meaningful use of health information exchange
TRANSCRIPT
Meaningful Use ofHealth information Exchange
Savannah, GeorgiaApril 26, 2013
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IOM Quality Chasm Report
• “If we want safer, higher‐quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes.”– IOM, Quality Chasm report, 2001
What is Meaningful Use? • Meaningful Use is using certified EHR technology 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 is required to receive incentives and avoid penalties
• 2014 Standards and Certification Criteria
• Stage 2 Meaningful Use
Stage 2 MU ACOs Stage 3 MU
PCMHs3‐Part Aim
Registries to manage patient populations
Team based care, case management
Enhanced access and continuity
Privacy & security protections
Care coordination
Privacy & security protections
Patient centered care coordination
Improved population health
Registries for disease
management
Evidenced based medicine
Patient self management
Privacy & security protections
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
Stage 1 MU
Privacy & security protections
Basic EHR functionality, structured data
Improve access to information
Use information to transform
Meaningful Use as a Building Block
Utilize technology to gather
information
CEHRT & MU Relationship
Meaningful Use Stage 2 (MU2)
CMS: Medicare and Medicaid EHR Incentive Programs Stage 2• outlines incentive payments (+$$$) for early adoption• outlines payment adjustments(‐$$$) for late adoption/non‐complianceReference: CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2 Final Rule 495.6
ONC: Standards, Implementation Specifications & Certification Criteria (SI&CC) 2014 Edition• Specifies the data and standards requirements for certified electronic health
record (EHR) technology (CEHRT) needed to achieve “meaningful use”Reference: ONC Health Information Technology : Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology 170.314(b)(1)&(2)
CEHRT & MU RelationshipCare Coordination / Transitions
Meaningful Use Stage 2 (MU2) – Care Coordination
CMS: Medicare and Medicaid EHR Incentive Programs Stage 2• Measure #2 : Provide an electronic ‘‘summary of care record for more than 10
percent of such transitions and referrals” using one of the accepted transport mechanisms specified in the rule.
Reference: CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2 Final Rule 495.6
ONC: Standards, Implementation Specifications & Certification Criteria (SI&CC) 2014 Edition• Electronically receive and incorporate a transition of care/referral summary
Electronically create and transmit a transition of care/referral summaryReference: ONC Health Information Technology : Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology 170.314(b)(1)&(2)
Meaningful Use HIE Requirements
MU Stage 2 Transitions of CareCore Objective
MU Stage 2 Medication ReconciliationCore Objective
The EP/EH/CAH that transitions a patient to another care setting or care provider or refers a patient to another care provider provides a summary care record for each transition of care or referral.
The EP/EH/CAH that receives a patient from another care setting or care provider or believes an encounter is relevant should perform medication reconciliation.
Transitions of Care Measure 1
Transitions of Care Measure 2
Transitions of Care Measure 3
Meaningful Use HIE Requirements
Transitions of Care Measure 1
Measure 1
The EP, EH, or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals.
Transitions of Care Measure 1
Transitions of Care Measure 2
Measure 2
The EP, EH, or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent of such transitions and referrals either:• Electronically transmitted using
CEHRT to a recipient OR• Where the recipient receives the
summary of care record via exchange facilitated by an organization that is a Nationwide Health Information Network (NwHIN) Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes
Transitions of Care Measure 1
Transitions of Care Measure 2
Transitions of Care Measure 3
Measure 3
An EP, EH, or CAH must satisfy one of the following:• Conducts one or more successful
electronic exchanges of a summary of care record meeting the measure specified in Requirement 2 of this section with a recipient using technology to receive the summary of care record that was designed by a different EHR developer than the sender's CEHRT certified OR
• Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period
Transitions of Care – EPs Transitions of Care – EH/CAHsPatient name Patient name
Sex SexDate of birth Date of birthRace (OMB Race and Ethnicity) Race (OMB Race and Ethnicity)Ethnicity (OMB Race and Ethnicity) Ethnicity (OMB Race and Ethnicity)Preferred language Preferred languageSmoking 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 additional known care team members beyond the referring or transitioning provideand 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
Common MU Data Set
Data Elements in Common Between EP and EH/CAH in Addition to Common MU Data Set
Elements that are different between EP and EH/CAH
All summary of care documents must include these data elements
MU Stage 2 Medication Reconciliation Core Objective
Objective:• The EP, EH, or CAH who
receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
Measures:• The EP who performs
medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP.
• The eligible hospital or CAH performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department.
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Why the attention on interoperability?
• “Unless interoperability is achieved, physicians will still defer IT investments, potential clinical and economic benefits won’t be realized, and we will not move closer to badly needed healthcare reform in the US.”
– Dr. David Brailer, HHS National HIT Coordinator, May 21, 2004
Federal Government Initiatives
Graphic: The Value Proposition for Exchange; Doug Fridsma, July 2011
• Federal Advisory Committees (FACAs) – HIT Policy Committee, Standards
• Nationwide Health Information Network (NwHIN)– Services, standards, policies, trust fabric
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Direct Project Facilitates Meaningful Use
• Other Providers/Authorized Entities:– Clinical information – Labs – test results– Referrals – summary of care record
• Patients:– Health information – Discharge instructions– Clinical Summaries– Reminders
• Public Health:– Immunization registries– Syndromic surveillance
Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements.
Examples of Meaningful Use ContentExamples of Meaningful Use Content
D I R E C T
CCSNPC Technology Partner
1993 1999 2006
20 Years 14 Years 7 Years
• Standards‐based Solutions for Health Information Exchange
• Commercial Software and Support
• Open Architecture• User Extensible• Application and Data Integration Experts
Software DevelopmentSoftware
DevelopmentHealthcare
FocusHealthcare
FocusMirth
Products
Mirth Product Overview
Mirth ApplianceReady‐to‐Run Platformfor Mirth Applications
Direct Messaging, Secure Chat, and HPD+ Provider
Directory
HL7, DICOM, X12, CCD, C‐CDA, and EHR Integration
MirthCare
Mirth Match
MirthMail
Mirth Connect
MirthResults
MirthAnalytics
MirthRules
eHealth and IHE Exchange
Mirth ResultsCentral Data Repository & Provider PortalMirth MailSecure Direct Messaging, Chat, & Provider DirectoryMirth CareChronic Disease Management & Care CoordinationMirth MatchEMPI & Record Locator ServiceMirth ConnectData Integration EngineMirth AnalyticsBusiness Intelligence, Reporting, & AnalyticsMirth RulesRules Engine for Clinical Decision Support
Mirth at ChathamHealthLink• Healthcare Data Repository
• Provider Portal• Available XDS.b Plugin• CCD and Consolidated CDA
• Agents – Data Detectors and Subject Groups
• Scheduled Reports• Central and Federated Deployment
• Standards‐based Integration with NextGateMatchMetrix EMPI and GeorgiaDirect HISP
Mirth ApplianceReady‐to‐Run Platformfor Mirth Applications
HL7, DICOM, X12, CCD, C‐CDA, and EHR Integration
Mirth Connect
MirthResults
eHealth and IHE Exchange
The Value of Mirth
• Talks Documents, Stores Data• Standards‐based HIE and EHR Integration• Improve Physician Alignment and Patient Engagement• Enable ED/IP Notification and Summary of Care Delivery
CCD EDI CDA HL7
Value Proposition for HIE
• Provide better, safer and more efficient patient care
• Distribute hospital information to doctors • Savings on uncompensated care related to unnecessary or avoidable services
• Provides outreach to community partners• Helps maintain referral patterns • Improved care coordination• Aligns with shifting reimbursement models
Capacity Building Funding• $492,500.00 funding award• Opportunity to connect • Move beyond the pilot• Next Steps:
– Strong policy development– Build sustainability model– Security assessment
