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Becoming Meaningful Users: Medical and Dental Application

Join Dan Belknap from M-CEITA/Altarum Institute on June 10, 2014, to learn about the requirements and benefits of meaningful use of electronic health records in the medical and dental fields, and how it can improve patient experience, population health, and reduce costs.

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Becoming Meaningful Users: Medical and Dental Application

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  1. Becoming Meaningful UsersMedical and Dental ApplicationDan BelknapM-CEITA / Altarum InstituteJune 10, 2014 Click to edit Master title style 6/4/2014 1

  2. Presentation Topics • Who is M-CEITA? • MU Stage 1: Summary of Objectives & Measures for Eligible Professionals (EPs) • NPRM (Notice of Proposed Rule Making) • Questions • MU Stage 2: Brief Overview (if time permits)

  3. THETRIPLEAIM 3 Improve patient experience Improve population health Reduce costs Who is M-CEITA? • Michigan Center for Effective Information Technology Adoption (M-CEITA) - 2010 • One of 62 ONC Regional Extension Centers (REC) providing education & technical assistance to primary care providers across the country • Founded as part of the HITECH Act to accelerate the adoption, implementation, and effective use of electronic health records (EHR), e.g. 90-days of MU • Funded by ARRA of 2009 (Stimulus Plan) • Purpose: support the Triple Aim by achieving 5 overall performance goals Performance Measurement Improve Quality, Safety & Efficiency Engage Patients & Families Improve Care Coordi- nation Improve Population And Public Health Ensure Privacy And Security Protections Meaningful Use Certified Technology Infrastructure

  4. M-CEITA Performance • 4,000+ providers enrolled for M-CEITA support • 3,700+ providers are live on EHR • 2,700+ have achieved Meaningful Use standards • Latest survey shows 96% of M-CEITA customers are satisfied with services

  5. M-CEITA Services with Subsidies

  6. Overview and Program Basics Meaningful Use

  7. Healthcare’s Shifting Paradigms Paradigm shift requires investment, innovative people and extensible tools.

  8. Meaningful use: Path to better outcomes and quality Clinical Transformation • Record standardized data at POC • Aggregate data by state, region, etc. • Create best practices from evidence-based findings • Return information at the POC to inform and support informed clinical decisions For more information on meaningful use of EHRs, visit: http://www.cms.gov/EHRIncentivePrograms/35_Meaningful_Use.asp

  9. Meaningful Use Timeline

  10. MU Stage 1 Summary of Objectives and Measures for Eligible Professionals (EPs)

  11. What are the requirements? • Certified ELECTRONIC HEALTH RECORD Technology (CEHRT) – 2014 certification • 13 COREMeasures– All EP’s must meet each Core measure (certain exclusions may apply) • 9MENUMeasures – All EP’s must achieve 5 out of the 9 available Menu measures (certain exclusions may apply) • 64 CLINICAL QUALITY MEASURES (CQM) – EP’s must record numerical counts in 9 non-performance based measures • 3-Month Reporting Period for all EP’s in 2014 Meaningful Use CEHRT + 13 + 5 + 9 = MU Complete or Core Menu CQM’s Meaningful Modular Measures Measures Use

  12. 13 Core Measures (EPs must meet all)

  13. CORE OBJECTIVESComputerized provider order entry (CPOE) What That Means For You What the Measure Requires Are You Excluded from Having to Do This? For at least 30% of the prescriptions ordered, you or a licensed staff person or certified MA have to use the EHR’s CPOE module to enter medication orders. You can be excluded from meeting this objective if you write fewer than 100 prescriptions during the reporting period. More than 30% of medication orders created by the EP during the EHR reporting period are recorded using CPOE.

  14. CORE OBJECTIVESMaintain an up-to-date problem list of current and active diagnoses

  15. CORE OBJECTIVESE-Prescribing (eRx)

  16. CORE OBJECTIVESRecord demographics

  17. CORE OBJECTIVESRecord and chart changes in vital signs What That Means For You What the Measure Requires Are You Excluded from Having to Do This? • For more than 50% your patients, you have to record the following in the EHR: • Height/length • Weight • Blood Pressure • A certified EHR will chart changes of those vital signs for you. No patients >2 years is excluded from recording blood pressure. None of vital signs are relevant to their scope of practice Height and weight are relevant but not blood pressure, then blood pressure is excluded Blood pressure is relevant, but not height and weight, then height and weight are excluded More than 50% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height/length and weight (for all ages) recorded as structured data.

  18. CORE OBJECTIVESImplement clinical decision support

  19. CORE OBJECTIVESProvide patients with the ability to view their health information online More than 50% of all unique patients are provided online access to their health information within 4 business days after the information is available to the EP. You can be excluded from meeting this objective if you do not order or create any of the required information, except for “Patient name” and “Provider name” and office contact information. You can also be excluded if your practice is in an area with low broadband availability. You must provide patients the ability to view their health information online, as in through a patient portal

  20. Patient Portal - Guidance Q. If a patient has been given the option of accessing a portal and has been given information about how to set up a portal but chooses not to set up a portal (does not provide email address or does not complete any validation steps or does not provide online permission, etc.) can this patient be included in the numerator?   A. Yes – provided all required health information maintained in an electronic form is available to the patient within four business days.

  21. CORE OBJECTIVESProvide clinical summaries for patientsfor each office visit

  22. CORE OBJECTIVESProtect electronic health information

  23. Questions?

  24. 9 Menu Measures (EPs must meet 5 of 9 Menu objectives)

  25. MENU OBJECTIVESIncorporate clinical lab-test results

  26. MENU OBJECTIVESSend reminders to patients forpreventative/follow-up care

  27. MENU OBJECTIVESMedication reconciliation

  28. MENU OBJECTIVESSummary of care record fortransitions of care

  29. MENU OBJECTIVESSubmit electronic data to immunization registries

  30. MENU OBJECTIVESSubmit electronic syndromic surveillancedata to public health agencies • You could be excluded from meeting this objective for either of these reasons: • You don’t collect any reportable syndromic data • There’s no system in place to which you can send information

  31. 2014 Clinical Quality Measures (CQM) • Every EP is required to report on CQM • CQM’s do not have thresholds that you have to meet – you simply have to report data (generated by the CEHRT) • Medicaid EP’s in 1st year of MU attest to CQM data, i.e. manually input numbers • Medicaid EP’s in 2ndyear of MU must electronically report their CQM data to State Medicaid Agency (MDCH) • In 2014, CQM reporting changes for all EP’s whether in Stage 1 or 2

  32. National Quality Strategy Domains • Patient and Family Engagement • Patient Safety • Care Coordination • Populations and Public Health • Efficient Use of Healthcare Resources • Clinical Processes/Effectiveness

  33. CQMs for Eligible Professionals • Children Who have Dental Decay or Cavities • Primary Caries Prevention Intervention • Hypertension • High Blood Pressure • Smoking • Asthma Measures • Closing Referral Loop • 57 other measures for Pediatric and Adults Requirement: report on 9 of 64 possible measures

  34. Questions?

  35. Putting the Pieces Together – Example 1 Patient Safety CPOE CPOE Medications Drug/Drug – Drug/Allergy Medications Allergies Formulary Allergies Drug/Drug – Drug/Allergy Formulary eRx eRx

  36. Putting the Pieces Together – Example 2 Clinical Processes CQM CQM Vitals Vitals Smoking Smoking Immunizations Labs Labs Immunizations Decision Support Decision Support

  37. Putting the Pieces Together – Example 3 Patient & Family engagement Clinical Summaries Clinical Summaries Educational Res. Educational Res. Reminders Reminders Security Risk Anal. Secure Messaging Secure Messaging Security Risk Anal. Patient Portal Patient Portal

  38. NPRM = Notice of Proposed Rule Making • NPRM grants flexibility to providers who are experiencing difficulties fully implementing 2014 Edition CEHRT to attest this year. The proposed rule would allow providers to use EHRs certified under: • 2011 Edition • combined 2011 and 2014 Editions • 2014 Edition NOTE: If a provider chooses this option they MUST attest that availability issues of CEHRT prevented them from fully implementing 2014 Edition CEHRT.

  39. Proposed Changes in 2014 (NPRM) • 60-day comment period ends July 21, 2014 • Final Rule may not be available until November, 2014 • AIU still requires 2014 CEHRT regardless of any change

  40. Recommendation: DO NOT CHANGE PLANS FOR 2014 Remember, in 2015: • Everyone is required to use 2014 Edition CEHRT • 365-day reporting periods begin January 1st • ICD10 is still expected to Go-Live on Oct 1st

  41. Questions? www.mceita.org Dan Belknap Dan.Belknap@altarum.org 313-529-5128 cell

  42. MU Stage 2

  43. Stage 2 – Core Measures

  44. Stage 2 – Core Measures

  45. Stage 2 – Menu Measures

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