1. Meaningful Use Measures Series – Session 3 Objectives related to interoperability and exchanging data to outside entity 1

2. MU 3 Session Series Physician Meaningful Use 3 Session Series 1)Sept. 20 - Session #1 Drug, Medication, eRx related 2)Oct. 18 - Session #2 Recording Patient Data 3)Nov. 15 - Session #3 Interoperability, Exchanging Data Outside the Clinic Other Than to Patients TAKEAWAY: Use Your resources – GA-HITREC & HomeTown Health 2

3. 25 Objectives in 5 Priority Outcomes  Improving quality, safety, efficiency and reducing health disparities  Engage patients and families in their health care  Ensure adequate privacy and security protections for personal health information  Improve care coordination  Improving population and public health 3

4. 25 Objectives in 5 Priority Outcomes 4 Stage I Meaningful Use for 2011  – Eligible Professionals must complete:  15 core objectives (e.g., maintain active medication list, etc.)  5 objectives out of 10 from menu set (e.g., implement drug formulary checks, etc.)  6 total Clinical Quality Measures(CQM) (3 core or alternate core, and 3 out of 38 from additional set)

5. Objective Requirements 5 15 Core Set Objectives Eligible Professionals must meet all Core Objectives to qualify for incentive payments

6. Objective Requirements 6 10 Menu Set Objectives Eligible Professionals will defer 5 Menu Objectives One of the remaining objectives must be from Improving population and public health priority

7. Measures Attestation 7 Have done the objective or not Yes/No Numerator - actions or subsets of patients seen or admitted during the EHR reporting period, only including patients or actions taken on behalf of those patients, whose records are kept using certified EHR technology. Denominator - all patients seen or admitted during the EHR reporting period regardless of whether their records are kept using certified EHR technology. Percentage Based

8. Exclusions 8 Some MU objectives are not applicable to every provider’s clinical practice They would not have any eligible patients or actions for the measure denominator Exclusions do not count against the 5 deferred Menu set objectives

9. Selected Objectives Related to: 9 Interoperability Exchanging data to outside entities

10. Defining Terms 10 The movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. Transition of Care An entity under the jurisdiction of the U.S. Department of Health and Human Services, tribal organization, State level and/or city/county level administration that serves a public health function. Public Health Agency

11. Defining Terms 11 All data needed to diagnose and treat disease. Examples include, but are not limited to, blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, and pulmonary function tests. Diagnostic Test Results A separate legal entity is an entity that has its own separate legal existence. Indications that two entities are legally separate would include (1) they are each separately incorporated; (2) they have separate Boards of Directors; and (3) neither entity is owned or controlled by the other. Different Legal Entities

12. Defining Terms 12 Clinical information must be sent between different legal entities with distinct certified EHR technology and not between organizations that share a certified EHR technology. Distinct certified EHR technologies are those that can achieve certification and operate independently of other certified EHR technologies. The exchange of information requires that the eligible professional must use the standards of certified EHR technology as specified by the ONC, not the capabilities of uncertified or other vendor specific alternative methods for exchanging clinical information. Exchange

13. Defining Terms 13 Any individual or organization to which the patient has granted access to their clinical information. Examples would include an insurance company that covers the patient, an entity facilitating health information exchange among providers, or a personal health record vendor identified by the patient. A patient would have to affirmatively grant access to these entities. Patient Authorized Entities

14. POLL QUESTION 14

15. POLL QUESTION 15

16. Core Objective–Electronic Exchange of Clinical Information 16 Objective Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. Measures Performed at least one test of certified EHR technology’s capacity to Electronically exchange key clinical information. Exclusions None

17. Defining Terms 17 EPs must attest YES to having performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information during the EHR reporting period to meet this measure. YES / NO

18. Additional Information – Electronic Exchange  The test of electronic exchange of key clinical information must involve the transfer of information to another provider of care with distinct certified EHR technology or other system capable of receiving the information. Simulated transfers of information are not acceptable to satisfy this objective.  The transmission of actual patient information is not required for the purposes of a test. The use of test information about a fictional patient that would be identical in form to what would be sent about an actual patient would satisfy this objective.  When the clinical information is available in a structured format it should be transferred in a structured format. However, if the information is unavailable in a structured format, the transmission of unstructured data is permissible. 18

19. Additional Information – Electronic Exchange  EPs must test their ability to electronically exchange key clinical information at least once prior to the end of the EHR reporting period. Testing may also occur prior to the beginning of the EHR reporting period. Every payment year requires its own, unique test. If multiple EPs are using the same certified EHR technology in a shared physical setting, testing would only have to occur once for a given certified EHR technology.  An unsuccessful test of electronic exchange of key clinical information will be considered valid for meeting the measure of this objective. 19

20. CMS - FAQ FAQ:  To meet the meaningful use objective “capability to exchange key clinical information” for the EHR Incentive Programs, can different providers of care share EHR technology and successfully meet this objective? Answer:  In order to meet this objective, clinical information must be sent between different legal entities with distinct certified EHR technology and not between organizations that share a certified EHR technology or organizations that are part of the same legal entity, since no actual exchange of clinical information would take place in these latter instances. Distinct certified EHR technologies are those that can achieve certification and operate independently of other certified EHR technologies. It is possible for different legal entities to meet this objective by using separate instances of the same certified EHR technology (e.g. both entities using separate license of the same program), subject to the following limitations: 20

21. ONC Regulations - FAQ FAQ: Could an interface that transmits lab results in HL7 message format between a hospital laboratory system and a physician’s EHR (presuming that the transmissions were occurring between two different legal entities) satisfy the certification criteria related to the exchange of key clinical information in 45 CFR 170.304(i) and 45 CFR 170.306(f)? If not, please specify the required data types and exchange characteristics that must be part of the required clinical information exchange Answer: As implied in the question, for certification a Complete EHR or an EHR Module must have the capability to electronically receive and display, and transmit certain key clinical information in accordance with one of two separate certification criteria (45 CFR 170.304(i) or 45 CFR 170.306(f)), depending on the setting for which the EHR technology is designed (ambulatory or inpatient, respectively). Generally speaking, these certification criteria require two types of information exchange capabilities 21

22. ONC Regulations - FAQ 1. Electronically receive and display a patient’s summary record, from other providers and organizations including, at a minimum, diagnostic tests results, problem list, medication list, and medication allergy list in accordance with the continuity of care document (CCD) standard (and the HITSP/C321 implementation specifications) or the continuity of care record (CCR) standard and that upon receipt of a patient summary record formatted according to the alternative standard, display it in human readable format. 2. Electronically transmit a patient summary record to other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list using the CCD standard (and the HITSP/C32 implementation specifications) or the CCR standard while also Representing specific named data elements (problems, laboratory test results, and medications) according to adopted standards. Note: The above uses language from 45 CFR 170.304(i). The certification criterion adopted at 45 CFR 170.306(f) also includes “procedures” as a required, standardized data element within these exchange capabilities 22

23. ONC Regulations - FAQ Therefore, an interface that transmits lab results in HL7 message format between a hospital laboratory system and a physician’s EHR (where the transmission is occurring between two different legal entities) would not qualify as an exchange of key clinical information that complies with the requirements of either of these two certification criteria. The interface would not satisfy the required capabilities included within the adopted certification criteria, and more specifically, the ability to transmit a patient summary record in accordance with the CCD standard (and the HITSP/C32 implementation specifications) or the CCR standard. 1HITSP Summary Documents Using HL7 Continuity of Care Document (CCD) 23

24. Azalea Lab Hub - Exchange 24 http://www.azaleahealth.com/labhub

25. Menu Objective – Transition of Care Summary 25 Objective The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. Measures The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent\ of transitions of care and referrals. Exclusions An EP who neither transfers a patient to another setting nor refers a patient to another provider during the HER reporting period.

26. Attestation Requirements – Transition of Care The resulting percentage (Numerator ÷Denominator) must be more than 50 percent in order for an EP to meet this measure. 26 Numerator Number of transitions of care and referrals in the denominator where a summary of care record was provided. Denominator Number of transitions of care and referrals during the HER reporting period for which the EP was the transferring or referring provider. Exclusion If an EP does not transfer a patient to another setting or refer a patient to another provider during the EHR reporting period then they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion

27. Additional Information – Transition of Care Sum  Only patients whose records are maintained using certified EHR technology should be included in the denominator for transitions of care.  The transferring party must provide the summary care record to the receiving party.  The EP can send an electronic or paper copy of the summary care record directly to the next provider or can provide it to the patient to deliver to the next provider, if the patient can reasonably expected to do so.  If the provider to whom the referral is made or to whom the patient is transitioned to has access to the medical record maintained by the referring provider then the summary of care record would not need to be provided, and that patient should not be included in the denominator for transitions of care. 27

28. Core Objective - Immunization Registries 28 Objective Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. Measures Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically). Exclusions An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.

29. Attestation Requirements Immunization Registries 29 Yes / No EPs must attest YES to having performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test was successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically) to meet this measure. Exclusion If an EP does not perform immunizations during the EHR reporting period, or if there is no immunization registry that has the capacity to receive the information electronically, then the EP would be excluded from this requirement. EPs must select NO next to the appropriate exclusion(s), then click the APPLY button in order to attest to the exclusion(s).

30. Additional Information – Immunization Registries  The test to meet the measure of this objective must involve the actual submission of information to a registry or immunization information system, if one exists that will accept the information. Simulated transfers of information are not acceptable to satisfy this objective.  The transmission of actual patient information is not required for the purposes of a test. The use of test information about a fictional patient that would be identical in form to what would be sent about an actual patient would satisfy this objective.  If multiple EPs are using the same certified EHR technology in a shared physical setting, testing would only have to occur once for a given certified EHR technology. 30

31. Additional Information – Immunization Registries  An unsuccessful test to submit electronic data to immunization registries or immunization information systems will be considered valid and would satisfy this objective.  If the test is successful, then the EP should institute regular reporting with the entity with whom the successful test was conducted, in accordance with applicable law and practice. There is not a measurement associated with this reporting.  The transmission of immunization information must use the standards at 45 CFR 170.302(k). 31

32. Menu Objective – Syndromic Surveillance Data Submission 32 Objective Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. Measures Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically). Exclusions An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically

33. Attestation Requirement -Syndromic Surveillance Data 33 Yes / No EPs must attest YES to having performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test was successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically) to meet this measure. Exclusion If an EP does not collect any reportable syndromic information on their patients during the EHR reporting period or if no public health agency that has the capacity to receive the information electronically, then the EP is excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion.

34. Additional Information – Syndromic Surveillance Data  The test to meet the measure of this objective must involve the actual submission of electronic syndromic surveillance data to public health agencies, if one exists that will accept the information. Simulated transfers of information are not acceptable to satisfy this objective.  The transmission of electronic syndromic surveillance data is not required for the purposes of a test. The use of test information about a fictional patient that would be identical in form to what would be sent about an actual patient would satisfy this objective.  An unsuccessful test to submit electronic syndromic surveillance data to public health agencies will be considered valid and would satisfy this objective.  If the test is successful, then the EP should institute regular reporting with the entity with whom the successful test was conducted, in accordance with applicable law and practice. There is not a measurement associated with this reporting. 34

35. Additional Information – Syndromic Surveillance Data  EPs must test their ability to submit electronic syndromic surveillance data to public health agencies at least once prior to the end of the EHR reporting period. Testing may also occur prior to the beginning of the EHR reporting period. Each payment year requires it own unique test.  If multiple EPs are using the same certified EHR technology in a shared physical setting, testing would only have to occur once for a given certified EHR technology.  The transmission of syndromic surveillance information must use the standards at 45 CFR 170.302(l). 35

36.  October 3, 2011 – Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program.  December 31, 2011 – Reporting year ends for eligible professionals.  February 29, 2012 – Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) 2011. 36 IMPORTANT DATES!

37. Reduction in reimbursement if meaningful use of certified EHR technology is NOT successfully demonstrated 2015 – 99% of Medicare FFS covered amount 2016 – 98% of Medicare FFS covered amount 2017 – 97% of Medicare FFS covered amount 2018 – if determined, payment adjustment can occur by 1% point each year until payment adjustment reaches 95% 37 2015 Payment Adjustments Begin

38. Resources  CMS Web Site for the Medicare and Medicaid EHR Incentive Program www.cms.gov/EHRIncentivePrograms www.cms.gov/EHRIncentivePrograms  Meaningful Use Measures Links http://www.cms.gov/EHRIncentivePrograms/Downloa ds/EP-MU-TOC.pdf http://www.cms.gov/EHRIncentivePrograms/Downloa ds/EP-MU-TOC.pdf  ERx Manual  http://www.trailblazerhealth.com/Publications/Training%20 Manual/E-Prescribing.pdf http://www.trailblazerhealth.com/Publications/Training%20 Manual/E-Prescribing.pdf  Georgia HITREC  http://www.ga-hitrec.org/gahitrec/ http://www.ga-hitrec.org/gahitrec/  We have 4 mid-level providers that are billed incident to the physician for the most part. We have a EHR and are going for meaningful use. Is it necessary for them to fill out a hardship waiver for the electronic prescriptions since they do less than 100 prescriptions/yr under their own billing #s. 38

39. EDUCATION – GA-HITREC.ORG 39 PROMO CODE - HITREC

40. Q&A 40 The patient should be on the forefront of every decision you make

41. Regional Extension Center Your Meaningful Use Expert Resource. Contact us today! 41 In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0004/01. IA-HITREC-03/11-219 This presentation is compliments of www.IowaHITREC.org www.IowaHITREC.org For More information go to: www.ga-hitrec.org