Series 1: Meaningful Use for Behavioral Health Providers

1. Series 1: Meaningful Use for Behavioral Health Providers From the CIHS Video Series “Ten Minutes at a Time” Module 2: The Role of the Certified Complete Electronic Health Record in Meaningful Use 9/2013

2. Module 2 Outline • Three key terms and one requirements • Required “functionality” in the Certified Complete EHR • Getting help - resources for technical assistance and training

3. Three Key Terms… • Certified for Ambulatory(Outpatient) Practice- EHR is certified for use in outpatient settings (as opposed to inpatient or hospital setting) • Complete –EHR includes all of the components necessary for meeting ALL of the standards for Stage 1 Meaningful Use • Certified – Passed tests by an “Office of the National Coordinator– Authorized Testing and Certification Body” (ONC-ATCB) verifying that the EHR meets the certification criteria to use the EHR to meet the standards for Stage 1 Meaningful Use • http://www.gpo.gov/fdsys/pkg/FR-2010-07-28/pdf/2010-17210.pdf

4. …and One Important Requirement • Meaningful Use (MU) rolled out in stages* • Stage 1 MU requires EHRs certified for Stage 1 (“2011 Edition”) • Stage 2 MU requires EHRs certified for Stage 2 (“2014 Edition”) • Stages apply to qualifying for the Eligible Professional Incentive Program payments • Can start participating in Stage 1 anytime until 2016 and collect incentives for two years before continuing to Stage 2 • * https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTablesforEP.pdf

5. Core Objectives* • 1. Computerized provider order entry (CPOE) • 2. E-Prescribing (eRx) • 3. Report ambulatory clinical quality measures to CMS/States • 4. Implement one clinical decision support rule • 5. Provide patients with an electronic copy of their health information, upon request • 6. Provide clinical summaries for patients for each office visit • 7. Drug-drug and drug-allergy interaction checks • 8. Record demographics • 9. Maintain an up-to-date problem list of current and active diagnoses • 10.Maintain active medication list • 11.Maintain active medication allergy list • 12.Record and chart changes in vital signs • 13.Record smoking status for patients 13 years or older • 14.Capability to exchange key clinical information among providers of care and • patient-authorized entities electronically • 15.Protect electronic health information • * https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EP-MU-TOC.pdf

6. Menu Objectives (may defer 5 of 10 to Stage 2) • 1. Drug-formulary checks • 2. Incorporate clinical lab test results as structured data • 3. Generate lists of patients by specific conditions • 4. Send reminders to patients per patient preference for preventive/follow up care • 5. Provide patients with timely electronic access to their health information • 6. Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate • 7. Medication reconciliation • 8. Summary of care record for each transition of care/referrals • 9. Capability to submit electronic data to immunization registries/systems* • 10. Capability to provide electronic syndromic surveillance data to public health agencies* • * At least 1 public health objective must be selected.

7. Example Certified EHR Functionality and MU Objectives/Measures • Core Objective #5 (what the Eligible Professional needs to do) • “Maintain Active Medication List” • Measure: “More than 80% of all unique patents seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data” • Certified EHR Technology (CEHRT) “Functionality” Certification Criterion • Final Rule Text: § 170.302(d). Maintain active medication list. Enable a user to electronically record, modify, and retrieve a patient’s active medication list as well as medication history for longitudinal care.

8. What “Certified” and “Complete” Do NOT Mean! • “Certified” does NOT guarantee a degree of quality • “Certified” only assures the buyer that the software meets the minimum standards, specifications and criteria for Stage 1 Meaningful Use • “Complete” does not mean that the software will meet all of your organization’s requirements • “Complete” means that the EHR will allow the eligible professional to implement the workflows and collect, access and utilize the patient data necessary to meet all 15 Core and all 10 Menu Objectives and Measures for Meaningful Use

9. Key Differences Among Certified EHRs • “Complete” as an EHR Business Product • Scenario 1 - All of the required functionality is built into the single software product. No additional certified software modules (for example, for ePrescribing) are required. • Scenario 2 - Individual software modules are “certified” but they have to be purchased separately and used together to make the EHR “complete.”

10. Key Differences, continued • Robust vs Anemic Meaningful Use Functionality • Anemic – meets minimum requirement • Robust – meets requirement and includes not-required but Meaningful Use applicable additional functionality • Example: Continuity of Care Record • Patient data set may include data in up to 17 areas of information • To meet certification criteria, the EHR only has to populate the minimum data set for 7 areas

11. Summary • Two basic types of certified EHRS – Ambulatory and Inpatient practice types • “Complete” refers to EHR functionality needed for meeting ALL if the Meaningful Use Measures/Objectives • “Certified” refers to the successful completion of the ONC-ATCB testing process EHR • Two Stages that the EHR can be certified in – Edition 1 (2011) for Stage 1, Edition 2 (2014) for Stage 2 • “Complete, Certified for Editions 2011 and 2014” does not indicate a level of quality, just a minimum standard for functionality

12. We Have Solutions for Integrating Primary and Behavioral Healthcare Contact CIHS for all types of primary and behavioral health care integration technical assistance and training needs 1701 K Street NW, Ste 400 Washington DC 20006 Web: www.integration.samhsa.gov Email: integration@thenationalcouncil.org Phone: 202-684-7457 Prepared and presented by Colleen O’Donnell, MSW, PMP, CHTS-IM for the Center for Integrated Health Solutions