Moderator Kevin Larsen, MD Medical Director, Meaningful Use Office of the National Coordinator for Health Information Technology Washington, D.C. Using Meaningful Use to Improve Quality of Care Developed as part of a Medscape education activity, Using Meaningful Use to Improve Quality of Care, supported by the U.S. Department of Health and Human Services. Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC Assistant Professor Johns Hopkins University Baltimore, Maryland

Summarize Meaningful Use objectives that can be used to help a practice assess its quality of care Propose opportunities to use Meaningful Use data to plan and implement quality improvement projects in the practice setting Program Goals

The Medicare & Medicaid EHR Incentive Programs provide incentive payments to eligible professionals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. CMS website. [1] Introduction

Meaningful Use is using certified EHR technology to −Improve quality, safety, efficiency, and reduce health disparities −Engage patients and family −Improve care coordination, and population and public health −Maintain privacy and security of patient health information CMS sets specific objectives for Meaningful Use that eligible professionals, eligible hospitals, and critical access hospitals must meet to qualify for Medicare & Medicaid EHR Incentive Programs Meaningful Use: Definition

Improve quality, safety and efficiency Reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Maintain privacy and security across all areas Interoperability Types of Meaningful Use Objectives

3 Stages of Meaningful Use CMS website. [2,3] Stage 1 −Data capture and sharing; in general, eligible professionals are in Stage 1 for 2 years −13 core objectives starting in 2014 −5 of 9 menu objectives Stage 2 −Advanced clinical processes −17 core objectives −3 of 6 menu objectives Stage 3 −Improved outcomes

Data collected for Meaningful Use are used for attestation in an EHR Incentive Program, but they also can help practices evaluate the care they deliver. Opportunities include −Better follow-up on chronic conditions −Improved rates of screening and preventive care −More efficient hand-offs between providers −Fewer medication or other errors −Population evaluation to look for patterns of disease or opportunities to improve, and measure results of quality improvement initiatives Meaningful Use: Foundation for Quality

MeasureObjective Record demographicsFor more than 80% of patients, record the following in the certified EHR: Preferred language, sex, race, ethnicity, date of birth Record vital signsMore than 80% of all unique patients seen by the EP have blood pressure (patient >3 years) and/or height and weight (all ages) recorded Record smoking statusMore than 80% of all unique patients >13 years have smoking status recorded Identify patients who should receive reminders for preventive/follow-up care More than 10% of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available CMS website. [4] Stage 2: Measures Related to Quality of Care

Recording Demographics, Vital Signs, Smoking Status Opportunities to −Identify patients who should receive preventive care (such as colonoscopy at age 50) −Monitor overall control of hypertension, obesity and other conditions based on BP, BMI, etc −Identify patients who would benefit from substance abuse interventions −Identify trends that could point to the need for new services or interventions (nutrition classes, etc)

CMS website. [5] MeasureObjective Incorporate clinical lab test results into Certified EHR Technology More than 55% of all clinical lab tests ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology Use clinical decision supportImplement 5 clinical decision support interventions related to 4 or more clinical quality measures, if applicable, at a relevant point in patient care for the entire EHR reporting period Perform medication reconciliationThe EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP Stage 2: Measures Related to Quality of Care (cont)

Opportunities to −Decrease medication errors −Apply evidence-based care algorithms −Reduce number of unnecessary or redundant lab referrals −Compare lab data over time more efficiently Lab Results, Medication Reconciliation, and Clinical Decision Support

CMS website. [6] MeasureObjective Generate lists of patients by specific conditions Generate at least 1 report listing patients of the EP with a specific condition Stage 2: Measures Related to Quality of Care (cont)

Lists and Summaries What can providers do with generated lists? −What’s important in today’s patient load? −What patients in the population need to be reminded about upcoming preventive care? Who on the office team can be designated to establish patient reminders?

CMS website. [7] MeasureObjective Provide summary care record for each transition of care or referral: Measure 1 Provide a summary of care record for more than 50% of transitions of care and referrals Measure 2Provide a summary of care record for more than 10% of the total number of transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is an eHealth Exchange (formerly NwHIN exchange) participant or in a manner that is consistent with the governance mechanism ONC establishes for the eHealth Exchange Stage 2: Measures Related to Quality of Care (cont)

Interoperability As part of Stage 2 Meaningful Use, eligible professionals are required to demonstrate interoperability as part of measures related to Transitions of care Lab exchange Patient engagement Public health measures ONC website. [8]

In addition to the Core and Menu Objectives, eligible professionals must select and report on 9 of a possible list of 64 approved eCQMs for the EHR Incentive Programs Topics range from diabetes to hypertension, cancer screening, and vaccinations New requirement: quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains: 1.Patient and Family Engagement 2.Patient Safety 3.Care Coordination 4.Population and Public Health 5.Efficient use of Health Care Resources 6.Clinical Processes/Effectiveness CMS website. [9] Electronic Clinical Quality Measures (eCQMs)

Electronic Clinical Quality Measures eCQMs are available to fit the clinical work of most specialties. By selecting eCQMs that best reflect their own practice mix, eligible professionals can fulfill Meaningful Use requirements and build a more accurate picture of their own practice. CMS website. [9]

Sample Measures Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode. Percentage of women years of age who had a mammogram to screen for breast cancer. Percentage of patients years of age with diabetes who had HbA 1c > 9.0% during the measurement period.

Meaningful Use requires eligible professionals to collect data about patients and their care processes These data can also help practices become more efficient and provide better care Choose eCQMs that best match your patient population Take time to evaluate your data and look for ways to improve! For more information about the incentive programs, visit Conclusion

Thank you for participating in this activity. To proceed to the online CME/CE test, click on the Earn CME/CE Credit link on this page.