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Stage 2 Meaningful Use

Stage 2 Meaningful Use. Eligible Hospitals (EH) & Critical Access Hospitals (CAH). Conflict of Interest Disclosures. None. Changes to Stage 1 Objectives. CPOE

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Stage 2 Meaningful Use

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  1. Stage 2 Meaningful Use Eligible Hospitals (EH) & Critical Access Hospitals (CAH)

  2. Conflict of Interest Disclosures None

  3. Changes to Stage 1 Objectives • CPOE • Denominator: More than 30% of medication orders created by the EP or authorized providers of the EH or CAH’s inpatient or emergency dept (POS 21 or 23) during the EHR reporting period are recorded using CPOE • Vital Signs • Denominator: More than 50% of all unique patient seen admitted to the EH or CAH’s inpatient or emergency dept (POS 21 or 23) during the EHR reporting period have blood pressure (for ages 3+ only) and height and weight (for all ages) recorded as structured data • Clinical Quality Measures • Objective removed • Hospitals are still required to report on CQMs • Now follow 2014 CQM requirements

  4. Where Are We At? • Stage 3 and Beyond… • Leveraging Information for Improved Patient Care • Stage 2 • Reporting • Exchanging Information • Patient Engagement • Stage 1 • Capture Information

  5. Understanding the Timing of Stage 2

  6. Stage 2 Meaningful Use • Report on total of 19 Objectives • Plus Clinical Quality Measures (CQM) • 16 Core Objectives • All Required • Many Stage 1 combined • 6 Menu Objectives • Choose 3 • Clinical Quality Measures (CQM) • Report on 16 of 29 approved CQMs • Selected CQMs must cover at least 3 of 6 National Quality Strategy Domains • Electronically repot to CMS

  7. MU in 2014 For 2014 only: • All EHs and CAHs regardless of their stage of meaningful use are only required to demonstrate meaningful use for a 3-month EHR reporting period. • CMS is permitting this one-time 3-month reporting period in 2014 only so that all hospitals who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems.

  8. MU in 2014 • Reporting Period = 3 month quarter (2014 Only) • Must be a fixed calendar quarter • January – March • April – June • July – September • October – December • Must be completed by December 31st • Start no later than October 1 • Payment Adjustments begin in 2015

  9. Avoiding Payment Adjustments • If you’re beginning in 2014 • Must demonstrate 90 days before 4th quarter • Must attest NO LATER than October 1, 2014 • Avoiding Medicare payment adjustments in the future • Must continue to demonstrate every year • If eligible for Medicare and Medicaid, must demonstrate every year • If eligible for Medicaid ONLY, you are not subject to adjustments

  10. Computer Provider Order Entry (CPOE) Objective Use CPOE for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. Denominator Medications: Number of medication orders created by the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Radiology: Number of radiology orders created by the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the reporting period. Laboratory: Number of lab orders created by the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the reporting period. Numerator The number of orders in the denominator recorded using CPOE Threshold: Medications: > 60% Labs: > 30% Radiology: > 30%

  11. Record Demographics Objective Record all of the following demographics: Preferred Language Sex Race Ethnicity Date of Birth Date & Preliminary Cause of Death (in the event of mortality in the EH or CAH) Denominator Number of unique patients admitted to the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator Number of patients in the denominator who have all the elements of demographics (or a specific notation if the patient declined to provide one or more of the elements) recorded as structured data. Threshold: > 80%

  12. Record Vital Signs Objective Record and chart changes in the following vital signs: Height/Length & Weight (no age limit) Blood Pressure (ages 3 and over) Calculate & Display BMI Plot & Display Growth Charts for Patients 0 – 20 yrs (including BMI) Denominator Number of unique patients admitted to the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator Number of patients in the denominator who have at least one entry of their height and weight (all ages) and/or blood pressure (ages 3 and over) recorded as structured data. Threshold: > 80%

  13. Record Smoking Status Objective Record smoking status for patients 13 yrs old and older Denominator Number of unique patients aged 13 or older admitted to the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator Number of patients in the denominator with smoking status recorded as structured data. Threshold: > 80%

  14. Clinical Decision Support (CDS) Objective Implement 5 Clinical Decision Support interventions related to 4 or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period AND Implement drug-drug and drug-allergy checks for the entire reporting period Attestation Requirement: Yes/No

  15. Patient Electronic Access Objective Provide patients the ability to view online, download, and transmit information about hospital admission.  Denominator Number of unique patients discharged from the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the reporting period. Numerator Access: Number of patients in the denominator whose information is available online within 36 hours of discharge Engagement: Number of patients in the denominator who have viewed online, downloaded, or transmitted to a third party the discharge information provided by the EH or CAH. Threshold: Access: > 50% Engagement: > 5%

  16. What Must be Available Online? The EH or CAH can make additional information available, however, the following information must be available to satisfy the objective and measure: • Patient Name • Admit and discharge date & location • Reason for hospitalization • Care team including the attending of record as well as other providers of care • Procedures performed during admission • Current and past problem list • Current medication list and medication history • Current medication allergy list and medication allergy history • Vital signs at discharge • Laboratory test results (available at time of discharge) • Summary of care record for transitions of care or referrals to another provider • Care plan field(s), including goals and instructions • Discharge instructions for patient • Demographics maintained by hospital • Smoking status

  17. Patient Portals & Minors Parents as Personal Representatives • Personal representative has the right of the individual • Rights should be cut off at age of majority • Parent may not be personal representative for certain information, such as when a minor can consent under state law • Personal representatives and minors can pose significant challenges to the organization • Will the organization require authorization before establishing proxy rights to the portal • How will the organization handle revocation of authorizations? Restriction requests? • How will the organization ensure parent’s access is revoked once patient reaches age of majority?

  18. Patient Portals & Minors What can the organization do? • Ensure compliance with applicable Federal & State laws regarding minors • Consult internal HIPAA privacy liaison to ensure portal access/rights are consistent with Federal & State laws and other organizational practices • Approaches by other Healthcare Providers: • For patients under the age of 14, parents are able to access the portal with parental signed request • For patients aged 14-18, • Require the child to sign a release form • Restrict parental access to certain sensitive data as required by applicable laws • Restrict portal access for minors ages 14-18 • Providers can withhold information if they believe it would jeopardize the health of their patient in accordance with HIPAA privacy regulations • Consult internal HIPAA privacy liaison • Also note that there are differences for minors who are emancipated

  19. Protect Electronic Health Information Objective Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider’s risk management process for eligible hospitals. Attestation Requirement: Yes/No

  20. Clinical Lab Test Results Objective Incorporate clinical lab test results into Certified EHR Technology (CEHRT) as structured data. Denominator Number of lab tests ordered during the EHR reporting period by the EH or CAH’s inpatient or emergency department (POS 21 or 23) whose results are expressed in either a positive/negative or numeric format. Numerator Number of lab test results which are expressed in a positive/negative or numeric result are incorporated into CEHRT as structured data. Threshold: > 55%

  21. Patient Lists Objective Generate at least one list of patients by specific condition to use for quality improvement, reduction of disparities, research, or outreach. Attestation Requirement: Yes/No

  22. Patient-Specific Education Resources Objective Use clinically relevant information from CEHRT to identify patient-specific education resources and provide those resources to the patient. Denominator Number of unique patients admitted to the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator Number of patients in the denominator who are subsequently provided patient-specific education resources identified by CEHRT. Threshold: > 10%

  23. Medication Reconciliation Objective The EH 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. Denominator Number of transitions of care during the EHR reporting period for which the EH or CAH’s inpatient or emergency department (POS 21 or 23) was the receiving party of the transition. Numerator Number of transitions of care in the denominator where medication reconciliation was performed. Threshold: > 50%

  24. Summary of Care Measure 1 Objective The EH or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary of care record for each transition of care or referral. Denominator Number of transitions of care and referrals during the EHR reporting period for which the EH or CAH’s inpatient or emergency department (POS 21 or 23) was the transferring or referring provider. Numerator Number of transitions of care and referrals in the denominator where a summary of care record was provided. Threshold: > 50%

  25. Summary of Care Measure 2 Objective The EH or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary of care record for each transition of care or referral. Denominator Number of transitions of care and referrals during the EHR reporting period for which the EH or CAH’s inpatient or emergency department (POS 21 or 23) was the transferring or referring provider. Numerator Number of transitions of care and referrals in the denominator where a summary of care record was: Electronically transmitted using CEHRT to a recipient OR Where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network. The organization can be a third-party or the sender’s own organization. Threshold: > 10%

  26. Summary of Care Measure 3 Objective The EH or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary of care record for each transition of care or referral. Attestation Requirement: Yes/No The EH or CAH must satisfy one of the two following criteria: Conducts one or more successful electronic exchanges of a summary of care document, which is counted in Measure 2 with a recipient who has EHR technology that was designed by a different EHR technology developer than the sender’s CEHRT OR Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period.

  27. What Must be Available on the Care Summary? A summary of care record must include the following: • Patient Name • Procedures • Encounter diagnosis • Immunizations • Laboratory test results • Vitals signs • Smoking status • Functional status, including activities of daily living, cognitive and disability status • Demographic information • Care plan field, including goals and instructions • Care team including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider • Discharge instructions • Current problem list • Current medication list • Current medication allergy list

  28. Immunization Registry Data Submission Objective Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. Attestation Requirement: Yes/No

  29. Electronic Reportable Lab Results Objective Capability to submit electronic reportable laboratory results to public health agencies, except where prohibited, and in accordance with applicable law and practice. Attestation Requirement: Yes/No

  30. Syndromic Surveillance Data Submission Objective Capability to submit syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice. Attestation Requirement: Yes/No

  31. Electronic Medication Administration Record (eMAR) Objective Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR). Denominator Number of medication orders created by authorized providers in the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator Number of orders in the denominator for which all doses are tracked using eMAR. Threshold: > 10%

  32. Advance Directives Objective Record whether a patient 65 years or older has an advance directive. Denominator Number of unique patients age 65 or older admitted to the EH or CAH’s inpatient department (POS 21) during the EHR reporting period. Numerator Number of patients in the denominator who have an indication of an advance directive status entered using structured data. Threshold: > 50%

  33. Electronic Notes Objective Record electronic notes in patient records. Denominator Number of unique patients admitted to the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator Number of patients in the denominator who have at least one electronic progress note from an authorized provider of the EH or CAH’s inpatient or emergency department (POS 21 or 23) recorded as text searchable data. Threshold: > 30%

  34. Imaging Results Objective Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. Denominator Number of tests whose result is one or more images ordered by an authorized provider on behalf of the EH or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator Number of results in the denominator that are accessible through CEHRT. Threshold: > 10%

  35. Family Health History Objective Record patient family health history as structured data. Denominator Number of unique patients admitted to the EH or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator Number of patients in the denominator with a structured data entry for one or more first-degree relatives. Threshold: > 20%

  36. ePrescribing (eRX) Objective Generate and transmit permissible discharge prescriptions electronically (eRX). Denominator Number new, changed, or refill prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances for patients discharged during the EHR reporting period. Numerator Number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically. Threshold: > 10%

  37. Lab Results to Ambulatory Providers Objective Provide structured electronic lab results to ambulatory providers. Denominator Number of electronic lab orders received. Numerator Number of structured clinical lab test results sent to the ordering provider. Threshold: > 20%

  38. Clinical Quality Measures (CQM) Requirement EHs & CAHs must report on 16 of 29 approved CQMs. Selected CQMs must cover at least 3 of the 6 National Quality Strategy domains: Patient & Family Engagement Patient Safety Care Coordination Population & Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness Reporting All CQMs will be submitted electronically to CMS

  39. To Review… • Stage 2 Objectives • 16 Core • 3 of 6 Menu • Clinical Quality Measures • 3 Month Reporting Period in 2014 • Must be completed by September 30th • Can begin no later than July 1 • Payment Adjustments begin in 2015 • Start no later than April 1 to avoid adjustments

  40. To Review… Core Objectives • CPOE for Med, Lab, Rad Orders • Demographics • Vital Signs • Smoking Status • Clinical Decision Support Rules • Patient Electronic Access • Privacy & Security • Clinical Lab Test Results • Patient List • Educational Resources • Medication Reconciliation • Summary of Care • Immunization Registries • Reportable Lab Test Results • Syndromic Surveillance • eMAR Menu Objectives • Advance Directives • Electronic Notes • Imaging Results • Family History • eRX • Lab Results to Ambulatory Providers Clinical Quality Measures • Report on 16 of 29

  41. Speaker Information • Natalie Stewart, MBA • Managing Advisor, Meaningful Use • Purdue Healthcare Advisors • nmstewart@purdue.edu(765) 496-1265 (phone)(765) 496-6990 (fax) • www.pha.purdue.edu • healthcareadvisors@purdue.edu • Visit us on @ Purdue Healthcare Advisors

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