Understanding Meaningful Use Stage 2

(1)

Miranda Ladue, Manager, Product Management

Adam Plotts, Manager, Product Management

(2)

Agenda

• Review MU Timeline

• MU 2 Overview

• Review of major changes

• EEHR Timeline & Proposed Functionality

• Q&A

A Connected Community of Health

• Review MU Timeline

• MU 2 Overview

• Review of major changes

• EEHR Timeline & Proposed Functionality

• Q&A

(3)

Stage of MU by first payment year

First Payment Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2011 1 1 1 2 2 3 3 TBD TBD TBD TBD 2012 1 1 2 2 3 3 TBD TBD TBD TBD 2013 1 1 2 2 3 3 TBD TBD TBD 2014 1 1 2 2 3 3 TBD TBD 2015 1 1 2 2 3 3 TBD 2016 1 1 2 2 3 3 2016 1 1 2 2 3 3 2017 1 1 2 2 3

“If there will be a Stage 4 of meaningful use, we expect to update this table in the rulemaking for Stage 3.”

(4)

Reporting periods

Provider Type

Reporting

Period Year 1 Submission Period Year 1

Subsequent

Reporting Periods

Subsequent Submission Periods

EP 90 days Anytime immediate following the end of the 90-day reporting period, but no later than February 28 of the following calendar year.

1 calendar year (January 1 -December 31)

2 months following the end of the EHR reporting period (January 1 -February 28)

Eligible Hospital / CAH

90 days Anytime immediate

following the end of the 90-day reporting period, but no later than November 30 of the following fiscal year.

1 fiscal year (October1 -September 30)

2 months following the end of the EHR reporting period (October 1 -November 30)

Eligible Hospital / CAH

Anytime immediate

following the end of the 90-day reporting period, but no later than November 30 of the following fiscal year.

1 fiscal year (October1 -September 30)

2 months following the end of the EHR reporting period (October 1 -November 30)

4

(5)

Q4 Proposed Stage 2

Ruling

60 Day Comment Period

5

Road to Meaningful Use Stage 2

Q1 Stage 2 Ruling HITPC Recommendations on Stage 2 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 2012 2012 20132013 20142014 Q3 Q4 2011 2011 Proposed Stage 2 Reporting Period (For Stage 1 2011/2012 Reporting) Stage 2 Ruling HITPC Recommendations

on Stage 2 _{Proposed Stage 2}

Reporting Period

(For Stage 1 2011/2012 Reporting)

Ambulatory Considerations

2

•• Clinical Decision SupportPatient Portal Requirements

• Emphasis on information exchange

• Stretch of MU Stage 1 Goals

(6)

Road to Meaningful Use Stage 2

Allscripts comments on NPRM

https://clientconnect.allscripts.com/groups/arrapractices/blog/2012/04/25/allscripts-guidance-for-mu-stage-2-comments

Allscripts comments on NPRM

https://clientconnect.allscripts.com/groups/arrapractices/blog/2012/04/25/allscripts-guidance-for-mu-stage-2-comments

(7)

Key themes

• Continuing the drive to value-driven healthcare

• Raising the bar on most measures

• Adding new administrative & clinical measures

• Special emphasis on information exchange

• Clinical measures

• Administrative measures

• More flexibility and options, including changes for 2013

• Special emphasis on penalties, reviews and appeals

• Continuing the drive to value-driven healthcare

• Raising the bar on most measures

• Adding new administrative & clinical measures

• Special emphasis on information exchange

• Clinical measures

• Administrative measures

• More flexibility and options, including changes for 2013

• Special emphasis on penalties, reviews and appeals

• Registries

(8)

Summary of Major Provisions

Stage 1 Stage 2

EP Measures 15 core, 5 of 10 menu 17 core, 3 of 5 menu

EH Measures 14 core, 5 of 10 menu 16 core, 2 of 4 menu

A Connected Community of Health 8

EP CQM 6 CQMs out of 46 12 CQMs out of 125

(9)

Stage 2 goals from ONC & CMS

• Expand upon the Stage 1 criteria

• Encourage the use of Health IT for continuous quality improvement at the point of care

• Encourage the exchange of information in the most structured format possible

• Stage 2 MU criteria include rigorous HIEs

• Demand requirements for ePrescribing

• Incorporate structured laboratory results

• Electronically transmit patient care summaries to support transitions in care across unaffiliated providers, settings and EHR systems

• Information follows the patient (Stage 3 also)

• Expand upon the Stage 1 criteria

• Encourage the use of Health IT for continuous quality improvement at the point of care

• Encourage the exchange of information in the most structured format possible

• Stage 2 MU criteria include rigorous HIEs

• Demand requirements for ePrescribing

• Incorporate structured laboratory results

• Electronically transmit patient care summaries to support transitions in care across unaffiliated providers, settings and EHR systems

(10)

Stage 2 State Flexibility with IR/SS

• States will have the flexibility with the public health measures in

Stage 2 similar to that of Stage 1

• True for Medicare and Medicaid participation

• States may also specify the means of transmission of the data

or otherwise change the public health measure

• States will have the flexibility with the public health measures in

Stage 2 similar to that of Stage 1

• True for Medicare and Medicaid participation

• States may also specify the means of transmission of the data

or otherwise change the public health measure

(11)

Stage 2 Exclusion Criteria

• Allowances for exclusions would change for both Stages 1 & 2

beginning in 2014

• At that point, should focus solely on those objectives they can

meet rather than those for which they have exclusion

• Exclusions just for EPs who are unable to meet certain objectives because

of scope of practice

• New exclusion criteria when necessary for new objectives will be added

as needed

• Allowances for exclusions would change for both Stages 1 & 2

beginning in 2014

• At that point, should focus solely on those objectives they can

meet rather than those for which they have exclusion

• Exclusions just for EPs who are unable to meet certain objectives because

of scope of practice

(12)

Stage 2 Multiple Practices/Locations

• EP must still have 50% or more of outpatient encounters at a

practice/location or practices/locations equipped with Certified EHR

Technology – can be fulfilled in a single or multiple locations.

• Starting in 2013, will no longer allow the practice of creating a

record in one location with no EHR and then later entering information

in a practice location with a certified EHR

• Do not have to include patients in reporting denominators that are

seen at practices/locations that are not equipped with Certified EHR

Technology as long as the EP clears the 50% threshold described

above

• EP must still have 50% or more of outpatient encounters at a

practice/location or practices/locations equipped with Certified EHR

Technology – can be fulfilled in a single or multiple locations.

• Starting in 2013, will no longer allow the practice of creating a

record in one location with no EHR and then later entering information

in a practice location with a certified EHR

• Do not have to include patients in reporting denominators that are

seen at practices/locations that are not equipped with Certified EHR

Technology as long as the EP clears the 50% threshold described

above

(13)

Stage 2 Denominators

• Include all patients in the denominators of all of the measures (except

those not seen at a location with a certified EHR)

• Create a uniform set of denominators

• Proposed denominators for EPs

• Unique patients seen by the EP during the EHR reporting period (stratified by age or previous office visit)

• Number of orders (medication, labs, radiology)

• Office visits, and

• Transitions of care/referrals.

• Include all patients in the denominators of all of the measures (except

those not seen at a location with a certified EHR)

• Create a uniform set of denominators

• Proposed denominators for EPs

• Unique patients seen by the EP during the EHR reporting period (stratified by age or previous office visit)

• Number of orders (medication, labs, radiology)

• Office visits, and

(14)

What Measures Are Not

Changing…. Much?

What Measures Are Not

Changing…. Much?

(15)

Common themes of small changes

• Increase of thresholds

• More stringent parameters

(16)

Increase of Thresholds

eRx

• Stage 1: More than 40% must be transmitted electronically

• Stage 2: More than 65% are compared to at least one drug formulary and transmitted electronically

Record patient demographics

• More than 50% of patient demographic data must be recorded as structured data.

• More than 80% of all unique patients have demographics recorded as structured data.

Record vital signs and chart changes

• More than 50% of patients >2 years old must have height, weight and blood pressure recorded as structured data

• More than 80% of patients >3 years old must have blood pressure measured and all patients have height and weight recorded as structured data.

A Connected Community of Health eRx

• Stage 1: More than 40% must be transmitted electronically

• Stage 2: More than 65% are compared to at least one drug formulary and transmitted electronically

Record patient demographics

• More than 50% of patient demographic data must be recorded as structured data.

• More than 80% of all unique patients have demographics recorded as structured data.

Record vital signs and chart changes

• More than 50% of patients >2 years old must have height, weight and blood pressure recorded as structured data

• More than 80% of patients >3 years old must have blood pressure measured and all patients have height and weight recorded as structured data.

(17)

Increase of Thresholds

Record smoking status

• More than 50% of patients age 13 or older have smoking status recorded as structured data

Lab results

• More than 40% of clinical lab results are in positive/negative or numerical format and stored as structured data

• Move to core requirement. More than 55% of all clinical lab tests are incorporated as structured data.

Record smoking status

Lab results

(18)

More Stringent Parameters

Provide patients with clinical summaries for each office visit

• Provide clinical summaries for more than 50% of all visits within 3 business days

• Provide clinical summaries for more than 50% of all visits within 24 hours

Privacy and Security

• Conduct a security risk analysis, implement security updates and correct identified issues

• Conduct a security risk analysis, implement security updates and correct identified issues,

including data at rest.

Provide patients with clinical summaries for each office visit

• Provide clinical summaries for more than 50% of all visits within 3 business days

• Provide clinical summaries for more than 50% of all visits within 24 hours

Privacy and Security

• Conduct a security risk analysis, implement security updates and correct identified issues

• Conduct a security risk analysis, implement security updates and correct identified issues,

including data at rest.

(19)

Move to Core from Menu

Lab results

Generate list of patients by specific condition

• Move to core requirement.

Send reminders to patients per patient preference

• More than 20% of patients aged 65 or older or 5 or younger must be sent appropriate reminders.

• Move to core requirement. More than 10% of all unique patients who had a visit within past 24 months were sent a reminder, per patient preference.

Lab results

Generate list of patients by specific condition

• Move to core requirement.

Send reminders to patients per patient preference

• More than 20% of patients aged 65 or older or 5 or younger must be sent appropriate reminders.

(20)

Move to Core from Menu

Patient-specific education resources

• More than 10% of patients are provided patient-specific education resources.

• Move to core requirement. Perform medication reconciliation

• Perform med reconciliation for more than 50% of transitions of care

• Move to core requirement. Perform medication reconciliation for more than 65% of transitions of care.

Submission of electronic immunization data

• Must perform at least one test of data submission and follow-up submission to immunization registries.

• Move to core requirement. Successful ongoing submission of electronic

immunization data to a registry or reporting system for entire EHR reporting period.

Patient-specific education resources

• More than 10% of patients are provided patient-specific education resources.

• Move to core requirement. Perform medication reconciliation

• Perform med reconciliation for more than 50% of transitions of care

• Move to core requirement. Perform medication reconciliation for more than 65% of transitions of care.

Submission of electronic immunization data

• Must perform at least one test of data submission and follow-up submission to immunization registries.

• Move to core requirement. Successful ongoing submission of electronic

immunization data to a registry or reporting system for entire EHR reporting period.

(21)

What Measures Should You Be

Thinking About?

(22)

Areas of major change

• CPOE

• Secured Messaging

• Patient Access: View, Download, Transmit

• Transitions of Care

• Clinical Decision Support

• CPOE

• Secured Messaging

• Patient Access: View, Download, Transmit

• Transitions of Care

• Clinical Decision Support

(23)

CPOE

• More than 60% of meds, lab, and rad orders created

by the EP during the reporting period use CPOE

= 60%

C

or

e

# of orders in the denominator recorded using CPOE

= 60%

C

or

e

Exclusion: Any EP who fewer of 100 meds, labs, and radiology orders COMBINED # of med, rad, and lab orders created by the EP

during the reporting period

(24)

CPOE EP Requirements

• Further defining CPOE

• CPOE should be used the first time the order becomes part of the record,

before any action can be taken on the order

• removing the possibility that a record of the order could be created prior to CPOE

• This means that the originating provider (whose judgment creates the

order) must personally use the CPOE function or verbally communicate

the order to someone else who will use the CPOE function

• Provider is responsible for including the orders in their

denominators if they are not recorded using CPOE

• Further defining CPOE

• CPOE should be used the first time the order becomes part of the record,

before any action can be taken on the order

• removing the possibility that a record of the order could be created prior to CPOE

• This means that the originating provider (whose judgment creates the

order) must personally use the CPOE function or verbally communicate

the order to someone else who will use the CPOE function

• Provider is responsible for including the orders in their

denominators if they are not recorded using CPOE

(25)

Patient Access

• 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

• 2 Report Calculations

C

or

e

_{Report #1}

• 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 • 2 Report Calculations

=

65%

C

or

e

#of unique patients seen by the EP during the reporting period

# of patients in the den. who have timely (within 4 business days after the information is available to

the EP) online access to their health information online

(26)

Patient Access

=

10%

C

or

e

# of unique patients (or their authorized representatives) in the den. who have viewed online or downloaded or transmitted to a third

party the patient's health information

Report #2

=

10%

26

C

or

e

Exclusion: Any EP who neither orders nor creates any of the information listed for inclusion as part of this measure may exclude both measures.

Any EP that conducts 50% or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the reporting period may exclude only the second measure.

(27)

Patient Access EP Requirements

• Patients must be able to access this information on demand

• This includes that patients with disabilities need equal access

• Its not just about the patient, but also their authorized representatives that

can access their health info

• Patients have to grant access to those representatives with the exception of minors

• Still uses the same business day logic as in stage 1

• Reporting

• A patient who views their info online, downloads it from the internet, or uses the internet to transmit it to a third party would count for the numerator

• New exclusions about the counties without high-speed internet

• Patients must be able to access this information on demand

• This includes that patients with disabilities need equal access

• Its not just about the patient, but also their authorized representatives that

can access their health info

• Patients have to grant access to those representatives with the exception of minors

• Still uses the same business day logic as in stage 1

• Reporting

• A patient who views their info online, downloads it from the internet, or uses the internet to transmit it to a third party would count for the numerator

(28)

Patient Access EP Requirements

• The following information must be made available within 4 days of the info being available to the EP:

• Patient name

• Provider's name and office contact information • Problem list

• Procedures

• Laboratory test results • Medication list

• Medication allergy list

• Vital signs (height, weight, blood pressure, BMI, growth charts*) • Smoking status

• Demographic information (preferred language, gender, race, ethnicity, date of birth) • Care plan field, including goals* and instructions

• Any additional known care team members* beyond the referring or transitioning provider and the receiving provider.

• Provider needs to be able to not send specific information when needed at the provider’s discretion

• The following information must be made available within 4 days of the info being available to the EP:

• Patient name

• Provider's name and office contact information • Problem list

• Procedures

• Laboratory test results • Medication list

• Medication allergy list

• Vital signs (height, weight, blood pressure, BMI, growth charts*) • Smoking status

• Demographic information (preferred language, gender, race, ethnicity, date of birth) • Care plan field, including goals* and instructions

• Any additional known care team members* beyond the referring or transitioning provider and the receiving provider.

• Provider needs to be able to not send specific information when needed at the provider’s discretion

(29)

Secured Messaging

• Use secure electronic messaging to communicate with

patients on relevant health information

= 10%

C

or

e

# of patients in the den. who send a secure

electronic message to the EP using the electronic messaging function of CEHRT during the reporting

period.

= 10%

C

or

e

Exclusion: Any EP who has no office visits during the reporting period

# of unique patients seen by the EP during the reporting period

# of patients in the den. who send a secure electronic message to the EP using the electronic messaging function of CEHRT during the reporting

(30)

Secured Messaging EP Requirements

• Secure Message must contain relevant health info

• Secure Messaging can occur through:

• Email with necessary safeguards

• Patient portals

• PHR

• Stand along messaging applications

• Patient must take action for provider to meet this measure

• CMS wants comments about behavioral health

• Secure Message must contain relevant health info

• Secure Messaging can occur through:

• Email with necessary safeguards

• Patient portals

• PHR

• Stand along messaging applications

• Patient must take action for provider to meet this measure

• CMS wants comments about behavioral health

(31)

Transitions of Care (TOC) Calculation

• EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral

=

65%

C

or

e

_{Report #1}

• EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral

=

65%

C

or

e

Exclusion: Any EP who neither transfers a patient to another setting nor refers a patient to another provider # of TOC and referrals during the reporting period

for which the EP was the transferring or referring provider

# of TOC and referrals in the denominator where a summary of care record was provided

(32)

Transitions of Care (TOC) Calculation

=

10%

C

or

e

# of TOC & referrals in the denominator where a summary of care record was electronically

transmitted using CEHRT to a recipient with no org affiliation and using a different CEHRT vendor than

the sender

Report #2

=

10%

32

C

or

e

Exclusion: Any EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period is excluded from both measures.

# of TOC and referrals during the reporting period for which the EP was the transferring or referring

provider

# of TOC & referrals in the denominator where a summary of care record was electronically

transmitted using CEHRT to a recipient with no org affiliation and using a different CEHRT vendor than

(33)

Clinical Decisions Support (CDS)

• Use clinical decision support to improve

performance on high-priority health

conditions

C

or

e

Threshold

• Use clinical decision support to improve

performance on high-priority health

conditions

C

or

e

5 Clinical Decision Support + DUR Alert

(34)

CDS EP Requirements

• User must use 5 Clinical Decision Support rules and they must be

related to 5 or more Quality Measures

• Related = intent is to improve performance of the Clinical Quality

Measure

• User does not need to show improvement in the Quality Measure.

• If user doesn't have an applicable CQM, they can choose to do another

related to patient care

• User must have enabled DUR interactions for the entire

reporting period

• User must use 5 Clinical Decision Support rules and they must be

related to 5 or more Quality Measures

• Related = intent is to improve performance of the Clinical Quality

Measure

• User does not need to show improvement in the Quality Measure.

• If user doesn't have an applicable CQM, they can choose to do another

related to patient care

• User must have enabled DUR interactions for the entire

reporting period

(35)

CDS EP Requirements

• Intervention must be done at a relevant point of time in the

workflow, before action is taken on the patient

• ex. create a trigger that prompts the provider to ask about influenza

immunization when a patient is 50 years or older.

• Intervention must be done at a relevant point of time in the

workflow, before action is taken on the patient

(36)

TOC Reporting Considerations

• Exchange Key Clinical Information from Stage 1 was combined into

this measure

• Combined Maintain Active Med List, Problem List, and Med Allergy

list into this measure

• EP must verify med/prob/allergies and they cannot be blank

• Denominator –

• If the referral is sent to a provider has access to the system, the referral does not count in the denominator

• Sending Electronically: USB, CD, Fax does not count

• Exchange Key Clinical Information from Stage 1 was combined into

this measure

• Combined Maintain Active Med List, Problem List, and Med Allergy

list into this measure

• EP must verify med/prob/allergies and they cannot be blank

• Denominator –

• If the referral is sent to a provider has access to the system, the referral does not count in the denominator

• Sending Electronically: USB, CD, Fax does not count

(37)

TOC Workflow Requirements

Summary of Care Document must contain the following (if available on the patient)

• Patient name

• Referring or transitioning provider's name and office contact information (EP only)

• Procedures

• Relevant past diagnoses

• Laboratory test results

• Vital signs (height, weight, blood pressure, BMI, growth charts)

• Smoking status

• Demographic information (preferred language, gender, race, ethnicity, date of birth)

• Any additional known care team members

• Care plan field, including goals and instructions

• Care Plan is defined as the management actions for various conditions, problems, and issue • Care Plan = Problem (focus) + Goal (Target

outcome) + Instructions given to patient

• Goal is defined as target or measure to be achieved in the process of patient care (expected outcome)

• An up-to-date problem list of current and active diagnoses

• An active medication list

• An active medication allergy list

• Patient name

• Referring or transitioning provider's name and office contact information (EP only)

• Procedures

• Relevant past diagnoses

• Laboratory test results

• Vital signs (height, weight, blood pressure, BMI, growth charts)

• Smoking status

• Demographic information (preferred language, gender, race, ethnicity, date of birth)

• Any additional known care team members

• Care plan field, including goals and instructions

• Care Plan is defined as the management actions for various conditions, problems, and issue • Care Plan = Problem (focus) + Goal (Target

outcome) + Instructions given to patient

• Goal is defined as target or measure to be achieved in the process of patient care (expected outcome)

• An up-to-date problem list of current and active diagnoses

• An active medication list

(38)

Reporting Changes

(39)

Stage 2 Reporting - EPs

• Report 12 CQMs from a menu of 125

• Includes most of the current 44

• Must include at least 1 CQM from each of the 6 domains

• All begin in 2014 for both Stage 1 and Stage 2

• Examples of new measures

• pediatric, obstetric, behavioral/mental health, HIV medical visits,

antiretroviral therapy, oral health – many geared towards Medicaid

providers

• Report 12 CQMs from a menu of 125

• Includes most of the current 44

• Must include at least 1 CQM from each of the 6 domains

• All begin in 2014 for both Stage 1 and Stage 2

• Examples of new measures

(40)

Stage 2 Reporting - EPs

• Online submission via XML files

• May submit as an individual or group

• Possible aggregation of performance here (!) unlike the batch reporting with the measures, which must remain individual

• Can only be done beginning in second year of MU

• Three group options:

• Different NPIs / one TIN: all members of group must report all CQMs as a group

• Different NPIs / one TIN, participating in the Medicare Shared Savings Program and Pioneer ACO model who use Certified EHR to submit ACO measures: all measures must be extracted by the Certified EHR

• Medicare EPs who satisfactorily report PQRS CQMs using Certified EHR Technology

• Online submission via XML files

• May submit as an individual or group

• Possible aggregation of performance here (!) unlike the batch reporting with the measures, which must remain individual

• Can only be done beginning in second year of MU

• Three group options:

• Different NPIs / one TIN: all members of group must report all CQMs as a group

• Different NPIs / one TIN, participating in the Medicare Shared Savings Program and Pioneer ACO model who use Certified EHR to submit ACO measures: all measures must be extracted by the Certified EHR

• Medicare EPs who satisfactorily report PQRS CQMs using Certified EHR Technology

(41)

CQM reporting options (2014)

• Option 1a:

• 12 measures, including at least 1 from each of 6 domains (NPRM Table

8)

• Option 1b:

• 11 “core” measures (NPRM Table 6) + 1 “menu” measure (NPRM Table

8)

• Option 2:

• Successfully report through PQRS

• Must continue to comply with PQRS as it evolves

• Option 1a:

• 12 measures, including at least 1 from each of 6 domains (NPRM Table

8)

• Option 1b:

• 11 “core” measures (NPRM Table 6) + 1 “menu” measure (NPRM Table

8)

• Option 2:

• Successfully report through PQRS

(42)

What are we planning?

(43)

11.3

New Features

Usability & VOC Improvements

DUR Enhancements

Clinical Item Contention (also in 11.2.3) Patient Education Connected Community Enhanced Community Portal ADX Integration 1.0 Maintenance

Performance & Technology Enhancements

43

Enterprise EHR Roadmap

Q2 2012 Q3 2012

Q1 2012 Q4 2012 Q1 2013 Q2 2013

New Features

Patient Goals

Patient Care team

Clinical Decision Support

Pop. Health Improvements

Orders Usability Improvements

Connected Community

Patient Portal Improvements

Referral Improvements

Regulatory

Meaningful Use Stage 2

Quality Measure Support

SureScripts NCPDP 10.6 STD

EPCS & Pharm Directory 4.4

11.4.1

Q2 2012 Q3 2012

Q1 2012

Focus of 11.4 & 11.4.1 Improved Usability while meeting regulatory req’s Focus of 11.4 & 11.4.1 Improved Usability while meeting regulatory req’s

Q4 2012 Q1 2013 Q2 2013

New Features

Email Distribution of scheduled reports

New filter options

Multi-Organization Support

Quality Measure Drill Down

Maintenance

Usability Defects

Stimulus Reporting 2.0 11.4

New Features

Problem Usability Improvements

My Priority Problem Lists

Problem Impression

Connected Community

ADX integration 1.5

Patient Portal Costume Forms

Regulatory

(44)

Questions

(45)

(46)

Requirement Stage 1 Standard Stage 2 Standard

1 CPOE More than30% of patients with at least one

medication must haveat least one medication ordered via CPOE

More than60% of medication, labs, and radiology orders are recorded using

CPOE. No requirement to order

electronically.

2 eRx More than40% must be transmitted

electronically More thanone drug formulary and transmitted65% are compared to at least

electronically 3 Record patient demographics More than50% of patient demographic

data must be recorded as structured data.

More than80% of all unique patients have

demographics recorded as structured data.

Improving Quality, Safety, Efficiency...

3 Record patient demographics More than50% of patient demographic

data must be recorded as structured data.

More than80% of all unique patients have

demographics recorded as structured data. 4 Record vital signs and chart changes More than50% of patients >2 years old

must have height, weight and blood pressure recorded as structured data

More than80% of patients >3 years old must

have blood pressure measuredand all patients have height and weight recorded as

structured data. 5 Record smoking status More than50% of patients age 13 or older

have smoking status recorded as structured data

More than80% of patients age 13 or older

have smoking status recorded as structured data

6 Clinical Decision Support Implementone clinical decision support

rule and track compliance with that rule Implementrulesrelated to 5 or more clinical qualityfive clinical decision support measures

And

(47)

7 Lab results More than40% of clinical lab results are in

positive/negative or numerical format and stored as structured data

Move to core requirement. More than 55% of all clinical lab tests are incorporated

as structured data. 8 Generate list of patients by specific

condition for use in quality improvement, reduction of disparities, research or outreach.

Generate one list of patients with a specific

condition. Move to core requirement.

9 Send reminders to patients per patient preference for preventative and follow up care

More than20% of patients aged 65 or older or 5 or younger must be sent

appropriate reminders.

Move to core requirement. More than 10% of all unique patients who had a visit within past 24 months were sent a

reminder, per patient preference.

Improving Quality, Safety, Efficiency...

9 Send reminders to patients per patient preference for preventative and follow up care

More than20% of patients aged 65 or older or 5 or younger must be sent

appropriate reminders.

Move to core requirement. More than 10% of all unique patients who had a visit within past 24 months were sent a

reminder, per patient preference.

M1 Imaging results. New measure. More than 40% of all scans

and tests ordered by EP are accessible through the certified EHR.

M2 Record patient family health history

(48)

10 Provide patients with ability to view online, download & transmit their health information.

New Requirement. 50% of all unique

patients provided online access to their health information within 4 business days after it is available to the EP (subject to EP discretion)

And

More than 10% unique patients view, download, or transmit their info to a third party.

11 Provide patients with clinical

summaries for each office visit Provide clinical summaries for more than50% of all visits within3 business days Provide clinical summaries for more than50% of all visits within24 hours

Engage Patients & Families

Provide patients with clinical

summaries for each office visit Provide clinical summaries for more than50% of all visits within3 business days Provide clinical summaries for more than50% of all visits within24 hours

12 Use EHR technology to identify patient-specific education resources as provide to patients as

appropriate.

More than 10% of patients are provided

patient-specific education resources. Move to core requirement.

13 Use secure electronic messaging. New requirement. A secure message was

(49)

14 Perform medication reconciliation Perform med reconciliation for more than

50% of transitions of care Move to core requirement. Performmedication reconciliation for more than65%

of transitions of care. 15 Provide summary of care record for

patients referred or transitioned to another provider.

Summary of care records are provided for at least 50% of patient transitions or referrals.

Move to core.

1. provide a summary of care for65% of

transitions or referrals;

and

2. transmit summary of care record to a recipient with no organizational affiliation and who uses a different certified technology vendor than the sender for more than 10% of

transitions or referrals.

Improve Care Coordination

Move to core.

1. provide a summary of care for65% of

transitions or referrals;

and

2. transmit summary of care record to a recipient with no organizational affiliation and who uses a different certified technology vendor than the sender for more than 10% of

(50)

24 Submission of electronic

immunization data Must perform at least one test of datasubmission and follow-up submission to immunization registries.

Move to core requirement. Successful ongoing submission of electronic

immunization data to a registry or reporting system for entire EHR reporting period.

M3 Syndromic surveillance data to

public health agencies Must perform at least one test of datasubmission and follow-up submission to public health agencies for syndromic surveillance.

Successful ongoing submission of

electronic immunization data to a public health agency for entire EHR reporting period.

M4 Report cancer cases to cancer

registry New measure. Successful ongoingsubmission of cancer case information to a cancer registry for entire EHR reporting period.

Improve Population & Public Health

Report cancer cases to cancer

registry New measure. Successful ongoingsubmission of cancer case information to a cancer registry for entire EHR reporting period.

M5 Report specific cases to

(51)

25 Privacy and Security Conduct a security risk analysis, implement security updates and correct identified issues