1. Christopher Geer, MBA Meaningful Use Project Manager Unity Health System cgeer@unityhealth.org

2.  The Health Information Technology for Economic and Clinical Health (HITECH) Act  Enacted as part of the American Recovery and Reinvestment Act of 2009  Promotes the adoption and meaningful use of health information technology. http://www.recovery.gov/About/Pages/The_Act.asp x

3. Data Capture and Sharing Advanced Clinical Process Improved Outcomes 1 2 3

4. First Payment Year Payment Year 2011201220132014201520162017 2011 Stage 1 (100%) Stage 1 (75%) Stage 1 (50%) Stage 2 (25%)Stage 2Stage 3 2012 Stage 1 (100%) Stage 1 (75%) Stage 2 (50%) Stage 2 (25%)Stage 3 2013 Stage 1 (100%) Stage 1 (75%) Stage 2 (50%) Stage 2 (25%)Stage 3 2014 Stage 1 (75%) Stage 1 (50%) Stage 2 (25%)Stage 2 2015 Stage 1 Stage 2 2016 Stage 1 “If there will be a stage 4 of Meaningful Use, we expect to update this table in the rulemaking stage 3” – CMS, Stage 2 NPRM

5. Possess Certified EHR Technology Attest to Meaningfully Using CEHRT Incentive Payment http://onc-chpl.force.com/ehrcert Is your vendor certified?

6. Meaningful Use Eligible Hospitals MedicaidMedicare Eligible Professionals MedicaidMedicare Dually-eligible Hospitals can participate in both programs Dually-eligible providers must pick 1 program

7. Medicaid ProgramMedicare Program Administered by the StateAdministered by Federal Government No payment reductionsPayment reductions begin in 2015 Adopt, Implement, Upgrade option for 1 st year Must demonstrate MU in year 1 Maximum EP incentive $63,750 Maximum incentive $44,000 for EP’s (10% bonus for EP’s in HPSAs) Fixed incentive over 6 years (EP) and 4 years (EH) in NYS (may vary by state) EP incentive paid over 5 years based on 75% of net allowable charges Require 30% (EP) and 10%(EH) minimum Medicaid volume No minimum volume threshold Can skip years once startingMust be done in consecutive years

8. Medicaid EP’s 30% Medicaid Volume Required Medicare EP’s No Volume Requirement PhysiciansDoctor of Medicine or Osteopathy Dentists Doctor of Oral Surgery or Dental Medicine Certified Nurse MidwifeDoctor of Podiatric Medicine Nurse PractitionerDoctor of Optometry Physician Assistant*Chiropractor *Must be practicing in a Rural Health Center or Federally Qualified Health Center led by a PA. Must render <90% of services in an Inpatient Acute or Emergency Setting

9.  Subsection (d) hospitals or Critical Access Hospitals in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS)

10. Eligible HospitalStage 1Stage 2 Core1416 Menu104 Menu Required52 Eligible ProfessionalStage 1Stage 2 Core1517 Menu105 Menu Required53

11.  Yes / No Attestation  Percentage-Based Measure Numerator / Denominator = Requirement Possible Denominators:  Unique Patients  Transitions of Care  Orders  There are exclusions for many of the objectives

12. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE  Requirement: 30%  Numerator: At least 1 medication order  Denominator: Unique patients with at least 1 medication in their med list  Requirement: 60 %  Numerator: Total orders entered using CPOE  Denominator: Total medication, lab, and radiology orders Objective : Use CPOE for orders entered

13. STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 CONSOLIDATED  Enable drug formulary checks  Consolidated into the eRx objective Objective: Implement drug-formulary checks

14. STAGE 1 EP: CORE EH: N/A PROPOSED STAGE 2 EP: CORE EH: MENU  Requirement: 40%  Numerator: E-prescriptions  Denominator: Prescriptions written  Requirement: EP: 65% EH: 10%  Numerator: E-prescriptions  Denominator: Prescriptions written (EH: Discharge Prescriptions)  Must be checked against at least 1 formulary Objective: Generate and transmit permissible prescriptions electronically (eRx).

15. STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 EP: CORE EH: CORE  Requirement: 10%  Numerator: Number of patients who are provided patient education specific resources  Denominator: Unique patients  Requirement: 10%  Numerator: Number of patients who are provided patient education specific resources  Denominator: EH: Unique patients EP: Office Visits Objective: Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.

16. STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 EP: CORE EH: CORE  Requirement: 50%  Numerator: Patients where medication reconciliation was performed.  Denominator: Transitions of care  Requirement: 65%  Numerator: Patients where medication reconciliation was performed.  Denominator: Transitions of care Objective: The EP or EH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation

17. STAGE 1 EP: MENU EH: N/A PROPOSED STAGE 2 EP: CORE EH: N/A  Requirement: 20%  Numerator: Patients who were sent reminders  Denominator: Number of unique patients 65 years old or older or 5 years older or younger.  Requirement: 10%  Numerator: Patients who were sent reminders  Denominator: Unique patients Objective: Send reminders to patients per patient preference for preventive/follow-up care.

18. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE  Requirement: 50%  Numerator: Number of patients will all elements captured  Denominator: Unique patients  Race/Ethnicity Standard: OMB Standards  Requirement: 80 %  Numerator: Number of patients will all elements captured  Denominator: Unique patients  Race/Ethnicity Standard: OMB Standards Objective : Record the following demographics: preferred language, gender, race and ethnicity, date of birth, and date and preliminary cause of death in the event of mortality in the eligible hospital or CAH http://www.whitehouse.gov/omb/fedreg_1997standards/

19. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 CONSOLIDATED  Requirement: 80%  Numerator: Unique patients with at least 1 recorded problem, medication, medication allergy, or an indication of none.  Denominator: Unique patients  Consolidated into the requirements for other objectives Objectives : Maintain an up-to-date problem list, medication list, and medication allergy list

20. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE  Requirement: 50%  Numerator: Number of patients with all elements captured  Denominator: Unique patients  Requirement: 80 %  Change BMI to age 3, and eliminate height/weight age restriction  Numerator: Number of patients will all elements captured  Denominator: Unique patients Objective: Record and chart height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 - 20 years, including BMI

21. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE  Requirement: 50%  Numerator: Number of unique patients with smoking status captured  Denominator: Unique patients  Requirement: 80 %  Numerator: Number of unique patients with smoking status captured  Denominator: Unique patients Objective: Record smoking status for patients 13 years old or older

22. STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 EP: CORE EH: CORE  Generate 1 list Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

23. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 REMOVED AS AN OBJECTIVE  Submit quality measures  Still required to submit to be considered a meaningful user  Electronic Submission Objective : Report quality measure to CMS or the states

24. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE  1 Rule  5 Rules related to the improvement of selected quality measures  Drug-Drug / Drug Allergy Checks included as part of this objective Objective : Implement clinical decision support rules related to specialty or high clinical priority

25. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 CONSOLIDATED  Enable drug-drug / drug- allergy checks  Consolidated into the Clinical Decision Support Objective  Enable drug-drug / drug- allergy checks Objective : Implement drug-drug and drug-allergy checks

26. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE  Perform Security Risk Assessment Objective: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

27. STAGE 1 EP: N/A EH: MENU PROPOSED STAGE 2 EP: N/A EH: MENU  Requirement: 50%  Numerator: Number of patients where an indication of an advance directive is entered  Denominator: Unique patients  Requirement: 50%  Numerator: Number of patients where an indication of an advance directive is entered  Denominator: Unique patients Objective: Record whether a patient 65 years old or older has an advanced directive as structured data

28. STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 EP: CORE EH: CORE  Requirement: 40%  Numerator: Lab orders received electronically  Denominator: Lab orders  Requirement: 55%  Numerator: Lab orders received electronically  Denominator: Lab orders Objective: Incorporate clinical lab-test results into EHR as structured data

29. Measure Stage 1 Requirement Stage 2 Hospital Status Stage 2 Ambulatory Status Immunization DataCore Lab DataCoreN/A Surveillance Data Core Menu Cancer Cases N/A Menu Other Specific Cases N/A Menu

30. STAGE 1 EP: N/A EH: N/A PROPOSED STAGE 2 EP: CORE EH: N/A  New with for stage 2  Requirement: 10%  Numerator: The number of patients who send a secure message to the provider  Denominator: Unique patients Objective: Use secure electronic messaging to communicate with patients on relevant health information.

31. STAGE 1 EP: N/A EH: N/A PROPOSED STAGE 2 EP: MENU EH: MENU  New with for stage 2  Requirement: 40% images captured 10% submitted to another provider of care  Numerator: Results accessible through the EHR  Denominator: Number of scans and tests whose result is one or more image ordered Objective: Imaging results and information are accessible through Certified EHR Technology.

32. STAGE 1 EP: N/A EH: N/A PROPOSED STAGE 2 EP: N/A EH: MENU  New with for stage 2  Requirement: 10%  Numerator: The number of orders tracked using eMAR.  Denominator: Medication orders Objective: Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).

33. STAGE 1 EP: N/A EH: N/A PROPOSED STAGE 2 EP: MENU EH: MENU  New with for stage 2  Requirement: 20%  Numerator: Patients with structured data entry for one or more first-degree relatives.  Denominator: Unique Patients Objective Record patient family health history as structured data

34. STAGE 1 EP: CORE EH: N/A PROPOSED STAGE 2 EP: CORE EH: N/A  Requirement: 50%  Numerator: Patients provided a clinical summary within 3 business days  Denominator: Unique Patients  Requirement: 50%  Numerator: Patients provided a clinical summary within 24 hours  Denominator: Unique Patients  Expanded requirements Objective Provide clinical summaries for patients for each office visit

35. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 CONSOLIDATED  Performed one test  Consolidated into the summary of care objective Objective: Capability to exchange key clinical information, among providers of care and patient authorized entities electronically

36. STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 EP: CORE EH: CORE  Requirement: 50%  Numerator: Number of patients where a summary of care was provided  Denominator: Number of transitions of care  Requirement: 60% Paper or electronic 10% electronically  Numerator: Number of patients where a summary of care was provided  Denominator: Number of transitions of care Objective: The EP or EH who transitions their patient to another setting of care should provide summary care record for each transition of care or referral

37. STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 CONSOLIDATED  Requirement: 50%  Numerator: Number of patients receiving their record electronically within 3 business days  Denominator: patient requests for an e-copy  At a minimum: must include Problems, medications, medication allergies, and diagnostic test results  Consolidated into the view, download, transmit objective. Objective: Provide patients with an electronic copy of their health information upon request

38. STAGE 1 EP: N/A EH: CORE PROPOSED STAGE 2 CONSOLIDATED  Requirement: 50%  Numerator: Number of patients receiving their instructions electronically  Denominator: patient requests for an e-discharge instructions  Consolidated into the view, download, transmit objective. Objective: Provide patients with an electronic copy of their health information upon request

39. STAGE 1 EP: MENU EH: N/A PROPOSED STAGE 2 CONSOLIDATED  Requirement: 10%  Numerator: Number of patients who have their record displayed online  Denominator: Unique patients  At a minimum: must include Problems, medications, medication allergies, and diagnostic test results  Consolidated into the view, download, transmit objective. Objective: Provide patients with timely electronic access to their health information within four business days of the information being available to the EP

40.  EP: Must provide information online in 4 business days 50% of unique patients are provided their health information online 10% of patients must access that information Standards  Patient Name  Provider name, practice  Problem List  SNOMED CT  Procedures  ICD-10, CPT-4  Laboratory test results  LOINC  Medication list  Medication Allergy List  Vital Signs  Smoking Status  Demographic Information  Care plan field, including goals and instructions  Additional known care team members

41.  EP: Must provide information online within 36 hours of discharge 50% of unique patients are provided their health information online 10% of patients must access that information Standards  Admit and discharge date/place  Reason for hospitalization  Providers of care  Problem List  SNOMED CT  Relevant past diagnosis  Laboratory test results  LOINC  Medication list  Medication Allergy List  Vitals at discharge  Demographic Information  Care transition plan  Discharge Instructions

42. Christopher Geer, MBA Meaningful Use Project Manager Unity Health System cgeer@unityhealth.org Questions?