1. WV HFMA January 23, 2014

2.  Understand Stage 1 changes starting in 2014  Understand Stage 2 Objectives & Quality Measures – changes from Stage 1 and what you need to know about what’s new  Understand options for reporting Quality Measures and PQRS measures together starting in 2014  Learn what you need to do to pass a CMS Meaningful Use Audit 2

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4. CMS RefObjectiveChange EP EH Capability to exchange key clinical information electronically Eliminated as Stage 1 Objective (2013) EP EH Provide patients with timely electronic access to their health information within four business days Eliminated as Stage 1 Objective (2014) EH Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request Eliminated as Stage 1 Objective (2014) EP EH Option to be orders based for CPOE vs. patient based for denominator 4

5. CMS RefObjectiveChange EP EH CPOEDenominator – Current : at least one medication order in the medications list (patient based) Alternate : All medication orders created by the EP (orders based) EP ePrescribingAdditional exclusion: if there is not a pharmacy at your organization or a pharmacy that accepts electronic prescriptions within 10 miles of each of an EP’s practice locations 5

6.  If 2014 is your first year to attest to Stage 1  must attest within first 9 months of the attestation period to avoid penalties o EHs – must meet MU for 90 days, but last 90 days will be Apr-June o EPs – must meet MU for 90 days, but last 90 days will be Jul-Sept o CAHs - this does not apply  Batch submission for EPs o Separate batches for Medicare and Medicaid o States not required to provide 6

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8. EP  17 Core Objectives  3 of 6 Menu Objectives  28+ Core measures & sub measures  3 of 6 menu 8 EH  16 Core Objectives  3 of 6 Menu Objectives  26+ Core measures & sub measures  3 of 6 menu

9.  CQMs selected must align with at least 3 of 6 National Quality Strategy Domains  Any EP or EH in 2 nd year of MU must submit CQMs electronically EP  Must choose 9 out of 64 available CQMs  CMS  priority CQMs (but not required to choose)  Medicare EPs  option to align MU CQMs with PQRS, Medicare Shared Savings Program or Pioneer ACO 9

10. EH  Must choose 16 out of 29 available CQMs 10

11. 2014 “Special Dispensation” Regardless of what Stage you are, you only need to meet MU for 90 days. If 2014 is your second year, the 90 days is based on a quarter, not a rolling 90 days 11

12. CMS RefObjectiveChange EP EH Implement drug-drug, drug-allergy check Incorporated into Stage 2 Decision Support objective EP EH Maintain problem list of current and active diagnosis Incorporated into Stage 2 Summary of Care document for TOC/Referrals EP EH Maintain Active Medication Allergy List Incorporated into Stage 2 Summary of Care document for TOC/Referrals EP EH Report clinical quality measures (CQMs) to CMS or the States As of 2014, all CQMs must be submitted electronically 12

13. CMS RefObjectiveChange EP EH Capability to exchange key clinical information electronically Eliminated in Stage 2 EP EH Implement drug formulary checks Incorporated into ePrescribing measure for Stage 2 EP EH Provide patients with timely electronic access to their health information Eliminated in Stage 2 13

14. CMS RefObjectiveChange EP EH CoreCPOEMeds: >60% (was 30%) Rad: >30% New Lab: >30% New Standard: RxNorm for drugs & allergies EPCoreGenerate and transmit permissible prescriptions electronically (eRx) >50% (was 40%) Must be compared to at least one drug formulary EP EH CoreRecord demographics>80% (was 50%) Standard: ISO 639-2 for language EP EH CoreRecord & chart changes in vital signs (BP, Height, Weight, BMI, growth charts) >80% (was 50%) Age Requirement Changes: Ages 3 & over for blood pressure; height/weight all ages 14

15. CMS RefObjectiveChange EP EH Core Record Smoking Status for patients 13 yrs. & older >80% (was > 50% ) Standard: Must map to Snomed CT EPCoreImplement CDS 5 CDS Rules (was 1 rule) Additional Requirements:  Must be tied to at least 4 CQMs  Must have drug-drug and drug- allergy interaction checks included EP EH Core Incorporate Lab test results as structured data >55% (was 40%) Moves from Menu  Core EP EH Core Submit date to immunization registries Ongoing submission (was “test” of capability) Standard: CVX Moves from Menu  Core 15

16. CMS RefObjectiveChange EHCoreSubmit data on reportable lab results Ongoing submission (was “test” of capability) Standard: LOINC Moves from Menu  Core EP EH CoreSubmit syndromic surveillance data Ongoing submission (was “test” of capability) Moves from Menu  Core for EH (remains as Menu for EP) EPCorePatient Reminders for follow up/preventative care 10% of all patients (was 20% of patients age 5 yrs & younger, and patients 65 yrs & older) Moves from Menu  Core EPCoreProvide clinical summary for patients for each office visit >50% of office visits within 1 business day (was >50% of office visits within 3 business days) 16

17. CMS RefObjectiveChange EHCoreProvide patient specific education resources >10% of all unique patients with office visits for the EP (was 10% of unique patients) Moves from Menu  Core EP EH CoreProtect Electronic Health Information Additional Focus: address the encryption/security of data at rest (45 CFR 164.308 (a)(1)) EP EH CoreMedication Reconciliation> 50% of transitions of care to the EP Moves from Menu  Core EPCoreGenerate Patient List by specific condition Generate at least one report of patients with a specific condition Moves from Menu  Core 17

18. CMS RefObjectiveChange EP EH CoreProvide Summary of Care Record (aka Transitions of Care or TOC)  > 50% of transitions of care or referrals (can be paper)  10% must be electronic directly from EHR to EHR or through an exchange (i.e. WVHIN)  Electronic transmission must be to a different EHR vendor or conduct a test with the CMS test designated EMR (Was >50% of transitions of care must provide Summary of Care record) Moves from Menu  Core 18

19. CMS RefObjectiveMeasure EHCoreAutomatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR) >10% of medication orders created … during the EHR reporting period for which all doses are tracked are tracked using eMAR EP EH MenuRecord electronic notes in patient records >30% - Enter at least one electronic progress note created, edited and signed by an EP … during the EHR reporting period 19

20. CMS RefObjectiveMeasure EP EH MenuImaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. >20% of all scans and tests whose result is an image ordered by the EP for patients seen during the EHR reporting period are incorporated into or accessible through CEHRT EP EH MenuRecord patient family health history as structured data > 20% of all unique patients… have structured data entry for one or more first-degree relatives or an indication that family health history has been reviewed 20

21. CMS RefObjectiveMeasure EHMenuGenerate and transmit permissible discharge prescriptions electronically (eRx) >10% of hospital discharge medication orders for permissible prescriptions (for new or changed prescriptions) are compared to at least one drug formulary and transmitted electronically using Certified HER Technology EHMenuProvide structured electronic lab results to ambulatory providers >20% of lab results for orders received by hospital labs are sent as structured electronic clinical lab results back to the ordering provider 21

22. CMS RefObjectiveMeasure EPCoreUse secure electronic messaging to communicate with patients on relevant health information > 5% of unique patients securely message their provider during the reporting period EPMenuCapability to identify and report cancer cases to a State cancer registry Ongoing Submission of cancer case information to a cancer registry for the entire EHR reporting period EPMenuCapability to identify and report specific cases to a specialized registry (other than a cancer registry) Ongoing Submission of specific case information to a pecialized registry for the entire EHR reporting period 22

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25.  Desk audits  Post payment audits for EPs and EHs  Pre payment audits for EPs  Candidate for audit after meeting MU for full year  In general, turnaround time is about 1 month. 25

26. Part 1 General Information  Proof of licensing of a certified EHR “…provide a copy of your licensing agreement with the vendor or invoices. Please ensure that the licensing agreements or invoices identify the vendor, product name and product version number”  Proof of method for calculating ED admissions (i.e. an explanation of how the ED admissions were calculated and a summary of ED admissions) 26

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29. Part II Core Set Objectives/Measures  Proof of Core Measures #1, 3, 4, 5, 6, 7, 8, 11, & 12 o Report from the certified EHR used to complete the attestation o Proof that the report used for attestation is from the certified EHR Vendor Logo Or Step by step screen shots of how report is generated from EHR 29

30. Part II Core Set Objectives/Measures  Proof that a security risk analysis was performed o Must show that it was during the MU reporting period o Must include implementation plan to address any deficiencies found, with completion dates 30

31. Part III Menu Set Objectives/Measures  Proof of Menu Measures #2, 3, 5, 6, or 7 o Report from the certified EHR used to complete the attestation o Proof that the report used for attestation is from the certified EHR Vendor Logo Or Step by step screen shots of how report is generated from HER  Proof of Yes/No Menu Set Measures #4, 8, 9, or 10 o Screen Shots 31

32.  Save EVERYTHING! o Reports from your EHR that you use to attest o The detail behind the numerator/denominator o Screen shots from EHR for YES/NO measures from reporting period o Medicare and Medicaid attestation confirmation o Medicaid screen shots from every step of the attestation o Medicare summary of all of your input from the attestation o Security Risk Analysis (and every re-evaluation done) o Recommendation: create a share drive with tightly controlled access to save off MU documents Remember: You need to do this for every individual EP…much easier for EH! 32

33.  Contact your EHR Vendor o What can/will they do to assist you with an audit? o What limitations do you have in terms of what you can submit without breaching proprietary property?  If Reporting MU from multiple EHRs… o Be sure that the reports used from each of the EHRs have the same items for attestation o All reports have to be submitted for the audit 33

34.  Documentation Submission o Be sure to follow the same order as requested in the letter from Figliozzi (or CMS) o Cover letter – outline exactly what you are submitting in response to each document request o Create a single PDF of all of the documents in the correct order along with a cover letter and submit o Most importantly… Don’t miss your submission deadline! 34

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