Transcript Realizing the Promise of Health IT for Behavioral

www.TheNationalCouncil.org
National Council
for Behavioral Health
Hill Day
Realizing the Promise of Health IT for
Behavioral Health
Michael R. Lardiere,LCSW
VP HIT & Strategic Development
September 16, 2013
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
This presentation at a glance
 Role of data in the healthcare system of the future
 How will information be used and data shared under





health reform
Using Data for Population Management
Health Information Exchange/DIRECT Secure Messaging
Meaningful Use – opportunities now
Meaningful Use – Opportunities in the Future
Strategies to Position your Organization
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
Innovations under CMS
• Payment reform; fundamental shift
•
•
•
•
•
away from fee-for-service
Delivery system reform: encourage
reorganization of system to take out
waste and deliver high‐value care
Different opportunities for providers
based on readiness
Strategic partnerships with data
Robust quality monitoring
Emphasis on multi‐payer strategies
and approaches
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
Jonathan Blum, CMS
|
7
…and from a business planning
perspective
• Shifts in revenue sources as
more people become eligible
and enroll in new insurance
options
• Increased competition as
health providers meet new
value-based purchasing
standards built on health
system partnerships and
accountability for clinical
outcomes
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
Connect with other providers
 Coverage expansions are ONLY
sustainable with delivery system
reform
 Collaborative Care
 Patient Centered Healthcare
Homes
 Accountable Care Organizations
 Accountability and quality improvement are
hallmarks of the new healthcare ecosystem
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
Using Data for Population
Based Interventions
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
5
Sharing Information is the Standard
 Health Information Exchange RULES!
 Integration and improved outcomes will
only be successful if we can share
information
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
6
Cost
Rank
Total Charges
No of members
Treatment Type
Average Charges
per Member
1
Community Support Services/15 min
$2,890,038
218
$13,257
2
Community Support Services /day
$1,916,375
181
$10,588
3
Personal care per diem
$1,394,614
123
$11,338
4
Habilitation, prevocational/15 min
$758,157
104
$7,290
5
Supported employment/15 min
$713,680
154
$4,634
6
Inpatient room and board
$699,602
90
$7,773
7
Targeted case management/15 min
$557,154
689
$1,009
8
Inpatient- ancillaries
$494,577
81
$6,878
9
Case management/ 15 min
$438,577
470
$1,052
10
Emergency room
$356,478
247
$1,776
11
Psych medication management
$356,478
1,086
$328
12
Inpatient-facility charges
$288,479
52
$5,548
13
Labs
$287,935
437
$659
14
ACT program
$286,773
115
$2,494
15
Medical supplies
$241,812
156
$1,550
16
Family therapy
$221,136
181
$1.222
24
Office visits – primary care
$154,773
616
$215
29
Surgery
$105,085
98
$1,072
36
Ambulance
$54,581
67
$815
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
7
Table of top cost by
diagnosis, January-March,2006
Cost
Rank
Primary Diagnosis
Total Charges
No of Members
Average Charges Per
Member
1
Schizophrenia and Affective Psychosis
$6,167,527
1,102
$5,597
2
Depression/Anxiety/Neuroses
$1,710,759
347
$4,930
3
Moderate Mental Retardation
$1,040,669
112
$9,292
4
Severe Mental Retardation
$1,032,094
74
$13,947
5
Profound Mental Retardation
$982,760
39
$25,199
6
Mild Mental Retardation
$709,344
131
$5,415
7
Alcohol and Drug Abuse
$283,077
177
$1,599
8
Pregnancy
$183,653
39
$4,709
9
Congestive heart Failure
$168,130
7
$24,019
10
Chest Pain
$161,260
65
$2,481
11
All Fractures and Dislocations
$137,901
19
$7,258
12
Diabetes Mellitus
$134,161
42
$3,194
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
8
Cost By Service Type
Community Support
Services/15 min
Top Cost by Treatment Type
January-March, 2006
Community Support Services
/day
Personal care per diem
Habilitation, prevocational/15
min
Supported employment/15 min
Inpatient room and board
Targeted case
management/15 min
Inpatient- ancillaries
Case management/ 15 min
Emergency room
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
9
Cost Data by Primary Diagnosis
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
10
www.TheNationalCouncil.org
Using Data for Individual
Interventions
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
11
High Utilizer Report
• 3 consumers with an average cost of $272,652 each
• Drill down: Consumer with brittle diabetes and personality
•
•
•
•
disorder - frequent ER and inpatient
4 consumers with average cost of $236,434 each
Drill down: Consumer with SUD without motivation &
personality disorder; multiple complex medical conditions
4 Consumers with average cost of $85,867 each
Drill down: Consumer with SUD- frequent detox ;lack of
community services
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
12
Case #1
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
13
Case 1: Continued
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
14
Timeframe
Charges
Jul2005
Aug2005
Sep2005
Oct2005
Nov2005
Dec2005
$49,010
$52,632
$18,050
$27,376
$42,493
$8,058
$60,000
$50,000
$40,000
$30,000
Charges
$20,000
$10,000
$0
Jul-05
Aug-05
Sep-05
Oct-05
Nov-05
Dec-05
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
15
Measuring Disparities
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
16
CDC Sortable Stats
http://wwwn.cdc.gov/sortablestats
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
17
Chronic Medical Conditions
At Risk Criteria
 Blood pressure combined
Systolic greater than 130 OR
Diastolic greater than 85
 BMI
Greater than or equal to 25
 Waist circumference
Male, greater than 102 cm
Female, greater than 88 cm
 Breath CO
Greater than or equal to 10
 Fasting Plasma Glucose
Greater than 100
 HgbA1c
Greater than or equal to 5.7
 Cholesterol
HDL, less than 40
LDL, greater than or equal to 130
Triglycerides, greater than or
equal to 150
 Others that the organizations
determine
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
18
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
19
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
20
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
21
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
22
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
23
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
24
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
25
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
26
Sharing Information is the Standard
 Health Information Exchange RULES!
 Integration and improved outcomes will
only be successful if we can share
information
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
27
Flavors of Health Information Exchange
4/13/2015
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
28
September 9, 2013
Office of the National Coordinator (ONC) Issued:
Certification Guidance for EHR Technology Developers
Serving Health Care Providers Ineligible for Medicare
and Medicaid EHR Incentive Payments
4/13/2015
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
29
Purpose:
Guidance is meant to serve as a building block for federal
agencies and stakeholders to use as they work with different
communities to achieve interoperable electronic health
information exchange.
4/13/2015
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
30
2014 Edition EHR
Certification Criterion
Short Description3
45 CFR §170.314(b)(1)
45 CFR §170.314(b)(2)
Transitions of Care
These two certification criteria require EHR technology to
be, at a minimum, capable of: A) electronically creating and
receiving summary care records with a common data set in
accordance with the Consolidated Clinical Document
Architecture (CCDA) standard; and B) electronically
exchanging in accordance with the Direct transport
specification.
45 CFR §170.314(b)(4)
Clinical Information
Reconciliation
Require EHR technology to allow a user to electronically
reconcile the data that represent a patient’s active
medication, problem, and medication allergy list.
4/13/2015
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
31
Exchange
Among
Providers in
One system
Somewhat Difficult but Occurring Nationally
4/13/2015
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
32
Exchange Among Providers in
Multiple Systems
More Difficult but
Occurring Nationally
4/13/2015
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
33
Secure Messaging Exchange
Uses DIRECT Protocols
Meets Meaningful Use Requirements
Easy
I encourage ALL providers to obtain and DIRECT Address!!
Even if you DO NOT have an EHR!!
4/13/2015
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
34
Addressing Confidentiality
 Common Barrier
 If not addressed, promotes stigma
 RI leads the nation through its work with the
SAMHSA/HRSA Center for Integrated Health
Solutions
 MH & SU Information can be shared securely in RI
 KY will follow soon
 There are ways to work within 42 CFR Part 2
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
35
Meaningful Use
Opportunities Now
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
36
Revised Definition of CEHRT
Effective Dates
EHR Reporting Period
FY/CY 2011
FY/CY 2012
FY/CY 2013
FY/CY 2014
MU Stage 1
MU Stage 1
MU Stage 1
MU Stage 1 or MU Stage 2
All EPs, EHs, and CAHs must have:
1)EHR technology that has been certified to all
applicable 2011 Edition EHR certification criteria or
equivalent 2014 Edition EHR certification criteria
adopted by the Secretary; or
2) EHR technology that has been certified to the 2014
Edition EHR certification criteria that meets the Base
EHR definition and would support the objectives,
measures, and their ability to successfully report
CQMs, for MU Stage 1.
All EPs, EHs, and CAHs must have
EHR technology certified to the 2014
Edition EHR certification criteria that
meets the Base EHR definition and
would support the objectives,
measures, and their ability to
successfully report the CQMs, for the
MU stage that they seek to achieve.
There is no such thing as being “Stage 1 Certified” or “Stage 2 Certified” – 2014 Edition EHR
technology would be able to support the achievement of either meaningful use Stage.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
2014 Edition CEHRT Easy as
1, 2, 3 + C*
What varies is the quantity of EHR technology
certified to the 2014 Edition EHR certification
criteria that would be necessary to be
used to meet MU
Base
EHR
1
EP/EH/CAH would only need to have
EHR technology with capabilities
certified for the MU menu set
objectives & measures for the stage of
MU they seek to achieve.
EP/EH/CAH would need to have EHR
technology with capabilities certified
for the MU core set objectives &
measures for the stage of MU they
seek to achieve unless the EP/EH/CAH
can meet an exclusion.
EP/EH/CAH must have EHR technology
with capabilities certified to meet the
Base EHR definition.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
2014 Edition EHR Certification Criteria
Mapped to the 2014 CEHRT
Definition for EHs & CAHs Seeking to Achieve
MU Stage 2 in and after CY 2014
2014 Certification Criteria associated with
a Base EHR:
>
>
>
>
>
>
>
>
>
>
2014 Certification Criteria associated with
MU Core Stage 2:
•Drug-drug, drug-allergy interaction checks
(170.314(a)(2))
•Vital signs, BMI, & growth charts
(170.314(a)(4))
•Smoking status (170.314(a)(11))
•Patient list creation (170.314(a)(14))
•Patient-specific education resources
(170.314(a)(15))
•eMAR (170.314(a)(16))
•Clinical information reconciliation
(170.314(b)(4))
•Incorporate lab tests & values/results
(170.314(b)(5))
•View, download, & transmit to 3rd Party
(170.314(e)(1))
•Immunization information (170.314(f)(1))
•Transmission to immunization registries
(170.314(f)(2))
•Transmission to PH agencies – syndromic
surveillance (170.314(f)(3))
•Transmission of reportable lab tests &
values/results (170.314(f)(4))
* optional
CPOE (170.314(a)(1))
Demographics (170.314(a)(3))
Problem list (170.314(a)(5))
Medication list (170.314(a)(6))
Medication allergy list (170.314(a)(7))
Clinical decision support (170.314(a)(8))
Transitions of care (170.314(b)(1) & (2))
Data portability (170.314(b)(7))
Clinical quality measures (170.314(c)(1) - (3))
Privacy and Security CC:
o Authentication, access control,
authorization (170.314(d)(1))
o Auditable events & tamper resistance (170.314(d)(2))
o Audit report(s) (170.314(d)(3))
o Amendments (170.314(d)(4))
o Automatic log-off (170.314(d)(5))
o Emergency access (170.314(d)(6))
o End-user device encryption (170.314(d)(7))
o Integrity (170.314(d)(8))
o Accounting of disclosures* (170.314(d)(9))
2014 Certification Criteria associated with
MU Menu Stage 2:
>
>
>
>
>
>
>
2014 ed. certification
criteria for which certification may be required:
> Automated numerator recording (170.314(g)(1))
> Automated measure calculation (170.314(g)(2))
> Safety-enhanced design (170.314(g)(3))
> Quality management system (170.314(g)(4))
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
Electronic notes (170.314(a)(9))
Drug-formulary checks (170.314(a)(10))
Image results (170.314(a)(12))
Family health history (170.314(a)(13))
Advance directives (170.314(a)(17))
eRx (170.314(b)(3))
Transmission of e-lab tests & values/results
to providers (170.314(b)(6))
Do you have EHR Technology that meets the
new Certified EHR Technology definition for
Meaningful Use Stage 1?
START HERE
Do you have a 2014
Edition Complete EHR for the
Ambulatory (EPs) or Inpatient
(EHs/CAHs) Setting?
Do you have EHR
technology that has been:
Certified to ≥ 9 CQMs

≥ 6 from CMS’
recommended core set

Address ≥ 3
domains from the set
selected by CMS for EPs?
Is your EHR technology certified to
the following certification criteria to
support the MU1 EP Core Objectives
you seek to achieve and for which
you cannot meet a MU exclusion?
§ 170.314:
(a)(2) – DD/DA
(a)(4) – Vitals
(a)(11) – Smoking
Is your EHR technology certified to the
following certification criteria to support
the MU1 EP Menu Objectives you seek
to meet? § 170.314:
(a)(10) – RxFormulary (b)(5) – Incorp Lab
(a)(14) – Pt List
(f)(1) – Immz Info
(a)(15) – Pt Edu
(f)(2) – Immz Tx
(b)(4) – ClinInfoRec
(f)(3) –
Syn Surv
(b)(3) – eRx
(e)(1) – VDTx3
(e)(2) – Clinical Sum
Is your EHR technology certified to the
following certification criteria required to
meet the Base EHR definition? § 170.314:
(a)(1),(3)&(5-8) – CPOE/Demogfrx/ProbList/
MedList/MedAllergyList/CDS
(b)(1),(2)&(7) – TOC/Data Port
(c)(1)-(3) – CQMS
(d)(1)-(8) – P&S
Do you have EHR
technology that has been:
Certified to ≥ 16 CQMs from
CMS’ selected set for
EH/CAHs
 Address ≥ 3 domains from the
set selected by CMS for
EH/CAHs?
Cont
2
Is your EHR technology certified
to the following certification criteria
to support the MU1 EH/CAH Core
Objectives you seek to achieve and
for which you cannot meet a MU
exclusion? § 170.314:
(a)(2) – DD/DA
Smoking
(a)(4) – Vitals
Is your EHR technology certified to
the following certification criteria to
support the MU1 EH/CAH Menu
Objectives you seek to meet? § 170.314:
(a)(10) – RxFormulary
(a)(14) – Pt List
(a)(15) – Pt Edu
(a)(17) – AD
(b)(4) – ClinInfoRec
(a)(11) –
(e)(1) – VDTx3
Note: To meet the CEHRT definition, EHR technology will need to have been certified to:
 Automated numerator recording (170.314(g)(1)) or Automated measure calculation
a c t (170.314(g)(2));
: [email protected]
 Safety-enhanced design (170.314(g)(3)); and
0  Quality
2 management
.
6 (170.314(g)(4))
8
4
.
7
4
5
system
g
|
7
(b)(5) – Incorp Lab
(f)(1) – Immz Info
(f)(2) – Immz Tx
(f)(3) – Syn Surv
(f)(4) – ELR
Stage 2 Resources
CMS Stage 2 Webpage:
• http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Stage_2.html
Links to the Federal Register
Tipsheets:
•
•
•
•
•
Stage 2 Overview
2014 Clinical Quality Measures
Payment Adjustments & Hardship Exceptions (EPs & Hospitals)
Stage 1 Changes
Stage 1 vs. Stage 2 Tables (EPs & Hospitals)
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
Clinical Quality Measures
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
42
CQM Alignment with HHS
Priorities
All providers must select CQMs from at
least 3 of the 6 HHS National Quality
Strategy domains:
•
•
•
•
•
•
Patient and Family Engagement
Patient Safety
Care Coordination
Population and Public Health
Efficient Use of Healthcare Resources
Clinical Processes/Effectiveness
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
CQMs in 2014 and Beyond
CQMs change in 2014:
Core Objective
EPs
Measure
2014 and Beyond*
Complete 6 out of 44
Complete 9 out of 64
• 3 core or 3 alt. core
• 3 menu
Choose at least 1 measure in 3 NQS
domains
Recommended core CQMs include:
• 9 CQMs for the adult population
• 9 CQMs for the pediatric population
• Prioritize NQS domains
Eligible Hospitals
and CAHs
Complete 15 out of 15
Complete 16 out of 29
• Choose at least 1 measure in 3 NQS
domains
* Regardless of the stage of meaningful use, all providers will complete this number of CQMs in
2014.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
Clinical Quality Measures
Behavioral Health Specific Clinical Quality Measures
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
Title: Anti-depressant medication management:
NQF 0105 (a) Effective Acute Phase Treatment
(b)Effective Continuation Phase Treatment
Description: The percentage of patients 18 years of age
and older who were diagnosed with a new episode of
major depression, treated with antidepressant
medication, and who remained on an antidepressant
medication treatment. Two rates are reported.
a)Percentage of patients who remained on an
antidepressant medication for at least 84 days (12 weeks)
b)Percentage of patients who remained on an
antidepressant medication for at least 180 days
(6 months)
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
NQF 0004
Title: Initiation and Engagement of Alcohol and Other Drug
Dependence Treatment: (a) Initiation, (b) Engagement
Description: The percentage of patients 13 years of age or
older
With a new episode of alcohol and other drug (AOD)
dependence who received the following. Two rates are
reported:
a) Percentage of patients who initiated treatment within
14days of the diagnosis
b) Percentage of patients who initiated treatment and who
had two or more additional services with an AOD diagnosis
within 30 days of the initiation visit
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
NQF
0028
Title: Preventive Care and Screening: Tobacco Use:
Screening and Cessation Intervention
Description: Percentage of patients aged 18 years and
older who were screened for tobacco use one or more
times within 24 months AND received cessation
counseling intervention if identified as a tobacco user
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
0022
Title: Use of High-Risk Medications in the Elderly
Description: Percentage of patients ages 65 years and older who
received at least one high-risk medication. Percentage of patients
65 years of age and older who received at least two different
high-risk medications.
a: Percentage of Patients who were ordered at least one high-risk
medication
b: Percentage of Patients who were ordered least two high-risk
medications during the measurement year
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
0101
Title: Falls: Screening for Fall Risk
Description: Percentage of patients aged 65 years and
older who were screened for future fall risk during the
measurement period
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
0104 Title: Major Depressive Disorder (MDD): Suicide Risk
Assessment
Description: Percentage of patients aged 18 years and
older with a new diagnosis or recurrent episode of MDD
who had a suicide risk assessment completed at each visit
during the measurement
period.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
0108
Title: ADHD: Follow-Up Care for Children Prescribed
Attention Deficit Hyperactivity Disorder (ADHD) Medication
Description: Percentage of children 6-12 years of age as of
age and newly dispensed a medication for attention
deficit/hyperactivity disorder (ADHD) who had appropriate
follow up care. Two rates are reported
a. Initiation Phase: Percentage of children who had one
follow up visit with a practitioner with prescribing authority
during the 30-day Initiation Phase
b. Percentage of children who remained on ADHD medication
for at least 210 days and who, in addition to the visit in the
Initiation Phase, had at least two additional follow-up visits
with a practitioner within 270 days (9 months) after the
Initiation Phase ended
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
0110
Title: Bipolar Disorder and Major Depression:
Appraisal for alcohol or chemical substance use
Description: Percentage of patients with depression
or bipolar disorder with evidence of an initial
assessment that includes an appraisal for alcohol or
chemical substance use.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
0418
Title: Preventive Care and Screening: Screening for
Clinical Depression and Follow-Up Plan
Description: Percentage of patients aged 12 years
and older screened for clinical depression on the
date of the encounter using an age appropriate
standardized depression screening tool AND if
positive, a follow up plan documented is
documented on the date of the positive screen.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
0419
Title: Documentation of Current Medications in the Medical
Record
Description: Percentage of specified visits for patients 18 years
and older for which the eligible professional attests to
documenting a list of current medications to the best of his/her
knowledge and ability. This list must include ALL prescriptions,
over the counter, herbals and vitamin/mineral/dietary (nutritional)
supplements AND must contain the medications’ name, dosage,
frequency and route of administration
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
0421
Title: Adult Weight Screening and Follow-Up
Description: Percentage of patients aged 18 years and older
with a calculated body mass index (BMI) in the past six
months or during the current reporting period documented
in the medical record AND if the most recent BMI is outside
of normal parameters, a follow-up plan is documented within
the past six months or during the current reporting period.
Normal Parameters: Age 65 years and older BMI ≥ 23 and <
30
Age 18-64 years BMI ≥ 18.5 and < 25
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
0710
Title: Depression Remission at Twelve Months
Description: Adult patients age 18 and older with major
depression or dysthymia and an initial PHQ-9 score > 9 who
demonstrate remission at twelve months defined as PHQ-9
score less than 5. This measure applies to both patients with
newly diagnosed and existing depression
whose current PHQ-9 score indicates a need for treatment.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
0712
Title: Depression Utilization of the PHQ-9 Tool
Description: Adult patients age 18 and older with the diagnosis
of major depression or dysthymia who have a PHQ-9 tool
administered at least once during a 4 month period in which
there was a qualifying visit.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
1365
Title: Child and Adolescent Major Depressive Disorder:
Suicide Risk Assessment
Description: Percentage of patient visits for those patients
aged 6 through 17 years with a diagnosis of major depressive
disorder with an assessment for suicide risk.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
Not yet
endorsed
Title: Dementia: Cognitive Assessment
Description: Percentage of patients, regardless of age, with
a diagnosis of dementia for whom an assessment of
cognition is performed and the results reviewed at least once
within a 12-month period.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
www.TheNationalCouncil.org
https://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/QualityMeasures/Downloads/EligibleProviders-2014-Proposed-EHR-Incentive-Program-CQM.pdf
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
How Will the Data be Shared?
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
62
Data Integrity
Follow the Continuity of Care Document
/ C-CDA
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
Psychotherapy
Notes are
not Sent
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
What Will This Data Look Like?
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
67
Good Health Clinic Continuity of Care Document
Created On: January 6, 2012
Patient
Henry Levin , the 7th
MRN
996-756-495
Birthdate
September 24, 1932
Sex
Male
Guardian
Kenneth Ross
17 Daws Rd.
Blue Bell, MA, 02368
tel:(888)555-1212
Next of Kin
Henrietta Levin
tel:(999)555-1212
Table of Contents












Purpose
Payers
Diagnosis
Allergies, Adverse Reactions, Alerts
Medications
Immunizations
Results
Treatment Plan
Progress Note
Suicide Risk
Risk of Violence
Substance Abuse
Purpose
Transfer of care
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
68
Payers
Payer name
Healthy Insurance
Policy type / Coverage type
Extended healthcare / Self
Covered party ID
14d4a520-7aae-11db-9fe1-0800200c9a66
Authorization(s)
Diagnosis






Axis I Primary : 296.21 - Major Depressive Disorder , Single Episode
Axis I Secondary : 303.90 - Alcohol Dependence
Axis II Primary : 301.6 - Dependent Personality Disorder
Axis III : None
Axis IV : Social Environment (Recently divorced), Occupational (Recently unemployed), Housing (Recently lost
home to foreclosure and is homeless), Other Problems (Recent evidence of male pattern baldness)
AxisV:58
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
69
Allergies, Adverse Reactions, Alerts
Substance
Penicillin
Aspirin
Codeine
Reaction
Hives
Wheezing
Nausea
Status
Active
Active
Active
Medications
Medication
Albuterol inhalant
Clopidogrel (Plavix)
Metoprolol
Prednisone
Cephalexin (Keflex)
Instructions
2 puffs QID PRN wheezing
75mg PO daily
25mg PO BID
20mg PO daily
500mg PO QID x 7 days (for bronchitis)
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
Start Date
Mar 28, 2000
Mar 28, 2000
|
7
Status
Active
Active
Active
Active
No longer active
70
Immunizations
Vaccine
Influenza virus vaccine
Influenza virus vaccine
Pneumococcal polysaccharide vaccine
Tetanus and diphtheria toxoids
Date
Nov 1999
Dec 1998
Dec 1998
1997
Status
Completed
Completed
Completed
Completed
Source of Information
Immunization Tracking System
Immunization Tracking System
Immunization Tracking System
Immunization Tracking System
Results
March 23, 2011
Hematology
HGB (M 13-18 g/dl; F 12-16 g/dl)
WBC (4.3-10.8 10+3/ul)
PLT (135-145 meq/l)
Chemistry
NA (135-145meq/l)
K (3.5-5.0 meq/l)
CL (98-106 meq/l)
HCO3 (18-23 meq/l)
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
April 06, 2011
13.2
6.7
123*
140
4.0
102
35*
|
7
71
Treatment Plan
Problem 05-Substance Abuse
Goal Accept chemical dependence and begin to actively participate in a recovery program.
Objective Describe childhood experience of alcohol abuse by immediate and extended family members.
Goal Establish a sustained recovery, free from the use of all mood-altering substances.
Objective Develop a right aftercare plan that will support the maintenance of long-term sobriety.
Progress Note
02/04/2009 Henry Levin was assessed and completed testing. He showed signs of alcohol dependence as evidenced by
marked tolerance, previous attempts at abstinence, relationship problems as well as hangovers and blackouts. He also
has a previous OWI and completed Level I with this program in 2007. Referred to XYZ Counseling Center for IOP.
Baseline UA taken.
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
72
Suicide Risk
Suicide
Thoughts?
Date of Last
Suicidal Thought
Risk Factors
Previous
attempts?
Date of Last
Attempt
Yes
04/15/2009
Guns in house, potentially
lethal medications
Yes - 1
11/27/1989
Additional
Information
Recently lost job,
feeling despondent
Risk of Violence
Threat
towards
others?
Existence
of Plan
Plan details
Yes
Moderate
Plan
Reduce the risk
of domestic
violence
Level of
Intent
Minor
History of
Violence?
History details
Risk
Factors
Additional
Information
Yes
Assault on 1
individual with
deadly weapon
Guns in
house
No vehicle to
carry out plan
Substance Abuse
Substance
Route
Frequency
Age of First Use Date of Last Use
Primary Methamphetamine Injection 3-6 times in the past week
15
05/04/2009
Secondary Methylphenidate
Oral 1-2 times in the past week
17
04/27/2009
Electronically generated by: on January 6, 2012
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
73
Meaningful Use
Opportunities in the Future
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
74
Mental Health and Addiction Policy Agenda
The National Council promotes a mental health and addiction policy agenda that
supports a strong mental health and addiction safety net. Our public policy agenda
includes:
Establishing federal status for community behavioral health organizations, as
outlined in the Excellence in Mental Health Act
Promoting federal initiatives that support public education on mental illness and
addiction such as the Mental Health First Aid Act
Working to ensure that behavioral health providers are eligible for health
information technology incentives, as in the Behavioral Health IT Act
Ensuring behavioral health’s full inclusion in health reform implementation
Protecting federal funding for Medicaid and protecting beneficiaries and providers
Preserving funding for other important behavioral health programs such as those
funded by the Substance Abuse and Mental Health Services Administration
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
75
www.TheNationalCouncil.org
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
76
Strategies to Position Yourself to
Effectively Use Data
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
77
 Focus on Interoperability
 Obtain a DIRECT Secure Messaging Address
 Speak to your vendor about compatibility with the C-CDA
 Select Clinical Quality Measures that the rest of health care is using
 Then add your own
 Begin sharing data with your health care partners
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
78
These Changes are Coming!!!!
www.TheNationalCouncil.org
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
79
www.TheNationalCouncil.org
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7
80
Michael R. Lardiere, LCSW
Vice President, HIT & Strategic Development
[email protected]
•
•
•
•
•
Website: www.thenationalcouncil.org
CIHS: www.integration.samhsa.gov
Blog: www.MentalHealthcareReform.org
Twitter: @nationalcouncil
Facebook: www.facebook.com/TheNationalCouncil
Contact: [email protected]
2
0
2
.
6
8
4
.
7
4
5
|
7