Road to Meaningful Use Webinars Meaningful Use Criteria in Centricity 9.5 Presented by Tom Forsberg & Mirian Smith HealthSystems October 15th

Meaningful Use Webinars Oct 15th - Road to Meaningful Use – MU Criteria in Centricity V9.5 Nov 19th - Road to Meaningful Use – MQIC / PQRI Dec 2nd - Road to Meaningful Use – Centricity Physician Discusses MU Objectives and Measures

Slide 2

Agenda 1. 2. 3. 4. 5. 6.

Meaningful Use Description Terms Preparing for Meaningful Use Meaningful Use Incentives Stage 1 – Meaningful Use Measures Meaningful Use Objectives certified with CPS and EMR Version 9.5

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“Meaningful Use” Description  HITECH Act • Part of American Recovery and Reinvestment Act of 2009 (ARRA) • $30B+ for HIT infrastructure and EMR adoption/use  Meaningful Use • Eligible Professionals (EP’s) must demonstrate “Meaningful Use” of a Certified EMR to receive Medicare or Medicaid EMR incentives. EP’s can only participate in one of these incentive programs, but not both.  Medicare Incentives • EP’s can receive up to $44,000 over a five year period.  Medicaid Incentives • EP’s with 30% of their volume attributable to Medicaid (20% for pediatricians) can receive up to $63,750 over a six year period.

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“Terms”  MU Objectives: EMR Certification Criteria to meet Meaningful Use  MU Measures: The reporting requirements for the defined EMR Criteria  CCR: Continuity of Care Record - A patient health summary standard that creates flexible documents containing the most relevant and timely core health information about a patient, that can be sent electronically from one care giver to another. It contains various sections such as patient demographics, insurance information, diagnosis and problem list, medications, allergies and care plan.  CCD: Continuity of Care Document - A patient summary standard containing a core data set of the most relevant administrative, demographic, and clinical information facts about a patient's healthcare, covering one or more healthcare encounters. It provides a means for one healthcare practitioner, system, or setting to aggregate all of the pertinent data about a patient and forward it to another practitioner, system, or setting to support the continuity of care.  ONC: The abbreviation for the Office of the National Coordinator for Health Information Technology  MQIC: The Medical Quality Improvement Consortium – A GE Solution for practices to report Meaning Use and get feedback on quality improvement.  NIST: National Institute of Standards and Technology  FIPS - Federal Information Processing Standards  ATNA - is a database auditing method called Audit Trail and Node Authentication (ATNA)  SHA-1 - is a secure data transmission method called cryptographic hash function designed by the National Security Agency (NSA)

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Preparing for “Meaningful Use” Meeting “Meaningful Use” requirements, will mean: – – – – –

Having an EMR solution Having an e-Prescribing solution Having a Patient Portal solution (with Secure Login) Having a plan to report the use of these solutions to CMS CPS Version 9.5 and EMR 9.5 will support the Stage 1 “Meaningful Use” requirements by CMS. Stage I focuses on capturing data in structured formats, implementing clinical decision support, and reporting clinical quality measures. – Stage 2 expands Stage I criteria to encourage continuous quality improvement at the point of care and the exchange of information including orders and diagnostic test results. Stage 2 will be released in the coming years – Stage 3 promotes improved quality outcomes related to safety and efficiency by emphasizing decision support for high priority decisions and will be released in the coming years. – CMS incentives are distributed based on the practice’s annual reporting of the appropriate measures related to “Meaningful Use”. Slide 6

Medicare Incentive Impact: Physicians Stimulus Physician Medicare Incentives Pay-Out Year Start Date 2011 2012 2013 2014 2015

2011 $ 18

Per Physician In Thousands

2012

2013

2014

2015

2016

$

44

2

$

44

$

4

$

39

$

4

$

24

$ 12

$

8

$

4

$

2

$ -

$ 18

$ 12

$

8

$

4

$

$ 15

$ 12

$

8

$ 12

$

8

$ -

Totals

$ -

$

-

Medicare Penalties: % of allowed charges: 2015 (1%), 2016 (2%), 2017+ (3%) Note: 2011 will only require reporting for a 90 Day window

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Meaningful Use Measures Core Set: Stage 1 measures for Eligible Professionals Measures 1 2 3 4 5 6 7 8 9 10 11

Requirement 30% Yes/No 40% 80% 80% 80% 50% 50% 50% Yes/No Yes/No

12 13 14 15

50% 50% Yes/No Yes/No

Description Of Criteria CPOE used for medication orders Drug to drug, drug to allergy interaction checks Prescriptions transmitted electronically when permissible with certified EMR Problems entered as structured data or none noted Medications entered as structured data or none noted Allergies entered as structured data or none noted Demographics entered as structured data Vital Signs are recorded in pt over 2 y/o with ht, wt, BP Smoking status is recorded in pt's over 13 y/o Implement 1 CDS rule relevant to specialty or high clinical priority Report quality measures to CMS - 3 core and 3 other Upon request provide pt electronic copy of health information within 3 days (dx results, prob/med/allergy) Clinical summaries provided for each office visit within 3 days Test certified EMR to electronically exchange key clinical data Conduct or review security risk analysis and implement security updates

Note: Practices will be required to report on all of the 15 core Set Measures

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Meaningful Use Measures – Reporting (continued) Menu Set: Stage 1 measures for Eligible Professionals Measures

Requirement

Description Of Criteria

1 2

Yes/No 50%

3

Yes/No

4

10%

Provide drug formulary check Clinical lab tests (neg/pos or numeric) are entered as structured data Generate lists of pt with specific conditions to use for QI, standardized management or outreach Provide pt electronic access to health information (lab results, prob/med/allergy lists)

5 6

20% 10%

Send reminders to pt (per pt preference) for preventive/ follow-up care Provide patient Education materials

7

50%

Perform medication reconciliation of relevant encounters and each transition of care

8 *9

50% Yes/No

Provide care summary for each transition of care and referral Test certified EMR capacity to submit electronic data to immunization registry

*10

Yes/No

Test certified EMR capacity to submit electronic data to public health agencies

Note: Practices will be required to report 5 of the 10 of the Menu Set measures. * Must select one public health reporting requirement Slide 9

Report quality measures to CMS - 3 Core Quality Measures and 3 Alternate set of Quality Measures “Core Set Measure 11”, means reporting 6 total quality measures from the selections below: Select 3 “Core Quality” Measures Child/Adolescent weight Childhood immunization status Adult over 50 Influenza status

* Alternate Core Measures if the above do not apply Blood pressure measurement Tobacco use Adult weight screening and follow-up

Select 3 Alternate Quality Measures 38 additional clinical quality measures to choose from

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Alternate Set of Clinical Quality Measures Select 3 from these 38 quality measures. 1. 2. 3. 4.

Diabetes: Hemoglobin A1c Poor Control Diabetes: Low Density Lipoprotein (LDL) Management and Control Diabetes: Blood Pressure Management Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) 6. Pneumonia Vaccination Status for Older Adults 7. Breast Cancer Screening 8. Colorectal Cancer Screening 9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD 10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 11. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment 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 the Physician Managing Ongoing Diabetes Care 15. Asthma Pharmacologic Therapy 16. Asthma Assessment 17. Appropriate Testing for Children with Pharyngitis 18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer 19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients

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Alternate Set of Clinical Quality Measures Select 3 from these 38 other quality measures. 20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 21. Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 22. Diabetes: Eye Exam 23. Diabetes: Urine Screening 24. Diabetes: Foot Exam 25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol 26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation 27. Ischemic Vascular Disease (IVD): Blood Pressure Management 28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement 30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) 31. Prenatal Care: Anti-D Immune Globulin 32. Controlling High Blood Pressure 33. Cervical Cancer Screening 34. Chlamydia Screening for Women 35. Use of Appropriate Medications for Asthma 36. Low Back Pain: Use of Imaging Studies 37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 38. Diabetes: Hemoglobin A1c Control (