Meaningful Use Measures Series – Session 2

Recording Patient Data in Certified EHR Technology

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MU 3 Session Series

Physician Meaningful Use 3 Session Series

1) Sept. 20 - Session #1  Drug, Medication, eRx related

2) Oct. 18 - Session #2  Recording Patient Data3) Nov. 15 - Session #3  Interoperability,

Exchanging Data Outside the Clinic Other Than to Patients

TAKEAWAY: Use Your resources – GA-HITREC & HomeTown Health

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25 Objectives in 5 Priority Outcomes

Improving quality, safety, efficiency and reducing health disparities

Engage patients and families in their health care

Ensure adequate privacy and security protections for personal health information

Improve care coordination Improving population and public health

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25 Objectives in 5 Priority Outcomes

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Stage I Meaningful Use for 2011 – Eligible Professionals must complete: 15 core objectives (e.g., maintain active

medication list, etc.) 5 objectives out of 10 from menu set (e.g.,

implement drug formulary checks, etc.) 6 total Clinical Quality Measures(CQM) (3 core or

alternate core, and 3 out of 38 from additional set)

Objective Requirements

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15 Core Set Objectives

Eligible Professionals must meet all Core Objectives to qualify for incentive payments

Objective Requirements

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10 Menu Set Objectives

Eligible Professionals will defer 5 Menu

Objectives

One of the remaining objectives must be

from Improving population and public

health priority

Measures Attestation

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Yes/No

• Have done the objective or not

Percentage Based • Numerator - actions or subsets of patients seen or

admitted during the EHR reporting period, only including patients or actions taken on behalf of those patients, whose records are kept using certified EHR technology.

• Denominator - all patients seen or admitted during the EHR reporting period regardless of whether their records are kept using certified EHR technology.

Exclusions

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Some MU objectives are not applicable to every provider’s clinical practice

They would not have any eligible patients or actions for the measure denominator

Exclusions do not count against the 5 deferred Menu set objectives

Defining Terms

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Preferred Language

• The language by which the patient prefers to communicate.

Defining Terms

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Unique Patient

• If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure.

• All the measures relying on the term ‘‘unique patient’’ relate to what is contained in the patient’s medical record.

• Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period.

Defining Terms

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Patient Encounters

• If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that denominator for the measure is based on all office visits.

• All the measures relying on the term ‘‘patient encounter’’ relate to what is contained in the patient’s medical record.

Defining Terms

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Structured Data

• Electronic health records (EHRs) that use structured data elements are documenting patient information using controlled vocabulary rather than narrative text.

• http://blogs.computerworld.com/18057/the_importance_of_structured_data_elements_in_ehrs

POLL QUESTION

POLL QUESTION

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Core Objective–Record Demographics

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Objective • • Record all of• the following• demographics:• (A) Preferred

language; • (B) Gender; • (C) Race; • (D) Ethnicity; • (E) Date of birth

Measures• More than 50• percent of all• unique patients• seen by the EP• have• demographics• recorded as• structured• data.

Exclusions• None

Attestation Requirements – Demographics

The resulting percentage (Numerator ÷Denominator) must be more than 50 percent in order for an EP to meet this measure. 15

Numerator• Number of patients

in the denominator who have all the elements of demographics (or a specific exclusion if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data.

Denominator

• Number of unique patients seen by the EP during the EHR reporting period.

Exclusion

• None

Additional Information – Demographics Race and ethnicity codes should follow current federalstandards published by the Office of Mgmt and Budget(http://www.whitehouse.gov/omb/inforeg_statpolicy/#dr). If a patient declines to provide all or part of the demographicinformation, or if capturing a patient’s ethnicity or race isprohibited by state law, such a notation entered as structureddata would count as an entry for purposes of meeting themeasure. In regards to patients who do not know theirethnicity, EPs should treat these patients the same way aspatients who decline to provide race or ethnicity—identify inthe patient record that the patient declined to provide thisinformation. EPs are not required to communicate with the patient in hisor her preferred language in order to meet the measure ofthis objective.

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Core Objective – Record Vital Signs

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Objective • Record and chart

changes in the following vital signs:

• (A) Height; • (B) Weight; • (C) Blood pressure; • (D) Calculate and

display body mass index (BMI);

• (E) Plot an display growth charts for children 2-20 years, including BMI.

Measures• For more than 50

percent of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data.

Exclusions• Any EP who either

see no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice.

Attestation Requirements – Vital Signs

The resulting percentage (Numerator ÷Denominator) must be more than 50 percent in order for an EP to meet this measure. 18

Numerator

• Number of patients in the denominator who have at least one entry of their height, weight and blood pressure are recorded as structured data.

Denominator

• Number of unique patients age 2 or over seen by the EP during the HER reporting period.

Exclusion• EPs who sees no

patients 2 years or older.

• EPs who believe that all 3 vital signs of height, weight, and BP have no relevance to their scope of practice.

• EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion.

Additional Information – Vital Signs The provider is permitted, but not required, to limit the measure of

this objective to those patients whose records are maintained using certified EHR technology.

The only information required to be inputted by the provider is the height, weight, and blood pressure of the patient. The certified EHR technology will calculate BMI and the growth chart if applicable to patient based on age.

Height, weight, and blood pressure do not have to be updated by the EP at every patient encounter. The EP can make the determination based on the patient’s individual circumstances as to whether height, weight, and blood pressure need to be updated.

Height, weight, and blood pressure can get into the patient’s medical record as structured data in a number of ways. Some examples include entry by the EP, entry by someone on the EP’s staff, transfer of the information electronically or otherwise from another provider.

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CMS - FAQ– Vital Signs

FAQ:In recording height as part of the core Meaningful Use objective “Recording vital signs,” how should providers account for patients who are too sick or otherwise cannot be measured safely?

Answer: In cases where taking an actual height measurement is

inappropriate, self-reported or estimated height can be used.

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Core Objective – Record Smoking Status

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Objective • Record

Smoking status for patients 13 years or older.

Measures• More than 50

percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.

Exclusions• Any EP who

sees no patients 13 years or older.

Attestation Requirements – Smoking Status

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Numerator

• Number of patients in the denominator with smoking status recorded as structured data/

Denominator

• Number of unique patients age 13 or older seen by the EP during the EHR reporting period.

Exclusion

• An EP who sees no patients 13 years or older would be excluded from this requirements.

• EP’s must enter “0” in the exclusion box to attest to exclusion from this requirement.

The resulting percentage (Numerator ÷Denominator) must be more than 50 percent in order for an EP to meet this measure.

Additional Information – Smoking Status The provider is permitted, but not required, to limit themeasure of this objective to those patients whoserecords are maintained using certified EHRtechnology. This is a check of the medical record for patients 13years old or older. If this information is already in themedical record available through certified EHRtechnology, an inquiry does not need to be madeevery time a provider sees a patient 13 years old orolder. The frequency of updating this information is left tothe provider and guidance is provided already fromseveral sources in the medical community..

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Menu Objective – Clinical Lab Test Results

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Objective • Incorporate

clinical lab results into EHR as structured data.

Measures• More than 40 percent

of all clinical lab test results ordered by the EP during the EHR period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

Exclusions• An EP who

orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period.

Attestation Requirements – Lab Tests

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Numerator• Number of lab

tests results whose results are expressed in a positive or negative affirmation or as a number which are Incorporated as structured data.

Denominator

• Number of lab tests ordered during the EHR reporting period by the EP whose results are expressed in a positive/negative affirmation or as a number.

Exclusion• If EPs order no lab

tests whose results are either in a + / -or numeric format during the EHR reporting period they would be excluded from this requirement.

• EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion.

The resulting percentage (Numerator ÷Denominator) must be more than 40 percent in order for an EP to meet this measure.

Additional Information – Lab Tests The provider is permitted, but not required, to limit the measureof this objective to labs ordered for those patients whoserecords are maintained using certified EHR technology. Structured data does not need to be electronically exchanged inorder to qualify for the measure of this objective. The EP is notlimited to only counting structured data received via electronicexchange, but may count in the numerator all structured dataentered through manual entry through typing, option selecting,scanning, or other means. Lab results are not limited to any specific type of laboratory or toany specific type of lab test. The Incentive Programs do not specify the use of code setstandards in meeting the measure for this objective. The ONChas adopted LOINC® v2.27, when such codes were receivedwithin an electronic transaction from a lab, for the entry ofstructured data for this measure and made this a requirement forEHR technology to be certified. 26

CMS - FAQ

FAQ: In a group practice, will each provider need to demonstrate

meaningful use in order to get Medicare and Medicaidelectronic health record (EHR) incentive payments or canmeaningful use be calculated or averaged at the grouplevel?

Answer: Yes. Medicare and Medicaid incentive payments are madeon a per EP basis, not by practice. Each EP will need todemonstrate the full requirements of meaningful use inorder to qualify for the EHR incentive payments. We madethis clear in the preamble to the final rule when we declinedto adopt alternative means for demonstrating meaningfuluse on a group-practice level (75 FR 44437).Published 08/16/2010 01:58 PM | Updated 03/24/2011 11:10 AM | Answer ID 10076

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CMS - FAQ

FAQ:How are the reporting periods for Medicaid patient volume and fordemonstrating meaningful use affected if an EP skips a year or takeslonger than 12 mo. between attestations?

Answer: For the Medicaid EHR Incentive Program, how are the reporting periods forMedicaid patient volume and for demonstrating meaningful use affected ifan eligible professional (EP) skips a year or takes longer than 12 monthsbetween attestations?Regardless of when the previous incentive payment was made, the following reporting

periods apply for the Medicaid EHR Incentive Program:• For patient volume, an eligible professional (EP) should use any continuous,representative 90-day period in the prior calendar year.• For demonstrating they are a meaningful users of Electronic Health Records(EHRs), EPs should use the EHR reporting period associated with thatpayment year (for the first payment year that an EP is demonstratingmeaningful use, the reporting period is a continuous 90-day period withinthe calendar year; for subsequent years the period is the full calendar year).

Published 08/23/2010 01:09 PM | Updated 03/24/2011 11:11 AM | Answer ID 1010028

Reduction in reimbursementif meaningful use of certified EHRtechnology is NOT successfully

demonstrated• 2015 – 99% of Medicare FFS covered amount• 2016 – 98% of Medicare FFS covered amount• 2017 – 97% of Medicare FFS covered amount• 2018 – if determined, payment adjustment can

occur by 1% point each year until payment adjustment reaches 95%

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2015 Payment Adjustments Begin

Resources CMS Web Site for the Medicare and Medicaid

EHR Incentive Program www.cms.gov/EHRIncentivePrograms

Meaningful Use Measures Links http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf

Georgia HITREC http://www.ga-hitrec.org/gahitrec/

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Q&A

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The patient should be on the forefront of every decision you make

Regional Extension Center

Your Meaningful Use Expert Resource.Contact us today!

32In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0004/01. IA-HITREC-03/11-219

This presentation is compliments of

www.IowaHITREC.org

For More information go to:www.ga-hitrec.org