Transcript comp1_unit10b_lecture_slides

Introduction to Healthcare and
Public Health in the US
Meaningful Use of Health
Information Technology
Lecture b
This material (Comp1_Unit10b) was developed by [University Name], funded by the Department of Health and Human
Services, Office of the National Coordinator for Health Information Technology under Award Number [enter the award
number(s)].
Meaningful Use (MU) of Health Information
Technology
Learning Objectives
• Define meaningful use (MU) of health information
technology in the context of the Health Information
Technology for Economic and Clinical Health (HITECH)
Act (Lecture a)
• Describe the major goals of meaningful use (Lecture a)
• Define the criteria for Stage 1 of meaningful use for
eligible professionals and eligible hospitals (Lecture b)
• Describe the standards specified for Stage 1 of
meaningful use, including those devoted to privacy and
security (Lecture b)
• Discuss the likely criteria for Stages 2-3 of meaningful
use (Lecture b)
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Meaningful Use of Health Information Technology
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Criteria for Stage 1 Meaningful
Use (MU) (Blumenthal, 2010;
CSC, 2010)
• Final rules specified
– Core objectives – all must be met
– Menu objectives – selected from set
• EPs must report on 15 core and 5 of 10 menu
objectives
• EHs must report on 14 core and 5 of 10 menu
objectives
• For EPs and EHs, one menu objective must be a
public health measure
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Stage 1 Core Objectives
• >50% of all unique patients have demographics
recorded: preferred language, gender, race,
ethnicity, date of birth
• >50% of all unique patients age 2+ have recorded
height, weight, blood pressure, calculated BMI,
growth charts age 2-20
• >80% of all unique patients have at least 1 entry or
indication of none on problem list
• >80% of all unique patients have at least 1 entry or
indication of none on med list
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Stage 1 Core Objectives
(continued)
• >80% of all unique patients have at least 1 entry
or indication of none on med allergy list
• >50% of patients age 13+ seen have smoking
status recorded
• Provide clinical summaries to patient for more
than 50% of all office visits within 3 business
days
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Stage 1 Core Objectives
(continued)
• >50% provide patients with an electronic copy of
health info upon request within 3 business days
• >40% of all permissible prescriptions transmitted
electronically (eRx)
• >30% of unique patients have at least 1 med
order entered using CPOE
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Stage 1 Core Objectives
(continued)
• Drug-drug and drug-allergy interaction checks enabled
• Perform at least 1 test of certified EHR technology's
capacity to electronically exchange key clinical
information
• Implement 1 clinical decision support rule relevant to
specialty or high clinical priority with ability to track
compliance
• Conduct or review a security risk analysis and implement
security updates as necessary
• Report quality measures to CMS or states – provide
aggregate numerator, denominator, and exclusions
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Stage 1 Menu Objectives
• Implement drug-formulary checks
• >40% results incorporate clinical lab-test results
in certified EHR technology as structured data
• Generate lists of patients by specific conditions
to use for QI, reduction of disparities, research
or outreach
• >10% use certified EHR technology to identify
patient-specific education resources and provide
those resources to the patient if appropriate
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Stage 1 Menu Objectives
(continued)
• Perform medication reconciliation for >50% of
transitions of care
• Summary of care record is provided for >50% of
patient transitions or referrals
• Capability to submit electronic data to
immunization registries or immunization
information systems
• Capability to submit electronic syndromic
surveillance data to public health agencies
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Stage 1 Menu Objectives for
Hospitals Only
• >50% of patients age 65+ have an indication of
an advance directive status recorded
• Perform at least one test of data submission and
follow-up submission (where public health
agencies can accept electronic data)
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Stage 1 Menu Objectives for
Professionals Only
• >20% of patients of age 65+ or <5 are sent
appropriate reminders for preventive and followup care
• Provide patients with timely electronic access to
their health information – >10% within 4
business days
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Required Standards for Stage 1
• Patient summary – CCR or CCD
• ePrescribing – NCPDP/SCRIPT 8.1 or 10.6
• Public health labs, surveillance, and immunizations
– HL7 2.3.1 or 2.5.1, CVX
• Problem list – SNOMED or ICD-9-CM
• Procedures – CPT-4
• Labs – LOINC
• Medications – any source in RxNorm
• Race/ethnicity – OMB standards
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Required Privacy/Security for
Stage 1
• Encryption/decryption
– Any approved algorithm in FIPS 140-2
– HIE requires encryption and integrity-protected link
• Record actions
– Date, time, patient, and user recorded for creation,
modification, access, and deletion
• Verification of no alteration in transit
– SHA-1 algorithm or stronger, as specified in FIPS
180-3
• Record TPO disclosures
– Date, time, patient, and user recorded for HIPAAallowed activities
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Clinical Quality Measures
• EPs must report on
– 3 core measures
• Can substitute alternate core measures if denominator
of any core measure is 0
– 3 of 38 additional measures
• EHs must report on 15 measures
• Reporting by attestation in 2011 and provision of
data in 2012 and beyond
• CMS aims to align all quality reporting programs,
i.e., PQRI, CHIPRA, RHQDAPU, etc.
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Core EP Quality Measures
• Hypertension – blood pressure measurement
• Tobacco use assessment and cessation
intervention
• Adult weight screening and follow up
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Alternative EP Quality Measures
• Weight assessment and counseling for children
and adolescents
• Influenza immunization for patients 50+ years
• Childhood immunization status
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EP Additional Quality Measures
(1-12 out of 38)
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Anti-depressant medication management: (a) Effective Acute Phase
Treatment, (b)Effective Continuation Phase Treatment
Appropriate Testing for Children with Pharyngitis
Asthma Assessment
Asthma Pharmacologic Therapy
Breast Cancer Screening
Cervical Cancer Screening
Chlamydia Screening for Women
Colorectal Cancer Screening
Controlling High Blood Pressure
Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients
with Prior Myocardial Infarction (MI)
Coronary Artery Disease (CAD): Drug Therapy for Lowering LDLCholesterol
Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for
Patients with CAD
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Introduction to Healthcare and Public Health in the US
Meaningful Use of Health Information Technology
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EP Additional Quality Measures
(13-24)
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Diabetes: Blood Pressure Management
Diabetes: Eye Exam
Diabetes: Foot Exam
Diabetes: Hemoglobin A1c Control (<8.0%)
Diabetes: Hemoglobin A1c Poor Control
Diabetes: Low Density Lipoprotein (LDL) Management and Control
Diabetes: Urine Screening
Diabetic Retinopathy: Communication with the Physician Managing Ongoing
Diabetes Care
Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and
Level of Severity of Retinopathy
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin
Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction
(LVSD)
Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Meaningful Use of Health Information Technology
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EP Additional Quality Measures
(25-38)
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Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation,
b) Engagement
Ischemic Vascular Disease (IVD): Blood Pressure Management
Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
Low Back Pain: Use of Imaging Studies
Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen
Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients
Pneumonia Vaccination Status for Older Adults
Prenatal Care: Anti-D Immune Globulin
Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate
Cancer Patients
Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and
Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c)
Discussing Smoking and Tobacco Use Cessation Strategies
Use of Appropriate Medications for Asthma
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Meaningful Use of Health Information Technology
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EH Quality Measures
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Anticoagulation overlap therapy
Emergency Department Throughput – admitted patients – Admission decision time to ED
departure time for admitted patients
Emergency Department Throughput – admitted patients – Median time from ED arrival to
ED departure for admitted patients
Incidence of potentially preventable venous thromboembolism
Intensive Care Unit venous thromboembolism prophylaxis
Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2
Ischemic or hemorrhagic stroke – Rehabilitation assessment
Ischemic or hemorrhagic stroke – Stroke education
Ischemic stroke – Anticoagulation for atrial fibrillation/flutter
Ischemic stroke – Discharge on anti-thrombotics
Ischemic stroke – Discharge on statins
Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom
onset
Platelet monitoring on unfractionated heparin
Venous thromboembolism discharge instructions
Venous thromboembolism prophylaxis within 24 hours of arrival
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Introduction to Healthcare and Public Health in the US
Meaningful Use of Health Information Technology
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How Much is All of This Going To
Cost?
• CMS estimates of EPs and EHs
– 477,500 eligible as Medicare EP
• 95,500 of these eligible as Medicaid EP
– 44,100 eligible as Medicaid-only EP
– 5,011 EHs
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3,620 acute care
1,302 CAH
78 children’s
11 cancer
• Estimated achievement of MU in ten years
– Low – 95.6% of EHs and 36% of EPs
– High – 100% of EHs and 70% of EPs
• Total cost: $9.7B (low) to $27.4B (high)
Health IT Workforce Curriculum
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Meaningful Use of Health Information Technology
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Beyond Stage 1
• Much speculation around what rules will be for Stage 2 (and Stage
3)
• Another challenge is wide variety of other requirements healthcare
organizations must undertake in next few years, such as 5010
standards for transactions, ICD-10 coding, and healthcare reform
• ONC HIT Policy Committee submitted recommendations in four
basic categories for changes in measures from Stage 1 to Stage 2
(Drazen, 2011)
– Measures unchanged
– Unchanged menu measures become core
– Increased threshold or wider scope – e.g., increased proportion
of CPOE, decision support rules, etc.
– New measures – including focus on usability (Classen, 2011)
and/or patient experience (Ralston, 2010)
Health IT Workforce Curriculum
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Meaningful Use of Health Information Technology
Lecture b
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Meaningful Use of Health Information
Technology
Summary – Lecture b
• Meaningful use of HIT in the context of the HITECH Act
• Core objectives of Stage 1 Meaningful Use
• Preview of Stages 2 and 3
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Introduction to Healthcare and Public Health in the US
Meaningful Use of Health Information Technology
Lecture b
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Meaningful Use of Health Information
Technology
Summary
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Meaningful use program of HITECH
Eligibility for incentive payments
Criteria for achieving those payments in Stage 1
Standards for Stage 1 of meaningful use, including those
devoted to privacy and security
• Overview of what might be expected in Stages 2 and 3
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Meaningful Use of Health Information Technology
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Meaningful Use of Health Information
Technology
References – Lecture b
References
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Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic health records. New
England Journal of Medicine, 363, 501-504.
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Classen, D., & Drazen, E. (2010). Update on Meaningful Use - Final Rules. Waltham, MA: Computer Sciences
Corp. Retrieved from http://www.csc.com/health_services/insights/28577update_on_meaningful_use_the_final_rule.
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Classen, D., & Bates, D. (2011). Finding the meaning in meaningful use. New England Journal of Medicine, 365,
855-858.
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Drazen, E. (2011). Update on Stage 2: Current Direction and Timing of Meaningful Use Requirements. Waltham,
MA: Computer Sciences Corp. Retrieved from http://www.csc.com/health_services/insights/67921update_on_stage_2_current_direction_and_timing_of_meaningful_use_requirements
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Ralston, J., Coleman, K., Reid, R., Handley, M., & Larson, E. (2010). Patient experience should be part of
meaningful-use criteria. Health Affairs, 29, 607-613.
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Meaningful Use of Health Information Technology
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