The latest changes from CMS regarding Meaningful Use Stage 3 , CCDA and reporting measures. We discuss the effort required, estimates in terms of cost and timelines.

1. Meaningful Use 3 – In a nutshell
iOS
ANDROID
WINDOWS
CRM
MICROSOFT
SOCIAL
CRM
DESIGN
EXPERIENCE
CLOUDJAVA
RWD
www.nalashaa.com

2. Who We Are
A Software services company focussed on providing cutting edge, next generation software technology solutions to ISVs, System Integrators
and End Customers.
New Jersey
HQ People
100+
New Jersey
200+
Bangalore
Clients
Spread across globally
Big Data
Analytics &
Intelligence
Mobility
Cloud/Web
Pull data from heterogeneous
data sources
Make sense of all these data
Extending applications to
mobile platforms
High availability
solutions using cloud
Technology Stack

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Our engagement approach
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Conduct assessment Submit findings Plan Develop Certify
• Sign an NDA
• Demo of your system
over a 2 hour call
• Gap analysis for MU3
• Execution plan with
timelines
• Estimation of effort
for your solution
• Presentation of
findings
• Detailed analysis of MU3
requirements
• User stories development
• Technical design
• UX design
• Team structure and
responsibilities
• Sprint priorities defined
by you
• 2 weeks sprints
• End to end testing
• Demonstrable output
every sprint
• We collaborate with
your own teams
• Help you with
certification process
• Prepare test data for
certification
• Do mock-runs with
actual test procedures
• Demonstrate
capabilities during
certification
We will help you simulate certification process, be with you during the certification and help you achieve it
Proposal acceptance

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Is MU3 for real?
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First Year
Demonstrating
Meaningful Use
Stage of Meaningful Use
2015 2016 2017 2018
2019 and Future
Years
2016 NA Modified Stage 2 Modified Stage 2 or Stage 3 Stage 3 Stage 3
2017 NA NA Modified Stage 2 or Stage 3 Stage 3 Stage 3
2018 NA NA
NA
Stage 3 Stage 3
2019 and Future Years NA NA NA NA Stage 3
Source: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRincentivePrograms/
With clarity from CMS on MU3’s future, most EHR vendors have started implementing MU3 requirements

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MU3 criteria split
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38%
7%
36%
12%
7%
Ambulatory settings
Unchanged Criteria
Minimally revised criteria
Revised Criteria
New Criteria
Public Health Criteria
35%
7%35%
14%
9%
Inpatient settings
Around 50% of criteria are either new or revised – Implies significant changes to the codebase

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What are the changes?
New measures and those that got revised…
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Information Capture
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Capture additional demographics
 Social, Psychological & behavioral, Sexual orientation and Gender identity
Access to UDIs for patient's implantable devices
Enable a user to
 Identify (e.g., label documents as advance directives and birth plans), record (capture + store) and access (examine +
review) patient health information documents
 Reference and link to patient health information documents
 Record and access information directly and electronically shared by a patient

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CCDA
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 Incorporate & reconcile clinical data from both V1.1 and V2.1 (ToC, Referral Note, Discharge Summary)
 Minimum common clinical data set along with the patient matching information as CDA documents
 CDA validation and verification
 Tag patient data at document level in accordance with DS4P
 Date based search on clinical data set; Real-time, automatic creation of documents as per user preferences
 Care plans in structured format using CCDA

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Application Access
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Patient Selection
 Receive a request with sufficient information to uniquely identify a patient and return an ID/token to be used by an
application for subsequent requests for that patient’s data
Data Category Request and All Data Request
 Respond to requests for patient data for each of the individual data categories or all data categories specified in the
Common Clinical Data Set and return the full set of data for that data category in a computable format.
 Respond to requests for patient data associated with a specific date and date range

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Reporting
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CQMs
 Import function - QRDA 1 R3 for one/multiple patients and to calculate CQMs
 Ability to export and create QRDA data files - QRDA I R3 and QRDA III
 Filter CQM results at patient & aggregate levels, create a data file (QRDA I, III) and display human readable results
 TIN, NPI, Type, Address, Insurance, age, gender, race/ethnicity, Problem list
Automated measures
 Automated Numerator Recording and measure calculation – Test procedures changed

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PHA Reporting
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Immunization registries (bidirectional)
 Updated IGs for Immunization Messaging, Transmission to registries
 Support for NDC code system for administered vaccines; CVX for historical vaccines
Syndromic surveillance
 Updated SNOMED CT, LOINC codes and HL7 IG
Electronic Case Reporting
Reportable Lab results (EHs, CAH)

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PHR & CDR Reporting
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Antimicrobial use and resistance reporting
 Generate AUR for three specified sections:
 Antimicrobial Resistance Option Report (Numerator),
 Antimicrobial Resistance Option (ARO) Summary Report (Denominator) and
 Antimicrobial Use (AUP) Summary Report (Numerator and Denominator) to CDC
National Health Care Surveys (NHCS)
 Create health care survey information for electronic transmission to CDC
Transmission to Cancer Registries

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Revised measures
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eRx
 Expand eRx transactions; Codify e-Rx instructions in structured Sig format; eRx all meds in metric unit standard, Support
bidirectional transactions
Direct Project, Edge Protocol, and XDR/XDM
 Adopt the new version of Applicability Statement for Secure Health Transport, Version 1.2
SNOMED CT updates
 Problem list, Smoking status, Family Health history

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Revised measures
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Information Integrity
 SHA2 hashing algorithm
 Audit modification of User Privileges and emergency access events relating to ePHI.
 Ensure tamper-resistance
Clinical Decision Support
 Diagnostic or therapeutic reference information using InfoButton standards based on a preferred language

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What’s the effort required?
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2% 5%
15%
10%
11%
8%
30%
19%
Category wise effort distribution
Access to patient data through patient-centered HIE
Decision support
Population health
Patient Access to Self-management tools
Patient health information
Security
Transmission of Patient Information
Improving quality, safety, and efficiency
~600
man
days
$130K*
Translates to about
* Ballpark figure meant for budgeting purposes. Actual figure might slightly vary.

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Is there enough time?
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MU3 development Certification System upgrade Provider training
Roughly the same as MU2
(6 months)
Paperwork, availability etc.
(1-2 months)
Will be phased
(1-2 months)
Dependency on provider schedule
(1-2 months)
Note: The timelines mentioned above are indicative and may vary across solution providers
Jun
2017
• For EHR vendors starting now, we see almost an year’s effort before MU3 reaches providers’ plate, i.e. around
Q4 2017, which doesn’t leave much time for any contingencies.
• With 25% weightage in MIPS, MU3 will be important; Address the components that you are clear about
• Integration with CDR state registries and PHA registries for e-Submission may be time-consuming

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For more information, contact amit.m@Nalashaa.com
Nalashaa Solutions llc.
555, US Highway One South, Ste 170, Iselin, NJ 08830
+1-732-602-2560 Ext: 200
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Thank You