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Miranda Ladue, Manager, Product ManagementAdam Plotts, Manager, Product Management
Understanding Meaningful Use Stage 2
Copyright © 2011 Allscripts Healthcare Solutions, Inc.
Agenda
• Review MU Timeline
• MU 2 Overview
• Review of major changes
• EEHR Timeline & Proposed Functionality
• Q&A
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Review MU Timeline
• MU 2 Overview
• Review of major changes
• EEHR Timeline & Proposed Functionality
• Q&A
2
Stage of MU by first payment yearFirst Payment
Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011 1 1 1 2 2 3 3 TBD TBD TBD TBD
2012 1 1 2 2 3 3 TBD TBD TBD TBD
2013 1 1 2 2 3 3 TBD TBD TBD
2014 1 1 2 2 3 3 TBD TBD
2015 1 1 2 2 3 3 TBD
2016 1 1 2 2 3 3
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
2016 1 1 2 2 3 3
2017 1 1 2 2 3
3
“If there will be a Stage 4 of meaningful use, we expect to update this table in the
rulemaking for Stage 3.”
NOTE: Medicare penalties we begin being assess 2015 for EP not attesting
Reporting periodsProviderType
ReportingPeriod Year 1 Submission Period Year 1
SubsequentReporting Periods
Subsequent SubmissionPeriods
EP 90 days Anytime immediate following theend of the 90-day reportingperiod, but no later than February28 of the following calendar year.
1 calendar year(January 1 -December 31)
2 months following theend of the EHR reportingperiod (January 1 -February 28)
EligibleHospital /CAH
90 days Anytime immediatefollowing the end of the 90-dayreporting period, but no later thanNovember 30 of the followingfiscal year.
1 fiscal year(October1 -September30)
2 months following theend of the EHR reportingperiod (October 1 -November 30)
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
EligibleHospital /CAH
Anytime immediatefollowing the end of the 90-dayreporting period, but no later thanNovember 30 of the followingfiscal year.
1 fiscal year(October1 -September30)
2 months following theend of the EHR reportingperiod (October 1 -November 30)
4
If you begin program participation in 2014, the 90 continues days of demonstrating
MU must conclude three months prior to the end of the year.
Q4
Proposed Stage 2Ruling60 Day Comment Period
5Road to Meaningful Use Stage 2
Q1
Stage 2 RulingHITPC Recommendationson Stage 2
Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
20122012 20132013 20142014
Q3 Q4
20112011
Proposed Stage 2Reporting Period(For Stage 1 2011/2012Reporting)
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
Stage 2 RulingHITPC Recommendationson Stage 2 Proposed Stage 2
Reporting Period(For Stage 1 2011/2012Reporting)
Ambulatory Considerations
2• Clinical Decision Support• Patient Portal Requirements• Emphasis on information exchange• Stretch of MU Stage 1 Goals
Clinical QualityMeasures
Stage 1 - 44Stage 2 – 125*
Road to Meaningful Use Stage 2Allscripts comments on NPRM
https://clientconnect.allscripts.com/groups/arrapractices/blog/2012/04/25/allscripts-guidance-for-mu-stage-2-comments
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
Allscripts comments on NPRM
https://clientconnect.allscripts.com/groups/arrapractices/blog/2012/04/25/allscripts-guidance-for-mu-stage-2-comments
6
Key themes
• Continuing the drive to value-driven healthcare
• Raising the bar on most measures
• Adding new administrative & clinical measures
• Special emphasis on information exchange
• Clinical measures
• Administrative measures
• More flexibility and options, including changes for 2013
• Special emphasis on penalties, reviews and appeals
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Continuing the drive to value-driven healthcare
• Raising the bar on most measures
• Adding new administrative & clinical measures
• Special emphasis on information exchange
• Clinical measures
• Administrative measures
• More flexibility and options, including changes for 2013
• Special emphasis on penalties, reviews and appeals
7
• Registries
• Attestation
Summary of Major Provisions
Stage 1 Stage 2EP Measures 15 core, 5 of 10 menu 17 core, 3 of 5 menu
EH Measures 14 core, 5 of 10 menu 16 core, 2 of 4 menu
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health 8
EP CQM 6 CQMs out of 46 12 CQMs out of 125
EH CQM 6 CQMs out of 46 24 CQMs out of 49
Stage 2 goals from ONC & CMS
• Expand upon the Stage 1 criteria
• Encourage the use of Health IT for continuous quality improvement at the point of
care
• Encourage the exchange of information in the most structured format possible
• Stage 2 MU criteria include rigorous HIEs
• Demand requirements for ePrescribing
• Incorporate structured laboratory results
• Electronically transmit patient care summaries to support transitions in care across
unaffiliated providers, settings and EHR systems
• Information follows the patient (Stage 3 also)
• Nearly every optional Stage 1objective to be required in Stage 2
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Expand upon the Stage 1 criteria
• Encourage the use of Health IT for continuous quality improvement at the point of
care
• Encourage the exchange of information in the most structured format possible
• Stage 2 MU criteria include rigorous HIEs
• Demand requirements for ePrescribing
• Incorporate structured laboratory results
• Electronically transmit patient care summaries to support transitions in care across
unaffiliated providers, settings and EHR systems
• Information follows the patient (Stage 3 also)
• Nearly every optional Stage 1objective to be required in Stage 2
9
Stage 2 State Flexibility with IR/SS
• States will have the flexibility with the public health measures in
Stage 2 similar to that of Stage 1
• True for Medicare and Medicaid participation
• States may also specify the means of transmission of the data
or otherwise change the public health measure
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• States will have the flexibility with the public health measures in
Stage 2 similar to that of Stage 1
• True for Medicare and Medicaid participation
• States may also specify the means of transmission of the data
or otherwise change the public health measure
10
Stage 2 Exclusion Criteria
• Allowances for exclusions would change for both Stages 1 & 2
beginning in 2014
• At that point, should focus solely on those objectives they can
meet rather than those for which they have exclusion
• Exclusions just for EPs who are unable to meet certain objectives because
of scope of practice
• New exclusion criteria when necessary for new objectives will be added
as needed
• Almost every menu objective in Stage 2 will be core in Stage 3
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Allowances for exclusions would change for both Stages 1 & 2
beginning in 2014
• At that point, should focus solely on those objectives they can
meet rather than those for which they have exclusion
• Exclusions just for EPs who are unable to meet certain objectives because
of scope of practice
• New exclusion criteria when necessary for new objectives will be added
as needed
• Almost every menu objective in Stage 2 will be core in Stage 3
11
Stage 2 Multiple Practices/Locations
• EP must still have 50% or more of outpatient encounters at a
practice/location or practices/locations equipped with Certified EHR
Technology – can be fulfilled in a single or multiple locations.
• Starting in 2013, will no longer allow the practice of creating a
record in one location with no EHR and then later entering information
in a practice location with a certified EHR
• Do not have to include patients in reporting denominators that are
seen at practices/locations that are not equipped with Certified EHR
Technology as long as the EP clears the 50% threshold described
above
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• EP must still have 50% or more of outpatient encounters at a
practice/location or practices/locations equipped with Certified EHR
Technology – can be fulfilled in a single or multiple locations.
• Starting in 2013, will no longer allow the practice of creating a
record in one location with no EHR and then later entering information
in a practice location with a certified EHR
• Do not have to include patients in reporting denominators that are
seen at practices/locations that are not equipped with Certified EHR
Technology as long as the EP clears the 50% threshold described
above
12
Stage 2 Denominators
• Include all patients in the denominators of all of the measures (except
those not seen at a location with a certified EHR)
• Create a uniform set of denominators
• Proposed denominators for EPs• Unique patients seen by the EP during the EHR reporting period (stratified
by age or previous office visit)
• Number of orders (medication, labs, radiology)
• Office visits, and
• Transitions of care/referrals.
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Include all patients in the denominators of all of the measures (except
those not seen at a location with a certified EHR)
• Create a uniform set of denominators
• Proposed denominators for EPs• Unique patients seen by the EP during the EHR reporting period (stratified
by age or previous office visit)
• Number of orders (medication, labs, radiology)
• Office visits, and
• Transitions of care/referrals.
13
What Measures Are NotChanging…. Much?
Copyright © 2011 Allscripts Healthcare Solutions, Inc.
What Measures Are NotChanging…. Much?
14
Common themes of small changes
• Increase of thresholds
• More stringent parameters
• Movement of Menu to Core
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health 15
Increase of ThresholdseRx• Stage 1: More than 40% must be transmitted electronically• Stage 2: More than 65% are compared to at least one drug formulary and
transmitted electronically
Record patient demographics• More than 50% of patient demographic data must be recorded as structured data.• More than 80% of all unique patients have demographics recorded as structured
data.
Record vital signs and chart changes• More than 50% of patients >2 years old must have height, weight and blood
pressure recorded as structured data• More than 80% of patients >3 years old must have blood pressure measured and
all patients have height and weight recorded as structured data.
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
eRx• Stage 1: More than 40% must be transmitted electronically• Stage 2: More than 65% are compared to at least one drug formulary and
transmitted electronically
Record patient demographics• More than 50% of patient demographic data must be recorded as structured data.• More than 80% of all unique patients have demographics recorded as structured
data.
Record vital signs and chart changes• More than 50% of patients >2 years old must have height, weight and blood
pressure recorded as structured data• More than 80% of patients >3 years old must have blood pressure measured and
all patients have height and weight recorded as structured data.
16
Increase of ThresholdsRecord smoking status• More than 50% of patients age 13 or older have smoking status recorded as
structured data• More than 80% of patients age 13 or older have smoking status recorded as
structured data
Lab results• More than 40% of clinical lab results are in positive/negative or numerical format
and stored as structured data• Move to core requirement. More than 55% of all clinical lab tests are incorporated
as structured data.
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
Record smoking status• More than 50% of patients age 13 or older have smoking status recorded as
structured data• More than 80% of patients age 13 or older have smoking status recorded as
structured data
Lab results• More than 40% of clinical lab results are in positive/negative or numerical format
and stored as structured data• Move to core requirement. More than 55% of all clinical lab tests are incorporated
as structured data.
17
More Stringent Parameters
Provide patients with clinical summaries for each office visit
• Provide clinical summaries for more than 50% of all visits within 3 business days
• Provide clinical summaries for more than 50% of all visits within 24 hours
Privacy and Security
• Conduct a security risk analysis, implement security updates and correct identified issues
• Conduct a security risk analysis, implement security updates and correct identified issues,
including data at rest.
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
Provide patients with clinical summaries for each office visit
• Provide clinical summaries for more than 50% of all visits within 3 business days
• Provide clinical summaries for more than 50% of all visits within 24 hours
Privacy and Security
• Conduct a security risk analysis, implement security updates and correct identified issues
• Conduct a security risk analysis, implement security updates and correct identified issues,
including data at rest.
18
Move to Core from MenuLab results
• More than 40% of clinical lab results are in positive/negative or numerical formatand stored as structured data
• Move to core requirement. More than 55% of all clinical lab tests are incorporatedas structured data.
Generate list of patients by specific condition
• Move to core requirement.
Send reminders to patients per patient preference
• More than 20% of patients aged 65 or older or 5 or younger must be sentappropriate reminders.
• Move to core requirement. More than 10% of all unique patients who had a visitwithin past 24 months were sent a reminder, per patient preference.
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
Lab results
• More than 40% of clinical lab results are in positive/negative or numerical formatand stored as structured data
• Move to core requirement. More than 55% of all clinical lab tests are incorporatedas structured data.
Generate list of patients by specific condition
• Move to core requirement.
Send reminders to patients per patient preference
• More than 20% of patients aged 65 or older or 5 or younger must be sentappropriate reminders.
• Move to core requirement. More than 10% of all unique patients who had a visitwithin past 24 months were sent a reminder, per patient preference.
19
Move to Core from MenuPatient-specific education resources
• More than 10% of patients are provided patient-specific education resources.
• Move to core requirement.
Perform medication reconciliation
• Perform med reconciliation for more than 50% of transitions of care
• Move to core requirement. Perform medication reconciliation for more than 65% of
transitions of care.
Submission of electronic immunization data
• Must perform at least one test of data submission and follow-up submission to
immunization registries.
• Move to core requirement. Successful ongoing submission of electronic
immunization data to a registry or reporting system for entire EHR reporting period.| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
Patient-specific education resources
• More than 10% of patients are provided patient-specific education resources.
• Move to core requirement.
Perform medication reconciliation
• Perform med reconciliation for more than 50% of transitions of care
• Move to core requirement. Perform medication reconciliation for more than 65% of
transitions of care.
Submission of electronic immunization data
• Must perform at least one test of data submission and follow-up submission to
immunization registries.
• Move to core requirement. Successful ongoing submission of electronic
immunization data to a registry or reporting system for entire EHR reporting period.20
What Measures Should You BeThinking About?
Copyright © 2011 Allscripts Healthcare Solutions, Inc.
What Measures Should You BeThinking About?
21
Areas of major change
• CPOE
• Secured Messaging
• Patient Access: View, Download, Transmit
• Transitions of Care
• Clinical Decision Support
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• CPOE
• Secured Messaging
• Patient Access: View, Download, Transmit
• Transitions of Care
• Clinical Decision Support
22
CPOE
• More than 60% of meds, lab, and rad orders created
by the EP during the reporting period use CPOE
= 60%
Cor
e
# of orders in the denominator recorded usingCPOE
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
= 60%
23
Cor
e
Exclusion: Any EP who fewer of 100 meds, labs, and radiology orders COMBINED
# of med, rad, and lab orders created by the EPduring the reporting period
# of orders in the denominator recorded usingCPOE
CPOE EP Requirements
• Further defining CPOE
• CPOE should be used the first time the order becomes part of the record,
before any action can be taken on the order
• removing the possibility that a record of the order could be created prior to CPOE
• This means that the originating provider (whose judgment creates the
order) must personally use the CPOE function or verbally communicate
the order to someone else who will use the CPOE function
• Provider is responsible for including the orders in their
denominators if they are not recorded using CPOE
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Further defining CPOE
• CPOE should be used the first time the order becomes part of the record,
before any action can be taken on the order
• removing the possibility that a record of the order could be created prior to CPOE
• This means that the originating provider (whose judgment creates the
order) must personally use the CPOE function or verbally communicate
the order to someone else who will use the CPOE function
• Provider is responsible for including the orders in their
denominators if they are not recorded using CPOE
24
Patient Access
• Provide patients the ability to view online, download, and transmit their
health information within 4 business days of the information being
available to the EP
• 2 Report Calculations
Cor
e
Report #1
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Provide patients the ability to view online, download, and transmit their
health information within 4 business days of the information being
available to the EP
• 2 Report Calculations
= 65%
25
Cor
e
Exclusion: Next slide
#of unique patients seen by the EP during thereporting period
# of patients in the den. who have timely (within 4business days after the information is available tothe EP) online access to their health information
online
Report #1
Patient Access
= 10%Cor
e
# of unique patients (or their authorizedrepresentatives) in the den. who have viewedonline or downloaded or transmitted to a third
party the patient's health information
Report #2
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
= 10%
26
Cor
e
Exclusion: Any EP who neither orders nor creates any of the information listed for inclusion aspart of this measure may exclude both measures.
Any EP that conducts 50% or more of his or her patient encounters in a county that does nothave 50 percent or more of its housing units with 4Mbps broadband availability according to thelatest information available from the FCC on the first day of the reporting period may excludeonly the second measure.
#of unique patients seen by the EP during thereporting period
Patient Access EP Requirements
• Patients must be able to access this information on demand
• This includes that patients with disabilities need equal access
• Its not just about the patient, but also their authorized representatives that
can access their health info
• Patients have to grant access to those representatives with the exception of minors
• Still uses the same business day logic as in stage 1
• Reporting
• A patient who views their info online, downloads it from the internet, or uses the
internet to transmit it to a third party would count for the numerator
• New exclusions about the counties without high-speed internet
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Patients must be able to access this information on demand
• This includes that patients with disabilities need equal access
• Its not just about the patient, but also their authorized representatives that
can access their health info
• Patients have to grant access to those representatives with the exception of minors
• Still uses the same business day logic as in stage 1
• Reporting
• A patient who views their info online, downloads it from the internet, or uses the
internet to transmit it to a third party would count for the numerator
• New exclusions about the counties without high-speed internet
27
Patient Access EP Requirements• The following information must be made available within 4 days of the info being available to the EP:
• Patient name
• Provider's name and office contact information
• Problem list
• Procedures
• Laboratory test results
• Medication list
• Medication allergy list
• Vital signs (height, weight, blood pressure, BMI, growth charts*)
• Smoking status
• Demographic information (preferred language, gender, race, ethnicity, date of birth)
• Care plan field, including goals* and instructions
• Any additional known care team members* beyond the referring or transitioning provider and the receiving
provider.
• Provider needs to be able to not send specific information when needed at the provider’s discretion
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• The following information must be made available within 4 days of the info being available to the EP:
• Patient name
• Provider's name and office contact information
• Problem list
• Procedures
• Laboratory test results
• Medication list
• Medication allergy list
• Vital signs (height, weight, blood pressure, BMI, growth charts*)
• Smoking status
• Demographic information (preferred language, gender, race, ethnicity, date of birth)
• Care plan field, including goals* and instructions
• Any additional known care team members* beyond the referring or transitioning provider and the receiving
provider.
• Provider needs to be able to not send specific information when needed at the provider’s discretion
28
Secured Messaging
• Use secure electronic messaging to communicate with
patients on relevant health information
= 10%
Cor
e # of patients in the den. who send a secureelectronic message to the EP using the electronicmessaging function of CEHRT during the reporting
period.
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
= 10%
29
Cor
e
Exclusion: Any EP who has no office visits during the reporting period
# of unique patients seen by the EP during thereporting period
# of patients in the den. who send a secureelectronic message to the EP using the electronicmessaging function of CEHRT during the reporting
period.
Secured Messaging EP Requirements
• Secure Message must contain relevant health info
• Secure Messaging can occur through:
• Email with necessary safeguards
• Patient portals
• PHR
• Stand along messaging applications
• Patient must take action for provider to meet this measure
• CMS wants comments about behavioral health
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Secure Message must contain relevant health info
• Secure Messaging can occur through:
• Email with necessary safeguards
• Patient portals
• PHR
• Stand along messaging applications
• Patient must take action for provider to meet this measure
• CMS wants comments about behavioral health
30
Transitions of Care (TOC) Calculation
• 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
• 2 Report Calculations
= 65%
Cor
e
Report #1
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• 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
• 2 Report Calculations
= 65%
31
Cor
e
Exclusion: Any EP who neither transfers a patient to another setting nor refers a patient to another providerduring the EHR reporting period is excluded from both measures.
# of TOC and referrals during the reporting periodfor which the EP was the transferring or referringprovider
# of TOC and referrals in the denominator wherea summary of care record was provided
Report #1
Transitions of Care (TOC) Calculation
= 10%Cor
e
# of TOC & referrals in the denominator where asummary of care record was electronically
transmitted using CEHRT to a recipient with no orgaffiliation and using a different CEHRT vendor than
the sender
Report #2
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
= 10%
32
Cor
e
Exclusion: Any EP who neither transfers a patient to another setting nor refers a patient to another providerduring the EHR reporting period is excluded from both measures.
# of TOC and referrals during the reporting periodfor which the EP was the transferring or referring
provider
# of TOC & referrals in the denominator where asummary of care record was electronically
transmitted using CEHRT to a recipient with no orgaffiliation and using a different CEHRT vendor than
the sender
Clinical Decisions Support (CDS)
• Use clinical decision support to improve
performance on high-priority health
conditions
Cor
e
Threshold
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Use clinical decision support to improve
performance on high-priority health
conditions
33
Cor
e
Exclusion: None
5 Clinical Decision Support + DUR AlertThreshold
CDS EP Requirements
• User must use 5 Clinical Decision Support rules and they must be
related to 5 or more Quality Measures
• Related = intent is to improve performance of the Clinical Quality
Measure
• User does not need to show improvement in the Quality Measure.
• If user doesn't have an applicable CQM, they can choose to do another
related to patient care
• User must have enabled DUR interactions for the entire
reporting period
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• User must use 5 Clinical Decision Support rules and they must be
related to 5 or more Quality Measures
• Related = intent is to improve performance of the Clinical Quality
Measure
• User does not need to show improvement in the Quality Measure.
• If user doesn't have an applicable CQM, they can choose to do another
related to patient care
• User must have enabled DUR interactions for the entire
reporting period
34
CDS EP Requirements
• Intervention must be done at a relevant point of time in the
workflow, before action is taken on the patient
• ex. create a trigger that prompts the provider to ask about influenza
immunization when a patient is 50 years or older.
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Intervention must be done at a relevant point of time in the
workflow, before action is taken on the patient
• ex. create a trigger that prompts the provider to ask about influenza
immunization when a patient is 50 years or older.
35
TOC Reporting Considerations
• Exchange Key Clinical Information from Stage 1 was combined into
this measure
• Combined Maintain Active Med List, Problem List, and Med Allergy
list into this measure
• EP must verify med/prob/allergies and they cannot be blank
• Denominator –
• If the referral is sent to a provider has access to the system, the referral
does not count in the denominator
• Sending Electronically: USB, CD, Fax does not count
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Exchange Key Clinical Information from Stage 1 was combined into
this measure
• Combined Maintain Active Med List, Problem List, and Med Allergy
list into this measure
• EP must verify med/prob/allergies and they cannot be blank
• Denominator –
• If the referral is sent to a provider has access to the system, the referral
does not count in the denominator
• Sending Electronically: USB, CD, Fax does not count
36
TOC Workflow RequirementsSummary of Care Document must contain the following (if available on the patient)• Patient name
• Referring or transitioning provider's name and
office contact information (EP only)
• Procedures
• Relevant past diagnoses
• Laboratory test results
• Vital signs (height, weight, blood pressure, BMI,
growth charts)
• Smoking status
• Demographic information (preferred language,
gender, race, ethnicity, date of birth)
• Any additional known care team members
beyond the referring or transitioning provider
and the receiving provider
• Care plan field, including goals and instructions
• Care Plan is defined as the management actions
for various conditions, problems, and issue
• Care Plan = Problem (focus) + Goal (Target
outcome) + Instructions given to patient
• Goal is defined as target or measure to be achieved in the
process of patient care (expected outcome)
• An up-to-date problem list of current and active
diagnoses
• An active medication list
• An active medication allergy list
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Patient name
• Referring or transitioning provider's name and
office contact information (EP only)
• Procedures
• Relevant past diagnoses
• Laboratory test results
• Vital signs (height, weight, blood pressure, BMI,
growth charts)
• Smoking status
• Demographic information (preferred language,
gender, race, ethnicity, date of birth)
• Any additional known care team members
beyond the referring or transitioning provider
and the receiving provider
• Care plan field, including goals and instructions
• Care Plan is defined as the management actions
for various conditions, problems, and issue
• Care Plan = Problem (focus) + Goal (Target
outcome) + Instructions given to patient
• Goal is defined as target or measure to be achieved in the
process of patient care (expected outcome)
• An up-to-date problem list of current and active
diagnoses
• An active medication list
• An active medication allergy list
37
Reporting Changes
Copyright © 2011 Allscripts Healthcare Solutions, Inc. 38
Stage 2 Reporting - EPs
• Report 12 CQMs from a menu of 125
• Includes most of the current 44
• Must include at least 1 CQM from each of the 6 domains
• All begin in 2014 for both Stage 1 and Stage 2
• Examples of new measures
• pediatric, obstetric, behavioral/mental health, HIV medical visits,
antiretroviral therapy, oral health – many geared towards Medicaid
providers
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Report 12 CQMs from a menu of 125
• Includes most of the current 44
• Must include at least 1 CQM from each of the 6 domains
• All begin in 2014 for both Stage 1 and Stage 2
• Examples of new measures
• pediatric, obstetric, behavioral/mental health, HIV medical visits,
antiretroviral therapy, oral health – many geared towards Medicaid
providers
39
Stage 2 Reporting - EPs
• Online submission via XML files
• May submit as an individual or group
• Possible aggregation of performance here (!) unlike the batch reporting with the measures,
which must remain individual
• Can only be done beginning in second year of MU
• Three group options:
• Different NPIs / one TIN: all members of group must report all CQMs as a group
• Different NPIs / one TIN, participating in the Medicare Shared Savings Program and
Pioneer ACO model who use Certified EHR to submit ACO measures: all measures must be
extracted by the Certified EHR
• Medicare EPs who satisfactorily report PQRS CQMs using Certified EHR Technology
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Online submission via XML files
• May submit as an individual or group
• Possible aggregation of performance here (!) unlike the batch reporting with the measures,
which must remain individual
• Can only be done beginning in second year of MU
• Three group options:
• Different NPIs / one TIN: all members of group must report all CQMs as a group
• Different NPIs / one TIN, participating in the Medicare Shared Savings Program and
Pioneer ACO model who use Certified EHR to submit ACO measures: all measures must be
extracted by the Certified EHR
• Medicare EPs who satisfactorily report PQRS CQMs using Certified EHR Technology
40
CQM reporting options (2014)• Option 1a:
• 12 measures, including at least 1 from each of 6 domains (NPRM Table
8)
• Option 1b:
• 11 “core” measures (NPRM Table 6) + 1 “menu” measure (NPRM Table
8)
• Option 2:
• Successfully report through PQRS
• Must continue to comply with PQRS as it evolves
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
• Option 1a:
• 12 measures, including at least 1 from each of 6 domains (NPRM Table
8)
• Option 1b:
• 11 “core” measures (NPRM Table 6) + 1 “menu” measure (NPRM Table
8)
• Option 2:
• Successfully report through PQRS
• Must continue to comply with PQRS as it evolves
41
ONC will finalize Option 1a or 1b
What are we planning?
Copyright © 2011 Allscripts Healthcare Solutions, Inc. 42
11.3
New FeaturesUsability & VOC
ImprovementsDUR EnhancementsClinical Item Contention
(also in 11.2.3)Patient EducationConnected CommunityEnhanced Community
PortalADX Integration 1.0MaintenancePerformance & Technology
Enhancements
43Enterprise EHR Roadmap
Q2 2012 Q3 2012Q1 2012 Q4 2012 Q1 2013 Q2 2013
New FeaturesPatient GoalsPatient Care teamClinical Decision SupportPop. Health ImprovementsOrders Usability ImprovementsConnected CommunityPatient Portal ImprovementsReferral ImprovementsRegulatoryMeaningful Use Stage 2Quality Measure SupportSureScripts NCPDP 10.6 STDEPCS & Pharm Directory 4.4
11.4.1
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health
Q2 2012 Q3 2012Q1 2012
Innovation Projects (Wombat, New Note, Humedica, App Store, Voice Enablement)
Focus of 11.4 & 11.4.1Improved Usability whilemeeting regulatory req’s
Focus of 11.4 & 11.4.1Improved Usability whilemeeting regulatory req’s
Q4 2012 Q1 2013 Q2 2013
New FeaturesEmail Distribution of scheduled
reportsNew filter optionsMulti-Organization SupportQuality Measure Drill DownMaintenanceUsability Defects
Stimulus Reporting 2.0 11.4
New FeaturesProblem Usability ImprovementsMy Priority Problem ListsProblem ImpressionConnected CommunityADX integration 1.5Patient Portal Costume FormsRegulatoryICD-10 Support
Questions
Copyright © 2011 Allscripts Healthcare Solutions, Inc.
Appendix
Copyright © 2011 Allscripts Healthcare Solutions, Inc.
Requirement Stage 1 Standard Stage 2 Standard1 CPOE More than 30% of patients with at least one
medication must have at least onemedication ordered via CPOE
More than 60% of medication, labs, andradiology orders are recorded usingCPOE. No requirement to orderelectronically.
2 eRx More than 40% must be transmittedelectronically
More than 65% are compared to at leastone drug formulary and transmittedelectronically
3 Record patient demographics More than 50% of patient demographicdata must be recorded as structured data.
More than 80% of all unique patients havedemographics recorded as structured data.
Improving Quality, Safety, Efficiency...
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health 46
3 Record patient demographics More than 50% of patient demographicdata must be recorded as structured data.
More than 80% of all unique patients havedemographics recorded as structured data.
4 Record vital signs and chart changes More than 50% of patients >2 years oldmust have height, weight and bloodpressure recorded as structured data
More than 80% of patients >3 years old musthave blood pressure measured and allpatients have height and weight recorded asstructured data.
5 Record smoking status More than 50% of patients age 13 or olderhave smoking status recorded asstructured data
More than 80% of patients age 13 or olderhave smoking status recorded as structureddata
6 Clinical Decision Support Implement one clinical decision supportrule and track compliance with that rule
Implement five clinical decision supportrules related to 5 or more clinical qualitymeasuresAndImplement drug-drug and drug-allergyinteraction checks
Requirement Stage 1 Standard Stage 2 Standard7 Lab results More than 40% of clinical lab results are in
positive/negative or numerical format andstored as structured data
Move to core requirement. More than55% of all clinical lab tests are incorporatedas structured data.
8 Generate list of patients by specificcondition for use in qualityimprovement, reduction ofdisparities, research or outreach.
Generate one list of patients with a specificcondition.
Move to core requirement.
9 Send reminders to patients perpatient preference for preventativeand follow up care
More than 20% of patients aged 65 orolder or 5 or younger must be sentappropriate reminders.
Move to core requirement. More than10% of all unique patients who had a visitwithin past 24 months were sent areminder, per patient preference.
Improving Quality, Safety, Efficiency...
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health 47
9 Send reminders to patients perpatient preference for preventativeand follow up care
More than 20% of patients aged 65 orolder or 5 or younger must be sentappropriate reminders.
Move to core requirement. More than10% of all unique patients who had a visitwithin past 24 months were sent areminder, per patient preference.
M1 Imaging results. New measure. More than 40% of all scansand tests ordered by EP are accessiblethrough the certified EHR.
M2 Record patient family health historyas structured data
New measure. More than 20% of all uniquepatients have a structured data entry for oneor more first-degree relatives.
Requirement Stage 1 Standard Stage 2 Standard10 Provide patients with ability to view
online, download & transmit theirhealth information.
New Requirement. 50% of all uniquepatients provided online access to theirhealth information within 4 business daysafter it is available to the EP (subject to EPdiscretion)AndMore than 10% unique patients view,download, or transmit their info to a thirdparty.
11 Provide patients with clinicalsummaries for each office visit
Provide clinical summaries for more than50% of all visits within 3 business days
Provide clinical summaries for more than50% of all visits within 24 hours
Engage Patients & Families
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health 48
Provide patients with clinicalsummaries for each office visit
Provide clinical summaries for more than50% of all visits within 3 business days
Provide clinical summaries for more than50% of all visits within 24 hours
12 Use EHR technology to identifypatient-specific education resourcesas provide to patients asappropriate.
More than 10% of patients are providedpatient-specific education resources.
Move to core requirement.
13 Use secure electronic messaging. New requirement. A secure message wassent using the Certified EHR by more than10% of unique patients seen.
Requirement Stage 1 Standard Stage 2 Standard14 Perform medication reconciliation Perform med reconciliation for more than
50% of transitions of careMove to core requirement. Performmedication reconciliation for more than 65%of transitions of care.
15 Provide summary of care record forpatients referred or transitioned toanother provider.
Summary of care records are provided forat least 50% of patient transitions orreferrals.
Move to core.1. provide a summary of care for 65% of
transitions or referrals;and
2. transmit summary of care record to arecipient with no organizationalaffiliation and who uses a differentcertified technology vendor than thesender for more than 10% oftransitions or referrals.
Improve Care Coordination
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health 49
Move to core.1. provide a summary of care for 65% of
transitions or referrals;and
2. transmit summary of care record to arecipient with no organizationalaffiliation and who uses a differentcertified technology vendor than thesender for more than 10% oftransitions or referrals.
Requirement Stage 1 Standard Stage 2 Standard24 Submission of electronic
immunization dataMust perform at least one test of datasubmission and follow-up submission toimmunization registries.
Move to core requirement. Successfulongoing submission of electronicimmunization data to a registry or reportingsystem for entire EHR reporting period.
M3 Syndromic surveillance data topublic health agencies
Must perform at least one test of datasubmission and follow-up submission topublic health agencies for syndromicsurveillance.
Successful ongoing submission ofelectronic immunization data to a publichealth agency for entire EHR reportingperiod.
M4 Report cancer cases to cancerregistry
New measure. Successful ongoingsubmission of cancer case information to acancer registry for entire EHR reportingperiod.
Improve Population & Public Health
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Report cancer cases to cancerregistry
New measure. Successful ongoingsubmission of cancer case information to acancer registry for entire EHR reportingperiod.
M5 Report specific cases tospecialized, non-cancer registry
New measure. Successful ongoingsubmission of specific case information to aspecialized, non-cancer registry for entireEHR reporting period.
Requirement Stage 1 Standard Stage 2 Standard25 Privacy and Security Conduct a security risk analysis, implement
security updates and correct identifiedissues
Conduct a security risk analysis, implementsecurity updates and correct identifiedissues, including data at rest.
Ensure Adequate Privacy
| Copyright © 2011 Allscripts Healthcare Solutions, Inc.A Connected Community of Health 51
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