stage 2 meaningful use - transforming into a superhero (alabama mgma)

Stage 2 Meaningful Use – Transforming into a Superhero

Adele AllisonNational Director of Government Affairs

March 2, 2012

Less Risk, More Results. That’s Success

888.879.7302 • www.SuccessEHS.com

Future of Meaningful Use – Stage 2

• Quick Overview Final Rule – Stage 1• MU - By the Numbers• Stage 2 – Infrastructure Wave • Stage 2 Proposed Measures• Practice Redesign Considerations• Questions


• Who’s the Prez?Who’s the Prez?• Who’s the Vice-Prez?Who’s the Vice-Prez?• What is law-making?What is law-making?• When a Bill is signed, it becomes an “Act.” What does that When a Bill is signed, it becomes an “Act.” What does that

mean?mean?• What is policy-making?What is policy-making?• How many cabinet positions are there?How many cabinet positions are there?• Which cabinet position is over U.S. Health Care?Which cabinet position is over U.S. Health Care?• How many agencies are under Secretary of HHS?How many agencies are under Secretary of HHS?• Who can influence policy-making?Who can influence policy-making?• Can you become involved?Can you become involved?

U.S. Government 101 – Ten Questions


The Hill• The Hill is like an ERThe Hill is like an ER

• Congress receives Congress receives 18M Postal and Postal and 313M Internet Internet Contacts/MonthContacts/Month

• Average Congressman – Average Congressman – 6,0006,000 Communications/Month Communications/Month• Average Member – Average Member – 13 Meetings/Day and Meetings/Day and 70 Hours/Week Hours/Week

• Average Staffer is Average Staffer is 2727 years old years old• Biggest Impact “Squeaking:”Biggest Impact “Squeaking:”

o 97%97% In Person Visit In Person Visito 96%96% Constituent Rep Contact Constituent Rep Contact

o 90%90% Letters Letterso 88%88% Email Emailo 86%86% Phone Phone


Legislation and Health IT• ↑↑ Freshmen than in 60 years Freshmen than in 60 years ((9696 House; House; 66 Senate) Senate)

• Priorities:Priorities:o #1 – Economy and Jobs#1 – Economy and Jobso #2 – Fiscal Budget #2 – Fiscal Budget (($3.73 Trillion $3.73 Trillion in Spending!)in Spending!)o #3 – Deficit – Super-Committee#3 – Deficit – Super-Committeeo #4 – Health Care Reform (‘Care, ‘Caid, CHIP)#4 – Health Care Reform (‘Care, ‘Caid, CHIP)

• Basics of legislative Process – An “Act” is a StatuteBasics of legislative Process – An “Act” is a Statute• Legislative Rulemaking ProcessLegislative Rulemaking Process

o Health Care Policy MakingHealth Care Policy Makingo NPRM and IFRNPRM and IFR

• EHR Vendor Rules come from ONCEHR Vendor Rules come from ONC• Provider / Hospital Rules come from CMSProvider / Hospital Rules come from CMS


The HIPAAMIPPACHIPRAARRAPPACA Era!• HIPAAHIPAA – – Electronic Transactions – 5010 / ICD-10Electronic Transactions – 5010 / ICD-10• MIPPAMIPPA – – Value-Based PurchasingValue-Based Purchasing• CHIPRACHIPRA – Extended CHIP – Extended CHIP• ARRAARRA – Meaningful Use of Certified EHRs – Meaningful Use of Certified EHRs• PPACAPPACA – Affordable Care for All Americans – Affordable Care for All Americans• ↑ ↑ Focus on Process and TechnologyFocus on Process and Technology• What systems are impacted?What systems are impacted?• How do you align disparate dates of compliance?How do you align disparate dates of compliance?• This is Herculean! Is there a map?This is Herculean! Is there a map?• CAN I RETIRE!CAN I RETIRE!


ARRA/HITECH (Generally)

• Signed 2/17/09 in Denver, CO• Purpose: Stimulate the economy through investments in

infrastructure, unemployment benefits, transportation, education, and healthcare.

• Health Care is in the Spotlight– Affordable Care Act - Health Care Reform ($828B)

– Fueling push for HIT ($54B per year savings)

– Rapid market movement and positioning

• Up to $45B for direct EHR adoption: – $20B in Medicare Incentives– $14B in Medicaid Incentives


Summing-up HITECH Goals

1. Adopt/Use Certified EHR Technology (CEHRT)2. Capture DATA3. Move DATA – Interoperability4. Report DATA – CQMs • $27B in “Carrots” - incentives:

Up to $48,400 through Medicare Up to $63,750 through Medicaid

• Stage 1 Meaningful Use = Marks 1 and 2• Stage 2 Meaningful Use = Marks 3 and 4


Meaningful Use – 3-Part Equation• 3-Part Equation for MU:

• Part 1: Certified EHR Technology – The Tool • Part 2: Implementation – Practice Reengineering / Redesign• Part 3: Support – Available, Responsive and Ongoing

ShamrockMeaningful Use of a Shamrock


Stage 1 – Objectives & Measures

• Objectives are broad spanning goals/activities• Measures are specific task(s) requirements• Meeting the measures = meeting the Objectives for that

Stage• Stage 1 MU

o 15 Core Measures required by all EP’so 10 Menu Measures from which EP’s choose 5

• 13 Exclusion Clauses – Exclusions will reduce the number of Objectives required by EP


Medicare Incentive – Stage 1 Eligible Provider Types - §495.100:

Medicare: MD, DO, DDS, DMD, DPM, OD, DC Must have PECOS Number with CMS Must register with CMS

Registration Website: cms.gov/EHRIncentivePrograms/

Year 1: 15 Core + 5 Menu Objectives/Measures for continuous 90-days

Year 2 and Beyond: Full Year of MU CY2011-13 - Must gather data, run calculations, attest and

send to CMS CY2014 and Beyond – Electronic Submission of CQMs Qualification is reviewed annually


Potential Medicare IncentivesCalendar

Year

First Calendar Year in which the EP Receives an Incentive Payment

2011 2012 2013 2014

2015 and subsequent

years – Penalties Start

2011 $18,000

2012 $12,000 $18,000

2013 $8,000 $12,000 $15,000

2014 $4,000 $8,000 $12,000 $12,000

2015 $2,000 $4,000 $8,000 $8,000 $0

2016 $2,000 $4,000 $4,000 $0

TOTAL $44,000 $44,000 $39,000 $24,000 $0Shortage Area

Totals* $48,400 $48,400 $42,900 $26,400 $0

* Providers practicing in a federally identified shortage area are eligible for a 10% increase.


Medicaid Incentives – Stage 1• Eligible Provider Types - §495.100:

– Medicaid: Physicians, Dentists, Certified Nurse Midwives, Nurse Practitioners, Physician Assistants (in FQHC/RHC led by a PA)

• EPs must meet a Medicaid volume threshold

• Year 1: Adopt, Implement, Upgrade - §495.302:– Acquire, purchase, or secure access to certified EHR technology;– Install/use certified EHR technology capable of MU; or– Expand functionality of certified EHR solution at the practice with:

• Staffing,• Maintenance,• Training, or• Upgrading from existing EHR to certified EHR technology.

• Year 2: MU for 90 continuous days• Years 3 through 6: MU for full year


Potential Medicaid IncentivesCalendar

Year

First Calendar Year in which the EP Receives an Incentive Payment

2011 2012 2013 2014 2015 2016

2011 $21,250

2012 $8,500 $21,250

2013 $8,500 $8,500 $21,250

2014 $8,500 $8,500 $8,500 $21,250

2015 $8,500 $8,500 $8,500 $8,500 $21,250

2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,2502017 $0 $8,500 $8,500 $8,500 $8,500 $8,5002018 $0 $0 $8,500 $8,500 $8,500 $8,5002019 $0 $0 $0 $8,500 $8,500 $8,5002020 $0 $0 $0 $0 $8,500 $8,5002021 $0 $0 $0 $0 $0 $8,500

TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750



• Quick Overview Final Rule – Stage 1

• MU - By the Numbers• Stage 2 – Infrastructure Wave • Stage 2 Proposed Measures• Practice Redesign Considerations• Questions


Meaningful Use – State of the Union • Active Registrations

o Hospitals → 3,247o Medicare Eligible Providers → 132,445o Medicaid Eligible Providers → 55,912

• Medicare EP Stage 1 Attestation → $412,866,000

• Medicaid EP Year 1 Attestation → $384,628,458

YTD Eligible Professionals – Year 1 Payments4,550 Internal Med. 4,896 Family Med. 1,652 Cardiology 388 OB/Gyn 1,031 Gastro

757 Urology 534 Nephrology 738 Gen’l Surgery 837 Orthopedics 569 Neurology

4,960 Other

YTD Eligible Professionals – Year 1 Payments13,652 Physicians 3,176 Nurse Prac. 401 Mid-Wives 887 Dentists 203 Physician Asst.


Meaningful Use – State of the State (AL)• Hospitals / Inpatient

o Type: Acute Care, Hospice, Skilled Nursing, Swing-Beds

o Medicaid Medicaid → → 1 ($3,431,698)1 ($3,431,698)o Medicaid/Medicare Medicaid/Medicare →→ 63 ($54,645,766)63 ($54,645,766)

• Eligible Providers Registeredo 2,185 Medicare EPso 1,245 Medicaid EPs

• Eligible Providers Paido Medicare Stage 1 → 293 ($5,274,000)o Medicaid Year 1 → 764 ($16,022,510)

• Moving Datao One Health Record (HIE)o State Immunization Registry (AL-IIS)



• Quick Overview Final Rule – Stage 1• MU - By the Numbers

• Stage 2 – Infrastructure Wave • Stage 2 Proposed Measures• Practice Redesign Considerations• Questions


Since Stage 1 Final Rule – July, 2010

• ONC - Exit Dr. Blumenthal, Enter Dr. Farzad Mostashari • Stage 2 – Workgroups• Rapid Market Positioning in HC Orgs• New Payment Models Developing

– CMMI → ACOs– PQRS → Value-Based Modifiers– Bundled Payments → Revenue Cycle Mgmt (RCM) and Enterprise

Resource Planning (ERP)– Value-Based Purchasing

• State Initiatives Challenged (RECs, HIEs)• Enter the iPad clinicians’ companion device• ONC adopting HIE transport standards – Direct, XDS, Exchange• Industry Hungry for Data


Stage 2 Meaningful Use – HIE

• ONC Considers Stage 2 the “Infrastructure Wave”ONC Considers Stage 2 the “Infrastructure Wave”o Seeking Seeking ProductionProduction HIE HIEo HIE across organizations and vendor boundariesHIE across organizations and vendor boundaries

• Transport Standards AnnouncedTransport Standards Announcedo DirectDirect (Push of information to a known recipient) required (Push of information to a known recipient) required

Optional use of Query/Retrieve HIEOptional use of Query/Retrieve HIE

o Standards Consensus Standards Consensus announcedannounced Specifically noted SNOMED, LOINCSpecifically noted SNOMED, LOINC

• Seeking production Registry reporting for Public Health – Seeking production Registry reporting for Public Health – noting noting immunizationsimmunizationso Optional Menu Measure – State Cancer RegistriesOptional Menu Measure – State Cancer Registrieso Optional Menu Measure – Specialty RegistriesOptional Menu Measure – Specialty Registries


Certified EHR Technology• Redefining “Certified EHR Technology” (CEHRT)Redefining “Certified EHR Technology” (CEHRT)

o For the 2011 Edition (Stage 1) – CEHRT meant provider had For the 2011 Edition (Stage 1) – CEHRT meant provider had adopted EHR that met adopted EHR that met ALLALL 25 Stage 1 measures 25 Stage 1 measures

o For 2014 Edition (Stage 2) For 2014 Edition (Stage 2)

BASIC EHR – Everyone must have; “fundamental set of criteria;” Statutorily defined

BASIC CORE EHR – EHR is certified for Core measures sought for the Stage sought by EP; Addresses specialists E.g., Psychiatrist does not do vitals = no certified vitals product required

CORE

MENU

MENU EHR – Most dynamic; Only certified for that sought by EP for Stage sought


Since Stage 1 – Timelines

• HITPC → Recommendations to CMS June 16th • ONC NPRM for Vendors (Certification) → Feb. 22nd • CMS NPRM for Providers → Feb. 22nd – Final Rule June / July,

2012• 5 Categories for Stage 2::

o Static Measureso Menu Measures Converted to Coreo Expansion of Stage 1 Thresholds and Scopeo New Stage 2 Measureso Removed / Consolidated Measures

• Changes to Stage 1 Proposed in NPRM• Possible Stage 4 Noted


Meaningful Use – Stage 2Timing• Providers Reporting Period – Calendar YearProviders Reporting Period – Calendar Year• 3 Stages Original Roadmap:3 Stages Original Roadmap:

• CMS Propose Meaningful Use Road Map:CMS Propose Meaningful Use Road Map:

First Payment Year

Payment Year2011 2012 2013 2014 2015

2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3

2012 Stage 1 Stage 1 Stage 2 Stage 3

2013 Stage 1 Stage 2 Stage 3

2014 Stage 1 Stage 3

2015 Stage 3

First Payment Year

Stage of Meaningful Use2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

2011 1 1 1 2 2 3 3 TBD TBD TBD TBD2012 1 1 2 2 3 3 TBD TBD TBD TBD2013 1 1 2 2 3 3 TBD TBD TBD2014 1 1 2 2 3 3 TBD TBD2015 1 1 2 2 3 3 TBD2016 1 1 2 2 3 32017 1 1 2 2 3


Proposed Stage 1 Changes – CY2013• CPOE DenominatorCPOE Denominator

o Currently: Currently: # of Unique Patients with 1 Rx seen by EP# of Unique Patients with 1 Rx seen by EPo ““Alternative”:Alternative”: # of orders for Rx during EHR Reporting Period # of orders for Rx during EHR Reporting Periodo CY2013 CY2013 →→ EPs can use eitherEPs can use eithero CY2014 CY2014 →→ New Denominator OnlyNew Denominator Only

• Vitals Exclusion ClauseVitals Exclusion Clauseo Currently: Currently: BP and Height/Weight not relevantBP and Height/Weight not relevanto ““Alternative”:Alternative”: EP can split to exclude 1 only EP can split to exclude 1 onlyo CY2013 CY2013 → → EPs can use eitherEPs can use eithero CY2014 CY2014 →→ New Denominator OnlyNew Denominator Only

• Vitals Age RequirementsVitals Age Requirementso Currently: Currently: See no patients age 2+See no patients age 2+o ““Alternative”:Alternative”: Sees no patients age 3+ Sees no patients age 3+o CY2013 CY2013 →→ EPs can use either EPs can use eithero CY2014 CY2014 →→ New Denominator OnlyNew Denominator Only


Proposed Stage 1 Changes – CY2013• Test of Exchanging Key Clinical InformationTest of Exchanging Key Clinical Information

o Proposed: Proposed: Remove from Stage 1 in 2013; actual submission in 2014Remove from Stage 1 in 2013; actual submission in 2014o Alternative 1: Require a successful testAlternative 1: Require a successful testo Alternative 2: Remove, but require Rx Reconciliation or Summary of Care Alternative 2: Remove, but require Rx Reconciliation or Summary of Care

for TOC and referralsfor TOC and referralso Alternative 3: Change to 1 case of actual transmission for real patient for Alternative 3: Change to 1 case of actual transmission for real patient for

TOC or referralTOC or referral

• 2 Measures 2 Measures →→ Making Info Electronically Available and Making Info Electronically Available and Timely Electronic AccessTimely Electronic Accesso 2014 Edition Vendor Certification = obsolete2014 Edition Vendor Certification = obsoleteo Proposed: Proposed: CY2014 Stage 1 EP must replace with Stage 2 measure of Patient CY2014 Stage 1 EP must replace with Stage 2 measure of Patient

View and DownloadView and Download

• Submission of CQMs Eliminated and Incorporated into Submission of CQMs Eliminated and Incorporated into definition of “Meaningful EHR User”definition of “Meaningful EHR User”

• Encouraging submission of Immunization Data even if not Encouraging submission of Immunization Data even if not state requiredstate required



• Quick Overview Final Rule – Stage 1• MU - By the Numbers• Stage 2 – Infrastructure Wave

• Stage 2 – Proposed MeasuresProposed Measures• Practice Redesign Considerations• Questions


ONC Original HIE Vision

Medicaid

Individual Facilities

NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE

OtherCommunityProviders

PhysicianOffices

ExternalData Source

ExternalData Consumer

ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

Hospital

PrivateHIE

PhysicianOffices

PhysicianOffices

PhysicianOffices

Personal HealthRecord System

Private HIE (Hosp)

PhysicianOffices

Hospital OtherCommunityProviders

MiHIN Conceptual Architecture

Query forDocuments

Service

StandardProtocols

LocalProtocols Local

Protocols

EMPI/RLS StandardProtocols

StandardProtocols

(Paid Connection)

StandardProtocols

(Paid Connection)StandardProtocols

StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse

MiHIN Backbone Provides:Infrastructure ServicesSecurity ServicesData ServicesTransactional Services

Standard Protocols Include:Level 4: Transaction PackagesLevel 3: Nomenclature StandardsLevel 2: Message StandardsLevel 1: Security Standards

MessagingGateway

Public ServiceRegistry

Payers

ProviderIndex

MedicationManagementPharmacies

State Agencies

Private HIE

NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

Hospital

PrivateHIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols


StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse



MessagingGateway


Payers

ProviderIndex


NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

Hospital

PrivateHIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols


StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse



MessagingGateway


Payers

ProviderIndex


Health Information Organizations Inter-State

NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

Hospital

PrivateHIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols


StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse



MessagingGateway


Payers

ProviderIndex


Public Health

Corrections

Fed Agencies

Other States

MD Office

MD Offices

Hospital (CAHs)

Hospital

Other Community Providers




Medicaid


NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

Hospital

PrivateHIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols

EMPI/RLSStandardProtocols

StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse



MessagingGateway


Payers

ProviderIndex


State Agencies

Private HIE

NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

HospitalPrivate

HIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols


StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse

MiHIN Backbone Provides :Infrastructure ServicesSecurity ServicesData ServicesTransactional Services


MessagingGateway


Payers

ProviderIndex


NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

Hospital

PrivateHIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols


StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse



MessagingGateway


Payers

ProviderIndex



NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

HospitalPrivate

HIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols


StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse



MessagingGateway


Payers

ProviderIndex


Public Health

Corrections

Fed Agencies

Other States

MD Office

MD Offices

Hospital (CAHs)

Hospital


Dr. Smith

Rural Health

Emergency

Urban Center

Query Retrieve

Billy Bob

RHIO

ONC Standard

ONC Standard

XDSXDSUse Case: Car Wreck

Alabama One Health Record


Alabama One Health Record



Medicaid


NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

Hospital

PrivateHIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols


StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse



MessagingGateway


Payers

ProviderIndex


State Agencies

Private HIE

NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

HospitalPrivate

HIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols


StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse



MessagingGateway


Payers

ProviderIndex


NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

Hospital

PrivateHIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols


StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse



MessagingGateway


Payers

ProviderIndex



NHIN

MiHIN Backbone

CommunityHIE

CommunityHIE


PhysicianOffices

ExternalData Source


ReferenceLabs

Hospital

SecurityServices

PublicHealth

ReportingService


PhysicianOffices

HospitalPrivate

HIE

PhysicianOffices

PhysicianOffices

PhysicianOffices


Private HIE (Hosp)

PhysicianOffices



Query forDocuments

Service

StandardProtocols


Protocols


StandardProtocols

(Paid Connection)

StandardProtocols


StandardProtocols

StandardProtocols

(Paid Connection)

DataWarehouse



MessagingGateway


Payers

ProviderIndex


Public Health

Corrections

Fed Agencies

Other States

MD Office

MD Offices

Hospital (CAHs)

Hospital


Dr. Smith

Internist

Dr. Heart

Cardiologist)

Consult Referral

Consult Report

Betty Lou

Use Case: Arrythmia

ONC Standard

ONC Standard

DIRECTDIRECT


Stage 2 Measures – 17 Core 17 Core Objectives

No. Objective Measure Threshold

New, Revised,

Expanded, or Unchanged

Exclusion

1 Computerized Provider Order Entry (CPOE)

Use CPOE for medication, lab and radiology orders entered by any professional permitted by law

60% (↑ from 40%) ExpandedEP has < 100 Rx, lab, radiology orders collectively

2Generate and Transmit

Permissible Prescriptions Electronically

Using a certified EHR technology and compared to at least 1 drug formulary (still excludes controlled substance [Sch. II-V] and OTC)

65% (↑ from 40%) Expanded

EP writes < 100 Rx; or,

No pharmacy w/in 25 miles of the practice

3 Record Patient Demographics

Gender, race, ethnicity, DOB, and preferred language as structured data

80% (↑ from 50%) ExpandedNone

4 Record Vital Signs and Chart Changes

Height & weight (all ages), blood pressure (ages 3+), BMI (all ages), and growth charts for children (0-20) as structured data

80% (↑ from 50%) Revised

No pts. age 3+ Ht., Wt., BP

irrelevant BP only

irrelevant

5 Record Smoking StatusPatients age 13 and older as structured data

80% (↑ from 50%) ExpandedEP does not see pts. age 13+


Stage 2 Measures – 17 Core

17 Core Objectives

No. Objective Measure Threshold

New, Revised, Expanded,

Consolidated or Unchanged

Exclusions

6 Implement Clinical Decision Support and Track Compliance

Implement CDS to improve on high-priority condition:1.5 CDS interventions for 5 or more CQMs during entire reporting period; and2.Enable drug-drug and drug-allergy checks for entire reporting period.

5 Rules and Rx alerting by attestation

Expanded / Consolidated

None

7 Provide Patients with Clinical Summaries

For each office visit to patients within 24 hours, which includes up-to-date lists of problems, medications and Rx allergies (paper and electronic must be avail. to pt.)

50% (Unchanged)Expanded /

Consolidated

EP has no office visit during EHR reporting period

8Implement Systems to Protect Privacy and Security of Patient

Data

Conduct/review a security risk analysis; implement security updates as necessary and correct security deficiencies; encrypt data at rest in accordance with 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3)

During Reporting Period by

attestationExpanded

None

9 Incorporate Clinical Lab Test Results into EHR

Incorporated as structured data – positive/negative or numerical format – within the EHR

55% (↑ from 40% and made Core)

Expanded

EP orders no lab tests during EHR reporting period

10 Generate Lists of Patients by Condition

1 List with a Specific Condition for use in quality improvement, reduction of disparities, research or outreach

By attestation (Made Core)

Unchanged None

11 Send Reminders to PatientsPreventative and follow-up care for all patients based on clinically relevant info for anyone with an OV in past 24 months

10% (↓ from 20%, all patients and

Made Core)Expanded

EP has no office visit in previous 24 months


Stage 2 Measures – 17 Core 17 Core Objectives

No. Objective Measure ThresholdNew, Revised,

Expanded, Consolidated or

Unchanged

Exclusions

12 Timely Electronic Access to Health Information

Patients can view online, download and transfer info within 4 days of being available to EP, subject to EPs discretion to withhold certain info

1. 50% of all pts., and

2. 10% of pts. accessNew

EP has no orders / creates info required

>50% visit in county with >50% with 4Mbps broadband avail.

13 Use EHR for Patient-Specific Education Resources

Provide patient-specific education resources to all patients

10% (Unchanged but made Core and “if

appropriate removed)

Expanded

EP has no office visit during EHR reporting period

14 Perform Medication Reconciliation

During transitions of care (TOC)65% (↑ from 50% and Made Core) Expanded

EP not recipient of any TOC during EHR reporting period

15 Provide Summary of Care Record

Patients referred or transitioned to another provider or setting and electronically transmit to a different system.

1. 65% of TOC or referrals (↑ from 50% and made core)

2. 10% electronically transmitted

Expanded; New

EP neither transfers nor refers patient during EHR reporting period


Stage 2 Measures – 17 Core

17 Core Objectives


Expanded, Consolidated or Unchanged

Exclusions

16 Use of secured messaging with Patients

Send secured messages to patients seen during reporting period

10% NewEP has no office visit during EHR reporting period

17Submission of Electronic

Immunization Data to Registry/Information

Systems

Ongoing submission

During Entire EHR Reporting Period (Made

Core)

Expanded

EP does not admin. immunizations,

No electronic registry available*

No registry that accepts CEHRT standards available*

*Exclusion does not apply if the registry can accept data through a designated HIE.


Stage 2 Measures – 3 of 5 Menu

3 of 5 Menu Objectives


Expanded, Consolidated or

Unchanged

Exclusions

1 Submission of Electronic Syndromic Surveillance Data

Ongoing data submission to Public Health agencies (where agencies can accept electronic data)

During Entire EHR Reporting Period Expanded

EP does not collect any data,

No electronic registry available*

No registry that accepts CEHRT standards available*

2 Imaging Results and Information

Are accessible through the CEHRT 40% New

EP does not perform diagnostic interpret. Of scans/test whose result is an image during reporting period

3 Patient Family Health History

Structured data entry for one or more first-degree relatives

20% NewEP has no office visits during reporting period

4 Submission of Cancer CasesOngoing data submission to a state cancer registry

During Entire EHR Reporting Period New

EP does not diagnose or directly treat CA

No public health agency is capable of receiving data

5 Submission of Specialized Cases

Ongoing data submission to a specialized registry

During Entire EHR Reporting Period New

EP does not diagnose or directly treat CA

No public health agency is capable of receiving data

*Exclusion does not apply if data can be accepted through a designated HIE


Clinical Quality Measures (CQMs)• Removed as MU Measure Removed as MU Measure – Now Part of Definition of – Now Part of Definition of

“Meaningful EHR User”“Meaningful EHR User”• Proposing Group Reporting OptionProposing Group Reporting Option• 1212 CQMs require, CQMs require, 33 reporting options proposed reporting options proposed

o 1212 CQMs from comprehensive table ( CQMs from comprehensive table (125125 CQMs), 1 each of each 6 CQMs), 1 each of each 6 domains, ordomains, or

o 1111 “Core” CQMs + “Core” CQMs + 11 “Menu” from comprehensive table, or “Menu” from comprehensive table, oro Participation in Participation in EHR-based PQRS EHR-based PQRS = = CQMsCQMs and and Bonuses for Both Bonuses for Both MU MU

and PQRSand PQRS• Eliminating Eliminating 33 CQMs starting CY2014 CQMs starting CY2014

o NQF #0013 BP Management – lacks NQF continued endorsementNQF #0013 BP Management – lacks NQF continued endorsemento NQF #0027 Smoking & Tobacco Cessation – duplicates NQF #0028 a and bNQF #0027 Smoking & Tobacco Cessation – duplicates NQF #0028 a and bo NQF #0084 Heart Failure – lacks NQF continued endorsementNQF #0084 Heart Failure – lacks NQF continued endorsement

• 22 Oral Health Measures Added Oral Health Measures Added



• Quick Overview Final Rule – Stage 1• MU - By the Numbers• Stage 2 – Infrastructure Wave• Stage 2 – Proposed Measures

• Practice Redesign Considerationsonsiderations• Questions


Assessment – “You Are Here”• Clinic Culture Prep

– Think about Users and Roles– Create a Vision Statement– Identify Leadership (Formal / Informal)– Communicate Plans

• Workflow AssessmentAssessment – Identify sources of: – Identify sources of:– Assessment Worksheet– Inefficiency / Delay / DDuplicationuplication– Risk / Liability / Non-Compliance (e.g. HIPAA)Non-Compliance (e.g. HIPAA)– Quality concerns– High costs


IT Vendor and Practice Redesign• Compliant and certified as Complete EHR Software?• Senior Leadership and Staff – Ongoing Awareness & Understanding

• Helps Identify Champions – Formal and Informal

• Assists with Key Partner Collaboration– Network / Hardware Vendor– Lab Interfaces– Immunization Interface– HIE Interface

• HIPAA Compliance – Datacenter?

• Implementing New Technologies− Patient Portal, CDS, Formulary Management, HIE, Structured Knowledge Management, HIE, Structured Knowledge

Base, etc.− IT Needs such as iPads, Smartphones, Business Continuity PlansBusiness Continuity Plans


Practice Redesign

• Plot Data Collection Considerations / Workflows• Must be consistent• Like CDS - Identifying the “5 Rights” in Workflow

• Right Information• Right Person Collecting• Right Format• Right Channel (e.g. EHR, Portal, PM)• Right Time in Workflow

• Consider Data Needs – E.g., Outreach, PCMH, Outreach, PCMH, Productivity,Productivity, Health Disparities Reduction, Research, Health Disparities Reduction, Research, Grant WritingGrant Writing


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