Proposed Changes to Meaningful Use 1 & 2...2015/07/20 · Adapted from: Brian Wagner, Senior Director of Policy and Public Affairs, eHealth Initiative (eHI) presentation to the MN

1

Proposed Changes to Meaningful Use 1 & 2

Paul Kleeberg, MD, FAAFP, FHIMSS

CMIO Stratis Health

2

Objectives

• Provide an overview of the proposed changes to stages 1 and 2 of the Meaningful Use program starting this year

• Enable you to understand what you may need to start now or do differently

• Help you to plan for 2016 and beyond

3

Meaningful Use Overview: Statutory Framework

• In HITECH, Congress established three fundamental criteria of requirements for meaningful use:

– Use of certified EHR technology in a meaningful manner

– The exchange of health information

– Submission of clinical quality data Adapted from: Brian Wagner, Senior Director of Policy and Public Affairs, eHealth Initiative (eHI)

presentation to the MN Exchange and Meaningful Use Workgroup January 15, 2010

4

4

Bending the Curve Towards Transformed Health

Data capture and sharing

Advanced clinical

processes

Improved outcomes

Stage 1 Stage 2

Stage 3

“Phased-in series of improved

clinical data capture supporting

more rigorous and robust quality

measurement and improvement.”

Source: Connecting for Health, Markle Foundation “Achieving

the Health IT Objectives of the American Recovery and

Reinvestment Act” April 2009

5

The Proposed Rule

• Meaningful Use Changes to Stage 1 and 2

– Released: April 15, 2015 and available in html at:

https://www.federalregister.gov/articles/2015/04/15/2015-08514/medicare-and-medicaid-programs-electronic-health-record-incentive-program-modifications-to

– Comments closed: June 15, 2015

























6

Proposed Timeline Changes for MU 1-2

• 90 Day reporting for all in 2015 • Providers scheduled to do MU1

– In 2015 will do MU2 with additional exemptions – In 2016 and 2017 will do MU 2 without additional exemptions

• Starting in 2017, Medicare first timers must do a full year (Medicaid only may do any 90 days)

X 2 X X X

90 days 90 days

* Still considered doing stage 2 even if they did stage 1

X 2

7

Reporting Periods

• 2015 – Hospitals

Starting in 2015 and continuing on have a calendar reporting year 15 reporting months in the 2015 year but only need to attest for

90 continuous days)

– Professionals Any 90 days in calendar year 2015

• 2016 – Any 90 days for first time attesters – Full year for those beyond their first year

• 2017 and later – Full year reporting for all except Medicaid only first year

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Attestation

• No changes to the method • All Medicare

– No 2015 Medicare attestations before January 2016 – New exception:

Hospitals in their first year may attest to 2015 before August 15 if they contact Elizabeth Holland ([email protected]) at the Division of Health IT at CMS and provide the hospital name, CMS Certification Number and contact person information

• Deadlines – Last day of February for all

• Medicaid – Providers who fall below 30% (or 20%) threshold, can attest under

Medicare to avoid the penalty without it constituting a switch in payment programs

mailto:[email protected]

9

Incentives

• Unchanged but winding down • Medicare

– If just starting 2014 was last year for EP to attest and begin to receive incentives 2015 is last year for CAH or PPS hospitals attest and begin to receive incentives

– Last incentive payment year: 2015 for CAHs 2016 for EPs and PPS hospitals

• Medicaid – If just starting

2016 is last year for EPs, CAH or PPS hospitals to receive incentives

– EPs 2021 is last payment year for EPs Max of 6 payments

– Hospitals Last possible payment year depends on the state – can be 3-6 years after 1st payment Any payment skipped after 2016 ends the program

10

Penalties and Exceptions

• Unchanged Except

– All who attest for the first time anytime in 2015 will not be penalized in either 2016 or 2017

The attestation system will not be available before January 2016 except as noted in the attestation slide

– All who attest for first time in 2016 will not be penalized in 2017 and 2018 if they attest before Oct 1 2016

– 2017 and later requires full year reporting

11

Miscellaneous Changes

• State Flexibility

– Unchanged

• Paper-based documents

– No longer count in numerators starting in 2015 except for patient education materials

12

Proposed Program Goals and Objectives

• Protect Patient Health Information • Electronic Prescribing • Clinical Decision Support • Computerized Provider Order Entry • Patient Electronic Access to Health

Information • Health Information Exchange • Public Health and Clinical Data Registry

Reporting

13

Changes to Stage 1: 2015-17

Measure Stage 1 2014 Stage 1 2015 Stage 1 2016-17

Security Risk Analysis C Y/N C Y/N C Y/N

eRx (EP) C 40% C 40% C 50%

Drug Formulary (EP) M Y/N Exclusion Exclusion C Y/N

eRx with Formulary (EH) C 10%

CDS C 1 C 1 C 5

Drug Interactions C Y/N C Y/N C Y/N

Medications C 30% C 30% C 60%

labs C 30%

Radiology C 30%

Patient Ed M 10% C 10% C 10%

Have access to VDT C 50% C 50% C 50%

Actually VDT C Y/N

Secure messages C Y/N

eSummary of Care C 10%

Med Rec M 50% C 50% C 50%

Immunization Registry M Y/N

EP:

1 of 5

EH:

2 of 6

Y/N

EP:

2 of 5

EH:

3 of 6

Y/N

Syndromic Surveillance M Y/N Y/N Y/N

Case Reporting Y/N Y/N

Public Health Registry Y/N Y/N

Clinical Data Registry Y/N Y/N

Reportable Labs (EH) M Y/N Y/N Y/N

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Changes to Stage 2: 2015-17

Measure Stage 2 2014 Stage 2 2015 Stage 2 2016-17

Security Risk Analysis C Y/N C Y/N C Y/N

ePrescribing (EP) C 50% C 50% C 50%

Drug Formulary (EP) C Y/N C Y/N C Y/N

eRx with Formulary (EH) M 10% M 10% C 10%

CDS C 5 C 5 C 5

Drug Interactions C Y/N C Y/N C Y/N

Medications C 60% C 60% C 60%

Labs C 30% C 30% C 30%

Radiology C 30% C 30% C 30%

Patient Ed C 10% C 10% C 10%

Have access to VDT C 50% C 50% C 50%

Patients Use VDT C 5% C 1 patient C 1 patient

Secure messages C 5% C Enabled C 1 patient

eSummary of Care C 10% C 10% C 10%

Med Rec C 50% C 50% C 50%

Immunization Registry C Y/N

EP: 2

of 5

EH: 3

of 6

Y/N

EP: 3

of 5

EH: 4

of 6

Y/N

Syndromic Surveillance EP: M

EH: C Y/N Y/N Y/N

Case Reporting Y/N Y/N

Public Health Registry Y/N Y/N

Clinical Data Registry Y/N Y/N

Reportable Labs (EH) C Y/N Y/N Y/N

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Protect Personal Health Information

Stage 1 (Core)

• Measure

– Conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies

• Denominator

– Yes/No Attest

• Exclusion

– None

Stage 2 (Core)

• Measure – Conduct or review a

security risk analysis, including the encryption/security of data stored in CEHRT, implement security updates as necessary and correct identified security deficiencies

• Denominator – Yes/No Attest

• Exclusion – None

15

Proposed

• Unchanged except:

– Implies that it is expanded to include all instances of electronically stored PHI not just on CEHRT

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Drug Formulary Check

Stage 1 (Menu)

• Measure – Implement drug

formulary checks with at least one internal or external formulary


• Exclusion – EP: writes <100

medication orders during the EHR reporting period

– EH: None

Stage 2 (Core/Menu)

• Measure

– EP: Incorporated into the eRx core item

– EH: Incorporated into the eRx menu item

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Proposed

• 2015

– Incorporated into the Stage 2 eRx item for EPs & EHs

17

ePrescribing (EP)

Stage 1 (Core)

• Measure – >40% of permissible

scripts are generated and transmitted electronically

• Denominator – Number of permissible

(non-controlled substance) scripts written by the EP

• Exclusion – Any EP who writes <100

prescriptions during the EHR reporting period.

– No pharmacies that accept e-prescriptions within 10 miles

Stage 2 (Core)

• Measure – >50 percent of permissible

or all prescriptions written are queried for a drug formulary and transmitted electronically

• Denominator – Number of permissible or

all scripts written by the EP

• Exclusion – Any EP who writes <100

permissible prescriptions during the EHR reporting period.

– No pharmacies that accept e-prescriptions within 10 miles

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Proposed

• Stage 1 – Unchanged for 2015 only

– Stage 2 requirement in 2016 & 2017

• Stage 2 – Unchanged

18

Discharge ePrescribing (EH)

Stage 1

• None

Stage 2 (Menu)

• Measure – >10 percent of hospital

discharge medication orders for permissible prescriptions are queried for a drug formulary and transmitted electronically.

• Denominator – Number of new, changed,

and refilled prescriptions

• Exclusion – No internal pharmacy that

can accept electronic prescriptions

– Not located within 10 miles of any pharmacy that accepts electronic prescriptions

18

Proposed

• Stage 1 – Not required in 2015 only


• Stage 2 – Not required in 2015 only

– Required element in 2016 & 2017

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Clinical Decision Support (CDS)

Stage 1 (Core)

• Measures (were separate)

– 1 CDS rule relevant to the specialty specific quality metric or high priority condition with the ability to track compliance

• Denominator

– Yes/No Attest

• Exclusion

– None

Stage 2 (Core)

• Measures

– 5 CDS interventions relevant to 4 quality metrics or high priority condition

• Denominator

– Yes/No Attest

• Exclusion

– None

19

Proposed

• Stage 1

– Unchanged for 2015 only


• Stage 2

– Unchanged

20

Drug-Drug and Drug-Allergy Interaction Checks

Stage 1 (Core)

• Measure

– This functionality is enabled for the entire EHR reporting period

• Denominator

– Yes/No Attest

• Exclusion

– None

Stage 2 (Core)

• Measure

– This functionality is enabled for the entire EHR reporting period

• Denominator

– Yes/No Attest

• Exclusion

– EP: if writes <100 medication orders

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Proposed

• Stage 1&2

– Unchanged

21

Computerized Provider Order Entry (CPOE)

Stage 1 (Core)

• Measure – >30% of patients on

any meds with ≥ one CPOE med order or may use >30% all orders

• Denominator – Unique patients or

unique orders)

• Exclusion: – Any EP who writes

<100 medication orders during the EHR reporting period.

Stage 2 (Core)

• Measures – >60% of all medication

orders, >30% of all laboratory and >30% radiology orders must be entered using CPOE

• Denominators: – Unique orders

• Exclusions: – Any EP who writes <100

medication, <100 radiology, or <100 laboratory orders during the EHR reporting period.

21

Proposed

• Stage 1

– Unchanged for 2015 only


• Stage 2

– Unchanged

Any licensed healthcare professionals and credentialed medical assistants, can enter orders into the medical record for

purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local and

professional guidelines.

22

Patient Education

Stage 1 (Menu)

• Measure

– >10% of all unique patients are provided patient- specific education resources identified by Certified EHR Technology.

• Denominator

– Unique patients

• Exclusion

– None

Stage 2 (Core)

• Measure

– >10% of all unique patients are provided patient- specific education resources identified by Certified EHR Technology.

• Denominator

– Unique patients

• Exclusion

– EP: No office visits

– EH: None

22

Proposed

• Stage 1

– May claim exclusion in 2015 only

• Stage 2

– Unchanged

– Paper still counts

• Denominator

– Unique patients

• Exclusion


– EH: None

23

Online Access to Health Information: Measure 1

Stage 1 Core

• Measure – >50% are provided

timely online access to their health information within 4 business days of it being available

• Denominator – Unique patients

• Exclusion – EP: Creates no

information, except for “Patient name” and “Provider's name” and office contact information.

Stage 2 (Core)

• Measure – >50% are provided

timely online access to their health information within 4 business days of it being available


• Exclusion – EP: Creates no

information, except for “Patient name” and “Provider's name” and office contact information.

23

Proposed

• Stage 1&2

– Unchanged

24

Online Access to Health Information: Elements

Professionals • Required elements

– Patient name – Provider's name contact info. – Current and past problem list. – Procedures. – Laboratory test results. – Current med list & med history. – Current med allergies & med allergy history. – Vital signs (height, weight, blood pressure,

BMI, growth charts). – Smoking status. – Demographic information (preferred

language, sex, race, ethnicity, date of birth). – Care plan field(s), including goals and

instructions. – Any known care team members including

the primary care provider (PCP) of record.

Hospitals • Required elements

– Patient name. – Admit & discharge date and location. – Reason for hospitalization. – Care team including the attending of record

and other providers of care. – Procedures performed during admission. – Current and past problem list. – 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 (sex,

race, ethnicity, date of birth, preferred language).

– Smoking status.

24

25

Online Access to Health Information: Measure 2

Stage 1

• None

Stage 2 Core

• Measure – >5% view, download, or

transmit (VDT) their health information


• Exclusions – EP: Creates no information,

except for “Patient name”, “Provider's name” and office contact information

– ALL: ≥50% encounters in a county with <50% of its housing units have 3 Mbps broadband http://www.broadbandmap.

gov/

25

Proposed

• Stage 1 – May be excluded in 2015


• Stage 2 – Required attesting that

one patient has done it

• Exclusion – Unchanged except now 4

Mbps broadband

http://www.broadbandmap.gov/

http://www.broadbandmap.gov/

26

Secure Electronic Messaging

Stage 1

• None

Stage 2 (Core) EP

• Measure – >5% of unique patients

(or their representatives) seen by the EP during the reporting period send the EP a secure message.


• Exclusion – No office visits

– ≥50% encounters in a county with <50% percent of its housing units have 3 Mbps broadband

26

Proposed EP & EH

• Stage 1 – May be excluded in 2015

– Stage 2 for 2016 & 2017

• Stage 2 – Required attesting that

capability is fully enabled

• Exclusion – Unchanged except now 4

Mbps broadband

27

Summary of Care / Referral

Stage 1 (Menu)

• Measure

– >50% of referrals and transitions of care

• Denominator

– Care transitions

• Exclusion

– EP: Does not refer or transition

– EH: None

Stage 2 (Core)

• Measure – >50% of referrals and

transitions of care

– >10% sent electronically

– One or more sent electronically to: A different provider with

a different EMR

The CMS designated test EHR

• Denominator – Care transitions

• Exclusion – EP: <100

transfers/referrals during the EHR reporting period

– EH: None

27

Proposed

• Stage 1 – May claim exclusion in

2015 only


• Stage 2 – SoC is created with

CEHRT and >10% eExchanged

• Denominator – Unchanged

• Exclusion – Unchanged

28

Summary of Care / Referral: Elements

• Patient name. • Referring or transitioning provider’s

name and contact information. • Procedures. • Encounter diagnosis. • Immunizations. • Laboratory test results. • Vital signs (height, weight, blood

pressure, BMI). • Smoking status. • Functional status, including

activities of daily living, cognitive and disability status.

• Demographic information (preferred language, sex, race, ethnicity, date of birth).

• 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.

• Reason for referral / Discharge instructions

• Current problem list (may also include historical problems).

• Current medication list. • Current medication allergy list.

29

Medication Reconciliation

Stage 1 (Menu)

• Measure – >50% of transitions of

care or a relevant encounter

• Denominator – # of transitions of care

(and relevant encounters if there is a policy)

• Exclusion – EP: No transitions of

care or referrals received

– EH: None

Stage 2 (Core)

• Measure – >50% of transitions of

care or a relevant encounter

• Denominator – # of transitions of care

(and relevant encounters if there is a policy)

• Exclusion – EP: No transitions of

care or referrals received

– EH: None

29

Proposed

• Stage 1

– May be excluded 2015


• Stage 2

– Unchanged

30

Public Health (PH) & Clinical Data Registry (CDR) Reporting

• Proposed Objective: – Active engagement with a Public Health Agency (PHA) or clinical

data registry (CDR) to submit electronic public health.

• Active Engagement: – Completed Registration to Submit Data:

Application submitted with 60 days of reporting period Awaiting invitation to test and validate

– Testing and Validation: EP/EH must respond to requests to test within 30 days

– Production: Active submission of data

• Exclusions – Agencies need to be capable at the start of the reporting period

31

PH & CDR Reporting Options

Measure

EP: Maximum Times

Measure Can Count • Stage 1 2015: Choose 1,

2016 on: Choose 2

• Stage 2: Choose 2

EH: Maximum Times

Measure Can Count • Stage 1 2015: Choose 2,

2016 on: Choose 3

• Stage 2: Choose 3

Immunization Registry

Reporting 1 1

Syndromic Surveillance

Reporting 1 1

Case Reporting 1 1

Public Health Registry

Reporting 3 4

Clinical Data Registry

Reporting 3 4

Electronic Reportable

Laboratory Results N/A 1

32

PH/CDR: Submit to Immunization Registry

Stage 1 (Menu)

• Measure – ≥ 1 test of submission

to state immunization registry except where prohibited with continued submission if successful


• Exclusions – Administers no

immunizations

– No registry with the capacity to receive

Stage 2 (Core)

• Measure – Successful ongoing

submission of electronic immunization data to an immunization registry or information system for the entire EHR reporting period


• Exclusion – Administers no

immunizations – No registry with the

capacity to receive

32

Proposed

• Measure

– Active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories

• Denominator

– Unchanged

• Exclusion

– Unchanged

33

PH/CDR: Syndromic Surveillance

Stage 1 (Menu)


to a public health agency except where prohibited with continued submission if successful


• Exclusions – Not in a category of

providers who collect this data

– No agency with the capacity to receive

Stage 2 (EP: Menu; EH: Core) • Measure

– Successful ongoing submission to a public health agency for the entire EHR reporting period


• Exclusion – EP: Not in a category of

providers who collect this data

– EH: No Emergency/Urgent Care

– No agency with the capacity to receive

33

Proposed

• Measure

– Active engagement with a public health agency to submit immunization syndromic surveillance data

• Denominator

– Unchanged

• Exclusion

– Unchanged

34

PH/CDR: Case Reporting

Stage 1 & 2

• None

Proposed • Measure:

– Active engagement with a public health agency to submit case reporting of reportable conditions as defined by the state, territorial, and local PHAs to monitor disease trends and support management of outbreaks.

• Denominator – Attest yes/no

• Exclusion: – EP does not diagnose any reportable

diseases for which data is collected

– No PHA with the capacity to receive

34

35

PH/CDR: Cancer Registry (EP)

Stage 1

• None

Stage 2 (Menu)


submission of cancer case information to a public health central cancer registry for the entire EHR reporting period.


• Exclusion: – EP does not diagnose

or directly treat cancer; – No PHA with the

capacity to receive electronic cancer case information

35

Proposed

• Measure:

– No longer specifically identified

36

PH/CDR: Public Health Registry Reporting (may do more than one)

Stage 1

• None

Stage 2 (Menu)

• Measure – Successful on-going

submission of specific case information to a specialized registry for the entire EHR reporting period.


• Exclusion: – EP does not diagnose

or treat relevant diseases;

– The EP operates in a jurisdiction for which no public health agency is capable

36

Proposed

• Measure:

– Active engagement with a public health agency to submit relevant data to public health registries

• Denominator

– Attest yes/no

• Exclusion:

– Does not diagnose or treat relevant diseases;


37

PH/CDR: Clinical Data Registry Reporting (may do more than one)

Stage 1

• None

Stage 2 (Menu)

• Measure – Successful on-going

submission of specific case information to a specialized registry for the entire EHR reporting period.


• Exclusion: – Does not diagnose or

treat relevant diseases;

– No registry with the capacity to receive

37

Proposed

• Measure: – Active engagement to

submit relevant data to a clinical data registry

– Defined: A record of the health status of patients with relevant diseases & the care they receive over time


• Exclusion: – Does not diagnose or

treat relevant diseases; – No registry with the

capacity to receive

38

PH/CDR: Reportable Labs (EH)

Stage 1 (Menu)


to a public health agency except where prohibited with continued submission if successful


• Exclusion: – Does not order

reportable labs;


Stage 2 (Core)


submission to a public health agency for the entire EHR reporting period


• Exclusion: – Does not order

reportable labs;


38

Proposed

• Measure:

– Active engagement with a public health agency to submit electronic reportable lab results.

• Denominator

– Unchanged

• Exclusion

– Unchanged

39

Deleted from Stage 1: 2015

Measure Stage 1 2014 Stage 1 2015 - 17

Summary of Care Any Method M 50% Exclusion 2015, eSoC after

Demographics C 50% (eAccess & eSoC)

Vital Signs C 50% (eAccess & eSoC)

Problem List C 80% (eAccess & eSoC)

Medication List C 80% (eAccess & eSoC)

Allergies C 80% (eAccess & eSoC)

Smoking C 50% (eAccess & eSoC)

Incorporate Labs M 40% (eAccess & eSoC)

Clinical Summaries (EP) C 50% (eAccess)

Advanced Directives (EH) M 50% Not Measured

Patient Lists M Y/N Not Measured

Patient Reminders (EP) M 20% Not Measured

40

Deleted from Stage 2: 2015-17

Measure Stage 2 2014 Stage 2 2015 on

Summary of Care Any Method C 50% (eSoC)

eSoC Diff EHR & system C Y/N (eSoC)

Provider Notes M 30% (eAccess & eSoC)

Demographics C 80% (eAccess & eSoC)

Vital Signs C 80% (eAccess & eSoC)

Smoking C 80% (eAccess & eSoC)

Incorporate Labs C 55% (eAccess & eSoC)

Clinical Summaries (EP) C 50 (eAccess)

Imaging Results M 10% Not Measured

Family History M 20 Not Measured

Advanced Directives (EH) M 50% Not Measured

Provide eLab Results (EH) M 20% Not Measured

eMAR (EH) C 10% Not Measured

Patient Lists C Y/N Not Measured

Patient Reminders (EP) C 10% Not Measured

41

Demographics

Stage 1 (Core)

• Measure

– >50% of patients seen: preferred language, gender, race, ethnicity, and DOB. For EHs: date and preliminary cause of death

• Denominator

– Unique Patients

• Exclusion

– None

Stage 2 (Core)

• Measure

– >80% of patients seen: preferred language, sex, race, ethnicity, DOB. For EHs: date and preliminary cause of death

• Denominator

– Unique Patients

• Exclusion

– None

41

Proposed

• Mandatory element in

– Online Access to Health Information

– Summary of Care

• No longer reported separately

42

Vital Signs

Stage 1 (Core)

• Measure – >50% of patients ≥ 2yo

seen: height, weight, BP, BMI, & for age 2-20: growth charts w/BMI. May split BP and height-weight, also may use only ≥ 3 for BP and all ages for H/W/BMI)


• Exclusion – EP: If outside scope of

practice – EH: None

Stage 2 (Core)

• Measure – >80% of patients

height/length, weight, BMI; ≥ 3yo: BP; age 0-20: growth charts w/BMI. May split BP and height/length-weight

• Denominator – Unique Patients

• Exclusion – EP: If BP or H/L-W is

outside scope of practice

– EH: None

42

Proposed



– Summary of Care


43

Problem List

Stage 1 (Core)

• Measure

– >80% of patients seen at least one or “none” as structured data

• Denominator

– Unique patients

• Exclusion

– None

Stage 2

• Measure

– Incorporated as a mandatory element in the transfer of care document

• Denominator

– Referrals or transfers of care

• Exclusion

– None

43

Proposed



– Summary of Care


44

Medication List

Stage 1 (Core)

• Measure


• Denominator

– Unique patients

• Exclusion

– None

Stage 2

• Measure


• Denominator


• Exclusion

– None

44

Proposed



– Summary of Care


45

Medication Allergies

Stage 1 (Core)

• Measure


• Denominator

– Unique patients

• Exclusion

– None

Stage 2

• Measure


• Denominator


• Exclusion

– None

45

Proposed



– Summary of Care


46

Smoking Status

Stage 1 (Core)

• Measure

– >50% of patients ≥ 13yo seen, record status as structured data

• Denominator

– Unique patients

• Exclusion

– No patients 13 years old or older.

Stage 2 (Core)

• Measure

– >80% of patients ≥ 13yo seen, record status as structured data

• Denominator

– Unique patients

• Exclusion

– No patients 13 years old or older.

46

Proposed



– Summary of Care


47

Family Health History

Stage 1

• None

Stage 2 (Menu)

• Measure

– >20% have a structured data entry for one or more first-degree relatives

• Denominator

– Unique patients

• Exclusion

– EH: None


47

Proposed

• Measure

– Not reported

– Not an element in SoC or eAccess

48

Advanced Directives (EH)

Stage 1 (Menu)

• Measure

– >50% of ≥65yo admitted indicate advanced directive recorded

• Denominator

– Unique inpatient admissions

• Exclusion

– No patients ≥65yo admitted

Stage 2 (Menu)

• Measure

– >50% of ≥65yo admitted indicate advanced directive recorded

• Denominator

– Unique inpatient admissions

• Exclusion

– No patients ≥65yo admitted

48

Proposed

• Measure

– Not reported


49

Electronic Medication Tracking eMAR (EH)

Stage 1

• None

Stage 2 (Core)

• Measure – >10 percent of

medication orders (includes all doses) are tracked from order to administration using eMAR.

• Denominator – Medication orders

• Exclusion – EH/CAH with average

daily census <10 patients

49

Proposed

• Measure

– Not reported


50

Electronic Provider Notes

Stage 1

• None

Stage 2 (Menu)

• Measure – >30% of unique

patients have at least one electronic progress note created, edited and signed by an authorized provider. The text must be text searchable and may contain drawings and other content



50

Proposed:

• Potentially appear in

– Online Access Care Plan Field

– Discharge Instructions (EH)

– Reason for Referral (EP)


51

Imaging Results

Stage 1

• None

Stage 2 (Menu)

• Measure – >10 percent of all tests

whose result is one or more images are accessible through Certified EHR Technology

• Denominator – Imaging studies

• Exclusion – EP: Orders <100 imaging

studies during the EHR reporting period or without access to electronic imaging results at the start of the EHR reporting period.

– EH: None

51

Proposed

• Measure

– Not reported


52

Incorporate Lab Results

Stage 1 (Menu)

• Measure

– >40% of labs with numeric or +/- result in chart as structured data

• Denominator

– Unique +/- or numeric lab results

• Exclusion

– EP: No results of this type ordered

– EH: None

Stage 2 (Core)

• Measure

– >55% of labs with numeric or +/- result in chart as structured data

• Denominator

– Unique +/- or numeric lab results

• Exclusion

– EP: No results of this type ordered

– EH: None

52

Proposed



– Summary of Care


53

Patient Lists

Stage 1 (Menu)

• Measure

– Generate at least one pt list based on a specific condition

• Denominator

– Yes/No Attest

• Exclusion

– None

Stage 2 (Core)

• Measure

– Generate at least one pt list based on a specific condition

• Denominator

– Yes/No Attest

• Exclusion

– None

53

Proposed

• Measure

– Not reported

– Could be considered an element of quality measurement

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Provide Electronic Lab Results (EH)

Stage 1

• None

Stage 2 (Menu)

• Measure – >20 percent of

electronic lab orders received, Hospital labs send structured electronic clinical lab results to the ordering provider

• Denominator – Electronic lab orders

received


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Proposed

• Measure

– Not required


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Clinical Summaries (EP)

Stage 1 (Core)

• Measure

– >50% of office visits, a patient gets a visit summary within 3 business days

• Denominator

– Office Visits

• Exclusion

– No office visits during the EHR reporting period

Stage 2 (Core)

• Measure

– >50% of office visits, a patient or their representative gets a visit summary within 1 business day

• Denominator

– Office Visits

• Exclusion

– No office visits during the EHR reporting period

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Proposed

• Potentially appear in

– Online Access Care Plan Field includes goals & instructions

• Paper no longer tracked


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Patient Reminders (EP)

Stage 1 (Menu)

• Measure

– >20% of pts ≥ 65 or ≤ 5yo sent reminders for follow up care

• Denominator

– Unique Patients

• Exclusion

– No patients ≥ 65 or ≤ 5yo

Stage 2 (Core)

• Measure – >10% pts with >1

office visit within 2 years receive reminders for follow-up care sent per patient preference.

• Denominator – Unique patients with

2 or more visits in past 24 months

• Exclusion – No office visits in 24

months before the measurement period

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Proposed

• Measure

– Not reported

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• Eligible Professional – Record Demographics – Record Vital Signs – Record Smoking Status – Clinical Summaries – Structured Lab Results – Patient List – Patient Reminders – Summary of Care Measure

• Any Method Measure • Test different vendor and system

– Electronic Notes – Imaging Results – Family Health History

• Eligible Hospital/CAH – Record Demographics – Record Vital Signs – Record Smoking Status – Structured Lab Results – Patient List – Summary of Care Measure

• Any Method Measure • Test different vendor and system

– eMAR – Advanced Directives – Electronic Notes – Imaging Results – Family Health History – Structure Labs to Ambulatory

Providers

Eliminated as Separate Measures

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CEHRT

• Use 2014 or 2015 Certified EHR Technology (CEHRT) or a combination through 2017 for MU 1 & 2

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CQM Reporting

• Same method, domain requirements and number as for 2014 • 2015

– Any 90 days in the calendar year – EHs, additional 3 months at end of CY 2014 (15 month reporting

year) – Can be more than 90 days and does not need to correspond with

MU objective reporting period

• 2016 – Full year reporting except first year MU

• 2017 – Full year reporting for all except first year Medicaid only – May attest to 2016 measures or e-submit to 2017 measures

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What to Expect

• Final rule in September or October – MU2 NPRM released 3/7/12, comments closed

5/6/12 – MU2 Final Rule released 9/4/12 – 4 months later – MU 1&2 Revisions NPRM comments closed 6/15

4 months later is October

• Therefore – Proceed with all current requirements – Plan for potential new requirements in 2015 – Prepare for a full year of MU2 in 2016

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Questions?

Paul Kleeberg, MD

CMIO Stratis Health [email protected]

This material was prepared by Telligen, the Quality Innovation Network

National Coordinating Center, under contract with the Centers for

Medicare & Medicaid Services (CMS), an agency of the U.S. Department

of Health and Human Services. The contents presented do not necessarily

reflect CMS policy. (11SOW-QINNCC-00325-07/13/15)

mailto:[email protected]

Documents

Proposed Changes to Meaningful Use 1 & 2...2015/07/20 · Adapted from: Brian Wagner, Senior Director of Policy and Public Affairs, eHealth Initiative (eHI) presentation to the MN