HITECH/MEANINGFUL USE Danielle Smith Trends and Issues in Healthcare December 2, 2014 Power Point Project

WHAT IS “HITECH”? The Health Information Technology for Economic and Clinical Health (HITECH) Act provides Health and Human Services (HHS) with the authority to establish programs to improve health care quality, safety and efficiency through the promotion of health IT, including electronic health records and private and secure electronic health information exchange. HITECH was enacted as part of the 2009 American Recovery and Reinvestment Act.

WHAT IS “MEANINGFUL USE”?  The use of a certified Electronic Health Record (EHR) in a meaningful manner.  The electronic exchange of health information to improve quality of health care.  The use of certified EHR technology to submit clinical quality and other measure.

THREE STAGES OF MEANINGFUL USE Stage One  Implementation and Usage of EMRs/EHRs  Started in 2011 Stage Two  Ideally starts in 2013  Core Objectives for Eligible Participants and Hospitals Stage Three  To be determined at a later date  Set to start sometime in 2016

STAGE ONE: CORE CQMS Healthcare providers must report all 3 of these measures on the EHR to remain eligible for reimbursement.  Hypertension: Blood Pressure Measurement  Preventative Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention  Adult Weight Screening and Follow-Up

STAGE ONE: ALTERNATE CQMS Eligible providers are also encouraged to report on alternate measures if any of these do not apply to their practice. Weight Assessment for Children and Adolescents Childhood Immunization Status Preventative Care and Screening: Influenza Immunization Initiation and Engagement of Alcohol and Other Drug Dependence Prenatal Care: Screening for HIV Prenatal Care: Anti-D Immune Globulin Controlling High Blood Pressure Cervical Cancer Screening Chlamydia Screening for Women Use of Appropriate Medications for Asthma Low Back Pain: Use of Imaging Studies IVD: Complete Lipid Panel an LDL Control Diabetes: HbA1c Control (<8%) Diabetes: HbA1c Poor Control Prostate Cancer: Avoidance of overuse of bone scan Pneumonia vaccination status for older adults Breast cancer screening Colorectal cancer screening Diabetes: Eye Exam Diabetes: Urine Screening Primary Open Angle Glaucoma: Optic Nerve Evaluation Diabetes: Foot Exam Diabetic Retinopathy: Document presence or absence Diabetic Retinopathy: Managing Ongoing diabetes care Coronary Artery Disease: drug therapy for lowering LDL- cholesterol Diabetes: LDL management and control Heart Failure: Warfarin therapy patients with atrial fib IVD: Blood Pressure Management IVD: Use of Aspirin or other Antithrombotic Diabetes: Blood Pressure Management Heart Failure: ACE or ARB therapy for LVSD Asthma Pharmacologic Therapy Coronary artery disease: oral antiplatelet therapy Asthma Assessment Appropriate testing for children with pharyngitis Coronary Artery Disease: Beta- Blocker Therapy Oncology Breast Cancer: hormonal therapy for stage Ic-IIIc Cancer Oncology Colon Cancer: Chemo for stage III patients Heart Failure: Beta-Blocker therapy for LVSD Anti-depressant medication management

STAGE TWO CORE CQMS: 17 CORE OBJECTIVES FOR ELIGIBLE PROFESSIONALS 1.Use computerized order entry (CPOE) for medication, laboratory and radiology orders 2.Generate and transmit permissible prescriptions electronically (eRx) 3.Record demographic information 4.Record and chart changes in vitals 5.Record smoking status for patients 13 years old and older 6.Use clinical decision support to improve performance on high-priority health conditions 7.Provide patients the ability to view online, download and transmit their health information 8.Provide clinical summaries for patients for each office visit 9.Provide electronic health information created or maintained by the Certified EHR Technology 10.Incorporate clinical lab-test results into Certified EHR Technology 11.Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach 12.Use clinically relevant information to identify patients who should receive reminders for preventative/follow-up care 13.Use certified EHR Technology (CEHRT) to identify patient specific education resources 14.Perform medication reconciliation 15.Provide summary of care record for each transaction of care of referral 16.Submit electronic data to immunization registries 17.Use secure electronic messaging to communicate with patients on relevant health information

STAGE TWO ALTERNATE CQMS: FOR ELIGIBLE PROFESSIONALS  Submit electronic syndromic surveillance data to public health agenies  Record electronic notes in patient health records  Imaging results accessible through CEHRT  Record patient family health history  Identify and report cancer cases to State cancer registry  Identify and report specific cases to a specialized registry (other than a cancer registry)

STAGE TWO CORE CQMS: 16 CORE OBJECTIVES FOR ELIGIBLE HOSPITALS 1.Use CPOE for medication, laboratory and radiology orders 2.Record demographic information 3.Record and chart changes in vital signs 4.Record smoking status for patients 13 years old and older 5.Use clinical decision support to improve performance on high-priority health conditions 6.Provide patients the ability to view online, download and transmit their health information within 36 hours of discharge 7.Protect electronic health information created or maintained by the CEHRT 8.Incorporate clinical lab-test results into CEHRT 9.Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach 10.Use CEHRT to identify patient-specific education resources and provide those resources to the patient if appropriate 11.Perform medication reconciliation 12.Provide summary of care record for each transition of care or referral 13.Submit electronic data to immunization registries 14.Submit electronic data on reportable lab results to public health agencies 15.Submit electronic syndromic surveillance data to public health agencies 16.Automatically track medications with an electronic medication administration record (eMAR)

STAGE TWO ALTERNATE CQMS: FOR ELIGIBLE HOSPITALS  Record whether or not a patient 65 years old or older has an advance directive  Record electronic notes in patient records  Imaging results accessible through CEHRT  Record patient family health history  Generate and transmit permissible discharge prescriptions electronically (eRx)  Provide structured electronic lab results to ambulatory providers

CHOOSING A PROGRAM: MEDICARE OR MEDICAID? There are two EHR Incentive Programs. CMS oversees the Medicare EHR Incentive Program, and the state Medicaid agencies manage the Medicaid EHR Incentive Program. The two programs are similar, but there are some differences between them. Medicare EHR Incentive ProgramMedicaid EHR Incentive Program Run by CMSRun by your state Medicaid agency Maximum Incentive amount is $44,000Maximum Incentive amount is $63,750 Payments over 5 consecutive yearsPayments over 6 years, does not have to be consecutive Payment adjustments will begin in 2015 for providers who are eligible but decide not to participate No payment adjustments for providers who are only eligible for the Medicaid program Providers must demonstrate meaningful use every year to receive incentive payments. In the first year providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate meaningful use in the remaining years to receive incentive payments.

REFERENCES What is Meaningful Use. (2014, November). Retrieved from Health Resources and Services Administration: Health IT Legislation and Regulation. (2014, September 11). Retrieved from HealthIT.gov: legislationwww.healthit.gov/policy-researchers-implementers/health-it- legislation What is Meaningful Use? (2010, September 30). Retrieved from EHR Incentive Programs. (2014, November 24). Retrieved from Centers for Medicaid and Medicare Services: Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentiveProgr amswww.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentiveProgr ams