1. Meaningful Use Overview for HIM Professionals Pat Gowan & JoAnne Hawkins Last Updated: June 11, 2012

2. Today’s Objectives Understand the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program Understand and differentiate the Meaningful Use Performance Measures and Meaningful Use Clinical Quality Measures Review the current Meaningful Use performance Measures as they pertain to HIM Professionals

3. Medicare and Medicaid EHR Incentive Program Overview The American Recovery and Reinvestment Act of 2009 provides incentive payments for Medicare and Medicaid Eligible Hospitals and Eligible Professionals that are meaningful users of certified EHR technology. The EHR incentive programs are part of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 which amended the Social Security Act. Indian Health Service (IHS), Tribal and Urban Indian health programs (I/T/U) eligible hospitals and eligible professionals can receive EHR incentive payments if they meet requirements of the Medicare and/or Medicaid EHR incentive programs starting in 2011. For, Medicare they need to demonstrate meaningful use of certified EHR. For Medicaid, they need to adopt, implement and upgrade to a certified EHR in their first participation year. **Eligible hospitals and eligible professionals must take steps to receive payments. The IHS Resource and Patient Management System (RPMS) successfully passed all tests required for certification as a complete EHR for ambulatory and inpatient use, based on criteria established by the Office of the National Coordinator for Health Information Technology. I/T/Us that do not use RPMS EHR must ensure that their EHR is certified separately.

4. MEANINGFUL USE

5. Meaningful Use: What is Meaningful Use? Meaningful Use is using certified EHR technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health All the while maintaining privacy and security

6. Meaningful Use: Stages of Meaningful Use 3 stages of Meaningful Use Requirements will increase over time…more work lies ahead Stage 1 2011-2012 Stage 2 2013-2014 Stage 3 2015+

7. MEDICARE EHR Incentive Program MEDICAID EHR Incentive Program Implemented by the Federal Government and started January 3, 2011 Voluntary for States to implement - Most are expected to start by late summer 2011 Must initiate participation by 2014 Must participate by 2012 to receive the maximum incentive payment Program ends in 2016 Must initiate participation by 2016 Must participate by 2016 to receive the maximum incentive payment Program ends in 2021 Must demonstrate MU in Year 1 over a consecutive 90-day report period A/I/U option for Year 1 No patient volume requirementMust meet patient volume thresholds Medicare payment reductions begin in 2015 for EH/EPs who do not demonstrate MU of certified EHR technology No Medicaid payment reductions

8. Meaningful Use: Definition of A/I/U Adopt: Acquire, purchase, or secure access to certified EHR technology Implement: Install or commence utilization of certified EHR technology capable or meeting MU requirements Upgrade: Expand the available functionality of certified EHR technology capable of meeting MU requirements at the practice site, including staffing, maintenance, and training or upgrade from existing EHR technology to certified EHR technology per the ONC EHR certification criteria

9. EHR CERTIFICATION

10. Name Space Package or ApplicationVersionPatchRelease Date AGPatient Registration7.1912/3/10 APCLExport3.02711/10/10 APSPPharmacy MOD-ePrescribing (eRx)7.010104/29/11 BGPClinical Reporting System (CRS)11.036/22/11 BJMDC321.016/24/11 BJPCPCC Mgmt Reporting2.066/2/11 BMCReferred Care Information System (RCIS) 4.075/12/11 BQIiCare2.13/11/11 BRNRelease of Information (ROI)2.034/13/11 BYIMImmunization Exchange Message2.0012/24/11 BGOElectronic Health Record (EHR)1.1806/10/11 LRLab5.21027 or 372 or 33412/07/10 PXRMEHR Reminders1.510074/13/10 BPHRPersonal Health Record (PHR)1.06/22/11 Central Ensemble2009.1.6921.0.104142011 GuardianEdge/ Symantec8.03/31/11 IPSEC (Windows)2010 VanDyke (AIX)2010 WinHasher1.62011 Universal Client or HIE Viewer The URL to access the application is http://ditdev4.d1.na.ihs.gov:9090/DocViewer http://ditdev4.d1.na.ihs.gov:9090/DocViewer 1.04/27/11

11. EHR Certification: EHR Certification Number* Inpatient Certification #: 30000002ELL6EAI Ambulatory Certification #: 30000002EJKDEAI *The number will be entered during CMS registration and attestation

12. ELIGIBLE PROFESSIONALS & HOSPITALS

13. Eligible Professionals: Medicare & Medicaid Comparison Medicare-only Eligible Professionals Could be eligible for both Medicare & Medicaid incentives Medicaid-only Eligible Professionals Professionals may be eligible for both Medicare & Medicaid, but can only participate in one program at a time

14. Hospitals only eligible for Medicare incentive Could be eligible for both Medicare & Medicaid (most hospitals) Hospitals only eligible for Medicaid incentive Eligible Hospitals: Medicare & Medicaid Comparison

15. Eligible Professional: Incentive Program Timeline CY 2012 01/01/12First day of calendar & EHR reporting year 09/30/12 LAST day to establish clean-date for the Medicare Incentive Program 10/01/12 LAST day to begin 90-day reporting period for the Medicare Incentive Program 12/31/12Last day of calendar & EHR reporting year 02/28/13 LAST day to register & LAST day to attest

16. Eligible Hospital: Incentive Program Timeline FY 2012 10/01/11 First day of calendar & EHR reporting year 06/30/12 LAST day to establish clean-date for the Medicare Incentive Program 07/01/12 LAST day to begin 90-day reporting period for the Medicare Incentive Program 09/30/12 Last day of fiscal year & EHR reporting year 11/30/12 LAST day to register & LAST day to attest

17. MEDICAID FOR ELIGIBLE PROFESSIONALS & HOSPITALS

18. Eligible Professionals & Medicaid: Patient Volume Threshold Eligible Professional (EP) If EP does not practice predominantly at FQHC/RHC: Minimum Medicaid patient volume thresholds If EP does practice predominantly at FQHC/RHC*: Minimum needy individual patient volume thresholds Physicians30% - Pediatricians20%30% Dentists30% Certified Nurse- Midwives 30% NPs30% PAs practicing at an FQHC/RHC that is led by a PA N/A30% * All Tribal clinics are deemed FQHC/RHC for the CMS incentive program

19. Eligible Hospital: Medicaid Patient Volume Requirement Eligible HospitalsMinimum Medicaid patient volume threshold Acute care hospitals, including Critical Access Hospitals 10% Medicare does not have a patient volume threshold

20. INCENTIVES

21. Eligible Professionals: Summary of Medicare & Medicaid Incentives MEDICAREMEDICAID Incentives Start CY 2011 Incentives End CY 2016 (max. 5 years, must start by 2014) 2021 (max. 6 years, must start by 2016) Incentive Amount Up to $44,000 total per provider Based on % Medicare claims Additional 10% bonus for EP’s in HPSAs Up to $63,750 total per provider Reimbursement Reduced CY 2015No penalties

22. Eligible Professionals: Medicare Incentive Payment Example Amount of Payment Each Year of Participation Calendar Year EP Receives a Payment CY 2011CY 2012CY 2013CY2014 CY 2015 and later CY 2011$18,000 CY 2012$12,000$18,000 CY 2013$8,000$12,000$15,000 CY 2014$4,000$8,000$12,000 CY 2015$2,000$4,000$8,000 $0 CY 2016$2,000$4,000 $0 TOTAL$44,000 $39,000$24,000$0

23. Eligible Professionals: Medicaid Incentive Payment Example Amount of Payment Each Year if Continues Meeting Requirements 1 st Calendar Year EP Receives a Payment CY 2011CY 2012CY 2013CY 2014CY 2015CY 2016 CY 2011$21,250 CY 2012$8,500$21,250 CY 2013$8,500 $21,250 CY 2014$8,500 $21,250 CY 2015$8,500 $21,250 CY 2016$8,500 $21,250 CY 2017$8,500 CY 2018$8,500 CY 2019$8,500 CY 2020$8,500 CY 2021$8,500 TOTAL$63,750

24. Eligible Hospital: Medicare & Medicaid Incentive Summary MEDICAREMEDICAID Incentives Start FY 2011 Incentives End FY 2016 (max. 4 years, must start by 2015) 2021 (max. 6 years, must start by 2016) Incentive Amount Varies, depending on % Medicare inpatient bed days CAHs based on EHR costs & % Medicare inpatient bed days Varies, depending on % Medicaid inpatient bed days Reimbursement Reduced FY 2015No penalties

25. PERFORMANCE MEASURES

26. Eligible Professionals: Meaningful Use Requirements STAGE 1: Meaningful Use Requirements 20 total Performance Measures 15 core performance measures* 5 performance measures out of 10 from menu set* 6 total Clinical Quality Measures 3 core or alternate core 3 out of 38 from menu set * Most measures require achievement of a performance target

27. Eligible Hospital: Meaningful Use Requirements STAGE 1: Meaningful Use Requirements 19 total Performance Measures 14 core performance measures* 5 performance measures out of 10 from menu set* 15 total Clinical Quality Measures * Most measures require achievement of a performance target

28. EPEHTargetMeasure 1.X>50%:Clinical Summaries 2.X>20%:Patient Reminders 3.X>50%:Transition of Care Summary 4.X>10%:Patient Electronic Access 5.XYes/NoPatient Lists 6.XX>50%:Electronic Copy of Health Information 7.XX>50%:Record demographics 8.XX>80%:Maintain Problem List 9.XX>80%:Active Medication List 10.XX>80%:Medication Allergy List Performance Measures

29. EPEHTargetMeasure 11.XX>50%:Record Smoking Status 12.XXYes/No:Clinical Quality Measures 13.XXYes/No:Electronic Exchange of Clinical Information 14.XXYes/No:Protect Electronic Health Information 15.XX>40%:Clinical Lab Test Results 16.X>50%:Electronic Copy of Discharge Instructions (upon request) 17.X>50%:Advance Directives 18.XXYes/No:*Immunization Registries Data Submission 19.XXYes/No:*Syndromic Surveillance Data Submission 20.XYes/No:*Reportable Lab Results to Public Health Agencies Performance Measures

30. MEANINGFUL USE REPORTS

31. 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

32. Meaningful Use Reports Reference Sheet MU ReportReport Name Relative pathKeys RequiredPackageName space VersionPatchRelease DateLinks to related documents EP Patient Volume PVPCORE>ABM>RPTP >MURP>MUPV ABMDZ MU PV SETUP Third Party Billing ABM2.6811/15/2011http://www.ihs.gov/RPM S/PackageDocs/abm/ab m_0260.07o.pdf Clean Date Report MUCDCORE > APC > MANR > MUR PCC *BJPC266/2/2011http://www.ihs.gov/mea ningfuluse/pdf/MUPerfor manceMeasuresLogic.p df EP MU Performance Measures MU1PCORE > APC > MANR > MUR n/aPCC *BJPC266/2/2011http://www.ihs.gov/mea ningfuluse/pdf/MUPerfor manceMeasuresLogic.p df EP MU CQM Report EPCORE>GPRA>CI11 >RPT>MUP BGPZMENU (required), BGPZ PATIENT LISTS (optional), BGPZ SITE PARAMETERS (optional), BGPZ TAXONOMY EDIT (optional), BGPZAREA (optional) Clinical Reporting System BGP11.1111/23/2011http://www.ihs.gov/mea ningfuluse/pdf/CRSMU CQMReportsSimpleLogi cDocument.pdf EH Patient Volume PVHCORE>ABM>RPTP >MURP>MUPV ABMDZ MU PV SETUP Third Party Billing ABM2.6811/15/2011http://www.ihs.gov/RPM S/PackageDocs/abm/ab m_0260.07o.pdf Clean Date Report MUCDCORE > APC > MANR > MUR PCC *BJPC266/2/2011http://www.ihs.gov/mea ningfuluse/pdf/MUPerfor manceMeasuresLogic.p df InPatient Bed Days FEIRCORE>ABM>RPTP >MURP Third Party Billing ABM2.6811/15/2011http://www.ihs.gov/RPM S/PackageDocs/abm/ab m_026u.pdf EH MU Performance Measures MU1HCORE > APC > MANR > MUR n/aPCC *BJPC266/2/2011http://www.ihs.gov/mea ningfuluse/pdf/MUPerfor manceMeasuresLogic.p df EH MU CQM Report CORE>GPRA>CI11 >RPT>MUP BGPZMENU (required), BGPZ PATIENT LISTS (optional), BGPZ SITE PARAMETERS (optional), BGPZ TAXONOMY EDIT (optional), BGPZAREA (optional) Clinical Reporting System BGP11.1111/23/2011http://www.ihs.gov/mea ningfuluse/pdf/CRSMU CQMReportsSimpleLogi cDocument.pdf * The Performance Measure report relies on a number of packages to collect the necessary data to run the report. Please refer to the EHR for Meaningful Use: Resource and Training Reference Tool for Eligible Professionals or Eligible Hospitals for which packages are needed for each measure. http://www.ihs.gov/meaningf uluse/pdf/EH RforMeaningf ulUseforEPsS cavengerHunt.pdf http://www.ihs.gov/mea ningfuluse/pdf/EHRforM eaningfulUseforEHsCA HsScavengerHunt.pdf

33. MU Reports: EP & EH Performance Reports

34. MU Reports: Clinical Quality Measure Report

35. WHAT DOES HIM REALLY NEED TO KNOW Differences/commonalities between: -CORE SET and MENU SETS -PERFORMANCE MEASURES and CLINICAL QUALITY MEASURES -MEASURES FOR EH/CAH versus EP Reports that demonstrate reaching meaningful use Measures that require attestation only Effects of accurate and timely completion of coding queue on MU Effects of inpatient coding and clinical documentation on reaching CQM Effects of PCC errors on MU Effects of complete and comprehensive patient registration on MU

36. 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.

37. 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.

38. 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.

39. 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.

40. 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.

41. 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.

42. 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.

43. 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.

44. 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

45. 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.

46. 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.

47. 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.

48. 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).

49. 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.

50. 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.

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

52. 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:

53. 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.

54. 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.

55. 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).

56. 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.

57. 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

58. 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.

59. 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.

60. 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.

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

62. 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.

63. 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.

64. 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.

65. 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

66. STAGE 2

67. Stage 2 – Proposed Rule Proposed delay of Stage 2 until 2014 Proposed new Performance Measures Proposed increase in targets for some measures Proposed moving menu set to core Proposed new Patient Volume methodology Proposed changes to Stage 1

68. Proposed Stage 2 Delay 201120122013201420152016 Stage1 MU 90 Days Stage 1 MU 365 Days Stage 1 MU 365 Days Stage 2 MU 365 Days Stage TBD MU 365 Days Stage1 MU 90 Days Stage 1 MU 365 Days Stage 2 MU 365 Days Stage TBD MU 365 Days Stage TBD MU 365 Days Stage1 MU 90 Days Stage 1 MU 365 Days Stage TBD MU 365 Days Stage TBD MU 365 Days Stage1 MU 90 Days Stage TBD MU 365 Days Stage TBD MU 365 Days

69. Eligible Professionals: Meaningful Use Requirements STAGE 1: 20 total Performance Measures 15 core performance measures* 5 performance measures out of 10 from menu set* 6 total Clinical Quality Measures 3 core or alternate core 3 out of 38 from menu set * Most measures require achievement of a performance target STAGE 2 (Proposed Rule) 20 total Performance Measures 17 core performance measures* 3 of 5 menu set measures 12 Total Clinical Quality Measures * Most measures require achievement of a performance target

70. Eligible Hospitals: Meaningful Use Requirements STAGE 1: Meaningful Use Requirements 19 total Performance Measures 14 core performance measures* 5 performance measures out of 10 from menu set* 15 total Clinical Quality Measures * Most measures require achievement of a performance target STAGE 2 (Proposed Rule) 18 total Performance Measures 16 core performance measures* 2 of 4 menu set measures 24 Total Clinical Quality Measures * Most measures require achievement of a performance target

71. Stage 1 Core vs. Stage 2 NPRM EPEHTargetStage 1 Core MeasureEPEHTargetStage 2 NPRM Core Measure X X >30%CPOE for Medication OrdersX X >60% CPOE for Medication, Laboratory, and Radiology Orders XX Yes/NoDrug Interaction Checks Incorporated into CDS XX >80%Maintain Problem List Incorporated into summary of care for transition of care X >40%E-Prescribing X >65%E-Prescribing XX >80%Active Medication List Incorporated into summary of care for transition of care XX>80%Medication Allergy List Incorporated into summary of care for transition of care XX>50%:Record demographicsXX>80%Record demographics XX >50%Record Vital Signs XX >80%Record Vital Signs XX >50%Record Smoking Status XX >80%Record Smoking Status XXYes/NoClinical Quality Measures CQM’s are included in the definition for demonstrating MU. They are no longer included in the objectives. Reporting on CQM’s will still be required.

72. Stage 1 Core vs. Stage 2 NPRM EPEHTargetStage 1 Core MeasureEPEHTargetStage 2 NPRM Core Measure XX Yes/NoClinical Decision Support Rule XX Yes/No Clinical Decision Support Rule (Implement 5) XX >50% Electronic Copy of Health Information Replaced objective with View, download and transmit X >50%Clinical SummariesX >50%Clinical Summaries X>50% Electronic Copy of Discharge Instructions Replaced objective with View, download and transmit XX Yes/No Electronic Exchange of Clinical Information Objective removed. Electronic Exchange included in Transition of Care Summary. XX Yes/No Protect Electronic Health Information XX Yes/No Protect Electronic Health Information New X >10%Secure Messaging New X >10%E-MAR NewXX >50% >10% Timely online access to health info Patients view, download, transmit

73. Stage 1 Menu moved to Stage 2 Core (NPRM) EPEHTargetStage 1 Menu Set MeasureEPEHTarget Stage 2 NPRM Menu moved to Core Set X >20%Patient RemindersX >10%Patient Reminders X 10%Patient Electronic AccessX >50% >10% Provided info online access Patients that view, download, transmit XX>10% Patient Specific Education Resources XX>10% Patient Specific Education Resources XX >50%Medication Reconciliation XX >65%Medication Reconciliation XX >50%Transition of Care Summary XX >65% >10% Transition of Care Summary Transitions to outside organization with different CEHR XX Yes/No *Immunization Registries Data Submission XX Yes/No *Immunization Registries Data Submission XX Yes/No *Syndromic Surveillance Data Submission Menu X Core X Yes/No *Syndromic Surveillance Data Submission XYes/No *Reportable Lab Results to Public Health Agencies XYes/No *Reportable Lab Results to Public Health Agencies

74. Stage 2 NPRM Menu Set EPEHTargetStage 1 Menu Set MeasureEPEHTarget Stage 2 NPRM Menu Set Measure XX Yes/NoDrug-Formulary Checks Incorporated objective into eRx X>50%Advance Directives X>50%Advance Directives NewXX>40%Imaging Results NewXX>20%Patient Family History New X>10%eRx discharge NewX Yes/No *Report Cancer Cases to State Cancer registry NewX Yes/No*Specialized Registry

75. AreaArea MU Contact EmailPhone Number AberdeenCAPT Scott Anderson Scott.Anderson@ihs.gov (605) 335-2504 Alaska Richard Hall Kimi Gosney Erika Wolter Karen Sidell rhall@anthc.org kgosney@anthc.org ewolter@anthc.org ksidell@anthc.org (907) 729-2622 (907) 729-2642 (907) 729-3907 (907) 729-2624 AlbuquerqueJacque Candelaria Jacque.Candelaria@ihs.gov (505) 946-9311 Bemidji Jason Douglas Bevin Moon Jason.Douglas@ihs.gov Bevin.Moon@ihs.gov (218) 444-0550 (505) 377-7888 BillingsCAPT James Sabatinos James.Sabatinos@ihs.gov (406) 247-7125 California Marilyn Freeman Steve Viramontes Marilyn.Freeman@ihs.gov Steve.Viramontes@ihs.gov (916) 930-3981 x.362 (916) 930-3981 x.359 NashvilleRobin Bartlett Robin.Bartlett@ihs.gov (615) 467-1577 Navajo CDR Michael Belgarde Donna Nicholls Michael.Belgarde@ihs.gov Donna.Nicholls@ihs.gov (928) 871-1416 (505) 205-9177 OklahomaAmy Rubin Amy.Rubin@ihs.gov (405) 951-3732 PhoenixCAPT Lee Stern Keith Longie, CIO Rick Bowman Lee.Stern@ihs.gov Keith.Longie@ihs.gov Richard.Bowman@ihs.gov (602) 364-5287 (602) 364-5080 (520) 254-2211 Portland Donnie Lee, MD Angela Boechler Donnie.Lee@ihs.gov Angela.Boechler@ihs.gov (503) 326-2017 (971) 221-8057 Tucson Scott Hamstra, MD Rick Bowman Scott.Hamstra@ihs.gov Richard.Bowman@ihs.gov (520) 295-2532 (520) 254-2211

76. Regional Extension Center RECREC ContactEmailAreas NIHBTom KauleyTkauley@nihb.orgTkauley@nihb.org; (505) 977-6053All ANTHC Richard Hall Kimi Gosney Erika Wolter Karen Sidell RHall@anthc.orgRHall@anthc.org; (907) 729-2622 KGosney@anthc.orgKGosney@anthc.org; (907) 729-2642 EWolter@anthc.orgEWolter@anthc.org; (907) 729-3907 KSidell@anthc.orgKSidell@anthc.org; (907) 729-2624 Alaska CRIHBTim Campbell Rosario Arreola Pro Amerita Hamlet Tim.campbell@ihs.govTim.campbell@ihs.gov; (707)889-3009 Rosario.arreolapro@crihb.netRosario.arreolapro@crihb.net; (916)929-9761 x.1300 Amerita.hamlet@crihb.netAmerita.hamlet@crihb.net; (916)929-9761 x.1323 California NPAIHBKatie JohnsonKjohnson@npaihb.org; (503) 416-3272Portland USETVicki French James Chavez Vicki.French@ihs.govVicki.French@ihs.gov (615)-467-1578 James.Chavez@ihs.govJames.Chavez@ihs.gov (505) 977-1754 Aberdeen Albuquerque Bemidji Billings Nashville Navajo Oklahoma Phoenix Tucson

77. IHS Meaningful Use: Contact Information Chris Lamer, Meaningful Use Project Lead, IHS Chris.Lamer@ihs.gov; (615) 669-2747Chris.Lamer@ihs.gov Luther Alexander, MU Project Manager, DNC Luther.Alexander@ihs.gov; (301) 443-8114 Luther.Alexander@ihs.gov JoAnne Hawkins, MU Healthcare Policy Analyst, DNC JoAnne.Hawkins@ihs.govJoAnne.Hawkins@ihs.gov; (505) 767-6600 x1525 Cecelia Rosales, MU Requirements Manager, DNC Cecelia.Rosales@ihs.gov; (505) 767-6600 x1230 Cecelia.Rosales@ihs.gov

78. Questions? Discussion Time Sign up for the MU Listserv! http://www.ihs.gov/listserver/index.cfm?module=signUpForm&list_id=168 More questions, contact us at: MeaningfulUseTeam@ihs.gov http://www.ihs.gov/listserver/index.cfm?module=signUpForm&list_id=168