1. Medicare & Medicaid EHR Incentive Program Final Rule Implementing the American Recovery & Reinvestment Act of 2009

10. Meaningful Use: Changes from the NPRM to the Final Rule NPRM Final Rule Meet all MU reporting objectives Must meet “core set”/can defer 5 from optional “menu set” 25 measures for EPs/23 measures for eligible hospitals 25 measures for EPs/24 for eligible hospitals Measure thresholds range from 10% to 80% of patients or orders (most at higher range) Measure thresholds range from 10% to 80% of patients or orders (most at lower to middle range) Denominators – To calculate the threshold, some measures required manual chart review Denominators – No measures require manual chart review to calculate threshold Administrative transactions (claims and eligibility) included Administrative transactions removed Measures for Patient-Specific Education Resources and Advanced Directives discussed but not proposed Measures for Patient-Specific Education Resources and Advanced Directives (for hospitals) included

11. Meaningful Use: Changes from the NPRM to the Final Rule, cont’d NPRM Final Rule States could propose requirements above/beyond MU floor, but not with additional EHR functionality States’ flexibility with Stage 1 MU is limited to seeking CMS approval to require 4 public health-related objectives to be core instead of menu Core clinical quality measures (CQM) and specialty measure groups for EPs Modified Core CQM and removed specialty measure groups for EPs 90 CQM total for EPs 44 CQM total for EPs – must report total of 6 35 CQM total for eligible hospitals and 8 alternate Medicaid CQM 15 CQM total for eligible hospitals 5 CQM overlap with CHIPRA initial core set 4 CQM overlap with CHIPRA initial core set

16. Meaningful Use – Stage 1 Core Set Health Outcomes Policy Priority Stage 1 Objective Stage 1 Measure Improving quality, safety, efficiency, and reducing health disparities Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital or CAH have at least one medication entered using CPOE Implement drug-drug and drug-allergy interaction checks The EP/eligible hospital/CAH has enabled this functionality for the entire EHR reporting period EP Only: Generate and transmit permissible prescriptions electronically (eRx) More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology Record demographics: preferred language, gender, race, ethnicity, date of birth, and date and preliminary cause of death in the event of mortality in the eligible hospital or CAH More than 50% of all unique patients seen by the EP or admitted to the eligible hospital or CAH have demographics as recorded structured data Maintain up-to-date problem list of current and active diagnoses More than 80% of all unique patients seen by the EP or admitted to the eligible hospital or CAH have at least one entry or an indication that no problems are known for the patient recorded as structured data

17. Meaningful Use – Stage 1 Core Set, cont’d Health Outcomes Policy Priority Stage 1 Objective Stage 1 Measure Improving quality, safety, efficiency, and reducing health disparities Maintain active medication list More than 80% of all unique patents seen by the EP or admitted to the eligible hospital or CAH have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data Maintain active medication allergy list More than 80% of all unique patents seen by the EP or admitted to the eligible hospital or CAH have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data Record and chart vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for children 2-20 years, including BMI For more than 50% of all unique patients age 2 and over seen by the EP or admitted to the eligible hospital or CAH, height, weight, and blood pressure are recorded as structured data Record smoking status for patients 13 years old or older More than 50% of all unique patients 13 years or older seen by the EP or admitted to the eligible hospital or CAH have smoking status recorded as structured data Implement one clinical decision support rule and the ability to track compliance with the rule Implement one clinical decision support rule Report clinical quality measures to CMS or the States For 2011, provide aggregate numerator, denominator, and exclusions through attestation; For 2012, electronically submit clinical quality measures

18. Meaningful Use – Stage 1 Core Set, cont’d Health Outcomes Policy Priority Stage 1 Objective Stage 1 Measure Engage patients and families in their healthcare Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures), upon request More than 50% of all unique patients of the EP, eligible hospital or CAH who request an electronic copy of their health information are provided it within 3 business days Hospitals Only: Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request More than 50% of all patients who are discharged from an eligible hospital or CAH who request an electronic copy of their discharge instructions are provided it EPs Only: Provide clinical summaries for each office visit Clinical summaries provided to patients for more than 50% of all office visits within 3 business days Improve care coordination Capability to exchange key clinical information (ex: problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically Performed at least one test of the certified EHR technology’s capacity to electronically exchange key clinical information Ensure adequate privacy and security protections for personal health information Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities Conduct or review a security risk analysis per 45 CFR 164.308(a)(1) and implement updates as necessary and correct identified security deficiencies as part of the EP’s, eligible hospital’s or CAH’s risk management process

19. Meaningful Use – Stage 1 Menu Set Health Outcomes Policy Priority Stage 1 Objective Stage 1 Measure Improving quality, safety, efficiency, and reducing health disparities Implement drug-formulary checks The EP/eligible hospital/CAH has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period Hospitals Only: Record advance directives for patients 65 years old or older More than 50% of all unique patients 65 years old or older admitted to the eligible hospital or CAH have an indication of an advance directive status recorded Incorporate clinical lab-test results into certified EHR technology as structured data More than 40% of all clinical lab test results ordered by the EP, or an authorized provider of the eligible hospital or CAH, for patients admitted during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition EPs Only: Send reminders to patients per patient preference for preventive/follow-up care More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period

20. Meaningful Use – Stage 1 Menu Set, cont’d Health Outcomes Policy Priority Stage 1 Objective Stage 1 Measure Engage patients and families in their health care EPs Only: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within 4 business days of the information being available to the EP More than 10% of all unique patients seen by the EP are provided timely (available to the patient within 4 business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient, if appropriate More than 10% of all unique patients seen by the EP or admitted to the eligible hospital or CAH are provided patient-specific education resources Improve care coordination The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital or CAH The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or refers their patient to another provider of care should provide a summary of care record for each transition of care or referral The EP, eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals

21. Meaningful Use – Stage 1 Menu Set, cont’d 1 Unless an EP, eligible hospital or CAH has an exception for all of these objectives and measures they must complete at least one as part of their demonstration of the menu set in order to be a meaningful EHR user. Health Outcomes Policy Priority Stage 1 Objective Stage 1 Measure Improve population and public health 1 Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice Performed at least one test of the certified EHR technology’s capacity to submit electronic data to immunization registries and follow-up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically) Hospitals Only: Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice Performed at least one test of certified EHR technology’s capacity to provide submission of reportable lab results to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically) Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically)

28. CQM: Core Set for EPs NQF Measure Number & PQRI Implementation Number Clinical Quality Measure Title NQF 0013 Hypertension: Blood Pressure Measurement NQF 0028 Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment b) Tobacco Cessation Intervention NQF 0421 PQRI 128 Adult Weight Screening and Follow-up

29. CQM: Alternate Core Set for EPs NQF Measure Number & PQRI Implementation Number Clinical Quality Measure Title NQF 0024 Weight Assessment and Counseling for Children and Adolescents NQF 0041 PQRI 110 Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older NQF 0038 Childhood Immunization Status

33. Participation in HITECH and other Medicare Incentive Programs for EPs Other Medicare Incentive Program Eligible for HITECH EHR Incentive Program? Medicare Physician Quality Reporting Initiative (PQRI) Yes, if the EP is eligible. Medicare Electronic Health Record Demonstration (EHR Demo) Yes, if the EP is eligible. Medicare Care Management Performance Demonstration (MCMP) Yes, if the practice is eligible. The MCMP demo will end before EHR incentive payments are available. Electronic Prescribing (eRx) Incentive Program If the EP chooses to practice in the Medicare EHR Incentive Program, they cannot participate in the Medicare eRx Incentive Program simultaneously in the same program year. If the EP chooses to participate in the Medicaid EHR Incentive Program, they can participate in the Medicare eRx Incentive Program simultaneously.