challenging meaningful use (mu) measures for eligible
TRANSCRIPT
Challenging
Meaningful Use (MU) Measures
for Eligible Professionals (EPs)
Beth Myers Policy and Outreach Lead, CMS eHealth Initiatives
July 28, 2014
Agenda
• Interoperability Overview
• Stage 2 Exchange Requirements
• Challenging Stage 2 Objectives
Summary of Care
Patient Electronic Access
• Resources
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Interoperability Overview
• What is interoperability? – The extent systems and devices can exchange and interpret
shared data
– For two systems to be interoperable, they must be able to exchange data and present that data in a understandable way
• Why is interoperability important? – Empowers patients to access, maintain, and exchange their
health information (i.e., patient electronic access)
– Streamlines communication through transitions of care
– Reduces duplication of effort
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Stage 2 Exchange Requirements
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The following Stage 2 of meaningful use objectives require
electronic health record (EHR) interoperability to exchange
health information
Examples • Provider-to-Provider (e.g.,
Transitions of Care [ToC])
• Provider-to-Patient (e.g., View,
Download, Transmit [VDT])
• e-Prescribing
• Public Health Reporting
Two challenging Stage 2 objectives that require exchange:
Challenging Stage 2 Objectives
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1. Summary of Care
2. Patient Electronic Access
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1. Summary of Care
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Why Summary of Care?
Purpose: Ensure eligible professional who transitions a patient
to another provider’s care sends most up-to-date
information available so that the next provider is able to make
more informed decisions
• When an EP transitions or
refers a patient to another
setting or provider of care,
the EP should send a
summary of care record
• Information generally
limited to what is available
in certified EHR
technology (CEHRT) at
time summary of care is
generated
Summary of Care Requirements
EPs must satisfy both Measure 1 and Measure 2:
• Measure 1 - Provide a summary of care record for more than 50% of
transitions of care and referrals
• Measure 2 - Provide a summary of care record for more than 10% of
transitions and referrals to a recipient either:
a) electronically transmitted using CEHRT, or
b) via exchange facilitated by an organization that is an eHealth
Exchange participant
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• For Measure 3, satisfy one of following criteria:
• Conduct one or more successful electronic exchanges of a summary of
care document, as part of which is counted in "measure 2" (with a
recipient who has EHR technology that was developed designed by a
different EHR technology developer than the sender's)
• Conduct one or more successful tests with the CMS designated test
EHR during the EHR reporting period
• Exclusion: Any EP who transfers a patient to another setting or refers a
patient to another provider less than 100 times during the EHR reporting
period is excluded from all three measures.
See the spec sheet for more information: http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_15_Summary
Care.pdf
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Summary of Care Requirements, cont.
Measure Guidance
• EP must verify that info was entered into EHR for problem list, medication list, and medication allergy list prior to generating summary of care
• Problem list, medication list, and medication allergy list must either contain specific information or a notation that the patient has none of these items
• Leaving field blank would not allow provider to meet objective
- If other data elements from required list is not available in EHR at time summary of care is generated, that info does not have to be made available in summary of care
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Information Requirements
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Information Requirements for
Summary of Care Measure
Create Consolidated Clinical Document
Architecture (C-CDA)
Enter information into CEHRT
Provide summary of care record when
patient is transferred to another setting
of care or referred to another provider
Withhold any information provider
determines could cause possible harm
Verify presence of elements; Problem
List, Medication List, and Medication
Allergy List
• Patient name
• Referring or transitioning provider’s name and office contact
information
• Procedure
• Encounter diagnosis
• Immunizations
• Laboratory test results
• Vital signs (height, weight, blood pressure, body mass index
[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
• Current problem list (EPs may also include historical
problems at their discretion)**
• Current medication list**
• Current medication allergy list**
**Required Fields
When reporting on the Summary of Care objective, which transitions would count toward the
numerator of the measures?
A transition of care is defined as the movement of a patient from one setting of care (hospital, ambulatory,
primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility)
to another. To count toward the Summary of Care objective, the transition or referral must take place between
providers with different billing identities such as a different National Provider Identifier (NPI) or hospital CMS
Certification Number (CCN).
For Measure 1: include the transitions of care in which a summary of care document was provided to the
recipient of the transition or referral by any means.
For Measure 2: include the transitions of care in which a summary of care document was transmitted
electronically using a Certified EHR Technology (CEHRT) to the recipient, or via exchange facilitated by an
organization that is an eHealth Exchange participant.
If the receiving provider already has access to the CEHRT of the initiating provider of the transition or referral,
simply accessing the patient’s health information does not count toward meeting this objective. However, if the
initiating provider also sends a summary of care document, this transition can be included in the denominator
and the numerator as long as it is counted consistently across the organization and across both measures if:
– For Measure 1, a summary of care document is also provided by any means.
– For Measure 2, a summary of care document is provided using the same technical standards used if the receiving
provider did not have access to the CEHRT,
For Measure 3: a single summary of care document sent to a provider using a different EHR and EHR
Vendor or a test with the CMS and Office of the National Coordinator (ONC) Randomizer test system would
meet the measure.
See FAQ 9690: https://questions.cms.gov/faq.php?faqId=9690
Additional Guidance: Summary of Care Calculation
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National Institute of Standards and Technology (NIST) EHR Randomizer Tool
• Allows providers to test electronic exchange to meet Summary of Care Measure #3: http://ehr-randomizer.nist.gov
• The NIST-hosted software system matches a provider with a designated test EHR designed by a different EHR technology developer
• A new user guide is available on the Educational Resources page to help providers use the Randomizer
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2. Patient Electronic Access
Why Patient Electronic Access?
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Purpose: Allows patients access to health information
to help them make informed decisions about their
care and share most recent clinical information with
other health care providers and their caregivers
The patient electronic access measure requires EPs to provide patients the ability to view online, download, and transmit their health information within four (4) business days of information being available to provider
• Measure 1: Provide more than 50% of all unique patients seen by the EP
during the EHR reporting period are provided the ability to view online,
download, and transmit their health information within four (4) business days
of the information becoming available to the EP
• Measure 2: More than 5% of all unique patients (or their authorized
representatives) view online, download, or transmit to a third party their
health information
• Exclusion: Any EP who:
1. Neither orders nor creates any of the information listed for inclusion as part of
both measures, except for "Patient name" and "Provider's name and office
contact information,” may exclude both measures.
2. Conducts 50% or more of his or her patient encounters in a county that does not
have 50% or more of its housing units with 3Mbps broadband availability
according to the latest information available from the FCC on the first day of the
EHR reporting period may exclude only the second measure.
See the spec sheet for more information: http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_7_PatientElectr
onicAccess.pdf
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Patient Electronic Access Requirements
Measure Guidance
• Providing patient electronic access is an ongoing
requirement
• If a specific data field is not available to EP at time info
is sent to patient portal, that info does not have to be
made available online and EP can still meet objective
• As new info for specific items listed becomes available
to provider, that info must be updated and made
available to patient online within four (4) business days
• EP may withhold any info from online disclosure if he or
she believes providing such info may result in
significant harm
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Information Requirements
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Information Requirements for Patient
Electronic Access Measure*
• Patient name
• Provider’s name and office contact
information
• Current and past problem list
• Procedures
• Laboratory test results
• Current medication list and medication
history
• Current medication allergy list and
medication 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
Enter information into certified EHR
technology as it becomes available
Withhold from online disclosure any
information provider determines could
cause possible harm
Make modified information available to
patient online within four (4) business
days
*Unless the information is not available in CEHRT is restricted from disclosure due to any federal, state, or
local law regarding the privacy of a person’s health information, including variations due to the age of the
patient, or the provider believes that substantial harm may arise from disclosing particular health
information in this manner.
Patient Access: Additional Guidance
If multiple EPs contribute information to a shared portal or to a patient's
online personal health record (PHR), how is it counted for meaningful use
when the patient accesses the information on the portal or PHR?
• If multiple EPs contribute information to an online portal or PHR during the
same EHR reporting period, all of the providers can count the patient to
meet the measure if the patient accesses any of the information in the portal
or PHR.
• A patient does not need to access the specific information an EP
contributed, in order for each of the EPs to count the patient to meet their
threshold.
See FAQ7735: https://questions.cms.gov/faq.php?faqId=7735
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Patient Access: Additional Guidance
In calculating the meaningful use objectives requiring patient action, if a
patient accesses his/her health information made available by their EP,
can the other EPs in the practice get credit for the patient’s action in
meeting the objectives?
• Yes. EPs in group practices are able to share credit to meet the patient
electronic access threshold if they each saw the patient during the EHR
reporting period and they are using the same certified EHR technology.
• The patient can only be counted in the numerator by all of these EPs if the
patient views, downloads, or transmits their health information online.
See FAQ 9686: https://questions.cms.gov/faq.php?faqId=9686
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Patient Access: Additional Guidance
Can an EP charge patients a fee to have access to their
health information?
CMS does not believe it would be appropriate for an EP to
charge patients fees to access certified EHR technology.
See FAQ 9112: https://questions.cms.gov/faq.php?id=5005&faqId=9112
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Related Tipsheets
• Data Sharing Tipsheet: Outlines the required data elements and provides additional guidance for Summary of Care, Clinical Summary, and Patient Electronic Access
• Patient Electronic Access Tipsheet: Outlines requirements for Patient Electronic Access in Stage 1 and Stage 2, as well as FAQs
Both available on Stage 2 and Educational Resources pages
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• CMS Program Website
www.cms.gov/EHRincentiveprograms
• CMS eHealth Website http://www.cms.gov/eHealth/
• ONC Program Website www.healthit.gov
• ONC JIRA Tool http://oncprojectracking.org/
• Is my EHR certified?
http://oncchpl.force.com/ehrcert?q=CHPL
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General Resources
Questions?
Contact Information
Beth Myers: [email protected]
EHR Incentive Programs Information Center:
888-734-6433 (TTY 888-734-6563)
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