1. Medicaid EHR Incentive Program Meaningful Use: Patient Engagement Kim Davis-Allen, Outreach Coordinator Kim.davis@ahca.myflorida.com

2. Program Updates Program Year 2014 Grace Period – ended June 30, 2015 CMS Proposed 2015 Modification Rule – Shorten reporting period to 90 days for 2015 – Align hospital reporting period to calendar year – Agency cannot make policy or program changes until final Stage 3 Meaningful Use – Earliest date for Eligible Professionals is January 2017 July 9, 20152

3. Actions taken to support our health and to benefit from health care Knowledge, skills, ability, and willingness of patients to manage their health and healthcare Active collaboration between a patient and a healthcare team Dialogue between patient and practitioner that can be driven by technology What is Patient Engagement? July 9, 20153

4. Patient Electronic Access Measure- More than 50% of unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within four business days after the information is available to the EP) online access to their health information, with the ability to view, download, and transmit to a third party (subject to the EP’s discretion to withhold certain information) Stage 1 Requirements July 9, 20154

5. Patient Electronic Access Measure One- More than 50% of unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within four business days after the information is available to the EP) online access to their health information, with the ability to view, download, and transmit to a third party (subject to the EP’s discretion to withhold certain information) Measure Two- More than 5% of unique patients seen by the EP during the EHR reporting period view, download, or transmit to a third party their health information July 9, 20155 Current Stage 2 Requirements -

6. Patient Electronic Access Measure One- More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (within four 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 Measure Two- At least one patient seen by the EP during the EHR reporting period (or their authorized representatives) views, downloads, or transmits his or her health information to a third party Proposed Modification Rule for Stage 2 July 9, 20156

7. Coordination of Care Through Patient Engagement- an EP must satisfy two of the three measures: Measure One- More than 25% of unique patients seen by the EP actively engage with the electronic health record made accessible by the provider. An EP may meet this measure by patients engaging to: – view, download, or transmit to a third party their health information; or – access health information through the use of an ONC-certified API that can be used by third-party applications or devices. *c omplete proposed rule found at: hhttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage3_Rule.pdfhhttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage3_Rule.pdf Proposed Stage 3* July 9, 20157

8. Coordination of Care Through Patient Engagement- an EP must satisfy two of the three measures: Measure Two- More than 35% of all unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or their authorized representatives), or in response to a secure message sent by the patient. Measure Three- More than 15% of all unique patients seen by the EP during the EHR reporting period, patient generated health data or data from a nonclinical setting is incorporated into the CEHRT *c omplete proposed rule found at: hhttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage3_Rule.pdfhhttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage3_Rule.pdf Proposed Stage 3* July 9, 20158

9. Patient Electronic Access- an EP must satisfy the two measures: Measure One- More than 25% of unique patients seen by the EP: – The patient (or patient authorized representatives) is provided access to view online, download, and transmit their health information within 24 hours of its availability to the provider; or – The patient (or patient authorized representatives) is provided access to an ONC-certified application-program interface (API) that can be used by third party applications or devices to provide patients (or patient authorized representatives) access to their health information, within 24 hours of its availability to the provider. *c omplete proposed rule found at: hhttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage3_Rule.pdfhhttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage3_Rule.pdf Patient Engagement: Proposed Stage 3* July 9, 20159

10. Patient Electronic Access- an EP must satisfy the two measures: Measure Two- For more than 35 percent of unique patients seen by the EP during the EHR reporting period, the EP must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to patients. *c omplete proposed rule found at: hhttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage3_Rule.pdfhhttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage3_Rule.pdf Patient Engagement: Proposed Stage 3* July 9, 201510

11. Do Patients Want to be Engaged? A Harris poll conducted in 2012 found that 75% of patients want access to their medical records Only about 20% of U.S. adults currently have access to their medical records online 80% of Americans who have access to the information in the electronic health records use it 41% of U.S. consumers would be willing to switch doctors to gain online access to their own electronic medical records July 9, 2015 Source: athenahealth. (2014). 5 Elements of a Successful Patient Engagement. 11

12. Use of Technology 63% of adult cell owners use their phones to go online 69% of U.S. adults track a health indicator like weight, diet, exercise routine or symptom 35% of U.S. adults have gone online to figure out a medical condition 39% of U.S. adults care for a loved one July 9, 2015 Recent Surveys from the Pew Research Center indicate a majority of US adults use technology to engage in their health care: Source: athenahealth. (2014). 5 Elements of a Successful Patient Engagement. 12

13. Components Health care-related online applications Allows patients to interact and communicate with their healthcare providers 24/7 availability Integrated with EHR or a stand alone system EHR functionality Considerations Security concerns Consent concern Staff training Patient exposure and training Portal choices Practice representation More than Having a Patient Portal July 9, 201513

14. Establish vision Create a culture of engagement Employ the right technology Empower patients Be ready to evolve Organizational Commitment July 9, 201514

15. Online Portal Tips July 9, 2015 Promote the Portal: – Post signs – Use telephone on-hold messages – Distribute flyers and letters to patients – “Gimmicks” to promote patient portal adoption – Make it everyone’s job to encourage using the portal – Develop talking points for staff 15 Engage patients with the Portal: – Explain the benefits – Provide incentives – Survey patients to determine additional needs – Add additional features – Have the doctor promote portal usage as part of the visit experience – Rely on the patient portal patient communication – Demonstrate portal use as part of discharge

16. Considerations July 9, 2015 Source: *athenahealth. (2014). 5 Elements of a Successful Patient Engagement. 16 Timeframes and Reporting Patient engagement takes time Patients Access 60% of lower income patients reported using email regularly * Patient Population AMA study showed that patients over 65 adopted portals at a greater rate than patients aged 18-35 * Workload Volume Studies have found that telephone volume decreases when secure messaging is introduced *

17. Resources for Patient Engagement Healthit.gov http://healthit.gov/providers-professionals/patient-education-and-engagement HIMSS http://himss.files.cms- plus.com/FileDownloads/The%20State%20of%20Patient%20Engagement%20and %20Health%20IT%20(HIMSS).pdf http://himss.files.cms- plus.com/FileDownloads/The%20State%20of%20Patient%20Engagement%20and %20Health%20IT%20(HIMSS).pdf NCQA http://www.ncqa.org/HEDISQualityMeasurement/Research/BuildingaStrategytoLe verageHealthInformationTechnology.aspx http://www.ncqa.org/HEDISQualityMeasurement/Research/BuildingaStrategytoLe verageHealthInformationTechnology.aspx Other Vendor User Groups Professional Associations July 9, 201517

18. Additional Contacts and Resources www.ahca.myflorida.com/medicaid/ehr EHR Incentive Program Call Center: (855) 231-5472 MedicaidHIT@AHCA.MyFlorida.com Kim.davis@ahca.myflorida.com www.Florida-HIE.net Florida HIE Help Desk: 850-412-3752 FLHII@ahca.myflorida.com July 9, 201518