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A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. DVHIMSS Summer Education Program Stage 2 and Regulatory.

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Presentation on theme: "A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. DVHIMSS Summer Education Program Stage 2 and Regulatory."— Presentation transcript:

1 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. DVHIMSS Summer Education Program Stage 2 and Regulatory Update Peg Meadow Director, Government & Industry Affairs, Siemens Healthcare June 14, 2012

2 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. A global company With a local footprint in over 190 countries 1847 Founding of 'Telegraphen-Bauanstalt von Siemens & Halske' in Berlin 1850First international sales agency in London 1853 Office opens in St. Petersburg, Russia 1904 First permanent office in China 1905 Founding of Siemens do Brasil 1924 Founding of Siemens India Ltd. 1961 Exports exceed 1 billion DM for first time 1968 Siemens passes the 100-country mark 1970 Founding of Siemens Corporation, USA

3 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Energy Divisions Fossil Power Generation Wind Power Solar & Hydro Oil & Gas Energy Service Power Transmission Healthcare Divisions Imaging & Therapy Systems Clinical Products Diagnostics Customer Solutions (HIT) Infrastructure & Cities Divisions Rail Systems Mobility and Logistics Low and Medium Voltage Smart Grid Building Technologies OSRAM* Industry Divisions Industry Automation Drive Technologies Customer Services Siemens Sectors and Divisions * In March 2011, Siemens announced its intention to publicly list OSRAM and, as an anchor shareholder, to hold a minority stake in OSRAM AG over the long term

4 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Siemens in the U.S. Is Home to Nine Worldwide Businesses/Divisions Healthcare Oncology Care Concord, CA Healthcare Ultrasound Mountain View, CA Industry PLM (Product Lifecycle Mgt.) Plano, TX Industry VAI Metals Worcester, MA Industry Water Tech. Warrendale, PA Healthcare Health Services Malvern, PA Energy Energy Service Orlando, FL Healthcare Diagnostics Tarrytown, NY Healthcare Molecular Imaging Hoffman Estates, IL Siemens Employs Over 60,000 People in All 50 States

5 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. American Recovery & Reinvestment Act (ARRA) HITECH – February 17, 2009 First Steps Adoption of certified EHRs Meaningful use of EHRs Incentive payments to eligible professionals and hospitals Investment in nationwide HIT infrastructure Grant money for demonstration projects The Intended Destination High quality, safe, effective, and equitable care for all Seamless patient-centric care Realigned incentives and measures that foster prevention, intervention, coordination, effectiveness Regional clinical information interoperability on a national backbone The goals are quality and efficiency…If we encourage better performance, then physicians are going to find ways to improve. And health information technology is one crucial way to do that. David Blumenthal MD, MPP National Coordinator for Health Information Technology, ONC

6 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. ARRA HITECH Framework for Meaningful Use of Electronic Health Records (EHRs) - $30B/Program Blumenthal D. N Engl J Med 2009;10.1056/NEJMp0912825

7 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. ONC (Office of the National Coordinator) FTEs 32 84 149 189

8 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. HITECH Meaningful Use and the Affordable Care Act The Market Will Develop in Two Waves 2009 2013 2017 Meaningful Use Affordable Care Act

9 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. ARRA HITECH EHR Incentive $$$$$ - BASICS An eligible provider using a certified EHR and demonstrating meaningful use qualifies for $$$ Eligible Hospitals / Critical Access Hospitals (EH/CAH) Medicare AND Medicaid Incentive Funds For Medicare, Four Consecutive Payment Years EH Must start in 2011, 2012, 2013 for Full Payment CAH must start in 2011 or 2012 for Full Payment Penalties begin in 2015 if not a meaningful user, increase over time, and remain in force Fiscal Year boundaries Eligible Professional (EP) Medicare OR Medicaid Incentive Funds For Medicare, Five Consecutive Payment Years Must start in 2011 or 2012 for Full Payment Penalties for those who are not meaningful users beginning in 2015 that increase over time Calendar Year

10 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Achieving Meaningful Use in Stages SOURCE: HIT-enabled Health Reform

11 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Health Outcomes Policy Priorities* Ensure privacy and security protections Improve population health Engage patients and families Improve care coordination Increase quality, safety, efficiency, and reduce health disparities *Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform Americas Healthcare. Washington, DC: National Quality Forum; 2008.

12 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. What Defines the ARRA HITECH Process? Meaningful Use* Final Rule (CMS) Test Tools & Procedures Standard & Criteria Final Rule (ONC) Certification Process Final Rule (ONC)

13 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. HIT Policy Committee Meaningful Use Workgroup HIT Policy/ Standards Committees Consumer/Patient Groups, Employers, Government, Multi- stakeholder Groups, Providers, Vendors HITPC MU Work Group Paul Tang, MD Co-Chair, Palo Alto Medical Foundation George Hripcsak, MD Co-Chair, Columbia University Michael Barr, MD American College of Physicians David Bates, Brigham & Womens Hospital Christine Bechtel, National Partnership for Women & Families Neil Calman, MD The Institute for Family Health Tim Cromwell Dept of Veterans Affairs Art Davidson, MD Denver Public Health Marty Fattig Nemaha County Hospital Joe Francis Veterans Administration Leslie Kelly Hall Healthwise Yael Harris HRSA David Lansky Pacific Business Group/Health Deven McGraw Center/Democracy & Technology Greg Pace Social Security Administration Latanya Sweeney Carnegie Mellon University Robert Tagalicod CMS/HHS Charlene Underwood, Siemens Amy Zimmerman Rhode Island Office of Health & Human Services

14 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Trends In Year-To-Date Payments From May 2011 To April 2012 ($ Millions) Data from CMS, as of April, 2012 May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr $190 $273 $397 $652 $860 $1,239 $1,836 $2,533 $3,119 $4,484 $3,850 $5,030

15 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Actual Year-To-Date Spending vs. Projections Core HIS Components Data from CMS, as of April, 2012 Actual Spending In FY 2011 Paid Thru 4/12 CMS Projection for FY 2011 CBO Score For FY 2011 $860.1M $1 to 2.8B $5.03B $4.7B Medicaid and Medicare EHR Incentive Spending In 2011 Actual Year-To-Date Spending versus Projections

16 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Actual Providers Paid & Amount Paid Through April 2012 Core HIS Components Data from CMS, as of April 30, 2012 Providers Paid Amount Paid Program-to-Date Program-to-Date Medicare Eligible Professionals 56,214 $953,388,119 Medicaid Eligible Professionals 35,040 $735,578,046 Eligible Hospitals 2,843** $3,341,140,043 Total 94,097 $5,030,106,208 ** 2843 – 566 (Dups paid by both) = 2101/5,011 is 42% of EHs whereas 949/ 5,011 EHs who received Medicare funds only for achieving meaningful use, represents 19%.

17 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. 2012 Congratulations to Siemens Customers Who Have Achieved Stage 1 MU - 36 enterprises and 62 facilities June 6, 2012 Alegent Health Alegent Health Altoona Regional Health System Altoona Regional Health System John D. Archbold Memorial Hospital John D. Archbold Memorial Hospital Bethesda Memorial Hospital Bethesda Memorial Hospital Caldwell Memorial Hospital Caldwell Memorial Hospital Caromont Memorial Health, Inc. Caromont Memorial Health, Inc. Catholic Health System Catholic Health System CentraState Medical Center CentraState Medical Center Champlain Valley Champlain Valley Clearfield Hospital Clearfield Hospital Crozer Keystone Health System Crozer Keystone Health System Danbury Hospital Danbury Hospital Ellis Medicine Ellis Medicine EMH Healthcare EMH Healthcare Faith Regional Health Services Faith Regional Health Services Grenada Lake Medical Center Grenada Lake Medical Center HealthAlliance Hospital HealthAlliance Hospital Lifespan Lifespan Main Line Health Main Line Health MedCentral Health System MedCentral Health System Mercy Health Partners Mercy Health Partners Meridian Health System Meridian Health System Nason Hospital Nason Hospital Nebraska Heart Hospital, Inc. Nebraska Heart Hospital, Inc. Niagara Falls Memorial Medical Center Niagara Falls Memorial Medical Center Nix Health Nix Health Care System Pinnacle Health System Pinnacle Health System Riverside Health System Riverside Health System Saint Joseph Hospital (Boston) Saint Joseph Hospital (Boston) St. Josephs Hospital and Med Ctr St. Josephs Hospital and Med Ctr South Jersey Health System South Jersey Health System Temple University Health (Jeanes) Temple University Health (Jeanes) Texas Regional Medical Center Texas Regional Medical Center Westchester Medical Center Westchester Medical Center Winthrop University Hospital Winthrop University Hospital Wyoming Valley Health Care System Wyoming Valley Health Care System

18 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Trends in Hospital EHR Adoption Show Increasing Adoption but Low Penetration of Full Function Percent of Non-Federal Acute Care Hospitals With Adoption of EHR Systems By Level of Functionality: 2008 - 2011 40% 35% 30% 25% 20% 15% 10% 5% 0% 2008200920102011 13.4% 16.1%* 19.1%* 34.8%* Comprehensive EHR Basic EHR With Clinician Notes Basic EHR Without Clinician Notes *Significantly different from previous year. Source: ONC/AHA, AHA Annual Survey Information Technology Supplement 1.6 7.8 4.0 9.4* 3.9 2.8* 3.6 12.0* 3.5 8.8* 18.8* 7.2*

19 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Physician Adoption of EHRs has Increased Steadily 20012002200320042005200620072008200920102011 60% 50% 40% 30% 20% 10% 0% Any EMR/EHR System Basic EMR/EHR System 18.2 17.3 20.8 23.9 29.2 34.8 42.0 48.3 50.7 56.9 10.5 11.8 16.9 21.8 24.9 33.8 Source: CDC/NCHS, National Ambulatory Medical Care Survey

20 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. However, Physician EHR Adoption is Uneven Source: Rao, SR, et al. JAMIA, May 2011. 1-2 Physicians 40 35 30 25 20 15 10 5 0 3-5 Physicians6-10 Physicians11+ Physicians 2 5 3 11 6 19 13 26 Fully Functional EHR Basic EHR

21 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Rollout of Meaningful Use Stage 2 Timeline JanFebMarAprMayJuneJulyAugSeptOctNovDecQ1Q2 January 13 HIT Policy Committee (HIT-PC) – Meaningful Use (MU) Workgroup issued a request for input on Draft Objectives/ Measures for Stage 2. 2Q 2012? CMS and ONC publish Final Rules. March – June MU Workgroup prepared recommendations to the HIT-PC which will then modify/ approve and send to CMS. Approved on June 8th. September – 1Q 2012 CMS and ONC formulate proposed rules for objectives, measures, standards, and certification criteria. June – September HIT Standards Committee identifies standards and certification criteria. March 7, 2012 Federal Register CMS Proposed Rule (EHR Incentive Program) and ONC Proposed Rule (Standards & Certification Criteria). 2011 2012

22 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Meaningful Use Stage 2: Two Proposed Rules CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2 Link to Federal Register 3/7/12Link to Federal Register 3/7/12 Overview Key Summary Points Timeline Change Objectives/Measures Clinical Quality Measures Payment Adjustments Appeal Process Medicaid EHR Incentive Program General Information/Stats ONC Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology Link to Federal Register 3/7/12Link to Federal Register 3/7/12 Standards & Certification Interoperability Privacy & Security Usability/Patient Safety

23 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Meaningful Use Stage 2: Two Additional Documents Published CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2 CORRECTIONS – 4/18/12 5/2/12 NIST releases EHR Technical Evaluation, Testing, and Validation of the Usability of EHRs (100+ pgs) Rationale for EHR Usability Protocol (EUP) and outlines procedures for design evaluation and human user performance testing of EHR systems.

24 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Proposed Timeline Change: Stage of MU Criteria by First Payment Year 1st Year20112012201320142015201620172018201920202021 2011 11 1 2233TBD 2012 112233TBD 2013 112233TBD 2014 112233TBD 2015 112233TBD 2016 112233 2017 11223 Red line indicates payment adjustments beginning in FY 2015

25 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. EHs/CAHs: July 1, 2014 (90-day reporting period must begin by April 3, 2014) Subsection (d) Hospital Payment Adjustments 201520162017201820192020+ % Decrease 25%50%75% % DECREASE IN THE PERCENTAGE INCREASE TO THE IPPS PAYMENT RATE THAT THE HOSPITAL WOULD OTHERWISE RECEIVE FOR THAT YEAR For example if the increase to IPPS for 2015 was 2% than a hospital subject to the payment adjustment would only receive a 1.5% increase Source: CMS at HIMSS12 Table 13: CMS NPRM To avoid Payment Adjustments EHs/CAHs must first meet MU by July 1, 2014 (90-day reporting period must begin by April 3, 2014)

26 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. EP Payment Adjustments 201520162017201820192020+ EP is not subject to the payment adjustment for e- Rx in 201499%98%97%96%95% EP is subject to the payment adjustment for e-Rx in 201498% 97%96%95% % ADJUSTMENT ASSUMING LESS THAN 75 PERCENT OF EPs ARE MEANINGFUL EHR USERS FOR CY 2018 AND SUBSEQUENT YEARS % ADJUSTMENT ASSUMING MORE THAN 75 PERCENT OF EPs ARE MEANINGFUL EHR USERS FOR CY 2018 AND SUBSEQUENT YEARS 201520162017201820192020+ EP is not subject to the payment adjustment for e-Rx in 201499%98%97% EP is subject to the payment adjustment for e-Rx in 201498% 97% Source: CMS at HIMSS12 To avoid Payment Adjustments EPs must first meet MU by 10/1, 2014 (90-day reporting must begin by 7/ 3, 2014)

27 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Proposed Meaningful Use Objectives Eligible Professionals 15 core objectives 5 of 10 menu objectives 20 total objectives Eligible Hospitals & CAHs 14 core objectives 5 of 10 menu objectives 19 total objectives Eligible Professionals 17 core objectives 3 of 5 menu objectives 20 total objectives Eligible Hospitals & CAHs 16 core objectives 2 of 4 menu objectives 18 total objectives Source: CMS at HIMSS12 Stage 1 Proposed Stage 2

28 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Proposed Changes to Stage 1 Effective 2013: Included in Stage 2 Proposed Rules Old 2011 Edition Objective/Measure New 2014 Edition Objective/Measure Timeframe Required CPOE Denominator: unique patient with at least one medication in their med list Denominator: number of orders during the EHR reporting period Optional in 2013. Required in 2014+ Vital Signs Age Limits: Age 2 for blood pressure & height/weight Age Limits: Age 3 for blood pressure. No age limit for height/weight. Optional in 2013. Required in 2014+ Vital Signs Exclusion: All three elements not relevant to scope of practice Exclusion: Allow BP to be separated from height/weight. Optional in 2013. Required in 2014+ Test of Health Information Exchange: One test of electronic transmission of key clinical information Requirement removed effective 2013 Effective 2013 E-Copy Objective: Provide patients with e-copy of health information upon request Online Access Objective: Provide electronic access to health information Replacement objective: Provide patients the ability to view online, download and transmit their health information Required in 2014+ Public Health Objectives: Immunizations, Reportable Labs, Syndromic Surveillance Addition of except where prohibited to all three. Effective 2013

29 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Proposed Clinical Quality Measures Eligible Professionals 3 core OR 3 alt. core CQMs plus 3 menu CQMs 6 total CQMs Eligible Hospitals & CAHs 15 total CQMs Eligible Professionals 1a) 12 CQMs (> 1 per domain) 1b) 11 core + 1 menu CQMs 2) PQRS or Group Reporting 12 total CQMs Eligible Hospitals & CAHs 24 CQMs (> 1 per domain) 24 total CQMs Align with ONCs 2011 Edition Certification Align with ONCs 2014 Edition Certification Stage 1 Proposed Stage 2

30 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Additional Reference Information - Hidden Slides in Appendix Additions/Changes/Deletions comparing Stage 2 to Stage 1 per each of the five Health Policy Outcomes (5 Slides) Stage 2 Objective and Measures Detail with Stage 1 (8 Slides) Clinical Quality Measures: Eligible Hospitals and CAHs (1 Slide) 49 Proposed Measures which includes 15 from Stage 1 (24 Required) Reporting and Reporting Methods Clinical Quality Measures: EP Reporting Options (1 Slide) 125 Proposed Measures includes 41 from Stage 1 (12 Required) Reporting Options, Reporting Methods and Group Reporting Vocabulary Standards (1 Slide) Consolidated CDA Sample with new data sections (1 Slide)

31 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Additions: EHs Medication tracking from order to administration using assistive technology - EHs EH menu ePrescribing (for discharge prescriptions) - EH menu set EP and EH menu set Image results and information accessible - EP and EH menu set EP and EH menu set Record patient family health history as structured data - EP and EH menu set Changes: EPs EPs Thresholds increases/changes: CPOE, demographics, ePrescribing for EPs, vital signs, smoking status, preventative reminders for EPs Lab and Radiology ordering required for CPOE Age requirements changed: Blood pressure, growth charts Clinical Decision support rules increased from 1 to 5 and expected to support CQMs Consolidated Objectives: Drug-drug and drug-allergy checks, problem list, medication list, medication allergy list, drug formulary check Reporting Clinical Quality Measures separated from MU objectives Increase quality, safety, efficiency, and reduce health disparities ** (stage 2 compared to Stage 1) - SEE APPENDIX **Health Outcomes Policy Priorities

32 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Stage 2 Objectives and Measures – SEE APPENDIX HOPPStage 2 ObjectivesStage 2 Measures Eligible ProfessionalsEligible Hospitals and CAHs Core Set 1Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local and professional guidelines to create the first record of the order. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines to create the first record of the order. More than 60 percent of medication, laboratory, and radiology orders created by the EP or authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE. Stage 1: More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have at least one medication order entered using CPOE. 1Generate and transmit permissible prescriptions electronically (eRx) More than 65 percent of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology. Stage 1: More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. 1Record the following demographics - Preferred language - Gender - Race - Ethnicity - Date of Birth Record the following demographics - Preferred language - Gender - Race - Ethnicity - Date of Birth - Date and preliminary cause of death in the event of mortality in the eligible hospital or CAH More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data Stage 1: More than 50% of all unique patients seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data

33 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Industry Calls for Stage 2 Changes….. > 400 comments for each NPRM. Many requests for clarifications. Timeframe impact on Final Rules and confusion over single source of truth. Make the transition period from Stage 1 to 2 realistic Requests for 90 Day Reporting for Stage 2 Delay Payment Adjustment reporting period to be in line with FY15 Reduce volume of Objectives/Measures and Quality Measures Actually 17 new to core or new to MU Objectives in Stage 2, some with multiple measures 174 Quality Measures (49 EH/CAH, 125 EP) Reduce complexity of 2011/2014 Edition CEHRTs and Stage 1 and 2 Allow use of 2011 Edition until CY 2015 so all will have same opportunity to spend two years on the same technology. Maintain link between Stage 1 and 2011 CEHRT Edition Eliminate holding providers responsible for patients actions Delete inclusion of ICD-10 and usability metrics Delete or delay to Stage 3 those standards and quality measures that are not vetted in the industry (i.e. Implementation experience of smoking status and NQF endorsement of measures)

34 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Executives Role in Orchestrating Health Reform … ICD-10 CM Meaningful Use Hospital Value-based Purchasing Program Accountable Care Organizations Hospital Readmissions Hospital-acquired Conditions Payment Bundling

35 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Links & References Office of the National Coordinator of Health Information Technology: www.hhs.gov/healthit/ CMS Electronic Health Record Incentive Programs: https://www.cms.gov/EHRIncentivePrograms/ https://www.cms.gov/EHRIncentivePrograms/ HIMSS Meaningful Use OneSource http://www.himss.org/ASP/topics_meaningfuluse.asp http://www.himss.org/ASP/topics_meaningfuluse.asp HealthIT.gov http://www.healthit.gov/

36 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Thank You.

37 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. DVHIMSS Summer Education Program Stage 2 and Regulatory Update APPENDIX Peg Meadow Director, Government & Industry Affairs, Siemens Healthcare June 14, 2012

38 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Additions: EHs Medication tracking from order to administration using assistive technology - EHs EH menu ePrescribing (for discharge prescriptions) - EH menu set EP and EH menu set Image results and information accessible - EP and EH menu set EP and EH menu set Record patient family health history as structured data - EP and EH menu set Changes: EPs EPs Thresholds increases/changes: CPOE, demographics, ePrescribing for EPs, vital signs, smoking status, preventative reminders for EPs Lab and Radiology ordering required for CPOE Age requirements changed: Blood pressure, growth charts Clinical Decision support rules increased from 1 to 5 and expected to support CQMs Consolidated Objectives: Drug-drug and drug-allergy checks, problem list, medication list, medication allergy list, drug formulary check Reporting Clinical Quality Measures separated from MU objectives Increase quality, safety, efficiency, and reduce health disparities ** (stage 2 compared to Stage 1) **Health Outcomes Policy Priorities

39 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Engage patients and families ** (Stage 2 compared to Stage 1) Deletions: Provide patients with e-copy of health information upon request Provide patients with e-copy of discharge instructions upon request Provide electronic access to health information Additions: EP / EH Provide patients with the ability to view online, download and transmit their health information – EP / EH EPs Secure Messaging - EPs EPs Record patient preference for communication medium - EPs **Health Outcomes Policy Priorities

40 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Improve Care Coordination ** (Stage 2 compared to Stage 1) Deletions:. EH Test of Health Information Exchange: Perform one test of electronic transmission of key clinical information removed as Stage 1 objective effective 2013 - EH Moved to Core: EP and EH Perform Medication Reconciliation for 65% of care transitions – EP and EH Additions: (EP)(EH) Send Care Summary (including care plan and care team members) for transitions of care (EP) or on discharge (EH) **Health Outcomes Policy Priorities

41 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Improve population health ** (Stage 2 compared to Stage 1) Moved to Core: EP and EH Submit Electronic Data to immunization registries – successful ongoing submission - EP and EH EP menu and EH Core Submit electronic syndromic surveillance – successful ongoing submission - EP menu and EH Core EH Submit electronic reportable lab results – successful ongoing submission - EH Additions: EP menu set Reporting to cancer and specialty registries included in the EP menu set. **Health Outcomes Policy Priorities

42 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Changes: New and changed standards proposed: Direct transport standards, single Consolidated CDA standard for clinical documents, HL7 2.5.1 based implementation guide for lab/results interfaces, consolidated vocabulary standards, quality measure standard data set to capture and report, single ePrescribing standard, new cancer registry & syndromic surveillance standards Changes to certified software for Privacy and Security: Secure message, amendments, auditable events, audit report, synchronized clock, encryption of data at rest for mobile and portable devices Key Changes to Meaningful Use Stage 2 Definition (compared to Stage 1)

43 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Stage 2 Objectives and Measures HOPPStage 2 ObjectivesStage 2 Measures Eligible ProfessionalsEligible Hospitals and CAHs Core Set 1Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per State, local and professional guidelines to create the first record of the order. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines to create the first record of the order. More than 60 percent of medication, laboratory, and radiology orders created by the EP or authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE. Stage 1: More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have at least one medication order entered using CPOE. 1Generate and transmit permissible prescriptions electronically (eRx) More than 65 percent of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology. Stage 1: More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. 1Record the following demographics - Preferred language - Gender - Race - Ethnicity - Date of Birth Record the following demographics - Preferred language - Gender - Race - Ethnicity - Date of Birth - Date and preliminary cause of death in the event of mortality in the eligible hospital or CAH More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data Stage 1: More than 50% of all unique patients seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data

44 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. HOPPStage 2 ObjectivesStage 2 Measures Eligible ProfessionalsEligible Hospitals and CAHs Core Set 1 Record and chart changes in vital signs: - Height/length - Weight - Blood pressure (age 3 and over) - Calculate and display BMI - Plot and display growth charts for patients 0-20 years, including BMI Stage 1 variances: - BP for all ages - Growth charts for 2-20 More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have blood pressure (for patients age 3 and over only) and height/length and weight (for all ages) recorded as structured data Stage 1: For more than 50% of all unique patients age 2 and over seen by the EP or admitted to eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23), height, weight, and blood pressure are recorded as structured data. 1 Record smoking status for patients 13 years old or older More than 80% of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have smoking status recorded as structured data Stage 1: More than 50% of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have smoking status recorded as structured data 1 Use clinical decision support to improve performance on high- priority health conditions Stage 1: Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance to that rule Use clinical decision support to improve performance on high-priority health conditions Stage 1: Implement one clinical decision support rule related to a high priority hospital condition along with the ability to track compliance to that rule 1. Implement 5 clinical decision support interventions related to 5 or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. 2. The EP, eligible hospital or CAH has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entre EHR reporting period. Stage 1: Implement one clinical decision support rule Stage 2 Objectives and Measures

45 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. HOPPStage 2 ObjectivesStage 2 Measures Eligible ProfessionalsEligible Hospitals and CAHs Core Set 1 Incorporate clinical lab-test results into Certified EHR Technology as structured data More than 55 percent of all clinical lab tests results ordered by the EP or by authorized providers of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23 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 Stage 1: More than 40% of all clinical lab test results ordered by the EP or by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) 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. 1 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, eligible hospital or CAH with a specific condition. Stage 1: Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition. 1 Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care Stage 1: Send reminders to patients per patient preference for preventive/follow-up More than 10 percent of all unique patients who have had an office visit with the EP within the 24 months prior to the beginning of the EHR reporting period were sent a reminder, per patient preference Stage 1: More than 20% of all unique patients 65 years or older or 5 years old or younger were sent a reminder during the EHR reporting period 1 Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR) Stage 2 Objectives and Measures

46 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. HOPPStage 2 ObjectivesStage 2 Measures Eligible ProfessionalsEligible Hospitals and CAHs Core Set 2Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP. 1. More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP's discretion to withhold certain information 2. More than 10 percent 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 2Provide patients the ability to view online, download, and transmit information about a hospital admission 1. More than 50 percent of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH have their information available online within 36 hours of discharge 2. More than 10 percent of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH view, download or transmit to a third party their information during the reporting period 2Provide clinical summaries for patients for each office visit Clinical summaries provided to patients within 24 hours for more than 50 percent of office visits. Stage 1: Clinical summaries provided to patients for more than 50% of all office visits within 3 business days 2Use Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all office visits by the EP. More than 10 percent of all unique patients admitted to the eligible hospital's or CAH's inpatient or emergency departments (POS 21 or 23) are provided patient- specific education resources identified by Certified EHR Technology Stage 1: More than 10% of all unique patients seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) are provided patient-specific education resources. 2Use secure electronic messaging to communicate with patients on relevant health information A secure message was sent using the electronic messaging function of Certified EHR Technology by more than 10 percent of unique patients seen during the EHR reporting period Stage 2 Objectives and Measures

47 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. HOPPStage 2 ObjectivesStage 2 Measures Eligible ProfessionalsEligible Hospitals and CAHs Core Set 3The 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 eligible hospital or CAH 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, eligible hospital or CAH performs medication reconciliation for more than 65 percent of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23). Stage 1: The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) 3The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. The eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. 1. The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 65 percent of transitions of care and referrals. 2. The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care or provider of care electronically transmits a summary of care record using certified EHR technology to a recipient with no organizational affiliation and using a different Certified EHR Technology vendor than the sender for more than 10 percent of transitions of care and referrals. Stage 1: The EP, eligible hospital or CAH who transitions or refers 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. Stage 2 Objectives and Measures

48 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. HOPPStage 2 ObjectivesStage 2 Measures Eligible ProfessionalsEligible Hospitals and CAHs Core Set 4Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice Stage 1 variances: Did not include except where prohibited Successful ongoing submission of electronic immunization data from Certified EHR Technology to an immunization registry or immunization information system for the entire EHR reporting period Stage 1: Performed at least one test of certified EHR technologys capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically) 4 Capability to submit electronic reportable laboratory results to public health agencies, except where prohibited, and in accordance with applicable law and practice Stage 1: Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice. Successful ongoing submission of electronic reportable laboratory results from Certified EHR Technology to public health agencies for the entire EHR reporting period as authorized. Stage 1: Performed at least one test of certified EHR technologys capacity to provide electronic submission of reportable lab results to public health agencies and follow- up submission if the test is successful (unless none of the public health agencies to which eligible hospital or CAH submits such information have the capacity to receive the information electronically) 4Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice Stage 1 variances: Did not include except where prohibited Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice Stage 1 variances: Did not have except where prohibited Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period Stage 1: Performed at least one test of certified EHR technologys capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically) Stage 2 Objectives and Measures

49 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. HOPPStage 2 ObjectivesStage 2 Measures Eligible ProfessionalsEligible Hospitals and CAHs Core Set 5Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities 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 at rest 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. Stage 1: 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 process Menu Set 1 Record whether a patient 65 years old or older has an advance directive More than 50 percent of all unique patients 65 years old or older admitted to the eligible hospital's or CAH's inpatient department (POS 21) during the EHR reporting period have an indication of an advance directive status recorded as structured data. Stage 1: More than 50 percent of all unique patients 65 years old or older admitted to the eligible hospital's or CAH's inpatient department (POS 21) during the EHR reporting period have an indication of an advance directive status recorded. 1Imaging results and information are accessible through Certified EHR Technology. More than 40 percent of all scans and tests whose result is an image ordered by the EP or by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 and 23) during the EHR reporting period are accessible through Certified EHR Technology 1Record patient family health history as structured data More than 20 percent of all unique patients seen by the EP or admitted to the eligible hospital or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period have a structured data entry for one or more first degree relatives 1 Generate and transmit permissible discharge prescriptions electronically (eRx) More than 10 percent 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 EHR Technology Stage 2 Objectives and Measures

50 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. HOPPStage 2 ObjectivesStage 2 Measures Eligible ProfessionalsEligible Hospitals and CAHs Menu Set 4Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period Stage 1: Performed at least one test of certified EHR technologys capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically) 4Capability to identify and report cancer cases to a State cancer registry, except where prohibited, and in accordance with applicable law and practice. Successful ongoing submission of cancer case information from Certified EHR Technology to a cancer registry for the entire EHR reporting period 4Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. Successful ongoing submission of specific case information from Certified EHR Technology to a specialized registry for the entire EHR reporting period Stage 2 Objectives and Measures

51 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Clinical Quality Measures: Eligible Hospitals and CAHs Domains: 1.Patient and Family Engagement 2.Patient Safety 3.Care Coordination 4.Population and Public Health 5.Efficient Use of Healthcare Resources 6.Clinical Process/Effectiveness FY 2014 The menu of 49 clinical quality measures will apply for all eligible hospitals and CAHs, regardless of whether they are in Stage 1 or Stage 2 49 Proposed Measures Includes 15 from Stage I 24 Required Reporting Select 24 measures from list. 1 measure required from each domain Medicaid: States determine how electronic reporting occurs Submit through a CMS designated portal in an XML- based format Submission similar to the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot Reporting Methods Proposed measures listed in Table 9, pg 13760 of the Final Rule

52 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Clinical Quality Measures: EP Reporting Options 125 Proposed Measures Includes 41 from Stage I 12 Required Reporting Options Reporting MethodsGroup Reporting CY 2014 Option 1a EP selects 12 measures from list. 1 measure required from each domain Option 1b EP reports 11core measures and one additional from list CY 2013 Physician Quality Reporting System Medicare EHR Incentive Pilot CY 2014 Reporting Options 1a and 1b EPs submit through a CMS designated portal Interim Submission Option: 90 day EHR PQRS reporting period for 1 st yr Stage I EPs Medicaid EPs: States determine how reporting occurs EHR Incentive Group Option for Medicare or Medicaid EPs Option for Medicare Shared Savings Program and Pioneer ACO model PQRS Group Practice Reporting Option using certified EHR

53 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. ONC NPRM – Use of Standards §170.207 Vocabulary standards for representing electronic health information DocumentationStandardized Vocabulary Encounter DiagnosisICD-10-CM ImmunizationsHL7 CVX – Vaccines Laboratory TestsLOINC® MedicationsRxNorm Preferred LanguageISO 639-1:2002 Preliminary Cause of DeathICD-10-CM ProblemsSNOMED-CT® ProceduresCPT-4 or ICD-10-PCS Race and EthnicityOMB Standards #15 Smoking StatusCDC recodes for Smoking status

54 A9133-101479-E1-4A00 Copyright © 2012 Siemens Medical Solutions USA, Inc. All rights reserved. Consolidated CDA Sample (with new data sections) Health Level Seven, © 2011


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