1. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services S1MU Part 1: An Overview of Core Requirements and Big Changes Ahead Moderator: Mary Zile, BSN, MHSA Presenters: Nathan Diller, MBA, MHSA Marty Larson, MS Stefanie Strinko, MBA, CPHIMS

2. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Agenda Overview of Meaningful Use Contrasting Stage 1 Meaningful Use (S1MU) to Stage 2 Meaningful Use (S2MU) Deep Dive: S2MU Core Measures Question & Answers 2

3. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Overview of Meaningful Use 3

4. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services HITECH: Policy Framework Better care for individuals, better health for populations, and lower per-capita costs. IHI-Triple Aim Initiative

5. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Pillars of Meaningful Use Improve quality, safety, efficiency, and reduce health disparities Provide access to comprehensive patient health data for patient’s health care team Use evidence-based order sets and CPOE Apply clinical decision support at the point of care Generate lists of patients who need care and use them to reach out to patients Engage patients and families Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health Improve care coordination Exchange meaningful clinical information among professional health care team Improve population and public health Submit immunization, syndromic surveillance and reportable disease data to public health agencies Ensure privacy and security protection for personal health information Protect confidential information through operating policies, procedures, and technologies Provide transparency of data sharing to patient

6. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Definition of Meaningful Use Use of ONC-HIT Certified Electronic Health Records (EHR) Electronic Exchange of Health Information Quality Reporting 6

7. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 7

8. Why S2MU Matters Stage 2 Meaningful Use serves as a foundation for other health care innovation initiatives S2MU is a glide path to: Accountable care organizations Medical home Payment reform initiatives 8

9. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Stages of Meaningful Use http://www.cms.gov/EHRIncentivePrograms

10. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 10

11. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 11 For Medicare Hospitals:

12. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Meaningful Use – Potential Penalties Penalties apply to Medicare only You must begin your first 90-day reporting period no later than July 3, 2014 EPs must attest to Meaningful Use no later than October 1, 2014 AIU for year one Medicaid does not count as attestation 12

13. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services The Penalty Adjustments will be applied as a percentage of Medicare Part B Professional Fee Schedule Charges Penalties scheduled to begin in Jan 1, 2015, and continue as follows: 2015: 1% 2016: 2% 2017: 3% 2018-2019: may increase 1% per year at discretion of HHS Secretary You cannot wait until 2015 to be Meaningful User if you are concerned about penalties 13

14. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Medicare Payment Adjustments EPs who first demonstrated meaningful use in 2011 or 2012 must demonstrate meaningful use for a full year in 2013 to avoid payment adjustments in 2015. They must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years. 14

15. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Hardship Exceptions for Medicare EPs EPs can apply for hardship exceptions in the following categories: Infrastructure New EPs Unforeseen circumstances By specialist/provider type 15

16. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Contrasting S1MU to S2MU An Overview

17. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Meaningful Use – Who is eligible for incentives? Eligible Providers in Medicare Eligible Providers in Medicaid Eligible Professionals (EPs) Doctor of Medicine or Osteopathy Physicians (Pediatricians have special eligibility & payment rules) Doctor of Dental Surgery or Dental Medicine Nurse Practitioners (NPs) Doctor of Podiatric MedicineCertified Nurse-Midwives (CNMs) Doctor of OptometryDentists ChiropractorPhysician Assistants (PAs) who practice in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is led by a PA Eligible Hospitals Acute Care Hospitals Critical Access Hospitals (CAHs)Children’s Hospitals No Changes from Stage 1 Meaningful Use

18. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Stage 2 Meaningful Use Overview Stage 2 Meaningful Use (S2MU) Final Rule was published on August 23, 2012. Beginning in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 for 2 or 3 years will need to meet S2MU criteria.

19. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services What is in the Rule Changes to Stage 1 of Meaningful Use Stage 2 of Meaningful Use New clinical quality measures (CQMs) New CQM reporting mechanisms Medicaid program changes

20. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services S2MU Change in Total Objectives Required 20 Stage 1 MU – Eligible ProfessionalsStage 2 MU – Eligible Providers 15 core objectives17 core objectives 5 of 10 menu objectives3 of 6 menu objectives 20 total objectives Stage 1 MU – Eligible Hospitals & CAHs Stage 2 MU – Eligible Hospitals & CAHs 14 core objectives16 core objectives 5 of 10 menu objectives3 of 6 menu objectives 19 total objectives

21. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services How to Get to S2MU 21 17 Core Objectives 3 of 6 Menu Objectives 9 Clinical Quality Measures Meaningful Use

22. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Key Changes to Stage 1 Meaningful Use Menu Objective Exclusion– While you can continue to claim exclusions if applicable for menu objectives, starting in 2014 these exclusions will no longer count towards the number of menu objectives needed.

23. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Medicaid Eligibility Changes The definition of what constitutes a Medicaid patient encounter has changed. A Medicaid encounter now includes anyone enrolled in a Medicaid program, including: Medicaid expansion encounters (excluding stand alone Title 21) Zero-pay claims 23

24. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Medicaid Eligibility Changes States have the option to allow providers to calculate Medicaid patient volume across 90-day period in last 12 months preceding a provider’s attestation. This also applies to needy patient volume and patient panel methodology with at least one Medicaid encounter taking place in the 24 months prior to the 90-day period. 24

25. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 2014 Changes EHRs Meeting ONC 2014 Standards – starting in 2014, all EHR Incentive Programs participants will have to adopt certified EHR technology that meets ONC’s Standards & Certification Criteria 2014 Final Rule

26. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 2014 Changes Reporting Period Reduced to Three Months – to allow providers time to adopt 2014 certified EHR technology and prepare for Stage 2, all participants will have a three- month reporting period in 2014. All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month EHR reporting period. 26

27. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 2014 Changes For Medicare providers, this 3-month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for EPs) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR). 27

28. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services 2014 Changes For Medicaid providers only eligible to receive Medicaid EHR incentives, the 3-month reporting period is not fixed, where providers do not have the same alignment needs. CMS is permitting this one- time three-month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems. 28

29. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Stage 2: Batch Reporting Stage 2 MU rules allows for batch reporting: Starting in 2014, groups will be allowed to submit attestation information for all of their individual EPs in one file for upload to the Attestation System, rather than having each EP individually enter data.

30. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services How do CQMs relate to the CMS Incentive Programs? Although reporting CQMs is no longer a core objective of the EHR Incentive Programs, all providers are required to report on CQMs in order to demonstrate Meaningful Use. In 2014 and beyond, reporting programs (i.e., PQRS, eRx reporting) will be streamlined in order to reduce provider burden.

31. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Reporting CQMs in 2014 and Beyond Beginning in 2014, all Medicare-eligible providers in their second year and beyond of demonstrating meaningful use must electronically report their CQM data to CMS. Medicaid providers will electronically report their CQM data to their state.

32. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Clinical Quality Measures ProviderPrior to 20142014 and Beyond* EPs Complete 6 out of 44: 3 core or 3 alt. core + 3 menu Complete 9 out of 64 Choose at least 1 measure in 3 NQS domains Recommended core CQMs include: 9 CQMs for the adult population 9 CQMs for the pediatric population Prioritize NQS domains Eligible Hospitals and CAHs Complete 15 out of 15 Complete 16 out of 29 Choose at least 1 measure in 3 NQS domains

33. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Deep Dive: S2MU Core Measures 33

34. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Stage 2 MU EP Core Objectives Core Objective Measure 1. CPOE Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology 2. E-RxE-Rx for more than 50% 3. DemographicsRecord demographics for more than 80% 4. Vital SignsRecord vital signs for more than 80% 5. Smoking StatusRecord smoking status for more than 80% 6. Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy 7. LabsIncorporate lab results for more than 55% 8. Patient ListGenerate patient list by specific condition 9. Preventive Reminders Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years

35. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Stage 2 MU EP Core Objectives Core ObjectiveMeasure 10. Patient Access Provide online access to health information for more than 50% with more than 5% actually accessing 11. Visit SummariesProvide office visit summaries for more than 50% of office visits 12. Education Resources Use EHR to identify and provide education resources more than 10% 13. Secure MessagesMore than 5% of patients send secure messages to their EP 14. Rx ReconciliationMedication reconciliation at more than 50% of transitions of care 15. Summary of Care Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR 16. ImmunizationsSuccessful ongoing transmission of immunization data 17. Security Analysis Conduct or review security analysis and incorporate in risk management process

36. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements ObjectiveStage 1 MUStage 2 MUSummary of Change Use of computerized provider order entry More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. More than 60% of medication, 30% of laboratory and 30% of radiology orders created by the EP during the reporting period are recorded using CPOE. Revised Threshold Revised Requirement 36

37. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 37 ObjectiveStage 1 MUStage 2 MUSummary of Change Generate and transmit permissible prescriptions electronically (eRx) More than 40% of all prescriptions written are transmitted electronically using certified EHR technology (CEHRT). More than 50% of all permissible prescriptions or all prescriptions written by the EP and queried for a drug formulary and transmitted electronically using CEHRT. Increased Threshold Revised Requirement

38. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements ObjectiveStage 1 MUStage 2 MUSummary of Change Record the following demographic s: Preferred language Gender Race Enthnicity Date of birth More than 50% of all unique patients seen by the EP have demographics recorded as structured data. More than 80% of all unique patients seen by the EP during the EHR reporting period have demographics recorded as structured data. Increased Threshold 38

39. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 39 ObjectiveStage 1 MUStage 2 MUSummary of Change Record and chart changes in the following vital signs: Height/length and weight Blood pressure Calculate and display BMI Plot and display growth charts for patients 0-20 years (incl. BMI) More than 50% of all unique patients’ age 2 and over seen by the EP height, weight and blood pressure are recorded as structured data. More than 80% of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height/length and weight (for all ages) recorded as structured data. Increased Threshold Revised Requirement

40. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 40 ObjectiveStage 1 MUStage 2 MUSummary of Change Record smoking status for patients 13 years old or older More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. More than 80% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Increased Threshold

41. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 41 ObjectiveStage 1 MUStage 2 MUSummary of Change Use clinical decision support to improve performance on high priority health conditions Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Revised Requirement Increased Threshold

42. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 42 ObjectiveStage 1 MUStage 2 MUSummary of Change Incorporate clinical lab- test results into CEHRT as structured data More than 40% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. More than 55% of all clinical lab tests ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in a CEHRT as structured data. Menu to Core Increased Threshold

43. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 43 ObjectiveStage 1 MUStage 2 MUSummary of Change Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach Generate at least one report listing patients of the EP with a specific condition. Menu to Core

44. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 44 ObjectiveStage 1 MUStage 2 MUSummary of Change Use clinically relevant information to identify patients who should receive reminders for preventive/follow- up care and send these patients the reminder, per patient preference More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. More than 10% of all unique patients who have had two or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available. Menu to Core Decreased Threshold

45. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 45 ObjectiveStage 1 MUStage 2 MUSummary of Change Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP More than 10% of all unique patients seen by the EP are provided timely electronic access to their health information. More than 50% of all unique patients seen by the EP are provided timely electronic access to their health information. More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download or transmit to a third party their health information. Menu to Core Revised Requirement

46. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 46 ObjectiveStage 1 MUStage 2 MUSummary of Change Provide clinical summaries for patients for each office visit Clinical summaries provided to patients for more than 50% of all office visits within 3 business days. Clinical summaries provided to patients within 1 business day for more than 50% of office visits. Revised Requirement

47. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 47 ObjectiveStage 1 MUStage 2 MUSummary of Change Use CEHRT to identify patient- specific education resources and provide those resources to the patient More than 10% of all unique patients seen by the EP during the EHR reporting period are provided patient-specific education resources. Patient-specific education resources identified by CEHRT are provided to patients for more than 10% of all office visits by the EP. Menu to Core Revised Requirement

48. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 48 ObjectiveStage 1 MUStage 2 MUSummary of Change Use secure electronic messaging to communicate with patients on relevant health information N/A A secure message was sent using the electronic messaging function of CEHRT by more than 5% of unique patients seen by the EP during the EHR reporting period. New Requirement

49. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 49 ObjectiveStage 1 MUStage 2 MUSummary of Change The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP. The EP performs medication reconciliation for more than 65% of transitions of care in which the patient is transitioned into the care of the EP. Increased Threshold Menu to Core

50. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 50 ObjectiveStage 1 MUStage 2 MUSummary of Change The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral The EP who transitions their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals. 10% of such transitions or referrals are electronically transmitted. One or more successful exchanges of a summary of care document with a recipient on a different EHR technology. Menu to Core Revised Requirement

51. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 51 ObjectiveStage 1 MUStage 2 MUSummary of Change Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless the immunization registries do not have the capacity to receive the information electronically). Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or immunization information system for the entire EHR reporting period. Revised Requirement Menu to Core

52. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services EP Core Requirements 52 ObjectiveStage 1 MUStage 2 MUSummary of Change Protect electronic health information created or maintained by the CEHRT through the implementati on of appropriate technical capabilities Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management. Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider’s risk management process. Revised Requirement

53. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Stage 2 MU EP Menu Objectives Menu ObjectiveMeasure 1. Imaging Results More than 20% of imaging results are accessible through Certified EHR Technology 2. Family History Record family health history for more than 20% of unique patients 3. Syndromic Surveillance Successful ongoing transmission of syndromic surveillance data 4. CancerSuccessful ongoing transmission of cancer case information 5. Specialized Registry Successful ongoing transmission of data to a specialized registry 6. Progress Notes Enter an electronic progress note for more than 30% of unique patients

54. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Q&A Session 54

55. REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services Additional MU Information Tri-State Regional Extension Center www.tristaterec.org/S2MU CMS EHR Incentive Program Home Page http://www.cms.gov/EHRIncentivePrograms/ Office of National Coordinator for Health IT http://healthit.gov/ 55