Meaningful Use ofHealth information ExchangeSavannah, GeorgiaApril 26, 2013
2IOM Quality Chasm Report• “If we want safer, higher‐quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes.”– IOM, Quality Chasm report, 2001
What is Meaningful Use? • Meaningful Use is using certified EHR technology to– Improve quality, safety, efficiency, and reduce health disparities – Engage patients and families in their health care – Improve care coordination – Improve population and public health – All the while maintaining privacy and security • Meaningful Use is required to receive incentives and avoid penalties
• 2014 Standards and Certification Criteria• Stage 2 Meaningful Use
Stage 2 MUACOs Stage 3 MUPCMHs3‐Part AimRegistries to manage patient populationsTeam based care, case managementEnhanced access and continuityPrivacy & security protectionsCare coordinationPrivacy & security protections Patient centered care coordinationImproved population healthRegistries for disease managementEvidenced based medicine Patient self managementPrivacy & security protectionsCare coordinationStructured data utilized Data utilized to improve delivery and outcomesData utilized to improve delivery and outcomesPatient informedPatient engaged, community resourcesStage 1 MUPrivacy & security protectionsBasic EHR functionality, structured dataImprove access to informationUse information to transformMeaningful Use as a Building BlockUtilize technology to gather information
CEHRT & MU RelationshipMeaningful Use Stage 2 (MU2)CMS: Medicare and Medicaid EHR Incentive Programs Stage 2• outlines incentive payments (+$$$) for early adoption• outlines payment adjustments(‐$$$) for late adoption/non‐complianceReference: CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2 Final Rule 495.6ONC: Standards, Implementation Specifications & Certification Criteria (SI&CC) 2014 Edition• Specifies the data and standards requirements for certified electronic health record (EHR) technology (CEHRT) needed to achieve “meaningful use”Reference: ONC Health Information Technology : Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology 170.314(b)(1)&(2)
CEHRT & MU RelationshipCare Coordination / TransitionsMeaningful Use Stage 2 (MU2) – Care CoordinationCMS: Medicare and Medicaid EHR Incentive Programs Stage 2• Measure #2 : Provide an electronic ‘‘summary of care record for more than 10 percent of such transitions and referrals” using one of the accepted transport mechanisms specified in the rule.Reference: CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2 Final Rule 495.6ONC: Standards, Implementation Specifications & Certification Criteria (SI&CC) 2014 Edition• Electronically receive and incorporate a transition of care/referral summary Electronically create and transmit a transition of care/referral summaryReference: ONC Health Information Technology : Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology 170.314(b)(1)&(2)
Meaningful Use HIE RequirementsMU Stage 2 Transitions of CareCore ObjectiveMU Stage 2 Medication ReconciliationCore ObjectiveThe EP/EH/CAH that transitions a patient to another care setting or care provider or refers a patient to another care provider provides a summary care record for each transition of care or referral.The EP/EH/CAH that receives a patient from another care setting or care provider or believes an encounter is relevant should perform medication reconciliation.
Transitions of Care Measure 1Transitions of Care Measure 2Transitions of Care Measure 3Meaningful Use HIE Requirements
Transitions of Care Measure 1Measure 1The EP, EH, or CAH that transitions orrefers their patient to another setting ofcare or provider of care provides asummary of care record for morethan 50 percent of transitions of careand referrals.
Transitions of Care Measure 1Transitions of Care Measure 2Measure 2The EP, EH, or CAH that transitions orrefers their patient to another setting ofcare or provider of care provides asummary of care record for more than 10percent of such transitions and referralseither:• Electronically transmitted usingCEHRT to a recipient OR• Where the recipient receives thesummary of care record via exchangefacilitated by an organization that is aNationwide Health InformationNetwork (NwHIN) Exchangeparticipant or in a manner that isconsistent with the governancemechanism ONC establishes
Transitions of Care Measure 1Transitions of Care Measure 2Transitions of Care Measure 3Measure 3An EP, EH, or CAH must satisfy one ofthe following:• Conducts one or more successfulelectronic exchanges of a summary ofcare record meeting the measurespecified in Requirement 2 of thissection with a recipient usingtechnology to receive the summary ofcare record that was designed by adifferent EHR developer than thesenders CEHRT certified OR• Conducts one or more successfultests with the CMS designated testEHR during the EHR reporting period
Transitions of Care – EPs Transitions of Care – EH/CAHsPatient name Patient nameSex SexDate of birth Date of birthRace (OMB Race and Ethnicity) Race (OMB Race and Ethnicity)Ethnicity (OMB Race and Ethnicity) Ethnicity (OMB Race and Ethnicity)Preferred language Preferred languageSmoking status (SNOMED‐CT value set) Smoking status (SNOMED‐CT value set)Problems (SNOMED‐CT value set) Problems (SNOMED‐CT value set)Medications (RxNorm) Medications (RxNorm)Medication allergies (RxNorm) Medication allergies (RxNorm)Laboratory test(s) (LOINC) Laboratory test(s) (LOINC)Laboratory value(s)/result(s) Laboratory value(s)/result(s)Vital signs (height, weight, blood pressure, BMI) Vital signs (height, weight, blood pressure, BMI)Care plan field(s), including goals and instructions Care plan field(s), including goals and instructionsProcedures (SNOMED‐CT or HCPCS/CPT‐4), optional CDT, optional ICD‐10‐PCS Procedures (SNOMED‐CT or HCPCS/CPT‐4), optional CDT, optional ICD‐10‐PCSCare Team Member(s), including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving providerCare Team Member(s), including the primary care provider of record and any additional known care team members beyond the referring or transitioning provideand the receiving providerEncounter diagnosis (ICD‐10‐CM or SNOMED‐CT) Encounter diagnosis (ICD‐10‐CM or SNOMED‐CT)Immunizations (HL7 Standard Code Set CVX) Immunizations (HL7 Standard Code Set CVX)Functional status, including activities of daily living and cognitive and disability statusFunctional status, including activities of daily living and cognitive and disability statusThe following are Elements that are different between EP and EH/CAHReason for referralDischarge instructionsReferring or transitioning providers name and office contact informationCommon MU Data SetData Elements in Common Between EP and EH/CAH in Addition to Common MU Data SetElements that are different between EP and EH/CAHAll summary of care documentsmust include these data elements
MU Stage 2 Medication Reconciliation Core ObjectiveObjective:• The EP, EH, or CAH whoreceives a patient fromanother setting of care orprovider of care orbelieves an encounter isrelevant should performmedication reconciliation.Measures:• The EP who performsmedication reconciliation formore than 50 percent oftransitions of care in whichthe patient is transitionedinto the care of the EP.• The eligible hospital or CAHperforms medicationreconciliation for more than50 percent of transitions ofcare in which the patient istransitioned into the care ofthe EP or admitted to theeligible hospitals or CAHsinpatient or emergencydepartment.
15Why the attention on interoperability? • “Unless interoperability is achieved, physicians will still defer IT investments, potential clinical and economic benefits won’t be realized, and we will not move closer to badly needed healthcare reform in the US.” – Dr. David Brailer, HHS National HIT Coordinator, May 21, 2004
Federal Government InitiativesGraphic: The Value Proposition forExchange; Doug Fridsma, July 2011• Federal Advisory Committees (FACAs) – HIT Policy Committee, Standards• Nationwide Health Information Network (NwHIN)– Services, standards, policies, trust fabricThis image cannot currently be displayed.
Direct Project Facilitates Meaningful Use• Other Providers/Authorized Entities:– Clinical information – Labs – test results– Referrals – summary of care record• Patients:– Health information – Discharge instructions– Clinical Summaries– Reminders• Public Health:– Immunization registries– Syndromic firstname.lastname@example.org Direct Project facilitates the communication of many different kinds of content necessary to fulfill meaningful use requirements.Examples of Meaningful Use ContentExamples of Meaningful Use ContentD I R E C T
CCSNPC Technology Partner1993 1999 200620 Years 14 Years 7 Years• Standards‐based Solutions for Health Information Exchange• Commercial Software and Support• Open Architecture• User Extensible• Application and Data Integration ExpertsSoftware DevelopmentSoftware DevelopmentHealthcare FocusHealthcare FocusMirth Products
Mirth Product OverviewMirth ApplianceReady‐to‐Run Platformfor Mirth ApplicationsDirect Messaging, Secure Chat, and HPD+ Provider DirectoryHL7, DICOM, X12, CCD, C‐CDA, and EHR IntegrationMirthCareMirth MatchMirthMailMirth ConnectMirthResultsMirthAnalyticsMirthRuleseHealth and IHE ExchangeMirth ResultsCentral Data Repository & Provider PortalMirth MailSecure Direct Messaging, Chat, & Provider DirectoryMirth CareChronic Disease Management & Care CoordinationMirth MatchEMPI & Record Locator ServiceMirth ConnectData Integration EngineMirth AnalyticsBusiness Intelligence, Reporting, & AnalyticsMirth RulesRules Engine for Clinical Decision Support
Mirth at ChathamHealthLink• Healthcare Data Repository• Provider Portal• Available XDS.b Plugin• CCD and Consolidated CDA• Agents – Data Detectors and Subject Groups• Scheduled Reports• Central and Federated Deployment• Standards‐based Integration with NextGateMatchMetrix EMPI and GeorgiaDirect HISPMirth ApplianceReady‐to‐Run Platformfor Mirth ApplicationsHL7, DICOM, X12, CCD, C‐CDA, and EHR IntegrationMirth ConnectMirthResultseHealth and IHE Exchange
The Value of Mirth• Talks Documents, Stores Data• Standards‐based HIE and EHR Integration• Improve Physician Alignment and Patient Engagement• Enable ED/IP Notification and Summary of Care DeliveryCCDEDICDAHL7
Value Proposition for HIE• Provide better, safer and more efficient patient care • Distribute hospital information to doctors • Savings on uncompensated care related to unnecessary or avoidable services• Provides outreach to community partners• Helps maintain referral patterns • Improved care coordination• Aligns with shifting reimbursement models
Capacity Building Funding• $492,500.00 funding award• Opportunity to connect • Move beyond the pilot• Next Steps:– Strong policy development– Build sustainability model– Security assessment