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Meaningful Use Stages 1 & 2Making Sure You Get the Most Out of Your EHRTracy McDonaldMedicaid EHR Incentive Program Coordinator

Agenda Meaningful Use Stages & Incentive ProgramTiming 2014 Changes to Stage 1 Stage 2’s New Core, Menu Set and ClinicalQuality Objectives 2015 Payment Adjustments Timeline

Stages of Meaningful UseStage 1Stage 2Data Captureand SharingAdvancedClinicalProcessesStage 3ImprovedOutcomes Capturing health informationin a standardized format More rigorous healthinformation exchange (HIE) Improving quality, safety, andefficiency Track key clinical conditions Increased requirements fore-prescribing, demographicsand vital signs Decision support for nationalhigh-priority conditions Communication of informationfor care coordination processes Report Clinical QualityMeasures & public healthinformation Electronic transmission ofpatient care summaries More patient-controlled data Patient and family engagement Patient access to selfmanagement tools Access to comprehensivepatient data through patientcentered HIE Improving population healthAdapted from HealthIT.gov 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights ReservedCORHIO Proprietary - Not For Redistribution3

Meaningful Use TimingIncentive Payment YearFirst Program Year2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 20212011 1112*233TBD TBD TBD TBD201220132014201520162017112*233TBD TBD TBD TBD11*2233TBD TBD TBD1*12233TBD TBD112233TBD11223311223* 90-day EHR Reporting Period for all Stages of MU in 2014 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights ReservedCORHIO Proprietary - Not For Redistribution4

Incentive Payments for EPs MedicareCalendarYearCY2011CY2012CY2013CY20142015 andbeyond2011 18,0002012 12,000 18,0002013 8,000 12,000 15,0002014 4,000 8,000 12,000 12,000-1%2015 2,000 4,000 8,000 8,000-2% 2,000 4,000 4,000-3%20162017-4%2018-5%TOTAL 44,000 44,000 39,000 24,000 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution0

Incentive Payments for EPs MedicaidCalendarYearCY20112011 21,2502012 8,500 21,2502013 8,500 8,500 21,2502014 8,500 8,500 8,500 21,2502015 8,500 8,500 8,500 8,500 21,2502016 8,500 8,500 8,500 8,500 8,500 21,250 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 8,500 OTALCY2016 8,500 63,750 63,750 63,750 63,750 63,750 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 63,750

Stage 1 & Stage 2Meaningful Use

Meaningful Use – More than justIncentive Continuous Quality ImprovementPatient and Family EngagementCheck in /Check outPatientIntake /RoomingProviderVisitOrders /Point ofCareClinicalAdminPrivacy and Security8

Meaningful Use Definitions Objective– Description of the Meaningful Use goal Measure– The level at which the EH or EP will demonstrate they metthe objective Core– Core objectives are required Menu Set– Menu set objectives are required; however, the EH or EP canchoose which objectives on which to report* These are changes as of this presentation – final changes from CMS are expected this Fall.

2014 Stage 1 to Stage 2OverviewStage 1Stage 213 Core Objectives5 of 9 Menu Objectives17 Core Objectives3 of 6 Menu Objectives9 Total Clinical QualityMeasures9 Total Clinical QualityMeasures27 Total29 Total

Stage 1 Changes* Menu Set Objectives– EPs will have to report on 5 of 9– What does this mean? Menu Objective: Timely access to health information has beenincorporated into a new Core Measure for 2014 Exclusion for Menu Set Objectives– Measures with exclusions will no longer count toward the 5required menu set objectives– What does this mean? If you take an exclusion, you must report on all other menu setmeasures (FAQ10162)* These are changes as of this presentation – final changes from CMS are expected this Fall.

Stage 1 Changes* Clinical Quality Measures– EPs & EHs will need to report on additional CQMs that fallinto at least 3 domains Electronic Copy of and Electronic Access to HealthInformation– These two measures will be eliminated and replaced in bothStage 1 and Stage 2 Record Vital Signs– The exclusions have been modified and divided– The objective has been clarified* These are changes as of this presentation – final changes from CMS are expected this Fall.

Meaningful Use - Core Objectives

Stage 2 Core Objectives –Measure IncreasesEP ObjectivePreviousMeasureNew MeasureWorkflowE-Prescribing40%50%Orders / Points of CareRecordDemographics50%80%Check in / Check outRecord SmokingStatus50%80%Patient Intake /RoomingClinical DecisionRule(s)15Provider VisitClinical Summaries50% / 3 days50% / 1 dayCheck in / Check outProtect ElectronicHealth InformationYesYesAnnually!! 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Stage 2 Core Objectives –Menu to CoreEP ObjectivePreviousMeasureNew MeasureWorkflowPatient ListsYesYes – Menu to n Resources10%10% – Menu to COREOrders / Points ofCareMedicationReconciliation50%50% - Menu to COREProvider VisitClinical Lab-TestResults40%55% - Menu to COREClinicalAdministration 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

CPOE for Medication, Laboratoryand Radiology Orders Stage 1 Medication orders entered directly by a licensedhealth care professional– 30% of all medication orders Stage 2 Medication, laboratory and radiology ordersentered directly by a licensed health care professional– 60% of all medication orders– 30% of all laboratory orders– 30% of all radiology ordersOrders /Point of CareCheck in /Check outPatient Intake /RoomingPatient ExamClinicalAdministration16

CPOE for Medication, Laboratoryand Radiology Orders Notes from CMS:– Electronic transmittal of the medication order is not arequirement for meeting the measure of this objective– CPOE is the entry of the order into the patient's EHR thatuses a specific function of CEHRT - it is not how that order isfilled or otherwise carried out– Any licensed health care professional and credentialedmedical assistants can enter orders into the medical recordfor purposes of including the order in the numerator of theCPOE objective Credentialing of the MA must come from an organization otherthan the employing organizationOrders /Point of CareCheck in /Check outPatient Intake /RoomingPatient ExamClinicalAdministration17

Record Vital Statistics Stage 1 2013 Record and chart vital signs: height, weight,blood pressure, calculate and display BMI, plot anddisplay growth charts for 2-20 years, including BMI– 50% of all unique patients Stage 2 Record and chart changes in the following vitalsigns: Height/length & weight (no age limit)Blood pressure (age 3 and older)BMI (no age limit)Growth charts, including BMI (age 0-20)Stage 12014– 80% of all unique patientsCheck in /Check outPatientIntake /RoomingPatient ExamOrders / Pointof CareClinicalAdministration18

Record Vital Statistics Notes from CMS:– The exclusions are extensive; research them if you do notthink they pertain to your scope of practice– Height, weight and blood pressure do not have to be updatedby the EP at every patient encounter At least once during the EHR Reporting Period EP can make the determination– Information can be entered in a number of ways: Directly by EPDesignated individual from EP’s staffData transfer from another provider electronicallyHIEData entered directly through a patient portalCheck in /Check outPatientIntake /RoomingPatient ExamOrders / Pointof CareClinicalAdministration19

Patient Electronic Access Stage 1 Provide patients with an electronic copy of theirhealth information (50% within 3 days), AND Stage 1 Provide patients with timely electronic access totheir health information (MENU SET, 10% within 4 days) Stage 2 Provide patients the ability to view online,download and transmit their health information within 4business days of the information being available to the EPStage 12014 Measure 1 More than 50% of all unique patients areprovided timely online access to their health information Measure 2 More than 5% of all unique patients view,download or transmit to a third party their healthinformationCheck in /Check outPatient Intake /RoomingPatient ExamOrders / Pointof CareClinicalAdministration20

Patient Electronic Access Notes from CMS:– CMS has a list of the information that must be madeavailable online Any information that is prohibited by any federal, state or locallaw does not need to be included Any information that the provider believes could causesubstantial harm to the patient does not need to be included– “Transmission” – any means of electronic transmissionincluding, but not limited to SMTP, FTP, REST, SOAP Physical electronic media (USB, CD, etc.) does not qualifyCheck in /Check outPatient Intake /RoomingPatient ExamOrders / Pointof CareClinicalAdministration21

Preventive Care / PatientReminders Stage 1 MENU SET – Send reminders to patients perpatient preference for preventive/follow-up care– More than 20% of all unique patients 65 or older or 5 yearsor younger Stage 2 Use clinically relevant information to identifypatients who should receive reminders forpreventive/follow-up care and send these patientsreminders per patient preference– More than 10% of all unique patients who have had 2 ormore office visits with the EP within the 24 months prior tothe EHR Reporting period were sent a reminderCheck in /Check outPatient Intake /RoomingPatient ExamOrders / Pointof CareClinicalAdministration22

Preventive Care / PatientReminders Notes from CMS– Patient Preference includes, but not limited to mail,phone or secure messaging Must follow HIPAA guidance 45 CFR 164.522(b)– If a patient declines to provide their preferred method,the provider may select one for them– The reminder must be for preventive/follow-up care thatthe patients isn’t already scheduled to receiveCheck in /Check outPatient Intake /RoomingPatient ExamOrders / Pointof CareClinicalAdministration23

Summary of Care / Transitionsof Care Stage 1 4 Measures––––Drug-Drug and Drug-Allergy Interaction ChecksProblem ListsActive Medication ListActive Medication Allergy List Stage 2 EP who transitions their patient to anothersetting of care or provider of care or refers their patient toanother provider of care should provide a summary carerecord for each transition of care or referral– This is a 3-part measureCheck in /Check outPatient Intake /RoomingPatient ExamOrders / Pointof CareClinicalAdministration24

Summary of Care / Transitionsof Care Summary of Care– Measures 1 & 2 must both be met Measure 1: EP who transitions or refers patients provides asummary of care record for more than 50% of transitions ofcare and referrals Measure 2: EP who transitions or refers patients provides asummary of care record for more than 10% of such transitionsand referrals with– (a) electronically transmitted using the CEHRT to a recipient, or– (b) where the recipient receives the summary of care record viaexchange facilitated by an organization that is a eHealthExchangeparticipant or in a manner that is consistent with the governancemechanism ONC establishes for the eHealthExchangeCheck in /Check outPatient Intake /RoomingPatient ExamOrders / Pointof CareClinicalAdministration25

Summary of Care / Transitionsof Care Summary of Care– Measure 3 must have one of the following criteria met Conducts one or more successful electronic exchanges of asummary of care document, as part of which is counted in“Measure 2”– The sending and receiving EHRs must be different Conducts one or more successful test with the CMS designatedtest EHR during the EHR reporting period– CMS is setting up a “dummy” site for this exchange so that the EPmay meet the measureCheck in /Check outPatient Intake /RoomingPatient ExamOrders / Pointof CareClinicalAdministration26