1. Meaningful Use Stage 1 & 2 Helping Colorado Providers Achieve Meaningful Use Tracy Rue Senior Consultant, Colorado Regional Extension Center

2. Agenda Three Stages of Meaningful Use Stage 1 & 2 Timing Regional Extension Center Objectives Comparing Stages 1 & 2 Clinical Quality Measures Stages 1 & 2 © 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

3. Meaningful Use: Laying the Foundation for Future Advances © 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved Meaningful Use Stage 1: Using electronic systems, structured data, point-of-care protocols, improved care coordination, security protocols & HIPAA standards in place Meaningful Use Stage 2: Exchanging clinical data with other sources, tracking clinical outcomes, targeted patient-care initiatives, patient access to self-management tools Stage 2: Walls & Windows Meaningful Use Stage 3: Fully integrated systems, reductions in errors & duplications, improved cost effectiveness, better coordinated care Stage 2: Walls & Windows Stage 3: Home is Built

4. Meaningful Use Timing 4 20112012201320142015201620172018201920202021 20111112*233TBD 2012112*233TBD 201311*2233TBD 20141*12233TBD 2015112233TBD 2016112233 201711223 Incentive Payment Year First Program Year *3-month quarter EHR reporting period for Medicare and continuous 90- day reporting for Medicaid EPs.

5. Colorado Regional Extension Center 5 MU Adopt EHR Select & Implement EHR Determine HIT & EHR Readiness Colorado REC’s mission is to provide the training and support services necessary for primary care providers in small practices, Rural Hospitals and Critical Access Hospitals to achieve Stage 1 Meaningful Use CORHIO has partnered with six healthcare organizations across Colorado to work with 2,295 providers and 33 rural and critical access hospitals to achieve the goals of the grant SUCCESS! 97% of participating providers have gone live on their EHR and 42% have reached Meaningful Use 85% of participating Rural and Critical Access hospitals have gone live and 67% have reached Meaningful Use

6. The EHR Incentive Programs

7. What is the EHR Incentive Program? HITECH Act of 2009/American Recovery & Reinvestment Act – Meaningful Use of Certified Electronic Health Records Technology (CEHRT) Three Stages (currently in Stage 1) Two programs: – Medicare » Opened in 2011 for Meaningful Use demonstration » Eligible Professionals, Eligible Hospitals and Critical Access Hospitals – Medicaid » Opened in 2012 for Adopt, Implement or Upgrade of a CEHRT » Opened in 2013 for Meaningful Use » Eligible Professionals, Eligible Hospitals and Critical Access Hospitals

8. Who is Eligible for Medicare EHR Incentives? 8 To qualify for an incentive payment under the Medicare EHR Incentive Program, an eligible professional must: Bill Medicare FFS “straight Medicare” Medicare Provider in good-standing Hospital-based providers are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place of Service code 21) or emergency room (Place of Service code 23) setting.

9. Incentive Payments for Medicare EPs Medicare Incentive is 75% of total allowed charges, based on a calendar year Calendar Year CY 2011CY 2012CY 2013CY 2014CY 2015 and later 2011 $18,000 2012 $12,000$18,000 2013 $8,000$12,000$15,000 2014 $4,000$8,000$12,000 2015 $2,000$4,000$8,000 -1% 2016 $2,000$4,000 -2% 2017-3% 2018-4% 2019-5% TOTAL$44,000 $39,000$24,0000 © 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution

10. Who is Eligible for Medicaid EHR Incentives? 10 To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria: Have a minimum 30% Medicaid patient volume* Have a minimum 20% Medicaid patient volume and is a pediatrician* Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria Hospital-based providers are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place of Service code 21) or emergency room (Place of Service code 23) setting.

11. Medicaid EPs can start receiving payments any time from CY 2011 through 2016, and there is no penalty for starting later – Payments based on participation year, so EPs can have gaps in meeting Meaningful Use requirements and still receive max $ No Medicaid payment reductions for not meeting Meaningful Use Incentive Payments for Medicaid EPs Calendar Year CY 2011CY 2012CY 2013CY 2014CY 2015CY2016 2011 $21,250 2012 $8,500$21,250 2013 $8,500 $21,250 2014 $8,500 $21,250 2015 $8,500 $21,250 2016 $8,500 $21,250 2017 $8,500 2018 $8,500 2019 $8,500 2020 $8,500 2021 $8,500 TOTAL $63,750 © 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution

12. Stage 1 & Stage 2 Meaningful Use

13. Definitions Structured Data (Discrete Data) – Data that is identifiable because it is organized in a structure………(i.e.. ICD-9, SNOMED) Denominator (MU) – Example: The number of Unique Patients seen within the reporting period Numerator (MU) – Example: The number of times the Meaningful Use Objective was met Unique Patient – A Unique patient means that even if a patient is seen multiple times during the reporting period they are only counted once.

14. Stage 2 Goals & Intentions Alignment of Clinical Quality Measures with other reporting programs Improving Patient Care with new objectives to improve patient care through better clinical decision support, care coordination and patient engagement Rigorous expectations for HIE through increased emphasis on exchanging clinical summary documents to improve care coordination, public health reporting and importing lab results in a structured manner

15. Eligible Hospitals and CAHs 14 Core 5 of 10 Menu 19 total objectives Eligible Hospitals and CAHs 16 Core 3 of 6 Menu 19 total objectives Eligible Professionals 15 Core 5 of 10 Menu 20 total objectives Eligible Professionals 17 Core 3 of 6 Menu 20 total objectives Stage 1 to Stage 2 Overview Stage 1 Stage 2 Adapted from HealthIT.gov

16. What are the Requirements of Stage 2 Meaningful Use? Core Objectives Menu Set Objectives Clinical Quality Measures

17. Meaningful Use - Core Objectives

18. Patient Check In & Out Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Record demographics Race Ethnicity Preferred Language DOB • > 50% of all unique patients Record demographics • > 80% of all unique patients Provide clinical summaries for patients for each office visit > 50% of all office visits within 3 business days Provide clinical summaries for patients for each office visit > 50% of all office visits within ONE business day

19. Rooming Patient Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Maintain active medication list > 80% of all unique patients No longer a separate objective for Stage 2 Incorporated into Transitions of Care Maintain active medication allergy list > 80% of all unique patients No longer a separate objective for Stage 2 Incorporated into Transitions of Care Record and chart changes in vital signs: • Height, Weight, BP, BMI • > 50% of all unique patients age 2 and older Record and chart changes in vital signs 3 years and older BP and Height and Weight can be reported separately. •• > 80% of all unique patients Record smoking status for patients 13 years or older > 50% of all unique patients 13 years or older Record smoking status for patients 13 years or older > 80% of all unique patients

20. Patient Exam Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Maintain an up-to- date problem list > 80% of all unique patients seen No longer a separate objective for Stage 2 Incorporated into Transitions of Care Report CQMsReport 6 CQMsNo longer a separate objective CQMs submitted electronically to CMS Implement one clinical decision support rule relevant to specialty Implement one clinical decision support rule Use clinical decision support to improve performance on high-priority health conditions Implement 5 clinical decision support interventions

21. Patient Exam Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Medication Reconciliation >50% of patients who transitioned into the care of the EP Stage 1 Menu Set Medication Reconciliation 50% of transitions of care in which the patient is transitioned into the care of the EP

22. Orders and Point of Care Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Use CPOE for medication orders > 30% of unique patients Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders > 60% of Medication > 30% of laboratory > 30% of radiology orders Implement drug- drug and drug- allergy interaction checks The EP has enabled this functionality for the entire EHR reporting period No longer a separate objective for Stage 2 Incorporated into the Stage 2 Clinical Decision Support measure

23. Orders and Point of Care Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Generate and transmit permissible prescriptions electronically (eRx) > 40% of all permissible prescriptions Generate and transmit permissible prescriptions electronically (eRx) > 50% of all permissible prescriptions Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate > 10% of all unique Stage 1 Menu Set Use certified EHR technology to identify patient- specific education resources and provide those resources to the patient if appropriate Patient-specific education resources identified by CEHRT provided to patients for more than 10% of all unique patients seen by EP during the EHR reporting period

24. Orders and Point of Care Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Implement drug- formulary checks Enabled functionality Stage 1 Menu Set No longer a separate objective for Stage 2 Incorporated into the e- Prescribing measure for Stage 2

25. Clinical Administration Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Give patients electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request > 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP > 50% of all unique patients seen by the EP within 4 business days after the information is available have online access to their health information > 5% of all unique patients seen by the EP (or their authorized representatives) view, download or transmit their health information to a third party

26. Clinical Administration Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Capability to exchange key clinical information Performed at least one test Eliminated from Stage 1 in 2013 No longer an objective for Stage 2 Eliminated from Stage 1 in 2013 No longer a measure for Stage 2 Incorporate clinical lab test results into certified EHR technology as structured data > 40% Stage 1 Menu Set Incorporate clinical lab test results into certified EHR technology as structured data > 55%

27. Clinical Administration Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure 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 with a specific condition Stage 1 Menu Set 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 with a specific condition Send reminders to patients per patient preference for preventive/follow-up care > 20% of all unique patients 65 years or older or 5 years old Stage 1 Menu Set Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care >10% of all patients with two or more office visits in the last 2 years

28. Clinical Administration Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Provide patients with timely electronic access to their health information > 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) Stage 1 Menu Set Eliminated from Stage 1 in 2014 No longer an objective for Stage 2 Eliminated from Stage 1 in 2014 No longer a measure for Stage 2

29. Clinical Administration Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure The EP who transitions their patient to another setting of care should provide summary of care record for each transition of care or referral >50% of transitions of care and referrals Stage 1 Menu The EP who transitions their patient to another setting of care should provide summary of care record for each transition of care or referral >50% of transitions of care >10% electronically This measure combines Stage 1 core items – problem list, active medication list and active medication allergy list - to emphasize increased data exchange

30. Clinical Administration Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice Performed at least one test Stage 1 Menu Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law Successful ongoing submission of electronic immunization data NEW Use secure electronic messaging to communicate with Patients > 5% of patients communicate electronically with their provider (s)

31. Administration Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Protect 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 Protect 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 and encryption/security of data at rest

32. Meaningful Use – Menu Set Objectives

33. Stage 2 Menu Set (EPs must select 3 of 6) Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure Capability to submit electronic syndromic surveillance data to public health agencies and actual submission except where prohibited and in accordance with applicable law and practice Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies Capability to submit electronic syndromic surveillance data to public health agencies and actual submission except where prohibited and in accordance with applicable law and practice Successful ongoing submission of electronic syndromic surveillance data NEW Record electronic notes in patient records Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of unique patients

34. Stage 2 Menu Set Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure NEW Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT More than 10% of all scans and tests whose result is an image ordered by the EP for patients seen during the EHR reporting period are incorporated into or accessible through CEHRT NEW Record patient family health history as structured data >20% of all unique have a structured data entry for one or more first-degree relatives

35. Stage 2 Menu Set Stage 1 ObjectiveStage 1 MeasureStage 2 ObjectiveStage 2 Measure NEW Capability 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 CEHRT to a cancer registry for the entire EHR reporting period NEW Capability 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 CEHRT to a specialized registry for the entire EHR reporting period

36. Clinical Quality Measure Requirements for Stage 1 Meet 6 total Clinical Quality Measures – 3 core or alternate core, and – 3 out of 38 from alternate set Most Electronic Health Record systems only report on the minimum 9 Clinical Quality Measures. Which Clinical Quality Measures can your system report? http://onc-chpl.force.com/ehrcert/chplhome

37. Clinical Quality Measures Stage 1 Core Set 1. Hypertension: Blood Pressure Measurement 2. Preventive Care and Screening Measure Pairs: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention 3. Adult Weight Screening and Follow-up Alternate Set 4. Weight Assessment and Counseling for Children and Adolescents 5. Preventive Care and Screening; Influenza Immunization for Patients 50 Years Old or Older 6. Childhood Immunization Status Must Choose 3 Additional CQMs 38 Additional CQMs Must choose 3 of the additional 38 CQMs

38. Clinical Quality Measures Stage 2 Provider2014 and Beyond* Eligible ProvidersComplete 9 out of 64 Submission of CQMs electronically (starting in 2014) Alignment with existing quality programs Providers must select from 3 of the 6 HHS National Quality Strategy 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 Processes/Effectiveness *Regardless of the stage of meaningful use, all providers will complete this number of CQMs in 2014 Adapted from HealthIT.gov

39. Helpful Links CMS Registration: https://ehrincentives.cms.gov/hitech/login.action https://ehrincentives.cms.gov/hitech/login.action Colorado Registration & Attestation System (CO R&A): http://co.arraincentive.com/ http://co.arraincentive.com/ Certified Health IT Product List (CHPL ID): http://oncchpl.force.com/ehrcert?q=chpl http://oncchpl.force.com/ehrcert?q=chpl Colorado Regional Extension Center http://www.corhio.org/ © 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

40. Contact Information Tracy Rue Senior Consultant, Colorado Regional Extension Center true@corhio.org true@corhio.org Phone: 720.285.3234 2/19/2013 © 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved