1. CMS Final Rules: Meaningful Use Criteria VITL Webinar August 5, 2010 Tonya H. Howard, MSN, FNP-C VITL Clinical Consultant

2. Today’s Objectives Covering rules only for Eligible Professionals (EP’s) Brief overview of the Final Rules Meaningful Use Criteria Look specifically at the Clinical Quality Measures reporting requirements Recommended next steps

3. What Was Changed? Changes based on 2000+ Comments Fewer requirements (20 vs. 25 for EP’s) Percentages required for meeting compliance lowered More clarity for some of the rules

4. Stage I Meaningful Use Objectives and Measures

5. Overview 15 Objectives in the Core Set Reporting on 3 Core and 3 Selected Clinical Quality Measures 10 “Menu” Objectives—select 5 to “defer” State may add up to 4 additional public health objectives to list of core objectives “Structured Data”—in a data field with limited or controlled entry possibilities; reportable, exchange-able; NOT free text or narrative

6. Health Outcomes Priority: Improve quality, safety, efficiency, reduce health disparities 1. CPOE (Computerized Physician Order Entry) for medication orders (>30%) 2.Implement drug-drug and drug-allergy interaction checks (Function enabled? Yes or No) 3.ePrescribing (>40%) 4.Record demographics (including Language, Race, Ethnicity) (50%)

7. Health Outcomes Priority: Improve quality, safety, efficiency, reduce health disparities 5. Up-to-date problem list of current and active diagnoses (>80%) 6. Maintain active medication list (>80%) 7.Maintain active medication allergy list (>80%) 8.Record and chart changes in vital signs: (>50%) – Height, Weight, BP – BMI for Adults – Plot and Display BMI for Children

8. Health Outcomes Priority: Improve quality, safety, efficiency, reduce health disparities 9.Record smoking status for patients 13 and older (>50%) 10. Implement one clinical decision support rule with ability to track compliance with that rule (Implented? Yes or No) 11. Report ambulatory clinical quality measures to CMS or the States (Provide numerator, denominator, and exclusions in 2011 2012 electronic submission)

9. Health Outcomes Priority: Engage Patients and Families in their Health Care 12. Provide patients with an electronic copy of their health information within 3 days(e.g., CD, Flash Drive, Web Portal, etc. (>50%) – Diagnostic test results – Problem List – Med List – Med Allergies 13. Clinical summaries for pts for each office visit within 3 days(>50%)

10. Health Outcomes Priority: Improve care coordination 14. Capability to exchange key clinical information among providers and patient authorized entities electronically (one test of capacity of EHR to exchange information)

11. Health Outcomes Priority: Ensure adequate privacy and security protections for PHI 15. Privacy and Security Risk Analysis (address risks)

12. Menu Set of Stage 1 Objectives: Choose 5 to eliminate 1.Drug-formulary checks 2.Lab results as structured data 3.Generate lists of patients by condition 4.Send reminders per patient preference for preventive/follow-up care 5.Patient access to health information within 4 days

13. Menu Set of Stage 1 Objectives: Continued 6. Electronic patient education/Resources 7. Medication reconciliation 8. Provide summary of care record 9. Submit data to immunization registries* 10. Submit syndromic surveillance data to* public health

14. Clinical Quality Measures Reporting **If you do not have patients for whom one or more of these measures applies, the measure(s) may be substituted for an Alternate Core Measure (e.g., Pediatrics) 3 Core Measures** o Hypertension: BP recorded o Tobacco Use Assessment and Cessation Intervention o Adult Weight Screening and Follow-up

15. Clinical Quality Measures Reporting 3 Alternate Core Measures o Weight Assessment and Counseling for Children and Adolescents o Influenza Immunization for Patients > 50 y/o o Childhood Immunization Status

16. Clinical Quality Measures Reporting 3 Selected Measures from a list of 38 (vs. 90 in the preliminary rules—no longer divided by specialty)

17. CQM: Additional Set for EP’s 1. Diabetes: Hemoglobin A1C poor control 2. Diabetes: LDL Management and Control 3. Diabetes: BP Management 4. Heart Failure: Ace/ARB Rx for LVSD 5. CAD: Beta Blocker for prior MI 6. Pneumonia Vaccination for Older Adults 7. Breast CA screening 8. Colorectal Cancer screening 9. CAD: Oral Antiplatelet Rx 10. Heart Failure: Beta Blocker for LVSD 11. Anti-depressant medication mgmt 12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 13. Diabetic Retinopathy: Documentation of presence or absence of Macular Edema and Level of Severity of Retinopathy 14.Diabetic Retinopathy: Communication with Managing Physician 15.Asthma Pharmacologic Therapy 16.Asthma Assessment 17.Appropriate testing for children with pharyngitis 18.Oncology Breast Cancer: Hormonal Tx for Estrogen/Progesterone Receptor Positive CA

18. CQM: Additional Set for EP’s (Cont’d) 19. Oncology Colon Cancer: Chemo for Stage III CA patients 20. Prostate CA: Avoid overuse of Bone Scan for Staging Low Risk pts 21. Smoking and Tobacco Use Cessation, Medical Assistance 22. Diabetes: Eye Exam 23. Diabetes: Urine screening 24. Diabetes: Foot Exam 25. CAD: Statin Rx for lowering LDL 26. Heart Failure: Warfarin for A-Fib 27. IVD: BP Management 28. IVD: Use of ASA/Antiplatelet 29. Initiate ETOH/Drug Abuse Tx 30. Prenatal Care: Screening for HIV 31. Prenatal Care: Anti-D Immunoglob 32. Controlling High BP 33. Cervical Cancer Screening 34. Chlamydia Screening for Women 35. Use of Appropriate Meds for Asthma 36. Low Back Pain: Use of Imaging Studies 37. IVD: Complete Lipid Panel and LDL Control 38. Diabetes: HBA1C Control (<8.0%)

19. 10 Menu Set Objectives 15 Core Objectives 44Clinical Quality Measures PQRI/NQF Measures Stage 1: Reporting Requirements 8/5/2010VITL19 CMS/State 15 measures 5 measures 3 core 3 additional or 3 alternate 1 must be public health measure State can move 4 from menu to core Hypertension Tobacco use Adult weight Alternate: Children Weight Flu Immunization > 50 yrs Children Immunization

20. Meaningful Use Assessment Tool Will be available on the VITL website in the next few days