Meaningful Use

Indiana Association for Health Care Quality, May 2013

What’s all this Meaningful Use stuff?

2012

3

What is America doing to modernize its Healthcare System through Health IT?

Why does America need to modernize using Health IT?

• Enable providers to securely and efficiently exchange patient health information.

• Give providers the right information, at the right time to offer their patients the right care.

• Give consumers tools to know their health information so that they can improve their health.

• Foundational to building a truly 21st century health system where we pay for the right care, not just more care.

Accelerating Meaningful

Use

Showing Outcomes

Protecting Privacy

and Security

Keeping Patients

Safe

Promoting Exchange

Engaging Consumers

Source: Doug Fridsma, MD, Chief Science Officer,Director, Office of Science & Technology, ONC

The Compelling Why…..of HITECH

2009 Hitech Act-ARRA

The Hitech Act of the American Recovery & Reinvestment Act (ARRA) was signed into law by President Obama in Feb. 2009

“It's an investment that will take the long overdue step of computerizing America's medical records, to reduce the duplication and waste that costs

billions of healthcare dollars and medical errors that cost thousands of lives each year. ... We have done more in 30 days to advance the cause of health-

care reform than this country has done in an entire decade.“ February 17, 2009

Appointed the Center for Medicare & Medicaid (CMS) to govern the clinical side of the program

The Office of the National Coordinator (ONC) governs the technical side: certification of the EHR at the code level.

Both sets of guidelines must be met to qualify for MUStage One Guidelines: Released July 2010. Stage Two Guidelines: Preliminary Release Feb. 2012, Final Release: Aug, 2012

2009 Hitech Act-ARRAThree progressive stages of “meaningful use” over next 5+

years– Stage 1: Capture and track basic data, communication and

coordination, sets stage for electronic quality reporting – Stage 2: Quality improvement at the point of care, clinical

data exchange– Stage 3: Advanced clinical decision support to promote

safety, quality and efficiency (e.g. national high priority conditions, patient access to self‐management tools, comprehensive patient data and improving population health)

Medicare $$ Incentives: payment for “Meaningful Use”(MU) of an electronic health record (EHR)-by Hospital or Physician

Medicaid $$ Incentives: Demonstrate “AIU” -Adoption, Implementation, Upgrade (first year only), or “Meaningful Use”

Eligibility

Medicare Fee for Service, Medicare Advantage and Medicaid providers

Eligible Professionals (EP) include: Doctors of Medicine or Osteopathy, Dentists, Podiatrists, Optometrists and Chiropractors. Medicaid also includes NPs, Certified Nurse Midwives & PAs.

Hospital based EPs are not included (90% or > services are provided on an Inpatient or ED setting).

Eligible Hospitals include: Acute Care Hospitals and Critical Access Hospitals, including Emergency Departments(pts being admitted or in an extended Observation status).

The Carrot….

•Eligible Providers: •Medicare Incentives: ~$44K/eligible provider/5 years •Medicaid Incentives: ~$64K/eligible provider/6 years

…….and the Stick

•Hospitals: Incentive calculated based on cost reporting to CMS•After 2015, Medicare penalties for Hospitals and EPs

Health Outcomes Priorities

• Improve quality, safety, efficiency

and reduce health disparities

• Engage patients and families in their health care

• Improve care coordination

• Improve population & public health

• Ensure adequate privacy and security protection of personal health information

Final Rulings-Stage 1

Stage 1: 1st Submission-90 days of data 2nd submission-12 consecutive

monthsMandatory Core Measures-15 for

Eligible Providers, 14 for Hospitals Menu Set-10 to choose from; 5 deferred

until Stage II. Total reporting requirements:

Eligible Providers: report on 20 of 25 MU Measures.

Hospitals: report on 19 of 24 MU Measures.

Stage 1 Core Measures-Mandatory

CPOE-1 med order >30% Hospital & Provider

ePrescribing-I med order >40% Provider

Drug/Drug, Drug/Allergy Checks ON Hospital & Provider

Problem List >80% Hospital & Provider

Medication List >80% Hospital & Provider

Medication Allergy >80% Hospital & Provider

Vital Signs: Ht, Wt, BP, >2yo >50% Hospital & Provider

Smoking Status, 13yo >50% Hospital & Provider

Demographic Data >50% Hospital & Provider

Stage 1 Core Measures-Mandatory

eCopy of Record, w/in 3 days >50% Hospital & Provider

Clinical Decision Support Rule 1 Hospital & Provider

E-Copy of Discharge Instruction >50% Hospital

Provide Clinic Summary >50% Provider

Information Exchange 1 test Hospital & Provider

Protect Pt Info, Security Analysis Conduct Hospital & Provider

Quality Measures: VTE, Stroke, ED 15 Hospital

Quality Measures: 3 core/3 menu + 38 options

6 Provider

Stage 1 Menu Measures-5 Optional

Incorporate Clinical Lab Results >40% Hospital & Provider

Patient List 1 Hospital & Provider

Patient Reminders >20% Provider

Pt Access to Information: 4days >10% Provider

ID Patient Education Needs >10% Hospital & Provider

Medication Reconciliation >50% Hospital & Provider

Drug Formulary Checks On Hospital & Provider

Transfer Summaries >50% Hospital & Provider

Record Advanced Directives >50% Hospital

Submit Syndromic Data to SDOH Test Hospital & Provider

Submit Lab Data to SDOH Test Hospital

Submit Immunizations to SDOH Test Hospital & Provider

What’s Coming with Stage 2?

• Goes into effect October 1, 2013. • Thresholds and complexity increases• Second year added to stage 2 with a 90

day quarterly measurement period; no change in payment model

• 2015 Payment adjustments confirmed (complete attestation by Oct 2014 to avoid penalties)

• Hospitals-Report on 19 out of 22 measures EPs-Report on 20 out of 23 measures

What’s Coming with Stage 2?

• Focus on Patient Engagement-Portal access; view, download or transmit

• Exclusions will not count toward Menu Items

• Batch reporting for EPs

• CPOE changes in denominator, addition of radiology and labs

• Addition of electronic notes, capturing care team, functional and cognitive status in the summary or care.

• Better Alignment of Quality measures against other CMS requirements: ACO, PQRS, CHIPRA etc

The Details

Core Objective Measure Hospital/Provider

CPOE Use of CPOE for >60% of medications, 30% of Laboratory and 30% of radiology Hospital/Provider

e-Prescribing E-Prescribing for >50% ProviderDemographics Record demographics for >80% Hospital/ProviderVital Signs Record Vital Signs for >80% Hospital/ProviderSmoking Status Record Smoking Status for >80% Hospital/Provider

Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy Hospital/Provider

Labs Incorporate lab results for >55% Hospital/Provider

Patient Lists Generate patient lists by specific condition Hospital/Provider

Preventive Reminders

Use the EHR to identify and provide reminders for preventive/follow-up care for

>10% of pts with 2 or more office visits in last 2 years.

Provider

The Details

Core Objective Measure Hospital/Provider

eMar Implement eMar and use for > 10% of medication orders (bar code med admin) Hospital

Patient Access Provide online access to health information for > 50% with >5% actually accessing Hospital/Provider

Visit Summaries Provide office visit summars for >50% of office visits Provider

Education Resources Use the EHR to identify and provide education resources for >10% of the patients Hospital/Provider

Secure Messages >5% of patients send secure messages to the EP Provider

Meds Reconciliation Medication Reconciliation is completed at > 50% of the transitions of care Hospital/Provider

Summary of Care

Provide Summary of Care Document for >50% of the transitions of care and referrals with

10% sent electronically and at least 1 sent to recipient with a different EHR vendor

Hospital/Provider

The Details

Core Objective Measure Hospital/Provider

Immunizations Successful ongoing transmission of immunization data Hospital/Provider

Labs Ongoing submission of reportable lab results Hospital

Syndromic Surveillance Ongoing submission of electronic syndromic surveillance data Hospital

Security Analysis Conduct or review security analysis and incorporate risk management process Hospital/Provider

The DetailsMENU Objective Measure Hospital/Provider

Progress Notes Enter an electronic progress note for >30% of unique patients Hospital/Provider

E-Prescribing >10% of discharge medication orders are e-prescribed Hospital

Imaging Results >20% of imaging results are accessible through the certified EHR Hospital/Provider

Family History Record family health history for >20% Hospital/Provider

Advanced Directives Record AD for >50% of patients 65yo or older Hospital

Labs Provide structured lab results to EPs for >20% Hospital

Syndromic Surveillance Ongoing submission of electronic syndromic surveillance data Provider

Cancer Registry Successful ongoing transmission of cancer case information Provider

Specialized Registry Successful ongoing transmission of data to a specialized registry Provider

Other Related Initiatives; Similar…..but not quite!

• ICD-9 vs ICD-10 -DEADLINE OCTOBER 2014

-Dx Codes: from 14,315 to 69,099 (483%) -Px Codes: from 3,838 to 71,957 (1875%)

Angioplasty-Moving from 1 code to 854 codes based on site, device & approach!

• Value Based Purchasing

• Medical Home

• Impact of Hospital Acquired Conditions

• Payment cuts for readmissions

• PQRI

• ePrescribing

• Bundled payments

• Quality Bonus Payments for Medicare Advantage

• Accountable Care Organization Mandates……..

Take Home Concepts

Meaningful Use and EHR adoption is a clinical care initiative supported by IT, not an IT program. It will forever change how we provide service to our patients.

Our success or failure will depend in great part on our ability to define and standardize our best practice clinical workflows throughout our system.

Physician and clinical operation’s leadership will be crucial in each clinic’s, service line’s and facility’s success or failure.

Resources

• CMS Attestation resources (including Calculator) available at: http://www.cms.gov/EHRIncentivePrograms/32_Attestation.asp#TopOfPage

• Beginners guide for MU at: https://www.cms.gov/EHRIncentivePrograms/Downloads/Beginners_Guide.pdf

• http://www.cms.gov/EHRIncentivePrograms

• http://healthit.hhs.gov

• www.himss.org/economicstimulus

• http://www.himss.org/ASP/topics_meaningfuluse.asp

• Payment Webpage: https://www.cms.gov/EHRIncentivePrograms/56_DataAndReports.asp#TopOfPage

So, in a nutshell………

Thank You

Kathy Mathena, MSN, RN

Executive Director, Clinical Information Systems

KMathena@iuhealth.org

Office: 317-963-7854