Brian AhierHealth Data Management WebinarOcotber 8, 2013

But we can figure this thing out!

Laws Affecting Quality Improvement

As consensus was reached around the importance of improving quality, Congress passed several important laws to establish new quality programs:

Medicare Prescript ion Drug, Improvement & Modernization Act (MMA)

Tax Relief and Health Care Act (TRHCA)

Medicare Improvements For Patients & Providers Act (MIPPA)

20052002 2004

Deficit Reduct ion Act (ORA)

Medicare, Medicaid ,& SCHIPExtensionAct (MMSEA)

American Recovery & Reinvestment Act (ARRA)

Mental Health Parity and Addict ion Equality Act (MHPAEA)

Affordable Care Act (ACA)

Selected Historical Landmarks in US Healthcare Quality

• 1999: To Err Is Human published by IOM

• 1999: National Quality Forum established

• 2001: Crossing the Quality Chasm published by IOM

• 2005: CMS Quality Roadmap established

• 2005: Petiormance Measurement: Accelerat ing Improvement published by IOM

• 2006: Medicare establishes QualityImprovement Organization Program

• 2008: NQF establishes National Priorities Partnership

First IOM Committee Report

To Err is Human: Building a Safer Health System (1999) begins to define the US quality problem:

• Medical errors harm 44,500 to 98,000 patients annually

• Medical errors cost $17 B to $29 B annually (including the expense of additional care necessitated by the errors, lost income and household productivity, and disability)

• Flawed systems, processes, and conditions lead people to make mistakes or fail to prevent them

Defining Quality

The IOM definit ion of quality becomes the guide for all national quality efforts:

"Quality care is defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."

Institute of Medicine (2001)

“There is no problem America has that is so large we can not invent our way out of it.”~ Todd Park

“You can always count on Americans to do the right thing - after they've tried everything else.”~Winston Churchill

In the U.S. we spend more per capita on healthcare thanany other country in the world

In spite of those expenditures, U.S. healthcare quality is often inferior to that of other nations and often doesn’t meet expected evidence-based guidelines

There are significant variations in quality and costs across the nation with increasing evidence that there may even be an inverse relationship between the two

Healthcare expenditures account for a larger section of the U.S. economy over the years and funding those expenditures is increasingly more difficult

Cost effectiveness analytics is resisted as a tool

Does your organization have a strategy formeeting the requirements of “Obamacare?”

Affordable Care Act signed March 23, 2010 Major components of the law:

New consumer rights and protections;

Holding insurance companies accountable;

Increasing access to affordable care; and

Improving quality and lowering costs.

Most sections take effect between 2010 and 2015

Title I: Quality, Affordable Health Care for allAmericans

Title II: Role of Public Programs Title III: Improving the Quality &

Efficiency of Health Care Title IV: Prevention of Chronic

Disease & Improving Public Health

Title V: Health Care Work Force

Title VI: Transparency and Public Reporting

Title VII: Improving Access to Innovative Medical Therapies

Title VIII: Community Living Assistance Services& Support (CLASS) Act

Title IX: Revenue Provisions Title X: Strengthening Quality,

AffordableHealth Care for All Americans (Amendments)

Major, Ongoing Demonstration & Testing Authority & Resources

(CMMI) Accountable Care Organizations Value Based Purchasing Programs Health Insurance Exchanges Expanded Medicaid Programs Care Transitions to Reduce Readmissions Expanded Quality Reporting Programs Expanded Preventative Services ….and much more

Quadrant 1High impact, high

complexity program areas tomanage

Quadrant 2High impact priorities to

monitor and maintain

Quadrant 4 Tertiary priorities to minimize resources

andconserve focus

Quadrant 3 Secondary priorities to monitor

and manage

1. Value Based Purchasing

2. Public and Quality Reporting

3. Reduced Readmissions4. Hospital Acquired

Conditions5. ACOs6. Center for Medicare and

Medicaid Innovation

Quadrant 2

Quadrant 3Quadrant 4

Increasing measurement of quality, efficiency & value

Public reporting and sharing of data Reimbursement linked to quality

improvement, efficient service delivery and cost reduction thru improvement

Increasing integration of delivery systems andcoordination of care across settings

Greater role in addressing public health issues

Greater use of health information technology

Creation of a learning environment in healthcare

Affordable Care Act (§3011) requiredSecretary to: Set priorities for improving American

healthcare; and Create a strategic plan for achieving

them through HHS-specific: Plans; Goals; Benchmarks; and Standardized quality metrics.

HHS developed drafts through public processes that included over 300 groups, organizations, and individuals. All major healthcare sectors represented.

Culminated in the “National Strategy forQuality Improvement in Health Care” (March2011).

Strategy has six overarching aims, goals andpriorities:1. Making care safer;2. Ensuring person- and family-centered care;3. Promoting better care communication and

coordination;4. Preventing and treating leading causes of

death (includingCVD);

5. Working in communities to promote healthy living; and

6. Making quality care more affordable.

Affordable Care Act (§3014) required Secretary to set up a “pre-rulemaking process” forselecting quality and efficiency measures by: Posting a list of measures under

consideration; Giving stakeholders a chance to

comment on this list; Publishing HHS’ rationale for selecting

any measures not endorsed by the National Quality Foundation (NQF); and

Assessing the impact of using NQF-endorsed measures every 3 years.

Quality Measures Life Cycle

Measure Developers

Joint Commissio

nAMA CMS AHRQ

Congress IOMProfessional Organizations

PROV IDERS SUPPLIERS

CONSUMERS

DHHS AQA NQFPilot Sites

• Is itimportant?

• Can it be measured?

• Should it be measured?

Measure Development

• Can the data be collected?

• Do th e results make sense?

• Is information useful?

• What is the • NQF- • Is itworking?

population? endorsed?• How should it • Alliance-

be reported? approved?Evaluation

Additional Requirements or Issues Identified

366 unique new measures across 23 CMS programs. Not all measures will be used right away. Not all measures are mandatory (e.g.,

voluntary reportingprograms).

Nearly all are supported by or were suggested by externalgroups.

Measures now with the NQF Measure ApplicationPartnership (MAP) which: Gathers a diverse public-private partnership; Gives stakeholders a voice before CMS selects

measuresthrough the rulemaking process;

Uses the National Quality Strategy as a touchstone; and

Operates transparently through NQF’s website.

Value based purchasing

§3001 - Hospital value-based purchasing§3006 - Value-based purchasing for SNF§3014 - Quality and efficiency measurement

§10301 - Develop a plan to implement VBP forambulatory surgical centers §10326 - Pilot testing for pay-for-performanceHospital

readmissions §3025 - Hospital readmissions reduction program

§3026 - Community-based care transitions program

Healthcare acquired conditions §2702 - Payment adjustment for health

care-acquired conditions §3008 - Payment adjustment for conditions

acquiredin hospitals

Accountable care organizations §2706 - Pediatric accountable care

organization demonstration project §3022 - Medicare Shared Savings

ProgramDual eligibles §2602 - Providing federal coverage and

payment coordination for dual eligible beneficiaries

Preventative services §4103 - Annual wellness visit providing a

personalized plan §4104 - Removing barriers to preventive

services §4105 - Evidence-based coverage of

preventive services

Coordination of care §2703 - State option to provide health homes

for enrolleeswith chronic conditions §2704 - Demonstration project to evaluate integrated carearound a hospitalization

Long term care

§2401 - Community first choice option§2402 - Removal of barriers to providing home andcommunity based services

§2403 - Money follows the person rebalancing demo§2404 - Protection for recipients of home and community-based services against spousal impoverishment §10202 - Incentives for states to offer home community basedservicedPublic

reporting

§10303 - Development of outcome measures§10327 - Improvements to the physician quality reportingsystem -- also see Provision 3002 10331 - Public reporting of performance informationQuality reporting

initiative

§2701 - Adult health quality measures§3002 - Improvements to the physician quality reportingsystem. §3004 - Quality Reporting for Long Term Care Hospitals(LTCH), inpatient rehabilitation hospitals, and hospice programs

§3005 - Quality reporting for PPS-exempt cancer hospitals§10322 - Quality reporting for psychiatric hospitals

Is your organization participating in: PQRS PCMH ACO Value Based

Purchasing None of the above

Although recently enacted into law under the ACA, VBP hasbeen in development for years Medicare Modernization Act (MMA) of 2003:

Congress commissioned the Institute of Medicine (IOM) to “identify and prioritize options to align performance to payment in Medicare.” The IOM reports provided the rationale to reconfigure the U.S. health care payment system, supporting a “pay for performance” (P4P) approach.

Deficit Reduction Act (DRA) of 2005 Section 5001(b): This act required HHS to develop a plan to implement a VBP

program for Medicare payment for subsection (d) hospitals, beginning with FY 2009. The Medicare Hospital VBP program would be built on the current Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) Program and be budget-neutral.

Medicare Improvements for Patients and Providers Act(MIPPA) of 2008 Section 131(d): This act required HHS to develop a VBP transition plan for

providers receiving Medicare payments. HHS submitted this report to Congress in December 2008 detailing a draft transition plan to a Medicare VBP program for physicians and other professional services, as well as the design issues under consideration.

“A major, overarching theme in the Affordable Care Act is one of measurement,transparency, and altering payment to reinforce, not simply volume of services, butthe quality of the effects of those services.

Instead of payment that asks, “How much did you do,” the Affordable Care Act clearly moves us toward payment that asks, “How well did you do?” and, more important, “How well did the patient do?”

That idea is at the heart of Value-Based Purchasing. It is not just a CMS idea; it is oneincreasingly pervading the agenda of all payers.”

Don Berwick, CMS Administrator, April 4, 2011

Affordable Care Act set up value-basedpurchasing (VBP) for: Hospitals (§3001); Skilled Nursing Facilities (§3006); Home Health Agencies (§3006); Ambulatory Surgery Centers (§3006);

and Physicians, through a “value modifier”

(§3007).Affordable Care Act also tied portions

of DRGpayments to: –Readmission rates (§3025); and Hospital-acquired conditions (§3008).

What does it all mean?

Doing the right things for patients will become easier and doing the wrong things will become more difficult – and expensive!

CMMI establishment mandated (Section §3021) Consultation & input from broad healthcare

sector inimplementation

Develop patient-centered payment models

Rapid piloting/testing of new payment programs

Encourage evidence-based, coordinated care for Medicare, Medicaid, CHIP

Focuses on populations “for which there are deficits in care leading to poor clinical outcomes or potentially avoidable expenditures”

“Risk-based comprehensive payment or salary-basedpayment” models

“Geriatric assessments and comprehensive care plans…interdisciplinary care teams…multiple chronic conditions…”

“transition health care providers away from fee-for- service-based reimbursement and towards salary- based”

“health information technology-enabled provider network that includes care coordinators, chronic disease registry, home telehealth technology”

Other key characteristics in the statute for paymentmodels Varying payment for advanced diagnostic

imaging services Medication therapy management services Community-based health teams to assist in

caremanagement

Patient decision-support tools State flexibility for dual-eligibles and all-payer

paymentreform demonstrations

Collaboratives of high-quality, low-cost institutions

$10 billion over 10 years funding for innovation

•Trend Analysis•Prototype Design and Modeling

• Collaborative DesignLab

•Best Practice Analysis

•Publication andCollaborative Learning

CollaborativeInnovation Laboratory

Stage

•Program trials and Demo development

•Technology betatesting•Results evaluation•Findings andRecommendations•Publications

Demonstration andProgram Trial Stage

•Program Policy Translation

Analysis and Evaluation

•Legislation/policy development

•Regulation and Rule Development

• Policy Execution andImplementation

•Re Evaluation/ Publication

Program Policy Translation

Evaluation and Diffusion

Stage

2 To 3 years Design to Program Translation Cycle Time

ACO Programs Bundled Payment Comprehensive Primary

CareInitiative

Financial Alignment Initiative

FQHC Advanced PrimaryPractice Demonstration

Graduate Nurse EducationDemonstration

Health Care InnovationAwards

Independence at HomeDemonstration

Initiative to Reduce Avoidable Hospitalizations Among Nursing Home Residents

Innovations Advisors Program

Medicaid EmergencyPsychiatric Demonstration

Medicaid Incentives for thePrevention of Chronic Diseases

Million Hearts Partnership for Patients:

CareTransitions: Community-based

State Innovations Models

Strong Start for Mothers &Newborns

Successful Payment and Service Model Innovation

Healthcare Delivery System Reform and Transformation

Program andPolicy Redesign

2012-2019

2011-2019

2014-2019

Medicare Shared Savings Program (Section 3022) Encourages multiple providers of

services and supplies to:

▪ Join together and create ACOs

▪ Be jointly accountable for health & experience ofcare for individuals over a period of time

▪ Improve population health, overlap with community

▪ Reduce rate of healthcare spending, improve quality

W hat i san ACO?

SUSTA INAB\lll

Source: Leavitt Partners report “Growth and Dispersion of Accountable Care Organizations, August 2013

The number and types of ACOs are expanding

Growth is centered in larger population centers

Hospital systems appear to be the primary backers of ACOs, but physician groups are playing an increasingly larger role

Non-Medicare ACOs are experimenting with more diverse models than Medicare-backed ACOs

The success of any particular ACO model is still

undetermined

Source: Leavitt Partners report “Growth and Dispersion of Accountable Care Organizations, August 2013

Source: Leavitt Partners report “Growth and Dispersion of Accountable Care Organizations, May 2012

Source: Leavitt Partners report “Growth and Dispersion of Accountable Care Organizations, August 2013

CMS has many different types of quality incentive

programs, several of which directly affect healthcareproviders and organizations:

Pay for reporting programs: PQRS Children's Health Insurance Program

Reauthorization ActQuality Reporting

Medicaid Adult Quality Reporting eRx Incentive Program

Payment adjustments in effect currently

Medicare and Medicaid EHR Incentive Program Almost $20 Billion in payments already Payment adjustments begin in 2015

Medicare Shared Savings Program (ACOs) Value-Based Purchasing Pay-for-Performance

Programs: Physician Feedback/Value-Based Modifier Program

▪ Medicare fee-for-service payment modifier starting in 2015 on voluntary basis, phased in to include ALL providers by 2017 (measurement year starts in 2013)

▪ Participating providers will receive annual feedback on their cost andquality scores

Hospital Value Base Purchasing End-Stage Renal Disease Quality Incentive

Program

Is your organization participating in the“meaningful use” EHR incentive program?

• In 2004 President Bush announced the critical need for the U.S. to begin assessing the need for electronic health records in all areas of the healthcare industry.

• On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) of 2009. This statute includes the Health Information Technology for Economic and Clinical Health (HITECH) Act.

• Section 3001of the HITECH Act established the Office of the National Coordinator for Health Information Technology (ONC) within the U.S. Department of Health and Human Services (HHS).

• The ONC is at the forefront of the government’s health information technology efforts, and is a resource to the entire health system to support the adoption of health information technology.

Two CMS EHR Financial Incentive Programs were establishedunder the HITECH Act: Medicare- administered by CMS Medicaid – joint administration by CMS and

state Both programs are voluntary however

eligible providers must choose which program they will participate in and penalties begin in 2015 for Medicare

Both programs require use of certified EHR technology

Medicare program requires demonstration of meaningfuluse during first year of participation

Medicaid provides for payment of financial incentives to EPs who meet patient volume requirements and adopt/implement/upgrade during their first year of participation

Meaningful Use is using certified EHRtechnology to Improve quality, safety, efficiency,

and reduce health disparities Engage patients and families in their

health care Improve care coordination Improve population and public health All the while maintaining privacy and

security Meaningful Use mandated in law

to receiveincentives

Stage 2 MUACOs

Stage 3 MUPCMHs

3-Part Aim

Registries to manage patient

populations

Team based care, case management

Privacy & securityprotections

Care coordination

Privacy & security protections

Improved population health

Enhanced access and continuity

Patient centered care coordination

Registries for disease

management

Evidenced based medicine

Patient self management

Privacy & securityprotections

Care coordination

Structured data utilized

Data utilized to improve

delivery and outcomes

Data utilized to improve

delivery and outcomes

Patient informed

Patient engaged, community resources

Basic EHR functionality,

structured data

Privacy & security

protections

Stage 1 MU

Improve accessto information

Use information to transform

Utilize technology to

gather information

Standards and Certification Criteria

Stage 2 Meaningful Use

HereH’setrhee’sfwuthuartei…t looks like today…

Certified EHR Technology

2014 Edition CEHRT

Base EHR

Base EHRCertification Criteria Required to Satisfy the Definition of a Base EHR

Base EHR Capabilities Certification Criteria

Includes patient demographic and clinical health information, such as medical history and problem lists

Demographics § 170.314(a)(3) Vital Signs § 170.314(a)(4)

Problem List § 170.314(a)(5) Medication List § 170.314(a)(6)

Medication Allergy List § 170.314(a)(7)

Capacity to provide clinical decision support Drug-Drug and Drug-Allergy Interaction Checks § 170.314(a)(2)Clinical Decision Support § 170.314(a)(8)

Capacity to support physician order entry Computerized Provider Order Entry § 170.314(a)(1)

Capacity to capture and query information relevant to health care quality

Clinical Quality Measures § 170.314(c)(1) and (2)

Capacity to exchange electronic health information with, and integrate such information from other sources

Transitions of Care § 170.314(b)(1) and (2)

View, Download, and Transmit to 3rd Party § 170.314(e)(1)

Capacity to protect the confidentiality, integrity, and availability of health information stored and exchanged

Privacy and Security § 170.314(d)(1)-(8)

BaseEHR

2014 Edition CEHRT

EP/EH/CAH would only need to have EHR technology with capabilities certified for the MU menu set objectives & measures for the stage of MU they seek to achieve.EP/EH/CAH would need to have EHR technology with capabilities certified for the MU core set objectives & measures for the stage of MU they seek to achieve unless the EP/EH/CAH can meet an exclusion.EP/EH/CAH must have EHR technology with capabilities certified to meet the definition of Base EHR.

2014 Certification Criteria associated with a Base EHR:

• Demographics (170.314(a)(3))• Vital signs, BMI, & growth charts

(170.314(a)(4))

• Problem list (170.314(a)(5))• Medication list (170.314(a)(6))• Medication allergy list (170.314(a)(7))• Drug-drug, drug-allergy

interaction checks (170.314(a)(2))

• CPOE (170.314(a)(1))• Clinical decision support

(170.314(a)(8))• Clinical quality measures

(170.314(c)(1)-(2))• Transition of Care – incorporatesummary care record (170.314(b)(1))

• Transition of Care – create and transmit summary care record (170.314(b)(2))

• View, download, and transmit to 3rd

Party (170.314(e)(1))• Privacy and Security CC:o Authentication, Access Control, &

Authorization (170.314(d)(1))o Auditable events & tamper resistance

(170.314(d)(2))o Audit report(s) (170.314(d)(3))o Amendments ( 70.314(d)(4))o Automatic log-off ( 170.314(d)(5))o Emergency access (170.314(d)(6))o Encryption of data at rest (170.314(d)

(7))o Integrity (170.314(d)(8))o Accounting of disclosures (optional)

(170.314(d)(9))

Base EHR

MU Core

MU Menu

• Automated numerator recording (170.314(g)(1))• Automated measure calculation (170.314(g)(2))• Non-%-based measure use report (170.314(g)

(3))• Safety -enhanced design (170.314(g)(4))

2014 Certification Criteria associated with MU Menu Stage 2:

• Imaging (170.314(a)(12))• Transmission to cancer registries (170.314(f)(8))• Cancer case information (170.314(f)(7))• Public health surveillance (170.314(f)(3))• Transmission to public health agencies

(170.314(f)(4))• Family health history (170.314(a)(13))

2014 Certification Criteria associated with MU Core Stage 2:• Smoking status (170.314(a)(11))

• eRx (170.314(b)(3))• Drug formulary checks

(170.314(a)(10))

• Patient lists (170.314(a)(14))• Patient reminders

(170.314(a)(15))• Patient-specific

education resources(170.314(a)(16))

• Clinical information reconciliation(170.314(b)(4))

• Clinical summaries (170.314(e)(2))

• Secure messaging (170.314(e)(3))

• Incorporate lab test and results/values (170.314(b)(5))

• Immunization information(170.314(f)(1))

• Transmission to immunization registries (170.314(f)(2))

1 2 3

14 core objectives

5 of 10 menu

objectives

19 total objectives

16 core objectives

2 of 4 menu

objectives

18 total objective

s

1) Use CPOE for more than 60%of medication,laboratory and radiology orders

2) Record demographics for more than 80%

3) Record vital signs for more than 80%

4) Record smoking status for more than 80%

5) Implement 5 clinical decision supportinterventions + drug/drug and drug/allergy

6) Incorporate lab results for more than 40%

7) Generate patient list by specific condition

8) More than 10% of medication orders aretracked using EMAR

9) Provide online access to health information for more than 50% with more than 5% actually accessing

10)Use EHR to identify and provide education resources more than 10%

11)Medication reconciliation at more than 50%of transitions of care

12) Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically

13)Successful ongoing transmission ofimmunization data

14)Successful ongoing submission of reportablelaboratory results

15)Successful ongoing submission of electronicsyndromic surveillance data

16)Conduct or review security analysis andincorporate in risk management process

1) Record indication of advanced directive for more than 50%

2) Incorporate more than 40% of imaging results

3) Record family health history for more than 20%

4) E-Rx for more than 10% of discharge prescriptions

What a summary of care must include:Patient name.Procedures.Relevant past diagnoses.Laboratory test results.Vital signs (height, weight, blood pressure,

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

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

Care plan field, including goals and instructions, and

Any additional known care team members beyond the referring or transitioning provider and the receiving provider.

Discharge instructions

AND:An up-to-date problem list of current and

active diagnosesAn active medication listAn active medication allergy list

The Transitions of Care objective combines elements of previous Stage 1 objectives that are no longer being measured individually:Maintain an up-to-date problem listMaintain an active medication listMaintain an active medication allergy list

If there are no problems, meds, or med allergies = Indication in record

Common MU Data Set

Data Elements in Common Between EP and EH/CAH in Addition toCommon MU Data Set

Elements that are different between EP and EH/CAHTransitions of Care – EPs Transitions of Care – EH/CAHs

Patient name Patient name

Sex Sex

Date of birth Date of birth

Race (OMB Race and Ethnicity) Race (OMB Race and Ethnicity)

Ethnicity (OMB Race and Ethnicity) Ethnicity (OMB Race and Ethnicity)

Preferred language Preferred language

Smoking status (SNOMED-CT value set) Smoking status (SNOMED-CT value set)

Problems (SNOMED-CT value set) Problems (SNOMED-CT value set)

Medications (RxNorm) Medications (RxNorm)

Medication allergies (RxNorm) Medication allergies (RxNorm)

Laboratory test(s) (LOINC) Laboratory test(s) (LOINC)

Laboratory value(s)/result(s) Laboratory value(s)/result(s)

Vital signs (height, weight, blood pressure, BMI) Vital signs (height, weight, blood pressure, BMI)

Care plan field(s), including goals and instructions Care plan field(s), including goals and instructions

Procedures (SNOMED-CT or HCPCS/CPT-4), optional CDT, optional ICD-10-PCS

Procedures (SNOMED-CT or HCPCS/CPT-4), optional CDT, optional ICD-10-PCS

Care Team Member(s), including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider

Care Team Member(s), including the primary care provider of record and any additiona known care team members beyond the referring or transitioning provider and the receiving provider

Encounter diagnosis (ICD-10-CM or SNOMED-CT) Encounter diagnosis (ICD-10-CM or SNOMED-CT)

Immunizations (HL7 Standard Code Set CVX) Immunizations (HL7 Standard Code Set CVX)

Functional status, including activities of daily living and cognitive and disability status

Functional status, including activities of daily living and cognitive and disability status

The following are Elements that are different between EP and EH/CAHReason for referral

Discharge instructions

Referring or transitioning provider's name and office contact information

15 core objectives

5 of 10 menu

objectives

20 total objectives

17 core objectives

3 of 5 menu objectives

20 total objectives

1) Use CPOE for more than 60% of medication, laboratory and radiology orders

2) E-Rx for more than 65%3) Record demographics for more than

80%4) Record vital signs for more than

80%5) Record smoking status for more

than 80%6) Implement 5 clinical decision

supportinterventions + drug/drug and drug/allergy

7) Incorporate lab results for more than 55%

8) Generate patient list by specific condition

9) Use EHR to identify and provide more than10% with reminders for preventive/follow-up

10) Provide online access to health information for more than 50% with more than 5% actually accessing

11)Provide office visit summaries in 24 hours

12)Use EHR to identify and provide education resources more than 10%

13)More than 10% of patients send secure messages to their EP

14)Medication reconciliation at more than 50% oftransitions of care

15) Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically

16)Successful ongoing transmission ofimmunization data

17)Conduct or review security analysis andincorporate in risk management process

1) More than 40% of imaging results are accessible through Certified EHR Technology

2) Record family health history for more than20%

3) Successful ongoing transmission of syndromic surveillance data

4) Successful ongoing transmission of cancercase information

5) Successful ongoing transmission of data to a specialized registry

Change from Stage 1 to Stage 2:

Clinical Quality Measure reporting is no longer a meaningful use core objective, but reporting CQMs is a basic requirement for meaningful use.

Patient and Family Engagement

Patient SafetyCare CoordinationPopulation and Public HealthEfficient Use of Healthcare

ResourcesClinical

Processes/Effectiveness

15 total CQM

24 CQMs (≥1 per domain)

24 total CQMs

3 coreOR

3 alt. core CQMs

plus 3 menu CQMs

6 total CQMs

1a) 12 CQMs (≥1 per

domain) 1b) 11 core +

1 menu CQMs

2) PQRS Group Reporting

12 total CQMs

Hospitals

Eligible Professionals

2 Types of CQM Reporting Methods Aggregate XML-based format

specified by CMS Manner similar to 2012

Medicare EHR Incentive Program Electronic Reporting Pilot