Meaningful Use Stage 2 Roundtable Kathy Branca Jesus Blasquez Ray Harms

Glossary 2011 Edition Certified EHR Technology – MU Stage 1 Criteria 2014 Edition Certified EHR Technology – MU Stage 2 Criteria CEHRT – Certified EHR Technology CHPL – Certified Health IT Product List CMS – Centers for Medicare & Medicaid Services (in HHS) CMS EHR Certification ID # – generated from CHPL when provider identifies the CEHRT used to support meaningful use.

Glossary EMR – Electronic Medical Record – (According to ONC) is a digital version of the paper chart in a doctor’s office. It contains patient medical & treatment history in one practice. EHR – Electronic Health Record - focus on the total health of the patient, across multiple providers, and compiles the information. HHS – Department of Health and Human Services ONC – Office of the National Coordinator for Health Information Technology (in HHS)

Introduction Goals of the incentive program include: – Reduce healthcare costs – Improve quality of care – Improve care coordination Implementation – Use incentives to get providers to capture & share patient data in structured format – Allow information to be easily retrieved & transferred Structured Data – CMS & ONC established structured data standards that EHRs must use to qualify for incentives.

The Basics IT Vendors – Manufacture software with functionality that supports specific criteria & have it certified Providers – Use certified EHR technology for specific timeframe – Attest to such use CMS sends incentive payments to Providers

FYI Until 2015, MU is an optional program. Medicare payments will be reduced by 2% due to sequestration. – Reduction affects any Medicare EHR Incentive payment starting 4/1/2013. – Medicaid payments exempt from sequestration, therefore Medicaid EHR Incentive Payments will not be reduced.

Timeline

SoftLab 4.0.3, 4.0.4, Edition Criteria (Stage 1) Core Items – Incorporate lab results – Security/Privacy Menu Item – Reportable lab results Objectives & Measures - 42 CFR 495.6(f) & (g) Criteria – 45 CFR & Standards – 45 CFR Subpart B  Authentication  General encryption  Encryption when exchanging electronic health information  Access  Emergency access  Automatic log-off  Audit log  Integrity

SoftLab & (Oracle) 2014 Edition Criteria (Stage 2) Core Items – Incorporate lab tests/results – Transmission of reportable lab tests/results NOTE: Modular EHRs do not need security criteria certification that was required in Stage 1 Menu Item – Transmission of electronic lab tests to ambulatory providers Objectives & Measures - 42 CFR 495.6(l) Criteria – 45 CFR Standards - 45 CFR 170 Subpart B

Vendor (SCC) Process IT vendors determine what criteria can be met by incorporating functionality in their products. Review test cases for the selected criteria Functionality is coded and vendor applies for certification Vendor undergoes testing by the ONC certifying body. Testing is much more rigorous for Stage 2 than it was for Stage 1. Some of the test cases are taking 4-6 hours. IT vendors receive EHR technology certification for specific criteria (or for all criteria)

Vendor (SCC) Process Certifying body (CCHIT) provides the vendor with an ONC CHPL Number & posts information on ONC website on the CHPL list.

Provider Certification ID Each provider obtains EHR Certification ID from ONC – enters certified EHR technology product from the CHPL – Unique ID is generated Currently on CHPL for inpatient criteria: – Only 17 products (10 vendors) listed for 2014 Edition – 1005 products are listed for the 2011 Edition For fiscal year 2013, can use CEHRT that is certified to: – 2011 edition – 2014 edition or – Combination of both

Provider Process User guides on CMS site & videos on YouTube. Register your facility on the CMS EHR registration site Enter all the information on the questionnaire EHR Certification ID is entered at registration or attestation. Attestation (after using CEHRT for entire reporting period) – Core objectives - enter numerator & denominator or Yes/No – Menu items - select 5 (at least 1 from Public Health List) – Enter numerator & denominator or Yes/No – Gives you a pass/fail for each criterion.

Side Note: HIMSS Analytics HIMSS Analytics - subsidiary of the HIMSS Providers participate in annual study to gather information systems data to determine current status of EMR implementation of healthcare providers. HIMSS Analytics® Database. Degree of EMR adoption is ranked into stages (0-7). If you hear about a system having clients at stage 7, it has nothing to do with “meaningful use” stages. In their marketing, a competitor is noting the percentage of hospitals at HIMSS Analytics Stage 7 that use their EMR.

HIMSS Analytics

Meaningful Use Stage 3 Published in Federal Register November 26, Open for public comments. Currently scheduled for 2016 Incorporate lab tests/results as structured data – 80% Provide structured electronic lab results to eligible professionals – 80% Submit electronic reportable lab results to public health agency – no change from Stage 2

Meaningful Use Stage 3 New - Electronically participate and send standardized data elements to a mandated jurisdictional registry (e.g., cancer, etc.) and health departments. (Stage 2 EP only) New - Electronically send standardized Healthcare Associated Infection (HAI) reports to the National Healthcare Safety Network (NHSN) using a common format from the Certified EHR.

Meaningful Use Stage 3 EHR must be able to query another entity for outside records and respond to such queries. (HIPAA implications) Asked for comment on an additional objective addressing test tracking (e.g. 10% of test results are acknowledged within 3 days).

Ray Harms Senior Interfaces Manager HL7 v

MU items ELR interface – Sending to state Departments of Health – HL7 v2.5.1 for MU1 and MU2 – Extensive list of new elements required for MU2 Result Reporting interface – Sending to EHRs – HL7 v2.5.1 for MU2 – Many of the same elements as ELR

LOINC and SNOMED LOINC codes – Ordered Tests – Component Tests – Micro antibiotics SNOMED Codes – Organism IDs

Some Key New Elements Patient Alias Mother's Maiden Name Alternate Patient Address Ethnic Group Species NoK Relationship NoK Phone NoK Organization Name Observation method Principal Result Interpreter Performing Organization Medical Director Specimen Number Specimen Type Modifier Specimen Additives Collection Method Specimen Source Site Specimen Source Site Modifier Specimen Role Specimen Collection Amount (Units) Specimen Rejection Reason Specimen Condition

Element Attributes Identifiers: – Assigning Facility – Assigning Authority – Universal IDs (ISO#) Names – Prefixes – Suffixes – Professional Suffixes Date/Time – Time Zone indicator Codes – Local code – HL7 code – Coding system/version Addresses – Type – County code Phone #s – Type – Comment – address

Assigning Authority & Facility Applies to – MRNs – Order Numbers (HIS, Lab) – Doctor codes – Facilities, organizations Identified by – Name – ISO# Captured – From inbound interfaces – Based on setup – Manually entered

Codes Standardized codes for: – Race – Ethnic group – Species – NoK Relationship – Doctors – Tests – Units – Abnormal Flags – Organisms – Specimen Type – Specimen Type Modifier – Specimen Additives – Collection Method – Specimen Source Site – Source Site Modifier – Specimen Role – Specimen Condition

Formats Discrete Lab – Ordered test and components Discrete Micro – Organism ID, Sensitivity Numeric results in “structured” form: – Titer result =^1^:^32 Patient Age to be sent as a result in an OBX segment

Where Does it Come From? Data can only be sent if it exists in the database – Posted from other systems HIS EMR EHR Ref Labs – Auto-filled when parent element manually entered – Manually captured

Changes ELR Interface SoftLab – Patient/Result database – Setup database – Application, screens SoftMic – Result database – Setup database – Application, screens

Other Changes ADT Interface – HIS needs to be able to send additional data Order Entry Interface – HIS needs to be able to send additional data Reference Lab Interface – Most RLs send sufficient data SoftID – Capture new specimen info at collection

SCC MRN AA/AF HIS# AA LIS#AA Full demographics HL7 codes Specimen info Dr. AA/AF Perform Org AA/AF Med Dir AA/AF LOINC SNOMED State DOH HIS MRN AA/AF HIS# AA Full demographics EHR MRN AA/AF HIS# AA Full demographics Ref Lab Perform Org AA/AF Med Dir AA/AF HL7 251 ADT/Orders HL7 251 ADT/Orders HL7 251 Results HL7 251 ELR “A” Options

SCC LIS#AA Specimen info Perform Org AA/AF Med Dir AA/AF LOINC SNOMED State DOH HIS MRN AA/AF HIS# AA LIS#AA Full demographics HL7 codes Specimen info Dr. AA/AF Perform Org AA/AF Med Dir AA/AF LOINC SNOMED Ref Lab Perform Org AA/AF Med Dir AA/AF HL7 251 Results HL7 251 ELR EHR MRN AA/AF HIS# AA LIS#AA Full demographics HL7 codes Specimen info Dr. AA/AF Perform Org AA/AF Med Dir AA/AF LOINC SNOMED HL7 251 Results HL7 251 Results HL7 251 ELR “B”

Product Release Challenges Current development plans cover Lab and higher due to: – Significant enough changes to warrant service pack level release – Db_Vista challenge Lengthy conversion – major downtime, Significant change in disk space usage (db_Vista pre- allocates space for extra columns) – Significant customer validation of the core system and affected external interfaces

QUESTIONS? COMMENTS?