Transcript Meaningful Use A Little Bit of Everything

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WV HFMA  January 23, 2014
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Understand Stage 1 changes starting in 2014
Understand Stage 2 Objectives & Quality Measures –
changes from Stage 1 and what you need to know about
what’s new
Understand options for reporting Quality Measures and
PQRS measures together starting in 2014
Learn what you need to do to pass a CMS Meaningful Use
Audit
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CMS Ref
Objective
Change
EP
EH
Capability to exchange key clinical
information electronically
Eliminated as Stage 1
Objective (2013)
EP
EH
Provide patients with timely
electronic access to their health
information within four business
days
Eliminated as Stage 1
Objective (2014)
EH
Provide patients with an electronic Eliminated as Stage 1
copy of their discharge
Objective (2014)
instructions at time of discharge,
upon request
EP
EH
Option to be orders based for
CPOE vs. patient based for
denominator
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CMS Ref
EP
EH
Objective
CPOE
Change
Denominator –
Current : at least one medication order in
the medications list (patient based)
Alternate : All medication orders created
by the EP (orders based)
ePrescribing
EP
Additional exclusion: if there is not a
pharmacy at your organization or a
pharmacy that
accepts electronic prescriptions within 10
miles of each of an EP’s practice
locations
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If 2014 is your first year to attest to Stage 1must attest
within first 9 months of the attestation period to avoid
penalties
o EHs – must meet MU for 90 days, but last 90 days will be Apr-June
o EPs – must meet MU for 90 days, but last 90 days will be Jul-Sept
o CAHs - this does not apply
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Batch submission for EPs
o Separate batches for Medicare and Medicaid
o States not required to provide
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EP
 17 Core Objectives
 3 of 6 Menu
Objectives
EH
 16 Core Objectives
 3 of 6 Menu
Objectives
 28+
Core measures &
sub measures
 3 of 6 menu
 26+
Core measures &
sub measures
 3 of 6 menu
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 CQMs
selected must align with at least 3 of 6
National Quality Strategy Domains
 Any EP or EH in 2nd year of MU must submit CQMs
electronically
EP
 Must choose 9 out of 64 available CQMs
 CMS  priority CQMs (but not required to choose)
 Medicare EPs  option to align MU CQMs with
PQRS, Medicare Shared Savings Program or
Pioneer ACO
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EH
 Must choose 16 out of 29 available CQMs
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2014 “Special Dispensation”
Regardless of what Stage you are, you only need to
meet MU for 90 days. If 2014 is your second year,
the 90 days is based on a quarter, not a rolling 90
days
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CMS Ref
EP
EH
EP
EH
Objective
Change
Implement drug-drug, drug-allergy
check
Incorporated into Stage
2 Decision Support
objective
Maintain problem list of current
and active diagnosis
Incorporated into Stage
2 Summary of Care
document for
TOC/Referrals
EP
EH
Maintain Active Medication Allergy Incorporated into Stage
List
2 Summary of Care
document for
TOC/Referrals
EP
EH
Report clinical quality
measures (CQMs) to
CMS or the States
As of 2014, all CQMs
must be submitted
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electronically
CMS Ref
EP
EH
EP
EH
EP
EH
Objective
Change
Capability to exchange
key clinical information
electronically
Eliminated in Stage 2
Implement drug formulary
checks
Incorporated into
ePrescribing measure for
Stage 2
Provide patients with timely
electronic access to their health
information
Eliminated in Stage 2
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CMS Ref
Objective
Change
EP
EH
Core
CPOE
Meds: >60% (was 30%)
Rad: >30% New
Lab: >30% New
Standard: RxNorm for drugs &
allergies
EP
Core
Generate and transmit
permissible prescriptions
electronically (eRx)
>50% (was 40%)
Must be compared to at least one
drug formulary
EP
EH
Core
Record demographics
>80% (was 50%)
Standard: ISO 639-2 for language
EP
EH
Core
Record & chart changes in
vital signs (BP, Height,
Weight, BMI, growth charts)
>80% (was 50%)
Age Requirement Changes: Ages
3 & over for blood pressure;
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height/weight all ages
CMS Ref
EP
EH
EP
Core
Core
Objective
Record Smoking Status for
patients 13 yrs. & older
Implement CDS
Change
>80% (was > 50% )
Standard: Must map to Snomed CT
5 CDS Rules (was 1 rule)
Additional Requirements:
 Must be tied to at least 4 CQMs
 Must have drug-drug and drugallergy interaction checks included
EP
EH
EP
EH
Core
Incorporate Lab test results
as structured data
>55% (was 40%)
Moves from MenuCore
Ongoing submission
Core
Submit date to
immunization registries
(was “test” of
capability)
Standard: CVX
Moves from Menu Core
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CMS Ref
EH
EP
EH
Core
Core
Objective
Submit data on reportable lab
results
Change
Ongoing submission
(was “test” of
capability)
Standard: LOINC
Moves from MenuCore
Submit syndromic surveillance Ongoing submission (was “test” of
capability)
data
Moves from Menu Core for EH
(remains as Menu for EP)
EP
Core
Patient Reminders for follow
up/preventative care
10% of all patients
(was 20% of
patients age 5 yrs & younger, and patients 65
yrs & older)
Moves from Menu Core
EP
Core
Provide clinical summary for
patients for each office visit
>50% of office visits within 1
business day (was >50% of office visits
within 3 business days)
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CMS Ref
EH
Core
Objective
Provide patient specific
education resources
Change
>10% of all unique patients
with office visits for the EP (was
10% of unique patients)
Moves from Menu Core
EP
EH
Core
Protect Electronic Health
Information
Additional Focus: address the
encryption/security of data
at rest (45 CFR 164.308 (a)(1))
EP
EH
Core
Medication Reconciliation
> 50% of transitions of care to
the EP
Moves from Menu Core
EP
Core
Generate Patient List by
specific condition
Generate at least one
report of patients with a specific
condition
Moves from Menu Core 17
CMS Ref
EP
EH
Core
Objective
Provide Summary of Care
Record (aka Transitions of
Care or TOC)
Change
 > 50% of transitions of care
or referrals (can be paper)
 10% must be electronic
directly from EHR to EHR or
through an exchange (i.e.
WVHIN)
 Electronic transmission must
be to a different EHR vendor
or conduct a test with the
CMS test designated EMR
(Was >50% of transitions of care must provide
Summary of Care record)
Moves from Menu Core
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CMS Ref
Objective
Measure
EH
Core
Automatically track
medications from order to
administration using
assistive technologies in
conjunction with an
electronic medication
administration record
(eMAR)
>10% of medication orders
created … during the
EHR reporting period for
which all doses are
tracked are tracked using
eMAR
EP
EH
Menu Record electronic notes in
patient records
>30% - Enter at least one
electronic progress note
created, edited and signed
by an EP … during the EHR
reporting period
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CMS Ref
Objective
Measure
EP
EH
Menu Imaging results consisting
of the image itself and any
explanation or other
accompanying information
are accessible through
CEHRT.
>20% of all scans and tests
whose result is an image
ordered by the EP for patients
seen during the EHR reporting
period are incorporated into or
accessible through CEHRT
EP
EH
Menu Record patient family health
history as structured data
>20% of all unique patients…
have structured data entry for
one or more first-degree
relatives or an indication that
family health history has been
reviewed
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CMS Ref
Objective
Measure
EH
Menu Generate and transmit
permissible discharge
prescriptions electronically
(eRx)
>10% of hospital discharge
medication orders for
permissible
prescriptions (for new or
changed prescriptions) are
compared to at least one drug
formulary and
transmitted electronically using
Certified HER Technology
EH
Menu Provide structured
electronic lab results to
ambulatory providers
>20% of lab results for orders
received by hospital labs are
sent as structured electronic
clinical lab results back to the
ordering provider
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CMS Ref
Objective
Use secure electronic
messaging to communicate
with patients on relevant
health information
Measure
EP
Core
> 5% of unique patients
securely message their provider
during the reporting period
EP
Menu Capability to identify and
report cancer cases to a
State cancer registry
Ongoing Submission of cancer
case information to a cancer
registry for the entire EHR
reporting period
EP
Menu Capability to identify and
report specific cases to a
specialized registry (other
than a cancer registry)
Ongoing Submission of specific
case information to a pecialized
registry for the entire EHR
reporting period
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 Desk
audits
 Post payment audits for EPs and EHs
 Pre payment audits for EPs
 Candidate for audit after meeting MU for full year
 In general, turnaround time is about 1 month.
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Part 1 General Information
 Proof
of licensing of a certified EHR
“…provide a copy of your licensing agreement with the vendor or invoices.
Please ensure that the licensing agreements or invoices identify the
vendor, product name and product version number”
 Proof
of method for calculating ED admissions
(i.e.
an explanation of how the ED admissions were calculated and a summary of ED
admissions)
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Part II Core Set Objectives/Measures
 Proof
of Core Measures #1, 3, 4, 5, 6, 7, 8, 11, &
12
o Report from the certified EHR used to complete the
attestation
o Proof that the report used for attestation is from the
certified EHR
• Vendor Logo Or
• Step by step screen shots of how report is generated from EHR
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Part II Core Set Objectives/Measures
 Proof
that a security risk analysis was performed
o Must show that it was during the MU reporting period
o Must include implementation plan to address any
deficiencies found, with completion dates
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Part III Menu Set Objectives/Measures
 Proof
of Menu Measures #2, 3, 5, 6, or 7
o Report from the certified EHR used to complete the
attestation
o Proof that the report used for attestation is from the
certified EHR
• Vendor Logo Or
• Step by step screen shots of how report is generated from HER
 Proof of Yes/No
o Screen Shots
Menu Set Measures #4, 8, 9, or 10
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Save EVERYTHING!
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Reports from your EHR that you use to attest
The detail behind the numerator/denominator
Screen shots from EHR for YES/NO measures from reporting period
Medicare and Medicaid attestation confirmation
Medicaid screen shots from every step of the attestation
Medicare summary of all of your input from the attestation
Security Risk Analysis (and every re-evaluation done)
Recommendation: create a share drive with tightly controlled access
to save off MU documents
Remember: You need to do this for every
individual EP…much easier for EH!
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 Contact your EHR Vendor
o What can/will they do to assist you with an audit?
o What limitations do you have in terms of what you can submit
without breaching proprietary property?
 If
Reporting MU from multiple EHRs…
o Be sure that the reports used from each of the EHRs have the
same items for attestation
o All reports have to be submitted for the audit
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 Documentation Submission
o Be sure to follow the same order as requested in the letter from
Figliozzi (or CMS)
o Cover letter – outline exactly what you are submitting in response to
each document request
o Create a single PDF of all of the documents in the correct order
along with a cover letter and submit
o Most importantly…
Don’t miss your submission deadline!
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