Meaningful Use: Managing Stage 2 and Beyond John Valutkevich Senior Supervisor

1. Meaningful Use: Managing Stage 2 and Beyond John Valutkevich Senior Supervisor Electronic Health Records and Federal Health Initiatives Lisa Palmer, Senior Specialist for Federal Health Initiatives MEDITECH Ambulatory

2. Review of Systems: • Industry Stats • MEDITECH Stats • Chronic Conditions Continue from Stage 1 • Prognosis - Stage 2 and Stage 3 • Plan of Action

3. Review of Systems • Industry Demands Facing Health Care This Year: • Meaningful Use demands • Healthcare Reform • Payment Reform • ICD-10 (delayed again) • 5010 • ACO’s and PCMH’s

4. Stage 1 Meaningful Use Summary Focus is deployment/adoption of Advanced Clinical Systems Electronic exchange of information Report on Meaningful Use Metrics and Clinical Quality Measures Complete EHR or EHR Modules must be "certified" To qualify for incentives, grants, or funding, users must demonstrate meaningful use of the EHR system.

5. Review of Systems

6. Review of Systems

7. Review of Systems Certification Status: Stage 1 Visit our certification page for updates and instructions on obtaining your CMS Certification Numbers

8. Review of Systems Preparing for Stage 2 Certification: Eligible Hospitals

9. Review of Systems Preparing for Stage 2 Certification: Eligible Professionals

10. Review of Systems • Why New Releases ? • Privacy & Security Requirements • Standardized Encryption of all connections to • SSL/TLS • Encryption of Downloads (CD, USB) • Enhanced Patient Centric Audit Logs in MIS • Increased Security Requirements in Stage 2 • Visit: MEDITECH Systems Support

11. Review of Systems • Why New Releases ? • Increased Standardization with Nomenclature • Increased use of SNOMED-CTFor Problem List • Mapping to Tests and Results: LOINC and SNOMED • SNOMED-CT for Nursing Terms, Orders • Standards for Medications, Allergies and Reactions Improvements to mapping standards

12. Review of Systems • Why New Releases? • Improvements to Usability • Enhanced Problem List Functionality • Improved Workflow for Medication Reconciliation • Patient and Clinician Discharge Processes • Robust CCD Enhancements • Ambulatory Checkout Process • Ambulatory Patient Education Increasing Clinician and Physician User Satisfaction

13. Chronic Conditions of Stage 1 Continue

14. Chronic Conditions Stage 1 • Computerized Provider Order Entry • Physician Adoption Historically is Slow • CMS Interpretations: • Licensed Professional • Must use CDS at time of order entry • Requiring only 1 Med - raises patient safety issues and disjointed care • Acute, ED or Both calculation MEDITECH certified CPOE solution resides within PCM and EDM for Acute and AOM/RXM for Ambulatory providers.

15. Chronic Conditions Stage 1 • Reporting Requirements: Eligible Hospitals • Utilization of Your EHR • EHR Utilization Metrics (i.e. 30% CPOE utilization) • 14 Required Functional Measures and 10 Menu Items • Utilization Reports are NPR and Report Designer for 90 days reporting • Longer reporting period (365 days) may require Data Repository for increased data retention

16. Chronic Conditions Stage 1 • Reporting Requirements: Eligible Hospitals • Clinical Quality Measures - The Big Gotcha!! • 15 Quality Measures for Stage 1: • ED Throughput • Stroke • VTE • Clinical Quality Measure Reports calculated from Data Repository • DR customers receive Quality Measures Report SQL Templates • For 2011 and 2012 - CMS requires attestation only – capability of your certified EHR to report the measures • Performance and Outcomes are not measured

17. Chronic Conditions Stage 1 • Reporting Requirements: Eligible Professionals • Utilization of Your EHR • EHR Utilization Metrics (i.e. 30% CPOE utilization) • 15 Required Core Measures and 10 Menu Items • Standard System Utilization Reports • provided for Core and Menu set items

18. Chronic Conditions Stage 1 • Reporting Requirements: Eligible Professionals • Clinical Quality Measures - The Big Gotcha!! • 44 Clinical Quality Measures for Stage 1 • 3 Core/3 Alternate Core Measures • 3 Additional Measures • Use of MPM Clinical Reporting tool for quality reporting • For 2011 and 2012 - CMS requires attestation only – capability of your certified EHR to report the measures • Performance and Outcomes are not measured

19. Chronic Conditions Stage 1 • Clinical Quality Reports … • … became as big an impact as CPOE ! • Required vocabularies not used widely in EHRs: (SNOMED CT, RxNorm, CVX) • Over 500 data elements in the 15 measures • Data capture must be in discrete fields • Impact on workflow for clinicians • Specification was incomplete and not maintained • Review of Best Practices is Critical

20. Chronic Conditions Stage 1 • Interoperability Requirements • Stage 1 - Just A Test! But with Whom? • Infrastructure lacking - exchange standards not defined • CCD: Capability to exchange key clinical information among providers - regardless of the transport – standard has to be a CCD • Public Health Reporting InterfacesMust choose 1 Public Health Objective to Demonstrate - (but own them all) • Capability to submit electronic data to immunization registries • Capability to provide electronic submission of reportable lab results to public health agencies • Capability to provide electronic syndromic surveillance data to public health agencies

21. Chronic Conditions Stage 1 • CMS Clarifications • FAQ Mechanism to clarify or re-write legislation • Wording in Final Rule – ambiguous and left open to much interpretation • Many, many “clarifications” from CMS and ONC – sometimes changing the ruling • What will be involved in an Audit?

22. Prognosis: Stage 2 and Beyond

23. Timeframe for Stage 2 • HIT Policy Panel submitted recommendations to ONC – July 7, 2011 • Associated standards for Stage 2 Measures submitted September 28, 2011 • CMS and ONC issued Notice of Proposed Rulemaking (NPRM) February 23, 2012 • CMS and ONC will then issue the final rule in middle of 2012 • Certification for Stage 2 in Fall 2012

24. Prognosis Stage 2 and Beyond Stage 2 Delay Start For Early Attesters

25. Stage 2 Eligible Hospitals • 16 CORE objectives – choose 2 of 4 menu items • All menu items in Stage 1 become core • Most Stage 1 thresholds increase in Stage 2 • Several new measures: • Reporting • Additional interoperability • requirements (orders and results) • e-Prescribing • Patient Portal – discharge • instructions and visit information • -Ability to view images in EHR for 40% orders • Clinician Notes (Physcian, PA, NP) • eMar in at least one unit • Record care plan goals and patient • instructions • Record health care team members • Address encryption of data at rest • Inclusion of Direct Protocol

26. Stage 2 Providers • 17 CORE Objectives - choose 3 of 5 menu items • All menu items in Stage 1 become core • Stage 1 thresholds increase in Stage 2 • Several new measures: • Patients are offered secure, online messaging • Patient Portal – view and download, transfer health information • Record Advance Directives • Increased clinical decision support rules • Record health care team members • Record Care Plan Goals and Patient Instructions • Submit Reportable Cancer Conditions • Ability to view images in EHR for 40% orders

27. Prognosis Stage 2 and Beyond The Future: Focus is on Patient and Consumer Engagement … (PCMH’s, ACO’s)

28. Prognosis Stage 2 and Beyond EH & EP Stage 2 - You will need a Patient Portal

29. Prognosis Stage 2 and Beyond EP Stage 2 – Secure Patient Messaging

30. Stage 2 – You will need to implement e-Prescribing • Integrated into MEDITECH’s PCM, EDM and PCS/Nursing Suites • Includes: • Access to medication histories • Updates patients' records • Check benefits while ordering • Communicate orders to retail and mail order pharmacies • Standards-based NCPDP Script interfaces • DrFirst as transaction clearinghouse *Eligible Professionals: Continue eRx measure from Stage 1 with increased threshold from 40% to 50%

31. Prognosis Stage 2 and Beyond EH Stage 2 – You will need to implement the Electronic Medication Administration Record

32. Prognosis Stage 2 and Beyond EH & EP Stage 2: You will need to implement “Electronic Notes”

33. Prognosis Stage 2 and Beyond Stage 2: Clinical Quality Measures • Data needed to be captured in discrete fields • Increase use of standard nomenclature • Subscription to IMO for vocabulary mapping • Best Practices for Workflow Guidance in development • Physician groups of a certain size can report quality data for their groups

34. Prognosis Stage 2 and Beyond Stage 2 Quality Reporting – 113 Proposed Measures for Hospitals and Providers • Stage 2 and Beyond: • Over 130 Proposed Quality Measures • Over 65,000 Data Elements mapped to standard nomenclature

35. Prognosis Stage 2 and Beyond Increased Interoperability: Order and Results exchanged electronically

36. Prognosis Stage 2 and Beyond Increased Interoperability: Electronically Transmit a summary of care record • “Electronic Exchange of Summary Care Documents to a recipient with no organizational affiliation and a different certified EHR technology vendor for more than 10% of transitions of care and referrals”

37. Stage 2 – new Exchange Requirements • Discharge Summaries • CCD’s • Referral • Consolidated CDA • SOAP transport option to Direct

38. Plan of Action: Meaningful Use Stage 2 and Beyond

39. Plan of Action • MEDITECH: A Dedicated Meaningful Use Team • ARRA Leadership - weekly meetings - VPs and • Management • Certified EHR Technology • Customer Implementation and Support - Best Practices • Integrated Collaboration – • Cross-division Meaningful Use Task Force • Industry Expertise and Leadership • Customer Outreach, Focus Groups and Advisory • Activities

40. Plan of Action • YOU: A Dedicated Meaningful Use Team • ARRA Leadership Team - establish weekly meetings • Educate, Educate, Educate – Staff, Board, Community • Prepare for increased Quality Measures – • do you need a “Quality Officer”? • Stay tuned in to meditech.com and lssdata.com – ARRA pages

41. Meaningful Use Resources A Step By Step to the Guides • Begin with MEDITECH • Eligible Hospitals • Eligible Professionals • Certified Product Listing • Registration for Incentive Programs • CMS FAQ Pages • ONC FAQ Pages