Today’s Objectives

1. Meaningful Use Overview Essentials for CAC’sJoAnne HawkinsMeaningful Use Field Team LeadDNC (Contractor) for  U.S. Indian Health ServiceFebruary 13, 2012

2. Today’s Objectives • Understand CMS EHR Incentive Program • Understand and differentiate the Meaningful Use Performance Measures and Meaningful Use Clinical Quality Measures • Review the current Meaningful Use performance Measures as they pertain to Clinical Application Coordinators

3. Meaningful Use

4. Meaningful Use: What is Meaningful Use? • Meaningful Use is using certified EHR technology to: • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • All the while maintaining privacy and security

5. Stage 3 2015+ Stage 2 2013-2014 Stage 1 2011-2012 Meaningful Use: Stages of Meaningful Use • 3 stages of Meaningful Use • Requirements will increase over time…more work lies ahead

6. EP Incentive Estimation CY11

7. $3,419,656 Hospital Incentives FY11 $608,000 $5,277,871 $1,727,019 $1,894,466 $2,584,199 $400,000 $2,730,769 $750,504

8. EH Incentive Estimation FY11

9. EHR Certification

11. EHR Certification: EHR Certification Number* • Inpatient Certification #: 30000002ELL6EAI • Ambulatory Certification #: 30000002EJKDEAI *The number will be entered during CMS registration and attestation

12. EHR Certification: Vendor Letter • Request Vendor Letter on the IHS MU website at http://www.ihs.gov/meaningfuluse/index.cfm?module=steps_request_letter • Enter information in each of the fields on the webpage • Click the “Submit” button • IHS will process the request for each facility • IHS will issue a letter to the requesting practice within 10 business days of the initial request • The facility will receive the signed IHS EHR Vendor Letter via email • The letter will be emailed to the individual that made the request

13. Eligible professionals & Hospitals

15. Eligible Professionals: Medicare & Medicaid Comparison Medicare-only Eligible Professionals Medicaid-only Eligible Professionals Professionals may be eligible for both Medicare & Medicaid, but can only participate in one program at a time Could be eligible for both Medicare & Medicaid incentives

16. Eligible Hospitals: Medicare & Medicaid Comparison Hospitals only eligible for Medicare incentive Hospitals only eligible for Medicaid incentive Could be eligible for both Medicare & Medicaid (most hospitals)

17. Eligible Professional: Incentive Program Timeline

18. Eligible Hospital: Incentive Program Timeline

19. Medicaid FOREligibleprofessionals & hospitals

20. Eligible Professionals & Medicaid: Patient Volume Threshold * All Tribal clinics are deemed FQHC/RHC for the CMS incentive program

21. Eligible Hospital: Medicaid Patient Volume Requirement Medicare does not have a patient volume threshold

22. Incentives

23. Eligible Professionals: Summary of Medicare & Medicaid Incentives

24. Eligible Professionals: Medicare Incentive Payment Example

25. Eligible Professionals: Medicaid Incentive Payment Example

26. Eligible Hospital: Medicare & Medicaid Incentive Summary

27. Performance Measures

28. Eligible Professionals: Meaningful Use Requirements • STAGE 1: Meaningful Use Requirements • 20 total Performance Measures • 15 core performance measures* • 5 performance measures out of 10 from menu set* • 6 total Clinical Quality Measures • 3 core or alternate core • 3 out of 38 from menu set • * Most measures require achievement of a performance target

29. Eligible Hospital: Meaningful Use Requirements • STAGE 1: Meaningful Use Requirements • 19 total Performance Measures • 14 core performance measures* • 5 performance measures out of 10 from menu set* • 15 total Clinical Quality Measures • * Most measures require achievement of a performance target

30. Performance Measures

31. Performance Measures

32. Eligible Professionals: Clinical Quality Measures Core Set: If denominator = 0, must report on the Alternate Core measures Alternate Core Set

33. Eligible Professionals: 38 Additional Clinical Quality Measures (Choose 3) • Diabetes: (9) • Heart Failure (HF): (3) • Coronary Artery Disease (CAD): (3) • Pneumonia Vaccination Status for Older Adults • Anti-depressant medication management: (2) • Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation • Asthma: (3) • Appropriate Testing for Children with Pharyngitis • Cancer Prevention and/ or Oncology: (6) • Smoking and Tobacco Use Cessation,(3) • Ischemic Vascular Disease (IVD): (3) • Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (2) • Prenatal Care: (2) • Controlling High Blood Pressure • Chlamydia Screening for Women • Low Back Pain: Use of Imaging Studies

34. Eligible Hospitals: 15 Clinical Quality Measures • Emergency Department Throughput – admitted patients • Median time from ED arrival to ED departure for admitted patients • Emergency Department Throughput – admitted patients • Admission decision time to ED departure time for admitted patients • Ischemic stroke – Discharge on anti-thrombotics • Ischemic stroke – Anticoagulation for A-fib/flutter • Ischemic stroke – Thrombolytic therapy for patients arriving within 2 hours of symptom onset • Ischemic or hemorrhagic stroke – Antithrombotic therapy by day 2 • Ischemic stroke – Discharge on statins • Ischemic or hemorrhagic stroke – Rehabilitation assessment • VTE prophylaxis within 24 hours of arrival • Anticoagulation overlap therapy • Ischemic or Hemorrhagic stroke – Stroke Education • Intensive Care Unit VTE prophylaxis • Platelet monitoring on unfractionated heparin • VTE discharge instructions • Incidence of potentially preventable VTE

35. Lessons Learned

36. Patient Wellness Handout (PWH) • Clinical Summaries: Clinical summaries provided to patients for >50% of all office visits within three business days. • Configuration: • Configure Patient Wellness Handout (PWH) within the EHR. • Provide patients their PWH at each patient encounter. • Monitor PWH count report. • The RPMS system automatically maintains a count of each PWH that is printed. • Note: Minimum required data elements include (1) medication list; (2) allergy list; (3) problem list; and (4) lab results

37. Patient Wellness Handout (PWH) • Patient Reminders: >20% of all unique patients who are 0-5 or 65+ years for whom a PWH was printed during the EHR reporting period. • Generate and provide a Patient Wellness Handout (PWH) to patients <=5 or 65+ years who are due for a screening/care. • Configuration: • Create a PWH • Add reminders such as: future visit, immunization due, women’s health • Attach it to a VA Health Summary type • BJPC, patch 7 delivers the future visit appointments and other useful components • What would lower your rate for this measure? • • Not inactivating records for inactive patients according to site policy. • • Not inactivating records for deceased patients in a timely manner. • Note: Printing of the PWH is counted for this measure.

38. Medication Reconciliation • Medication Reconciliation: Perform medication reconciliation for >50% of transitions of care in which the patient is transitioned into the care of the EP. • Configuration: • EP must document Medication Reconciliation patient education code (M-MR). • Provide patient with medication reconciliation PWH. • Perform the medication reconciliation for transitions of care. • Notes: • • Printing the Patient Wellness Handout (PWH) and presenting a copy to the patient is recommended as this will allow the EP to meet additional Performance Measures. • • This MU Performance Measure addresses medication reconciliation when an EP receives a patient into care, but other accreditation bodies (e.g., the Joint Commission, AAAHC) require MR to be done at every transition of care.

39. C32 • There are two C32 Buttons • The standalone button in EHR meets Electronic Copy of Health Information and Electronic Exchange of Clinical Information • The C32 button in RCIS meets Transition of Care Summary

40. C32 • Electronic Copy of Health Information: >50% of all patients of the EP who request an electronic copy of their health information during the EHR reporting period are provided it within three business days. • Configuration: • Configure PCC Health Summary, Patient Wellness Handout (PWH), Discharge Summary, and Discharge Instructions within the EHR. • Provide the information electronically to the patient, such as by CD provided by the facility or encrypted e- mail (HIM). • Document in Release of Information (ROI) requests for electronic copy of health information (enter as Patient/Agent Request Type=Electronic). • Document in ROI information was provided electronically (enter as Record Dissemination =Electronic) AND record the Disclosure Date

41. C32 • Electronic Exchange of Clinical Information: Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information. • Configuration: • This will be accomplished using the C32 button to enable delivery of C32 documents to outside destinations. • All federal sites will perform the test by submitting their C32s to the IHS national repository. • Results from this test should be entered as a “Yes” or “No” in the Stage 1 Meaningful Use Performance Report for EPs for the purposes of attestation. • Tribal RPMS sites have the option to perform the test as described above or with another entity (e.g. a state Health Information Exchange (HIE). • Note: Master Patient Index patch will need to be installed for testing to take place. Each site will need to coordinate with their area office for testing.

42. C32 • Transition of Care Summary: The EH/CAH that transitions or refers their patient to another care setting/provider provides a summary of care record for >50% of transitions of care/referrals. • Configuration: • Print C32 Summary of Care record for all active referrals and give to patient and/or receiving provider. • Access the RCIS tab to view list of referrals, including those that have not had a C32 printed. • To print a C32, select the patient, click Referrals tab, click the referral, and click the “Print C32 for Referral” button • Or RCIS staff views a list of active referrals for which C32s need to be printed by running the “Active Referrals without a Printed C32” report from the Administrative Reports menu. They can then login to the RPMS EHR to • print the C32 for a specific referral and provide to the patient and/or receiving provider.

43. MUCD • Drug Interaction Checks: The EP has enabled this functionality for the entire EHR reporting period. • Configuration: Establishing Meaningful Use Clean Date (MUCD) • Enable and set to mandatory ten order checks to include: (1) Allergy- Contrast Media Interaction, (2) Allergy- Drug Interaction, (3) Critical Drug Interaction, (4) Dangerous Meds for Patients >64, (5) Estimated Creatinine Clearance, (6) Glucophage-Contrast Media, (7) Glucophage-Lab Results, (8) No Allergy Assessment, (9) Allergy Unassessible and (10) Renal Functions Over Age 65. • Run the MUCD (Meaningful Use Clean Date) system check in PCC to verify that order checks are configured correctly. • Configure order checks and run the MUCD prior to the first day of the EHR reporting period. • What would prevent you from meeting this measure? • • Not having your order checks configured correctly. • • Not running the MUCD prior to the first day of the EHR reporting period. • Note: When site is configured correctly, the MUCD will be set equal to that day’s date. Running the option again doesn’t reset the date. The initial clean date remains the same.

44. Taxonomies • Identify Taxonomies that should be populated for Meaningful Use and coordinate with GPRA coordinator. Taxonomies affect Clinical Quality Measures. • Add to taxonomies but never delete from the list. • Taxonomies can be view and edited through iCare or RPMS with appropriate keys.

45. Meaningful use Reports

47. WHAT DOES A CAC REALLY NEED TO KNOW • Differences/commonalities between: • -CORE SET and MENU SETS • -PERFORMANCE MEASURES and CLINICAL QUALITY MEASURES • -MEASURES FOR EH/CAH versus EP • Reports that demonstrate reaching meaningful use • Measures that require attestation only • Effects of accurate and timely completion of coding queue on MU • Effects of inpatient coding and clinical documentation on reaching CQM • Effects of PCC errors on MU • Effects of complete and comprehensive patient registration on MU

48. Area MU Coordinators

49. Area MU Consultants(contractors)

50. IHS Meaningful Use: Contact Information • Chris Lamer, Meaningful Use Project Lead, IHS (615) 669-2747 Chris.Lamer@ihs.gov • Cathy Whaley, Meaningful Use Project Manager, DNC (520) 622-2069 Catherine.Whaley@ihs.gov • JoAnne Hawkins, MU Field Team Lead, DNC (505) 382-4228 JoAnne.Hawkins@ihs.gov