ELIGIBLE HOSPITALS (EH) & CRITICAL ACCESS HOSPITALS (CAH) Stage 2 Meaningful Use

E L I G I B L E H O S P I TA L S ( E H ) &

C R I T I C A L A C C E S S H O S P I TA L S ( C A H )

Stage 2 Meaningful Use

Conflict of Interest Disclosures

None

Changes to Stage 1 Objectives

• CPOE• Denominator: More than 30% of medication orders created by the EP or authorized providers of the EH

or CAH’s inpatient or emergency dept (POS 21 or 23) during the EHR reporting period are recorded using CPOE

• Vital Signs• Denominator: More than 50% of all unique patient seen admitted to the EH or CAH’s inpatient or

emergency dept (POS 21 or 23) during the EHR reporting period have blood pressure (for ages 3+ only) and height and weight (for all ages) recorded as structured data

• Clinical Quality Measures• Objective removed• Hospitals are still required to report on CQMs• Now follow 2014 CQM requirements

Stage 1 • Capture

Information

Stage 2 • Reporting • Exchanging

Information• Patient

Engagement

Stage 3 and Beyond…• Leveraging

Information for Improved Patient Care

Where Are We At?

Understanding the Timing of Stage 2

Stage 2 Meaningful Use

• Report on total of 19 Objectives• Plus Clinical Quality Measures (CQM)

• 16 Core Objectives• All Required• Many Stage 1 combined

• 6 Menu Objectives• Choose 3

• Clinical Quality Measures (CQM)• Report on 16 of 29 approved CQMs• Selected CQMs must cover at least 3 of 6 National Quality Strategy Domains• Electronically repot to CMS

MU in 2014

For 2014 only:• All EHs and CAHs regardless of their stage of meaningful use are only

required to demonstrate meaningful use for a 3-month EHR reporting period.

• CMS is permitting this one-time 3-month reporting period in 2014 only so that all hospitals who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems.

MU in 2014

• Reporting Period = 3 month quarter (2014 Only)• Must be a fixed calendar quarter

• January – March• April – June• July – September• October – December

• Must be completed by December 31st• Start no later than October 1

• Payment Adjustments begin in 2015

Avoiding Payment Adjustments

• If you’re beginning in 2014• Must demonstrate 90 days before 4th quarter• Must attest NO LATER than October 1, 2014

• Avoiding Medicare payment adjustments in the future• Must continue to demonstrate every year

• If eligible for Medicare and Medicaid, must demonstrate every year

• If eligible for Medicaid ONLY, you are not subject to adjustments

Objective Use CPOE for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.

Denominator Medications: Number of medication orders created by the EH

or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

Radiology: Number of radiology orders created by the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the reporting period.

Laboratory: Number of lab orders created by the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the reporting period.

NumeratorThe number of orders in the denominator recorded using CPOE

Threshold: Medications: > 60% Labs: > 30% Radiology: > 30%

Increased medication threshold 30% to 60%

30% radiology and 30% lab orders added to objective

Denominator changes to number of orders

Computer Provider Order Entry (CPOE)

Objective Record all of the following demographics: Preferred Language Sex Race Ethnicity Date of Birth Date & Preliminary Cause of Death (in the event of mortality in

the EH or CAH)

DenominatorNumber of unique patients admitted to the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

NumeratorNumber of patients in the denominator who have all the elements of demographics (or a specific notation if the patient declined to provide one or more of the elements) recorded as structured data.

Threshold: > 80%

Threshold increased from 50% to 80%

Terminology change: “Gender” replaced with “Sex”

Record Demographics

Objective Record and chart changes in the following vital signs: Height/Length & Weight (no age limit) Blood Pressure (ages 3 and over) Calculate & Display BMI Plot & Display Growth Charts for Patients 0 – 20 yrs (including

BMI)


NumeratorNumber of patients in the denominator who have at least one entry of their height and weight (all ages) and/or blood pressure (ages 3 and over) recorded as structured data.

Threshold: > 80%


Blood pressure on patients aged 2 yr olds no longer required

Patients aged 0-2 yrs old now included in Growth Charts

Record Vital Signs

Objective Record smoking status for patients 13 yrs old and older

DenominatorNumber of unique patients aged 13 or older admitted to the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

NumeratorNumber of patients in the denominator with smoking status recorded as structured data.

Threshold: > 80%


SNOMED Codes required

8 smoking status selections to include cigar & pipe smokers

Record Smoking Status

Objective Implement 5 Clinical Decision Support interventions related to 4 or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period

AND

Implement drug-drug and drug-allergy checks for the entire reporting period

Attestation Requirement: Yes/No

Increased from 1 to 5 CDS Rules

CDS must relate to clinical quality measures

Incorporates Drug-Drug/Drug-Allergy Interaction Checks

Clinical Decision Support (CDS)

Objective Provide patients the ability to view online, download, and transmit information about hospital admission.

DenominatorNumber of unique patients discharged from the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the reporting period.

NumeratorAccess: Number of patients in the denominator whose information is available online within 36 hours of dischargeEngagement: Number of patients in the denominator who have viewed online, downloaded, or transmitted to a third party the discharge information provided by the EH or CAH.

Threshold:Access: > 50% Engagement: > 5%

Replaces Stage 1 eCopy of PHI objective

Requires 5% patient engagement

Denominator is now 50% of all discharged patients rather than those requesting

Patient Electronic Access

What Must be Available Online?

The EH or CAH can make additional information available, however, the following information must be available to satisfy the objective and measure:

• Patient Name• Admit and discharge date & location• Reason for hospitalization• Care team including the attending of record as well as other providers of care• Procedures performed during admission• Current and past problem list• Current medication list and medication history• Current medication allergy list and medication allergy history• Vital signs at discharge• Laboratory test results (available at time of discharge)• Summary of care record for transitions of care or referrals to another provider• Care plan field(s), including goals and instructions• Discharge instructions for patient• Demographics maintained by hospital• Smoking status

Patient Portals & Minors

Parents as Personal Representatives• Personal representative has the right of the individual

• Rights should be cut off at age of majority

• Parent may not be personal representative for certain information, such as when a minor can consent under state law

• Personal representatives and minors can pose significant challenges to the organization• Will the organization require authorization before establishing proxy rights to the portal• How will the organization handle revocation of authorizations? Restriction requests?• How will the organization ensure parent’s access is revoked once patient reaches age of

majority?

Patient Portals & Minors

What can the organization do?

• Ensure compliance with applicable Federal & State laws regarding minors• Consult internal HIPAA privacy liaison to ensure portal access/rights are consistent with

Federal & State laws and other organizational practices• Approaches by other Healthcare Providers:

• For patients under the age of 14, parents are able to access the portal with parental signed request• For patients aged 14-18,

• Require the child to sign a release form• Restrict parental access to certain sensitive data as required by applicable laws• Restrict portal access for minors ages 14-18

• Providers can withhold information if they believe it would jeopardize the health of their patient in accordance with HIPAA privacy regulations• Consult internal HIPAA privacy liaison

• Also note that there are differences for minors who are emancipated

Objective Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider’s risk management process for eligible hospitals.


Update risk management processes to address any newly identified risks since last SRA

Risk analysis function required to place emphasis on encryption of PHI stored in CEHRT

Objective not meant to replace, change, or supersede HIPAA Privacy & Security Rule

Protect Electronic Health Information

Objective Incorporate clinical lab test results into Certified EHR Technology (CEHRT) as structured data.

DenominatorNumber of lab tests ordered during the EHR reporting period by the EH or CAH’s inpatient or emergency department (POS 21 or 23) whose results are expressed in either a positive/negative or numeric format.

NumeratorNumber of lab test results which are expressed in a positive/negative or numeric result are incorporated into CEHRT as structured data.

Threshold: > 55%

Moved from Menu to Core Set


Clinical Lab Test Results

Objective Generate at least one list of patients by specific condition to use for quality improvement, reduction of disparities, research, or outreach.

Attestation Requirement: Yes/NoMoved from Menu to Core Set

Must be based on information contained within the following fields: problems, medications, medication allergies, demographics, labs

Patient Lists

Objective Use clinically relevant information from CEHRT to identify patient-specific education resources and provide those resources to the patient.


NumeratorNumber of patients in the denominator who are subsequently provided patient-specific education resources identified by CEHRT.

Threshold: > 10%

CEHRT is certified to use problem list, medication list, or lab results to identify educational resources

Education resources do not have to be stored within or generated by CEHRT

Utilize CEHRT in a manner where the technology suggests patient-specific educational resources based on information stored within CEHRT

Patient-Specific Education Resources

Objective The EH 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.

DenominatorNumber of transitions of care during the EHR reporting period for which the EH or CAH’s inpatient or emergency department (POS 21 or 23) was the receiving party of the transition.

NumeratorNumber of transitions of care in the denominator where medication reconciliation was performed.

Threshold: > 50%


Information included in the process of medication reconciliation is determined by the provider & patient

Medication Reconciliation

Objective The EH or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary of care record for each transition of care or referral.

DenominatorNumber of transitions of care and referrals during the EHR reporting period for which the EH or CAH’s inpatient or emergency department (POS 21 or 23) was the transferring or referring provider.

NumeratorNumber of transitions of care and referrals in the denominator where a summary of care record was provided.

Threshold: > 50%


Must verify current problem list, current medication list, and current medication allergy list includes the most recent information known at the time

Can send paper or electronic copy of summary care record directly to next provider, or can provide it to patient to deliver to next provider (if patient can be reasonably expected to do so)

Summary of Care Measure 1


DenominatorNumber of transitions of care and referrals during the EHR reporting period for which the EH or CAH’s inpatient or emergency department (POS 21 or 23) was the transferring or referring provider.

NumeratorNumber of transitions of care and referrals in the denominator where a summary of care record was: Electronically transmitted using CEHRT to a recipient

OR Where the recipient receives the summary of care record via

exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network. The organization can be a third-party or the sender’s own organization.

Threshold: > 10%

Requires electronic transmission

The summary of care record must be received by the provider to whom the sending provider is referring or transmitting the patient




The EH or CAH must satisfy one of the two following criteria: Conducts one or more successful electronic exchanges of a

summary of care document, which is counted in Measure 2 with a recipient who has EHR technology that was designed by a different EHR technology developer than the sender’s CEHRT

OR Conducts one or more successful tests with the CMS designated

test EHR during the EHR reporting period.


Incorporates Stage 1 Electronic Exchange of Key Clinical Information objective

“EHR Randomizer” will randomly match EH or CAH with a designated test EHR that is designed by a different EHR technology developer than theirs

Current Designated Test EHRs: McKesson, Meditech, iPatientCare

What Must be Available on theCare Summary?

A summary of care record must include the following:• Patient Name• Procedures• Encounter diagnosis• Immunizations• Laboratory test results• Vitals signs• Smoking status• Functional status, including activities of daily living, cognitive and disability status• Demographic information• Care plan field, including goals and instructions• Care team including the primary care provider of record and any additional known care team

members beyond the referring or transitioning provider and the receiving provider• Discharge instructions• Current problem list• Current medication list• Current medication allergy list

Objective Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice.

Attestation Requirement: Yes/No Moved from Menu to Core Set

Successful ongoing submission is required

Immunization Registry Data Submission

Objective Capability to submit electronic reportable laboratory results to public health agencies, except where prohibited, and in accordance with applicable law and practice.



Electronic Reportable Lab Results

Objective Capability to submit syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice.



Syndromic Surveillance Data Submission

Objective Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).

DenominatorNumber of medication orders created by authorized providers in the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

NumeratorNumber of orders in the denominator for which all doses are tracked using eMAR.

Threshold: > 10%

New objective

If a medication is ordered but not all doses of the medication are tracked using eMAR, then that order may not be included in the numerator

Electronic Medication Administration Record (eMAR)

Objective Record whether a patient 65 years or older has an advance directive.

DenominatorNumber of unique patients age 65 or older admitted to the EH or CAH’s inpatient department (POS 21) during the EHR reporting period.

NumeratorNumber of patients in the denominator who have an indication of an advance directive status entered using structured data.

Threshold: > 50%

No changes from Stage 1

Patients admitted to the emergency department are not included in this objective

Providers need only to record the indication that an advance directive exists

Advance Directives

Objective Record electronic notes in patient records.


NumeratorNumber of patients in the denominator who have at least one electronic progress note from an authorized provider of the EH or CAH’s inpatient or emergency department (POS 21 or 23) recorded as text searchable data.

Threshold: > 30%

New objective

Text must be searchable

Drawings and other content can be included with searchable text notes

Electronic Notes

Objective Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT.

DenominatorNumber of tests whose result is one or more images ordered by an authorized provider on behalf of the EH or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

NumeratorNumber of results in the denominator that are accessible through CEHRT.

Threshold: > 10%

New objective

No limitations on the resolution of the image

Native storage of the image is not required; images can be scanned into CEHRT

Imaging Results

Objective Record patient family health history as structured data.


NumeratorNumber of patients in the denominator with a structured data entry for one or more first-degree relatives.

Threshold: > 20%

New objective

First-degree relatives include parents, siblings, and offspring

When applicable, structured data entry of “Unknown” is acceptable

Family Health History

Objective Generate and transmit permissible discharge prescriptions electronically (eRX).

DenominatorNumber new, changed, or refill prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances for patients discharged during the EHR reporting period.

NumeratorNumber of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically.

Threshold: > 10%

New objective

Electronic transmissions within and outside the organization should be included

ePrescribing (eRX)

Objective Provide structured electronic lab results to ambulatory providers.

DenominatorNumber of electronic lab orders received.

NumeratorNumber of structured clinical lab test results sent to the ordering provider.

Threshold: > 20%

New objective

Methods that have no potential for automatic incorporation, such as “Portal View” do not count

Order must be sent electronically from the ordering provider in such a way that the hospital lab does not have to print a hard copy of the order to view it

Lab Results to Ambulatory Providers

RequirementEHs & CAHs must report on 16 of 29 approved CQMs. Selected CQMs must cover at least 3 of the 6 National Quality Strategy domains: Patient & Family Engagement Patient Safety Care Coordination Population & Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness

ReportingAll CQMs will be submitted electronically to CMS

Must report on 16 of 29 approved measures

Electronic submission is required beginning in 2014

Clinical Quality Measures (CQM)

To Review…

• Stage 2 Objectives• 16 Core• 3 of 6 Menu• Clinical Quality Measures

• 3 Month Reporting Period in 2014• Must be completed by September 30th

• Can begin no later than July 1

• Payment Adjustments begin in 2015• Start no later than April 1 to avoid adjustments

To Review…

Core Objectives CPOE for Med, Lab, Rad Orders Demographics Vital Signs Smoking Status Clinical Decision Support Rules Patient Electronic Access Privacy & Security Clinical Lab Test Results Patient List Educational Resources Medication Reconciliation Summary of Care Immunization Registries Reportable Lab Test Results Syndromic Surveillance eMAR

Menu Objectives Advance Directives Electronic Notes Imaging Results Family History eRX Lab Results to Ambulatory Providers

Clinical Quality Measures Report on 16 of 29

Speaker Information

Natalie Stewart, MBAManaging Advisor, Meaningful UsePurdue Healthcare [email protected](765) 496-1265 (phone)(765) 496-6990 (fax)

[email protected]

Visit us on @ Purdue Healthcare Advisors

mailto:[email protected]

http://www.pha.purdue.edu/

mailto:[email protected]

Documents

ELIGIBLE HOSPITALS (EH) & CRITICAL ACCESS HOSPITALS (CAH) Stage 2 Meaningful Use