Meaningful Use Overview (State of Affairs) April 23, 2015 Presented by: Peter Minio Product Manager, Pediatric and Primary Care Solutions Co-Presenter: Cindy Malek Training Specialist General Session

Learning Objectives Overview of the EHR Incentive Program. Understanding of Meaningful Use stages and which one applies to you. Know the reporting criteria. Executive summary on proposed rule for Stage 3.

Incentive Payment Calendar Source: www.cms.gov

Who is Eligible? Under the Medicaid EHR Incentive Program Physicians Nurse practitioner Physician Assistant (PA) who furnishes services in a FQHC or Rural Health Clinic that is led by a PA Other (Certified nurse-midwives, Dentists) Do I qualify: Have a minimum 30% Medicaid patient volume Have a minimum 20% Medicaid patient volume, and is a pediatrician NOTE: Medicaid patient volume includes individuals enrolled in Medicaid managed care organizations, prepaid inpatient health plans, prepaid ambulatory health plans, and Medicaid medical home programs or Primary Care Case Management. Children's Health Insurance Program (CHIP) patients do not count toward the threshold.

Meaningful Use Stages A Conceptual Approach to Meaningful Use Source: www.cms.gov/EHRIncentivePrograms/

Your Path to $63,750 Source: www.cms.gov First year demonstrating Meaningful Use (Stage 1), reporting period is 90 days. All other years of participation, the reporting period is a full calendar year (Jan 1 - Dec 31). Source: www.cms.gov

Stages: Proposed Rules Proposed on April 10th with a 60-day public comment period. All Eligible Providers (EPs) will report on Modified Stage 2 criteria effective immediately. Stage 3 criteria will be optional in 2017, but required in 2018. Source: www.cms.gov

A little bit about AIU Adopt: Acquire or install certified EHR technology (CEHRT). Required evidence varies by state (e.g, evidence of installation). Implement: Begin using CEHRT (e.g., training or initial data entry). Upgrade: Update existing software (e.g., upgrade to CEHRT from a non-certified product).

Stage 1 Source: www.cms.gov

Stage 1: Core Measures

Stage 1: Menu Measures

Stage 2 Source: www.cms.gov

Stage 2: Core Measures

Stage 2: Menu Measures

QIC

Clinical Quality Measures (CQMs) Both MU stages share the same set of CQMs. Providers must select 9 CQMs from at least 3 of 6 National Quality Strategy (NQS) domains: Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Health Care Resources Clinical Processes/Effectiveness OP 14 is certified for 23 CQMs across 5 domains and it includes all 9 core pediatric measures.

OP 14 Certified CQMs

Things to Remember about CQMs Source: www.cms.gov

Affecting CQMs Has Changed Before OP prescribed a workflow to affect each certified CQM. CQMs are now affected by a myriad of chart elements and complex calculations. Use of Appropriate Medications for Asthma (p. 4 of 10) Source: http://ushik.ahrq.gov/

CQM Library How to obtain complete library of CQMs? Register for a license to the Unified Medical Language System (UMLS) at https://uts.nlm.nih.gov//license.html Log in at http://ushik.ahrq.gov Source: www.ushik.ahrq.gov

Population Health Management Engine Source: www.projectpophealth.org

Reporting Period 90-day reporting period for an EPs first year demonstrating Meaningful Use. Full calendar year (Jan. 1 - Dec. 31) each subsequent year. Providers must use 2014 Certified EHR Technology (CEHRT) starting in 2015.

Reporting Period: Proposed Rule Full year reporting period with several exceptions: 90-day reporting period in 2015 In 2016 all new EPs may use a 90-day period. Medicaid EPs will still be allowed to use a 90-day reporting period. For 2015 ONLY: The Flexibility in Health IT Reporting (Flex-IT) Act of 2014 (H.R. 5481) proposed by Congresswoman Renee Ellmers of North Carolina would allow for a 90 day reporting periods.

Attestation Participation in the Medicaid EHR Program means you will need to submit your attestation each year through your state. More information: State Contacts (e.g., attestation websites): https://www.cms.gov/apps/files/statecontacts.pdf Regional Extension Centers (RECs): http://www.healthit.gov/providers-professionals/regional-extension-centers-recs OP’s certification: http://officepracticum.com/about/ratings-awards-accreditations/ After each calendar year ends, the states have a tail period for EPs to complete their attestations (typically 60-120 days).

Proposed Rules

Stage 2 - Proposed Rule Proposed on April 10 with a 60-day public comment period. Effective immediately for all EPs. Redundant, duplicative, or topped-out measures are removed. There is no more distinction between Core and Menu objectives with 9 remaining measures plus one public health measure. Exemption: With the remaining measures, EPs who would have attested to Stage 1 in 2015 will be allowed to meet the lesser of the requirements between what was defined as 2014 Stage 1 and Stage 2. OP 14 and OP 15 certifications will be valid through December 31, 2017.

Stage 2 - Proposed Rule Measures removed: Problem List Medication Allergies Medication List Record demographics Record vital signs Record smoking status Clinical Summaries Structured lab results Patient List Patient Reminders Summary of Care Electronic Notes Imaging Results Family Health History

Stage 2 - Proposed Rule Remaining Objectives CPOE ePrescribing with formulary checking Clinical Decision Support (CDS) Patient Access VDT threshold dropped from 5% to >=1 patient Protect Electronic Health Information (attest only) Patient Specific Education Medication Reconciliation Summary of Care (outbound referral) - electronic transmission can be DIRECT or HIE. Secure Messaging ch- changed to functionality fully enabled with no minimum threshold percentage.

Stage 2 - Proposed Rule Remaining Objectives Public Health Reporting - All public health measures have been consolidated into on objective, and EPs must report “active engagement” (rather than “ongoing submission”) for any 2 of the following 5 (in 2015 only, EPs who would have been Stage 1 may report 1 of 5): Immunization Registry Syndromic Surveillance Case Reporting Public Health Registry Reporting (may claim up to 3 of this type, other than IIS) Clinical (non-Public Health Agency) Data Registry Reporting (may claim up to 3 of this type)

Stage 3 - Proposed Rule Proposed to be optional in 2017, but required for all providers starting in 2018 Eight objectives: Protect Patient Health Information Electronic Prescribing (eRx) Clinical Decision Support (CDS) Computerized Provider Order Entry (CPOE) Patient Electronic Access to Health Information Coordination of Care through Patient Engagement Health Information Exchange (HIE) Public Health and Clinical Data Registry Reporting Public comment due by May 29, 2015.

Protect Patient Health Information Objective: Protect electronic protected health information (ePHI) created or maintained by CEHRT through the implementation of appropriate technical, administrative, and physical safeguards. Measure: Conduct or review a security risk analysis upon install or upgrade to new Edition of CEHRT. Perform risk analysis annually in subsequent years. Address the security (including encryption) of data stored in EHR. Implement security updates as necessary, and correct identified security deficiencies as part of the provider's risk management process. The practice must implement appropriate technical, administrative, and physical safeguards.

Electronic Prescribing (eRx) Objective: Generate and transmit permissible prescriptions electronically. Measure: More than 80 percent of all permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically. Inclusion of controlled substances optional.

Clinical Decision Support Objective: Implement clinical decision support (CDS) interventions focused on improving performance on high-priority health conditions. Measures: Implement five CDS interventions related to four or more CQMs at a relevant point in patient care for the entire EHR reporting period. If four CQMs are not related to scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions. Implement drug-drug and drug-allergy interaction checks for the entire EHR reporting period.

Computerized Provider Order Entry (CPOE) Objective: Use CPOE for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant; who can enter orders into the medical record per state, local, and professional guidelines.

Computerized Provider Order Entry (CPOE) Measures: More than 80 percent of medication orders created by the EP during the EHR reporting period are recorded using CPOE More than 60 percent of laboratory orders created by the EP during the EHR reporting period are recorded using CPOE More than 60 percent of diagnostic imaging orders created by the EP during the EHR reporting period are recorded using CPOE.

Patient Electronic Access Objective: Provide access for patients to view online, download, and transmit their health information, or retrieve their health information through an API, within 24 hours of its availability. Measures: For more than 80% of all unique patients seen by the EP: The patient (or authorized representative) is provided access to view online, download, and transmit their health information within 24 hours; or Provide access to clinically relevant patient-specific educational resources to more than 35% of unique patients seen.

Coordination of Care Objective: Use communications functions of CEHRT to engage with patients or their authorized representatives about the patient’s care. Measures: More than 25% of unique patients seen during reporting period view, download or transmit their health information to a third party. Send a secure message or respond to a secure message for more than 35% of all unique patients seen. Patient-generated health data or data from a non-clinical setting (e.g., Nutrition, PT) is incorporated into the CEHRT for more than 15% of unique patients seen.

Health Information Exchange (HIE) Objective: Provide a summary of care record when transitioning or referring patients to another care setting, retrieve a summary of care record upon the first encounter with a new patient, and incorporate summary of care information from other providers into the EHR. Measures: Choose 2 of 3. Create a summary of care record and electronically exchange it for more than 50% of transitions of care and referrals. Incorporate patient information into the EHR from an electronic summary of care document for more than 40% of transitions or referrals received. Perform a clinical information reconciliation (medications, medication allergies, problems)for more than 80% of new patient encounters.

Public Health and Clinical Data Reporting Objective: Active engagement to submit public health data in a meaningful way using CEHRT. Active engagement means the provider is in the process of moving towards sending production data. Completed registration to submit. Testing and validation. Production. Measures: Choose any combination of three. Source: HIMSS

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