A Roadmap to Meaningful Use

Protecting Your Peace of MindProtecting Your Peace of Mind

A Roadmap to Meaningful Use

Session One:Unraveling What it Takes to be a

Meaningful User

August 24, 2010


Objectives

Basics

Core Criteria

Menu criteria

Report/AttestMeaningful User

Navigating Stage One


Meaningful Facts

ARRA HITECH EHR Incentive Program

Program to Provide Monetary Incentives for the “Meaningful Use” of Healthcare Technology

Final Rule Published July 28, 2010(http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf)

http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf


Meaningful Facts

Healthcare Transformation

Quality

Efficiency

Information Exchange

Safety Improved Health of

Americans

Protecting Your Peace of Mind

Implementation Approach

Stage One

Stage TwoStage ThreeStage One


Stage One at a GlanceMenu Criteria Core Criteria


Core Set Criteria Patient Demographics Vital Signs Problem List Medication List Medication Allergy List Smoking Status Clinical Summaries or

Discharge Summary Electronic Copies of

Patient Health Information Electronic Prescriptions

(eRx)

CPOE (Medications) Drug-Drug, Drug-Allergy

Interactions Electronically Exchange

Key Clinical Info Among Providers and Patient-Authorized Entities

Clinical Decision Support

Privacy & Security Clinical Quality

Reporting


Patient Demographics

Record patient demographics (sex, race, ethnicity, date of birth,

preferred language, and in the case of hospitals, date and preliminary

cause of death in the event of mortality)

•Measure: •More than 50% of patient’s demographic data recorded as

structured data•Denominator:•The number of unique patients seen by the EP or admitted

as IP or through ER during the EHR reporting period•Numerator: •The number of patients in the denominator who have all the

elements of demographics (or a specific exclusion if the patient declines to provide one or more elements) recorded as structured data

Begins on pg 44340 of Federal RegisterHelpful Link: http://www.whitehouse.gov/omb/inforeg_statpolicy/#dr

http://www.whitehouse.gov/omb/inforeg_statpolicy/#dr


Vital Signs

Record vital signs and chart changes (height, weight, blood

pressure, body-mass-index, growth charts for children)

•Measure: •More than 50% of patients 2 years of age or older have

height, weight, and blood pressure recorded as structured data

•Denominator:•The number of unique patients age 2 or older seen by the EP

or admitted as IP or through ER during the EHR reporting period

•Numerator: •The number of patients in the denominator who have at

least one entry of their height, weight and blood pressure recorded as structured data

Begins on pg 44342 of Federal Register


Problem List

Maintain up-to-date problem list of current

and active diagnosis

•Measure: •More than 80% of patients have at least one entry recorded

as structured data•Denominator:•The number of unique patients seen by the EP or admitted

as IP or through ER during the EHR reporting period•Numerator: •The number of patients in the denominator who have at

least one entry or an indication that no problems are known for the patient recorded as structured data in their problem list



Medication List

Maintain active medication list



as IP or through ER during the EHR reporting period•Numerator: •The number of patients in the denominator who have a

medication (or an indication that the patient is not currently prescribed any medication) recorded as structured data



Medication Allergy List

Maintain active medication allergy

list



as IP or through ER during the EHR reporting period•Numerator: •The number of patients in the denominator who have at

least one entry (or an indication that the patient has no known medication allergies) recorded as structured data in their medication allergy list



Smoking Status

Record smoking status for patients 13 years of age or older

•Measure: •More than 50% of patients 13 years of age or older

have smoking status recorded as structured data•Denominator:•The number of unique patients seen by the EP or

admitted as IP or through ER during the EHR reporting period

•Numerator: •The number of patients in the denominator with

smoking status recorded as structured data.

Begins on pg 44344 of Federal RegisterHelpful Link: http://www.cdc.gov/nchs/nhis/tobacco/tobacco_recodes.htm.

http://www.cdc.gov/nchs/nhis/tobacco/tobacco_recodes.htm


Office Visit Summaries / Discharge Instructions

For individual professionals, provide patients with clinical summaries for

each office visit; for hospitals, provide an electronic copy of hospital

discharge instructions on request

•Measure: •Summaries provided to patients for more than 50% of all office

visits within 3 business days; more than 50% of all patients who are discharged from the IP department or ER department of hospitals and who request an electronic copy of their discharge instructions are provided with it

•Denominator:•The number of unique patients seen by the EP or admitted as IP

or through ER during the EHR reporting period•Numerator: •The number of patients in the denominator who are provided a

clinical summary of their visit within three business days



Electronic Copies of Patient Health Information

On request, provide patients with an electronic copy of their health

information (including diagnostic test results, problem list, medication lists,

medication allergies, and for hospitals, discharge summary and procedures)

•Measure: •More than 50% of requesting patients receive an electronic

copy within 3 business days•Denominator:•The number of patients of the EP or hospital who request an

electronic copy of their electronic health information within 3 business days prior to the end of the EHR reporting period

•Numerator: •The number of patients in the denominator who receive an

electronic copy of their electronic health information within 3 business days



CPOE (Medications)

Computer provided order entry (CPOE)

for medication orders

•Measure: •More than 30% of patients with at least one medication in

their list have at least one medication ordered through CPOE•Denominator:•The number of unique patients with at least one medication

in their medication list seen by the EP or admitted as IP or through ER during the EHR reporting period

•Numerator: •The number of patients in the denominator that have at

least one mediation order entered using CPOE



Electronic Prescriptions (eRx)

Generate and transmit permissible prescriptions electronically (does not

apply to hospitals)

•Measure: •More than 40% are transmitted electronically using certified

EHR technology•Denominator:•The number of prescriptions written (for those patients

whose records are maintained using certified EHR technology) for drugs requiring a prescription in order to be dispensed other than controlled substances during the reporting period

•Numerator: •The number of prescriptions in the denominator generated

and transmitted electronically

Begins on pg 44337 of Federal RegisterHelpful Link: http://www.deadiversion.usdoj.gov/schedules/orangebook/e_cs_sched.pdfObjective applies to EPs only.

http://www.deadiversion.usdoj.gov/schedules/orangebook/e_cs_sched.pdf


Electronic Prescriptions (eRx)

200 Prescriptions

80% (or percentage

allowable by law)

160 prescriptions allowable by

law

160 Prescriptions

40% sent electronically

64 prescriptions

sent electronically


Drug-Drug, Drug-Allergy Interactions

Implement drug-drug and drug-allergy

interaction checks

•Measure: •Functionality is enabled for these

checks for the entire reporting period•Denominator:•N/A (Attestation)•Numerator: •N/A (Attestation)



Electronically Exchange Key Clinical Info Among Providers and Patient-Authorized Entities

Implement capability to electronically exchange key clinical information among

providers and patient-authorized entities

•Measure: •Perform at least one test of EHR's

capacity to electronically exchange information

•Denominator:•N/A (Attestation)•Numerator: •N/A (Attestation)



Clinical Decision Support (CDS)

EPs: Implement one CDS rule relevant to specialty or high clinical priority along with

the ability to track compliance.EHs/CAHs: Implement one CDS rule

related o a high priority hospital condition along with the ability to track compliance

•Measure: •One clinical decision support rule

implemented•Denominator:•N/A (Attestation)•Numerator: •N/A (Attestation)



Privacy & Security

Implement systems to protect privacy and

security of patient data in the EHR

•Measure: •Conduct or review a security risk analysis,

implement security updates as necessary, and correct identified security deficiencies


Begins on pg 44368 of Federal RegisterHelpful Link: http://edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.308.pdf

http://edocket.access.gpo.gov/cfr_2003/octqtr/pdf/45cfr164.308.pdf


Clinical Quality Measures

Report clinical quality measures to CMS or states

•Measure: •EPs report on a minimum of three

Core Clinical Quality Measures and three optional Clinical Quality Measures (from 44 available options). EHs, CAHs, MA Hospitals report on 15 hospital specific measures

Begins on pg 44380 of Federal RegisterHelpful Link: http://www.ama-assn.org/ama1/pub/upload/mm/399/ehr-clinical-quality-measures.pdf

http://www.ama-assn.org/ama1/pub/upload/mm/399/ehr-clinical-quality-measures.pdf


Menu Set Criteria Drug Formulary Checks Clinical Laboratory Test Results as Structured Data Report Patients By Condition Patient-Specific Education Medication Reconciliation Summary of Care Records for Transitions of Care Submit Immunization Data Syndromic Surveillance Reporting Advanced Directives Indicator (EH or CAH ONLY) Lab Results Reports (EH or CAH ONLY) Patient Reminders for Preventative Care (EP OPTION ONLY) Provide Patients Timely Electronic Access to Health

Information (EP OPTION ONLY)


Drug Formulary Checks

Implement drug formulary checks

•Measure: •Drug formulary check system is

implemented and has access to at least one internal or external drug formulary for the entire reporting period




Clinical Laboratory Test Results as Structured Data

Incorporate clinical laboratory test results

into EHRs as structured data

•Measure: •More than 40% of clinical laboratory test results whose results are in

positive/negative or numerical format are incorporated into EHRs as structured data

•Denominator:•The number of lab tests ordered during the EHR reporting period by

the EP or authorized providers of the eligible hospital or CAH for patients admitted to and EH or CAH's IP or ER dept whose results are expressed in a positive or negative affirmation or as numbers

•Numerator: •The number of lab test results whose results are expressed in a

positive or negative affirmation or as a number which are incorporated as structured data



Report Patients By Condition

Generate lists of patients by specific conditions to use for

quality improvement, reduction of disparities,

research or outreach

•Measure: •Generate at least one listing of

patients with a specific condition•Denominator:•N/A (Attestation)•Numerator: •N/A (Attestation)



Patient-Specific Education

Use EHR technology to identify patient-specific education

resources and provide those to the patient as appropriate

•Measure: •More than 10% of patients are provided with

patient-specific education resources•Denominator:•The number of unique patients seen by the EP or

admitted as IP or through ER during the EHR reporting period

•Numerator: •The number of patients in the denominator who are

provided patient education specific resources



Medication Reconciliation

The EP, eligible hospital or CAH who receives a patient from another

setting of care or provider of care or believes an encounter is relevant

should perform medication reconciliation

•Measure: •Medication reconciliation is performed for more

than 50% of transitions of care•Denominator:•The number of transitions of care during the EHR

reporting period for which the EP or hospital's IP or ER dept was the receiving party of the transition

•Numerator: •The number of transitions of care in the

denominator where medication reconciliation was performed



Summary of Care Records for Transitions of Care

Provide summary of care record for patients referred or transitioned to another

provider or setting

•Measure: •Summary of care record is provided for more than

50% of patient transitions or referrals•Denominator:•The number of transitions of care during the EHR

reporting period for which the EP or hospital's IP or ER dept was the transferring or referring provider

•Numerator: •The number of transitions of care and referrals in

the denominator where a summary of care record was provided



Submit Immunization Data

Submit electronic immunization data to

registries or immunization information systems (IIS)

•Measure: •Perform at least one test of data submission

and follow-up submission (where registries can accept electronic submission)


Begins on pg 44325 of Federal RegisterHelpful Link: : http://www.cdc.gov/vaccines/programs/iis/stds/cvx.htm Helpful Link: http://www.cdc.gov/vaccines/programs/iis/contacts-state-iis.htm#a

http://www.cdc.gov/vaccines/programs/iis/stds/cvx.htm

http://www.cdc.gov/vaccines/programs/iis/contacts-state-iis.htm#a


Syndromic Surveillance Reporting

Submit electronic syndromic surveillance data to public health

agencies


and follow-up submission (where public health agencies can accept electronic data)




Advanced Directive Indicator

Record advanced directives for patients

65 years of age or older

•Measure: •More than 50% of patients 65 years of age or older

have an indication of an advanced directive status recorded

•Denominator:•The number of unique patients admitted as IP or

through ER during the EHR reporting period•Numerator: •The number of patients in the denominator who

have an indication of an advanced directive status record

Begins on pg 44345 of Federal RegisterApplies to EHs, CAH, and MA Hospitals Only


Lab Results Reports

Submit of electronic data on reportable

laboratory results to public health agencies


and follow-up submission (where public health agencies can accept electronic data)


Begins on pg 44366 of Federal RegisterApplies to EHs, CAH, and MA Hospitals Only


Preventative Care Reminders

Send Reminders to patients (per patient preference) for preventative and follow up

care

•Measure: •More than 20% of patients 65 years of age or older of 5

years of age or younger are sent appropriate reminders•Denominator:•The number of unique patients (for those patients

whose records are maintained using certified EHR technology) ages 65 and older or 5 years and younger

•Numerator: •The number of patients in the denominator who were

sent the appropriate reminder

Begins on pg 44357 of Federal RegisterApplies to EPs Only


Provide Patients Timely Access to Health Information

Provide patients with timely electronic access to their health

information (including laboratory results, problem list, medication

list, medication allergies)

•Measure: •More than 10% of patients are provided electronic access to

information within 4 days of its being updated in the EHR (subject to the EP's discretion to withhold certain information)

•Denominator:•The number of unique patients seen by the EP during the EHR

reporting period•Numerator: •The number of patients in the denominator who have timely

(available to the patient within 4 business days of being updated in the certified EHR technology) electronic access to their health information online

Begins on pg 170 of Federal RegisterApplies to EPs Only


Next Steps

Complete Assessments

Certi

fied

Tech

nolo

gyPurchase?Review Vendor Plan?

Chan

ge M

anag

emen

tGauge EHR Readiness

Elig

ibili

tySelect ProgramEnroll

Core

Set

Obj

ectiv

esIdentify GapsCreate Implementation Plan

Men

u Se

t Obj

ectiv

esSelect five criteriaIdentify GapsCreate Implementation Plan


MMIC Meaningful Use Resources

Visit us at: www.mmicgroup.com

Join us for future MU webinars– Meaningful Evaluation: Assessments for MU Success • Tuesday, September 21, 2010

– Building and Implementing your MU Strategy • Tuesday, October 12, 2010

Review MU reference material– MU Program Overview and FAQs– MU Core Criteria FAQs– MU Menu Criteria FAQs

http://www.mmicgroup.com/


MMIC Meaningful Use Services

Contact MMIC Health IT for:– EHR Incentive Program Eligibility Assessment– EHR Gap Analysis and Summary Report Services– Meaningful Use Roadmap and Project Planning

Contact Information:– Beth Schultz, Implementation Manager – [email protected]– 952-838-6854

mailto:[email protected]


Helpful Websites

http://www.cms.gov/EHRIncentivePrograms/

http://healthit.hhs.gov

Additional Questions/Support? Contact: [email protected]

Thank you

http://www.cms.gov/EHRIncentivePrograms/

http://healthit.hhs.gov/

mailto:[email protected]

Documents

A Roadmap to Meaningful Use