2015 User Conference Pre-Conference: Meaningful Use Stage 1 2015 April 23, 2015 Presented by: Angela Schnack Training Specialist EHR Session

2015 User Conference

Pre-Conference: Meaningful Use Stage 1 2015April 23, 2015

Presented by:

Angela SchnackTraining Specialist

EHR Session

2015 Office Practicum User Conference

Isn’t this what it is all about?

“We've made more progress with EHRs in the past 2 years than we have in 20."

Farzad Mostashari, MD(former ONC Chief)


Meaningful Use Stage 1

Today’s Objectives:

▪ Define key elements of Meaningful Use

▪ Identify required fields in Office Practicum to capture MU data

▪ Interpret Quality Improvement Calculator (QIC) metrics



Stage 1 - Year 1: AIU: Adopt, Implement or Upgrade

Stage 1

If you are in this stage, you will need the 2014 CEHRT edition of Office Practicum

CEHRT: Certified Electronic Health Record Technology

● Stage 1 - Year 2: ● Stage 1 & 2 no longer

split● 2015 is 90 days using

Modified Stage 2 Objectives

● 2016 - full year reporting unless new to MU


Stage 1

Stage 2

Stage 32018 Stage 3Proposed ruling in process*May elect to move to Stage 3 in 2017, required to in 2018

Note: ● 2016 Last year to initiate participation in Medicaid

EHR incentive program● 2021 Last year to receive Medicaid EHR incentive

payment.

● Stages 1 & 2 are no longer split.

● Combined into one with modified reporting


First Reporting Year - Prepare

●Begin now● Designate a Meaningful Use Team● Check QIC to identify areas the measures

are not met● Meet regularly with staff and providers -

share results● Develop workflow changes if necessary


Meaningful Use Stage 1(Modified Stage 2)

What needs to be reported?

Under New Proposed Ruling:■ 9 Objectives Required ■ 13 required core objectives■ 5 Menu objectives from a list of 9

available in OP■ 9 Clinical Quality Measures Required

▪ Must be chosen from at least 3 of 6 Domains



Let’s get started!


CPOE - (Modified Stage 2 Objective)

Use CPOE for more than 60% medications, 30% of laboratory, and 30% of radiologyExclusion: Fewer than 100 medications, laboratory or radiology orders written during the reporting period

907A

907B

907C

Denominator: Total medications written during the reporting period

Numerator: Medications written with a Purpose of "Med - to dispense" or "Med - office sample" or "Med - office �administered

Denominator: Total Lab requisitions written during the reporting period

Numerator: Labs with a result date

Denominator: Total Radiology Lab requisitions written during the reporting period

Numerator: Radiology Labs with a result date


CPOE - Minimum Requirement*

CPOE:Computerized Physician Order

Entry>30%▪ Medication written using:

▪ Med-to dispense▪ Med- office sample▪ Med-Administered

▪ Unique Patient▪ Visit during reporting period

*For EP’s who would have been Stage 1 in 2015, this is the minimum requirement to meet the objective.


E-Prescribing (Modified Stage 2)

> 50% (May elect the lesser -

>40%)*▪Medication written using:▪ Med-to dispense▪ e-Rx ID

▪All medications written during the reporting periodExclusion:

1. Any EP who writes fewer than 100 prescriptions during the EHR reporting period.2. Any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period.

*EP’s who would have been in Stage 1 reporting may report the lesser percentage


Clinical decision support rule (Intervention)

How do we do this?

Care Plans


Interventions - (Modified Stage 2)

▪ 5 Interventions required

▪ Must be able to track compliance

▪For EP’s who would have been Stage 1 in 2015 - Must report minimum of one intervention


Patient Access (Modified Stage 2)

>50%▪Provide timely online access to health information▪ Within 4 business days* after information

available to EP▪ 5% View, Download or Transmit▪ View, Download or Transmit (at least one

patient)

▪All visits during reporting period

You must have the portal implemented at your practice so patients can have accounts created

*The QIC excludes weekends, but not holidays


Protect electronic health information

Attest to Only

Cyber Security Checklist

http://www.healthit.gov/providers-professionals-newsroom/top-10-tips-cybersecurity-health-care


Patient Specific Education Resources

>10 %▪ Patient education given checked▪ Unique patient▪ Visit during reporting period


Patient specific education resources

▪ When a task is created during the visit, the box will automatically be checked

▪ Manually checking the box will populate the QIC▪ Utilize a text area in the note to document

the education given


Medication Reconciliation (Previously Menu)

▪ Med reconciliation selected as performed or not required

▪ Referral tracking entry created

-OR-▪ Response to

Referral performed

>50%


Summary of Care for Referrals (Previously Menu)

>50%▪ Include care

summary box checked

▪ Referral to specialist created


Secure Messaging (Modified Stage 2)

Attest To Only (>5% unique patients seen are sent

secure electronic message)

▪ Functionally is fully enabled▪ Message sent to portal by Provider▪ No minimum patient usage threshold%

You must have the portal implemented at your practice to attest functionality is fully enabled


Demonstration

Let’s Try It!


Questions?


Public Health Objective - New

▪ Single Objective with multiple options▪ Report “active engagement” for 2 of the 5

▪ Immunization Registry - bidirectional (if available)▪ Syndromic Surveillance▪ Case Reporting▪ Public Health Registry Reporting (up to 3 of this type) - other

than IIS▪ Clinical Data Registry Reporting (up to 3 of this type) - includes

ACOs and other non-governmental groups (ePROS)

▪ Multiple exemptions apply▪ Not available to the EP in their area▪ As long as you either registered within 60 days of the start of

your reporting period and are awaiting an invitation from the other party, or are in Testing/Validation, or in Production, you are covered for this objective.

EP’s who would have been Stage 1 in 2015 only required to report a single objective

http://www2.aap.org/pros/epros/


Objectives Removed But...Best Practices

▪ Objectives that have been removed from reporting:▪ Record Demographics▪ Problem List▪ Medication List▪ Allergies▪ Vital Signs▪ Risk Assessment▪ Patient Exit Note (Clinical Visit Summary)

▪ Assumption is you are already doing this CMS is no longer “looking over your shoulder”

Note: If you are also participating in PCMH, these still apply to meet the standards.


Record Demographics (Previously Core)

>50%▪ Gender▪ Date of birth▪ Language▪ Ethnicity▪ Race▪ Unique Patient▪ Visit during reporting period

*All 5 fields must be completed


>80%

▪Problem marked as active/tracking▪SNOMED Code or▪No Active Problems▪Unique Patient▪Visit during reporting period

Up to date Problem List (Previously Core)


Active Medication List (Previously Core)

>80%

▪Entered as structured data with NDC code▪Chronic Flag= Y or▪No Active Medications▪Unique Patient▪Visit during reporting period


Medication Allergy List (Previously Core)

>80%

▪Medication Allergy marked as active▪Medication with NDC #▪SNOMED Code or▪No Active Medication Allergies▪Unique Patient▪Visit during reporting period


Interaction Checking

Attest to Only

▪ Med/Med▪ Med/Allergy▪ Must be available and enabled

during reporting period


Vital Signs

>50%

▪ Measurements recorded (in the vitals/growth tab):

▪ Height▪ Weight▪ BP

▪ BMI calculated▪ Growth measurements plotted▪ Unique patient▪ Visit during reporting period▪ All ages for height/weight▪ Patient >3 years for BP▪ Ages 2-20 for BMI and Growth charts


Risk Assessment

>50%

▪Smoking status recorded

▪Unique patient▪Visit during reporting period▪13 years or older


Clinical Summaries

>50%

▪Patient exit note created▪ Electronic or printed▪ Within 3 business days*

▪All visits during reporting period


MU Stage 1 - Menu Measures

There will not be any Menu Measures to choose from in 2015 through 2017 in Modified Stage 2 Reporting

•5 of 9 measures must be reported

•1 Measure must be from the Public Health Menu Options

•Measures are performance based with some "Attest Only"


Drug Formulary Checks (Previously Menu)

▪ From the medication finder, the Check Formulary box is available. For all connected payers, Office Practicum is fully integrated with DrFirst to populate any formulary information available.

This is “attest to” only


Patient List by Specific Conditions - Menu

▪ Attest to Only▪ This can be accomplished by using the

demographic analysis/recall report


Clinical Lab Test Results (Previously Menu)

>40%

▪ Positive/Negative result or numeric value

▪ All labs ordered during reporting period

Hearing/Vision do not count toward totalIf your practice has a lab interface, this can be more easily achieved


Patient Reminders (Previously Menu)

>20%

▪ Reminder or recall sent using Patient Message Exchange*

▪ Unique patient▪ 5 years and younger

*Must have and use the Patient Message Exchange in OP for Reminders


Demonstration

Let’s Try It!


Questions?


Intermission


Meaningful Use


Have you run the QIC?

Quality Improvement Calculator

Threshold not met

Exclusions; no minimum threshold; no data

Threshold met


Lets run the QIC

Let’s Run the QIC!


Questions?


Clinical Quality Measures

● Clinical Quality Measures (9 total)● Must come from at least 3 of the

6 policy domains○ Patient and family

engagement○ Patient Safety○ Care Coordination○ Population and Public Health○ Efficient use of Healthcare

Resources○ Clinical

Processes/Effectiveness

What needs to be Reported?

No required threshold/passing metrics for CQM’s



QRDA file

Patient

QRDA III file

Provider Patient files



LET’S TAKE A LOOK BY DOMAIN

The information presented are the reports delivered in the QIC for the 2014 CQM’s. Must have OP 14 installed for the 2015 CQM calculations.



PEDIATRIC SUGGESTED CLINICAL QUALITY MEASURES

Measure Domain

Appropriate Testing for Children with Pharyngitis Efficient Use of Healthcare Resources

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

Efficient Use of Healthcare Resources

Chlamydia Screening for Women Population/ Public Health

Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents

Population/ Public Health

Childhood Immunization Status Population/ Public Health



PEDIATRIC SUGGESTED CLINICAL QUALITY MEASURES

Measure Domain

Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

Population/ Public Health

ADHD: Follow-Up Care for Children Prescribed Attention Deficit/Hyperactivity Disorder (ADHD) Medication

Clinical Process/ Effectiveness

Children who have dental decay or cavities Clinical Process/ Effectiveness

Use of Appropriate Medications for Asthma Clinical Process/ Effectiveness



EFFICIENT USE OF HEALTHCARE RESOURCES

Measure: NQF 0002

Appropriate Testing for Children with Pharyngitis

● Patients 2-18 years old● Coding on visit for Pharyngitis● Strep test complete● Antibiotic prescribed, if appropriate




Measure: NQF 0069

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

● Patients 3 months - 18 years old● Coding on visit for Upper Respiratory Infection● Antibiotic not prescribed up to 3 days after the

diagnosis



POPULATION AND PUBLIC HEALTH

Measure: NQF 0033

Chlamydia Screening for Women

● Sexually Active women aged 16-24● One Chlamydia test done during the reporting

period



POPULATION AND PUBLIC HEALTHMeasure: NQF 0033

Chlamydia Screening for Women

● Problem List entry for Sexually Active● Set Visibility level on problem list entry for

confidentiality● Make active the Chlamydia Care Plan● Enroll in Chlamydia Care Plan● Test for Chlamydia

Suggested Documentation in OP





● Children 3-17 years● BMI calculated● Documented counseling for nutrition (V65.3) and

physical activity (V65.41) during the reporting period.○ *ICD-10 Code Z71.3 - Nutrition○ *ICD-10 Code Z71.89 - Physical Activity





● ICD-9 code included with well visit: V65.41 (Physical Activity Counseling) *ICD-10=Z71.89

● ICD9 code included with well visit: V65.3 (Nutrition Counseling) *ICD-10=Z71.3

● Height/Weight taken at visit to calculate BMI● Templates include documentation (Anticipatory

Guidance)

Suggested Documentation in OP:




Childhood Immunization Status● Follow vaccine schedule for vaccines

administered prior to 2nd birthday● 4 DTaP● 3 IPV● 1 MMR● 3 HiB● 3 Hep B● 1 Varicella● 4 PCV● 1 Hep A● 2-3 Rotavirus● 2 flu


Demonstration

Let’s try it!




Measure: NQF 0418

Screening for Clinical Depression and Follow-Up Plan

● 12 years and older prior to the beginning of the measure period

● Screening for depression on date of visit● If positive, follow up plan documented on date of

visit


Suggested Documentation in OP:● Survey complete for depression

○ Add survey to templates○ Risk Assessment

● If survey is positive, plan documented for follow-up○ document in the Plan of the note○ document in the Counseling of the note (can

set visibility)○ Follow-up task for return visit for depression


Screening for Clinical Depression and Follow-Up Plan




CLINICAL PROCESSES/EFFECTIVENESS

Measure: NQF 0108_a

Follow-Up Care for Children Prescribed ADHD Medication● Patients aged 6-12 years● Newly prescribed ADHD medication during initial

visit● Follow up care 30 days after prescribing

medication● 2 additional follow-up visits after the initial 30

days (within 9 months)



CLINICAL PROCESSES/EFFECTIVENESSMeasure: NQF 0108_a

Follow-Up Care for Children Prescribed ADHD Medication

● First time prescribing ADHD Medication

● Follow-up visit within 30 days of prescribing

● 2 additional follow-up visits after the initial 30 days○ must be charted within 9 months○ must have remained on the medication

prescribed





Measure: CMS75v1

Children with Dental Decay or Cavities

● Patients aged 0-20 years● Dental cavities or tooth decay noted during the

reporting period




Measure: CMS75v1

Children with Dental Decay or Cavities

● ICD code on visit for Dental Decay/cavities-OR-

● Problem List entry for Dental Decay/cavities

● Document findings in visit note





Measure: NQF 0036

Use of Appropriate Medications for Asthma

● Patients aged 5-64 years● Persistent Asthma identified● Asthma medication prescribed during the

reporting period




Measure: NQF 0036

Use of Appropriate Medications for Asthma

● Problem List entry for Persistent Asthma○ SNOMED code with the word persistent

-OR-○ Stage/Severity with the word persistent

● Asthma medication prescribed during the reporting period



Demonstration

Let’s try it!


Questions?



ALTERNATE PEDIATRIC REPORTS AVAILABLE IN OFFICE

PRACTICUMMeasure Domain

Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment

Patient Safety

Closing the Referral Loop: Receipt of Specialist Report Care Coordination

Influenza Immunization Population and Public Health

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Clinical Processes/Effectiveness

Hemoglobin A1c Test for Pediatric Patients Clinical Processes/Effectiveness

Primary Caries Prevention Intervention Clinical Processes/Effectiveness



PATIENT SAFETY

Measure: NQF 1365Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment

● Patients aged 6-17 years● Diagnosis of MDD● Suicide risk assessment completed at each visit

during the measurement period.



CARE COORDINATION

Measure: CMS50v1Closing the Referral Loop: Receipt of Specialist Report

● No age restriction● Referral created during the reporting period● Report received from the provider the patient

was referred (specialist)




Influenza Immunization

● 6 months and older● Seen between October 1 and March 31● OR prior influenza immunization




Measure: NQF 0004_a

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

● Patients 13 years and older● Diagnosis of AOD during a visit in the first 11

months of the reporting period● Treatment initiated within 14 days of the

diagnosis




Measure: NQF 0060

Hemoglobin A1c Test for Pediatric Patients

● Patients aged 5-17 years● Diabetes recorded on the Problem List● Visit during the reporting period and a visit 12

months prior● HgbA1c test done during the reporting period




Measure: CMS74v2

Primary Caries Prevention Intervention

● Patients aged 0-20 years● Fluoride varnish application during the reporting

period



OTHER REPORTS AVAILABLE IN OFFICE PRACTICUM

Measure Domain

Documentation of Current Medication Patient Safety

Preventive Care and Screening Pair: Tobacco Use Assessment and Tobacco Cessation Intervention

Population and Public Health

Adult Weight Screening and Follow-up Population and Public Health

Maternal Depression Screening Population and Public Health

Screening for High Blood Pressure and Follow-Up Documented

Population and Public Health



OTHER REPORTS AVAILABLE IN OFFICE PRACTICUM

Measure Domain

Use of Imaging Studies for Low Back Pain Efficient Use of Healthcare Resources

Controlling High Blood Pressure Clinical Processes/Effectiveness

Antidepressant Medication Management Clinical Processes/Effectiveness



PATIENT AND FAMILY ENGAGEMENT

No reporting will be available within this domain in Office Practicum for Pediatrics.



PATIENT SAFETY

Measure: NQF 0419Documentation of Current Medications

● 18 years and older prior to the beginning of the reporting period

● Complete medication list to include OTC’s, herbals, vitamins, etc.

● Must contain name, dosage, frequency and route




Preventive Care and Screening Pair: Tobacco Use Assessment and Tobacco Cessation Intervention

● 18 years and older● Risk Assessment/Smoking Status evaluated● If positive, counseling done or smoking

cessation prescribed




Adult Weight Screening and Follow-up

● 18 years and older● BMI calculated and outside the normal

parameters during the encounter or 6 months prior

● Follow up plan documented 6 months prior to reporting period or during the reporting period.




Measure: NQF 1401

Maternal Depression Screening

● Child turned 6 months within the reporting period

● Visit during the reporting period● Maternal screening done between 0 - 6

months (Edinburgh or PHQ-2 surveys)



POPULATION AND PUBLIC HEALTHMeasure: CMS22v1

Screening for High Blood Pressure and Follow-Up Documented

● 18 years and older● Problem list entry for Hypertension● Recommended follow up documented



Measure: NQF 0052

Use of Imaging Studies for Low Back Pain

● Patient aged 18-50 years● Visit coded for low back pain● No imaging studies within 28 days of the

diagnosis





Measure: NQF 0018

Controlling High Blood Pressure● Patients aged 18-85 years● Hypertension recorded on Problem List prior to the

reporting period or 6 months within the reporting period

● Blood Pressure measured less than 140/90 during the reporting period



Measure: NQF 0105_a

Antidepressant Medication Management

● Patients 18 years and older● Diagnosis of major depression 6 months prior or

the first 6 months of the reporting period● Treatment with antidepressant medication for at

least 84 days



Action Items

▪ Update to latest OP version to receive new QIC with 2014 reports

▪ Decide on reporting period▪ Choose Menu Measures▪ Choose your Public Health objectives▪ Choose Clinical Quality Measures for

reporting ▪ Run QIC to determine a baseline▪ Share results with your staff▪ Create strategies and develop internal

workflows to ensure measures are met


Resources

2014 Definition Stage 1 of Meaningful Use

Meaningful Use Core and Menu Set Objectives

Introduction to EHR Incentive Program for Eligible Professionals

Stage 1 Worksheet

Federal Register

Regional Extension Centers

OP Patient Portal

OP Demographic Analysis and Recall Report

OP Patient Message Exchange

http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_MU_TableOfContents.pdf

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_Medicaid_Guide_Remediated_2012.pdf

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_Medicaid_Guide_Remediated_2012.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_Attestation_Stage1Worksheet_2014Edition.pdf

https://www.federalregister.gov/articles/2014/05/23/2014-11944/medicare-and-medicaid-programs-modifications-to-the-medicare-and-medicaid-electronic-health-record

http://www.healthit.gov/providers-professionals/listing-regional-extension-centers

https://help.connexinsoftware.com/display/PortalDoc16/Welcome

https://help.connexinsoftware.com/display/OP140/Demographic+Analysis+and+Recall

https://help.connexinsoftware.com/display/OP140/Patient+Message+eXchange


Meaningful Use - Stage 1


Meaningful Use - 2015

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Documents

2015 User Conference Pre-Conference: Meaningful Use Stage 1 2015 April 23, 2015 Presented by: Angela Schnack Training Specialist EHR Session