PowerPoint Presentation

Series 1: Meaningful Use for Behavioral Health ProvidersFrom the CIHS Video Series Ten Minutes at a Time

Module 2: The Role of the Certified Complete Electronic Health Record in Meaningful Use9/2013

Welcome to the SAMHSA-HRSA Center for Integrated Health Solutions video series Ten Minutes at a Time. This information on how to meet the standards for Meaningful Use and how to select and successfully implement an electronic health record system is organized into brief, convenient modules targeted to Behavioral Health providers. This is Series 1: Meaningful Use for Behavioral Health Providers Module 2: The Role of the Certified Complete Electronic Health Record in Meaningful Use The goal of this module is to support understanding of the relationship between implementing Meaningful Use and using the Certified Complete Electronic Health Record.1Module 2 Outline Three key terms and one requirements

Required functionality in the Certified Complete EHR

Getting help - resources for technical assistance and training

We will begin by explaining three key terms and one requirement. Then we will discuss what we mean by the required functionality that the EHR must have in order to be considered both Certified and Complete. We will conclude with resources for further technical assistance and training.

2Three Key Terms Certified for Ambulatory (Outpatient) Practice- EHR is certified for use in outpatient settings (as opposed to inpatient or hospital setting)

Complete EHR includes all of the components necessary for meeting ALL of the standards for Stage 1 Meaningful Use

Certified Passed tests by an Office of the National Coordinator Authorized Testing and Certification Body (ONC-ATCB) verifying that the EHR meets the certification criteria to use the EHR to meet the standards for Stage 1 Meaningful Use

http://www.gpo.gov/fdsys/pkg/FR-2010-07-28/pdf/2010-17210.pdf

There are two types of EHR certifications related to practice type One is for ambulatory or outpatient practice. The other is for inpatient practice in either a hospital or Community Acute Hospital setting. The vast majority of Community Behavioral Health Providers will be interested in EHRs certified for ambulatory practice. The certifying entity in Stage 1 is the Office of the National Coordinator - Authorized Testing and Certification Body (ONC-ATCBs).

In order to be considered a Complete EHR, for Stage 1 Meaningful Use, the EHR must be able to implement ALL of the Core and Menu Objectives. An EHR that is certified and complete has passed all of the tests applied by the ONC-ATCB verifying that the EHR actually has the necessary Stage 1 functionality. EHRs can also be certified as separate modules intended for specific purposes, such as ePrescribing and combined to create a complete Certified EHR.

http://www.gpo.gov/fdsys/pkg/FR-2010-07-28/pdf/2010-17210.pdf

3Meaningful Use (MU) rolled out in stages*Stage 1 MU requires EHRs certified for Stage 1 (2011 Edition)

Stage 2 MU requires EHRs certified for Stage 2 (2014 Edition)

Stages apply to qualifying for the Eligible Professional Incentive Program payments

Can start participating in Stage 1 anytime until 2016 and collect incentives for two years before continuing to Stage 2

* https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTablesforEP.pdf

and One Important Requirement

So, for a provider to meet the standards for Stage 1 Meaningful Use they must begin with an EHR that has Stage 1 certification. This is referred to as the 2011 Edition certification, the year Stage 1 started.

Stage 2 Meaningful Use will require an EHR certified for Stage 2 implementation. This is referred to as the 2014 Edition. 2014 is the year Stage 2 starts.

And finally an EHR can be certified for both 2011 and 2014 Editions, meaning it can support the implementation of both Stage 1 and Stage 2.

Keep in mind that the timelines for adopting Stage 1 and Stage 2 only apply to the Eligible Professionals Incentive Program. However, as more and more health care facilities attest to Meaningful Use, the landscape for the quality of health care will change. Behavioral Health will need to be prepared to keep up with these changes.

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTablesforEP.pdf

4Core Objectives*1. Computerized provider order entry (CPOE)2. E-Prescribing (eRx)3. Report ambulatory clinical quality measures to CMS/States4. Implement one clinical decision support rule5. Provide patients with an electronic copy of their health information, upon request6. Provide clinical summaries for patients for each office visit7. Drug-drug and drug-allergy interaction checks8. Record demographics9. Maintain an up-to-date problem list of current and active diagnoses10.Maintain active medication list11.Maintain active medication allergy list12.Record and chart changes in vital signs13.Record smoking status for patients 13 years or older14.Capability to exchange key clinical information among providers of care and patient-authorized entities electronically15.Protect electronic health information * https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EP-MU-TOC.pdf

Modules 3 and 4 in this library look closely at each of the Meaningful Use Objectives and how they can be met. We are listing them here because in order to meet each objective, the EHR has to be able to play a strong supporting role. This is a list of the required, or Core Objectives for Stage 1. Each of these has a Measure that the Eligible Professional must meet. The provider must be able to use an EHR to help them meet each of the Objectives.

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EP-MU-TOC.pdf

5Menu Objectives (may defer 5 of 10 to Stage 2)

1. Drug-formulary checks2. Incorporate clinical lab test results as structured data3. Generate lists of patients by specific conditions4. Send reminders to patients per patient preference for preventive/follow up care5. Provide patients with timely electronic access to their health information6. Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate7. Medication reconciliation8. Summary of care record for each transition of care/referrals9. Capability to submit electronic data to immunization registries/systems*10. Capability to provide electronic syndromic surveillance data to public health agencies** At least 1 public health objective must be selected.

This is the list of Menu Objectives for Stage 1. The provider has the option of selecting 5 and deferring 5 to Stage 2. In both lists, the provider does not have to meet the objective if the exclusion rule for that objective applies. For example, if the EP does not perform immunizations (Menu Objective #9) they meet the exclusion rule for that objective. This is covered in detail in Modules 3 and 4. However, providers need to be able to select from a full menu, so for Stage 1, the certified Complete EHR must meet all of the electronic specifications and requirements for each Core and each Menu objective. 6Example Certified EHR Functionality and MU Objectives/MeasuresCore Objective #5 (what the Eligible Professional needs to do)Maintain Active Medication ListMeasure: More than 80% of all unique patents seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data

Certified EHR Technology (CEHRT) Functionality Certification CriterionFinal Rule Text: 170.302(d). Maintain active medication list. Enable a user to electronically record, modify, and retrieve a patients active medication list as well as medication history for longitudinal care.

This is an example of a Meaningful Use Objective and Measure, and the corresponding EHR certification specifications and requirements. Core Objective 5 concerning the Active Medication List may seem familiar since we used it as an example in Module 1. In this slide, we are comparing the Objectives Measure requirements to the corresponding EHR certification standard. This standard says that the user has to be able to go into the EHR and record, modify and retrieve the active medication list as well as the patients medication history.

7What Certified and Complete Do NOT Mean!Certified does NOT guarantee a degree of quality Certified only assures the buyer that the software meets the minimum standards, specifications and criteria for Stage 1 Meaningful Use

Complete does not mean that the software will meet all of your organizations requirementsComplete means that the EHR will allow the eligible professional to implement the workflows and collect, access and utilize the patient data necessary to meet all 15 Core and all 10 Menu Objectives and Measures for Meaningful Use

The Office of the National Coordinator for Health Information Technology has tried to strike a balance between advancing a set of standards for care and giving both health care providers and EHR businesses the time and flexibility that they need to achieve these challenging goals. Therefore, many of the Meaningful Use and certification standards concern minimum requirements this is the least that the EP and the product have to be able to do in order to meet the standard. The term complete refers to the softwares capacity to support workflows required to meet each one of the Objectives and Measures for Meaningful Use.

8Key Differences Among Certified EHRsComplete as an EHR Business ProductScenario 1 - All of the required functionality is built into the single software product. No additional certified software modules (for example, for ePrescribing) are required. Scenario 2 - Individual software modules are certified but they have to be purchased separately and used together to make the EHR complete.

It is important to be aware that EHRs are developed, certified and then marketed in different ways. In the first scenario, all of the criteria for EHR certification are met within a single, fully integrated software system. When you buy the product you are purchasing the full set of functionality necessary to meet the minimum Meaningful Use criteria. You may need to purchase additional software to fully exploit this functionality, perhaps a lab interface for example, but the minimum functionality that is required for Meaningful Use is rolled into one product. In the second scenario, there is usually a core certified software product and then a collection of individual certified modules. These can be purchased separately or along with the core product. They can be combined to create a Certified Complete EHR.

9Key Differences, continuedRobust vs Anemic Meaningful Use FunctionalityAnemic meets minimum requirementRobust meets requirement and includes not-required but Meaningful Use applicable additional functionality

Example: Continuity of Care Record Patient data set may include data in up to 17 areas of information To meet certification criteria, the EHR only has to populate the minimum data set for 7 areas

Another key difference is varying functionality related to the standards for Meaningful Use. Some EHRs meet only the minimum standard, but other EHRs may meet the full standards. For example, communication between providers and with patients is central to Meaningful Use. The patient data sets used for communication can be very robust, with comprehensive information about the patient reported over several domains. But it does not have to be fully populated, and may contain only the minimum amount of information that is needed for certification. This data set is discussed in more detail in Module 9.10SummaryTwo basic types of certified EHRS Ambulatory and Inpatient practice types

Complete refers to EHR functionality needed for meeting ALL if the Meaningful Use Measures/Objectives

Certified refers to the successful completion of the ONC-ATCB testing process EHR

Two Stages that the EHR can be certified in Edition 1 (2011) for Stage 1, Edition 2 (2014) for Stage 2

Complete, Certified for Editions 2011 and 2014 does not indicate a level of quality, just a minimum standard for functionality

Here is a summary of things to keep in mind. Of the two basic types of certified EHRs, Behavioral Health providers almost all use the EHRs designed for Ambulatory or outpatient practice types. The EHR may be marketed as a certified core product with a set of certified modules that can be purchased separately, or as a single EHR that contains both behavioral health and Meaningful Use functionality. in both cases, the software has to be tested and certified by an ONC-ATCB for Stage 1 of Meaningful Use. Software certified for Edition 2 can be used to implement Stage 2 Meaningful Use, and software can also be certified for both Stage 1 and Stage 2. Certified does not guarantee a level of quality in the product, just a level of functionality. There are minimum standards for certification these may be all that a product actually meets. Complete does not mean the EHR is guaranteed to meet all of your business needs, just those related to Meaningful Use. And how well the EHR will be able to do even this varies from product to product. Please review Module #6 for information on Using the EHR as an Effective Tool in Meaningful Use. 11We Have Solutions for Integrating Primary and Behavioral Healthcare

Contact CIHS for all types of primary and behavioral health care integration technical assistance and training needs

1701 K Street NW, Ste 400 Washington DC 20006

Web: www.integration.samhsa.govEmail:integration@thenationalcouncil.orgPhone:202-684-7457

Prepared and presented by Colleen ODonnell, MSW, PMP, CHTS-IM for the Center for Integrated Health Solutions

Our thanks go to SAMHSA and to HRSA for providing support to the Center for Integrated Health Solutions (CIHS) for this and many other forms of training and technical assistance related to the integration of primary and behavioral health care. Please visit our web site at www.integration.samhsa.gov, email us at integration@thenationalcouncil.org, or just pick up the phone and give us a call at 202-684-7457.

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