Proposed Changes to Meaningful Use 1 and 2 Paul Kleeberg, MD, - - PowerPoint PPT Presentation
Proposed Changes to Meaningful Use 1 and 2 Paul Kleeberg, MD, FAAFP, FHIMSS Burning Issues Webinar June 1, 2015 Objectives Provide an overview of the proposed changes to stages 1 and 2 of the Meaningful Use program starting this year
Paul Kleeberg, MD, FAAFP, FHIMSS Burning Issues Webinar June 1, 2015
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Data capture and sharing Advanced clinical processes Improved
Stage 1 Stage 2 Stage 3 “Phased-in series of improved clinical data capture supporting more rigorous and robust quality measurement and improvement.”
Source: Connecting for Health, Markle Foundation “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009
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Adapted from: Brian Wagner, Senior Director of Policy and Public Affairs, eHealth Initiative (eHI) presentation to the MN Exchange and Meaningful Use Workgroup January 15, 2010
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X 2 X X X
90 days 90 days * Still considered doing stage 2 even if they did stage 1
X 2
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– Last incentive year is 2015 for CAHs and 2016 for EPs and PPS hospitals.
– If just starting:
– EPs:
– Hospitals:
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security risk analysis, implement security updates as necessary and correct identified security deficiencies
security risk analysis, including the encryption/security
CEHRT, implement security updates as necessary and correct identified security deficiencies
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formulary checks with at least one internal
medication orders during the EHR reporting period
into the eRx core item
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Measure
scripts are generated and transmitted electronically
Denominator
(non-controlled substance) scripts written by the EP
Exclusion
prescriptions during the EHR reporting period.
accept e-prescriptions within 10 miles
Measure
are queried for a drug formulary and transmitted electronically
Denominator
all scripts written by the EP
Exclusion
permissible prescriptions during the EHR reporting period.
accept e-prescriptions within 10 miles
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in 2016 & 2017
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Measure
discharge medication
prescriptions are queried for a drug formulary and transmitted electronically.
Denominator
and refilled prescriptions
Exclusion
can accept electronic prescriptions
miles of any pharmacy that accepts electronic prescriptions
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in 2016 & 2017
unchanged
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to the specialty specific quality metric or high priority condition with the ability to track compliance
interventions relevant to 4 quality metrics or high priority condition
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in 2016 & 2017
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enabled for the entire EHR reporting period
enabled for the entire EHR reporting period
medication orders
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any meds with ≥ one CPOE med order or may use >30% all
unique orders)
<100 medication
EHR reporting period.
Measures
laboratory and >30% radiology orders must be entered using CPOE
Denominators:
Exclusions:
medication, <100 radiology, or <100 laboratory orders during the EHR reporting period.
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in 2016 & 2017
Any licensed healthcare professionals and credentialed medical assistants, can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local and professional guidelines.
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patients are provided patient- specific education resources identified by Certified EHR Technology.
patients are provided patient- specific education resources identified by Certified EHR Technology.
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timely online access to their health information within 4 business days of it being available
information, except for “Patient name” and “Provider's name” and office contact information.
timely online access to their health information within 4 business days of it being available
information, except for “Patient name” and “Provider's name” and office contact information.
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Required elements
history.
BMI, growth charts).
language, sex, race, ethnicity, date of birth).
instructions.
the primary care provider (PCP) of record.
Required elements
and other providers of care.
discharge).
care or referrals to another provider.
instructions.
race, ethnicity, date of birth, preferred language).
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Measure
transmit (VDT) their health information
Denominator
Exclusions
information, except for “Patient name”, “Provider's name” and
a county with <50% of its housing units have 3 Mbps broadband
– http://www.broadbandmap. gov/ 23
in 2016 & 2017
that one patient has done it
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Measure
(or their representatives) seen by the EP during the reporting period send the EP a secure message.
Denominator
Exclusion
county with <50% percent of its housing units have 3 Mbps broadband
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2017
that capability is fully enabled
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and transitions of care
Measure
transitions of care
electronically to:
– A different provider with a different EMR – The CMS designated test EHR
Denominator
Exclusion
transfers/referrals during the EHR reporting period
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in 2015 only
in 2016 & 2017
CEHRT and >10% eExchanged
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pressure, BMI).
(preferred language, sex, race, ethnicity, date of birth).
care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider.
instructions
include historical problems).
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care or a relevant encounter
care (and relevant encounters if there is a policy)
care or referrals received
care or a relevant encounter
care (and relevant encounters if there is a policy)
care or referrals received
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in 2016 & 2017
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Measure EP: Maximum Times Measure Can Count
2016 on: Choose 2
EH: Maximum Times Measure Can Count
2016 on: Choose 3
Immunization Registry Reporting 1 1 Syndromic Surveillance Reporting 1 1 Case Reporting 1 1 Public Health Registry Reporting 3 4 Clinical Data Registry Reporting 3 4 Electronic Reportable Laboratory Results N/A 1
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to state immunization registry except where prohibited with continued submission if successful
immunizations
capacity to receive
submission of electronic immunization data to an immunization registry or information system for the entire EHR reporting period
immunizations
capacity to receive
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to a public health agency except where prohibited with continued submission if successful
providers who collect this data
capacity to receive
Measure
submission to a public health agency for the entire EHR reporting period
Denominator
Exclusion
providers who collect this data
Emergency/Urgent Care
capacity to receive
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health agency to submit case reporting of reportable conditions as defined by the state, territorial, and local PHAs to monitor disease trends and support management of outbreaks.
reportable diseases for which data is collected
receive
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Measure
submission of cancer case information to a public health central cancer registry for the entire EHR reporting period.
Denominator
Exclusion:
directly treat cancer;
capacity to receive electronic cancer case information
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Measure
submission of specific case information to a specialized registry for the entire EHR reporting period.
Denominator
Exclusion:
treat relevant diseases;
jurisdiction for which no public health agency is capable
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with a public health agency to submit relevant data to public health registries
treat relevant diseases;
capacity to receive
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submission of specific case information to a specialized registry for the entire EHR reporting period.
treat relevant diseases;
capacity to receive
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Measure:
submit relevant data to a clinical data registry
health status of patients with relevant diseases & the care they receive
Denominator
Exclusion:
treat relevant diseases;
capacity to receive
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to a public health agency except where prohibited with continued submission if successful
reportable labs;
capacity to receive
submission to a public health agency for the entire EHR reporting period
reportable labs;
capacity to receive
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seen: preferred language, gender, race, ethnicity, and
and preliminary cause of death
seen: preferred language, sex, race, ethnicity, DOB. For EHs: date and preliminary cause of death
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2yo seen: height, weight, BP, BMI, & for age 2-20: growth charts w/BMI. May split BP and height- weight, also may use
all ages for H/W/BMI)
height/length, weight, BMI; ≥ 3yo: BP; age 0-20: growth charts w/BMI. May split BP and height/length- weight
practice
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seen at least one or “none” as structured data
mandatory element in the transfer of care document
transfers of care
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seen at least one or “none” as structured data
mandatory element in the transfer of care document
transfers of care
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seen at least one or “none” as structured data
mandatory element in the transfer of care document
transfers of care
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13yo seen, record status as structured data
13yo seen, record status as structured data
years old or older.
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structured data entry for one or more first-degree relatives
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SoC or eAccess
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admitted indicate advanced directive recorded
admissions
admitted
admitted indicate advanced directive recorded
admissions
admitted
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SoC or eAccess
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medication orders (includes all doses) are tracked from
average daily census <10 patients
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SoC or eAccess
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patients have at least
progress note created, edited and signed by an authorized provider. The text must be text searchable and may contain drawings and
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Instructions (EH)
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Measure
whose result is one or more images are accessible through Certified EHR Technology
Denominator
Exclusion
imaging studies during the EHR reporting period or without access to electronic imaging results at the start of the EHR reporting period.
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SoC or eAccess
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numeric or +/- result in chart as structured data
numeric lab results
this type ordered
numeric or +/- result in chart as structured data
numeric lab results
this type ordered
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a specific condition
a specific condition
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considered an element of quality measurement
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electronic lab orders received, Hospital labs send structured electronic clinical lab results to the
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a patient gets a visit summary within 3 business days
during the EHR reporting period
a patient or their representative gets a visit summary within 1 business day
during the EHR reporting period
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≤ 5yo sent reminders for follow up care
≤ 5yo
years receive reminders for follow- up care sent per patient preference.
with 2 or more visits in past 24 months
months before the measurement period
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– Record Demographics – Record Vital Signs – Record Smoking Status – Clinical Summaries – Structured Lab Results – Patient List – Patient Reminders – Summary of Care Measure
– Electronic Notes – Imaging Results – Family Health History
– Record Demographics – Record Vital Signs – Record Smoking Status – Structured Lab Results – Patient List – Summary of Care Measure
– eMAR – Advanced Directives – Electronic Notes – Imaging Results – Family Health History – Structure Labs to Ambulatory Providers
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Measure Stage 1 2014 Stage 1 2015 Stage 1 2016-17 Security Risk Analysis C Y/N C Y/N C Y/N eRx (EP) C 40% C 40% C 50% Drug Formulary (EP) M Y/N Exclusion Exclusion C Y/N eRx with Formulary (EH) C 10% CDS C 1 C 1 C 5 Drug Interactions C Y/N C Y/N C Y/N Medications C 30% C 30% C 60% labs C 30% Radiology C 30% Patient Ed M 10% C 10% C 10% Have access to VDT C 50% C 50% C 50% Actually VDT C Y/N Secure messages C Y/N eSummary of Care C 10% Med Rec M 50% C 50% C 50% Immunization Registry M Y/N EP: 1 of 5 EH: 2 of 6 Y/N EP: 2 of 5 EH: 3 of 6 Y/N Syndromic Surveillance M Y/N Y/N Y/N Case Reporting Y/N Y/N Public Health Registry Y/N Y/N Clinical Data Registry Y/N Y/N Reportable Labs (EH) M Y/N Y/N Y/N
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Measure Stage 1 2014 Stage 1 2015 - 17 Summary of Care Any Method M 50% Exclusion 2015. eSoC after Demographics C 50% (eAccess & eSoC) Vital Signs C 50% (eAccess & eSoC) Problem List C 80% (eAccess & eSoC) Medication List C 80% (eAccess & eSoC) Allergies C 80% (eAccess & eSoC) Smoking C 50% (eAccess & eSoC) Advanced Directives (EH) M 50% Not Measured Incorporate Labs M 40% (eAccess & eSoC) Clinical Summaries (EP) C 50% (eAccess) Patient Lists M Y/N Not Measured Patient Reminders (EP) M 20% Not Measured
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Measure Stage 2 2014 Stage 2 2015 Stage 2 2016-17 Security Risk Analysis C Y/N C Y/N C Y/N ePrescribing (EP) C 50% C 50% C 50% Drug Formulary (EP) C Y/N C Y/N C Y/N eRx with Formulary (EH) M 10% C 10% C 10% CDS C 5 Rules C 5 Rules C 5 Rules Drug Interactions C Y/N C Y/N C Y/N Medications C 60% C 60% C 60% Labs C 30% C 30% C 30% Radiology C 30% C 30% C 30% Patient Ed C 10% C 10% C 10% Have access to VDT C 50% C 50% C 50% Patients Use VDT C 5% C 1 patient C 1 patient Secure messages C 5% C Enabled C Enabled eSummary of Care C 10% C 10% C 10% Med Rec C 50% C 50% C 50% Immunization Registry C Y/N EP: 2 of 5 EH: 3 of 6 Y/N EP: 3 of 5 EH: 4 of 6 Y/N Syndromic Surveillance EP: M EH: C Y/N Y/N Y/N Case Reporting Y/N Y/N Public Health Registry Y/N Y/N Clinical Data Registry Y/N Y/N Reportable Labs (EH) C Y/N Y/N Y/N
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Measure Stage 2 2014 Stage 2 2015-17 Summary of Care Any Method C 50% (eSoC) eSoC Diff EHR & system C Y/N (eSoC) Cancer Registry (EP) M Y/N (Clin Reg) Specialized Registries (EP) M Y/N (Clin Reg) Demographics C 80% (eAccess & eSoC) Vital Signs C 80% (eAccess & eSoC) Smoking C 80% (eAccess & eSoC) Family History M 20 Not Measured Advanced Directives (EH) M 50% Not Measured eMAR (EH) C 10% Not Measured Provider Notes M 30% (eAccess & eSoC) Imaging Results M 10% Not Measured Incorporate Labs C 55% (eAccess & eSoC) Clinical Summaries (EP) C 50 (eAccess) Patient Lists C Y/N Not Measured Patient Reminders (EP) C 10% Not Measured Provide eLab Results (EH) M 20% Not Measured
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This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MN-B4-15-05 022315