Health Reform and Meaningful Use
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Health Reform and Meaningful Use

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Penalties are coming. Are you prepared? Widely recognized as one of healthcare's most knowledgeable speakers on healthcare policy, Brian Ahier will provide an in-depth look at current healthcare ...

Penalties are coming. Are you prepared? Widely recognized as one of healthcare's most knowledgeable speakers on healthcare policy, Brian Ahier will provide an in-depth look at current healthcare reform and more specifically the implications of the HITECH Act from 2009 as well as the Patient Protection and Affordable Care Act.

In this webinar, Brian covers: 1) The most important details defining the Affordable Care Act regulation, 2) Future implications of this body of reform legislation, 3) Paths healthcare executives can take to prepare,4) The importance of analytics to navigate healthcare reform, 5) The fundamental issues pertaining to Meaningful Use.

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    Health Reform and Meaningful Use Health Reform and Meaningful Use Presentation Transcript

    • Brian Ahier Health Data Management Webinar Ocotber 8, 2013
    • But we can figure this thing out!
    • Laws Affecting Quality Improvement As consensus was reached around the importance of impro ving quality, Congress passed several important laws to establish new quality progra ms: Medicare Prescript io n Drug, Improvement & Modernizatio n Act (MMA) 2002 2004 Tax Relief and Healt h Care Act (TRHCA) Medicare Improvements For Patients & Providers Act (MIPPA) 2005 Deficit Reduc t io n Act (ORA) Medicare, American Recovery & Reinvestment Act (ARRA) Medicaid , & SCHIP Extensio n Act (MMSEA) Mental Healt h Parity and Addic t io n Equality Act (MHPAEA) Affordabl e Care Act (ACA)
    • Selected Historical Landmarks in US Healthcare Quality • 1999: To Err Is Human published by IOM • 1999: National Quality Forum established • 2001: Crossing the Quality Chasm published by IOM • 2005: CMS Quality Roadmap established • 2005: Petiormance Measurement: Accelerating Improvement published by IOM • 2006: Medicare establishes Quality Improvement Organization Program • 2008: NQF establishes National Priorities Partnership
    • First IOM Comm ittee Report To Err is Human: Building a Safer Health System (1999) begins to define the US quality problem: • Medical errors harm 44,500 to 98,000 patients annually • Medical errors cost $17 B to $29 B annually (including the expense of additional care necessitated by the errors, lost income and household productivity, and disability) • Flawed systems, processes, and conditions lead people to make mistakes or fail to prevent them
    • Defining Quality The IOM definition of quality becomes the guide for all national quality efforts: "Quality care is defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." Institute of Medicine (2001)
    • “There is no problem America has that is so large we can not invent our way out of it.” ~Todd Park “You can always count on Americans to do the right thing - after they've tried everything else.” ~Winston Churchill
    •      In the U.S. we spend more per capita on healthcare than any other country in the world In spite of those expenditures, U.S. healthcare quality is often inferior to that of other nations and often doesn’t meet expected evidence-based guidelines There are significant variations in quality and costs across the nation with increasing evidence that there may even be an inverse relationship between the two Healthcare expenditures account for a larger section of the U.S. economy over the years and funding those expenditures is increasingly more difficult Cost effectiveness analytics is resisted as a tool
    •  Does your organization have a strategy for meeting the requirements of “Obamacare?”
    •  Affordable Care Act signed March 23, 2010  Major components of the law:  New consumer rights and protections;  Holding insurance companies accountable;  Increasing access to affordable care; and  Improving quality and lowering costs.  Most sections take effect between 2010 and 2015
    •      Title I: Quality, Affordable Health Care for all Americans Title II: Role of Public Programs Title III: Improving the Quality & Efficiency of Health Care Title IV: Prevention of Chronic Disease & Improving Public Health TitleV: Health CareWork Force
    •      TitleVI:Transparency and Public Reporting TitleVII: Improving Access to Innovative Medical Therapies TitleVIII: Community LivingAssistance Services & Support (CLASS) Act Title IX: Revenue Provisions Title X: Strengthening Quality, Affordable Health Care for All Americans (Amendments)
    •  Major,Ongoing Demonstration &TestingAuthority & Resources (CMMI)  AccountableCare Organizations  Value Based Purchasing Programs  Health Insurance Exchanges  Expanded Medicaid Programs  CareTransitions to Reduce Readmissions  ExpandedQuality Reporting Programs  Expanded Preventative Services  ….and much more
    • Quadrant 2 High impact priorities to monitor and maintain Quadrant 4 Tertiary priorities to minimize resources and conserve focus Quadrant 1 High impact, high complexity program areas to manage Quadrant 3 Secondary priorities to monitor and manage
    • Quadrant 2 Quadrant 4 1. 2. 3. 4. 5. 6. Value Based Purchasing Public and Quality Reporting Reduced Readmissions Hospital AcquiredConditions ACOs Center for Medicare and Medicaid Innovation Quadrant 3
    •        Increasing measurement of quality, efficiency & value Public reporting and sharing of data Reimbursement linked to quality improvement, efficient service delivery and cost reduction thru improvement Increasing integration of delivery systems and coordination of care across settings Greater role in addressing public health issues Greater use of health information technology Creation of a learning environment in healthcare
    •  Affordable Care Act ( 3011) required Secretary to:  Set priorities for improving American healthcare; and  Create a strategic plan for achieving them through HHS-specific: Plans;  Goals;  Benchmarks; and  Standardized quality metrics.  HHS developed drafts through public processes that included over 300 groups, organizations, and individuals. All major healthcare sectors represented.
    •  Culminated in the “National Strategy for Quality Improvement in Health Care” (March 2011).  Strategy has six overarching aims, goals and priorities: Making care safer; Ensuring person- and family-centered care; Promoting better care communication and coordination; Preventing and treating leading causes of death (including CVD); 5. Working in communities to promote healthy living; and 6. Making quality care more affordable. 1. 2. 3. 4.
    •  Affordable Care Act ( 3014) required Secretary to set up a “pre-rulemaking process” for selecting quality and efficiency measures by:  Posting a list of measures under consideration;  Giving stakeholders a chance to comment on this list;  Publishing HHS’ rationale for selecting any measures not endorsed by the National Quality Foundation (NQF); and  Assessing the impact of using NQF-endorsed measures every 3 years.
    • Quality Measures Life Cycle Congress IOM Professional Organizations • Is it important ? • Can it be measured? • Should it be measured? Measure Developers Joint Commission AMA DHHS CMS AHRQ Measure Development • What is the p o p u latio n ? • How should it be reported? AQA Pilot Sites • Can the data be collected? • Do th e results make sense? • Is informatio n useful? NQF • NQFendorsed? • Allianceapproved? Additional Requirements or Issues Identified PROV IDERS SUPPLIERS CO NSUMERS • Is it worki n g ? Evaluation
    •  366 unique new measures across 23 CMS programs.  Not all measures will be used right away.  Not all measures are mandatory (e.g., voluntary reporting programs).  Nearly all are supported by or were suggested by external groups.  Measures now with the NQF MeasureApplication Partnership (MAP) which:  Gathers a diverse public-private partnership;  Gives stakeholders a voice before CMS selects measures through the rulemaking process;  Uses the National Quality Strategy as a touchstone; and  Operates transparently through NQF’s website.
    • Value based purchasing 3001 - Hospital value-based purchasing  3006 -Value-based purchasing for SNF   3014 - Quality and efficiency measurement  10301 - Develop a plan to implementVBP for ambulatory surgical centers 10326 - Pilot testing for pay-for-performance  Hospital readmissions  3025 - Hospital readmissions reduction program  3026 - Community-based care transitions program Healthcare acquired conditions  2702 - Payment adjustment for health care-acquired conditions  3008 - Payment adjustment for conditions acquired in hospitals Accountable care organizations  2706 - Pediatric accountable care organization demonstration project  3022 - Medicare Shared Savings Program Dual eligibles  2602 - Providing federal coverage and payment coordination for dual eligible beneficiaries Preventative services  4103 - Annual wellness visit providing a personalized plan  4104 - Removing barriers to preventive services  4105 - Evidence-based coverage of preventive services Coordination of care 2703 - State option to provide health homes for enrollees  with chronic conditions 2704 - Demonstration project to evaluate integrated care  around a hospitalization Long term care 2401 - Community first choice option  2402 - Removal of barriers to providing home and  community based services 2403 - Money follows the person rebalancing demo  2404 - Protection for recipients of home and community based services against spousal impoverishment 10202 - Incentives for states to offer home community based  serviced Public reporting 10303 - Development of outcome measures  10327 - Improvements to the physician quality reporting  system -- also see Provision 3002 10331 - Public reporting of performance information  Quality reporting initiative 2701 - Adult health quality measures  3002 - Improvements to the physician quality reporting  system. 3004 - Quality Reporting for LongTerm Care Hospitals  (L TCH), inpatient rehabilitation hospitals, and hospice programs 3005 - Quality reporting for PPS-exempt cancer hospitals  10322 - Quality reporting for psychiatric hospitals 
    •  Is your organization participating in:  PQRS  PCMH  ACO  Value Based Purchasing  None of the above
    • Although recently enacted into law under the ACA, VBP has been in development for years  Medicare ModernizationAct (MMA) of 2003:  Congress commissioned the Institute of Medicine (IOM) to “identify and prioritize options to align performance to payment in Medicare.”The IOM reports provided the rationale to reconfigure the U.S. health care payment system, supporting a “pay for performance” (P4P) approach.  Deficit ReductionAct (DRA) of 2005 Section 5001(b):  This act required HHS to develop a plan to implement aVBP program for Medicare payment for subsection (d) hospitals, beginning with FY 2009.The Medicare HospitalVBP program would be built on the current Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) Program and be budgetneutral.  Medicare Improvements for Patients and ProvidersAct (MIPPA) of 2008 Section 131(d):  This act required HHS to develop aVBP transition plan for providers receiving Medicare payments. HHS submitted this report to Congress in December 2008 detailing a draft transition plan to a MedicareVBP program for physicians and other professional services, as well as the design issues under consideration.
    • “A major, overarching theme in the Affordable Care Act is one of measurement, transparency, and altering payment to reinforce, not simply volume of services, but the quality of the effects of those services. Instead of payment that asks, “How much did you do,” the Affordable Care Act clearly moves us toward payment that asks, “How well did you do?” and, more important, “How well did the patient do?” That idea is at the heart ofValue-Based Purchasing. It is not just a CMS idea; it is one increasingly pervading the agenda of all payers.” Don Berwick, CMS Administrator, April 4, 2011
    •  AffordableCareAct set up value-based purchasing (VBP) for:  Hospitals ( 3001);      Skilled Nursing Facilities ( 3006); Home Health Agencies ( 3006); Ambulatory SurgeryCenters ( 3006); and Physicians, through a “value modifier” ( 3007). AffordableCareAct also tied portions of DRG payments to: –Readmission rates ( 3025); and  Hospital-acquired conditions ( 3008).
    • What does it all mean? Doing the right things for patients will become easier and doing the wrong things will become more difficult – and expensive!
    •  CMMI establishment mandated (Section 3021)  Consultation & input from broad healthcare sector in implementation     Develop patient-centered payment models Rapid piloting/testing of new payment programs Encourage evidence-based, coordinated care for Medicare, Medicaid, CHIP Focuses on populations “for which there are deficits in care leading to poor clinical outcomes or potentially avoidable expenditures”
    •     “Risk-based comprehensive payment or salary-based payment” models “Geriatric assessments and comprehensive care plans…interdisciplinary care teams…multiple chronic conditions…” “transition health care providers away from fee-forservice-based reimbursement and towards salarybased” “health information technology-enabled provider network that includes care coordinators, chronic disease registry, home telehealth technology”
    •  Other key characteristics in the statute for payment models  Varying payment for advanced diagnostic imaging services  Medication therapy management services  Community-based health teams to assist in care management  Patient decision-support tools  State flexibility for dual-eligibles and all-payer payment reform demonstrations  Collaboratives of high-quality, low-cost institutions  $10 billion over 10 years funding for innovation
    • 2 To 3 years Design to Program Translation Cycle Time • TrendAnalysis • Prototype Design and Modeling • Collaborative Design Lab • Best PracticeAnalysis • Publication and Collaborative Learning Collaborative Innovation Laboratory Stage Demonstration and ProgramTrial Stage •Program trials and Demo development •Technology beta testing •Results evaluation •Findings and Recommendations •Publications • Program Policy Translation Analysis and Evaluation • Legislation/policy development • Regulation and Rule Development • Policy Execution and Implementation • Re Evaluation/ Publication Program Policy Translation Evaluation and Diffusion Stage
    •         ACO Programs Bundled Payment Comprehensive Primary Care Initiative Financial Alignment Initiative FQHCAdvanced Primary Practice Demonstration Graduate Nurse Education Demonstration Health Care Innovation Awards Independence at Home Demonstration         Initiative to Reduce Avoidable Hospitalizations Among Nursing Home Residents Innovations Advisors Program Medicaid Emergency Psychiatric Demonstration Medicaid Incentives for the Prevention of Chronic Diseases Million Hearts Partnership for Patients: Care Transitions: Community-based State Innovations Models Strong Start for Mothers & Newborns
    • Healthcare Delivery System Reform and Transformation Program and Policy Redesign Successful Payment and Service Model Innovation 2014-2019 2012-2019 2011-2019
    •  Medicare Shared Savings Program (Section 3022)  Encourages multiple providers of services and supplies to: ▪ Join together and create ACOs ▪ Be jointly accountable for health & experience of care for individuals over a period of time ▪ Improve population health, overlap with community ▪ Reduce rate of healthcare spending, improve quality
    • What is an ACO? SU A ST INABlll
    •      The number and types of ACOs are expanding Growth is centered in larger population centers Hospital systems appear to be the primary backers of ACOs, but physician groups are playing an increasingly larger role Non-Medicare ACOs are experimenting with more diverse models than Medicare-backed ACOs The success of any particularACO model is still undetermined Source: Leavitt Partners report “Growth and Dispersion of Accountable Care Organizations, August 2013
    • Source: Leavitt Partners report “Growth and Dispersion of Accountable Care Organizations, August 2013
    • Source: Leavitt Partners report “Growth and Dispersion of Accountable Care Organizations, May 2012
    • Source: Leavitt Partners report “Growth and Dispersion of Accountable Care Organizations, August 2013
    • CMS has many different types of quality incentive programs, several of which directly affect healthcare providers and organizations:  Pay for reporting programs:  PQRS  Children's Health Insurance Program Reauthorization Act Quality Reporting  Medicaid Adult Quality Reporting  eRx Incentive Program  Payment adjustments in effect currently
    •  Medicare and Medicaid EHR Incentive Program  Almost $20 Billion in payments already  Payment adjustments begin in 2015   Medicare Shared Savings Program (ACOs) Value-Based Purchasing Pay-for-Performance Programs:  Physician Feedback/Value-Based Modifier Program ▪ Medicare fee-for-service payment modifier starting in 2015 on voluntary basis, phased in to include ALL providers by 2017 (measurement year starts in 2013) ▪ Participating providers will receive annual feedback on their cost and quality scores  Hospital Value Base Purchasing  End-Stage Renal Disease Quality Incentive Program
    •  Is your organization participating in the “meaningful use” EHR incentive program?
    • • • In 2004 President Bush announced the critical need for the U.S. to begin assessing the need for electronic health records in all areas of the healthcare industry. On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) of 2009. This statute includes the Health Information T echnology for Economic and Clinical Health (HITECH) Act.
    • • • Section 3001of the HITECH Act established the Office of the NationalCoordinator for Health InformationTechnology (ONC) within the U.S. Department of Health and Human Services (HHS). The ONC is at the forefront of the government’s health information technology efforts, and is a resource to the entire health system to support the adoption of health information technology.
    • Two CMS EHR Financial Incentive Programs were established under the HITECH Act:  Medicare- administered by CMS  Medicaid – joint administration by CMS and state  Both programs are voluntary however eligible providers must choose which program they will participate in and penalties begin in 2015 for Medicare  Both programs require use of certified EHR technology  Medicare program requires demonstration of meaningful use during first year of participation  Medicaid provides for payment of financial incentives to EPs who meet patient volume requirements and adopt/implement/upgrade during their first year of participation
    •  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 mandated in law to receive incentives
    • Use information to transform Improved population health Improve access to information Enhanced access and continuity Data utilized to improve delivery and outcomes Data utilized to improve delivery and outcomes Patient self management Patient engaged, community resources Care coordination Care coordination Patient centered care coordination Patient informed Evidenced based medicine Team based care, case management Basic EHR functionality, stru ctured data Structured data utilized Registries for disease management Registries to manage patient populations Privacy & security protections Privacy & security protections Privacy & security protections Privacy & security protections Stage 1 MU Stage 2 MU PCMHs 3-Part Aim Utilize technology to gather information ACOs Stage 3 MU
    •  Standards and Certification Criteria  Stage 2 Meaningful Use
    • Certified EHR Technology HereHetrhe fwhat i…looks like today… ’s e’s uture t
    • 2014 Edition CEHRT Base EHR
    • Base EHR Certification Criteria Required to Satisfy the Definition of a Base EHR Base EHR Capabilities Includes patient demographic and clinical health information, such as medical history and problem lists Capacity to provide clinical decision support Capacity to support physician order entry Capacity to capture and query information relevant to health care quality Capacity to exchange electronic health information with, and integrate such information from other sources Capacity to protect the confidentiality, integrity, and availability of health information stored and exchanged Certification Criteria Demographics 170.314(a)(3) Vital Signs 170.314(a)(4) Problem List 170.314(a)(5) Medication List 170.314(a)(6) Medication Allergy List 170.314(a)(7) Drug-Drug and Drug-Allergy Interaction Checks 170.314(a)(2) Clinical Decision Support 170.314(a)(8) Computerized Provider Order Entry 170.314(a)(1) Clinical Quality Measures 170.314(c)(1) and (2) Transitions of Care 170.314(b)(1) and (2) View, Download, and Transmit to 3rd Party Privacy and Security 170.314(e)(1) 170.314(d)(1)-(8)
    • 2014 Edition CEHRT Base EHR EP/EH/CAH would only need to have EHR technology with capabilities certified for the MU menu set objectives & measures for the stage of MU they seek to achieve. EP/EH/CAH would need to have EHR technology with capabilities certified for the MU core set objectives & measures for the stage of MU they seek to achieve unless the EP/EH/CAH can meet an exclusion. EP/EH/CAH must have EHR technology with capabilities certified to meet the definition of Base EHR.
    • 2014 Certification Criteria associated with a Base EHR: 2014 Certification Criteria associated with MU Menu Stage 2: • • • • • Imaging (170.314(a)(12)) Transmission to cancer registries (170.314(f)(8)) Cancer case information (170.314(f)(7)) Public health surveillance (170.314(f)(3)) Transmission to public health agencies (170.314(f)(4)) • Family health history (170.314(a)(13)) • Demographics (170.314(a)(3)) • Vital signs, BMI, & growth charts (170.314(a)(4)) • Problem list (170.314(a)(5)) • Medication list (170.314(a)(6)) • Medication allergy list (170.314(a)(7)) • Drug-drug, drug-allergy interaction checks (170.314(a)(2)) MU Menu MU Core Base EHR 2014 Certification Criteria associated with MU Core Stage 2: • Smoking status (170.314(a)(11)) • eRx (170.314(b)(3)) • Drug formulary checks (170.314(a)(10)) • Patient lists (170.314(a)(14)) • Patient reminders (170.314(a)(15)) • Patient-specific education resources (170.314(a)(16)) • Clinical information reconciliation (170.314(b)(4)) • Clinical summaries (170.314(e)(2)) • Secure messaging (170.314(e)(3)) • Incorporate lab test and results/values (170.314(b)(5)) • Immunization information (170.314(f)(1)) • Transmission to immunization registries (170.314(f)(2)) 1 2 3 • CPOE (170.314(a)(1)) • Clinical decision support (170.314(a)(8)) • Clinical quality measures (170.314(c)(1)-(2)) • Transition of Care – incorporate summary care record (170.314(b)(1)) • Transition of Care – create and transmit summary care record (170.314(b)(2)) • View, download, and transmit to 3rd Party (170.314(e)(1)) • Privacy and Security CC: o o • • • • Automated numerator recording (170.314(g)(1)) Automated measure calculation (170.314(g)(2)) Non-%-based measure use report (170.314(g)(3)) Safety -enhanced design (170.314(g)(4)) o o o o o o o Authentication, Access Control, & Authorization (170.314(d)(1)) Auditable events & tamper resistance (170.314(d)(2)) Audit report(s) (170.314(d)(3)) Amendments ( 70.314(d)(4)) Automatic log-off ( 170.314(d)(5)) Emergency access (170.314(d)(6)) Encryption of data at rest (170.314(d)(7)) Integrity (170.314(d)(8)) Accounting of disclosures (optional) (170.314(d)(9))
    • 14 core objectives 16 core objectives 5 of 10 menu objectives 19 total objectives 2 of 4 menu objectives 18 total objectives
    • 1) 2) 3) 4) 5) 6) Use CPOE for more than 60%of medication, laboratory and radiology orders Record demographics for more than 80% Record vital signs for more than 80% Record smoking status for more than 80% Implement 5 clinical decision support interventions + drug/drug and drug/allergy Incorporate lab results for more than 40%
    • Generate patient list by specific condition More than 10% of medication orders are tracked using EMAR 9) Provide online access to health information for more than 50% with more than 5% actually accessing 10) Use EHR to identify and provide education resources more than 10% 11) Medication reconciliation at more than 50% of transitions of care 7) 8)
    • 12) 13) 14) 15) 16) Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically Successful ongoing transmission of immunization data Successful ongoing submission of reportable laboratory results Successful ongoing submission of electronic syndromic surveillance data Conduct or review security analysis and incorporate in risk management process
    • Record indication of advanced directive for more than 50% 2) Incorporate more than 40% of imaging results 3) Record family health history for more than 20% 4) E-Rx for more than 10% of discharge prescriptions 1)
    • What a summary of care must include:  Patient name.  Procedures.  Relevant past diagnoses.  Laboratory test results.  Vital signs (height, weight, blood pressure, BMI, growth charts).  Smoking status.  Demographic information (preferred language, gender, race, ethnicity, date of birth).  Care plan field, including goals and instructions, and  Any additional known care team members beyond the referring or transitioning provider and the receiving provider.  Discharge instructions
    • AND:  An up-to-date problem list of current and active diagnoses  An active medication list  An active medication allergy list TheTransitions ofCare objective combines elements of previous Stage 1 objectives that are no longer being measured individually:  Maintain an up-to-date problem list  Maintain an active medication list  Maintain an active medication allergy list If there are no problems, meds, or med allergies = Indication in record
    • Common MU Data Set Data Elements in Common Between EP and EH/CAH in Addition to Common MU Data Set Elementsthat are different between EP and EH/CAH Transitions of Care – EPs Transitions of Care – EH/CAHs Patient name Patient name Sex Sex Date of birth Date of birth Race (OMB Race and Ethnicity) Race (OMB Race and Ethnicity) Ethnicity (OMB Race and Ethnicity) Ethnicity (OMB Race and Ethnicity) Preferred language Preferred language Smoking 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 instructions Procedures (SNOMED-CT or HCPCS/CPT-4), optional CDT, optional ICD-10-PCS Procedures (SNOMED-CT or HCPCS/CPT-4), optional CDT, optional ICD-10-PCS Care Team Member(s), including the primary care provider of record and any additional Care Team Member(s), including the primary care provider of record and any additiona known care team members beyond the referring or transitioning provider and the known care team members beyond the referring or transitioning provider and the receiving provider receiving provider Encounter 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 status Functional status,including activities of daily living and cognitive and disability status The following are Elements that are different between EP and EH/CAH Reason for referral Discharge instructions Referring or transitioning provider's name and office contact information
    • 15 core objectives 5 of 10 menu objectives 20 total objectives 17 core objectives 3 of 5 menu objectives 20 total objectives
    • 1) 2) 3) 4) 5) 6) 7) Use CPOE for more than 60% of medication, laboratory and radiology orders E-Rx for more than 65% Record demographics for more than 80% Record vital signs for more than 80% Record smoking status for more than 80% Implement 5 clinical decision support interventions + drug/drug and drug/allergy Incorporate lab results for more than 55%
    • Generate patient list by specific condition 9) Use EHR to identify and provide more than 10% with reminders for preventive/follow-up 10) Provide online access to health information for more than 50% with more than 5% actually accessing 11) Provide office visit summaries in 24 hours 12) Use EHR to identify and provide education resources more than 10% 8)
    • More than 10% of patients send secure messages to their EP 14) Medication reconciliation at more than 50% of transitions of care 15) Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically 16) Successful ongoing transmission of immunization data 17) Conduct or review security analysis and incorporate in risk management process 13)
    • 1) 2) 3) 4) 5) More than 40% of imaging results are accessible through Certified EHRTechnology Record family health history for more than 20% Successful ongoing transmission of syndromic surveillance data Successful ongoing transmission of cancer case information Successful ongoing transmission of data to a specialized registry
    • Change from Stage 1 to Stage 2: Clinical Quality Measure reporting is no longer a meaningful use core objective, but reporting CQMs is a basic requirement for meaningful use.
    • Patient and Family Engagement  Patient Safety  Care Coordination  Population and Public Health  Efficient Use of Healthcare Resources  Clinical Processes/Effectiveness 
    • Hospitals 15 total CQM 24 CQMs (≥1 per domain) 24 total CQMs Eligible Professionals 3 core OR 3 alt. core CQMs plus 3 menu CQMs 6 total CQMs 1a) 12 CQMs (≥1 per domain) 1b) 11 core + 1 menu CQMs 2) PQRS Group Reporting 12 total CQMs
    •  2Types of CQM Reporting Methods  Aggregate XML-based format specified by CMS  Manner similar to 2012 Medicare EHR Incentive Program Electronic Reporting Pilot