Kentucky Regional Extension Center

1. Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Kentucky Regional Extension Center Your EHR Resource Contact: Dr. Martha Riddell and Dr. Carol Ireson Meaningful Use Advisors, Kentucky REC Martha.Riddell@uky.edu Clires0@email.uky.edu 859-323-3090

2. Pillars of Meaningful Use 1) Improve quality, safety, efficiency, and reduce health disparities • Provide access to comprehensive patient health data for patient’s health care team • Use evidence-based order sets and CPOE • Apply clinical decision support at the point of care • Generate lists of patients who need care and use them to reach out to patients 2) Engage patients and families • Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health 3) Improve care coordination • Exchange meaningful clinical information among professional health care team 4) Improve population and public health • Submit immunization, syndromic surveillance and reportable disease data to public health agencies 5) Ensure privacy and security protection for personal health information • Protect confidential information through operating policies, procedures, and technologies • Provide transparency of data sharing to patient

3. Kentucky Regional Extension Center Mission The Kentucky Regional Extension Center based at the University of Kentucky will assist primary care providers and critical access/rural hospitals with EHR adoption, HIE participation, and achievement of meaningful use. Vision The long-term vision of the Kentucky Regional Extension Center is to improve the quality and value of health care for the people of Kentucky and to serve as a model for other areas that face similar challenges.

4. Incentives for Meaningful Use (MU) The ARRA/HITECH Act authorizes incentive funding for health care providers who demonstrate “meaningful use of health information technology.” The federal government will pay eligible professionals who meet meaningful use (MU): • Up to $44,000 under Medicare • or Up to $63,750 under Medicaid

5. Medicare Incentives – MU Stages

6. What are the Three Main Components of Meaningful Use? • The Recovery Act specifies the following 3 components of Meaningful Use: Use of certified EHR in a meaningful manner (e.g., e-prescribing) • Use of certified EHR technology for electronic exchange of health information to improve quality of health care • Use of certified EHR technology to submit clinical quality measures(CQM) and other such measures selected by the Secretary

7. How to get to MU: What are the provisions? • Eligible Providers must comply with 20 objectives to reach • meaningful use. • Providers must attest to 15 core objectives along with another • 5 objectives chosen off a menu list of 10 objectives.

8. Thresholds Applicable core objectives and menu objectives have specific thresholds a provider must meet. For more information on thresholds for stage one Meaningful use contact KYREC@UKY.EDU

9. Core Set • Use computerized order entry for medication orders. • Implement drug-drug, drug-allergy checks. • Generate and transmit permissible prescriptions electronically. • Record demographics. • Maintain an up-to-date problem list of current and active diagnoses. • Maintain active medication list. • Maintain active medication allergy list. • Record and chart changes in vital signs. • Record smoking status for patients 13 years old or older. • Implement one clinical decision support rule. • Report ambulatory quality measures to CMS or the States. • Provide patients with an electronic copy of their health information upon request. • Provide clinical summaries to patients for each office visit. • Capability to exchange key clinical information electronically among providers and patient authorized entities. • Protect electronic health information (privacy & security)

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14. Menu Set • Implement drug-formulary checks. • Incorporate clinical lab-test results into certified EHR as structured data. • Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach. • Send reminders to patients per patient preference for preventive/ follow-up care • Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) • Use certified EHR to identify patient-specific education resources and provide to patient if appropriate. • Perform medication reconciliation as relevant • Provide summary care record for transitions in care or referrals. • *Capability to submit electronic data to immunization registries and actual submission. • *Capability to provide electronic syndromic surveillance data to public health agencies and actual transmissions

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18. Menu Set Objective • Submit electronic syndromic surveillance data to public health agencies. • Send reminders to patients (per patient preference) for preventive and follow-up care. • Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication lists, and medication allergies).

19. Clinical Quality Measures In addition to the 20 core and menu measures, providers must report 6 clinical quality measures: • 3 core quality measures • and an additional 3 from a set of 38. *There are no thresholds for these quality measures; providers only need to submit them to meet the requirement.

20. Clinical Quality Measures Core Clinical Quality Measures • Blood Pressure Measurement • Tobacco Use Assessment & Counseling • Adult Weight Screening Alternate Core Measures • Weight Assessment & Counseling for Children • Influenza Vaccination for Pts >50 yrs • Childhood Immunization Status

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22. Clinical Quality Measures Choose 3 of 38 additional clinical quality measures. Examples: Pneumonia Vaccination for Patients 65 Years and Older Screening Mammography Colorectal Cancer Screening Cervical Cancer Screening Controlling High Blood Pressure Asthma: Pharmacologic Therapy Diabetes Mellitus: Foot Exam

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33. Steps for Meaningful Use • Register for the Incentive Program • Medicare: Eligible professionals can register starting in January 2011. • Registration will be online at http://cms.gov/EHrIncentivePrograms/ • Medicaid: The registration process will be the same as for Medicare. A registration link will be available when the New York state program begins. • Implement and meaningfully use certified EHR Technology • Achieve and Attest to the Meaningful Use functional measures and the clinical quality measures • For 2011, CMS will accept provider attestations for demonstration of all the meaningful use measures, including clinical quality measures. • Starting in 2012, CMS will continue attestation for most of the meaningful use objectives but plans for electronic submission of the clinical quality measures. States will also support attestation initially and then subsequent electronic submission of clinical quality measures for Medicaid providers’ demonstration of meaningful use. • Payments • CMS expects to initiate Medicare incentive payments May 2011. For Medicaid, States are determining their own deadlines, but are required to make timely payments. CMS expects that the majority of States will have launched their programs by the summer of 2011.

34. Adopt/Implement/Upgrade for Incentives • MEDICAID –Only for first participation year • Adopted –Acquired and Installed Eg: Evidence of installation prior to incentive • Implemented –Commenced Utilization of Eg: Staff training, data entry of patient demographic information into HER • Upgraded –Expanded Upgraded to certified EHR technology or added new functionality to meet the definition of certified EHR technology • Must be certified EHR technology capable of meeting meaningful use • No EHR reporting period

35. Medicare Incentive Payment Schedule Fall 2010 Certification of EHR vendors will start April 2011 Attestation of meaningful use begins 2011-2012 Clinicians can begin using a certified EHR in a meaningful Manner (must use for 90 days) 2010 2011 Jan. 2011 Registration with CMS can begin. This will be done through PECOS May 2011 CMS payments Will begin *Medicaid EHR incentives will be managed by states

36. Questions? http://hitrc-collaborative.org/jeopardy/frameset.htm

37. Contact Information Dr. Martha Riddell Meaningful Use Advisor Kentucky REC Martha.Riddell@uky.edu 859-323-3090 Dr. Carol Ireson Meaningful Use Advisor Kentucky REC Clires0@email.uky.edu 859-323-3090 General REC Information Contact: Kentucky Regional Extension Center 2333 Alumni Park Plaza, Suite 200 Lexington, KY 40517 Toll Free: 866-KY-RECEHR 859-323-3090 KYREC@uky.edu