Christopher Geer, MBA Meaningful Use Project Manager Unity Health System
The Health Information Technology for Economic and Clinical Health (HITECH) Act Enacted as part of the American Recovery and Reinvestment Act of 2009 Promotes the adoption and meaningful use of health information technology. x
Data Capture and Sharing Advanced Clinical Process Improved Outcomes 1 2 3
First Payment Year Payment Year Stage 1 (100%) Stage 1 (75%) Stage 1 (50%) Stage 2 (25%)Stage 2Stage Stage 1 (100%) Stage 1 (75%) Stage 2 (50%) Stage 2 (25%)Stage Stage 1 (100%) Stage 1 (75%) Stage 2 (50%) Stage 2 (25%)Stage Stage 1 (75%) Stage 1 (50%) Stage 2 (25%)Stage Stage 1 Stage Stage 1 “If there will be a stage 4 of Meaningful Use, we expect to update this table in the rulemaking stage 3” – CMS, Stage 2 NPRM
Possess Certified EHR Technology Attest to Meaningfully Using CEHRT Incentive Payment Is your vendor certified?
Meaningful Use Eligible Hospitals MedicaidMedicare Eligible Professionals MedicaidMedicare Dually-eligible Hospitals can participate in both programs Dually-eligible providers must pick 1 program
Medicaid ProgramMedicare Program Administered by the StateAdministered by Federal Government No payment reductionsPayment reductions begin in 2015 Adopt, Implement, Upgrade option for 1 st year Must demonstrate MU in year 1 Maximum EP incentive $63,750 Maximum incentive $44,000 for EP’s (10% bonus for EP’s in HPSAs) Fixed incentive over 6 years (EP) and 4 years (EH) in NYS (may vary by state) EP incentive paid over 5 years based on 75% of net allowable charges Require 30% (EP) and 10%(EH) minimum Medicaid volume No minimum volume threshold Can skip years once startingMust be done in consecutive years
Medicaid EP’s 30% Medicaid Volume Required Medicare EP’s No Volume Requirement PhysiciansDoctor of Medicine or Osteopathy Dentists Doctor of Oral Surgery or Dental Medicine Certified Nurse MidwifeDoctor of Podiatric Medicine Nurse PractitionerDoctor of Optometry Physician Assistant*Chiropractor *Must be practicing in a Rural Health Center or Federally Qualified Health Center led by a PA. Must render <90% of services in an Inpatient Acute or Emergency Setting
Subsection (d) hospitals or Critical Access Hospitals in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS)
Eligible HospitalStage 1Stage 2 Core1416 Menu104 Menu Required52 Eligible ProfessionalStage 1Stage 2 Core1517 Menu105 Menu Required53
Yes / No Attestation Percentage-Based Measure Numerator / Denominator = Requirement Possible Denominators: Unique Patients Transitions of Care Orders There are exclusions for many of the objectives
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE Requirement: 30% Numerator: At least 1 medication order Denominator: Unique patients with at least 1 medication in their med list Requirement: 60 % Numerator: Total orders entered using CPOE Denominator: Total medication, lab, and radiology orders Objective : Use CPOE for orders entered
STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 CONSOLIDATED Enable drug formulary checks Consolidated into the eRx objective Objective: Implement drug-formulary checks
STAGE 1 EP: CORE EH: N/A PROPOSED STAGE 2 EP: CORE EH: MENU Requirement: 40% Numerator: E-prescriptions Denominator: Prescriptions written Requirement: EP: 65% EH: 10% Numerator: E-prescriptions Denominator: Prescriptions written (EH: Discharge Prescriptions) Must be checked against at least 1 formulary Objective: Generate and transmit permissible prescriptions electronically (eRx).
STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 EP: CORE EH: CORE Requirement: 10% Numerator: Number of patients who are provided patient education specific resources Denominator: Unique patients Requirement: 10% Numerator: Number of patients who are provided patient education specific resources Denominator: EH: Unique patients EP: Office Visits Objective: Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.
STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 EP: CORE EH: CORE Requirement: 50% Numerator: Patients where medication reconciliation was performed. Denominator: Transitions of care Requirement: 65% Numerator: Patients where medication reconciliation was performed. Denominator: Transitions of care Objective: The EP or EH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation
STAGE 1 EP: MENU EH: N/A PROPOSED STAGE 2 EP: CORE EH: N/A Requirement: 20% Numerator: Patients who were sent reminders Denominator: Number of unique patients 65 years old or older or 5 years older or younger. Requirement: 10% Numerator: Patients who were sent reminders Denominator: Unique patients Objective: Send reminders to patients per patient preference for preventive/follow-up care.
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE Requirement: 50% Numerator: Number of patients will all elements captured Denominator: Unique patients Race/Ethnicity Standard: OMB Standards Requirement: 80 % Numerator: Number of patients will all elements captured Denominator: Unique patients Race/Ethnicity Standard: OMB Standards Objective : Record the following demographics: preferred language, gender, race and ethnicity, date of birth, and date and preliminary cause of death in the event of mortality in the eligible hospital or CAH
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 CONSOLIDATED Requirement: 80% Numerator: Unique patients with at least 1 recorded problem, medication, medication allergy, or an indication of none. Denominator: Unique patients Consolidated into the requirements for other objectives Objectives : Maintain an up-to-date problem list, medication list, and medication allergy list
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE Requirement: 50% Numerator: Number of patients with all elements captured Denominator: Unique patients Requirement: 80 % Change BMI to age 3, and eliminate height/weight age restriction Numerator: Number of patients will all elements captured Denominator: Unique patients Objective: Record and chart height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children years, including BMI
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE Requirement: 50% Numerator: Number of unique patients with smoking status captured Denominator: Unique patients Requirement: 80 % Numerator: Number of unique patients with smoking status captured Denominator: Unique patients Objective: Record smoking status for patients 13 years old or older
STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 EP: CORE EH: CORE Generate 1 list Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 REMOVED AS AN OBJECTIVE Submit quality measures Still required to submit to be considered a meaningful user Electronic Submission Objective : Report quality measure to CMS or the states
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE 1 Rule 5 Rules related to the improvement of selected quality measures Drug-Drug / Drug Allergy Checks included as part of this objective Objective : Implement clinical decision support rules related to specialty or high clinical priority
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 CONSOLIDATED Enable drug-drug / drug- allergy checks Consolidated into the Clinical Decision Support Objective Enable drug-drug / drug- allergy checks Objective : Implement drug-drug and drug-allergy checks
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 EP: CORE EH: CORE Perform Security Risk Assessment Objective: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities
STAGE 1 EP: N/A EH: MENU PROPOSED STAGE 2 EP: N/A EH: MENU Requirement: 50% Numerator: Number of patients where an indication of an advance directive is entered Denominator: Unique patients Requirement: 50% Numerator: Number of patients where an indication of an advance directive is entered Denominator: Unique patients Objective: Record whether a patient 65 years old or older has an advanced directive as structured data
STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 EP: CORE EH: CORE Requirement: 40% Numerator: Lab orders received electronically Denominator: Lab orders Requirement: 55% Numerator: Lab orders received electronically Denominator: Lab orders Objective: Incorporate clinical lab-test results into EHR as structured data
Measure Stage 1 Requirement Stage 2 Hospital Status Stage 2 Ambulatory Status Immunization DataCore Lab DataCoreN/A Surveillance Data Core Menu Cancer Cases N/A Menu Other Specific Cases N/A Menu
STAGE 1 EP: N/A EH: N/A PROPOSED STAGE 2 EP: CORE EH: N/A New with for stage 2 Requirement: 10% Numerator: The number of patients who send a secure message to the provider Denominator: Unique patients Objective: Use secure electronic messaging to communicate with patients on relevant health information.
STAGE 1 EP: N/A EH: N/A PROPOSED STAGE 2 EP: MENU EH: MENU New with for stage 2 Requirement: 40% images captured 10% submitted to another provider of care Numerator: Results accessible through the EHR Denominator: Number of scans and tests whose result is one or more image ordered Objective: Imaging results and information are accessible through Certified EHR Technology.
STAGE 1 EP: N/A EH: N/A PROPOSED STAGE 2 EP: N/A EH: MENU New with for stage 2 Requirement: 10% Numerator: The number of orders tracked using eMAR. Denominator: Medication orders Objective: Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).
STAGE 1 EP: N/A EH: N/A PROPOSED STAGE 2 EP: MENU EH: MENU New with for stage 2 Requirement: 20% Numerator: Patients with structured data entry for one or more first-degree relatives. Denominator: Unique Patients Objective Record patient family health history as structured data
STAGE 1 EP: CORE EH: N/A PROPOSED STAGE 2 EP: CORE EH: N/A Requirement: 50% Numerator: Patients provided a clinical summary within 3 business days Denominator: Unique Patients Requirement: 50% Numerator: Patients provided a clinical summary within 24 hours Denominator: Unique Patients Expanded requirements Objective Provide clinical summaries for patients for each office visit
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 CONSOLIDATED Performed one test Consolidated into the summary of care objective Objective: Capability to exchange key clinical information, among providers of care and patient authorized entities electronically
STAGE 1 EP: MENU EH: MENU PROPOSED STAGE 2 EP: CORE EH: CORE Requirement: 50% Numerator: Number of patients where a summary of care was provided Denominator: Number of transitions of care Requirement: 60% Paper or electronic 10% electronically Numerator: Number of patients where a summary of care was provided Denominator: Number of transitions of care Objective: The EP or EH who transitions their patient to another setting of care should provide summary care record for each transition of care or referral
STAGE 1 EP: CORE EH: CORE PROPOSED STAGE 2 CONSOLIDATED Requirement: 50% Numerator: Number of patients receiving their record electronically within 3 business days Denominator: patient requests for an e-copy At a minimum: must include Problems, medications, medication allergies, and diagnostic test results Consolidated into the view, download, transmit objective. Objective: Provide patients with an electronic copy of their health information upon request
STAGE 1 EP: N/A EH: CORE PROPOSED STAGE 2 CONSOLIDATED Requirement: 50% Numerator: Number of patients receiving their instructions electronically Denominator: patient requests for an e-discharge instructions Consolidated into the view, download, transmit objective. Objective: Provide patients with an electronic copy of their health information upon request
STAGE 1 EP: MENU EH: N/A PROPOSED STAGE 2 CONSOLIDATED Requirement: 10% Numerator: Number of patients who have their record displayed online Denominator: Unique patients At a minimum: must include Problems, medications, medication allergies, and diagnostic test results Consolidated into the view, download, transmit objective. Objective: Provide patients with timely electronic access to their health information within four business days of the information being available to the EP
EP: Must provide information online in 4 business days 50% of unique patients are provided their health information online 10% of patients must access that information Standards Patient Name Provider name, practice Problem List SNOMED CT Procedures ICD-10, CPT-4 Laboratory test results LOINC Medication list Medication Allergy List Vital Signs Smoking Status Demographic Information Care plan field, including goals and instructions Additional known care team members
EP: Must provide information online within 36 hours of discharge 50% of unique patients are provided their health information online 10% of patients must access that information Standards Admit and discharge date/place Reason for hospitalization Providers of care Problem List SNOMED CT Relevant past diagnosis Laboratory test results LOINC Medication list Medication Allergy List Vitals at discharge Demographic Information Care transition plan Discharge Instructions
Christopher Geer, MBA Meaningful Use Project Manager Unity Health System Questions?