Meaningful Use: Past, Present and Future Bruce Maki, MA M-CEITA / - PowerPoint PPT Presentation

Click to edit Master title style Meaningful Use: Past, Present and Future Bruce Maki, MA M-CEITA / Altarum Institute Regulatory Analyst and Project Manager 8/24/2016 1 1

Agenda ▲ Overview of M-CEITA ▲ Meaningful Use – Where have we been? – Where are we now? – Where are we headed? ▲ Questions and Answers 2

Who is M-CEITA? ▲ Michigan Center for Effective Information THE TRIPLE AIM Technology Adoption (M-CEITA) 3 ▲ One of 62 ONC Regional Extension Improve patient experience Improve population health Centers (REC) originally funded to provide Reduce costs education & technical assistance to primary care providers across the country ▲ Founded as part of the HITECH Act to Performance accelerate the adoption, implementation, and Measurement effective use of electronic health records Improve Ensure Improve Improve Engage (EHR), e.g. 90-days of MU Population Privacy Care Quality, Patients And And Coordi- Safety & & ▲ Originally Funded by ARRA of 2009 Public Security nation Efficiency Families Health Protections (Stimulus Plan) Meaningful Use ▲ Purpose: support the Triple Aim by Certified Technology Infrastructure achieving 5 overall performance goals 3

M-CEITA Services Meaningful Use Support Technical assistance, including workflow redesign, security risk assessment and MU compliance. (e.g. patient portal and clinical quality measures) Security Risk Assessment Support meeting the requirements of MU Measure: Protect Electronic Health Information, including an assessment using our exclusive tool. Audit Preparation A review of Meaningful Use attestation documentation using our exclusive Audit File Checklist to correct any issues before completing the process. Targeted Process Optimization (Lean) A workflow analysis and redesign of core processes using Lean principles to increase efficiency and reduce duplication. (e.g. chart prep, document management, test tracking, revenue cycle, etc.) PQRS Support Technical Assistance for the Physician Quality Reporting System including measure selection as well as reporting method selection and assistance. GLPTN - Great Lakes Practice Transformation Network No cost Technical Assistance to eligible providers in support of quality improvement initiatives, PQRS support, and preparing for upcoming advanced payment model changes under MACRA/MIPS. 4

The Past A Brief History of Meaningful Use 5

Healthcare’s Shifting Paradigm Role Changing Paradigm Healthcare Combating Illness Improving Wellness Physicians Directors of Care Collaborators in Care Patients Passive Recipients Active Participants Health Siloed and Episodic Integrated and Longitudinal Information Health IT Supporting Tasks Enhancing Understanding This paradigm shift requires significant investments, innovative people and extensible tools. 6

HITECH Act: Transformation Catalyst Health Information Technology for Economic and Clinical Health Act HITECH Act Paper Records HIT & HIE Pre 2009 2009 2014 A system plagued by EHR Incentive Programs Widespread adoption and inefficiencies and 62 Regional Extension meaningful use of HIT Centers (RECs) 7

Meaningful Use…as defined by CMS ▲ Meaningful Use is using certified electronic health record (EHR) technology to: – Improve quality, safety, efficiency, and reduce health disparities – Engage patients and families – Improve care coordination and population and public health – Maintain privacy and security of patient health information ▲ Ultimately, it is hoped that Meaningful Use compliance will result in: – Better clinical outcomes – Improved population health outcomes – Increased transparency and efficiency – Empowered individuals – More robust research data on health systems 8

Meaningful Use: A path to Stage 3 better outcomes and quality Improved outcomes Stage 2 Advanced clinical processes Stage 1 Data capture and sharing  Better clinical outcomes  Improved population health outcomes  Increased transparency and efficiency  Empowered individuals  More robust research data on health systems For more information on meaningful use of EHRs, visit: 9 http://www.cms.gov/EHRIncentivePrograms/35_Meaningful_Use.asp

2013 MU Stage 1 – Summary of Measures 1 CPOE for medications (entered into the electronic record) 30% 15 Core Measures (EPs must meet all) 2 Drug-drug and drug-allergy interaction checks ( enable only ) YES 3 Problem list of current & active diagnoses 80% 4 E-Prescribing (transmission to pharmacy) 40% 5 Active medication list 80% 6 Active medication allergy list 80% 7 Demographics recorded as structured data 50% 8 Record/chart changes in vitals (height, weight and blood pressure, etc.) 50% 9 Record smoking status as structured data, 13+ years old 50% 10 Clinical Quality Measures (CQM) YES 11 Implement (1) clinical decision support rule YES 12 Electronic copy of patient health information, upon request w/in 3 days 50% 13 Clinical Summaries, within 3 business days 50% 14 Electronic exchange of key clinical information among providers of care YES 15 Protect electronic health information (SRA) YES 10

2013 MU Stage 1 – Summary of Measures 10 Menu Measures (EPs must meet 5 of 10 ) 1 Drug Formulary Checks – implemented ( enable only ) YES 2 Clinical lab test results (as structured data) 40% 3 Patient lists (by specific condition) YES 4 Patient reminders (65+ years, and < 5 years) 20% 5 Patient electronic access (patient portal) 10% 6 Patient-specific education resources 10% 7 Medication reconciliation 50% 8 Transition of care summary 50% 9 Immunization registries data submission YES 10 Syndromic Surveillance data submission YES *Public health objective: At least one public health objective must be selected. 11

The Present Modified Stage 2 12

Medicare and Medicaid Programs; Electronic Health Record Incentive Program — Stage 3 and Modifications to Meaningful Use in 2015 Through 2017 Final Rule with Comment Period (aka Modified Stage 2 / Stage 3 Final Rule) ▲ Released: October 6, 2015 ▲ Published: October 16, 2015 ▲ Effective: December 15, 2015 13

Key changes in the Modified Stage 2 Rule ▲ Stage 1 and Stage 2 objectives and measures restructured to align with Stage 3 ▲ Streamlined the program by removing redundant, duplicative, and topped out (RDT) measures ▲ One set of objectives and measures for all participants ▲ Patient engagement objectives that require “patient action” were modified ▲ Limited accommodations for “Scheduled” Stage 1 EPs in 2016 (CPOE) ▲ Significant changes to the Public Health objective ▲ Optional “Alternate Exclusions” added to Public Health (2015 -2016) – No proof of intent/documentation required to claim Alt Exclusions 14

Meaningful Use Reporting Periods ▲ 2016 – New Participants: Any continuous 90 days within the Calendar Year (CY) – Returning Participants: Full Calendar Year (366 days)  NPRM (notice of proposed rule making) will likely reduce this to 90 days. Final Rule due by Nov 1 ▲ 2017 – New Participants: Any continuous 90 days within the CY – Providers electing Stage 3: Any continuous 90 days within the CY (requires 2015 CEHRT) – Returning Participants: Full Calendar Year (365 days) 15

Measures removed under Modified Stage 2 (…but “Still Meaningful”) 16

“Modified Stage 2” Meaningful Use Objectives: 1 . Protect Patient Health Information (SRA)  Not Episodic, should cover entire program year  Conduct within same CY as reporting period, acceptable to be conducted outside of reporting period if reporting period is < CY but must be conducted prior to attestation 2. Clinical Decision Support (CDS) (2 measures)  Implement CDS Interventions  Implement Interaction Checks 3. Computerized Provider Order Entry (CPOE) (3 measures)  Medication Orders  Laboratory Orders **  Radiology Orders ** ** EPs scheduled to be in Stage 1 in 2016 are not required to report on Lab and Radiology orders, only Medication orders 17

“Modified Stage 2” MU Objectives (cont’d): 4. Electronic Prescribing (eRx) 5. Health Information Exchange (formerly Summary of Care) 6. Patient Specific Education 7. Medication Reconciliation 8. Patient Electronic Access (VDT/Pt Portal) (2 measures)  Timely Access  Usage 9. Secure Electronic Messaging 10. Public Health Reporting (3 measures)  Immunization Registry  Syndromic Surveillance Registry  Specialized Registry 18

Meaningful Use Progression for EPs 2011 - 2015 - 2014 2018 2013 2017 Stage 1 Stage 1 Modified Stage 2 Stage 3 15 Core 13 Core 10 Objectives 8 Objectives 5 Menu 5 Menu 9 CQMs CQM reporting 6 CQMs 9 CQMs is required by Stage 3 regulations; Stage 2 Optional: 2017 Medicare 17 Core 8 Objectives, rulemaking to 3 Menu some with address 9 CQMs lowered reporting thresholds requirements 19

The Future STAGE 3 or MACRA/MIPS/APM …or both! 20