Transcript Pre-Conference: Meaningful Use Stage 1 2015 April 23, 2015

2015 User Conference
Pre-Conference: Meaningful Use Stage 1 2015
April 23, 2015
Presented by:
Angela Schnack
Training Specialist
EHR Session
Isn’t this what it is all about?
“We've made more progress
with EHRs in the past 2 years
than we have in 20."
Farzad Mostashari, MD
(former ONC Chief)
2015 Office Practicum User Conference
Meaningful Use Stage 1
Today’s Objectives:
▪ Define key elements of Meaningful Use
▪ Identify required fields in Office Practicum
to capture MU data
▪ Interpret Quality Improvement Calculator
(QIC) metrics
2015 Office Practicum User Conference
Meaningful Use Stage 1
Stage 1 - Year 1:
AIU: Adopt, Implement or Upgrade
If you are in this stage, you will need the 2014
CEHRT edition of Office Practicum
Stage 1
● Stage 1 - Year 2:
● Stage 1 & 2 no longer split
● 2015 is 90 days using
Modified Stage 2
Objectives
● 2016 - full year reporting
unless new to MU
CEHRT: Certified Electronic Health Record Technology
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2018 Stage 3
Proposed ruling in process
*May elect to move to Stage 3 in
2017, required to in 2018
Stage 2
● Stages 1 & 2 are no
longer split.
● Combined into one
with modified reporting
Stage 1
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Note:
● 2016 Last year to initiate participation in Medicaid EHR
incentive program
● 2021 Last year to receive Medicaid EHR incentive payment.
First Reporting Year - Prepare
●Begin now
● Designate a Meaningful Use Team
● Check QIC to identify areas the measures are not
met
● Meet regularly with staff and providers - share
results
● Develop workflow changes if necessary
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Meaningful Use Stage 1(Modified Stage 2)
What needs to be reported?
Under New Proposed Ruling:
■ 9 Objectives Required
■ 13 required core objectives
■ 5 Menu objectives from a list of 9 available in
OP
■ 9 Clinical Quality Measures Required
▪ Must be chosen from at least 3 of 6 Domains
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Meaningful Use Stage 1
Let’s get started!
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CPOE - (Modified Stage 2 Objective)
Use CPOE for more than 60% medications, 30% of laboratory, and 30% of
radiology
Exclusion: Fewer than 100 medications, laboratory or radiology orders written during
the reporting period
907A
Denominator:
Total medications written during the reporting period
Numerator:
Medications written with a Purpose of "Med - to dispense"•or
"Med - office sample" or "Med - office administered
907B
Denominator:
Total Lab requisitions written during the reporting period
Numerator:
Labs with a result date
907C
Denominator:
Numerator:
Total Radiology Lab requisitions written during the reporting
period
Radiology Labs with a result date
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CPOE - Minimum Requirement*
CPOE:
Computerized Physician Order Entry
>30%
▪ Medication written using:
▪ Med-to dispense
▪ Med- office sample
▪ Med-Administered
▪ Unique Patient
▪ Visit during reporting period
*For EP’s who would have been Stage 1 in 2015, this is the minimum requirement to meet
the objective.
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E-Prescribing (Modified Stage 2)
> 50%
(May elect the lesser - >40%)*
▪Medication written using:
▪ Med-to dispense
▪ e-Rx ID
▪All medications written during the reporting period
Exclusion:
1. Any EP who writes fewer than 100 prescriptions during the EHR
reporting period.
2. Any EP who does not have a pharmacy within their organization
and there are no pharmacies that accept electronic prescriptions
within 10 miles of the EP's practice
location at the start of his/her EHR reporting period.
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*EP’s who would have been in
Stage 1 reporting may report the
lesser percentage
Clinical decision support rule (Intervention)
How do we do this?
Care
Plans
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Interventions - (Modified Stage 2)
▪ 5 Interventions required
▪ Must be able to track compliance
▪For EP’s who would have been Stage 1 in 2015 Must report minimum of one intervention
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Patient Access (Modified Stage 2)
>50%
▪Provide timely online access to health information
▪ Within 4 business days* after information
available to EP
▪ 5% View, Download or Transmit
▪ View, Download or Transmit (at least one patient)
▪All visits during reporting period
You must have the portal implemented at your practice so
patients can have accounts created
*The QIC excludes weekends, but not holidays
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Protect electronic health information
Attest to Only
Cyber Security Checklist
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Patient Specific Education Resources
>10 %
▪ Patient education given checked
▪ Unique patient
▪ Visit during reporting period
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Patient specific education resources
▪ When a task is created during the visit, the
box will automatically be checked
▪ Manually checking the box will populate the
QIC
▪ Utilize a text area in the note to document the
education given
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Medication Reconciliation (Previously Menu)
>50%
▪ Med reconciliation
selected as
performed or not
required
▪ Referral tracking
entry created
-OR▪ Response to
Referral
performed
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Summary of Care for Referrals (Previously Menu)
>50%
▪ Include care summary
box checked
▪ Referral to specialist
created
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Secure Messaging (Modified Stage 2)
Attest To Only
(>5% unique patients seen are sent secure
electronic message)
▪ Functionally is fully enabled
▪ Message sent to portal by Provider
▪ No minimum patient usage threshold%
You must have the portal implemented at your practice to attest
functionality is fully enabled
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Demonstration
Let’s
Try It!
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Questions?
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Public Health Objective - New
▪ Single Objective with multiple options
▪ Report “active engagement” for 2 of the 5
▪
▪
▪
▪
▪
Immunization Registry - bidirectional (if available)
Syndromic Surveillance
Case Reporting
Public Health Registry Reporting (up to 3 of this type) - other than IIS
Clinical Data Registry Reporting (up to 3 of this type) - includes ACOs
and other non-governmental groups (ePROS)
▪ Multiple exemptions apply
▪
▪
Not available to the EP in their area
As long as you either registered within 60 days of the start of your
reporting period and are awaiting an invitation from the other party, or
are in Testing/Validation, or in Production, you are covered for this
objective.
EP’s who would have been Stage 1 in 2015 only required to report a single objective
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Objectives Removed But...Best Practices
▪ Objectives that have been removed from
reporting:
▪
▪
▪
▪
▪
▪
▪
Record Demographics
Problem List
Medication List
Allergies
Vital Signs
Risk Assessment
Patient Exit Note (Clinical Visit Summary)
▪ Assumption is you are already doing this
CMS is no longer “looking over your shoulder”
Note: If you are also participating in PCMH, these still apply to meet the standards.
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Record Demographics (Previously Core)
>50%
▪
▪
▪
▪
▪
▪
▪
Gender
Date of birth
Language
Ethnicity
Race
Unique Patient
Visit during reporting period
*All 5 fields must be completed
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Up to date Problem List (Previously Core)
>80%
▪Problem marked as active/tracking
▪SNOMED Code or
▪No Active Problems
▪Unique Patient
▪Visit during reporting period
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Active Medication List (Previously Core)
>80%
▪Entered as structured data with NDC code
▪Chronic Flag= Y or
▪No Active Medications
▪Unique Patient
▪Visit during reporting period
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Medication Allergy List (Previously Core)
>80%
▪Medication Allergy marked as active
▪Medication with NDC #
▪SNOMED Code or
▪No Active Medication Allergies
▪Unique Patient
▪Visit during reporting period
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Interaction Checking
Attest to Only
▪ Med/Med
▪ Med/Allergy
▪ Must be available and enabled during
reporting period
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Vital Signs
>50%
▪ Measurements recorded (in the vitals/growth tab):
▪ Height
▪ Weight
▪ BP
▪ BMI calculated
▪ Growth measurements plotted
▪ Unique patient
▪ Visit during reporting period
▪ All ages for height/weight
▪ Patient >3 years for BP
▪ Ages 2-20 for BMI and Growth charts
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Risk Assessment
>50%
▪Smoking status recorded
▪Unique patient
▪Visit during reporting period
▪13 years or older
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Clinical Summaries
>50%
▪Patient exit note created
▪ Electronic or printed
▪ Within 3 business days*
▪All visits during reporting period
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MU Stage 1 - Menu Measures
There will not be any Menu Measures to
choose from in 2015 through 2017 in
Modified Stage 2 Reporting
•5 of 9 measures must be reported
•1 Measure must be from the Public Health Menu
Options
•Measures are performance based with some "Attest
Only"
2015 Office Practicum User Conference
Drug Formulary Checks (Previously Menu)
▪
From the medication finder, the Check Formulary box
is available. For all connected payers, Office
Practicum is fully integrated with DrFirst to populate
any formulary information available.
This is “attest to” only
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Patient List by Specific Conditions - Menu
▪ Attest to Only
▪ This can be accomplished by using the
demographic analysis/recall report
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Clinical Lab Test Results (Previously Menu)
>40%
▪ Positive/Negative result or numeric value
▪ All labs ordered during reporting period
Hearing/Vision do not count toward total
If your practice has a lab interface, this can be more easily achieved
2015 Office Practicum User Conference
Patient Reminders (Previously Menu)
>20%
▪ Reminder or recall sent using Patient Message
Exchange*
▪ Unique patient
▪ 5 years and younger
*Must have and use the Patient
Message Exchange in OP for
Reminders
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Demonstration
Let’s
Try It!
2015 Office Practicum User Conference
Questions?
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Intermission
2015 Office Practicum User Conference
Meaningful Use
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Have you run the QIC?
Quality Improvement Calculator
Threshold not met
Exclusions; no minimum
threshold; no data
Threshold met
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Lets run the QIC
Let’s
Run the
QIC!
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Questions?
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Clinical Quality Measures
What needs to be Reported?
● Clinical Quality Measures (9 total)
● Must come from at least 3 of the 6
policy domains
○ Patient and family engagement
○ Patient Safety
○ Care Coordination
○ Population and Public Health
○ Efficient use of Healthcare
Resources
○ Clinical Processes/Effectiveness
No required threshold/passing metrics for CQM’s
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Clinical Quality Measures
QRDA file
Patient
QRDA III
file
Provider Patient files
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Clinical Quality Measures
LET’S TAKE A LOOK BY DOMAIN
The information presented are the reports delivered in the QIC for the 2014
CQM’s. Must have OP 14 installed for the 2015 CQM calculations.
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Clinical Quality Measures
PEDIATRIC SUGGESTED CLINICAL QUALITY
MEASURES
Measure
Domain
Appropriate Testing for Children with Pharyngitis
Efficient Use of Healthcare Resources
Appropriate Treatment for Children with Upper Respiratory
Infection (URI)
Efficient Use of Healthcare Resources
Chlamydia Screening for Women
Population/ Public Health
Weight Assessment and Counseling for Nutrition and Physical
Activity for Children and Adolescents
Population/ Public Health
Childhood Immunization Status
Population/ Public Health
2015 Office Practicum User Conference
Clinical Quality Measures
PEDIATRIC SUGGESTED CLINICAL QUALITY
MEASURES
Measure
Domain
Preventive Care and Screening: Screening for Clinical
Depression and Follow-Up Plan
Population/ Public Health
ADHD: Follow-Up Care for Children Prescribed Attention
Deficit/Hyperactivity Disorder (ADHD) Medication
Clinical Process/ Effectiveness
Children who have dental decay or cavities
Clinical Process/ Effectiveness
Use of Appropriate Medications for Asthma
Clinical Process/ Effectiveness
2015 Office Practicum User Conference
Clinical Quality Measures
EFFICIENT USE OF HEALTHCARE
RESOURCES
Measure: NQF 0002
Appropriate Testing for Children with Pharyngitis
●
●
●
●
Patients 2-18 years old
Coding on visit for Pharyngitis
Strep test complete
Antibiotic prescribed, if appropriate
2015 Office Practicum User Conference
Clinical Quality Measures
EFFICIENT USE OF HEALTHCARE
RESOURCES
Measure: NQF 0069
Appropriate Treatment for Children with Upper
Respiratory Infection (URI)
● Patients 3 months - 18 years old
● Coding on visit for Upper Respiratory Infection
● Antibiotic not prescribed up to 3 days after the diagnosis
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 0033
Chlamydia Screening for Women
● Sexually Active women aged 16-24
● One Chlamydia test done during the reporting period
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 0033
Chlamydia Screening for Women
Suggested Documentation in OP
●
●
●
●
●
Problem List entry for Sexually Active
Set Visibility level on problem list entry for confidentiality
Make active the Chlamydia Care Plan
Enroll in Chlamydia Care Plan
Test for Chlamydia
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 0024
Weight Assessment and Counseling for Nutrition and
Physical Activity for Children and Adolescents
● Children 3-17 years
● BMI calculated
● Documented counseling for nutrition (V65.3) and
physical activity (V65.41) during the reporting period.
○ *ICD-10 Code Z71.3 - Nutrition
○ *ICD-10 Code Z71.89 - Physical Activity
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 0024
Weight Assessment and Counseling for Nutrition and
Physical Activity for Children and Adolescents
Suggested Documentation in OP:
● ICD-9 code included with well visit: V65.41 (Physical
Activity Counseling) *ICD-10=Z71.89
● ICD9 code included with well visit: V65.3 (Nutrition
Counseling) *ICD-10=Z71.3
● Height/Weight taken at visit to calculate BMI
● Templates include documentation (Anticipatory
Guidance)
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 0038
Childhood Immunization Status
● Follow vaccine schedule for vaccines administered prior
to 2nd birthday
●
●
●
●
●
●
●
●
●
●
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4 DTaP
3 IPV
1 MMR
3 HiB
3 Hep B
1 Varicella
4 PCV
1 Hep A
2-3 Rotavirus
2 flu
Demonstration
Let’s
try it!
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 0418
Screening for Clinical Depression and Follow-Up Plan
● 12 years and older prior to the beginning of the measure
period
● Screening for depression on date of visit
● If positive, follow up plan documented on date of visit
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 0418
Screening for Clinical Depression and Follow-Up Plan
Suggested Documentation in OP:
● Survey complete for depression
○ Add survey to templates
○ Risk Assessment
● If survey is positive, plan documented for follow-up
○ document in the Plan of the note
○ document in the Counseling of the note (can set
visibility)
○ Follow-up task for return visit for depression
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: NQF 0108_a
Follow-Up Care for Children Prescribed ADHD Medication
●
●
●
●
Patients aged 6-12 years
Newly prescribed ADHD medication during initial visit
Follow up care 30 days after prescribing medication
2 additional follow-up visits after the initial 30 days
(within 9 months)
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: NQF 0108_a
Follow-Up Care for Children Prescribed ADHD Medication
Suggested Documentation in OP:
● First time prescribing ADHD Medication
● Follow-up visit within 30 days of prescribing
● 2 additional follow-up visits after the initial 30 days
○ must be charted within 9 months
○ must have remained on the medication prescribed
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: CMS75v1
Children with Dental Decay or Cavities
● Patients aged 0-20 years
● Dental cavities or tooth decay noted during the
reporting period
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: CMS75v1
Children with Dental Decay or Cavities
Suggested Documentation in OP:
● ICD code on visit for Dental Decay/cavities
-OR● Problem List entry for Dental Decay/cavities
● Document findings in visit note
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: NQF 0036
Use of Appropriate Medications for Asthma
● Patients aged 5-64 years
● Persistent Asthma identified
● Asthma medication prescribed during the reporting
period
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: NQF 0036
Use of Appropriate Medications for Asthma
Suggested Documentation in OP:
● Problem List entry for Persistent Asthma
○ SNOMED code with the word persistent
-OR○ Stage/Severity with the word persistent
● Asthma medication prescribed during the reporting
period
2015 Office Practicum User Conference
Demonstration
Let’s
try it!
2015 Office Practicum User Conference
Questions?
2015 Office Practicum User Conference
Clinical Quality Measures
ALTERNATE PEDIATRIC REPORTS
AVAILABLE IN OFFICE PRACTICUM
Measure
Domain
Child and Adolescent Major Depressive Disorder: Suicide Risk
Assessment
Patient Safety
Closing the Referral Loop: Receipt of Specialist Report
Care Coordination
Influenza Immunization
Population and Public Health
Initiation and Engagement of Alcohol and Other Drug
Dependence Treatment
Clinical Processes/Effectiveness
Hemoglobin A1c Test for Pediatric Patients
Clinical Processes/Effectiveness
Primary Caries Prevention Intervention
Clinical Processes/Effectiveness
2015 Office Practicum User Conference
Clinical Quality Measures
PATIENT SAFETY
Measure: NQF 1365
Child and Adolescent Major Depressive Disorder: Suicide
Risk Assessment
● Patients aged 6-17 years
● Diagnosis of MDD
● Suicide risk assessment completed at each visit during
the measurement period.
2015 Office Practicum User Conference
Clinical Quality Measures
CARE COORDINATION
Measure: CMS50v1
Closing the Referral Loop: Receipt of Specialist Report
● No age restriction
● Referral created during the reporting period
● Report received from the provider the patient was
referred (specialist)
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 0041
Influenza Immunization
● 6 months and older
● Seen between October 1 and March 31
● OR prior influenza immunization
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: NQF 0004_a
Initiation and Engagement of Alcohol and Other Drug
Dependence Treatment
● Patients 13 years and older
● Diagnosis of AOD during a visit in the first 11 months of
the reporting period
● Treatment initiated within 14 days of the diagnosis
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: NQF 0060
Hemoglobin A1c Test for Pediatric Patients
● Patients aged 5-17 years
● Diabetes recorded on the Problem List
● Visit during the reporting period and a visit 12 months
prior
● HgbA1c test done during the reporting period
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: CMS74v2
Primary Caries Prevention Intervention
● Patients aged 0-20 years
● Fluoride varnish application during the reporting period
2015 Office Practicum User Conference
Clinical Quality Measures
OTHER REPORTS AVAILABLE IN
OFFICE PRACTICUM
Measure
Domain
Documentation of Current Medication
Patient Safety
Preventive Care and Screening Pair: Tobacco Use Assessment
and Tobacco Cessation Intervention
Population and Public Health
Adult Weight Screening and Follow-up
Population and Public Health
Maternal Depression Screening
Population and Public Health
Screening for High Blood Pressure and Follow-Up Documented
Population and Public Health
2015 Office Practicum User Conference
Clinical Quality Measures
OTHER REPORTS AVAILABLE IN
OFFICE PRACTICUM
Measure
Domain
Use of Imaging Studies for Low Back Pain
Efficient Use of Healthcare Resources
Controlling High Blood Pressure
Clinical Processes/Effectiveness
Antidepressant Medication Management
Clinical Processes/Effectiveness
2015 Office Practicum User Conference
Clinical Quality Measures
PATIENT AND FAMILY ENGAGEMENT
No reporting will be available within this domain in Office
Practicum for Pediatrics.
2015 Office Practicum User Conference
Clinical Quality Measures
PATIENT SAFETY
Measure: NQF 0419
Documentation of Current Medications
● 18 years and older prior to the beginning of the
reporting period
● Complete medication list to include OTC’s, herbals,
vitamins, etc.
● Must contain name, dosage, frequency and route
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 0028
Preventive Care and Screening Pair: Tobacco Use
Assessment and Tobacco Cessation Intervention
● 18 years and older
● Risk Assessment/Smoking Status evaluated
● If positive, counseling done or smoking cessation
prescribed
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 00421
Adult Weight Screening and Follow-up
● 18 years and older
● BMI calculated and outside the normal parameters
during the encounter or 6 months prior
● Follow up plan documented 6 months prior to reporting
period or during the reporting period.
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: NQF 1401
Maternal Depression Screening
● Child turned 6 months within the reporting period
● Visit during the reporting period
● Maternal screening done between 0 - 6 months
(Edinburgh or PHQ-2 surveys)
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTH
Measure: CMS22v1
Screening for High Blood Pressure and Follow-Up
Documented
● 18 years and older
● Problem list entry for Hypertension
● Recommended follow up documented
2015 Office Practicum User Conference
Clinical Quality Measures
EFFICIENT USE OF HEALTHCARE
RESOURCES
Measure: NQF 0052
Use of Imaging Studies for Low Back Pain
● Patient aged 18-50 years
● Visit coded for low back pain
● No imaging studies within 28 days of the diagnosis
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: NQF 0018
Controlling High Blood Pressure
● Patients aged 18-85 years
● Hypertension recorded on Problem List prior to the
reporting period or 6 months within the reporting period
● Blood Pressure measured less than 140/90 during the
reporting period
2015 Office Practicum User Conference
Clinical Quality Measures
CLINICAL PROCESSES/EFFECTIVENESS
Measure: NQF 0105_a
Antidepressant Medication Management
● Patients 18 years and older
● Diagnosis of major depression 6 months prior or the first 6
months of the reporting period
● Treatment with antidepressant medication for at least 84
days
2015 Office Practicum User Conference
Action Items
▪ Update to latest OP version to receive new
▪
▪
▪
▪
▪
▪
▪
QIC with 2014 reports
Decide on reporting period
Choose Menu Measures
Choose your Public Health objectives
Choose Clinical Quality Measures for
reporting
Run QIC to determine a baseline
Share results with your staff
Create strategies and develop internal
workflows to ensure measures are met
2015 Office Practicum User Conference
Resources
2014 Definition Stage 1 of Meaningful Use
Meaningful Use Core and Menu Set Objectives
Introduction to EHR Incentive Program for Eligible
Professionals
Stage 1 Worksheet
Federal Register
Regional Extension Centers
OP Patient Portal
OP Demographic Analysis and Recall Report
OP Patient Message Exchange
2015 Office Practicum User Conference
Meaningful Use - Stage 1
2015 Office Practicum User Conference
Meaningful Use - 2015
We want your feedback!
2015 Office Practicum User Conference