Transcript Meaningful Use Overview (Powerpoint)

Christopher Geer, MBA
Meaningful Use Project Manager
Unity Health System
[email protected]
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The Health Information
Technology for
Economic and Clinical
Health (HITECH) Act
Enacted as part of the
American Recovery and
Reinvestment Act of 2009
Promotes the adoption
and meaningful use of
health information
technology.
http://www.recovery.gov/About/Pages/The_Act.asp
x
3
2
1
Data
Capture and
Sharing
Advanced
Clinical
Process
Improved
Outcomes
Payment Year
First Payment
Year
2011
2012
2013
2014
2015
2016
2017
2011
Stage 1
(100%)
Stage 1
(75%)
Stage 1
(50%)
Stage 2
(25%)
Stage 2
Stage 3
Stage 3
Stage 1
(100%)
Stage 1
(75%)
Stage 2
(50%)
Stage 2
(25%)
Stage 3
Stage 3
Stage 1
(100%)
Stage 1
(75%)
Stage 2
(50%)
Stage 2
(25%)
Stage 3
Stage 1
(75%)
Stage 1
(50%)
Stage 2
(25%)
Stage 2
Stage 1
Stage 1
Stage 2
Stage 1
Stage 1
2012
2013
2014
2015
2016
“If there will be a stage 4 of Meaningful Use, we expect to update this
table in the rulemaking stage 3” – CMS, Stage 2 NPRM
Possess
Certified
EHR
Technology
Attest to
Meaningfully
Using
CEHRT
Incentive
Payment
Is your vendor certified?
http://onc-chpl.force.com/ehrcert
Meaningful
Use
Eligible
Hospitals
Medicaid
Eligible
Professionals
Medicare
Dually-eligible
Hospitals can
participate in both
programs
Medicaid
Medicare
Dually-eligible
providers must pick
1 program
Medicaid Program
Medicare Program
Administered by the State
Administered by Federal Government
No payment reductions
Payment reductions begin in 2015
Adopt, Implement, Upgrade option for
1st year
Must demonstrate MU in year 1
Maximum EP incentive $63,750
Maximum incentive $44,000 for EP’s
(10% bonus for EP’s in HPSAs)
Fixed incentive over 6 years (EP) and
4 years (EH) in NYS (may vary by
state)
EP incentive paid over 5 years based
on 75% of net allowable charges
Require 30% (EP) and 10%(EH)
minimum Medicaid volume
No minimum volume threshold
Can skip years once starting
Must be done in consecutive years
•Must render <90% of services in an Inpatient Acute or Emergency Setting
Medicaid EP’s
Medicare EP’s
30% Medicaid Volume Required
No Volume Requirement
Physicians
Doctor of Medicine or Osteopathy
Dentists
Doctor of Oral Surgery or Dental
Medicine
Certified Nurse Midwife
Doctor of Podiatric Medicine
Nurse Practitioner
Doctor of Optometry
Physician Assistant*
Chiropractor
*Must be practicing in a Rural Health Center or Federally Qualified Health Center led by a PA.
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Subsection (d) hospitals or Critical Access Hospitals in the 50
states or DC that are paid under the Inpatient Prospective Payment
System (IPPS)
Eligible Hospital
Stage 1
Stage 2
Core
14
16
Menu
10
4
Menu Required
5
2
Eligible Professional
Stage 1
Stage 2
Core
15
17
Menu
10
5
Menu Required
5
3
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Yes / No Attestation
Percentage-Based Measure
• Numerator / Denominator = Requirement
• Possible Denominators:
 Unique Patients
 Transitions of Care
 Orders
There are exclusions for many of the objectives
Objective : Use CPOE for orders entered
STAGE 1
EP: CORE EH: CORE
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Requirement: 30%
Numerator: At least 1
medication order
Denominator: Unique
patients with at least 1
medication in their med list
PROPOSED STAGE 2
EP: CORE EH: CORE
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Requirement: 60 %
Numerator: Total orders
entered using CPOE
Denominator: Total
medication, lab, and
radiology orders
Objective: Implement drug-formulary checks
STAGE 1
EP: MENU EH: MENU
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Enable drug formulary checks
PROPOSED STAGE 2
CONSOLIDATED
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Consolidated into the eRx
objective
Objective: Generate and transmit permissible prescriptions electronically
(eRx).
STAGE 1
EP: CORE EH: N/A
PROPOSED STAGE 2
EP: CORE EH: MENU
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Requirement: 40%
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Requirement: EP: 65%
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Numerator: E-prescriptions
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Numerator: E-prescriptions
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Denominator: Prescriptions
written
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EH: 10%
Denominator: Prescriptions
written (EH: Discharge
Prescriptions)
Must be checked against at least
1 formulary
Objective: Use clinically relevant information from Certified EHR
Technology to identify patient-specific education resources and provide
those resources to the patient.
STAGE 1
EP: MENU EH: MENU
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Requirement: 10%
Numerator: Number of patients
who are provided patient
education specific resources
Denominator: Unique patients
PROPOSED STAGE 2
EP: CORE EH: CORE
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Requirement: 10%
Numerator: Number of patients
who are provided patient
education specific resources
Denominator:
EH: Unique patients
EP: Office Visits
Objective: The EP or EH who receives a patient from another setting of care
or provider of care or believes an encounter is relevant should perform
medication reconciliation
STAGE 1
EP: MENU EH: MENU
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Requirement: 50%
Numerator: Patients where
medication reconciliation was
performed.
Denominator: Transitions of care
PROPOSED STAGE 2
EP: CORE EH: CORE
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Requirement: 65%
Numerator: Patients where
medication reconciliation was
performed.
Denominator: Transitions of care
Objective: Send reminders to patients per patient preference for
preventive/follow-up care.
STAGE 1
EP: MENU EH: N/A
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Requirement: 20%
Numerator: Patients who were
sent reminders
Denominator: Number of unique
patients 65 years old or older or 5
years older or younger.
PROPOSED STAGE 2
EP: CORE EH: N/A
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Requirement: 10%
Numerator: Patients who were
sent reminders
Denominator: Unique patients
Objective : Record the following demographics: preferred language, gender,
race and ethnicity, date of birth, and date and preliminary cause of death in
the event of mortality in the eligible hospital or CAH
STAGE 1
EP: CORE EH: CORE
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Requirement: 50%
Numerator: Number of patients
will all elements captured
Denominator: Unique patients
Race/Ethnicity Standard: OMB
Standards
PROPOSED STAGE 2
EP: CORE EH: CORE
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Requirement: 80 %
Numerator: Number of patients
will all elements captured
Denominator: Unique patients
Race/Ethnicity Standard: OMB
Standards
http://www.whitehouse.gov/omb/fedreg_1997standards/
Objectives : Maintain an up-to-date problem list, medication list, and
medication allergy list
STAGE 1
EP: CORE EH: CORE
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Requirement: 80%
Numerator: Unique patients
with at least 1 recorded
problem, medication,
medication allergy, or an
indication of none.
Denominator: Unique patients
PROPOSED STAGE 2
CONSOLIDATED
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Consolidated into the
requirements for other
objectives
Objective: Record and chart height, weight and blood pressure and
calculate and display body mass index (BMI) for ages 2 and over; plot and
display growth charts for children 2 - 20 years, including BMI
STAGE 1
EP: CORE EH: CORE
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Requirement: 50%
Numerator: Number of patients
with all elements captured
PROPOSED STAGE 2
EP: CORE EH: CORE
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Requirement: 80 %
Change BMI to age 3, and
eliminate height/weight age
restriction
Denominator: Unique patients
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Numerator: Number of patients
will all elements captured
Denominator: Unique patients
Objective: Record smoking status for patients 13 years old or older
STAGE 1
EP: CORE EH: CORE
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Requirement: 50%
Numerator: Number of unique
patients with smoking status
captured
Denominator: Unique patients
PROPOSED STAGE 2
EP: CORE EH: CORE
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Requirement: 80 %
Numerator: Number of unique
patients with smoking status
captured
Denominator: Unique patients
Objective: Generate lists of patients by specific conditions to use for quality
improvement, reduction of disparities, research, or outreach
STAGE 1
EP: MENU EH: MENU
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Generate 1 list
PROPOSED STAGE 2
EP: CORE EH: CORE
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Generate 1 list
Objective : Report quality measure to CMS or the states
STAGE 1
EP: CORE EH: CORE
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Submit quality measures
PROPOSED STAGE 2
REMOVED AS AN OBJECTIVE
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Still required to submit to
be considered a
meaningful user
Electronic Submission
Objective : Implement clinical decision support rules related to specialty or
high clinical priority
STAGE 1
EP: CORE EH: CORE
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1 Rule
PROPOSED STAGE 2
EP: CORE EH: CORE
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5 Rules related to the
improvement of selected
quality measures
Drug-Drug / Drug Allergy
Checks included as part of
this objective
Objective : Implement drug-drug and drug-allergy checks
STAGE 1
EP: CORE EH: CORE
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Enable drug-drug / drugallergy checks
PROPOSED STAGE 2
CONSOLIDATED
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Consolidated into the
Clinical Decision Support
Objective
Enable drug-drug / drugallergy checks
Objective: Protect electronic health information created or maintained by
the certified EHR technology through the implementation of appropriate
technical capabilities
STAGE 1
EP: CORE EH: CORE
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Perform Security Risk
Assessment
PROPOSED STAGE 2
EP: CORE EH: CORE
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Perform Security Risk
Assessment
Objective: Record whether a patient 65 years old or older has an advanced
directive as structured data
STAGE 1
EP: N/A EH: MENU
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Requirement: 50%
Numerator: Number of patients
where an indication of an
advance directive is entered
Denominator: Unique patients
PROPOSED STAGE 2
EP: N/A EH: MENU
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Requirement: 50%
Numerator: Number of patients
where an indication of an
advance directive is entered
Denominator: Unique patients
Objective: Incorporate clinical lab-test results into EHR as structured data
STAGE 1
EP: MENU EH: MENU
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Requirement: 40%
Numerator: Lab orders received
electronically
Denominator: Lab orders
PROPOSED STAGE 2
EP: CORE EH: CORE
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Requirement: 55%
Numerator: Lab orders received
electronically
Denominator: Lab orders
Stage 2
Hospital
Status
Stage 2
Ambulatory
Status
Immunization Data
Core
Core
Lab Data
Core
N/A
Measure
Surveillance Data
Stage 1
Requirement
Core
Menu
Cancer Cases
N/A
Menu
Other Specific Cases
N/A
Menu
Objective: Use secure electronic messaging to communicate with patients on
relevant health information.
STAGE 1
EP: N/A EH: N/A
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New with for stage 2
PROPOSED STAGE 2
EP: CORE EH: N/A
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Requirement: 10%
Numerator: The number of
patients who send a secure
message to the provider
Denominator: Unique patients
Objective: Imaging results and information are accessible through Certified
EHR Technology.
STAGE 1
EP: N/A EH: N/A
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New with for stage 2
PROPOSED STAGE 2
EP: MENU EH: MENU
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Requirement:
• 40% images captured
• 10% submitted to another
provider of care
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Numerator: Results accessible
through the EHR
Denominator: Number of scans
and tests whose result is one or
more image ordered
Objective: Automatically track medications from order to administration
using assistive technologies in conjunction with an electronic medication
administration record (eMAR).
STAGE 1
EP: N/A EH: N/A
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New with for stage 2
PROPOSED STAGE 2
EP: N/A EH: MENU
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Requirement: 10%
Numerator: The number of orders
tracked using eMAR.
Denominator: Medication orders
Objective Record patient family health history as structured data
STAGE 1
EP: N/A EH: N/A
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New with for stage 2
PROPOSED STAGE 2
EP: MENU EH: MENU
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Requirement: 20%
Numerator: Patients with
structured data entry for one or
more first-degree relatives.
Denominator: Unique Patients
Objective Provide clinical summaries for patients for each office visit
STAGE 1
EP: CORE EH: N/A
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Requirement: 50%
Numerator: Patients provided a
clinical summary within 3
business days
PROPOSED STAGE 2
EP: CORE EH: N/A
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Requirement: 50%
Numerator: Patients provided a
clinical summary within 24 hours
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Denominator: Unique Patients
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Expanded requirements
Denominator: Unique Patients
Objective: Capability to exchange key clinical information, among
providers of care and patient authorized entities electronically
STAGE 1
EP: CORE EH: CORE
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Performed one test
PROPOSED STAGE 2
CONSOLIDATED
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Consolidated into the summary of
care objective
Objective: The EP or EH who transitions their patient to another setting of care
should provide summary care record for each transition of care or referral
STAGE 1
EP: MENU EH: MENU
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Requirement: 50%
Numerator: Number of patients
where a summary of care was
provided
PROPOSED STAGE 2
EP: CORE EH: CORE
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Requirement:
• 60% Paper or electronic
• 10% electronically
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Denominator: Number of
transitions of care
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Numerator: Number of patients
where a summary of care was
provided
Denominator: Number of
transitions of care
Objective: Provide patients with an electronic copy of their health
information upon request
STAGE 1
EP: CORE EH: CORE
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Requirement: 50%
Numerator: Number of patients
receiving their record
electronically within 3 business
days
Denominator: patient requests for
an e-copy
At a minimum: must include
Problems, medications, medication
allergies, and diagnostic test results
PROPOSED STAGE 2
CONSOLIDATED
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Consolidated into the view,
download, transmit objective.
Objective: Provide patients with an electronic copy of their health
information upon request
STAGE 1
EP: N/A EH: CORE
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Requirement: 50%
Numerator: Number of patients
receiving their instructions
electronically
Denominator: patient requests for
an e-discharge instructions
PROPOSED STAGE 2
CONSOLIDATED
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Consolidated into the view,
download, transmit objective.
Objective: Provide patients with timely electronic access to their health
information within four business days of the information being available to
the EP
STAGE 1
EP: MENU EH: N/A
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Requirement: 10%
Numerator: Number of patients who
have their record displayed online
Denominator: Unique patients
At a minimum: must include
Problems, medications, medication
allergies, and diagnostic test results
PROPOSED STAGE 2
CONSOLIDATED
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Consolidated into the view,
download, transmit objective.
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EP:
• Must provide information online in 4 business days
• 50% of unique patients are provided their health information online
• 10% of patients must access that information
Standards
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Patient Name
Provider name, practice
Problem List
 SNOMED CT
Procedures
 ICD-10, CPT-4
Laboratory test results
 LOINC
Medication list
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Medication Allergy List
Vital Signs
Smoking Status
Demographic Information
Care plan field, including goals
and instructions
Additional known care team
members
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EP:
• Must provide information online within 36 hours of discharge
• 50% of unique patients are provided their health information online
• 10% of patients must access that information
Standards
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Admit and discharge date/place
Reason for hospitalization
Providers of care
Problem List
 SNOMED CT
Relevant past diagnosis
Laboratory test results
 LOINC
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Medication list
Medication Allergy List
Vitals at discharge
Demographic Information
Care transition plan
Discharge Instructions
Questions?
Christopher Geer, MBA
Meaningful Use Project Manager
Unity Health System
[email protected]