PowerPoint Presentation

Series 1: Meaningful Use for Behavioral Health ProvidersFrom the CIHS Video Series Ten Minutes at a Time

Module 1: What is Meaningful Use?

9/2013

Welcome to the SAMHSA-HRSA Center for Integrated Health Solutions video series Ten Minutes at a Time. This information on how to meet the standards for Meaningful Use and how to select and successfully implement an electronic health record system is organized into brief, convenient modules targeted to Behavioral Health providers. This is Series 1: Meaningful Use for Behavioral Health Providers and it begins with Module 1, What is Meaningful Use? The goal of this module is to create a frame of reference for understanding and implementing Stage 1 of Meaningful Use.

1Module 1 Outline Four key terms and one important requirement

Meaningful Use as a national healthcare goal

Meaningful Use as a set of concrete Objectives with Measures for evaluating progress

An example of a Meaningful Use Objective and its Measure

Getting help - resources for technical assistance and training

We will begin by explaining four commonly used terms and one important requirement. Then we will discuss Meaningful Use as a national goal, and also as set of concrete Objectives, each with a specific Measure to evaluate progress towards attaining the Objective and achieving the Meaningful Use standard. To illustrate this, we will examine one of the Objectives and its Measure in depth. There are links to additional resources throughout this video, and it concludes with identifying some additional options for Meaningful Use technical assistance and training.

2Four Key Terms HIT Health Information TechnologyHIE Health Information ExchangeEHR Electronic Health RecordStructured Dataand One Important RequirementCertified Complete EHR An EHR can be certified when it meets national standards for electronic health data and technology.To find out if an EHR is certified, try this link: http://oncchpl.force.com/ehrcert?q=chpl

First, there are four frequently used terms and one important requirement you will need to become familiar with. HIT stands for Health Information Technology. This term can be used to refer to any aspect of information technology that is related to health care this includes databases, hardware, software, infrastructure, and so on. HIE stands for Health Information Exchange. Personal health information can be exchanged at the state level, the regional level, in point-to-point transmission and receipt between providers, or some combination of all three. EHR stands for Electronic Health Record. The EHR is the electronic, or computerized version of the paper chart, but offers many significant advantages over paper-based information storage and retrieval. Structured data is information that is entered into the computer in a way that makes it possible for the computer to find the information and use it for different purposes.

There is also an important requirement to keep in mind. To implement Meaningful Use, you must begin with a certified Complete EHR. This is an EHR that is verified by a specially accredited testing and certification organization to meet at least the minimum standards necessary for attaining Meaningful Use. Usually the certified Complete EHR is sold as a single product, but it is also sold as separate, certified modules that can be purchased and sometimes combined to create the Certified Complete EHR.

To find out if an EHR is certified, try the link provided: http://oncchpl.force.com/ehrcert?q=chpl

3What is Meaningful Use?As a concept:Individual providers and patients have routine access to comprehensive patient health information and use it to improve the effectiveness, efficiency and quality of patient careEssential, up-to-date patient information, shared among providers regardless of specialty or physical locationPatients access their information: know what it means and how to use it to actively engage in their own careSharing and access are incorporated into organizational policies and procedures

Click the link below for more information:http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives

So, what exactly is Meaningful Use? Understanding it as a concept makes it easier to understand as a standard of care. When health care providers and their patients have real-time access to comprehensive patient health information, they are able to use this information to improve the effectiveness, efficiency and quality of patient care. In other words, both the provider and the patient are able to use the information in a meaningful way. To make information comprehensive, the providers involved in the patients care, regardless of specialty or physical location, contribute critical information to a shared record. It is just as important to share information with the patient. This implies that the wide range of practices related to implementing Meaningful Use must be built into organizational policies and procedures http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives

4What Shared Information is Considered Essential?Data standard includes up to 17 areas of information, but only the minimum data set has to be available

Minimum data set includes: a list of the medications the patient is currently taking (Active Medication List); patient allergies (Allergy List); a list of patient diagnosis Problem List; and diagnostic test results (for example, labs results)

Does not include treatment plans, progress, psychotherapy notes

Must meet federal and state regulations re: confidentiality, privacy, security

Click link below for a more detailed exploration of the information for exchangehttp://www.corepointhealth.com/sites/default/files/whitepapers/continuity-of-care-record-ccr.pdf

There are national data standards regarding the nature of patient information to be shared. There are also national technology standards to help protect this information from access by unauthorized entities. Data and technology standards are covered in more detail in Module 2, and the patient data set that is shared is examined more closely in Module 9. For right now it is important to understand that especially when it comes to information exchange, behavioral health providers should always align their practices with national standards and not try to change or modify these standards by adding or removing data. Patient treatment plans, progress notes and psychotherapy notes are not exchanged. Whenever information is shared, providers must adhere to all applicable federal and state regulations regarding confidentiality, privacy and security.

Click the link below for more detailed information: http://www.corepointhealth.com/sites/default/files/whitepapers/continuity-of-care-record-ccr.pdf

5As a set of concrete Objectives and Measures (standard of care)Administered by the Center for Medicaid/Medicare Services (CMS), assisted by the state Medicaid agencies

Implemented in 3 stages: currently in Stage 1 Goal is achieved through achieving Objectives and meeting MeasuresCore Objectives (15)Menu Objectives (select 5 of 10)Total 20 Objectives and Measures Objective related activities support exchange of health information, patient engagement in treatment, safety of care, security of dataFor more information about Objectives and Measures, click link below:

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EP-MU-TOC.pdf

What is Meaningful Use?

The Meaningful Use initiative is administered by the Center for Medicaid/Medicare Services (CMS). There is a track for Medicaid and another track for Medicare. The national plan is to implement Meaningful Use in 3 Stages. We are currently in Stage 1. Those who are now completing two years of Stage 1 will be starting Stage 2 in January, 2014.

Meaningful Use as a standard is attained by meeting a set of Objectives, each with its own Measure for evaluating progress. The Objectives are attained by individual health care professionals during the course of patient treatment as the certified EHR is used to manage information. They achieve a maximum of 20 Objectives through activities that improve quality, safety and efficiency of care; reduce health disparities; improve care coordination; improve population and public health; and ensure adequate privacy and security protections for patient health information. These Objectives and Measures were identified through a public, national consensus building process that ensured the widest possible participation and input from health professionals all over the country, from many different perspectives.

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/download6Safety and Quality Issues Medications Adverse drug events (ADEs) cause more than 770,000 injuries and deaths each yearAt least three-quarters of these ADEs are caused by systemic errors*

*Agency for Healthcare Research and Quality (AHRQ). (2001). Reducing and preventing adverse drug events to decrease hospital costs. Retrieved March 2013 from http://www.ahrq.gov/research/findings/factsheets/errors-safety/aderia/index.html Meaningful Use and Opportunities for Improvement in Healthcare

The standards for Meaningful Use are intended to address specific areas that have been identified as opportunities for improvement in health care. For example, there are significant safety and quality concerns around the management of patient medications. Health care leadership organizations noted that taking specific steps, for example taking steps to reduce the incidence of Adverse Drug Events (ADEs), would have a direct and positive impact.

Click this link to access the AHRQ report: http://www.ahrq.gov/research/findings/factsheets/errors-safety/aderia/index.htm7Stage 1 Meaningful Use

Improve Quality, Safety, Efficiency

5 Core and 2 Menu Objectives related to medication

Improved medication management

It makes sense then, that many of the Objectives target medications information management activities for improvement. The diagram shows five of the Core Objectives and two of the Menu Objectives that are intended to improve the quality, effectiveness and efficiency of medications management. It also illustrates one of the important considerations in implementing Meaningful Use - that is, Objectives are attained as a collection of inter-related strategies, not as a checklist of tasks.8How An Objective Is Met and MeasuredEach Objectives is clearly statedCore Objective #5 Maintain Active Medication List

Each Objective has a Measure with a Numerator and DenominatorMore than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data.

Each Objective has Specifications for ImplementationSpecifications define terms, explain requirements and offer additional information. Click on #5 in the linked list below:

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Hosp_CAH_MU-TOC.pdf

Lets look more closely at one of these medications-related Objectives, Core Objective #5 regarding the Active Medication List, to see how it is attained and how that attainment is measured. You may notice that the Measure language is very specific. The Objective can be stated in general terms, but the Measure has to be precise in order to ensure everyone is measuring the same things in the same ways. So each Core and Menu Objective is stated, then high-level specifications for attaining the Objective follows in the form of a Measure.

In this case, the health professional knows that they have met this Objective when 80% of their patients have at least one entry recorded in the EHR as structured data. More detailed specifications and requirements that define terms and explain conclusions are accessible through the CMS web site.

Click this link for additional information: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Hosp_CAH_MU-TOC.pdf

9The Incentive Program for Adopting Meaningful UseImplemented through a monetary incentive program in annual awards to individual Eligible Professionals or EPs

EP awards are usually immediately passed to the provider organization

Two tracks one for Medicare, one for Medicaid

Incentives are not the only reason to participate. Widespread adoption of EHRs and patient information exchange is transforming the health care landscape

http://www.socialworktoday.com/archive/051313p24.shtml

Meaningful Use is not a federal requirement. Instead, it is being implemented with support from an incentive program. Eligible Professionals, or EPs who demonstrate they have attained the Objectives by meeting the Measures may receive an annual incentive payment. This incentive is usually not pocketed by the EP, but is instead passed directly to the provider organization. The payment can be used to mitigate the cost of implementing the EHR.

But the incentive program is only one of many reasons to implement Meaningful Use. The health care landscape is being transformed by the widespread adoption of EHRs, and by the data and technology standards for sharing patient information. Although there are many ongoing challenges, there is no question that it is the road the country is taking to improve the efficiency, effectiveness and quality of patient care. Psychiatrists and psychiatric nurse practitioners are Eligible Professionals. But behavioral health care is not high on the list of priorities in this national effort. Behavioral health providers often take the initiative to participate, rather than risk being left behind.

Click on these links for more information: http://www.socialworktoday.com/archive/051313p24.shtml10SummaryThere are many new terms and new ways of thinking in Meaningful Use. Each module in this series explains key terms and ideas, and provides links to more informationWhen Meaningful Use is understood as a concept, meeting the standard for Meaningful Use is more easily achievedMeaningful Use is intended to address systemic shortcomings in the health care system, but it is implemented by individual Eligible ProfessionalsThere are two tracks in Meaningful Use one for Medicaid and one for MedicareMeaningful Use is a national effort (underway since 2004), will soon be the new normal in healthcare.http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

In summary, there are many new terms and acronyms to learn in Meaningful Use. We will try to address this as we go by beginning each module with an explanation of key terms and concepts. There are two tracks in Meaningful Use one for Medicaid and one for Medicare. Behavioral health providers usually follow the Medicaid track. When Meaningful Use is understood as a concept, Meaningful Use as a standard makes intuitive sense. It is clearly intended to address systemic shortcomings in the health care system, and so must be fully integrated into policies and procedures to be effective. Meaningful Use is a national effort that is quickly becoming the new normal in healthcare.

Click this link for more information: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

11We Have Solutions for Integrating Primary and Behavioral Healthcare

Contact CIHS for all types of primary and behavioral health care integration technical assistance and training needs

1701 K Street NW, Ste 400 Washington DC 20006

Web: www.integration.samhsa.govEmail:integration@thenationalcouncil.orgPhone:202-684-7457

Prepared and presented by Colleen ODonnell, MSW, PMP, CHTS-IM for the Center for Integrated Health Solutions

Our thanks go to SAMHSA and to HRSA for providing support to the Center for Integrated Health Solutions (CIHS) for this and many other forms of training and technical assistance related to the integration of primary and behavioral health care. Please visit our web site at www.integration.samhsa.gov, email us at integration@thenationalcouncil.org, or just pick up the phone and give us a call at 202-684-7457.

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