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Minimizing Surprise in Meaningful Use: Moving from Stage 1 to Stage

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SEPTEMBER 17, 2014

ALYSEN F ICKLIN, RN, BHA - CL INICAL CONSULTANT

Supporting the Healthcare Foundations of Our Communities

Excellence  |  Trust  |  Community

Form No. 0074-0914

Alysen Ficklin, RN, BHAWide River Clinical Consultant

Alysen has a number of years of experience in healthcare, she brings the background of an active floor nurse paired with advanced education in healthcare administration. 

She has experience with implementation and strategic planning of comprehensive patient portal solutions, including direct messaging, billing and mobile app components. 

Alysen excels at clinician engagement and change acceleration, using her personal strengths to facilitate excitement and excellence in the field of patient care.

Speaker

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Stage 1 GroundworkLeveraging earlier work

Stage 2 General ChallengesTimelineUpgrade CostsOngoing Staff EducationCMS Audits

Stage 2 Measurement ChallengesPatient Engagement Transitions of CareClinical Decision SupportClinical Quality MeasuresPublic Health Reporting

Keys to SuccessPhysician Engagement – How to

secure itMeaningful Use Team – Who to

invite to the tablePortal Strategies – How to

engage your patients

Objectives

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Where We Have Been

Stage One

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Stage 1 is the foundation on which to build“Can you put data into the system?”

We are documenting the basics of good careFocus was on adoption and creation of workflows

Re-evaluate workflows for Stage 2Not all workflows will require re-writes, but evaluating

them all will prevent surprises after the start of the reporting period

Do your policies reflect the approved workflows?Remember “Lessons Learned” when informing staff

How did they feel about training at GoLive?Can you improve on it?Do you have a culture of change acceptance?

Stage 1 Groundwork

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Facing the General Challenges

Stage Two

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Upgrade Costs2014 Certification is required to report on Stage 2CMS recently finalized the proposed rule – vendor delays have

clearly been an issue Many sites did a full rip/replace in 2014

Ongoing Staff EducationThe nature of frequent upgrades means staff have to be flexible

and willing to accept changeCommunication

CMS AuditsCan happen up to 6 years after attestationSite may be on a new versionCMS can reclaim past incentive payments with interest in the

case of a failed audit

Stage 2 Challenges

Timeline – Reporting Periods

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Problem Measures

Stage Two

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CMS Defines:Transition of Care – The movement of a patient from

one setting of care (hospital, ambulatory PCP, ambulatory specialty, long term care, home health, rehab) to another.o For EH: At a minimum this includes all discharges

from the inpatient department and ED when follow-up care is ordered.

o For EP: At a minimum this includes all referrals ordered by the EP, including direct admits to inpatient and instructions to go to the ED.

What about Swing Beds?Inpatient – PoS 21ED – PoS 23Swing – PoS 30/31

Transitions of Care

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Summary of Care record is how providers communicate vital information with each other about the care of a patient.

CMS says the summary of care record must include the following elements:Patient nameReferring or transitioning provider's name and office contact

information (EP only) ProceduresEncounter diagnoses ImmunizationsLaboratory test resultsVital signs (height, weight, blood pressure, BMI)Smoking statusFunctional status, including activities of daily living, cognitive and

disability status

Summary of Care Record

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Demographic information (preferred language, sex, race, ethnicity, date of birth)

Care plan field, including goals and instructionsCare 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 referralCurrent problem list (EPs and hospitals may also

include historical problems at their discretion)Current medication listCurrent medication allergy list

Elements, Continued

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Summary of Care – EP/EH

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CMS defines Med Rec: The process of identifying the most accurate list of all

medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital or other provider.

Medication Reconciliation

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The Patient Portal is how providers communicate vital information with their patients

2014 Certified System neededPrior to 2014 – Only needed to provide an “electronic copy” of the patient’s health record, and even that was only “on request”

Prior to 2014 – Menu measurePatient Portal = Patient Engagement

Engaged patients are more involved and typically more satisfied with their care

Explaining the value of portal use to a patient requires an “elevator speech”

Patient Portals

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CMS states the following information must be available to the patient via the portal:Patient nameAdmit/Discharge date and location (EH)Provider’s name and office contact information (EP)

Reason for hospitalization (EH)Care teamProcedures performedCurrent and past problem listCurrent med list and med historyCurrent med allergy list and allergy history

Portal Requirements

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Vital signs at discharge (EH)Vital signs including height, weight, BP, BMI and growth charts (EP)

Lab test results Summary of Care record for transitions of care or referrals to another provider

Care plan fields, including goals and instructionsDischarge instructions for patient (EH)DemographicsSmoking status

Portal Info Continued

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CMS Defines “Access”When a patient possesses all of the necessary information

needed to view, download or transmit their information.

Patient Electronic Access

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The EH/CAH will typically use the Summary of Care record as their discharge summary, but the EP has a separate measure for this

List of minimum elements required for the EP clinical summary

EP – Clinical Summary

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EP – Use Secure Electronic Messaging

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CMS defines Decision SupportHIT functionality that builds upon the foundation of an EHR to

provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.

Clinical Decision Support

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Encourage technology use as a tool Identify patients at risk at point of careWhat do your providers want to know about their

patient populations?Decision support tracking

What can alert triggers tell us about our patient populations?

Beware of “Popup Fatigue”Define tools that make sense for you

Evidence-based, MU, QualityConsider your patient population

Tracking improvement in population health for the communityPublic Health Reporting

Using CDS to Improve Quality

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Register with DHHSDHHS staff will then contact you to work through the

onboarding and testing process – helping you create a connection from your EHR to their registries.

Public Health Reporting

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Many other measures also see significant changes, either in percentages or details/definitions.CPOE – adds lab and radiology orders while increasing the medication percentage

Demographics – increased to 80%Problem List – CDA/Visit SummaryMedication List – CDA/Visit SummaryVital Signs – increased to 80% and some detail changes

Other Objective Changes

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CMS offers 29 different clinical quality measures for EH and 64 for EP

Select based on your practice and patient population for attestation as well as need to participate in IQR/OQR or PQRS

Clinical Quality Measures

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Strategies for Success

MU Leadership

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Experts at the tableEHR staff - informatics/ITPhysician leadershipNurse leadershipPharmacy leadershipOther voices, depending on workflow/measure

Meet weekly or bi-weekly, dependingEvaluate MU numbersBrainstorm tactics/strategies for improvement

Generating Success:Your MU Team

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Physician/Provider Champion of the EHRDoes your organization have one?Are they allocated hours to work on MU or other

changes?Did you have provider input during the EHR

selection process?Areas to gain engagement:

Patient portal – problem listClinical Decision SupportClinical Quality MeasuresICD-10 and SNOMED

Generating Success:Physician Engagement

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Strong LeadershipSelect a “portal champion”Do you need a separate team?

Compare document requirementsEP Clinical summary vs. portal elementsEH Summary of care record vs. portal elementsMinimize duplication and simplify workflows where possible

Engage the PatientMarketing the portalHelp them login and view, download or transmitTest messages

Determine workflows for proxy accessParents and guardians of minorsChildren of elderly patients/POA

Generating Success: Portal Strategies

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Any EP or EH (including the CAHs) who have attested to receive an incentive payment for either the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program may be subject to an audit.

When can audits happen?The contractors can audit a given attestation up to 6 years after incentive payment was made.

What happens if I fail?In a failed audit, CMS will require full repayment of incentives, plus interest within 30 days.

Audits

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Mistakes we’ve seen:MU is one person’s responsibility. Waiting until an audit letter is received to generate supporting documentation.

Change of EHR Vendors.The belief that small clinics and systems are not audited.

Ignoring the details of the yes/no measures.Waiting too long to ask for help.

How to Fail an Audit

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Questions?

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Excellence  |  Trust  |  CommunityAt Wide River, everything begins and ends with the pursuit of Excellence.  When we earn our clients' Trust we build strong, mutually beneficial relationships that enable our healthcare Communities to thrive.

• Meaningful Use Assistance Onsite Consulting Audit Preparation Expert Help Desk

• Regulatory and Quality Improvement Consulting

• Clinical Workflow Redesign

• Project Management Services

• Informatics Training / Mentoring

• Contract Staffing• EHR Rip-and-Replace

Assessments• EHR Customization,

Optimization and Training

Wide River offers the following services:

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