Introduction to Healthcare and Public Health in the US

1. Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b This material (Comp1_Unit10b) was developed by [University Name], funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number [enter the award number(s)].

2. Meaningful Use (MU) of Health Information TechnologyLearning Objectives • Define meaningful use (MU) of health information technology in the context of the Health Information Technology for Economic and Clinical Health (HITECH) Act (Lecture a) • Describe the major goals of meaningful use (Lecture a) • Define the criteria for Stage 1 of meaningful use for eligible professionals and eligible hospitals (Lecture b) • Describe the standards specified for Stage 1 of meaningful use, including those devoted to privacy and security (Lecture b) • Discuss the likely criteria for Stages 2-3 of meaningful use (Lecture b) Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b

3. Criteria for Stage 1 Meaningful Use (MU) (Blumenthal, 2010; CSC, 2010) • Final rules specified • Core objectives – all must be met • Menu objectives – selected from set • EPs must report on 15 core and 5 of 10 menu objectives • EHs must report on 14 core and 5 of 10 menu objectives • For EPs and EHs, one menu objective must be a public health measure Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 3

4. Stage 1 Core Objectives • >50% of all unique patients have demographics recorded: preferred language, gender, race, ethnicity, date of birth • >50% of all unique patients age 2+ have recorded height, weight, blood pressure, calculated BMI, growth charts age 2-20 • >80% of all unique patients have at least 1 entry or indication of none on problem list • >80% of all unique patients have at least 1 entry or indication of none on med list Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 4

5. Stage 1 Core Objectives (continued) • >80% of all unique patients have at least 1 entry or indication of none on med allergy list • >50% of patients age 13+ seen have smoking status recorded • Provide clinical summaries to patient for more than 50% of all office visits within 3 business days Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 5

6. Stage 1 Core Objectives (continued) • >50% provide patients with an electronic copy of health info upon request within 3 business days • >40% of all permissible prescriptions transmitted electronically (eRx) • >30% of unique patients have at least 1 med order entered using CPOE Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 6

7. Stage 1 Core Objectives (continued) • Drug-drug and drug-allergy interaction checks enabled • Perform at least 1 test of certified EHR technology's capacity to electronically exchange key clinical information • Implement 1 clinical decision support rule relevant to specialty or high clinical priority with ability to track compliance • Conduct or review a security risk analysis and implement security updates as necessary • Report quality measures to CMS or states – provide aggregate numerator, denominator, and exclusions Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 7

8. Stage 1 Menu Objectives • Implement drug-formulary checks • >40% results incorporate clinical lab-test results in certified EHR technology as structured data • Generate lists of patients by specific conditions to use for QI, reduction of disparities, research or outreach • >10% use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 8

9. Stage 1 Menu Objectives (continued) • Perform medication reconciliation for >50% of transitions of care • Summary of care record is provided for >50% of patient transitions or referrals • Capability to submit electronic data to immunization registries or immunization information systems • Capability to submit electronic syndromic surveillance data to public health agencies Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 9

10. Stage 1 Menu Objectives for Hospitals Only • >50% of patients age 65+ have an indication of an advance directive status recorded • Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data) Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 10

11. Stage 1 Menu Objectives for Professionals Only • >20% of patients of age 65+ or <5 are sent appropriate reminders for preventive and follow-up care • Provide patients with timely electronic access to their health information – >10% within 4 business days Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 11

12. Required Standards for Stage 1 • Patient summary – CCR or CCD • ePrescribing – NCPDP/SCRIPT 8.1 or 10.6 • Public health labs, surveillance, and immunizations – HL7 2.3.1 or 2.5.1, CVX • Problem list – SNOMED or ICD-9-CM • Procedures – CPT-4 • Labs – LOINC • Medications – any source in RxNorm • Race/ethnicity – OMB standards Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 12

13. Required Privacy/Security for Stage 1 • Encryption/decryption • Any approved algorithm in FIPS 140-2 • HIE requires encryption and integrity-protected link • Record actions • Date, time, patient, and user recorded for creation, modification, access, and deletion • Verification of no alteration in transit • SHA-1 algorithm or stronger, as specified in FIPS 180-3 • Record TPO disclosures • Date, time, patient, and user recorded for HIPAA-allowed activities Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 13

14. Clinical Quality Measures • EPs must report on • 3 core measures • Can substitute alternate core measures if denominator of any core measure is 0 • 3 of 38 additional measures • EHs must report on 15 measures • Reporting by attestation in 2011 and provision of data in 2012 and beyond • CMS aims to align all quality reporting programs, i.e., PQRI, CHIPRA, RHQDAPU, etc. Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 14

15. Core EP Quality Measures • Hypertension – blood pressure measurement • Tobacco use assessment and cessation intervention • Adult weight screening and follow up Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 15

16. Alternative EP Quality Measures • Weight assessment and counseling for children and adolescents • Influenza immunization for patients 50+ years • Childhood immunization status Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 16

17. EP Additional Quality Measures(1-12 out of 38) • Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment • Appropriate Testing for Children with Pharyngitis • Asthma Assessment • Asthma Pharmacologic Therapy • Breast Cancer Screening • Cervical Cancer Screening • Chlamydia Screening for Women • Colorectal Cancer Screening • Controlling High Blood Pressure • Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) • Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol • Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 17

18. EP Additional Quality Measures(13-24) • Diabetes: Blood Pressure Management • Diabetes: Eye Exam • Diabetes: Foot Exam • Diabetes: Hemoglobin A1c Control (<8.0%) • Diabetes: Hemoglobin A1c Poor Control • Diabetes: Low Density Lipoprotein (LDL) Management and Control • Diabetes: Urine Screening • Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care • Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy • Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) • Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) • Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 18

19. EP Additional Quality Measures(25-38) • Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement • Ischemic Vascular Disease (IVD): Blood Pressure Management • Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control • Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic • Low Back Pain: Use of Imaging Studies • Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer • Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients • Pneumonia Vaccination Status for Older Adults • Prenatal Care: Anti-D Immune Globulin • Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) • Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation • Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients • Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies • Use of Appropriate Medications for Asthma Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 19

20. EH Quality Measures • Anticoagulation overlap therapy • Emergency Department Throughput – admitted patients – Admission decision time to ED departure time for admitted patients • Emergency Department Throughput – admitted patients – Median time from ED arrival to ED departure for admitted patients • Incidence of potentially preventable venous thromboembolism • Intensive Care Unit venous thromboembolism prophylaxis • Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2 • Ischemic or hemorrhagic stroke – Rehabilitation assessment • Ischemic or hemorrhagic stroke – Stroke education • Ischemic stroke – Anticoagulation for atrial fibrillation/flutter • Ischemic stroke – Discharge on anti-thrombotics • Ischemic stroke – Discharge on statins • Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom onset • Platelet monitoring on unfractionated heparin • Venous thromboembolism discharge instructions • Venous thromboembolism prophylaxis within 24 hours of arrival Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 20

21. How Much is All of This Going To Cost? • CMS estimates of EPs and EHs • 477,500 eligible as Medicare EP • 95,500 of these eligible as Medicaid EP • 44,100 eligible as Medicaid-only EP • 5,011 EHs • 3,620 acute care • 1,302 CAH • 78 children’s • 11 cancer • Estimated achievement of MU in ten years • Low – 95.6% of EHs and 36% of EPs • High – 100% of EHs and 70% of EPs • Total cost: $9.7B (low) to $27.4B (high) Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 21

22. Beyond Stage 1 • Much speculation around what rules will be for Stage 2 (and Stage 3) • Another challenge is wide variety of other requirements healthcare organizations must undertake in next few years, such as 5010 standards for transactions, ICD-10 coding, and healthcare reform • ONC HIT Policy Committee submitted recommendations in four basic categories for changes in measures from Stage 1 to Stage 2 (Drazen, 2011) • Measures unchanged • Unchanged menu measures become core • Increased threshold or wider scope – e.g., increased proportion of CPOE, decision support rules, etc. • New measures – including focus on usability (Classen, 2011) and/or patient experience (Ralston, 2010) Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 22

23. Meaningful Use of Health Information Technology Summary – Lecture b • Meaningful use of HIT in the context of the HITECH Act • Core objectives of Stage 1 Meaningful Use • Preview of Stages 2 and 3 Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 23

24. Meaningful Use of Health Information Technology Summary • Meaningful use program of HITECH • Eligibility for incentive payments • Criteria for achieving those payments in Stage 1 • Standards for Stage 1 of meaningful use, including those devoted to privacy and security • Overview of what might be expected in Stages 2 and 3 Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 24

25. Meaningful Use of Health Information Technology References – Lecture b References Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 363, 501-504. Classen, D., & Drazen, E. (2010). Update on Meaningful Use - Final Rules. Waltham, MA: Computer Sciences Corp. Retrieved from http://www.csc.com/health_services/insights/28577-update_on_meaningful_use_the_final_rule. Classen, D., & Bates, D. (2011). Finding the meaning in meaningful use. New England Journal of Medicine, 365, 855-858. Drazen, E. (2011). Update on Stage 2: Current Direction and Timing of Meaningful Use Requirements. Waltham, MA: Computer Sciences Corp. Retrieved from http://www.csc.com/health_services/insights/67921-update_on_stage_2_current_direction_and_timing_of_meaningful_use_requirements Ralston, J., Coleman, K., Reid, R., Handley, M., & Larson, E. (2010). Patient experience should be part of meaningful-use criteria. Health Affairs, 29, 607-613. Introduction to Healthcare and Public Health in the US Meaningful Use of Health Information Technology Lecture b Health IT Workforce Curriculum Version 3.0/Spring 2012 25