Click to edit Master title style Becoming Meaningful
Click to edit Master title style Becoming Meaningful Users Medical and Dental Application Dan Belknap M-CEITA / Altarum Institute June 10, 2014 6/4/2014 1 1
Presentation Topics 1. Who is M-CEITA? 2. MU Stage 1: Summary of Objectives & Measures for Eligible Professionals (EPs) 3. NPRM (Notice of Proposed Rule Making) 4. Questions 5. MU Stage 2: Brief Overview (if time permits) 2
Who is M-CEITA? ▲ Michigan Center for Effective Information Technology Adoption (M-CEITA) - 2010 ▲ One of 62 ONC Regional Extension Centers (REC) providing education & technical assistance to primary care providers across the country ▲ Founded as part of the HITECH Act to accelerate the adoption, implementation, and effective use of electronic health records (EHR), e. g. 90 -days of MU ▲ Funded by ARRA of 2009 (Stimulus Plan) ▲ Purpose: support the Triple Aim by achieving 5 overall performance goals THE TRIPLE AIM 3 Improve patient experience Improve population health Reduce costs Performance Measurement Improve Ensure Improve Engage Improve Population Privacy Quality, Patients Care And Coordi. Safety & & Public Security Efficiency Families nation Health Protections Meaningful Use Certified Technology Infrastructure 3
M-CEITA Performance Participation by Region Beacon 4% ▲ 4, 000+ providers enrolled for M- CEITA support ▲ 3, 700+ providers are live on EHR SE MICH 50% Lansing 8% Other 14% Michigan Meaningful Users *Total Paid: 5, 038 (as of 2/28/2013) ▲ Latest survey shows 96% of M- CEITA customers are satisfied with services Grand Rapids 13% K'zoo 4% ▲ 2, 700+ have achieved Meaningful Use standards U. P. 6% Other 68% MCEITA 32% 4
M-CEITA Services with Subsidies M-CEITA Service Delivery PCP (1 st 90 -days) Specialists PCP (beyond 1 st 90 -days) Fee Waived (MPCA) $200/EP Engagement Establish baseline performance, educate EHR Selection (if needed) Guidance for 2014 certified products Planning Develop transition plans, process changes Implementation Establishing timelines for project mgmt. Meaningful Use Support MU objectives, Pop Health, Portal Cost per Provider 5
Meaningful Use Overview and Program Basics 6
Healthcare’s Shifting Paradigms Role Changing Paradigm Healthcare Combating Illness Improving Wellness Physicians Directors of Care Collaborators in Care Patients Passive Recipients Active Participants Health Information Siloed and Episodic Integrated and Longitudinal Health IT Supporting Tasks Enhancing Understanding Paradigm shift requires investment, innovative people and extensible tools. 7
Meaningful use: Path to better outcomes and quality Stage 2 Stage 3 Improved outcomes Advanced clinical processes Stage 1 Data capture and sharing Ø Record standardized data at POC Ø Aggregate data by state, region, etc. Ø Create best practices from evidencebased findings Ø Return information at the POC to inform and support informed clinical decisions For more information on meaningful use of EHRs, visit: http: //www. cms. gov/EHRIncentive. Programs/35_Meaningful_Use. asp 8
Meaningful Use Timeline 9
MU Stage 1 Summary of Objectives and Measures for Eligible Professionals (EPs) 10
What are the requirements? ▲ Certified ELECTRONIC HEALTH RECORD Technology (CEHRT) – 2014 certification ▲ 13 CORE Measures– All EP’s must meet each Core measure (certain exclusions may apply) ▲ 9 MENU Measures – All EP’s must achieve 5 out of the 9 available Menu measures (certain exclusions may apply) ▲ 64 CLINICAL QUALITY MEASURES (CQM) – EP’s must record numerical counts in 9 non-performance based measures ▲ 3 -Month Reporting Period for all EP’s in 2014 Meaningful Use CEHRT + 13 + 5 + 9 = MU Complete or Modular Core Measures Menu Measures CQM’s Meaningful Use 11
13 Core Measures (EPs must meet all) 1 CPOE for medications (enter into the electronic record) 30% 2 Drug-drug and drug-allergy interaction checks (enable only) YES 3 Problem list of current & active diagnoses 80% 4 E-Prescribing (transmission to pharmacy) 40% 5 Active medication List 80% 6 Active medication allergy list 80% 7 Demographics recorded as structured data 50% 8 Record/chart changes in vitals (height, weight and blood pressure, etc. ) 50% 9 Record smoking status as structured data, 13+ years old 50% 10 Implement ONE clinical decision support rule YES 11 Provide patients the ability to view their health information online 50% 12 Clinical Summaries of each patient visit, within 3 business days 50% 13 Protect electronic health information SRA 12
CORE OBJECTIVES Computerized provider order entry (CPOE) What the Measure Requires More than 30% of medication orders created by the EP during the EHR reporting period are recorded using CPOE. What That Means For You Are You Excluded from Having to Do This? For at least 30% of the prescriptions ordered, you or a licensed staff person or certified MA have to use the EHR’s CPOE module to enter medication orders. You can be excluded from meeting this objective if you write fewer than 100 prescriptions during the reporting period. 13
CORE OBJECTIVES Maintain an up-to-date problem list of current and active diagnoses 14
CORE OBJECTIVES E-Prescribing (e. Rx) 15
CORE OBJECTIVES Record demographics 16
CORE OBJECTIVES Record and chart changes in vital signs What the Measure Requires What That Means For You More than 50% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height/length and weight (for all ages) recorded as structured data. For more than 50% your patients, you have to record the following in the EHR: • Height/length • Weight • Blood Pressure A certified EHR will chart changes of those vital signs for you. Are You Excluded from Having to Do This? 1) No patients >2 years is excluded from recording blood pressure. 2) None of vital signs are relevant to their scope of practice 3) Height and weight are relevant but not blood pressure, then blood pressure is excluded 4) Blood pressure is relevant, but not height and weight, then height and weight are excluded 17
CORE OBJECTIVES Implement clinical decision support 18
CORE OBJECTIVES Provide patients with the ability to view their health information online More than 50% of all unique patients are provided online access to their health information within 4 business days after the information is available to the EP. You must provide patients the ability to view their health information online, as in through a patient portal You can be excluded from meeting this objective if you do not order or create any of the required information, except for “Patient name” and “Provider name” and office contact information. You can also be excluded if your practice is in an area with low broadband availability. 19
Patient Portal - Guidance Q. If a patient has been given the option of accessing a portal and has been given information about how to set up a portal but chooses not to set up a portal (does not provide email address or does not complete any validation steps or does not provide online permission, etc. ) can this patient be included in the numerator? A. Yes – provided all required health information maintained in an electronic form is available to the patient within four business days. 20 20
CORE OBJECTIVES Provide clinical summaries for patients for each office visit 21
CORE OBJECTIVES Protect electronic health information 22
Questions? 23 23
9 Menu Measures (EPs must meet 5 of 9 Menu objectives) 1 Drug Formulary Checks – implemented (enable only) YES 2 Clinical lab test results (as structured data) 40% 3 Generate patient list (by specific condition) YES 4 Patient reminders for preventive/follow-up care (>64 yrs, and <6 years) 20% 5 Patient-specific education resources 10% 6 Medication reconciliation 50% 7 Transition of care summary 50% PUBLIC HEALTH MEASURES (must select at least one/or exclude from both) 8 Immunization registries data submission YES 9 Syndromic Surveillance data submission YES *Public health objective: At least one public health objective must be selected. 24
MENU OBJECTIVES Incorporate clinical lab-test results 25
MENU OBJECTIVES Send reminders to patients for preventative/follow-up care 26
MENU OBJECTIVES Medication reconciliation 27
MENU OBJECTIVES Summary of care record for transitions of care 28
MENU OBJECTIVES Submit electronic data to immunization registries 29
MENU OBJECTIVES Submit electronic syndromic surveillance data to public health agencies You could be excluded from meeting this objective for either of these reasons: • You don’t collect any reportable syndromic data • There’s no system in place to which you can send information 30
2014 Clinical Quality Measures (CQM) ▲ Every EP is required to report on CQM ▲ CQM’s do not have thresholds that you have to meet – you simply have to report data (generated by the CEHRT) ▲ Medicaid EP’s in 1 st year of MU attest to CQM data, i. e. manually input numbers ▲ Medicaid EP’s in 2 nd year of MU must electronically report their CQM data to State Medicaid Agency (MDCH) ▲ In 2014, CQM reporting changes for all EP’s whether in Stage 1 or 2 Prior to 2014 and Beyond* Complete 6 of 44 Complete 9 of 64 3 Core or Alternate core, 3 Additional At least 1 measure from 3 of 6 NQS domains 31
National Quality Strategy Domains 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Populations and Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Processes/Effectiveness 32
CQMs for Eligible Professionals ▲ ▲ ▲ ▲ Children Who have Dental Decay or Cavities Primary Caries Prevention Intervention Hypertension High Blood Pressure Smoking Asthma Measures Closing Referral Loop 57 other measures for Pediatric and Adults Requirement: report on 9 of 64 possible measures 33
Questions? 34 34
Putting the Pieces Together – Example 1 CPOE PATIENT SAFETY CPOE Medications Allergies Drug/Drug – Drug/Allergy Formulary Medications Drug/Drug – Drug/Allergy Allergies Formulary e. Rx 35
Putting the Pieces Together – Example 2 CQM CLINICAL PROCESSES CQM Vitals Smoking Labs Immunizations Decision Support 36
Putting the Pieces Together – Example 3 Clinical Summaries Educational Res. Reminders Secure Messaging Security Risk Anal. PATIENT & FAMILY ENGAGEMENT Clinical Summaries Educational Res. Reminders Secure Messaging Security Risk Anal. Patient Portal 37
NPRM = Notice of Proposed Rule Making ▲ NPRM grants flexibility to providers who are experiencing difficulties fully implementing 2014 Edition CEHRT to attest this year. The proposed rule would allow providers to use EHRs certified under: – 2011 Edition – combined 2011 and 2014 Editions – 2014 Edition NOTE: If a provider chooses this option they MUST attest that availability issues of CEHRT prevented them from fully implementing 2014 Edition CEHRT. 38
Proposed Changes in 2014 (NPRM) ▲ 60 -day comment period ends July 21, 2014 ▲ Final Rule may not be available until November, 2014 ▲ AIU still requires 2014 CEHRT regardless of any change 2014 STATUS 2011 CEHRT: Combined 2011 & 2014 CEHRT: 2014 CEHRT STAGE 1 2013 Stage 1 MU measures 2013 Stage 1 MU Measures -or 2014 Stage 1 MU Measures 2014 Stage MU Measures 2013 Stage 1 MU Measures -or 2014 Stage 1 MU Measures -or. Stage 2 MU Measures STAGE 2 39
Recommendation: DO NOT CHANGE PLANS FOR 2014 Remember, in 2015: ▲ Everyone is required to use 2014 Edition CEHRT ▲ 365 -day reporting periods begin January 1 st ▲ ICD 10 is still expected to Go-Live on Oct 1 st 40
Questions? www. mceita. org Dan Belknap Dan. Belknap@altarum. org 313 -529 -5128 cell 41
MU Stage 2 42
Stage 2 – Core Measures Core Objective Measure 1 CPOE Use CPOE for >60% of medications, >30% of laboratory and >30% of radiology 2 e. Rx for >50% 3 Demographics Record demographics for >80% 4 Vital signs Record vital signs for >80% 5 Smoking Status Record smoking status for >80% 6 CDS Interventions Implement 5 clinical decision support rules 7 Labs Incorporate lab results for >55% 8 Patient List Generate patient list for specific condition 9 Preventive Measures Use EHR to identify and provide reminders for preventive/follow-up care for >10% of patients with 2 or more offices visits in last two years 43
Stage 2 – Core Measures Core Objective Measure 10 Patient Access Provide online access to health information for >50% with >5% accessing (V/D/T) 11 Visit Summaries Provide office visit summaries for >50% of office visits 12 Education Resources Use EHR to identify and provide education resources for >10% of all unique patients 13 Secure Messages >5% of patients send secure messages to their EP 14 Med. Reconciliation Medication reconciliation for >50% of transitions of care 15 Summary of Care Provide So. C documents for >50% of transitions of care and referrals, 10% sent electronically, and at least 1 sent to recipient with a different EHR vendor or successfully using CMS test EHR (So. C) 16 Immunizations Successful on-going transmission of immunization data 17 Security Analysis Conduct or review security analysis and incorporate in risk management process 44
Stage 2 – Menu Measures Core Objective Measure 1 Imaging Results > 20% of imaging results are accessible through CEHRT 2 Family History Record Family History for >20% 3 Syndromic Surveillance Successful on-going transmission of syndromic surveillance data 4 Cancer Successful on-going transmission of cancer case information 5 Specialized Registry Successful on-going transmission of data on specialized registry 6 Progress Notes Enter an electronic progress note for >30% of unique patients 45
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