1. PCC Practices and its Impact on Meaningful Use Moderator: Carmen Land Meaningful Use National Team Business Analyst DNC (Contractor) for U.S. Indian Health Service OIT Last Updated: February 8, 2012

2. Today’s Objectives Understand the difference between the Patient Volume Report, Performance Measures Report, and Clinical Quality Measures Report; and which reports are affected by data entry / coding Review the current Meaningful Use Performance Measures as they pertain to HIM Professionals

3. Demonstrating Meaningful Use Eligibility Patient Volume Report 3 rd Party Billing Calculates: * EP Medicaid patient volume rates * group practice rates in lieu of calculating the rate for each individual EP * EH Medicaid patient volume rates Performance Measures Report PCC Calculates Performance Measures for EPs and EHs 1 out of 15 core Performance Measures: Submit CQMs to CMS EPs: 15 core EHs: 14 core EPs & EHs: 5 out of 10 menu No delay in data capture caused by data entry / coding Stage 1 Meaningful Use Reports Clinical Quality Measures Report Clinical Reporting Calculates Clinical Quality Measures for EPs and EHs No targets for Stage 1 EPs: 6 total CQMs 3 core or alternate core 3 out of 38 from menu set EHs: 15 total CQMs Affects of Data Entry / Coding Medicaid: Patient Volume Report - Coding must be up to date so that a claim can be generated and paid Medicare : Allowable Charges Clinical Quality Measures Report - If coding isn’t up to date, CQM report results may be low

5. What HIM Really Needs to Know Differences/commonalities between: –-Core sets vs. Menu Sets of Measures –-Performance Measures vs. Clinical Quality Measures –-Measures for EPs vs. EHs/CAHs Which reports demonstrate meaningful use Performance Measures that require yes/no attestation only Effects of accurate and timely completion of coding queue on Meaningful Use reports Effects of inpatient coding and clinical documentation on reaching CQM report Effects of PCC errors on Meaningful Use Effects of complete and comprehensive patient registration on Meaningful Use

6. Maintain Problem List (Core) Measure: More than 80% of all unique patients seen by the eligible provider (EP) or admitted to the eligible hospital’s (EH) or Critical Access Hospital’s (CAH) inpatient or emergency department (POS 21 or 23*) have at least one entry or an indication that no problems are known for the patient recorded as structured data.

7. Maintain Problem List HIM Procedures 1. Educate the provider that they are responsible for the management of a current and accurate Problem List for each patient. 2. Ensure that at least one entry of a problem or an indication that “No Active Problems” exist for each patient. 3. A facility specific policy should be in place to notify clinical staff of maintenance of a current and accurate Problem List. 4. Generate a list of problems/diagnoses not coded (.9999) in Patient Care Component (PCC) MGR→DEU→SUP→PRB. 5. A list of No Active Problems can be generated from VGen. Problems not coded must be coded according to the Provider Narrative and other documentation in the EHR such as the Note.

8. Active Medication List (Core) Measure: More than 80% of all unique patients seen by the eligible provider (EP) or admitted to the eligible hospital's (EH) or Critical Access Hospital's (CAH) inpatient or emergency department (POS 21 or 23*) have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data.

9. Active Medication List HIM Procedures 1. Ensure that at least one entry of a medication or an indication that the patient has “No Active Medications”. 2. All medications must be entered by clinicians. PCC data entry/coders no longer enter Medications in PCC. 3. A facility specific policy should be in place to notify clinical staff of maintenance of a current and accurate Active Medication List. 4. If outside medications are documented in a note and are not found in the Medication Tab, notify the clinician according to facility policy.

10. Medication Allergy List (Core) Measure: More than 80% of all unique patients seen by the eligible provider (EP) or admitted to the eligible hospital’s (EH) or Critical Access Hospital’s (CAH) inpatient or emergency department (POS 21 or 23*) have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data.

11. Medication Allergy List HIM Procedures 1.Educate the clinician that they are responsible for the management of a current and accurate Medication Allergy List for each patient. 2.Ensure that at least one entry of an allergy or an indication that “No Known Allergies” exist for each patient. 3.A facility specific policy should be in place to notify clinical staff of maintenance of a current and accurate Medication Allergy List. 4.Generate the Problem List Allergy List (PLAL) report at least monthly to identify patient drug allergies on the patient’s Problem List but not on their Allergies List. 5.Remove allergies from the Problem List and enter into the Adverse Reaction Tracking using the ALG mnemonic in the Adverse Reaction Tracking per local policy. The GMRA User key must be assigned.

12. Record Demographics (Core) Measure: More than 50% of all unique patients seen by the eligible provider (EP) or admitted to the EH or CAH inpatient or emergency department (POS 21 or 23*) have demographics recorded as structured data.

13. Record Demographics HIM Procedures (cont.) 1.Set Preferred Language, Race, and Ethnicity as Required (mandatory) in Patient Registration, Table Maintenance, Options (OPT). Gender and date of birth are already set as required/mandatory. 2.If patient declines to provide the information, Patient Registration shall select “Declined to Answer.” 3.Patient Registration shall update patient demographics during patient interviews or Contract Health Services (CHS) may update demographics during the referral process.

14. Record Demographics HIM Procedures (cont.) 4.For in-hospital deaths, enter the date and preliminary cause of death in the Admission/Discharge/Transfer (ADT) of the Patient Information Management System (PIMS), CODE, Other Mnemonics, Mnemonic: UCD (Underlying Cause of Death). The cause of death is the preliminary cause indicated by the physician and not on the death certificate. 5.The following discharge types must have an underlying cause of death recorded in ADT: a.DEATH W/I 48 HRS W AUTOPSY b.DEATH W/I 48 HRS W/O AUTOPSY c.DEATH AFTER 48 HRS W AUTOPSY d.DEATH AFTER 48 HRS W/O AUTOPSY

15. Record Demographics HIM Procedures (cont.) 6.For deaths in the emergency room, enter the date and cause of death in the visit file of the Patient Care Component (PCC) using Mnemonic UCD. The cause of death is the preliminary cause indicated by the physician and not on the death certificate.

16. Record Smoking Status (Core) Measure: More than 50% of all unique patients 13 years old or older seen by the eligible provider (EP) or admitted to the eligible hospital’s (EH) or Critical Access Hospital’s (CAH) inpatient or emergency department (POS 21 or 23*) have smoking status recorded as structured data.

17. Record Smoking Status HIM Procedures 1.Monitor documentation of smoking status in the EHR with one of the following: a)Current smoker, every day b)Current smoker, some day c)Current smoker, status unknown d)Previous (former) smoker e)Never smoked f)Smoking status unknown Note: Ceremonial Use Only and Cessation-Smoker factors do not count toward the MU measure.

18. Record Smoking Status HIM Procedures (cont.) 2.Educate the clinician that they are responsible for the management of current and accurate documentation of a Smoking Status for each patient. 3.Ensure that at least one entry of a Smoking Status exist for each patient. 4.A facility specific policy should be in place to notify clinical staff of the requirement to document Smoking Status for patients 13 years old or older. 5.If smoking status is documented in the note but not entered as a health factor, add the smoking status in PCC using the Mnemonic HF (Health Factors).

19. Clinical Quality Measures Measure: For 2011 provide aggregate numerator, denominator, and exclusions through attestation as discussed in Section II (A)(3) of this Final rule. For 2012 electronically submit the CQMs as discussed in Section II (A)(3) of this Final rule.

20. Clinical Quality Measures HIM Procedures 1.Ensure both inpatient and outpatient coding is accurate and timely in accordance with the IHS Internal Control Policy at: http://www.ihs.gov/ihm/index.cfm?module=dsp_ihm_pc_p5c1#5- 1.3G. Scroll down to section 5-1.3G, Health Information Management Coding/Data Entry. 2.HIM should be familiar with the CQM selected by the facility or provider to report. Be aware that each provider may select any CQM measure they choose to report on during the EHR reporting period. 3.Assist the provider in selecting CQM measures that demonstrate the best outcomes for their patients. 4.Collaborate with the local Meaningful Use (MU) Coordinator and/or MU team regarding the selection of CQM measures.

21. Clinical Decision Support Rule (Core) Measure: Implement one clinical decision support rule.

22. Clinical Decision Support Rule HIM Procedures 1.Ensure either the Clinical Reminders package is installed* and at least one of the national reminders is implemented, OR 2.At least one of the following is implemented and available: a)Diabetes Supplement b)Pre-Diabetes Supplement c)Asthma Supplement d)Anti-coagulation Supplement e)Women's Health Supplement f)Immunization Package Forecasting g)Health Maintenance Reminders * Clinical Reminder is on:

23. Clinical Decision Support Rule HIM Procedures (cont.) 3. For hospitals, at least one disease-specific admission menu is implemented. 4. Ensure that at least one of the above listed reminders is available as a Health Summary item located in the Reports Tab.

24. Electronic Copy of Health Information (Core) Measure: More than 50% of all patients of the eligible provider (EP) or the inpatient or emergency departments of the eligible hospital’s (EH) or Critical Access Hospital’s (CAH) (POS 21 or 23*) who request an electronic copy of their health information, are provided it within 3 business days.

25. E-Copy of Health Information HIM Procedures (cont.) 1.Ensure the facility’s Clinical Applications Coordinator (CAC) creates a Patient Wellness Handout that contains the problem list, medication list, medication allergies, and lab results and make this report available in EHR. 2.Upon request for an electronic copy of health information, the patient shall complete and sign the authorization form IHS-810 Authorization for Use or Disclosure of Protected Health Information at: http://www.ihs.gov/CIO/PUF/ or http://intranet.hhs.gov/forms (IHS staff only).

26. E-Copy of Health Information HIM Procedures 3.The form and format should be human readable and comply with the HIPAA Privacy Rule. Refer to IHS HIPAA Privacy policies and procedures Authorization or Valid Written Request at: http://www.ihs.gov/ihm/index.cfm?module=dsp_ihm_pc_p2c7_ex _d and Access, Inspect & Obtain a Copy of Their Protected Health Information at: http://www.ihs.gov/ihm/index.cfm?module=dsp_ihm_pc_p2c7_ex _a. 4.Provide the information to the patient in an electronic format such as by CD provided by the facility or encrypted e-mail within three business days.

27. E-Copy of Health Information HIM Procedures (cont.) 5.It is imperative to account for the disclosure in the Release of Information application to meet the Meaningful Use measure by entering the following: a.The Date Request Initiated and Patient/Agent Request Type: Electronic b.The Disclosure Date and Record Dissemination: Electronic

28. E-Copy of Discharge Instructions (Core) Measure: More than 50% of all patients who are discharged from an eligible hospital’s (EH) or Critical Access Hospital’s (CAH) inpatient or emergency department (POS 21 or 23*) and who request an electronic copy of their discharge instructions are provided it.

29. E-Copy of Discharge Instructions HIM Procedures 1.Ensure TIU Note Titles “E-copy Discharge Instr Received” OR “E-copy Discharge Inst Not Received” DELIVERED in the patch TIU 1007 are utilized for accounting REQUEST OF ELECTRONIC COPY of their discharge instructions. These note titles are used in the report logic to achieve Meaningful Use. This note title should not be used for the discharge instruction themselves but only for documenting disclosure of the electronic copy. 2.Refer to IHS HIPAA Privacy policy and procedure Access, Inspect & Obtain a Copy of Their Protected Health Information at: http://www.ihs.gov/ihm/index.cfm?module=dsp_ihm_pc_p2c7_ex _a.

30. E-Copy of Discharge Instructions HIM Procedures (cont.) 3.Educate clinical staff on the process of patient’s request for an electronic copy of their discharge instructions. 4.Provide the information to the patient in an electronic format such as by CD provided by the facility or encrypted e-mail in accordance with local policy. 5.Generate TIU/SSD list of titles to verify that the E-copy note titles are being used for the intended purposes and not for the discharge instructions themselves.

31. E-Exchange of Clinical Information (Core) Measure: Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information.

32. E-Exchange of Clinical Information HIM Procedures 1.Ensure at least one test of the certified EHR technology’s capacity to electronically exchange key clinical information during the EHR reporting period is conducted. The Area Office MU Coordinator may accomplish or assist facilities with this task. The test does not need to be successful and you do not need to use real patient information. 2.At a minimum the following set of information should be transmitted: diagnostic test results, problem list, medication list, and medication allergy list. 3.During Stage I, transmission/exchange of actual patient information is not required, this is only a test.

33. Protect Electronic Health Information (Core) Measure: Conduct or review a security risk analysis per 45 CFR 164.308 (a) (1) of the certified EHR technology, and implement security updates and correct identified security deficiencies as part of its risk management process.

34. Protect Electronic Health Info HIM Procedures 1.Ensure IHS meets Federal requirements for Meaningful Use by conducting a security risk analysis or review and security updates are implemented. 2.Participate with the facility in conducting a security risk analysis or review. 3.Raise management’s awareness and report any identified privacy and security deficiencies.

35. Protect Electronic Health Info HIM Procedures (cont.) 4.Propose recommendations for mitigation and correct all identified deficiencies as part of the risk management process. 5.Examine and utilize role-based access as it applies to the EHR, HIPAA Privacy & Security Rule & FISMA (Federal Information Security Management Act). Refer to the IHS HIPAA Privacy policy & procedure at: http://www.ihs.gov/ihm/index.cfm?module=dsp_ihm_pc_p2c7_ex _k. http://www.ihs.gov/ihm/index.cfm?module=dsp_ihm_pc_p2c7_ex _k

36. IHS Meaningful Use: Contact Information Chris Lamer, Meaningful Use Project Lead, IHS (615) 669-2747 Chris.Lamer@ihs.gov Cathy Whaley, Meaningful Use Project Manager, DNC (520) 622-2069 Catherine.Whaley@ihs.gov Cecelia Rosales, Meaningful Use National Team Lead, DNC (505) 248-4359 Cecelia.Rosales@ihs.gov Carmen Land, Meaningful Use National Team Business Analyst, DNC (505) 248-4402 Carmen.Land@ihs.gov

37. Questions? Sign up for the MU Listserv! MeaningfulUseTeam@ihs.gov