Meaningful Use

1. Meaningful Use Bob Hoyt MD January 16 2010

2. Steps towards reimbursement

3. Meaningful use • Goals of meaningful use • Improving quality, safety, efficiency and disparities • Engage patients/families in their healthcare • Improve care coordination • Improve public and population health • Ensure adequate privacy and security protection • There will be three stages of meaningful use with stage 1 beginning in 2011

4. Meaningful use stages

5. Stage 1 meaningful use criteria • Computerized Physician Order Entry (CPOE) on all orders but NOT transmitted (80%*) • Implement drug-drug, drug-allergy and drug formulary checks (demonstrate this has been implemented) • Electronically submit prescriptions (75%of eligible prescriptions) and maintain active drug (80%) and drug allergy lists (80%) * Measurements that must be reported and frequency percentage (in red). Medicare physicians report to CMS, Medicaid reports to states

6. Stage 1 meaningful use criteria • Maintain an electronic problem summary list using ICD or SNOMED CT to create structured data (80%) • Maintain demographics: preferred language, insurance type, gender, race and ethnicity, and date of birth as structured data (80%) • Record vital signs: height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 - 20 years, including BMI (80%)

7. Stage 1 meaningful use criteria • Record smoking status for patients 13 years old or older (80%) • Incorporate clinical lab-test results into EHR as structured data (50%) • Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach (generate at least one list)

8. Stage 1 meaningful use criteria • Report ambulatory quality measures to CMS for Medicare and report to states for Medicaid. NQF approved measures like % of adult diabetics with recent LDL-C level < 100. (attestationonly until 2012) • Send reminders to patients (over age 50) per patient preference for preventive/follow-up care (50%) • Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules (To be determined)

9. Stage 1 meaningful use criteria • Administrative • Check insurance eligibility electronically from public and private payers (80%) • Submit claims electronically to public and private payers (80%) • Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request (80% provided within 48 hours)

10. Stage 1 meaningful use criteria • Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) (provide access for at least 10% of patients) • Provide clinical summaries to patients for each office visit. The after-visit clinical summary contains an updated medication list, laboratory and other diagnostic test orders, procedures and other instructions based on clinical discussions that took place during the office visit. The clinical summary can be provided through a PHR, patient portal on the web site, secure email, electronic media such as CD or USB fob, or printed copy (80%) **

11. Stage 1 meaningful use criteria • Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically (Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information) • Perform medication reconciliation at relevant encounters and each transition of care (Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care)

12. Stage 1 meaningful use criteria • Provide summary care record for each transition of care and referral. The summary of care record can be provided through an electronic exchange, accessed through a secure portal, secure email, electronic media such as CD or USB fob, or printed copy (80%) • Capability to submit electronic data to immunization registries and actual submission where required and accepted (Performed at least one test)

13. Stage 1 meaningful use criteria • Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice (Performed at least one test) • Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities (Conduct or review a security risk analysis) * Determined to take 9 hours/clinician to report all measures during a reporting period!

14. Stage 2 meaningful use (2013) • “Encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry(CPOE) and the electronic transmission of diagnostic test results and other such data needed to diagnose and treat disease”

15. Stage 3 meaningful use (2015) • “To focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health”

16. How will meaningful use be accepted? • The public will have 60 days to make comments, so expect changes • Already, many organizations have voiced concerns, primarily about new reporting requirements that will likely have glitches and cost physicians time and money • Will CMS be ready to receive reports? • Will payments to physicians be timely or slowed down by bureaucracy?