Transforming healthcare using health IT: Meaningful Use Stage 2

1. Transforming healthcare using health IT: Meaningful Use Stage 2 Lisa-Nicole Danehy, MHS Office of the National Coordinator for Health IT June 25, 2013

2. Stages of Meaningful Use Stage 3 2016-17 Stage 2 2014-15 Stage 1 2011-13 • Increases objective thresholds • Menu items become core • Increases exchange between providers • Requires electronic connectivity • Promotes patient engagement • Increases data security requirements

3. Meaningful Use as a Building Block Transformation • Enhanced access and continuity Access information • Performance and population management • Improved population health • CQM data enables outcome improvements • Case management & longitudinal viewing • Patient centered, team based care • Care coordination Use technology • Robust CDS (evidenced based medicine & practice goals) • Patient engagement • Use of clinical decision support • Patient informed • Structured data capture Stage 1 MU Stage 2 MU Stage 3 MU Future

4. MU should be Integrated into Workflow Continuous Quality improvement Continuous Quality improvement Patient & Family Engagement Privacy & Security

6. Stage 2 Meaningful Use • Family history • Electronic progress notes • Submit syndromic surveillance data • Imaging results access • Report to cancer registries • Report to specialty registry • Exceptions for menu items do not count towards the total. You must use a different menu item if possible. • Record demographics • Smoking status • Vital signs • CPOE (meds, labs, imaging) • e-Prescribing + Formulary Checks • Generate patient list • Patient reminders • Patient-specific education • 5 CDS interventions + DDI • Structured labs results • Summary of patient visit (AVS) • Medication reconciliation • Care summary at ToC • View, download, transmit (VDT) • Secure electronic messaging • Submit to immunization registry • Protect health information Menu Set: Must Do 3 of 6* Core Set: Must Do All 17 Clinical Quality Measures to CMS

7. Keys to Success • Team based care approach to maximize data entry into EHR • Prepare for coding changes (e.g., LOINC, SNOMED and ICD10) • Streamline workflow to ensure prepared for increased measure thresholds • Increase focus on quality improvement using CDS interventions • Maximize point of care documentation to leverage EHR functionality • Establish online patient access and communication (Patient Portal) for access to clinical information and secure messaging • Review patient portal during visit to better engage patients • Establish external connectivity through results interface and Health Information Exchange (HIE) • Think about ways to incorporate and streamline patient generated data (e.g., patient input of social and family HX) • Prepare for 2014 system upgrade

8. Summary of Care at Transitions • Objective: The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. • Work closely with EHR vendor and possibly HIE or local HIO • Setting up the infrastructure to send and receive will take time and practice resources

9. Quality Improvement • More rigorous quality improvement requirements • 5 clinical decision support interventions • Reporting requirement for clinical quality measures 8

10. Quality Improvement Resources

11. Clinical Decision Support Tool Office of the National Coordinator for Health Information Technology

12. Clinical Quality Measures 2014 - New CQMs in certified EHRs • Removed as a Core Objective but required to demonstrate Meaningful Use • EPs must report on 9 of the 64 approved CQMs electronically to CMS (Medicare), or to state (Medicaid) http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/ClinicalQualityMeasuresTipsheet.pdf

13. Stage 2 framework for the reporting of CQM • Submit 9 of 64 CQMs from at least 3 of 6 National Quality Standard domains: (includes adult and pediatric recommended core CQMs)

14. PQRS and MU Alignment • Submit and satisfactorily report CQMs under the PQRS's EHR Reporting Option • Medicare EPs who participate in both the PQRS and the Medicare EHR Incentive Program will satisfy the CQM reporting component of meaningful use if they submit and satisfactorily report PQRS CQMs under the PQRS's EHR reporting option using CEHRT. • EPs choosing to report under this option for purposes of the Medicare EHR Incentive Program will be subject to the reporting periods established for the PQRS EHR reporting option, which may be different from their EHR reporting period for the meaningful use objectives and measures.

15. Measure harmonization goals Reduces burden on providers by eliminating competing measurement approaches Facilitates public reporting, comparisons across systems, and monitoring of progress Helps identify high-performers and improvements to cultivate and diffuse best practices May eventually support approaches in which providers are paid more for better preventive care

16. NQF tool

17. Common Measures

18. Selecting the Right Measures • Review your patient population • Identify measures that correlate to prevalent diseases within your patient mix • Identify measure alignment with other programs you may be participating in • Verify that your vendor is certified for this measure

19. Review of Stage 2 preparation items • Maximize training time to fully understand EHR functionality and capabilities • Attend vendor training • Plan for 2014 certification and system update • Customize CDS interventions based upon patient population • Use team based care approach to maximize data entry and empower staff • Embrace technology in the exam room and document at the point of care • Engage patients and families by providing them with tools and education for self management and care coordination

20. Stage 3 of MU – Improving Outcomes Stage 3 2016-17 Stage 2 2014-15 Stage 1 2011-13

21. Thank you! Lisa-Nicole.Danehy@hhs.gov