Meaningful Use Stage 1 & 2 Helping Colorado Providers Achieve

Meaningful Use Stage 1 & 2 Helping Colorado Providers Achieve Meaningful Use Tracy Rue Senior Consultant, Colorado Regional Extension Center

Agenda Three Stages of Meaningful Use Stage 1 & 2 Timing Regional Extension Center Objectives Comparing Stages 1 & 2 Clinical Quality Measures Stages 1 & 2 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Meaningful Use: Laying the Foundation for Future Advances Meaningful Use Stage 3: Fully integrated systems, reductions in errors & duplications, improved cost effectiveness, better coordinated care Meaningful Use Stage 2: Exchanging clinical data with other sources, tracking clinical outcomes, targeted patient-care initiatives, patient access to selfmanagement tools Stage 3: Home is Built Stage 2: Walls & Windows Stage 2: Walls & Windows Meaningful Use Stage 1: Using electronic systems, structured data, point-of-care protocols, improved care coordination, security protocols & HIPAA standards in place 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Meaningful Use Timing Incentive Payment Year First Program Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 201 1 1 1 2* 2 3 3 TB TB TB TB 1 D D D D 201 2 201 3 201 4 201 5 1 1 2* 2 3 3 TB D TB D TB D TB D 1 1* 2 2 3 3 TB D TB D TB D 1* 1 2 2 3 3 TB D TB D 1 1 2 2 3 3 TB D 201 1 1 2 2 3 *3-month quarter EHR reporting period for Medicare and 6 continuous 90-day reporting for Medicaid1EPs. 1 201 2 2 7 3 3 4

Colorado Regional Extension Center M U Colorado REC’s mission is to provide the training and support services necessary for primary care providers in small practices, Rural Hospitals and Critical Access Hospitals to achieve Stage 1 Meaningful Use Adopt EHR Select & Implement EHR Determine HIT & EHR Readiness CORHIO has partnered with six healthcare organizations across Colorado to work with 2,295 providers and 33 rural and critical access hospitals to achieve the goals of the grant SUCCESS! 97% of participating providers have gone live on their EHR and 42% have reached Meaningful Use 85% of participating Rural and Critical Access hospitals have gone live and 67% have reached Meaningful Use 5

The EHR Incentive Programs

What is the EHR Incentive Program? HITECH Act of 2009/American Recovery & Reinvestment Act – Meaningful Use of Certified Electronic Health Records Technology (CEHRT) Three Stages (currently in Stage 1) Two programs: – Medicare » Opened in 2011 for Meaningful Use demonstration » Eligible Professionals, Eligible Hospitals and Critical Access Hospitals – Medicaid » Opened in 2012 for Adopt, Implement or Upgrade of a CEHRT » Opened in 2013 for Meaningful Use » Eligible Professionals, Eligible Hospitals and Critical Access Hospitals

Who is Eligible for Medicare EHR Incentives? Eligible Providers - Medicare Eligible Professionals (EPs)* Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Podiatric Medicine Doctor of Ophthalmology Chiropractor To qualify for an incentive payment under the Medicare EHR Incentive Program, an eligible professional must: Bill Medicare FFS “straight Medicare” Medicare Provider in good-standing Hospital-based providers are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place of Service code 21) or emergency room (Place of Service code 23) setting. 8

Incentive Payments for Medicare EPs Medicare Incentive is 75% of total allowed charges, based on a calendar year Calendar Year CY 2011 2011 18,000 2012 12,000 18,000 2013 8,000 12,000 15,000 2014 4,000 8,000 12,000 12,000 2015 2,000 4,000 8,000 8,000 -1% 2,000 4,000 4,000 -2% 2016 CY 2012 CY 2013 CY 2014 CY 2015 and later 2017 -3% 2018 -4% 2019 -5% TOTAL 44,000 44,000 39,000 24,000 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution 0

Who is Eligible for Medicaid EHR Incentives? Eligible Providers - Medicaid Eligible Professionals (EPs)* Physicians Nurse Practitioners (NPs) Certified Nurse-Midwives (CNMs) Dentists Physician Assistants (PAs) who lead a FQHC or RHC To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria: Have a minimum 30% Medicaid patient volume* Have a minimum 20% Medicaid patient volume and is a pediatrician* Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria Hospital-based providers are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place of Service code 21) or emergency room 10

Incentive Payments for Medicaid EPs Medicaid EPs can start receiving payments any time from CY 2011 through 2016, and there is no penalty for starting later – Payments based on participation year, so EPs can have gaps in meeting Meaningful Use requirements and still receive max No Medicaid payment reductions for not meeting Meaningful Use Calendar Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 CY 2011 TOTAL 63,750 63,750 63,750 63,750 63,750 63,75 0 21,250 8,500 8,500 8,500 8,500 8,500 CY 2012 21,250 8,500 8,500 8,500 8,500 8,500 CY 2013 21,250 8,500 8,500 8,500 8,500 8,500 CY 2014 21,250 8,500 8,500 8,500 8,500 8,500 CY 2015 21,250 8,500 8,500 8,500 8,500 8,500 CY2016 21,250 8,500 8,500 8,500 8,500 8,500 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved CORHIO Proprietary - Not For Redistribution

Stage 1 & Stage 2 Meaningful Use

Definitions Structured Data (Discrete Data) – Data that is identifiable because it is organized in a structure (i.e. ICD-9, SNOMED) Denominator (MU) – Example: The number of Unique Patients seen within the reporting period Numerator (MU) – Example: The number of times the Meaningful Use Objective was met Unique Patient – A Unique patient means that even if a patient is seen multiple times during the reporting period they are only counted once.

Stage 2 Goals & Intentions Alignment of Clinical Quality Measures with other reporting programs Improving Patient Care with new objectives to improve patient care through better clinical decision support, care coordination and patient engagement Rigorous expectations for HIE through increased emphasis on exchanging clinical summary documents to improve care coordination, public health reporting and importing lab results in a structured manner

Stage 1 to Stage 2 Overview Stage 1 Stage 2 Eligible Professionals 15 Core 5 of 10 Menu 20 total objectives Eligible Professionals 17 Core 3 of 6 Menu 20 total objectives Eligible Hospitals and CAHs 14 Core 5 of 10 Menu 19 total objectives Eligible Hospitals and CAHs 16 Core 3 of 6 Menu 19 total objectives Adapted from HealthIT.gov

What are the Requirements of Stage 2 Meaningful Use? Core Objectives Menu Set Objectives Clinical Quality Measures

Meaningful Use - Core Objectives

Patient Check In & Out Stage 1 Objective Record demographics Race Ethnicity Preferred Language DOB Provide clinical summaries for patients for each office visit Stage 1 Measure Stage 2 Objective Stage 2 Measure 50% of all unique patients Record demographics 80% of all unique patients 50% of all office visits within 3 business days Provide clinical summaries for patients for each office visit 50% of all office visits within ONE business day

Rooming Patient Stage 1 Objective Stage 1 Measure Maintain active medication list 80% of all unique patients Maintain active medication allergy list 80% of all unique patients Record and chart changes in vital signs: Height, Weight, BP, BMI 50% of all unique patients age 2 and older Record smoking status for patients 13 years or older 50% of all unique patients 13 years or older Stage 2 Objective Stage 2 Measure No longer a Incorporated into separate Transitions of objective for Stage Care 2 No longer a Incorporated into separate Transitions of Care objective for Stage 2 Record and chart 80% of all unique changes in vital signs patients 3 years and older BP and Height and Weight can be reported separately. Record smoking status for patients 13 years or older 80% of all unique patients

Patient Exam Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Maintain an upto-date problem list 80% of all unique patients seen No longer a separate objective for Stage 2 Incorporated into Transitions of Care Implement one clinical decision support rule relevant to specialty Implement one clinical decision support rule Use clinical decision support to improve performance on high-priority health conditions Implement 5 clinical decision support interventions Report CQMs Report 6 CQMs No longer a separate objective CQMs submitted electronically to CMS

Patient Exam Stage 1 Objective Medication Reconciliation Stage 1 Measure 50% of patients who transitioned into the care of the EP Stage 1 Menu Set Stage 2 Objective Medication Reconciliation Stage 2 Measure 50% of transitions of care in which the patient is transitioned into the care of the EP

Orders and Point of Care Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Use CPOE for medication orders 30% of unique patients Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders 60% of Medication 30% of laboratory 30% of radiology orders Implement drugdrug and drugallergy interaction checks The EP has enabled this functionality for the entire EHR reporting period No longer a separate objective for Stage 2 Incorporated into the Stage 2 Clinical Decision Support measure

Orders and Point of Care Stage 1 Objective Stage 1 Measure Generate and transmit permissible prescriptions electronically (eRx) Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate 40% of all permissible prescriptions 10% of all unique Stage 1 Menu Set Stage 2 Objective Generate and transmit permissible prescriptions electronically (eRx) Use certified EHR technology to identify patientspecific education resources and provide those resources to the patient if appropriate Stage 2 Measure 50% of all permissible prescriptions Patient-specific education resources identified by CEHRT provided to patients for more than 10% of all unique patients seen by EP during the EHR reporting period

Orders and Point of Care Stage 1 Objective Stage 1 Measure Implement drugformulary checks Enabled functionality Stage 1 Menu Set Stage 2 Objective Stage 2 Measure Incorporated into No longer a the e- Prescribing separate objective for Stage measure for Stage 2 2

Clinical Administration Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Give patients electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP 50% of all unique patients seen by the EP within 4 business days after the information is available have online access to their health information 5% of all unique patients seen by the EP (or their authorized representatives) view, download or transmit their health information to a

Clinical Administration Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Capability to exchange key clinical information Performed at least one test Eliminated from Stage 1 in 2013 No longer an objective for Stage 2 Eliminated from Stage 1 in 2013 No longer a measure for Stage 2 Incorporate clinical lab test results into certified EHR technology as structured data 40% Stage 1 Menu Set Incorporate clinical lab test results into certified EHR technology as structured data 55%

Clinical Administration Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Generate at least one Generate lists of Generate at least one Generate lists of patients patients by specific report listing patients report listing patients by specific conditions conditions to use for of the EP with a of the EP with a to use for quality quality improvement, specific condition specific condition improvement, reduction of Stage 1 Menu Set reduction of disparities, research disparities, research, or outreach or outreach Send reminders to patients per patient preference for preventive/follow-up care 20% of all unique patients 65 years or older or 5 years old Stage 1 Menu Set Use clinically relevant 10% of all patients with two or more information to identify patients who office visits in the last 2 years should receive reminders for preventive/follow-up care

Clinical Administration Stage 1 Objective Stage 1 Measure Provide patients 10% of all with unique patients timely electronic seen by the EP are access to their provided timely health information (available to the patient within four business days of being updated in the certified EHR technology) Stage 1 Menu Set Stage 2 Objective Stage 2 Measure Eliminated from Stage 1 in 2014 No longer an objective for Stage 2 Eliminated from Stage 1 in 2014 No longer a measure for Stage 2

Clinical Administration Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure The EP who 50% of The EP who 50% of transitions transitions transitions of care transitions of care and referrals 10% electronically their patient to their patient to This measure another setting of another setting of combines Stage 1 Stage 1 Menu care should care should provide summary provide summary core items – problem of care record for of care record for list, active medication list and active each transition of each transition of medication allergy care or referral care or referral list - to emphasize increased data exchange

Clinical Administration Stage 1 Objective Stage 1 Measure Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice Performed at least one test NEW Stage 1 Menu NEW Stage 2 Objective Stage 2 Measure Capability to submit Successful ongoing electronic data to submission of immunization electronic registries or immunization data Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law Use secure electronic messaging to communicate with Patients 5% of patients communicate electronically with their provider (s)

Administration Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Protect electronic Conduct or review Protect electronic Conduct or review a health a health information created or security risk information security risk maintained by the analysis created or analysis and certified EHR maintained by the encryption/security technology certified EHR of data at rest through the technology implementation of through the appropriate implementation of technical appropriate capabilities technical capabilities

Meaningful Use – Menu Set Objectives

Stage 2 Menu Set (EPs must select 3 of 6) Stage 1 Objective Stage 1 Measure Stage 2 Objective Capability to submit Performed at least Capability to submit electronic syndromic one test of certified electronic syndromic surveillance data to EHR technology's surveillance data to public health capacity to provide public health agencies and actual electronic syndromic agencies and actual submission except surveillance data to submission except where prohibited and public health where prohibited and in accordance with agencies in accordance with applicable law and applicable law and practice practice NEW NEW Record electronic notes in patient records Stage 2 Measure Successful ongoing submission of electronic syndromic surveillance data Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of unique patients

Stage 2 Menu Set Stage 1 Objective NEW NEW Stage 1 Measure NEW NEW Stage 2 Objective Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT Record patient family health history as structured data Stage 2 Measure More than 10% of all scans and tests whose result is an image ordered by the EP for patients seen during the EHR reporting period are incorporated into or accessible through CEHRT 20% of all unique have a structured data entry for one or more first-degree relatives

Stage 2 Menu Set Stage 1 Objective Stage 1 Measure NEW NEW NEW NEW Stage 2 Objective Stage 2 Measure Capability to identify Successful ongoing and submission report cancer cases of cancer case to a state cancer information from registry, except CEHRT to a cancer where prohibited, registry for the entire and in accordance EHR reporting period with applicable law and practice Capability to identify Successful ongoing and submission report specific cases of specific case to a specialized information from registry (other than a CEHRT to a cancer registry), specialized registry except where for the entire EHR prohibited, and in reporting period accordance with applicable law and practice

Clinical Quality Measure Requirements Stage 1 for Meet 6 total Clinical Quality Measures –3 core or alternate core, and –3 out of 38 from alternate set Most Electronic Health Record systems only report on the minimum 9 Clinical Quality Measures. Which Clinical Quality Measures can your system report? http://onc-chpl.force.com/ehrcert/chplhome

Clinical Quality Measures Stage 1 Must Choose 3 Core Set Alternate Set 1. Hypertension: Blood Pressure Measurement 4. Weight Assessment and Counseling for Children and Adolescents 2. Preventive Care and Screening Measure Pairs: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention 5. Preventive Care and Screening; Influenza Immunization for Patients 50 Years Old or Older 3. Adult Weight Screening and Follow-up 6. Childhood Immunization Status Additional CQMs 38 Additional CQMs Must choose 3 of the additional 38 CQMs

Clinical Quality Measures Stage 2 Submission of CQMs electronically (starting in 2014) Alignment with existing quality programs Providers must select from 3 of the 6 HHS National Quality Strategy domains: 1. 2. 3. 4. 5. 6. Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness Provider 2014 and Beyond* Eligible Providers Complete 9 out of 64 *Regardless of the stage of meaningful use, all providers will complete this number of CQMs in 2014 Adapted from HealthIT.gov

Helpful Links CMS Registration: https:// ehrincentives.cms.gov/hitech/login.action Colorado Registration & Attestation System (CO R&A): http://co.arraincentive.com/ Certified Health IT Product List (CHPL ID): http:// oncchpl.force.com/ehrcert?q chpl Colorado Regional Extension Center http://www.corhio.org/ 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved

Contact Information Tracy Rue Senior Consultant, Colorado Regional Extension Center [email protected] Phone: 720.285.3234 2/19/2013 2013 Colorado Regional Health Information Organization (CORHIO) - All Rights Reserved