10/28/2014. Learning Objectives. Problem Statement. Achieving Meaningful Use Stage II Electronic Patient Access Requirements

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Achieving Meaningful Use Stage II

Electronic Patient Access Requirements

CPT codes, descriptions and material only are Copyright 2012 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in applicable FARS/DFARS restrictions to government use.

Dennis Mihale MD MBA

Chief Medical Officer

CareSync

Amy Gleason RN BSN

Chief Operating Officer

CareSync

Learning Objectives



Develop strategies to meet Meaningful Use Stage 2

electronic patient access requirements



Compare the effectiveness of different types of social

media with patients



Engage patients in practice technologies

Problem Statement

Meaningful Use Stage II has 17 Core Objectives, all of which must be met. You do not get to pick and choose.

Some of them seem almost impossible to meet. You are being asked to get someone else (the patient) to do something. No matter whose fault it is, the physician will pay the price. Mobile computing/technology may provide a priceless tool to improve patient and family engagement and help meet MU II.

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Topics Covered



Review Meaningful Use Stage II



Identify the Most Difficult Terms



Understand Impact of Patient Engagement on MU II



Understand how technology impacts MU II



Determine how to leverage technology for MU II

Meaningful Use Stage II Core

 Use CPOE for meds, labs and radiology orders  Electronic Prescriptions

 Record demographics: language, sex, race, ethnicity, DOB  Record Vita Signs

• Height and Weight (all ages) and Blood Pressure (Age 3 and over)

• Document BMI (all ages) and Display Growth Charts (Ages 0 to 20)

• Record smoking status (Ages 13 and over)

• Use Clinical Decision Support: improve performance (high priority)

Meaningful Use Stage II Core

 Provide patients the ability to view, download and transmit health information within 4 days of availability to physician: Portal

• 5% must use this ability or send secure message

 Provide clinical summaries for patients for each office visit  Protect Electronic Health Information: Certified EHR/Tech Capabilities  Incorporate Clinical Lab-Test Results: Certified EHR Technology  Generate Lists of Patients by specific conditions to use: pop. health

• Quality improvement, reduction of disparities, research or outreach

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Meaningful Use

Send Reminders for preventive/follow up care:

•Identify which patients and use patient preferred method

Certified EHR Technology: identify/provide patient specific education Medication Reconciliation: EP receives patient from another

setting/provider



Summary record for each transition of care or referral



Able to submit electronic data to immunization registries



Use Secure Electronic Messaging: communicate with patients

Challenging Core Objectives in MU II

 Provide patients the ability to view, download and transmit health information within 4 days of availability to physician: Portal



Use Secure Electronic Messaging:



communicate with patients

 Send Reminders for preventive/follow up care:

 Identify which patients and use patient preferred method

 Medication Reconciliation:

 EP receives patient from another provider

Meaningful Use (MU) Audits

 Only 13% of physicians say their EHR can support 14 of 17 core Stage II objectives (CDC Report). Healthcare IT News Jan 22, 2014

 Meaningful Use is an “All or Nothing” deal: If one component of the attestation is faulty, the provider must return all of the money. No partial credit. Fierce EMR 10/17/13

 If, based on an audit, a provider is found to not be eligible for an EHR incentive payment, the payment will be recouped. CMS.GOV

• https://questions.cms.gov/faq.php?faqId=7711 (See handout)

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Meaningful Use (MU) Audits

CMS Recoups All Meaningful Use Money From Providers if Audits Turn Up Errors: AIS Health (from Health Business Daily) 9/16/13

• It appears hospitals and physicians will have to give back their entire Meaningful Use incentive payment if CMS auditors find any errors.

• So far, more clients than not are having audit findings and owing money.

• EHR continually updates system: no proof patient received info at DC. •You get no credit for getting 90%. You owe all the money back.

FierceEMR, 10/1/13

•“It is not the 1% or 2% reduction in payment that scares me.”

Dennis P.H. Mihale, MD

RFI for Meaningful Use (MU) Audits

 EHR Meaningful Use Incentive Payment Program Audits

 Apr 10, 2014 Solicitation Number: HHSM-500-2012-00042G

 THIS NOTICE IS FOR INFORMATION PURPOSES ONLY

 This work (HITECH Audit Support) is being done as a modification to an existing contract, GS-23F-0133M/ HHSM-500-2012-00042G that was awarded to FIGLIOZZI AND COMPANY.

 This contract was competitively awarded on April 16, 2012

 Figliozzi:

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_AuditGuidan ce.pdf

RFI for Meaningful Use (MU) Audits

The Office of the National Coordinator for Health Information Technology (ONC), along with CMS, has identified criteria to define meaningful use of EHR’s.

 Early stages: users attest that they are meaningful users of EHRs  Upon attestation, eligible to receive an incentive payment  CMS Office of Financial Management is responsible for auditing

components of the HITECH program  Oversees the audit process and the contractor

 Monitoring control process to ensure users are in compliance with regulations  eligible to participate in the program.  CMS Management will evaluate the evidence in order to make a

final determination of each meaningful EHR user’s eligibility.

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Mobile Health Computing

• Exchange of information to and from provider

before, during, and after the point of care

• Patient activities between visits can be reported

as they happen

• Helps identify missing diagnosis and also helps

identify co-morbidities: but only if the patient can

participate

Mobile Computing

• Smartphone app use (not browser use) exceeded PC use for the first time in January 2014 (CNN Money, Feb 2014)

• Smartphones are widely used by all age groups and income levels (Pew Research Internet Project, January 2014)

• 58% of American adults have a smart phone

• Medicaid/Medicare members use smart phones and tablets 47% with household incomes <30K/year

• 44% high school grad or less • Race/Ethnicity:

•White: 53% •African-American: 59% •Hispanic: 61%

• Seniors (65 or older) • 27% own tablet or e-Reader

• 18% own a smartphone

Mobile Computing Overview

Mobile computing enables all healthcare stakeholders to actively interact with patients, their family, and caregivers on an easy to manage and understand, structured, cost-efficient, and patient-centric platform.

Mobile computing improves physician care management, increases member interaction with their own healthcare without being intrusive, and helps health plans better understand utilization, care spend, provider & patient interaction, and overall care protocols.

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Patient/Family Engagement Through Mobile

Patient and family engagement is the most important asset in health care (IOM: Partnering with Patients, 2/25/13 Workshop)  Families and caregivers have access to mobile applications even

when away from the patient

 Wearable and mobile integrations capture contemporaneous data usually not available to the provider

 Outcomes increased when provider has access to the data between visits

 Patient satisfaction is increased with access to data between visits

 Mobile is the new way to take notes and provide helpful information at the visit/point of care

Challenging Core Objectives in MU II

 Provide patients the ability to view, download and transmit

health information within 4 days of availability to physician:

Portal



Use Secure Electronic Messaging:

communicate with patients

 Send Reminders for preventive/follow up care:

• Identify which patients and use patient preferred method

• Medication Reconciliation: Eligible provider (EP) receives patient from another provider

View, Download and Transmit

5% must use this ability or send secure messages

 How do you get patients to come to portal and retrieve data?  Do it at the office (point of care) as they “check out.”  Send emails with links back to your portal  Send alerts (texts/SMS) to the patient’s phone  Let them schedule visits online via their phone

 For every test, lab or study  alert: come to secure portal  Allow third parties, approved by the patient, to do it for them

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Secure Electronic Messaging

 Do it at the office (point of care) as they “check out”  Send secure emails with links back to your portal  Send alerts (texts/SMS) to the patient’s phone

 For every test, lab or study  alert: come to secure portal



Send reminders for appointment

Send Reminders for Care

Use patient preferred method

 What if preferred method is mobile?  Paper is easy and e-mail is not much harder?  Mobile means texts, security and messaging.  There are trustworthy vendors to help.

 Build interface from EHR to Mobile Platform (solution).

Meet MU Core Objective

AND

Make Patients Happy

Medication Reconciliation

Eligible Provider receives patient from another provider



Let’s ask the patient to help!



Why not ask the family to help, too?



What is the patient

really

taking?



What have they stopped taking?



What are they taking that neither doctor prescribed?

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Patient Engagement Pilot

Pilot Task List

1. Demo technology to staff.

2. Implementation manager discusses and clarifies pilot goals and timeline.

3. Identify patients/caregivers to target for pilot.

4. Create & send on-boarding materials (email, mail, and print) to selected patients/caregivers, introducing them to technology. 5. Train staff on technology.

6. Invite patients/caregivers to begin using technology

.

Patient Engagement Pilot

Pilot Task List (cont.)

7. Patient/Caregiver receives personalized phone introduction. 8. Technology specialists assist patients/caregivers in using system. 9. Information Technology (IT) specialists help patients get started:

the hard part.

10. Follow up with patients to ensure they are comfortable with new technology.

11. Team reviews project to ensure technology is driving MU compliance.

12. Patient/Caregiver receives ongoing training and encouragement. 13. Team meets to discuss lessons learned.

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Pilot Results



Size of test group



Adoption rate

–

Staff

–

Patients

–

Caregivers/Family

Pilot Results (cont.)



Lessons learned

–

Training

–

Ongoing support

–

Feedback from Staff

–

Feedback from Patients

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REFERENCES

Almost every Reference you Need

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

Stage 2 Audit Programs

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Audi tGuidance.pdf

Appendix

CC 1: CPOE for Med, Lab & Radiology Orders

Definition: Computerized Provider Order entry (CPOE)

is the provider’s use of a computer assistance to

directly enter medical orders



Objective: Use CPO to enter medication, lab and

radiology orders



Measure: > 60% meds, > 30% lab and > 30%

radiology orders created using CPOE



Exclusion: Provider writing < 100 med, lab or

radiology orders during EMR reporting period

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CC 2: Electronic Prescriptions

Definition: Permissible prescriptions are those not

restricted due to controlled substance schedules II-IV



Objective: Generate and transmit permissible

prescriptions electronically



eRx



Measure: > 50% of all permissible prescriptions or all

prescriptions are queried for drug formulary and

transmitted electronically using CEHRT



Exclusion 1: EP writing < 100 permissible prescriptions



Exclusion 2: No pharmacy accepts eRx within 10 miles

CC 3: Record Demographics

Definition: Preferred language



patient choice

Unique patient



only counts once in denominator



Objective: Record preferred language, sex, race,

ethnicity, date of birth



Measure: > 80% of all unique patients seen by EP have

structured demographics recorded



Exclusion: NONE

CC 4: Record Vital Signs

Definition: Unique patient



counted once



Objective: Record height/length and weight; BP (>

3); BMI; growth charts for patients 0 – 20



Measure: > 80% of unique patients have BP (Age

>3)

AND/OR

height/weight recorded



Exclusion 1: All patients < 3



BP excluded



Exclusion 2: Believes 3 VS have no relevance



Exclusion 3: Believes BP not relevant



Excluded



Exclusion 4: Believes height/weight not relevant

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CC 5: Record Smoking Status

Definition: Unique patient counts once



Objective: Record smoking status for patients 13

years or older



Measure: > 80% unique patients have smoking

status recorded



Exclusion: All patients seen or admitted < 13

CC 6: Use Clinical Decision Support

Clinical Decision Support is HIT functionality that

provides information, filtered and organized, to

enhance health care



Objective: Use clinical decision support to improve

performance on high priority health conditions



Measure 1: Use five (5) clinical decision support

interventions for 4 or more quality measures



Measure 2: EP has implemented functionality for

drug-drug and drug-drug-allergy interactive checks



Exclusion Measure2: EP writes < 100 medication orders

CC 7: View, Download and Transmit



Objective: Provide patients the ability to view online,

download and transmit their information within 4

business days (M-F) of information being available to

the EP.



Measure 1: > 50% of patients provided timely, within 4

days, online access to their information



Measure 2: > 5% of patients view, download or

transmit to a 3

rd

_{party their information}



Exclusion 1: EP who does not create any info



Exclusion 2: EP in county with <50% broadband

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CC 8: Provide Clinical Summaries

Clinical Summary: After visit summary providing

patient with relevant and actionable information



Objective: Provide clinical summaries for each

office visit



Measure: clinical summaries for > 50% of office

visits within one business day



Exclusion: Provider with no office visits

CC 9: Protect Electronic Health Information

Attestation: EP must attest YES to conducting or

reviewing security risk analysis and implementing security

updates as needed to meet this measure



Objective: Protect EHI created or maintained by

certified EHR technology (CEHRT) through

implementation of appropriate technical capabilities

 Measure: Conduct or review a security risk analysis in

accordance with 45 CFR 164.308 (a) 1, including addressing encryption/security of data stored in CEHRT

 Exclusion: NONE

CC 10: Incorporate Clinical Results

Attestation Requirements: Allow limiting measure of objective to labs ordered for patients with records maintained using CEHRT

 Objective: Incorporate clinical lab-test results into CEHRT

as structured data

 Measure: > 55% of all clinical lab-test results ordered,

with positive/negative or numerical format are incorporated into CEHRT as structured data

 Exclusion: No lab-tests ordered or results are not in a

positive/negative or numerical format

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CC 11: Generate Patient Lists by Condition

Specific Conditions: Conditions listed in the active

patient problem list.



Objective: Generate lists of patients by specific

conditions to use for quality improvement,

reduction of disparities, research or outreach



Measure: Generate at least one report listing

patients of the EP with a specific condition



Exclusion: NONE

CC 12: Send Reminders for Preventive Care

Definition: Patient preference is the reminder

communication method patient’s prefer for



Objective: Use clinically relevant information to identify

patients to receive reminders for preventive/follow up

care and use patient preference



Measure: > 10% patients with 2 or more office visits

within 24 preceding months are sent reminder



Exclusion: No office visits preceding 24 months

CC 13: Certified EMR Technology

Patient Specific Education Resources Identified by CEHRT: Resources identified through logic built into CEHRT which evaluates information about patients and suggests education resources of value to the patients

 Objective: Use clinically relevant information from CEHRT

to identify patient specific education resources and provide these resources to the patient