Configuring Electronic Health Records

1. Configuring Electronic Health Records Meaningful Use and Implementation Lecture a This material (Comp11_Unit8a) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Meaningful Use and ImplementationLearning Objectives • Describe meaningful use (MU) of health information technology in the context of the Health Information Technology for Economic and Clinical Health (HITECH) Act (Lecture a) • Define the criteria for Stage 1 of meaningful use for eligible professionals and eligible hospitals (Lecture a) • Demonstrate examples of meaningful use using the VistA Electronic Health Record (EHR) (Lecture b) Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

3. Meaningful Use and HITECH • Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery and Reinvestment Act (ARRA) • Incentives for electronic health record (EHR) adoption by physicians and hospitals (up to $27B) • Direct grants administered by federal agencies ($2B) • HITECH provides financial incentives for “meaningful use” (MU) of HIT (Blumenthal, 2010; Trotter, 2011) Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

4. MU is Driven by Underlying Goals for Healthcare System • All MU criteria must “map” to one of more of five goals for the healthcare system • Improving quality, safety, and efficiency • Engaging patients in their care • Increasing coordination of care • Improving the health status of the population • Ensuring privacy and security • Examples • Implement drug-drug interaction checks → Improving quality, safety, and efficiency • Provide summary of care to patients → Engaging patients in their care Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

5. Overall Requirements for MU • Use certified EHR technology in a meaningful manner • Use certified EHR technology connected in a manner that provides for health information exchange to improve the quality of care • Using certified EHR technology, the provider submits information on clinical quality measures Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

6. Certified EHR • A qualified EHR certified by an approved certifying entity • A qualified EHR is an electronic record of health-related information on an individual that • Includes patient demographic and clinical health information, such as medical history and problem lists • Has the capacity to • Provide clinical decision support • Support physician/provider order entry • Capture and query information relevant to healthcare quality • Exchange electronic health information with, and integrate such information from, other sources Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

7. MU Implemented in Three Stages 2.1 Figure: Stage 1 rules set in 2010 (Blumenthal, 2010); Stage 2 rules likely to be announced in 2012 (Drazen, 2011). (Missouri Health Information Technology Assistance Center, nd.) Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

8. Implementation • Implemented through increased Medicare or Medicaid reimbursement to • Eligible professionals (EPs) • Medicare: MD, DO, DDS/DMD, DPM, OD, DC • Medicaid: MD, DO, DDS/DMD, Certified Nurse Midwives, Nurse Practitioners, Physicians Assistants operating at an FQHC/RHC • Hospital-based EPs not eligible (>90% service in hospital, e.g., pathologist, emergency physician) • Eligible hospitals (EHs) • Medicare: Acute Care Hospitals, Critical Access Hospitals (CAHs) • Medicaid: Acute Care Hospitals, CAHs, Children’s Hospitals • Within the 50 states and DC • Various differences in Medicare vs. Medicaid for amount reimbursed, rules, and other aspects Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

9. Payment for Eligible Professionals (Eps) • Medicare • Up to $44,000 over five years if start in 2011 or 2012; less if start later • Up to extra $4,400 if practice in Health Professional Shortage Area • Medicaid • Up to $63,750 over six years, with one-third in first year • Can receive money for first year just for implementing or upgrading to a certified EHR Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

10. Payment for Eligible Hospitals (EHs) • More complex depending on Medicare vs. Medicaid, hospital type, and share of patients • Multi-campus hospitals count as one EH • General formula is that payment is multiplication of • Initial amount – $2M + $200 per discharge for 1,150th to 23,000th discharge (maximum for 21,850 discharges is $2M + $4.37M = $6.37M) • Medicare or Medicaid share • Transition factor – 1.0, 0.75, 0.5, and 0.25 over four years depending on when become eligible Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

11. Rules • Stage 1 final rules published on July 28, 2010 • CMS – Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule • ONC – Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology • For those without time to read hundreds of pages, there are excellent summaries and other materials from HHS, HIMSS, CSC, and Geek Doctor blog • CMS Web site for program • http://www.cms.gov/ehrincentiveprograms/ • EHR certification process guided by Temporary Certification Rule released on June 24, 2010, to be superseded by Permanent Certification Rule released in January, 2011 to start in 2012 • http://healthit.hhs.gov/certification/ Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

12. Criteria for Stage 1 MU • 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 (Blumenthal, 2010; CSC, 2010) Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

13. 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 Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

14. 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 Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

15. 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 Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

16. 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 Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

17. 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 Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

18. 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 Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

19. 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) Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

20. 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 Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

21. Meaningful Use and ImplementationSummary – Lecture a • The HITECH Act of ARRA legislated incentives for the “meaningful use” (MU) of health IT • MU means that criteria for use of IT are tied back to goals of the healthcare system • These criteria are met by eligible professionals and eligible hospitals to receive incentive payments for use of EHRs Configuring Electronic Health Records Meaningful Use and Implementation Lecture a

22. Meaningful Use and ImplementationReferences – Lecture a References Anonymous. (2010). Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule. Washington, DC: Federal Register Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf. Anonymous. (2010). Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Final Rule. (E9-31216). Washington, DC: Federal Register Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf. Blumenthal, D. (2010). Launching HITECH. New England Journal of Medicine, 362, 382-385. Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 363, 501-504. 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 Trotter, F., & Uhlman, D. (2011). Getting to Meaningful Use and Beyond. Sebastopol, CA: O'Reilly Media. Charts, Tables, Figures • 2.1 Figure: Overview: What is Meaningful Use?, Missouri Health Information Technology Assistance Center. Stage 1 rules set in 2010 (Blumenthal, 2010); Stage 2 rules likely to be announced in 2012 (Drazen, 2011). Retrieved from http://assistancecenter.missouri.edu/node/17. Accessed Jan 2012. Configuring Electronic Health Records Meaningful Use and Implementation Lecture a