Arun Krishnaraj, an assistant radiologist at Massachusetts General Hospital and instructor at Harvard Medical School, presented on key aspects of the Meaningful Use program for radiologists. He provided an overview of the Meaningful Use process and regulations established by CMS and ONC. He discussed challenges radiologists may face in meeting Meaningful Use objectives, such as whether to use their hospital's EHR directly or a certified radiology IT system. The presentation addressed how radiologists can report Meaningful Use data to CMS and aggregate information from different systems and care providers.

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

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

14. MU Fundamentals

15. October 3, 2012

16. MU Fundamentals

28. MU Fundamentals

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

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

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

32. MU Fundamentals

36. MU Fundamentals

41. TELERADIOLOGY DIAGNOSTICS INTERVENTIONAL

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

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

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

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

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

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

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

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

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

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. To Submit a Question:
Live Q&A • Type your question in the
white Q&A box.
Session • Hit submit to deliver your
question to the speaker.
Arun Krishnaraj, MD, MPH
Assistant Radiologist, Massachusetts General Hospital
Instructor in Radiology, Harvard Medical School
akrishnaraj99@gmail.com
Mary Tierney
VP, Chief Content Officer, Health Imaging
mtierney@healthimaging.com
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