Meaningful Use: A Practical Approach

1. Meaningful Use:A Practical Approach

2. Mary M Ceita Case Scenario A Practical Approach to Thinking Through Meaningful Use

3. TrmtRm Lounge Specialist Exam Rm Exam Rooms Mary M Ceita Supply Lab X-Ray / Rad Ultrasound Stress Test Admin Dress Rm Patient Waiting Area and Reception Exam Room

4. Mary M Ceita, an established patient, calls the clinic complaining of abdominal pain and bloating she has had for 2+ days with loss of appetite, requests earliest available appointment.

5. Satisfies Core Measure?? __________ 7 Mary M Ceita Enters the clinic and approaches the receptionist for check-in Mary M Ceita provides her driver’s license and insurance cards to front office staff for scanning. Front office staff checks and updates demographics (sex, race, ethnicity, date of birth, preferred language, and updated contact information) in the EHR. Mary M Ceita is then directed to take a seat and wait for the nurse to call her back.

6. Satisfies MU Core Measure??? __________ 8 A nurse or MA escorts Mary M Ceita to the vitals area .Nurse takes vitals: Height, weight, blood pressure, and calculated the BMI. Since Mary is over 20 years, there is no need to plot and display growth charts for MU (although this may be helpful for Mary!).Vitals are recorded in EHR as structured data.

7. Satisfies MU Menu Measure??? ________ Satisfies MU Core Measure??? ________ 2 9 A nurse escorts Mary to an exam room. After reviewing the electronic chart, the nurse identifies that Mary is presently being treated for diabetes mellitus and is currently taking insulin. There is also some new lab information  Mary went to the lab on the previous day; lab test results were transmitted and received in the EHR (as structured data).The nurse then questions Mary about her present smoking status. Mary states she continues to smoke ½ pack/day. The nurse records her smoking status and then asks Mary if she would like her seasonal flu vaccination. Mary agrees to the vaccination.

8. The doctor comes in and reviews Mary’s chart, affirming her age, previous history,diagnoses, and chief complaint.The doctor updates the problem list and then evaluates Left Upper Quadrant (LUQ) abdominal pain. Doctor reviews the most recent blood sugar level from the EHR (received from the lab interface) and identifiesthat the level is above the normal range. The doctor electronically orders a complete blood panel and explains to Mary that her lab results will be available electronically within 4 business days of when the doctor receives the results. Doctor questions Mary about her med list, history of medication allergies, and her smoking status, then records this in the EHR as structured data. Mary affirms that she has no sign/symptoms of drug allergies but states she does continue to smoke, ½ pack a day. • The system alerts the physician that due to Mary’s age and chronic conditions, she is due for a flu immunization. This was discussed and Mary agreed to receive the immunization. Satisfies MU Core Measure??? Satisfies MU Menu Measure??? 3,5,6,9,11 2,5,9

9. Diagnosis: Type II IDDM , uncontrolled Treatment Plan • Mary is referred to Endocrinologist for further evaluation of abdominal pain. • The Doctor electronically shares Mary’s summary of care record with the Endocrinologist through an HIE, since the Endocrinologist uses a different, certified EHR system. • A smoking cessation plan is discussed. • Finally, the Doctor notes that no new medications have been prescribed, but performs medication reconciliation. • The Nurse administers the flu shot and updates immunization record in the EHR. • The Nurse also prints education for Mary, whichwas flagged by the EHR and confirmed by the Doctor. • Mary is also provided a printed care summary for her files at home. Satisfies MU Core Measure??? Satisfies MU Menu Measure??? 5,9, 13,14 6,8 9

10. Which Core Measures didn’t we discuss? • #1 – There were no new medications, so CPOE wasn’t utilized. The CPOE measure does require more than 30% of all unique patients with at least 1 medication in their list seen by the EP to have at least 1 medication order entered using CPOE. • #12 -- Mary didn’t request a copy of her electronic health information … but the EP must be able to do this for more than 50% of their patients who request it within 3 business days. • #15 – The practice has to perform a security risk analysis, not just assume the technology covers HIPAA

11. Which Menu Measures were missing? • #1 Implement drug formulary checks • #3  Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. • #4  Send reminders to patients per patient preference for preventive/follow up care • #7  The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. • #10  Capability to submit electronic syndromic surveillance data to public health agencies

12. Improve Quality, Safety & Efficiency Engage Patients & Families Improve Care Coordi- nation Improve Population And Public Health Ensure Privacy And Security Protections Meaningful Use Jeopardy! 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500 600 pts Tie Breaker 300 pts Tie Breaker End Jeopardy Game

13. 100 Points: Improve Quality and Safety What is the exclusion for the MU Objective: Record Smoking Status ? • Any EP where 60% of their patients are 13 years or younger. • An EP with 100% of their patient population >13 years old. • An EP whose patient population is 50% 13 years old or younger. Answer: • An EP with 100% of their patient population >13 years old. Back to Jeopardy Board

14. 200 points: Improve Quality and Safety What structured data elements are required to meet the demographics measure? • Preferred language, country of birth, gender, date of birth • Preferred language, gender, race, ethnicity, date of birth • Gender, race, ethnicity, date of birth • Answer: • Preferred language, gender, race, ethnicity, date of birth Back to Jeopardy Board

15. 300 points: Improve Quality and Safety Name the MU Menu Objective for this EXCLUSION: Any EP who writes fewer than 100 prescriptions during the EHR reporting period. • Implement drug formulary checks • CPOE • Implement drug-drug and drug-allergy checks Answer: • Implement drug formulary checks is the MENU objective. (This is also true for CPOE – but CPOE is a CORE objective.) Back to Jeopardy Board

16. 400 points : Improve Quality and Safety Name the report required by the provider to satisfy the MU Measure: Generate at least one report listing patients of the EP with a specific condition. • Chronic Disease patients • Geriatric patients • The report is at the provider’s discretion Answer: • The report is at the provider’s discretion: This objective does not dictate the report. An EP is best positioned to determine which reports are most useful to their care efforts. Back to Jeopardy Board

17. 500 points : Improve Quality and Safety What measures are satisfied by this case study? A Spanish-speaking male with hypoglycemia is brought to the M-CEITA Medical Clinic by family. The patient had fallen in his apartment bathroom and presents with a laceration above the right eyebrow. Front desk staff requested family to update all contact and demographic information, and also requested patient’s insurance cards for scanning into the EHR. Nurse Lemme Help immediately took the patient back to the examination room where she cleaned and prepped the laceration. A blood sugar finger stick was conducted revealing a very low blood sugar level. Vitals were also conducted and recorded in the EHR. Dr. AryaListn entered the room having reviewed Nurse Lemme Help’s triage notes documented in the EHR. He spoke with the patient and family regarding the accident. A simple neurologic eye exam was positive. Dr AryhaListn recommended a CT scan and further evaluation. Dr dressed the laceration and prepped patient for transfer. Summary of Care record was produced for transition of care/referral. Dr AryaListn reviewed the most up-to-date list of all medications patient is presently taking for accuracy, including the name, dosage, frequency and route of each medication. Medication reconciliation was entered into the EHR as structured data. The patient was then transferred by EMS to a regional hospital for CT scan and further neurological evaluation.   Core: demographics, vitals Menu: medication reconciliation, care summary Back to Jeopardy Board

18. 100 Points: Engage Patients & Family Which of the following apply as options for an EP to attest to the Core objective of providing an electronic copy of health information upon request? • Enter ‘0’ in the exclusion box • Provide evidence that >40% of all patients who request an electronic copy of their health info are provided it within 3 business days. • Provide evidence that >50% of all patients who request an electronic copy of their health info are provided it within 3 business days. • #1 and #3 Answer: • #1 and #3 Back to Jeopardy Board

19. 200 points: Engage Patients & Family Which of the following accurately describes the methods by which an EP may share the Clinical Summary with their patient? • Patient portal • Phone call • E-mail Answer: • Patient portal Back to Jeopardy Board

20. 300 points: Engage Patients & Family Which of the following would prevent a provider from successfully attesting to the Menu measure of providing patient-specific education? • The EP attests to providing patient-specific education at more than 10% of their patient visits. • The EP chooses which education to provide based on the patient’s visit, but suggested by logic from a certified EHR vendor. • The EP attests to providing patient-specific education for more than10% of their unique patients. Answer: • 1. The EP attests to providing patient-specific education for more than10% of their patient visits. Back to Jeopardy Board

21. 400 points : Engage Patients & Family Which of the following correctly describes the instances when information may be withheld from being electronically accessible by patients? • The EP decides that electronic access is not the best forum to communicate results. • The information was not maintained electronically • The EP withholds information from the electronic access of a patient’s PHI in accordance with the HIPAA Privacy rule • #1 and #2 only • #1, #2, and #3 Answer: • #1, #2, and #3 Back to Jeopardy Board

22. 500 points : Engage Patients & Family What measures are satisfied by this case study? A 67 year old patient with rheumatoid arthritis is being treated with gold. She goes to see her family physician for a check up on her condition. Her family physician orders a therapeutic drug test to measure the level of gold in her system. He indicates that he will keep her medication the same until the electronic test results are received. While she is there, her physician is alerted that she is due for her annual flu shot. When he enters the order, an alert reminds the physician that flu shots are contra-indicated with gold injections. She is provided with a copy of her visit summary so she can update her records. Also, the medical assistant checks the patients vitals and records the blood pressure information and her weight. Core: Maintain active medication list, Drug Interaction Checks, Update vitals, Provide clinical summary, Clinical Decision Support rule Menu: Lab interface Back to Jeopardy Board

23. 100 Points: Improve Care Coordination Which of the following ‘count’ for exchange of key clinical information ? • Problem List • Medication List • Medication Allergies • Diagnostic test results • Clinical judgment of the EP Answer: All of the above. Back to Jeopardy Board

24. 200 points: Improve Care Coordination Which of the following would qualify as achievement of exchange of key clinical information? • Attestation of the capability, demonstration with test patient information using unencrypted data • Attestation of the capability, authorization of the patient and demonstration with actual patient information using encrypted data Answer: All of the above. Back to Jeopardy Board

25. 300 points: Improve Care Coordination Which of the following scenarios would qualify for performing medical reconciliation (med rec) between care settings or providers? • The EP performs med rec for >50% of transitions of care. • The EP performs med rec for >30% of transitions of care. • The EP performs med rec for >60% of transitions of care. Answer: • The EP performs med rec for >50% of transitions of care. Back to Jeopardy Board

26. 400 points: Improve Care Coordination Which of the following correctly defines the exclusion for Summary of Care provisions for each transfer of care or referral? • An EP who sends the patient to another PCP down the road. • An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period. • An EP who sends their patient to a specialist. Answer: • An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period. Back to Jeopardy Board

27. 500 points: Improve Care Coordination What measures are satisfied by this case study? Mia Hamm’s 15 year old daughter, Grace, fell playing soccer and hurt her knee. So, Mia called and set up an appointment with her pediatrician, who fit her in the next day. At check-in, Grace and Mia confirmed the demographic info and indicated Grace remains a non-smoker. Then, Grace and Mia were taken back to an exam room. The provider questioned Grace about her injury and pain level and updated her problem list. Next, the provider did a few tests on her knee. The doctor concluded that Grace should see a specialist on suspicion of a torn ACL. An MRI was electronically ordered and a referral made to a specialist. The doctor also sent the specialist a CCD/CCR through an encrypted email. The doctor entered an order for a pain medication, but was alerted to an adverse effect and e-prescribed Tylenol 3 through the EHR. The provider printed a Clinical Summary for Grace and Mia and some education on knee injuries. The nurse then walked them to the check out, where they were assisted in making an appt with the Orthopedic Surgeon. Core: CPOE, drug-allergy check (enabled function), up to date problem list, demographics, smoking status, clinical summary, eRX, Menu: Patient education, summary of care record for transition of care Back to Jeopardy Board

28. 100 Points: Improve Population Health Which registry test submission, followed by actual submissions if the simulation is successful, is covered in the Menu set of measures? • Demographic information • Immunization data • Medication List Answer: • Immunization data Back to Jeopardy Board

29. 200 points: Improve Population Health A valid exclusion of the Immunization Registry Data Submission Menu Measure would be: • The provider didn’t perform any immunizations in the reporting period. • There is no immunization registry that has the capacity to receive the information electronically. • The provider performed less than 100 immunizations in the reporting period. • #1 and #2 • #1, #2, and #3 Answer: • #1 and #2 Back to Jeopardy Board

30. 300 points: Improve Population Health How many syndromic surveillance data submissions must be made by a certified EHR to meet the Menu objective? • One • Two • Three Answer: • One Back to Jeopardy Board

31. 400 points: Improve Population Health Which of the following situations would satisfy the Syndromic Surveillance Data Submission Menu Set Measure? • Simulated transfer of information • An unsuccessful test to submit electronic syndromic surveillance data to public health agencies. • The use of test information about a fiction patient that would be identical in form to what would be sent about an actual patient. • #1 and #2 • #2 and #3 • #1 and #3 Answer: • #2 and #3 Back to Jeopardy Board

32. 500 points: Improve Population Health What measures are satisfied by this case study? Mrs Jones presents at the clinic with a cut hand. Upon reaching the office, she updates her information, including R/E/L. She is taken to the exam room. Dr Greatest comes in, assesses the cut, and applies two stitches to the wound. He checks her immunization record to determine when her last tetanus was given. He cannot find any record of a tetanus in the last 10 years so he orders this immunization which is given by his MA. He prescribes a pain medication and verifies the pharmacy information and asks her about any new allergies. Dr Greatest finishes bandages Mrs. Jones’ hand. The EHR prompts for suture care instructions which are provided for Mrs. Jones, and she goes to check-out where she is informed her visit will be available in her PHR within 3 days. Core: Demographic info, up to date problem list, CPOE, drug-drug & drug-allergy interaction checks, update medication list, eRX Menu: Patient specific education materials, electronic access to health information Back to Jeopardy Board

33. 100 Points: Ensure Privacy & Security True/False? The Ensure Adequate Privacy and Security Protections for Personal Health Information pillar is supported by Core and Menu items for EP’s and EH’s. Answer: • False – There are no “menu” items associated with this pillar. Back to Jeopardy Board

34. 200 points: Ensure Privacy & Security True/False? Providers seeing fewer than 500 patients during the reporting period are exempt from conducting or reviewing a security risk analysis. Answer: • False – there are no exclusions associated with this measure. 500 patients is the threshold for notifying “prominent media outlets” and HHS if a security breach of unsecured e-PHI occurs. Back to Jeopardy Board

35. 300 points: Ensure Privacy & Security True/False? Updating software, improving physical security, and making changes to practice workflow are all examples of acceptable security updates that can be implemented to address security deficiencies. • Answer: • True – security measures come in many forms including digital and physical protections. (e.g. antivirus software, lock on server room, etc.) Back to Jeopardy Board

36. 300 points: Tie Breaker Which of the following EP measures require a Y/N attestation for Stage 1 meaningful use? • Conduct or review a security risk analysis in accordance with the requirement under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of the risk management process. • Generate at least one report listing patients of the EP with a specific condition. • More than 20% of all patients 65 years and older or 5 years and under were sent an appropriate reminder during the EHR reporting period. • #1 and #2 • All of the above • Answer: • #1 and #2 Back to Jeopardy Board

37. 500 points: Ensure Privacy & Security Name 5 Meaningful Use Measures that have no exclusions Core:2,3,5,6,7,10,11,14 and 15 Menu: 3 and 6 Back to Jeopardy Board

38. 400 points: Privacy and Security The only stage one measure in this MU pillar refers to 45 CFR 164.308 (a)(1). Which federal legislation does this refer to? • ARRA • HITECH • HIPAA Privacy Rule • HIPAA Security Rule • B and D Answer: • HIPAA Security Rule Back to Jeopardy Board

39. 600 points: TIE BREAKERBack to the Basics! What do the numbers 15, 5, 3, and 3 stand for?? • Answer: • 15 Core Measures, 5 Menu Measures, 3 core CQMs, and 3 Additional CQMs Back to Jeopardy Board

40. Resources CMS MU WORKBOOK CMS Information Website:http://www.cms.gov/EHRIncentiveprograms

41. Comments Questions