Meaningful Use Stage 1 & 2Helping Colorado Providers Achieve Meaningful Use

Tracy RueSenior Consultant, Colorado Regional Extension Center

Agenda

• Three Stages of Meaningful Use• Stage 1 & 2 Timing• Regional Extension Center • Objectives Comparing Stages 1 & 2• Clinical Quality Measures Stages 1 &

2

© 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Meaningful Use: Laying the Foundation for Future Advances

© 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Meaningful Use Stage 1:Using electronic systems, structured data, point-of-care protocols, improved care coordination, security protocols & HIPAA standards in place

Meaningful Use Stage 2:Exchanging clinical data with other sources, tracking clinical outcomes, targeted patient-care initiatives, patient access to self-management tools

Stage 2: Walls & Windows

Meaningful Use Stage 3:Fully integrated systems, reductions in errors & duplications, improved cost effectiveness, better coordinated care Stage 2: Walls & Windows

Stage 3: Home is Built

Meaningful Use Timing

4

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 20212011

1 1 1 2* 2 3 3 TBD

TBD

TBD

TBD

2012

1 1 2* 2 3 3 TBD

TBD

TBD

TBD

2013

1 1* 2 2 3 3 TBD

TBD

TBD

2014

1* 1 2 2 3 3 TBD

TBD

2015

1 1 2 2 3 3 TBD

2016

1 1 2 2 3 3

2017

1 1 2 2 3

Incentive Payment Year

Fir

st P

rog

ram

Year

*3-month quarter EHR reporting period for Medicare and continuous 90-day reporting for Medicaid EPs.

5

Colorado Regional Extension Center

MUAdopt EHR

Select & Implement EHR

Determine HIT & EHR Readiness

• Colorado REC’s mission is to provide the training and support services necessary for primary care providers in small practices, Rural Hospitals and Critical Access Hospitals to achieve Stage 1 Meaningful Use

• CORHIO has partnered with six healthcare organizations across Colorado to work with 2,295 providers and 33 rural and critical access hospitals to achieve the goals of the grant

SUCCESS!• 97% of participating providers have

gone live on their EHR and 42% have reached Meaningful Use

• 85% of participating Rural and Critical Access hospitals have gone live and 67% have reached Meaningful Use

The EHR Incentive Programs

What is the EHR Incentive Program?• HITECH Act of 2009/American Recovery

& Reinvestment Act– Meaningful Use of Certified Electronic

Health Records Technology (CEHRT)• Three Stages (currently in Stage 1)• Two programs:

– Medicare» Opened in 2011 for Meaningful Use demonstration» Eligible Professionals, Eligible Hospitals and Critical Access

Hospitals

– Medicaid» Opened in 2012 for Adopt, Implement or Upgrade of a

CEHRT» Opened in 2013 for Meaningful Use » Eligible Professionals, Eligible Hospitals and Critical Access

Hospitals

Who is Eligible for Medicare EHR Incentives?

8

Eligible Providers - Medicare

Eligible Professionals (EPs)* Doctor of Medicine or Osteopathy

Doctor of Dental Surgery or Dental Medicine

Doctor of Podiatric Medicine

Doctor of Ophthalmology

Chiropractor

To qualify for an incentive payment under the Medicare EHR Incentive Program, an eligible professional must:• Bill Medicare FFS “straight Medicare”• Medicare Provider in good-standing

Hospital-based providers are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place of Service code 21) or emergency room (Place of Service code 23) setting.

Incentive Payments for Medicare EPs

Medicare Incentive is 75% of total allowed charges, based on a calendar year

Calendar Year

CY 2011 CY 2012 CY 2013 CY 2014 CY 2015and later

2011 $18,0002012 $12,000 $18,0002013 $8,000 $12,000 $15,0002014 $4,000 $8,000 $12,000 $12,0002015 $2,000 $4,000 $8,000 $8,000 -1%2016 $2,000 $4,000 $4,000 -2%

2017 -3%

2018 -4%

2019 -5%

TOTAL $44,000 $44,000 $39,000 $24,000 0

© 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution

Who is Eligible for Medicaid EHR Incentives?

10

Eligible Providers - Medicaid

Eligible Professionals (EPs)*PhysiciansNurse Practitioners (NPs)Certified Nurse-Midwives (CNMs)DentistsPhysician Assistants (PAs) who lead a FQHC or RHC

To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria:• Have a minimum 30% Medicaid patient volume*• Have a minimum 20% Medicaid patient volume and is a pediatrician*• Practice predominantly in a Federally Qualified Health Center or Rural Health

Center and have a minimum 30% patient volume attributable to needy individuals

• Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria

Hospital-based providers are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place of Service code 21) or emergency room (Place of Service code 23) setting.

• Medicaid EPs can start receiving payments any time from CY 2011 through 2016, and there is no penalty for starting later– Payments based on participation year, so EPs can have gaps in meeting

Meaningful Use requirements and still receive max $

• No Medicaid payment reductions for not meeting Meaningful Use

Incentive Payments for Medicaid EPs

Calendar Year

CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY2016

2011 $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 $21,2502017 $8,500 $8,500 $8,500 $8,500 $8,5002018 $8,500 $8,500 $8,500 $8,5002019 $8,500 $8,500 $8,5002020 $8,500 $8,5002021 $8,500TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,75

0© 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution

Stage 1 & Stage 2 Meaningful Use

Definitions

• Structured Data (Discrete Data)– Data that is identifiable because it is organized in a

structure………(i.e.. ICD-9, SNOMED)• Denominator (MU)

– Example: The number of Unique Patients seen within the reporting period

• Numerator (MU)– Example: The number of times the Meaningful Use

Objective was met• Unique Patient

– A Unique patient means that even if a patient is seen multiple times during the reporting period they are only counted once.

Stage 2 Goals & Intentions

• Alignment of Clinical Quality Measures with other reporting programs

• Improving Patient Care with new objectives to improve patient care through better clinical decision support, care coordination and patient engagement

• Rigorous expectations for HIE through increased emphasis on exchanging clinical summary documents to improve care coordination, public health reporting and importing lab results in a structured manner

Eligible Hospitals and CAHs

14 Core5 of 10 Menu

19 total objectives

Eligible Hospitals and CAHs

16 Core3 of 6 Menu

19 total objectives

Eligible Professionals15 Core

5 of 10 Menu20 total objectives

Eligible Professionals17 Core

3 of 6 Menu20 total objectives

Stage 1 to Stage 2 Overview

Stage 1 Stage 2

Adapted from HealthIT.gov

What are the Requirements of Stage 2 Meaningful Use?

• Core Objectives

• Menu Set Objectives

• Clinical Quality Measures

Meaningful Use - Core Objectives

Patient Check In & Out

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Record demographics• Race• Ethnicity• Preferred

Language• DOB

�

> 50% of allunique patients

Record demographics

�

> 80% of all unique patients

Provide clinical

summaries for patients for each office visit

> 50% of all office visits within 3 business days

Provide clinical

summaries for patients for each

office visit

> 50% of all office visits within ONE

business day

Rooming Patient

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Maintain activemedication list

> 80% of allunique patients

No longer a separate

objective for Stage 2

Incorporated into Transitions of

Care

Maintain active

medication allergy list

> 80% of all

unique patients

No longer a separate

objective for Stage 2

Incorporated into Transitions of Care

Record and chart

changes in vital signs:

� Height, Weight, BP, BMI

�

> 50% of

all unique patients age

2 and older

Record and chart

changes in vital signs

3 years and older

BP and Height and Weight can be

reported separately.

��

> 80% of all unique

patients

Record smoking status

for patients 13 years

or older

> 50% of allunique patients 13

years or older

Record smoking status

for patients 13 years

or older

> 80% of all unique patients

Patient Exam

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Maintain an up-to-date

problem list

> 80% of allunique patients

seen

No longer a separate

objective for Stage 2

Incorporated into Transitions

of Care

Report CQMs Report 6 CQMs No longer a separate objective

CQMs submitted electronically to

CMS

Implement one clinical

decision support rule relevant to

specialty

Implement one clinical

decision support rule

Use clinical decision

support to improve

performance on high-priority

health conditions

Implement 5 clinical

decision support interventions

Patient Exam

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Medication Reconciliation

>50% of patients who transitioned

into the care of the EP

Stage 1 Menu Set

Medication Reconciliation

50% of transitions of care in which the patient is transitioned

into the care of the EP

Orders and Point of Care

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Use CPOE formedication orders

> 30% ofunique patients

Use computerizedprovider order

entry (CPOE) for medication,

laboratory and radiology orders

> 60% ofMedication > 30% of laboratory> 30% of

radiology orders

Implement drug-drug and drug-

allergy interaction

checks

The EP has enabled

this functionality for the entire

EHR reporting period

No longer a separate

objective for Stage 2

Incorporated into the Stage

2 Clinical Decision Support measure

Orders and Point of Care

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Generate and transmit

permissible prescriptions

electronically (eRx)

> 40% of allpermissible

prescriptions

Generate and transmit

permissible prescriptions electronically

(eRx)

> 50% of allpermissible

prescriptions

Use certified EHR

technology to identify patient-specific

education resources and provide those resources to the

patient if appropriate

> 10% of all

unique

Stage 1 Menu Set

Use certified EHR

technology to identify patient-

specific education resources and provide those

resources to the patient if

appropriate

Patient-specific education resources

identified by CEHRT provided

to patients for more than 10% of all unique patients seen by EP during the EHR reporting

period

Orders and Point of Care

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Implement drug-

formulary checks

Enabled

functionality

Stage 1 Menu Set

No longer a separate

objective for Stage 2

Incorporated into the e- Prescribing measure for Stage

2

Clinical Administration

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Give patientselectronic copy of

their health information (including

diagnostic test results, problem list, medication lists, medication allergies) upon

request

> 50% of allpatients of the EP who request an

electronic copy of their health

information are provided it within 3 business days

Provide patients the

ability to view online, download

and transmit their health information

within 4 business days of the

information being available to the

EP

> 50% of allunique patients seen by the EP

within 4 business days after the information is available have

online access to their health information

> 5% of all

unique patients seen by the EP (or their authorized representatives)

view,download or

transmit their health

information to a third party

Clinical Administration

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Capability to exchange key

clinical information

Performed at least one test

Eliminated from Stage 1 in 2013

No longer an objective for Stage

2

Eliminatedfrom Stage 1 in

2013No longer a

measure for Stage 2

Incorporate clinical lab test

results into certified EHR technology as

structured data

> 40%

Stage 1 Menu Set

Incorporate clinical lab test results into

certified EHR technology as

structured data

> 55%

Clinical Administration

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Generate lists of

patients by specific conditions to use for quality improvement,

reduction of disparities, research

or outreach

Generate at least one

report listing patients of the EP with a

specific condition

Stage 1 Menu Set

Generate lists of patients

by specific conditions to use for quality

improvement, reduction of

disparities, research, or outreach

Generate at least one

report listing patients of the EP with a

specific condition

Send reminders to

patients per patient preference for

preventive/follow-up care

> 20% of all

unique patients 65 years or older or 5

years old

Stage 1 Menu Set

Use clinically relevant

information to identify patients who

should receive reminders for

preventive/follow-up care

>10% of all patients with two or more

office visits in the last 2 years

Clinical Administration

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Provide patients with

timely electronic access to their

health information

> 10% of all unique patients

seen by the EP are provided timely (available to the

patient within four business days of being updated in

thecertified EHR technology)

Stage 1 Menu Set

Eliminated from Stage 1 in 2014

No longer an objective for

Stage 2

Eliminatedfrom Stage 1 in

2014No longer a

measure for Stage 2

Clinical Administration

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

The EP who transitions

their patient to another setting of

care should provide summary of care record for each transition of care or referral

>50% of transitions of care

and referrals

Stage 1 Menu

The EP who transitions

their patient to another setting of

care should provide summary of care record for each transition of care or referral

>50% of transitions of care

>10% electronicallyThis measure

combines Stage 1 core items – problem list, active medication

list and active medication allergy list - to emphasize

increased data exchange

Clinical Administration

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Capability to submitelectronic data to

immunization registries or

Immunization Information Systems

and actual submission except where

prohibited and in accordance with

applicable law and practice

Performed at least one test

Stage 1 Menu

Capability to submitelectronic data to

immunization registries or

Immunization Information Systems

and actual submission except where

prohibited and in accordance with applicable law

Successful ongoingsubmission of

electronic immunization data

NEW NEW

Use secure electronicmessaging to

communicate with Patients

> 5% of patients communicate

electronically with their provider (s)

Administration

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Protect electronichealth information

created or maintained by the

certified EHR technology through the

implementation of appropriate

technical capabilities

Conduct or review a

security risk analysis

Protect electronic health

information created or

maintained by the certified EHR

technology through the

implementation of appropriate

technical capabilities

Conduct or review a

security risk analysis and

encryption/security of data at rest

Meaningful Use – Menu Set Objectives

Stage 2 Menu Set (EPs must select 3 of 6)

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

Capability to submitelectronic syndromic surveillance data to

public health agencies and actual submission except

where prohibited and in accordance with applicable law and

practice

Performed at leastone test of certified EHR technology's

capacity to provide electronic syndromic surveillance data to

public health agencies

 

Capability to submitelectronic syndromic surveillance data to

public health agencies and actual submission except

where prohibited and in accordance with applicable law and

practice

Successful ongoing submission

of electronic syndromic

surveillance data

NEW NEWRecord electronic

notesin patient records

Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of

unique patients

Stage 2 Menu Set

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

NEW NEW

Imaging resultsconsisting of the

image itself and any explanation or other

accompanying information are

accessible through CEHRT

More than 10% of all scans and

tests whose result is an image ordered by the EP for patients

seen during the EHR reporting period are incorporated into or accessible through

CEHRT

NEW NEW Record patient family

health history as structured data

>20% of all unique have a structured

data entry for one or more first-degree

relatives

Stage 2 Menu Set

Stage 1 Objective

Stage 1 Measure Stage 2 Objective

Stage 2 Measure

NEW NEW

Capability to identify and

report cancer cases to a state cancer registry, except

where prohibited, and in accordance with applicable law

and practice

Successful ongoing submission

of cancer case information from CEHRT to a cancer

registry for the entire EHR reporting period

NEW NEW

Capability to identify and

report specific cases to a specialized

registry (other than a cancer registry),

except where prohibited, and in accordance with

applicable law and practice

Successful ongoing submission

of specific case information from

CEHRT to a specialized registry

for the entire EHR reporting period

Clinical Quality Measure Requirements for Stage 1

Meet 6 total Clinical Quality Measures

–3 core or alternate core, and –3 out of 38 from alternate set

Most Electronic Health Record systems only report on the minimum 9 Clinical Quality

Measures.

Which Clinical Quality Measures can your system report?

http://onc-chpl.force.com/ehrcert/chplhome

Clinical Quality MeasuresStage 1

Core Set

1. Hypertension: Blood Pressure Measurement

2. Preventive Care and Screening Measure Pairs: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention

3. Adult Weight Screening and Follow-up

Alternate Set4. Weight Assessment and Counseling for Children and Adolescents

5. Preventive Care and Screening; Influenza Immunization for Patients 50 Years Old or Older

6. Childhood Immunization Status

Must Choose 3

Additional CQMs38 Additional CQMs

• Must choose 3 of the additional 38 CQMs

Clinical Quality Measures Stage 2

Provider 2014 and Beyond*

Eligible Providers Complete 9 out of 64

• Submission of CQMs electronically (starting in 2014)• Alignment with existing quality programs• Providers must select from 3 of the 6 HHS National Quality Strategy

domains:1. Patient and Family Engagement2. Patient Safety3. Care Coordination4. Population and Public Health5. Efficient Use of Healthcare Resources6. Clinical Processes/Effectiveness

*Regardless of the stage of meaningful use, all providers will complete this number of CQMs in 2014

Adapted from HealthIT.gov

Helpful Links

CMS Registration: https://ehrincentives.cms.gov/hitech/login.action

Colorado Registration & Attestation System (CO R&A): http://co.arraincentive.com/

Certified Health IT Product List (CHPL ID): http://oncchpl.force.com/ehrcert?q=chpl

Colorado Regional Extension Centerhttp://www.corhio.org/

© 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Contact Information

Tracy RueSenior Consultant, Colorado Regional Extension Center true@corhio.orgPhone: 720.285.3234

2/19/2013 © 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved