORE EH: CORE


Enable drug-drug / drug-allergy checks

Consolidated into the Clinical Decision Support Objective

Enable drug-drug / drug-allergy checks

Objective : Implement drug-drug and drug-allergy checks



Perform Security Risk Assessment

Perform Security Risk Assessment

Objective: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

STAGE 1EP: N/A EH: MENU

PROPOSED STAGE 2 EP: N/A EH: MENU

Requirement: 50%

Numerator: Number of patients where an indication of an advance directive is entered


Requirement: 50%

Numerator: Number of patients where an indication of an advance directive is entered


Objective: Record whether a patient 65 years old or older has an advanced directive as structured data



Requirement: 40%

Numerator: Lab orders received electronically

Denominator: Lab orders

Requirement: 55%

Numerator: Lab orders received electronically

Denominator: Lab orders

Objective: Incorporate clinical lab-test results into EHR as structured data

STAGE 1EP: N/A EH: N/A


New with for stage 2 Requirement: 10%

Numerator: The number of patients who send a secure message to the provider


Objective: Use secure electronic messaging to communicate with patients on relevant health information.


PROPOSED STAGE 2 EP: MENU EH: MENU

New with for stage 2 Requirement: • 40% images captured• 10% submitted to another

provider of care

Numerator: Results accessible through the EHR

Denominator: Number of scans and tests whose result is one or more image ordered

Objective: Imaging results and information are accessible through CertifiedEHR Technology.


PROPOSED STAGE 2 EP: N/A EH: MENU


Numerator: The number of orders tracked using eMAR.

Denominator: Medication orders

Objective: Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).


PROPOSED STAGE 2 EP: MENU EH: MENU


Numerator: Patients with structured data entry for one or more first-degree relatives.

Denominator: Unique Patients

Objective Record patient family health history as structured data

STAGE 1EP: CORE EH: N/A


Requirement: 50%

Numerator: Patients provided a clinical summary within 3 business days


Requirement: 50%

Numerator: Patients provided a clinical summary within 24 hours


Expanded requirements

Objective Provide clinical summaries for patients for each office visit



Performed one test Consolidated into the summary of care objective

Objective: Capability to exchange key clinical information, among providers of care and patient authorized entities electronically



Requirement: 50%

Numerator: Number of patients where a summary of care was provided

Denominator: Number of transitions of care

Requirement: • 60% Paper or electronic• 10% electronically

Numerator: Number of patients where a summary of care was provided

Denominator: Number of transitions of care

Objective: The EP or EH who transitions their patient to another setting of care should provide summary care record for each transition of care or referral



Requirement: 50%

Numerator: Number of patients receiving their record electronically within 3 business days

Denominator: patient requests for an e-copy

At a minimum: must include Problems, medications, medication allergies, and diagnostic test results

Consolidated into the view, download, transmit objective.

Objective: Provide patients with an electronic copy of their health information upon request

STAGE 1EP: N/A EH: CORE


Requirement: 50%

Numerator: Number of patients receiving their instructions electronically

Denominator: patient requests for an e-discharge instructions


Objective: Provide patients with an electronic copy of their health information upon request

STAGE 1EP: MENU EH: N/A


Requirement: 10%

Numerator: Number of patients who have their record displayed online


At a minimum: must include Problems, medications, medication allergies, and diagnostic test results


Objective: Provide patients with timely electronic access to their health information within four business days of the information being available to the EP

EP:• Must provide information online in 4 business days• 50% of unique patients are provided their health information online• 10% of patients must access that information

Standards

Patient Name Provider name, practice Problem List

SNOMED CT Procedures

ICD-10, CPT-4 Laboratory test results

LOINC Medication list

Medication Allergy List Vital Signs Smoking Status Demographic Information Care plan field, including goals

and instructions Additional known care team

members

EP:• Must provide information online within 36 hours of discharge• 50% of unique patients are provided their health information online• 10% of patients must access that information

Standards

Admit and discharge date/place

Reason for hospitalization Providers of care Problem List

SNOMED CT Relevant past diagnosis Laboratory test results

LOINC

Medication list Medication Allergy List Vitals at discharge Demographic Information Care transition plan Discharge Instructions

Christopher Geer, MBAMeaningful Use Project Manager

Unity Health [email protected]

Questions?

meaningful use overview

Documents

menuproposed stage

coreproposed stage

naproposed stage

rulemaking stage

years ep

maximum ep incentive

qualified health center

rural health center