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The Road To Meaningful UseHow Do We Get There?

HIMformatics

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Discussion Focus

About MU

How Do I Qualify?

Roadblocks

Next Steps

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About MUUnder the Health Information Technology for Economic and Clinical Health (HITECH Act), enacted under the American Recovery and Reinvestment Act of 2009 (ARRA), incentive payments are available to eligible professionals (EPs) who demonstrate meaningful use of certified electronic health records (EHR).

1. Certified clinical system (EMR/EHR)2. Health Information Exchange (HIE)3. Clinical quality reporting

Meaningful Use (MU) requires three components :

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Stages of Meaningful Use

Stage 1

Stage 2

Stage 3

Data Capture and SharingElectronically capture data in coded format as well as report health information for tracking key clinical conditions

Advanced Clinical ProcessesGuide and support care processes and coordination through the exchange of information

Improved Outcomes Achieve improved performance through the effective adoption and use of care processes as well as advance key health system outcomes

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Who is Eligible?

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Medicare Incentives for EPs

Incentive pays 75% of Medicare billings, up to the above annual cap

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Qualification Year to Avoid Adjustments

For EPs attesting in 2014 to avoid the 2015 payment adjustment, EP must attest no later than October 1, 2014, which means they must begin their 90 day EHR reporting

period no later than July 1, 2014.

Payment Adjustment Year 2015 2016 2017 2018 2019 2020

90-day EHR Reporting Period 2014

Full Year EHR Reporting Period

2013 2015 2016 2017 2018

EP (CY) who demonstrates MU in CY 2011 or 2012

Payment Adjustment Year 2015 2016 2017 2018 2019 2020

90 day EHR Reporting Period 2013 2014

Full Year EHR Reporting Period

2015 2016 2017 2018

EP who demonstrates MU in CY 2013 for 1st Time

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How much will I lose - EPs?

Payment Adjustment Year 2015 2016 2017 2018 2019 2020

EP is not subject to the payment adjustment for e-Rx in 2014

99% 98% 97% 96% 95% 95%

EP is subject to the payment adjustment for e-Rx in 2014

98% 98% 97% 96% 95% 95%

% Adjustment shown below assumes less than 75% of EPs are meaningful users for CY 2018 and subsequent years

Payment Adjustment Year 2015 2016 2017 2018 2019 2020

EP is not subject to the payment adjustment for e-Rx in 2014

99% 98% 97% 97% 97% 97%

EP is subject to the payment adjustment for e-Rx in 2014

98% 98% 97% 97% 97% 97%

% Adjustment shown below assumes more than 75% of EPs are meaningful users for CY 2018 and subsequent years

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Payment Adjustments

To Avoid Payment Adjustments in subsequent years, EPs & hospitals must

continue to demonstrate meaningful use every year

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Core and Menu Objectives

Eligible Professionals15 core objectives

5 of 10 menu objectives 20 total objectives

Eligible Hospitals & CAHs

14 core objectives 5 of 10 menu objectives

19 total objectives

Eligible Hospitals & CAHs

16 core objectives 3 of 6 menu objectives

19 total objectives

Eligible Professionals17 core objectives

3 of 6 menu objectives 20 total objectives

Stage 1 Stage 2

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Stage 1 Meaningful UseCore Requirements

# Objective Measurement

1 CPOE (computerized practitioner order entry)

More than 30% of unique patients with at least one medication order entered using CPOE(Optional: Denominator - Number of orders during the EHR Reporting Period)

2 Drug-drug and drug-allergy interaction checks

Functionality is enabled for the entire EHR reporting period

3 E-prescribing More than 40% of all permissible prescriptions written are transmitted electronically using certified EHR

4 Record demographics More than 50% of all unique patients have demographics recorded as structured data: Preferred language, Insurance type., Gender, Race, Ethnicity, Date of birth, Date and cause of death (Hospital Only)

5 Active problem and diagnosis list

More than 80% of all unique patients have at least one entry or an indication that no problems are known recorded as structured data

6 Active medication list More than 80% of all unique patients have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data

7 Active medication allergy list

More than 80% of all unique patients have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data

All 15 Core Requirements are needed to achieve Stage 1

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Stage 1 Meaningful UseCore Requirements (continued)

# Objective Measurement

8 Record vital signs More than 50% of all unique patients age 2 and over have height, weight and blood pressure recorded as structured data: Height , Weight, Blood pressure, Calculate and display BMI, Plot and display growth charts for children 2-20 years, including BMI

9 Smoking status More than 50% of all unique patients 13 years old or have smoking status recorded as structured data

10 Clinical decision support

Implement one clinical decision support rule and ability to track compliance

11 Report CMS Quality measures

6 measures from 44 (3 core, 3 selected)2013: provide aggregate numerator, denominator, and exclusions through attestationObjective is incorporated directly into the definition of a meaningful EHR user and eliminated as an objective

12 Patient copy of health information

More than 50% of all patients who request an electronic copy of their health information are provided it within 3 business days

13 Clinical summaries Clinical summaries provided to patients for more than 50% of all office visits within 3 business days

14 Exchange patient information – Removed from Requirements for 2013

Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information (Not Required for 2013)

15 Protect electronic health information

Conduct or review a security risk analysis, implement security updates as necessary, and correct identified security deficiencies as part of risk management process

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Stage 1 Meaningful UseMenu Requirements

# Objective Measurement

1 Drug formulary checks Function is enabled for the entire EHR reporting period

2 Lab test results More than 40% of all clinical lab tests results ordered for patients admitted to its inpatient or emergency department during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data

3 Patient lists Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition

4 Patient reminders More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period

5 Patient access to information

More than 10% of all unique patients are provided timely (available to the patient within 4 business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information

5 of 10 Menu Requirements are needed to achieve Stage 1, including at least one Public Health Reporting requirement

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Stage 1 Meaningful UseMenu Requirements (continued)

# Objective Measurement

6 Patient education More than 10% of all unique patients are provided patient-specific education resources

7 Medication reconciliation

Medication reconciliation is performed for more than 50% of transitions of care in which the patient is transitioned

8 Summary of care A summary of care record is provided for more than 50% of transitions of care and referrals

9 Immunization registries* Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries have the capacity to receive the information electronically)

10 Syndromic surveillance data*

Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless the public health agencies do not have the capacity to receive information electronically)

* Public health reporting requirement

Before 2014 2014 and Beyond

Complete 6 out of 44 o 3 core or 3 alternate

core o 3 menu

• Complete 9 out of 64 • Choose at least 1 measure in 3 NQS

domains* • Recommended core CQMs include:

o 9 CQMs for the adult population o 9 CQMs for the pediatric

population Prioritize NQS domains

Clinical Quality Measures (CQM)

* NQS healthcare policy domains:

1) Patient and Family Engagement

2) Patient Safety 3) Care Coordination

4) Population and Public Health

5) Efficient Use of Healthcare Resources

6) Clinical Processes/Effectiveness

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Stage 1 CQMs • EPs must complete 3 of the following core

measures (or 3 alternate core measures):• Hypertension – Blood Pressure Measurement• Preventive Care and Screening

• Tobacco Use Assessment• Tobacco Cessation Intervention

• Adult Weight Screening and Follow-up• (alt) Weight Assessment and Counseling for Children

and Adolescents• (alt) Preventive Care and Screening

• Influenza Immunization (> 50 years)• (alt) Childhood Immunization Status

• Must also complete 3 of 38 in an additional set• This is the link to the CMS CQM Site:

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures.html

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Stage 1 CQMs Examples

MeasureNumber

Clinical Quality MeasureTitle & Description

Clinical Quality MeasureDeveloper & ContactInformation

Electronic MeasureSpecifications Information

PQRI 1NQF 0059

Title: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes MellitusDescription: Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1c greater than 9.0%

National Committee forQuality Assurance (NCQA)Contact Information:www.ncqa.org

http://www.cms.hhs.gov/PQRI/20_AlternativeReportingMechanisms.asp#TopOfPage

PQRI 3NQF 0061

Title: Diabetes Mellitus: High Blood PressureControl in Diabetes MellitusDescription: Percentage of patients aged 18 through 75 years with diabetes mellitus who had most recent blood pressure in control (less than 140/80 mmHg)

NCQAContact Information:www.ncqa.org

http://www.cms.hhs.gov/PQRI/20_AlternativeReportingMechanisms.asp#TopOfPage

PQRI 64NQF 0001

Title: Asthma AssessmentDescription: Percentage of patients aged 5 through 40 years with a diagnosis of asthma and who have been seen for at least 2 office visits, who were evaluated during at least one office visit within 12 months for the frequency (numeric) of daytime and nocturnal asthma symptoms.

AMA-PCPIContact Information:cpe@ama-assn.org

http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage

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Stage 1 CQM ExamplesCertified in MOSAIQ

MeasureNumber Recommended Measure Title Recommended Measure Description

NQF0385

Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients

Percentage of patients aged 18 years and older with Stage IIIA through IIIC colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy within the 12-month reporting period.

NQF0387

Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period.

NQF0389

Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer

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Registration• Good user guide available from CMS

• http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html

• Register EP’s now!• Before an EP registers, determine

• Should they register for Medicare or Medicaid? • At this time, all EPs should be registering for Medicare

• Will they use a proxy of attest for themselves?• If they use a proxy, who will it be?• Proxy and EP must create an I&A web user account if

they don’t have one• Which Tax Identification Number (TIN) will the

incentive payment go to?

• In order to register, the provider must have an NPI and an NPPES web user account

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Reporting & Attestation• Reporting mechanism in 2012 is “Attestation

Methodology” • Attestation is via web based Medicare and

Medicaid EHR Incentive Program Registration and Attestation System Fill in numerators and denominators for meaningful

use objectives and clinical quality measures Indicate if EP qualifies for exclusions to specific

objectives Legally attest that EP has successfully demonstrated

meaningful use

• Reference for detailed requirements: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf

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Reporting & Attestation• Starting in 2014

• No longer allowed to count an exclusion toward the minimum of 5 menu objectives on which providers must report if there are other menu objectives which they can select.

• Batch reporting for groups supported• Clinical Quality Measures reported electronically for all

providers who are not in their first participation year

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Audit PreparationAudit Information

• Meaningful Use audits are a ‘when’ not an ‘if’• Retain documentation for 6 years post-

attestation• If found to not be eligible for an EHR incentive

payment, payment will be recovered• Audit trail should include:

Relevant IT systems, system configurations, roles, and processes for each MU criteria

System certification documentation (versions, certification #s, etc.)

Reports/data for each reporting period Confirmations or other communication for CMS or State

CMS reference site: http://www.cms.gov/EHRIncentivePrograms/32_Attestation.asp#10

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Potential MU RoadblocksProcess Redesign and Change Management

MU criteria reporting generally requires significant process redesign and training in addition to application enhancements.

• Added responsibility and process change for clinicians and administrative staff, such as:• CPOE• Smoking cessation counseling• Responding to patient requests for electronic copy of

health record• Providing Clinical Visit Summaries for at least 50% of

all encounters

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Potential MU RoadblocksClinical Quality Reporting

• Data capture for clinical quality measures may require substantial workflow and clinical documentation changes

• Most current electronic documentation does not capture everything needed to meet the MU measure specifications

• To achieve these measures, EPs may need to implement additional functionality

• Good news is that Stage 1 does not have any minimum thresholds

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Potential MU RoadblocksBy 2014, EPs will need a Patient Portal

• EP Objective: Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP.

• EP Measure: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP's discretion to withhold certain information.

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Road To MU SuccessThe Target Is In Sight

Meaningful Use

Next Exit

HIMformatics

Each year, EP must attest within 2-months of end of reporting period (i.e.,Feb 28)

CQMs for CY2014 must be submitted electronically if reporting second year & beyond

EP Key Dates

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CY 2013 CY 2014 CY 2015

Q1

Jan, 1, 2015• Medicare Penalties begin for

non-MU EP’s

Q2 Q3 Q4

90d90d

Tentative Plan: a 90 day period between Apr 1st – July 31st 90 Day Period for Baptist EP’s

Sep 30, 2014• Latest date to have 2014 CEHRT

in place and qualify for CY2014 incentives

Oct 1, 2014• Latest date to attest for MU &

avoid 2015 penalties• ICD-10 Deadline

Jul 1, 2014• Latest date to apply for 2015

hardship exemption• Latest date to start 90-day reporting

period & avoid 2015 penalties (must have 2014 CEHRT in place)

Jan 1, 2014• Other changes to Stage

1 criteria take effect• New CQM criteria take

effect (Stage 1 & 2)

Reporting period options for 2014 attestation

Full Year Reporting Required for 2015

Stage 2

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Get In The Driver’s SeatMU Checklist

Register with CMS https://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp

MU readiness assessment (Gap Analysis)o Completed for MOSAIQ Practiceso Will begin in February for AllScripts Practices

BHS Timelines have been identified Implement changes needed to successfully meet

Stage 1 MU Objectives (all Core and Menu activities will be required for Stage 2 with additional complexities)o Core Objectives – all 15 functionso Menu Objectives– 5 of 10 functions

Report to CMS

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Any Questions?

For MU Specific Questions:Coleman SmithHIMformaticscsmith@himformatics.com

For AllScripts Practices:Tricia JulianTricia.julian@bhsi.com

For MOSAIQ Practices:Mitchell D. ClemonsMCLEMONS@bhsi.com

Thank you for your time!

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Appendix

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Definitions

CCHIT - Certification Commission for Health Information TechnologyCPOE - Computerized Provider Order EntryEHR - Electronic Health Record; EMR - Electronic Medical RecordEH - Eligible Hospital to receive stimulus funds

MU - Meaningful Use, the term used in ARRA to describe a hospital or physician who demonstrates achievement of specific goals and can earn Medicare and/or Medicaid incentive paymentsONC - Office of the National Coordinator

EP - Eligible Professional -- one of five types of professionals legally authorized to practice their profession under state lawHIE - Health Information ExchangeHIPAA - Health Insurance Portability & Accountability ActHITECH - Health Information Technology for Economic and Clinical Health