Care Coordination and Interoperable Health IT Systems

1. Care Coordination and Interoperable Health IT Systems Unit 7: Policy and Interoperable Health IT Lecture c – Meaningful Use, ONC Certification, and Interoperability (Part 2) This material (Comp 22 Unit 7) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Policy and Interoperable Health ITLearning Objectives • Objective 1: List and discuss the impact of key health interoperability related topics in health care legislation (Lecture a) • Objective 2: Identify and discuss how the Meaningful Use program and the ONC certification programs have impacted interoperable health IT (Lectures b and c) • Objective 3: Assess and leverage Meaningful Use, ONC certification, and other health IT policy activities to facilitate interoperability (Lecture d)

3. Stage 3 regulations were released October 7, 2015 • Meaningful Use (MU): • Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 through 2017 • Standards and Certification: • 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications

4. Stage 3 regulations included new timeline and “Modified Stage 2” 7.5 Table (U.S. Department of Health and Human Services, 2015)

5. Modified Stage 2: eligible providers 7.6 Table (Lorenzi, V., 2016). Adapted from U.S. Department of Health and Human Services, 2015.

6. Modified Stage 2: eligible providers (Cont’d – 1) 7.7 Table (Lorenzi, V., 2016). Adapted from U.S. Department of Health and Human Services, 2015.

7. Modified Stage 2: eligible hospitals 7.8 Table (Lorenzi, V., 2016). Adapted from U.S. Department of Health and Human Services, 2015.

8. Modified Stage 2: eligible hospitals (Cont’d – 1) 7.9 Table (Lorenzi, V., 2016). Adapted from U.S. Department of Health and Human Services, 2015.

9. Stage 3’s primary focus is interoperability • Stage 3 objectives, with interoperability-specific ones in bold: • Protection of Electronic Health Information • Electronic Prescribing (EP 60%, EH 25%) • Clinical Decision Support • Computerized Provider Order Entry (CPOE) • Patient Electronic Access to Health Information • Coordination of Care through Patient Engagement • Health Information Exchange (HIE) • Public Health and Clinical Data Registry Reporting • MU Stage 3 also requires electronic submission of quality measure data. • IPPS and MIPS also require use of the eCQMeSubmission

10. Stage 3 Objective 5: Patient Electronic Access, Measure 1 • For more than 80% of all unique patients seen by the eligible provider or discharged from eligible hospital: • The patient (or the patient authorized representative) is provided timely access to view online, download, and transmit his or her health information; and • The eligible provider ensures the patient’s health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the API in the provider’s certified EHR technology

11. Stage 3 Objective 5: Patient Electronic Access, Measure 2 • The eligible provider must use clinically relevant information from certified EHR technology to identify patient-specific educational resources and provide electronic access to those materials to more than 35% of unique patients seen by the eligible provider or discharged from eligible hospital

12. Stage 3 Objective 6: Coordination of Care through Patient Engagement, Measure 1 • More than 10% of all unique patients (or patient-authorized representative) seen by the eligible provider or discharged by the eligible hospital actively engage with the EHR made accessible by the provider. An eligible provider may meet the measure by either: • (1) view, download, or transmit to a third party their health information; or • (2) access their health information through the use of an API that can be used by applications chosen by the patient and configured to the API in the provider's certified EHR technology; or • (3) a combination of (1) and (2)

13. Stage 3 Objective 6: Coordination of Care through Patient Engagement, Measures 2 and 3 • Measure 2: For more than 25% of all unique patients seen by the eligible provider or discharged by the eligible hospital during the EHR reporting period, a secure message was sent using the electronic messaging function of certified EHR technology to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative.) • Measure 3: Patient-generated health data or data from a non-clinical setting is incorporated into the certified EHR technology for more than 5% of all unique patients seen by the eligible provider or discharged from the eligible hospital during the EHR reporting period

14. Stage 3 Objective 7: Health Information Exchange, Measure 1 • For more than 50% of transitions of care and referrals, the eligible provider or eligible hospital that transitions or refers their patient to another setting of care or provider of care: • (1) creates a summary of care record using certified EHR technology; and • (2) electronically exchanges the summary of care record

15. Stage 3 Objective 7: Health Information Exchange, Measures 2 and 3 • Measure 2: For more than 40% of transitions or referrals received and patient encounters in which the eligible provider has never before encountered the patient, the eligible provider or eligible hospital receives or retrieves and incorporates into the patient's record an electronic summary of care document • Measure 3: For more than 80% of transitions or referrals received and patient encounters in which the eligible provider or eligible hospital has never before encountered the patient, the eligible provider performs clinical information reconciliation

16. Stage 3 Enhanced Common Clinical Data Set (CCDS) for Patient Engagement and HIE • Patient Name • Sex • Date of Birth • Race • Ethnicity • Preferred Language • Smoking Status • Medications • Medication Allergies • Laboratory Tests • Laboratory Value / Results • Vital Signs • Procedures • Care Team Members • Immunizations • Unique Device Identifiers • Assessment and Plan of Treatment • Goals • Health Concerns

17. Stage 3 Patient Engagement:CCDS and these fields • Laboratory test reports • Diagnostic image reports • Activity history log • Ambulatory setting • Provider name • Office contact information • Inpatient setting • Admission and discharge dates and locations • Discharge instructions • Reason(s) for hospitalization

18. Stage 3 Health Information Exchange: CCDS and these fields • Encounter diagnosis • Cognitive status • Functional status • Ambulatory setting • Reason for referral • Referring provider’s name and office contact information • Inpatient setting • Discharge instructions • Patient matching • First name, last name, previous name, middle name, suffix, date of birth, address, phone number, and sex

19. Stage 3 Objective 8: Public Health • Eligible providers choose two, eligible hospitals choose four • Measure 1: Immunization Registry Reporting • Measure 2: SyndromicSurveillance Reporting • Measure 3: Electronic Case Reporting • Measure 4: Public Health Registry Reporting • Measure 5:Clinical Data Registry Reporting • Measure 6: Reportable Lab Results Reporting (EH only)

20. ONC 2015 features to support interoperability • Adopts new and updated vocabulary and content standards for enhanced interoperability • Includes enhanced data export and transitions of care functionality • Provides an application programming interface (API) to access EHR data • Includes health IT to support a variety of care and practice settings, such as long-term care and behavioral health • (ONC 2015 Fact Sheet)

21. Meaningful Use interoperability: patient-centered care 7.10 Table (Lorenzi, V., 2016).

22. Meaningful Use interoperability: care coordination 7.11 Table (Lorenzi, V., 2016).

23. Meaningful Use interoperability: learning health system 7.12 Table (Lorenzi, V., 2016).

24. Merit-based Incentive Payment System (MIPS) • Is an incentive program that replaces Meaningful Use for Medicare eligible professionals • Requires most of the Meaningful Use objectives that are in the Modified Stage 2 and Meaningful Use Stage 3 rule • However, not all thresholds are required • Meaningful Use is only a percentage of the requirements needed to obtain incentives • Note: Does not apply to hospitals • https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm

25. Unit 7: Policy and Interoperable Health IT, Summary – Lecture c, Meaningful Use, ONC Certification, and Interoperability (Part 2) • Stage 3 and Modified Stage 2 Meaningful Use was released in October 2015 • Stage 3 included more data types and 2015 ONC certification requirements to support interoperability • Stage 3’s primary focus was interoperability, with specific objectives that also encouraged patient-centered care, care coordination, and the learning health system

26. Policy and Interoperable Health IT References – Lecture c (Cont’d) References Office of the National Coordinator for Health Information Technology (2015). ONC Fact Sheet: 2015 Edition Health IT Certification Criteria, Base EHR Definition, and ONC Health IT Certification Program Modifications Final Rule. https://www.healthit.gov/sites/default/files/factsheet_draft_2015-10-06.pdf. U.S. Government (2016). Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. (2016). https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm Charts, Tables, Figures 7.5 Table: U.S. Department of Health and Human Services. (2015). https://www.gpo.gov/fdsys/pkg/FR-2015-10-16/pdf/2015-25595.pdf. 7.6 Table: Lorenzi, V. (2016). Modified Stage 2: eligible providers. Adapted from U.S. Department of Health and Human Services, 2015.

27. Policy and Interoperable Health IT References – Lecture c Charts, Tables, Figures 7.7 Table: Lorenzi, V. (2016). Modified Stage 2: eligible providers (Cont’d – 1). Adapted from U.S. Department of Health and Human Services, 2015. 7.8 Table: Lorenzi, V. (2016). Modified Stage 2: eligible hospitals. Adapted from U.S. Department of Health and Human Services, 2015. 7.9 Table: Lorenzi, V. (2016). Modified Stage 2: eligible hospitals. (Cont’d – 1). Adapted from U.S. Department of Health and Human Services, 2015. 7.10 Table: Lorenzi, V. (2016). Meaningful Use interoperability: patient-centered care. 7.11 Table: Lorenzi, V. (2016). Meaningful Use interoperability: care coordination. 7.12 Table: Lorenzi, V. (2016). Meaningful Use interoperability: learning health system.

28. Unit 7: Policy and Interoperable Health IT, Lecture c – Meaningful Use, ONC Certification, and Interoperability (Part 2) This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004.