Using Meaningful Use to Improve Quality of Care

1. Using Meaningful Use to Improve Quality of Care Moderator Kevin Larsen, MD Medical Director, Meaningful Use Office of the National Coordinator for Health Information Technology Washington, D.C. Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC Assistant Professor Johns Hopkins University Baltimore, Maryland Developed as part of a Medscape education activity, Using Meaningful Use to Improve Quality of Care, supported by the U.S. Department of Health and Human Services.

2. Program Goals • Summarize Meaningful Use objectives that can be used to help a practice assess its quality of care • Propose opportunities to use Meaningful Use data to plan and implement quality improvement projects in the practice setting

3. Introduction • The Medicare &Medicaid EHR Incentive Programs provide incentive payments to eligible professionals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. CMS website.[1]

4. Meaningful Use: Definition • Meaningful Use is using certified EHR technology to • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and family • Improve care coordination, and population and public health • Maintain privacy and security of patient health information • CMS sets specific objectives for Meaningful Use that eligible professionals, eligible hospitals, and critical access hospitals must meet to qualify for Medicare & Medicaid EHR Incentive Programs

5. Types of Meaningful Use Objectives • Improve quality, safety and efficiency • Reduce health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • Maintain privacy and security across all areas • Interoperability

6. 3 Stages of Meaningful Use • Stage 1 • Data capture and sharing; in general, eligible professionals are in Stage 1 for 2 years • 13 core objectives starting in 2014 • 5 of 9 menu objectives • Stage 2 • Advanced clinical processes • 17 core objectives • 3 of 6 menu objectives • Stage 3 • Improved outcomes CMS website.[2,3]

7. Meaningful Use: Foundation for Quality • Data collected for Meaningful Use are used for attestation in an EHR Incentive Program, but they also can help practices evaluate the care they deliver. • Opportunities include • Better follow-up on chronic conditions • Improved rates of screening and preventive care • More efficient hand-offs between providers • Fewer medication or other errors • Population evaluation to look for patterns of disease or opportunities to improve, and measure results of quality improvement initiatives

8. Stage 2: Measures Related to Quality of Care CMS website.[4]

9. Recording Demographics, Vital Signs, Smoking Status • Opportunities to • Identify patients who should receive preventive care (such as colonoscopy at age 50) • Monitor overall control of hypertension, obesity and other conditions based on BP, BMI, etc • Identify patients who would benefit from substance abuse interventions • Identify trends that could point to the need for new services or interventions (nutrition classes, etc)

10. Stage 2: Measures Related to Quality of Care (cont) CMS website.[5]

11. Lab Results, Medication Reconciliation, and Clinical Decision Support • Opportunities to • Decrease medication errors • Apply evidence-based care algorithms • Reduce number of unnecessary or redundant lab referrals • Compare lab data over time more efficiently

12. Stage 2: Measures Related to Quality of Care (cont) CMS website.[6]

13. Lists and Summaries • What can providers do with generated lists? • What’s important in today’s patient load? • What patients in the population need to be reminded about upcoming preventive care? • Who on the office team can be designated to establish patient reminders?

14. Stage 2: Measures Related to Quality of Care (cont) CMS website.[7]

15. Interoperability • As part of Stage 2 Meaningful Use, eligible professionals are required to demonstrate interoperability as part of measures related to • Transitions of care • Lab exchange • Patient engagement • Public health measures ONC website.[8]

16. Electronic Clinical Quality Measures (eCQMs) • In addition to the Core and Menu Objectives, eligible professionals must select and report on 9 of a possible list of 64 approved eCQMs for the EHR Incentive Programs • Topics range from diabetes to hypertension, cancer screening, and vaccinations • New requirement: quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains: • Patient and Family Engagement • Patient Safety • Care Coordination • Population and Public Health • Efficient use of Health Care Resources • Clinical Processes/Effectiveness CMS website.[9]

17. Electronic Clinical Quality Measures • eCQMs are available to fit the clinical work of most specialties. By selecting eCQMs that best reflect their own practice mix, eligible professionals can fulfill Meaningful Userequirements and build a more accurate picture of their own practice. CMS website.[9]

18. Sample Measures • Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode. • Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer. • Percentage of patients 18-75 years of age with diabetes who had HbA1c> 9.0% during the measurement period.

19. Conclusion • Meaningful Use requires eligible professionals to collect data about patients and their care processes • These data can also help practices become more efficient and provide better care • Choose eCQMs that best match your patient population • Take time to evaluate your data and look for ways to improve! For more information about the incentive programs, visit www.cms.gov/EHRIncentivePrograms

20. Thank you for participatingin this activity. To proceed to the online CME/CE test, click on the Earn CME/CE Credit link on this page.