The document discusses the complexities around the Meaningful Use (MU) process in radiology, highlighting the challenges that radiologists face in integrating electronic health record (EHR) systems. It outlines the financial implications and certification criteria for participation, noting that radiologists may not use EHRs in the same way as other eligible professionals, potentially impacting their incentive eligibility. Additionally, it references contributions from various speakers and emphasizes the need for consistent policies regarding patient interactions in the context of MU measures.

1. Arun Krishnaraj, MD, MPH Assistant Radiologist, Massachusetts General Hospital Instructor in Radiology, Harvard Medical School Chair, Council Steering Committee IT Workgroup, American College of Radiology

2. Disclosures None

4. Radiologists are not included… Radiology was singled out… RIS/PACS is excluded… RIS/PACS is included… XXX has been included in Stage 2… XXX has been excluded from Stage 2… It is impossible to achieve… Don’t have to worry about penalties… If I wait, this will all go away… FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE FALSE

11. CMS Notice of Proposed Rule ONC Interim Final Rule Feb 2009 Mar 2010 Apr 2010 May 2010 Jun 2010 Jul 2010 Aug 2010 Sep 2010 Oct 2010 Nov 2010 Dec 2010 Jan 2011 Feb 2010 Jan 2010 American Recovery and Reinvestment Act Public Comments Continuing Extension Act CMS Final Rule: EHR Incentive Program ONC Final Rule: Certification Criteria for EHR Technology ONC Final Rule: Revisions CMS Amendment ONC Final Rule Public Comment Review

14. MU Fundamentals

15. October 3, 2012

16. MU Fundamentals

28. MU Fundamentals

29. Meaningful Use Process Overview Health and Human Services Code of Federal Regulations 25 Meaningful Use Measures 33 Certification Criteria Authorized Testing and Certification Bodies HCIT Vendors $ Office of the National Coordinator for HIT Centers for Medicare and Medicaid Services Eligible Professionals

30. Meaningful Use Process Overview Health and Human Services Code of Federal Regulations 25 Meaningful Use Measures 33 Certification Criteria Authorized Testing and Certification Bodies HCIT Vendors $ Office of the National Coordinator for HIT Centers for Medicare and Medicaid Services Eligible Professionals

31. Meaningful Use Process Overview Health and Human Services Code of Federal Regulations 25 Meaningful Use Measures 33 Certification Criteria Authorized Testing and Certification Bodies HCIT Vendors Office of the National Coordinator for HIT Centers for Medicare and Medicaid Services Eligible Professionals

32. MU Fundamentals

36. MU Fundamentals

41. INTERVENTIONAL DIAGNOSTICS TELERADIOLOGY

45. Staff EPs Non-EP Care Providers MU EP Dashboard MU Reporting to CMS Rad 1 Rad 2 Rad … MU Data Aggregation Complete Certified EHR/RIS

46. Staff EPs Non-EP Care Providers MU EP Dashboard MU Reporting to CMS Rad 1 Rad 2 Rad … RIS MU Data Aggregation Complete Certified EHR

47. MU EP Dashboard MU Reporting to CMS Rad 1 Rad 2 Rad … Complete Certified RIS MU Data Aggregation Non-Certified Information System

48. MU EP Dashboard MU Reporting to CMS Rad 1 Rad 2 Rad … Modular Certified RIS MU Data Aggregation Non-Certified Information System Complete Certified EHR Possessed Technology

49. MU EP Dashboard MU Reporting to CMS Rad 1 Rad 2 Rad … Modular Certified RIS Complete Certified EHR Non-Certified Information System

53. Total Financial Impact $100M Eligible Hospital Component $42M Eligible Professional Component (Non-Radiology) $50M Eligible Professional Component (Radiology) $8M

54. Q4 2009 Q1 2010 Q2 2010 July 2010 Aug 2010 Sept 2010 Notice of proposed rule making 60 day comment period Review Gap analysis based on proposed rule Completed Final Gap Analysis LMR Exec. Approval for Cert. projects Define reasonable approaches to all MU gaps Oct 2010 Nov 2010 Dec 2010 Jan 2011 Feb 2011 Mar 2011 Apr 2011 May 2011 Final Rules Published Insight into ONC-Authorized Testing and Certification Body

55. 1. Master e-prescribing (eRx) CPOE (30% medication orders) Transmit prescriptions electronically (40%) Implement drug-drug / drug-allergy (attest) Maintain active medication list (80%) Implement drug Formulary (attest) Core 1 1 1 1 Menu 1 2. Leverage Care Team Record demographics (50%) Record vital signs (50%) Record smoking status (50%) Provide patients with an electronic copy of health info. (50%) Provide clinical summaries for each office visit (50%) 1 1 1 1 1 3. Leverage Enterprise Application Implement 1 clinical decision support rule (attest) 1 - test of EHR capability to exchange key clinical information (attest) Capability to submit immunization to immunization registries (attest) Capability to submit electronic syndromic surv. data (attest) Incorporate clinical lab test results unto EHR / structured data (40%) Generate Lists of patients by specific conditions (attest) 1 1 1 1 1 1 4. Focus on Structured Data Elements Maintain problem list (80%) Maintain active medication allergy list (80%) Quality Reporting (report measures) 1 1 1 5. Practice Assessment Work Conduct security risk analysis (attest) 1 15 5 IS and Admin Practice Staff Eligible Providers

56. Meaningful Use Options Challenges Don’t Participate Financial Impact, Perception Issues Use Hospital EHR Directly Rads don’t use the EHR like other EPs do Use Hospital EHR and Rad IT Rad IT needs integration to MU system Use RIS/PACS alone MU path separate from other MGH EPs Use Certified Rad EHR Technology purchase, integration issues

57. MGH EPs Care Providers MU EP Dashboard MU Reporting to CMS Rad 1 Rad 2 Rad … Modular Certified RIS INTERPRETATIONS PT ENCOUNTERS MU Data Aggregation Complete Certified EHR

62. . "The implication of this FAQ is that, for MU measures that include the 'seen by' verbiage, a diagnostic radiologist could conceivably choose to limit his/her 'seen' patients to physical visits and leave out teleradiology and similar services. There is a good amount of flexibility in the current language of this new FAQ. The key is CMS wants each EP to have a consistent policy on what services do and do not count as 'seeing' patients.” -Keith J. Dreyer, DO, PhD, Co-chair of ACR's IT and Informatics Committee

65. Live Q&A Session Arun Krishnaraj, MD, MPH Assistant Radiologist, Massachusetts General Hospital Instructor in Radiology, Harvard Medical School [email_address] Mary Tierney VP, Chief Content Officer, Health Imaging [email_address] To view this presentation again, please login into the conference and visit the Auditorium. All presentations will be available OnDemand within 48 hours. To Submit a Question: Type your question in the white Q&A box. Hit submit to deliver your question to the speaker.