Stage 2 Meaningful Use: Core Objectives

James R. Christina, DPM Director Scientific Affairs

APMA

What Stage Am I In?

2

2

EHR Must Have 2014 ONC Certification

Reporting Period for 2014

Stage 2 Requirements

Core Objectives

Computerized Provider Order Entry (CPOE)

Do I have to enter orders for x-rays taken in my office? I asked this question of CMS: For Stage 2 Core Measure 1 CPOE--if a

eligible provider has ability to take x-rays in their office, do they need to put an order for an x-ray as a CPOE even though the x-ray is taken on site in their office and if so then they need to make that available under the menu set measure as structured data in the patient's record--correct?

To expand on this most podiatrists have x-ray

capability in their offices to take foot and ankle x-ray films. They bill for both components—taking the x-rays and reading and interpreting the x-rays, so no other health care provider is involved. It seems tedious for them to enter an order for the x-rays in the patient record to take these on site. Also, for the menu set measure, they would then have to somehow get the films from their office into a digital form (probably a digital photograph of the x-ray) and scan it into the patient record as structured data.

I appreciate clarification of this measure.

This was the CMS response: The CMS Stage 2 Final Rule states that the

CPOE function should be used the first time the order becomes part of the patient’s medical record and before any action can be taken on the order. . . The provider must make the determination as to what constitutes the patient’s medical record and what does not based on their existing policies and applicable state and Federal law. Our only requirements in this regard are that the determination be made by the provider prior to the start of the EHR reporting period and be uniformly applied.

You are correct that if an x-ray is entered via CPOE then Menu Measure 3 objective is that the imaging results and any explanation accompanying the image result need to be accessible through CEHRT for more than 10% of all tests ordered by the EP during the reporting period. There is an exclusion for any EP who orders less than 100 imaging tests during the reporting period.

E-Prescribing (eRx)

Record Demographics

Record Vital Signs

Record Smoking Status

Use Clinical Decision Support

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (Population and Public Health)

Preventive Care and Screening: Influenza Immunization (Population and Public Health)

Pneumonia Vaccination Status for Older Adults (Clinical Processes/Effectiveness)

Diabetes: Eye Exam (Clinical Processes/Effectiveness) Diabetes: Foot Exam (Clinical Processes/Effectiveness) Diabetes: Hemoglobin A1c Poor Control (Clinical Processes/Effectiveness)

Hemoglobin A1c Test for Pediatric Patients (Clinical Processes/Effectiveness)

Diabetes: Urine Protein Screening (Clinical Processes/Effectiveness) Diabetes: Low Density Lipoprotein (LDL) Management (Clinical Processes/Effectiveness)

Falls: Screening for Future Fall Risk (Patient Safety)

Documentation of Current Medications in the Medical Record (Patient Safety)

Closing the referral loop: receipt of specialist report (Care Coordination)

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up (Population and Public Health)

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (Population and Public Health)

Potential CQMs for Podiatrists

Provide Patients the Ability to View Online, Download and Transmit Their Health Information

Provide Clinical Summaries

Security Risk Analysis

http://www.healthit.gov/providers-professionals/security-risk-assessment

Incorporate Clinical Lab Test Results

Generate Lists of Patients by Specific Conditions

Reminders for Preventive/Follow-Up Care

Patient Education Resources

Medication Reconciliation

Summary of Care Record

Submit to Immunization Registries

Use Secure Electronic Messaging with Patients

CMS Attestation Calculator

http://www.cms.gov/apps/stage-2-meaningful-use-attestation-calculator/

Questions

James R. Christina, DPM jrchristina@apma.org

301-581-9265

Register for Part 2 of this webinar to be held on Tuesday June 10, 2014 at 8:00 pm EDT on the APMA website (www.apma.org) It will cover Stage 2 Menu Set Objectives and Clinical Quality Measure reporting.