• New Jersey Institute of Technology • Enterprise Development Center (EDC)

1. Stage 2 Meaningful Use June 14, 2012 • New Jersey Institute of Technology •Enterprise Development Center (EDC) • 211 Warren Street, Newark, NJ 07103 • Phone: 973-642-4055 • Fax: 973-622-2075 • Email: info@njhitec.org• www.njhitec.org

2. Disclaimer The presentation was created from a set of proposed regulations (1. Centers for Medicare & Medicaid Services 42 CFR Parts 412, 413, and 495, 2. Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition) and the details may change in the final rule. This Presentation has been prepared by NJHITEC for the purpose of briefing Stage 2 regulations and is for the exclusive use of the recipients to whom it is addressed.

3. Objectives • Timeline for Stage 2 • Overview of Stage 2 interim rule • Minor changes to Stage 1 of meaningful use • Changes to Clinical quality measures • Changes to Medicaid program • ONC Implementation and Standards interim rule

4. Timeline • June 2011 HITPC Recommendations on Stage 2 • Feb 2012 Stage 2 Proposed Rule • Summer 2012 Stage 2 Final Rule • Oct 1, 2013/ Jan 1, 2014 Proposed Stage 2 Start Dates

5. What is in the Proposed Rule? • Minor changes to Stage 1 of meaningful use • Stage 2 of meaningful use • New clinical quality measures • New clinical quality measure reporting mechanisms • Details on the Medicare payment adjustments • Other minor program changes (Medicare Adv, Appeals) • Medicaid program changes

6. Stage 1 to Stage 2 Eligible Professionals 15 core objectives5 of 10 menu objectives Eligible Professionals 17 core objectives3 of 5 menu objectives

7. Changes • Exclusions no longer count to meeting one of the menu objectives • All denominators include all patient encounters at outpatient locations equipped with certified EHR technology

8. Core Objectives Use CPOE for more than 60% of medication, laboratory and radiology orders (S1 – 30%) E-Rx for more than 65% (S1 – 40%) Record demographics for more than 80% (S1 – 50%) Record vital signs for more than 80% (S1 – 50%) Record smoking status for more than 80% (S1 – 50%) Implement 5 clinical decision support (CQM) interventions + drug/drug and drug/allergy (S1 – 1 rule) Incorporate lab results for more than 55% (S1 – 40%, Menu)

9. Core Objectives Generate patient list by specific condition (S1 – Menu) Use EHR to identify and provide more than 10% of Unique patients with reminders for preventive/follow-up (S1 – 20%, Menu) Provide online access to health information for more than 50% with more than 10% actually accessing (S1 – 10%, Menu, accessing not Req) Provide office visit summaries in 24 hours (S1 – 72 hours) Use EHR to identify and provide education resources more than 10% (S1 – Menu)

10. Core Objectives More than 10% of patients send secure messages to their EP(S1 – N/A) Medication reconciliation at more than 65% of transitions of care (S1 – 50%, Menu) Provide summary of care document for more than 65% of transitions of care and referrals with 10% sent electronically(S1 – 50%, Menu, combines Elec copy, HIE measures, 3 lists) Successful ongoing transmission of immunization data (S1 – Menu, Test was sufficient) Conduct or review security analysis and incorporate in risk management process (S1 – No change)

11. Menu Objectives More than 40% of imaging results are accessible through Certified EHR Technology and 10% exchange (S1 – N/A) Record family health history for more than 20% - First degree relatives (S1 – N/A) Successful ongoing transmission of syndromicsurveillance data (S1 – No change) Successful ongoing transmission of cancer case information (S1 – N/A) Unless Prohibited Successful ongoing transmission of data to a specialized registry (S1 – N/A) – HIE & Public Health

12. Changes to Stage 1 Changes are optional in 2013 and required for 2014 CPOE Denominator: Number of Orders during the EHR Reporting Period Vital Sign Age Limit: Age 3 for blood pressure, No age limit for Height/Weight Vital Sign Exclusion: Allows BP to be separated from height/weight Health Information Exchange: Removed from the core requirement (Effective 2013)

13. Clinical Quality Measures CQMs are no longer a Meaningful Use core objective, but reporting CQMs is still a requirement for meaningful use 1a) 12 CQMs (≥1 per domain) 1b) 11 Core + 1 Menu CQMs 2) PQRS Group Reporting 12 totalCQMs 3 CoreOR 3 alt. CoreCQMs3 Menu CQMs 6 total CQMs

14. Medicaid EHR Incentive Program Changes • Expanded definition of a Medicaid encounter to include: • Any encounter with an individual receiving medical assistance under 1905(b), including Medicaid expansion populations (Does not affect NJ) • Inclusion of patients on panels seen within 24 months instead of just 12 (Does not affect NJ) • To permit patient volume to be calculated from the most recent 12 months or previous calendar year, instead of on the previous calendar year only. • To include zero-pay Medicaid claims

15. CQM – Reporting Methods 1) Attestation 2) 2012 Electronic Reporting Pilots extended to 2013 3) Medicaid – State-based e-submission

16. ONC Interim Rule or Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition

17. ONC Proposed Rule - Highlights • Referred to as 2014 edition Standards & Certification Rule • Public comment template on HealthIT.gov website • The proposed rule identifies certain “unchanged” 2014 Edition EHR certification criteria that would permit the developer to claim just a gap certification

18. ONC Proposed Rule - Highlights • EPs can have a Base EHR as well as the additional EHR technology necessary to meet JUSTthe meaningful use objectives and measures • Temporary certification program will sun set on the day of Final rule • New certification program will be called – ONC HIT Certification Program

19. ONC Proposed Rule - Highlights • Comments Sought on • Data Portability - whether ONC should adopt a certification criterion that focuses on the portability of data stored within CEHRT • Price Transparency - this provision would require EHR technology developers to disclose only the full cost of a certified Complete EHR or certified EHR Module – Public information • User- Centric Design – IOM - “HHS should specify the quality and risk management process requirements that health IT vendors must adopt, with a particular focus on human factors, safety culture, and usability” – 8 selected measures • Quality – IOM – “Establish quality management principles and processes in health IT” – Publicly available

20. Ambulatory & Inpatient Electronic Notes - Enable a user to electronically record, change, access, and search electronic notes- Imaging (access to) - Electronically indicate to a user the availability of a patient’s images and/or narrative interpretations (relating to the radiographic or other diagnostic test(s) and enable immediate electronic access to such images and narrative interpretations- DICOM Family Health History - Enable a user to electronically record, change, and access a patient’s family health history– SNOMED, HL7 Amendments - Enable a user to electronically amend a patient’s health record

21. Ambulatory & Inpatient View, Download, & Transmit to 3rd party - Web Content Accessibility Guidelines (WCAG) 2.0, CDA, ICD 10, SNOMED, DICOM etc. Auto numerator recording Non-%-based measure use report –log of when the capability was enabled, disabled, and/or executed.

22. Ambulatory Only Securemessaging–Federal Information Processing Standard (FIPS) Cancer case information – HL7, CDA, SNOMED and LOINC

23. Questions & Comments?