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Meaningful Use Are you ready? Jay Anders, MD, CMIO

Meaningful Use Are you ready? Jay Anders, MD, CMIO. Proprietary and Confidential. Goals. Acceleration of HIT adoption for savings of 0.3% between 2011 and 2019; greater than $60 billion in savings.

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Meaningful Use Are you ready? Jay Anders, MD, CMIO

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  1. Meaningful UseAre you ready?Jay Anders, MD, CMIO Proprietary and Confidential

  2. Goals Acceleration of HIT adoption for savings of 0.3% between 2011 and 2019; greater than $60 billion in savings. The CBO projects that without the stimulus, about 45% of hospitals and 65% of physicians will have adopted qualifying health IT in 2019. CBO estimates the incentive will boost adoption rates to about 70% for hospitals and about 90% for physicians. For informational purposes only, does not constitute legal or business advice

  3. Moving Target Stage 1: Meaningful Use criteria focus on electronically capturing health information in coded formats to track clinical conditions and communication of information for care coordination. Stage 1 also addresses clinical decision support tools to facilitate disease management and medication management. Stage 2: Meaningful Use criteria will focus on expanding in the areas of disease management, clinical decision support, medication management, support for patient access to health information, care transitions, quality measurement, research, and bi-directional communication with public agencies. Proof beyond attestation will be required.

  4. Programs • Providers may only submit for one incentive option - Medicare or Medicaid. • Medicare • 75% of Allowable Medicare Part B claims up to a cap of $18,000 in 2011/2012 – Professional only not Tech Component • Medicaid • Must have 30% Medicaid patients in practice, or 20% for Pediatric practices • Flat fee based on “net average allowable” cost Year 1: $21,250/Years 2-6: $8,500 • CMS has determined average allowable cost to be $54,000 year one and $20,610 years 2-6

  5. Definitions • Eligible Provider Physicians, licensed to practice medicine including optometrists, podiatrists, DO’s and Chiropractors Medicaid incentive includes nurse midwives, physician assistants, and nurse practitioners. Physicians working in a hospital environment, including anesthesiologists, pathologists and emergency • Certified EHR Technology The Office of the National Coordinator (ONC) within Health and Human Services (HHS) is now certifying ACTB (Ambulatory Certification and Testing Bodies. EHR products will be certified through those entities.

  6. Incentives and Penalties

  7. E-Prescribing and PQRI • The E-Prescribing incentive will sunset when a provider enrolls in either the Medicare or Medicaid stimulus program. • The ONC has been directed to role the PQRI program into the stage II Meaningful Use guidelines. It is yet unclear whether this program will be discontinued when this occurs January 1, 2013.

  8. Participation • Application in 2011 – To receive payment in 2011, eligible providers must attest to completion of 90 continuous days of compliance with all Meaningful Use criteria. • Application in 2012 - To receive payment in 2012, eligible providers must submit attestation proving they met all Meaningful Use criteria for the full year.

  9. Choice in Criteria • Eligible providers need to meet all 15 core requirements. • Eligible providers may choose five of the “Menu Set” criteria for Stage I, and defer the remaining five for Stage II.

  10. Meaningful use criteria – Medicare • There are 20 (Originally 25) unique criteria that eligible providers will have to meet in 2011 and 2012. • 170.302 General certification criteria for Complete EHRs or EHR Modules. • 170.304 Specific certification criteria for Complete EHRs or EHR Modules designed for an ambulatory setting. • “Menu” options from both categories

  11. General certification criteria 170.302(a) • Eligible Provider (Eligible Provider) has enabled drug-drug, drug-allergy alerts • The EHR displays drug-drug, drug-allergies • Must be enabled throughout the reporting year

  12. General certification criteria 170.302(c) • More than 80% of all patients seen by the Eligible Provider must have an up-to-date problem list with at least one entry or indication of “none” recorded as structured data. • The EHR must allow capture of diagnoses as ICD9 codes. • Maintain a current problem list for each patient and document review of problem list.

  13. General certification criteria 170.302(d) • More than 80% of all patients seen by Eligible Provider must have an active medication list with at least one entry or “none” as structured data. • EHR allows entry of prescribed meds on the med list by Eligible Provider, incoming medications from the SureScripts med history, as well as manual documentation of meds or recording of none

  14. General certification criteria 170.302(e) • At least 80% of all patients seen by the Eligible Provider have at least one active medication allergy entry or an indication of “none” if the patient has no medication allergies recorded as structured data. • The EHR Allergy section must allow providers to capture the current medications allergy list. • Review and enter medication allergy data.

  15. General certification criteria 170.302(f) • More than 50%(originally 80%) of all patients age 2 and over seen by the Eligible Provider must have height, weight and blood pressure recorded, and BMI calculated/displayed; additionally, plot/display growth charts are required for children age 2 to 20. • The EHR Vitals must allow capture of vital sign measurements including all required data and display of growth charts. Eligible Provider to indicate that fields were populated and growth charts complete • “Patients seen” include any patient for which visit notes are produced, including nurse visits with notes.

  16. General certification criteria 170.302(g) • More than 50% (Originally 80%) of all patients 13 years old or older seen by Eligible Provider have “smoking status” recorded. • The EHR allows capture of smoking status in social history. • Specific criteria must be met: • Current everyday smoker • Current some day smoker • Former smoker • Never smoked • Current status unknown • Unknown if ever smoked • Ask patients about and document smoking status and record as structured data.

  17. General certification criteria 170.302 (o,p,q,r,s,t,u,v,w) Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary. O- access controls s- integrity p- emergency access t- authentication q- auto log-off u- encryption, general r- audit log v- encryption, exchange w- accounting of disclosures Providers must receive verification of compliance. Must implement internal policy and procedures to be fully compliant

  18. Specific ambulatory criteria170.304(a) • Computerized Physician Order Entry (CPOE) is used for at least 30%(originally 80%) of patients with at least one medication in their list, must have at least one medication ordered electronically.

  19. Specific ambulatory criteria 170.304(b) • More than 40% (originally 75%) of all permissible prescriptions written for patients by the Eligible Provider are transmitted electronically using certified EHR technology. • The EHR must qualify for electronically prescribing and renewing medications with functionality for reviewing. • Ensure that system is set up to process all permissible prescriptions electronically.

  20. Specific ambulatory criteria 170.304(c) • More than 50%(originally 80%) of all patients seen by Eligible Provider have demographics recorded as structured data. Required Fields: preferred language, insurance type, gender, race and ethnicity and date of birth. • The EHR allows upload of demographic data from the Practice Management system. The EHR can capture this directly as well. • Ensure required data including ethnicity and preferred language is captured in the patient registration process.

  21. Specific ambulatory criteria 170.304(e) Implement One(Originally five) clinical decision support rule relevant to the clinical quality metrics the Eligible Provider is responsible for managing. Alerts can be used to accomplish this. The EHR alerts module must be able to create patient-specific alerts. Alert firing and responses are audited to provide data for Eligible Provider. It is recommended that alerts be set for all providers within a practice to ease maintenance requirements.

  22. Specific ambulatory criteria 170.304(f) More than 50% (Originally 80%) of patients who request an electronic copy of health information receive delivery within 3 business days(Originally 48) hrs including lab results, problems lists, med lists and allergies. The EHR must allow patient information be exported to a CCD and provided electronically, and/or allows immunization records to be printed.

  23. Specific ambulatory criteria 170.304(h) Clinical summaries (CCD) including problem list, medication list, allergies, procedures, immunizations and diagnostic test results provided for more than 50%(Originally 80%) of office visits within 3 business days. Eligible Provider must also document that CCD was delivered.

  24. Specific ambulatory criteria 170.304(j) Submit three quality measures NQF 0013 Hypertension / Blood Pressure management NCF 0028 Tobacco Use Assessment and Cessation counseling PQRI 128 Adult Weight Screening There are alternate measures if a particular provider has no patients that qualify.

  25. Specific ambulatory criteria 170.304(i) Implement the ability to exchange clinical information electronically Must complete one test of exchange with CCD format Relates to Menu Set 170.304(i): Provide a summary of care for 50% of patients who transition to another provider or location of service

  26. “Menu” Set • There are 10 measures that make up the menu • EPs can elect 5 measures to meet in 2011 • The remaining 5 menu measures can be deferred until Stage II • There are some exceptions (ex: An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.

  27. Menu Set General Certification Criteria 170.302(b) • Implement the ability for the EHR to do Formulary checking for medications

  28. Menu Set General Certification Criteria 170.302(h) • Results of more than 40%(Originally 50%) of all clinical lab tests ordered by the Eligible Provider and available in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. • Lab results can be loaded to the EHR manually or via an interface as discrete data and/or free-text (microbiology results). Cross referencing to LOINC values can be done in the EHR through a translation table.

  29. Menu Set General Certification Criteria 170.302(i) Generate at least one report listing patients of the Eligible Provider with a specific condition. Report showing all patients within a HMI Category or ICD9 is available now. Must be able to select, sort, retrieve and generate the list according to elements in problems, meds, demographics or lab test results.

  30. Menu Set General Certification Criteria 170.302(j) Perform medication reconciliation for more than 50%(Originally 80%) of relevant patient encounters. Use the EHR capabilities to document the required level of compliance. Best approach – Use med history from SureScripts and document that medication list was reviewed on every visit.

  31. Menu Set General Certification Criteria 170.302(k) • Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. • Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically).

  32. Menu Set General Certification Criteria 170.302(l) • Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. • Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically).

  33. Menu Set General Certification Criteria 170.302(m) • Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. • More than 10 percent of all unique patients seen by the EP are provided patient-specific education resources.

  34. Menu Set Specific ambulatory criteria 170.304(d) • Send reminders to patients per patient preference for preventive/followup care. • More than 20 percent of all patients 65 years or older or 5 years old or younger are sent an appropriate reminder during the EHR reporting period.

  35. Menu Set Specific ambulatory criteria 170.304(g) • At least 10% of patients seen by Eligible Provider are provided timely electronic access to their health information including lab results, problems lists, med lists, allergies, immunizations and procedures within 4 business days (Originally 96 hours) of information being available to Eligible Provider, subject to the EP’s discretion to withhold certain information. • This must include • Problem list • Medication list • Laboratory results • Allergies

  36. Menu Set Specific ambulatory criteria 170.304(i) • Provide a summary of care for 50% of patients who transition to another provider or location of service. • Examples: • Clinic to Hospital • Clinic to Long Term Care Facility

  37. This criteria was removed Insurance eligibility checked electronically for at least 80% of all patients seen by Eligible Provider. Check eligibility using PM system and payor websites. Record eligibility in PM system to ensure that billing information is captured and Meaningful Use criteria levels are achieved.

  38. This criteria was removed At least 80% of all claims filed electronically by the Eligible Provider. Use electronic submission functionality in the PM system and upload data to InteGreat EHR to ensure that required levels are achieved.

  39. InteGreat EHR Roadmap for Meaningful Use

  40. Currently Supported Core Criteria v.6.2.1 • CPOE • Drug-to-drug, drug-allergy • Problems list documented • ePrescribe • Active medication list documented • Medication allergies documented • Vitals and growth charts • Smoking status recorded • Security Requirements

  41. Core Criteria in v6.3(beta) • Implement and track responses to one clinical decision support rule relevant to the clinical quality metrics the EP is responsible for managing • At least 50% of patients who request an electronic copy of health information receive delivery within 3 business days including lab results, problem lists, medications and allergies. • Lab results must be added to CCD, in release 6.4 • Clinical summaries (CCD) including problem list, medication list, allergies, procedures, immunizations and diagnostic test results provided for more than 50% of office visits within 3 business days. • Visit specific, lab results added in v6.4 • Implement the ability to exchange clinical information electronically, perform at least 1 test • CCD in v6.3 • electronic exchange with lab results in v6.4

  42. Core Criteria in v6.4beta Q4 2010 • At least 50% of patients have demographics recorded as structured data including required fields for preferred language, insurance type, gender, race, ethnicity and DOB • Report ambulatory quality measures to CMS or States • Ability to record data is in GA • New reports for Stage I reporting in v6.4

  43. Currently Supported Menu Sets Criteria v.6.2.1 • Drug-formulary checks • Lab Results with structured data • Patient lists by specific condition • Reminders for preventative/followup care • must add communication preferences • Patients are provided timely electronic access to health information including lab results, problem lists, med lists, and allergies within (4) business days of being updated • Via InteGreat PHR • CCD generation in beta • Patient-specific education resources available • Medication reconciliation • Submit electronically to immunization registries • Receipt added in beta 6.2.x release • Transmit syndromic surveillance data to public health agencies

  44. Menu Sets available in v6.3(beta) • Summary of care in CCD format available for transition of care

  45. Questions ?

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