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Meaningful Use Overview

Meaningful Use Overview. Christopher Geer, MBA Meaningful Use Project Manager Unity Health System cgeer@unityhealth.org. What is Meaningful Use?. The Health Information Technology for Economic and Clinical Health (HITECH) Act

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Meaningful Use Overview

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  1. Meaningful Use Overview Christopher Geer, MBA Meaningful Use Project Manager Unity Health System cgeer@unityhealth.org

  2. What is Meaningful Use? • The Health Information Technology for Economic and Clinical Health (HITECH) Act • Enacted as part of the American Recovery and Reinvestment Act of 2009 • Promotes the adoption and meaningful use of health information technology. http://www.recovery.gov/About/Pages/The_Act.aspx

  3. Meaningful Use Stages 3 2 1

  4. Staging Methodology “If there will be a stage 4 of Meaningful Use, we expect to update this table in the rulemaking stage 3” – CMS, Stage 2 NPRM

  5. Path to Payment Is your vendor certified? http://onc-chpl.force.com/ehrcert

  6. Meaningful Use Programs Dually-eligible Hospitals can participate in both programs Dually-eligible providers must pick 1 program

  7. Key Program Differences

  8. What is an Eligible Professional? • Must render <90% of services in an Inpatient Acute or Emergency Setting *Must be practicing in a Rural Health Center or Federally Qualified Health Center led by a PA.

  9. What is an Eligible Hospital? • Subsection (d) hospitals or Critical Access Hospitals in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS)

  10. Meaningful Use Objectives

  11. Measurement Information • Yes / No Attestation • Percentage-Based Measure • Numerator / Denominator = Requirement • Possible Denominators: • Unique Patients • Transitions of Care • Orders • There are exclusions for many of the objectives

  12. Computerized Provider Order Entry (CPOE) Objective : Use CPOE for orders entered Stage 1EP: Core EH: Core Proposed Stage 2 EP: Core EH: Core • Requirement: 30% • Numerator: At least 1 medication order • Denominator: Unique patients with at least 1 medication in their med list • Requirement: 60 % • Numerator: Total orders entered using CPOE • Denominator: Total medication, lab, and radiology orders

  13. Drug Formulary Check Objective: Implement drug-formulary checks Stage 1 EP: Menu EH: Menu Proposed Stage 2Consolidated • Enable drug formulary checks • Consolidated into the eRx objective

  14. eRx Objective: Generate and transmit permissible prescriptions electronically (eRx). Stage 1 EP: Core EH: N/A Proposed Stage 2 EP: Core EH: Menu • Requirement: 40% • Numerator: E-prescriptions • Denominator: Prescriptions written • Requirement: EP: 65% EH: 10% • Numerator: E-prescriptions • Denominator: Prescriptions written (EH: Discharge Prescriptions) • Must be checked against at least 1 formulary

  15. Provide Patient Education Objective: Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. Stage 1EP: Menu EH: Menu Proposed Stage 2 EP: Core EH: Core • Requirement: 10% • Numerator: Number of patients who are provided patient education specific resources • Denominator: Unique patients • Requirement: 10% • Numerator: Number of patients who are provided patient education specific resources • Denominator: EH: Unique patientsEP: Office Visits

  16. Medication Reconciliation Objective: The EP or EH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation Stage 1EP: Menu EH: Menu Proposed Stage 2 EP: Core EH: Core • Requirement: 50% • Numerator: Patients where medication reconciliation was performed. • Denominator: Transitions of care • Requirement: 65% • Numerator: Patients where medication reconciliation was performed. • Denominator: Transitions of care

  17. Patient Reminders Objective: Send reminders to patients per patient preference for preventive/follow-up care. Stage 1EP: Menu EH: N/A Proposed Stage 2 EP: Core EH: N/A • Requirement: 20% • Numerator: Patients who were sent reminders • Denominator: Number of unique patients 65 years old or older or 5 years older or younger. • Requirement: 10% • Numerator: Patients who were sent reminders • Denominator: Unique patients

  18. Record Demographics Objective : Record the following demographics: preferred language, gender, race and ethnicity, date of birth, and date and preliminary cause of death in the event of mortality in the eligible hospital or CAH Stage 1EP: Core EH: Core Proposed Stage 2 EP: Core EH: Core • Requirement: 50% • Numerator: Number of patients will all elements captured • Denominator: Unique patients • Race/Ethnicity Standard: OMB Standards • Requirement: 80 % • Numerator: Number of patients will all elements captured • Denominator: Unique patients • Race/Ethnicity Standard: OMB Standards http://www.whitehouse.gov/omb/fedreg_1997standards/

  19. Problem List, Medication List, Medication Allergy List Objectives : Maintain an up-to-date problem list, medication list, and medication allergy list Stage 1EP: Core EH: Core Proposed Stage 2Consolidated • Requirement: 80% • Numerator: Unique patients with at least 1 recorded problem, medication, medication allergy, or an indication of none. • Denominator: Unique patients • Consolidated into the requirements for other objectives

  20. Record Vital Signs Objective: Record and chart height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 - 20 years, including BMI Stage 1EP: Core EH: Core Proposed Stage 2 EP: Core EH: Core • Requirement: 50% • Numerator: Number of patients with all elements captured • Denominator: Unique patients • Requirement: 80 % • Change BMI to age 3, and eliminate height/weight age restriction • Numerator: Number of patients will all elements captured • Denominator: Unique patients

  21. Record Smoking Status Objective: Record smoking status for patients 13 years old or older Stage 1EP: Core EH: Core Proposed Stage 2 EP: Core EH: Core • Requirement: 50% • Numerator: Number of unique patients with smoking status captured • Denominator: Unique patients • Requirement: 80 % • Numerator: Number of unique patients with smoking status captured • Denominator: Unique patients

  22. Generate Patient Lists Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach Stage 1EP: Menu EH: Menu Proposed Stage 2 EP: Core EH: Core • Generate 1 list • Generate 1 list

  23. Report Quality Measures Objective : Report quality measure to CMS or the states Stage 1EP: Core EH: Core Proposed Stage 2 Removed as an Objective • Submit quality measures • Still required to submit to be considered a meaningful user • Electronic Submission

  24. Clinical Decision Support Objective : Implement clinical decision support rules related to specialty or high clinical priority Stage 1EP: Core EH: Core Proposed Stage 2 EP: Core EH: Core • 1 Rule • 5 Rules related to the improvement of selected quality measures • Drug-Drug / Drug Allergy Checks included as part of this objective

  25. Drug-Drug / Drug Allergy Checks Objective : Implement drug-drug and drug-allergy checks Stage 1 EP: Core EH: Core Proposed Stage 2Consolidated • Enable drug-drug / drug-allergy checks • Consolidated into the Clinical Decision Support Objective • Enable drug-drug / drug-allergy checks

  26. Protect Health Information Objective: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Stage 1EP: Core EH: Core Proposed Stage 2 EP: Core EH: Core • Perform Security Risk Assessment • Perform Security Risk Assessment

  27. Advance Directives Objective: Record whether a patient 65 years old or older has an advanced directive as structured data Stage 1EP: N/AEH: Menu Proposed Stage 2 EP: N/A EH: Menu • Requirement: 50% • Numerator: Number of patients where an indication of an advance directive is entered • Denominator: Unique patients • Requirement: 50% • Numerator: Number of patients where an indication of an advance directive is entered • Denominator: Unique patients

  28. Incorporate Lab Results Objective: Incorporate clinical lab-test results into EHR as structured data Stage 1EP: Menu EH: Menu Proposed Stage 2 EP: Core EH: Core • Requirement: 40% • Numerator: Lab orders received electronically • Denominator: Lab orders • Requirement: 55% • Numerator: Lab orders received electronically • Denominator: Lab orders

  29. Public Health Reporting Objectives

  30. Electronic Messaging Objective: Use secure electronic messaging to communicate with patients on relevant health information. Stage 1EP: N/AEH: N/A Proposed Stage 2 EP: Core EH: N/A • New with for stage 2 • Requirement: 10% • Numerator: The number of patients who send a secure message to the provider • Denominator: Unique patients

  31. Imaging Results Objective: Imaging results and information are accessible through Certified EHR Technology. Stage 1EP: N/AEH: N/A Proposed Stage 2 EP: Menu EH: Menu • New with for stage 2 • Requirement: • 40% images captured • 10% submitted to another provider of care • Numerator: Results accessible through the EHR • Denominator: Number of scans and tests whose result is one or more image ordered

  32. Electronic medication administration record (eMAR) Objective: Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR). Stage 1EP: N/AEH: N/A Proposed Stage 2 EP: N/A EH: Menu • New with for stage 2 • Requirement: 10% • Numerator: The number of orders tracked using eMAR. • Denominator: Medication orders

  33. Family History Objective Record patient family health history as structured data Stage 1EP: N/A EH: N/A Proposed Stage 2 EP: Menu EH: Menu • New with for stage 2 • Requirement: 20% • Numerator: Patients with structured data entry for one or more first-degree relatives. • Denominator: Unique Patients

  34. Provide Clinical Summary Objective Provide clinical summaries for patients for each office visit Stage 1EP: Core EH: N/A Proposed Stage 2 EP: Core EH: N/A • Requirement: 50% • Numerator: Patients provided a clinical summary within 3 business days • Denominator: Unique Patients • Requirement: 50% • Numerator: Patients provided a clinical summary within 24 hours • Denominator: Unique Patients • Expanded requirements

  35. Exchange Key Clinical Information Objective: Capability to exchange key clinical information, among providers of care and patient authorized entities electronically Stage 1EP: Core EH: Core Proposed Stage 2Consolidated • Performed one test • Consolidated into the summary of care objective

  36. Summary of Care at Transition Objective: The EP or EH who transitions their patient to another setting of care should provide summary care record for each transition of care or referral Stage 1EP: Menu EH: Menu Proposed Stage 2 EP: Core EH: Core • Requirement: 50% • Numerator: Number of patients where a summary of care was provided • Denominator: Number of transitions of care • Requirement: • 60% Paper or electronic • 10% electronically • Numerator: Number of patients where a summary of care was provided • Denominator: Number of transitions of care

  37. Provide Patient E-Copy Objective: Provide patients with an electronic copy of their health information upon request Stage 1EP: Core EH: Core Proposed Stage 2Consolidated • Requirement: 50% • Numerator: Number of patients receiving their record electronically within 3 business days • Denominator: patient requests for an e-copy • At a minimum: must include Problems, medications, medication allergies, and diagnostic test results • Consolidated into the view, download, transmit objective.

  38. Provide Electronic Discharge Instructions Objective: Provide patients with an electronic copy of their health information upon request Stage 1EP: N/A EH: Core Proposed Stage 2Consolidated • Requirement: 50% • Numerator: Number of patients receiving their instructions electronically • Denominator: patient requests for an e-discharge instructions • Consolidated into the view, download, transmit objective.

  39. Provide Patient Access Objective: Provide patients with timely electronic access to their health information within four business days of the information being available to the EP Stage 1EP: Menu EH: N/A Proposed Stage 2Consolidated • Requirement: 10% • Numerator: Number of patients who have their record displayed online • Denominator: Unique patients • At a minimum: must include Problems, medications, medication allergies, and diagnostic test results • Consolidated into the view, download, transmit objective.

  40. View Online, Download, and Transmit Standards • Patient Name • Provider name, practice • Problem List • SNOMED CT • Procedures • ICD-10, CPT-4 • Laboratory test results • LOINC • Medication list • Medication Allergy List • Vital Signs • Smoking Status • Demographic Information • Care plan field, including goals and instructions • Additional known care team members • EP: • Must provide information online in 4 business days • 50% of unique patients are provided their health information online • 10% of patients must access that information

  41. View Online, Download, and Transmit Standards • Admit and discharge date/place • Reason for hospitalization • Providers of care • Problem List • SNOMED CT • Relevant past diagnosis • Laboratory test results • LOINC • Medication list • Medication Allergy List • Vitals at discharge • Demographic Information • Care transition plan • Discharge Instructions • EP: • Must provide information online within 36 hours of discharge • 50% of unique patients are provided their health information online • 10% of patients must access that information

  42. Questions? Christopher Geer, MBA Meaningful Use Project Manager Unity Health System cgeer@unityhealth.org

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