Overview of the EHR Incentive Program
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Meaningful Use Stages 1 & 2
Presented by Practice Velocity, LLC
As a part of the American Recovery and Reinvestment Act of 2009 (ARRA), the Health
Infor-mation Technology for Economic and Clinical Health (HITECH) Act was passed by Congress
and signed into law by President Obama in 2009. This long-awaited legislation is intended to
improve the quality, efficiency, and safety of the nation’s healthcare system by incentivizing
qualifying physicians and hospitals who embrace information technology. These incentives,
which are being offered to qualifying physicians who adopt certified electronic health records,
come in the form of two payment programs available through Medicare and Medicaid.
The purpose of these incentives is a part of a broader effort to reform the U.S. healthcare
system through the acceleration of the usage of health information technology (HIT) and
electronic health records (EHR). The goal is for the meaningful use of EHR technology, which
must meet the certification standards defined by the Office of the National Coordinator for
Health Information Technology (ONC), to result in healthcare that is patient-centered,
evi-dence-based, prevention-oriented, efficient, and equitable.
Overview of the Medicare EHR Incentive Program
The Medicare EHR Incentive Program began in 2011, and EHR incentive payments under
Medicare will continue through 2016. Depending on the first year they participate, eligible
professionals (EP) can participate for up to five continuous years throughout the duration of
the program, and can receive up to $44,000 over five years. Additional incentives are available
to eligible professionals who provide services in a Health Professional Shortage Area (HPSA).
The last year to begin participation in the Medicare EHR Incentive Program is 2014.
Qualifying EPs are eligible to receive up to 75 percent of their Medicare allowable charges,
subject to maximum payments, with incentive payments ending after 2016. The reporting
pe-riod for the first year is any 90 continuous days during the calendar year. The reporting pepe-riod
for all subsequent years is the entire calendar year, except for 2014 during which EPs can
retain the 90-day reporting period.
After 2015, Medicare EPs who do not successfully demonstrate meaningful use will receive a
1 percent payment reduction in their Medicare allowed charges. This reduction will increase by
1 percent each year and is projected to cap at 5 percent, with the penalty potentially
becom-ing permanent based on the discretion of the Secretary of Health and Human Services.
The HITECH Act includes an exception for the payment reduction in order to assist EPs who
may experience significant hardship by complying with the requirements for being a
meaning-ful EHR user, such as a rural EP without sufficient Internet access. These exemptions will be
determined by the Secretary on a case-by-case basis and will be subject to annual renewal.
However, no EP will be granted an exemption for more than 5 years.
Table 1: Medicare EHR Incentive Program Payment Schedule for Eligible Professionals
If qualified to
receive first
payment in 2011
2012
2013
2014
2015
Payment amount for
2011 will be
2012
2013
2014
2015
2016
Total payment
$18,000
$12,000
$8,000
$4,000
$2,000
$-$44,000
$-$18,000
$12,000
$8,000
$4,000
$2,000
$44,000
$-$15,000
$12,000
$8,000
$4,000
$39,000
$-$12,000
$8,000
$4,000
$24,000
$-Medicare eligible
professional (EP)
• Doctor of medicine or
osteopathy
• Doctor of dental surgery or
dental medicine
• Doctor of podiatric medicine
• Doctor of optometry
• Chiropractor
Overview of Medicaid EHR Incentive Program
Eligible professionals can receive up to $63,750 as they adopt, implement, upgrade, or
demonstrate meaningful use of certified EHR technology in their first year of participation and
demonstrate meaningful use for up to six remaining years. It’s important to note this distinction
from the Medicare program, as Medicaid program participants are not necessarily required to
prove meaningful use in their first participation year. It is possible for Medicare program
par-ticipants to qualify within their first participation year by adopting, implementing, or upgrading
of/to certified EHR technology and demonstrating meaningful use in subsequent participation
years.
The Medicaid program is voluntarily offered by individual states and territories. As of May 2013,
the EHR Incentive Program is offered with open registration for all states except Hawaii. The
District of Columbia opened July 2013. There are no payment adjustments under the Medicaid
EHR Incentive Program.
EPs who meet the requirements of both the Medicare and Medicaid programs may participate
in only one program and must designate the program in which they would like to participate.
After a payment is made, EPs can change their program selection only once before 2015. In
order to prevent duplicate payments, hospital-based eligible professionals, which are defined
as EPs who furnish 90 percent or more of their allowed services in a hospital inpatient setting
or hospital emergency department, are not eligible for either incentive program.
As of March 2013, more than 259,000 health care providers received payment for
participat-ing in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. As of
March 2013, more than $8.2 billion in Medicare EHR Incentive Program payments have been
made, and more than $5.2 billion in Medicaid EHR Incentive Program payments have been
made.
Certified Technology
In order to receive certification, EHR technology must meet the standards of technology
capability, functionality, and security that assist purchasers and users in meeting the
mean-ingful use criteria set by the Centers for Medicare and Medicaid Services (CMS), a crucial
component of the incentive program. CMS worked closely with ONC to ensure the certification
standards for EHR technology are coordinated with the definition of meaningful use of certified
EHR technology.
Table 2: Medicaid EHR Incentive Program Payment Schedule for Eligible Professionals
If qualified to
receive first
payment in 2011
2012
2013
2014
2015
2016
Payment amount
for 2011 will be
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
Total payment
$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$-$63,750
$-$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$-$63,750
$-$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$-$63,750
$-$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$-$63,750
$-$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$-$63,750
$-$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$63,750
Medicaid eligible
professional (EP)
• Physician
• Nurse practitioner
• Certified nurse-midwife
• Dentist
Meaningful Use
It’s not enough to simply adopt and implement EHR technology; eligible professionals must
use the technology in a “meaningful” way in order to achieve the health and efficiency goals
outlined in the HITECH Act. The main components of meaningful use involve the use of
cer-tified EHR technology for the electronic exchange of health information to improve the quality
of healthcare and to submit clinical qualities and other measures. EPs, however, will not just
reap financial benefits from complying with the meaningful use regulations. They will also
experience benefits such as reduction in errors; availability of records and data; reminders and
alerts; clinical decision support; and e-prescribing/refill automation.
Criteria for Meaningful Use
In the Medicare and Medicaid Programs and Electronic Health Record Incentive Program
Final Rule, CMS acknowledges the final regulations for meaningful use are ambitious given
the current state of technology and standards of care. However, the expectation is that the
delivery of healthcare will evolve through the implementation of the incentive programs. The
criteria for meaningful use outlined in the Final Rule is based on what technology is currently
available coupled with provider practice experience, with a more robust definition to be
deter-mined in the future based on anticipated developments in technology.
To allow for this continued evolvement of meaningful use criteria, CMS will implement the
criteria outlined in the Final Rule in three stages.
Stage 1 (2011, 2012, 2013) sets the baseline
for electronic data capture and information sharing, while
Stage 2 (2014) and Stage 3 (2016)
will continue to expand on this baseline. As the expectations for health information exchange
become more inclusive in Stages 2 and 3, the end result is to bring to fruition the goal that
information follows the patient.
Table 3: Important Incentive Program Dates
Jan. 1, 2013 Reporting year begins for eligible professionals
• 90 days for first year of participation.
• Entire year for subsequent years of participation.
Some Stage 1 changes take effect, others are optional.
Feb. 28, 2013 Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year
(CY) 2012.
Sept. 30, 2013 Last day of the federal fiscal year.
Oct. 3, 2013 Last day for eligible professionals to begin their 90-day reporting period for CY 2013 for the Medicare EHR
Incentive Program.
Dec. 31, 2013 Reporting year ends for eligible professionals.
Jan. 1, 2014 Reporting period begins for eligible professionals for CY 2014
• 90 days for ALL participants.
Stage 2 begins for eligible professionals.
Eligible professionals attest for a three-month reporting period, regardless of when they began participation
in the Medicare EHR Incentive Program.
Last year eligible professionals can begin the Medicare EHR Incentive Program.
Feb. 28, 2014 Last day for eligible professionals to register and attest to receive an Incentive Payment for CY 2013 for
the Medicare EHR Incentive Program.
Sept. 30, 2014 Last day of the federal fiscal year.
Oct. 3, 2014 Last day for eligible professionals to begin 90-day reporting period for CY 2014 for the Medicare EHR
Incentive Program.
Stage 1
The main focus in stage 1 is establishing the functionalities of certified EHR technology that
set the stage for continuous quality improvement and ease of information exchange. Under
Stage 1, EPs must meet 14 required core objectives and 5 menu objectives from a list of 10.
Each objective is aligned with a measure for how healthcare professionals will be expected
to report on their usage of EHR technology, as well as any exclusions that take into account
healthcare professionals with practice limitations that hinder their participation in the program.
Previously in the Stage 1 meaningful use regulations, CMS had established a time line that
required providers to progress to Stage 2 criteria after two program years under the Stage 1
criteria. This original time line would have required Medicare providers who first demonstrated
meaningful use in 2011 to meet the Stage 2 criteria in 2013.
However, CMS delayed the onset of Stage 2 criteria. The earliest the Stage 2 criteria will be
effective is in calendar year 2014 for EPs. Table 4 below illustrates the progression of
meaning-ful use stages from when a Medicare provider begins participation in the program.
In the first year of participation of Stage 1, providers must demonstrate meaningful use for a
90-day EHR reporting period; in subsequent years, providers will demonstrate meaningful use
for a full calendar year EHR reporting period except in 2014, described below. Providers who
participate in the Medicaid EHR Incentive Programs are not required to demonstrate
mean-ingful use in consecutive years as described by the table below, but their progression through
the stages of meaningful use would follow the same overall structure of two years meeting the
criteria of each stage, with the first year of meaningful use participation consisting of a 90-day
EHR reporting period.
As of January 1, 2013, some changes to the Stage 1 meaningful use objectives, measures,
and exclusions for eligible professionals have taken effect. Other Stage 1 changes will not take
effect until 2014 and are optional in 2013.
Table 4: Stages of Meaningful Use Criteria by Payment Year
First
Payment
Year
Stage of Meaningful Use
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2011
Stage 1
Stage 1
Stage 1
Stage 2
Stage 2
Stage 3
Stage 3
TBD
TBD
TBD
TBD
2012
Stage 1
Stage 1
Stage 2
Stage 2
Stage 3
Stage 3
TBD
TBD
TBD
TBD
2013
Stage 1
Stage 1
Stage 2
Stage 2
Stage 3
Stage 3
TBD
TBD
TBD
2014
Stage 1
Stage 1
Stage 2
Stage 2
Stage 3
Stage 3
TBD
TBD
2015
Stage 1
Stage 1
Stage 2
Stage 2
Stage 3
Stage 3
TBD
2016
Stage 1
Stage 1
Stage 2
Stage 2
Stage 3
Stage 3
2017
Stage 1
Stage 1
Stage 2
Stage 2
Stage 3
For 2014 Only
All providers regardless of their stage of meaningful use are only required to demonstrate
meaningful use for a three-month EHR reporting period.
•
For Medicare providers, this three-month reporting period is fixed to the quarter of the
calendar year in order to align with existing CMS quality measurement programs, such as
the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting
(IQR).
•
For Medicaid providers only eligible to receive Medicaid EHR incentives, the three-month
reporting period is not fixed, where providers do not have the same alignment needs.
CMS is permitting this one-time, three-month reporting period in 2014 only so that all providers
who must upgrade to 2014 Certified EHR Technology will have adequate time to implement
new Certified EHR systems.
Goals for Stage 1
1. Electronically capturing health
information in a standardized
format
2. Using that information to track
key clinical conditions
3. Communicating that information
for care coordination processes
4. Initiating the reporting of clinical
quality measures and public
health information
Stage 2
CMS published the Final Rule in September 2012 that specifies the Stage 2 criteria that EPs
must meet in order to continue to participate in the Medicare and Medicaid EHR Incentive
Programs. All providers must achieve meaningful use under the Stage 1 criteria before moving
to Stage 2. The earliest the Stage 2 criteria will be effective is in fiscal year 2014.
Stage 2 retains the core and menu structure for meaningful use objectives. Although some
objectives have been combined or eliminated, most of the Stage 1 objectives are now core
objectives under the Stage 2 criteria. For many of these Stage 2 objectives, the threshold that
providers must meet for the objective has been raised as CMS expects providers in Stage 2 to
demonstrate meaningful use for an even larger portion of their patient populations. To
demon-strate meaningful use under Stage 2 criteria, EPs must meet 17 core objectives and 3 menu
objectives that they select from a total list of 6, or a total of 20 objectives.
Though most of the new objectives introduced for Stage 2 are menu objectives, EPs have a
new core objective they must achieve. CMS believes this objective will have a positive impact
on patient care and safety and are therefore requiring all providers to meet the objectives in
Stage 2.
New Stage 2 Core Objective for EPs:
Use secure electronic messaging to communicate with patients on relevant health information
Stage 2 also replaces the previous Stage 1 objectives to provide electronic copies of health
information or discharge instructions and provide timely access to health information with
objectives that allow patients to access their health information online.
Stage 2 Patient Access Objective for EPs:
Provide patients the ability to view online, download and transmit their health information
within four business days of the information being available to the EP
The Stage 2 criteria place an emphasis on health information exchange between providers to
improve care coordination for patients. One of the core objectives for EPs requires providers
who transition or refer a patient to another setting of care to provide a summary of care record
for more than 50 percent of those transitions of care and referrals. Additionally, there are new
requirements for the electronic exchange of summary of care documents: For more than 10
percent of transitions and referrals, EPs that transition or refer their patient to another setting
of care or provider of care must provide a summary of care record electronically.
The EP that transitions or refers their patient to another setting of care or provider of care
must either a) conduct one or more successful electronic exchanges of a summary of care
record with a recipient using technology that was designed by a different EHR developer than
the sender’s, or b) conduct one or more successful tests with the CMS-designated test EHR
during the EHR reporting period.
Stage 3
The Health IT Policy Committee (HITPC) released the preliminary recommendations for
Mean-ingful Use Stage 3 requirements, slated to go into effect in 2016. The proposed rule will focus
on sustainability of the program through improvements in quality, safety, and efficiency that
improve health outcomes.
Preliminary recommendations for Stage 3 would retire some measures, increase thresholds for
others and add new requirements to achieve meaningful use. Some key Stage 3 changes are:
• Smoking status would be tracked by a CQM.
• Implementing 15 clinical decision support intervention requirements.
• Requiring clinical summaries be sent to patients within one business day during 50 percent
of eligible encounters.
• Directing practices to use EHRs to query research systems for clinical trials. New
certifica-tion criteria would identify patient eligibility for relevant trials.
• Requiring the identification of education resources in five non-English languages; 80 percent
of materials written in at least one of those languages be made available to patients.
Goals for Stage 2
1. More rigorous health
information exchange (HIE)
2. Increased requirements for
e-prescribing and incorporating
lab results
3. Electronic transmission of
patient care summaries across
multiple settings
4. More patient-controlled data
Goals for Stage 3
1. Improving quality, safety, and
efficiency, leading to improved
health outcomes
2. Decision support for national
high-priority conditions
3. Patient access to self-
management tools
4. Access to comprehensive patient
data through patient-centered
HIE
Stage 1
Core Set Objectives
Objectives
Measures
Exclusions
Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.
More than 30% of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. Op-tional Alternate: More than 30% of medication orders
created by the EP during the EHR reporting period are recorded using CPOE.
Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
Implement drug-drug and drug-allergy interaction
checks. The EP has enabled this functionality for the entire EHR reporting period. No exclusion. Maintain an up-to-date problem list of current and active
diagnoses. More than 80% of all unique patients seen by the EP have at least one entry or an indication that no prob-lems are known for the patient recorded as structured data.
No exclusion.
Generate and transmit permissible prescriptions
elec-tronically (eRx). More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.
1.) Any EP who writes fewer than 100 prescriptions during the EHR reporting period; 2.) Any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice location at the start of his/her EHR reporting period.
Maintain active medication list. More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data.
No exclusion.
Maintain active medication allergy list. More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as struc-tured data.
No exclusion.
Record all of the following demographics: preferred
language, gender, race, ethnicity, date of birth. More than 50% of all unique patients seen by the EP have demographics recorded as structured data. No exclusion. Record and chart changes in the following vital signs:
height; weight; blood pressure; calculate and display body mass index (BMI); plot and display growth charts for children 2–20 years, including BMI.
For more than 50% of all unique patients ages 2 and older seen by the EP, height, weight, and blood pres-sure are recorded as structured data. New Measure
(Optional 2013; Required 2014 and beyond): For
more than 50% of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data.
Any EP who either sees no patients 2 years or older or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice. Any EP who either sees no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice. New Exclusion (Optional 2013; Replaces
exclusion above in 2014): Any EP who 1.) Sees no
patients 3 years or older is excluded from recording blood pressure; 2.) Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; 3.) Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or 4.) Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight.
Record smoking status for patients 13 years old or
older. More than 50% of all unique patients ages 13 or older seen by the EP have smoking status recorded as structured data.
Any EP who sees no patients 13 years or older.
Report ambulatory clinical quality measures to CMS or,
in the case of Medicaid EPs, the states. Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS.
No exclusion.
Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.
Implement one clinical decision support rule. No exclusions.
Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request.
More than 50% of all patients who request an electronic copy of their health information are provided it within 3 business days.
Any EP who has no requests from patients or their agents for an electronic copy of patient health informa-tion during the EHR reporting period.
Provide clinical summaries for patients for each office
visit. Clinical summaries provided to patients for more than 50% of all office visits within 3 business days. Any EP who has no office visits during the EHR report-ing period. Protect electronic health information created or
main-tained by the certified EHR technology through the implementation of appropriate technical capabilities.
Conduct or review a security risk analysis in accor-dance with the requirements under 45 CFR 164.308(a) (1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.
Stage 1
Menu Set Objectives
Objectives
Measures
Exclusions
Implement drug formulary checks. The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period.
Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
Incorporate clinical lab test results into EHR as
struc-tured data. More than 40% of all clinical lab test results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.
An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period.
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
Generate at least one report listing patients of the EP
with a specific condition. No exclusion. Send reminders to patients per patient preference for
preventive/follow-up care. More than 20% of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period.
An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology.
Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within four business days of the information being available to the EP.
At least 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health informa-tion subject to the EP’s discreinforma-tion to withhold certain information.
Any EP that neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR 170.304(g)) during the EHR reporting period.
Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.
More than 10% of all unique patients seen by the EP
are provided patient-specific education resources. No exclusion. The EP who receives a patient from another setting
of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP.
An EP who was not the recipient of any transitions of care during the EHR reporting period.
The 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.
The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals.
An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.
Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.
Performed at least one test of certified EHR technol-ogy’s capacity to submit electronic data to immuniza-tion registries and follow-up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the ca-pacity to receive the information electronically), except where prohibited.
An EP who administers no immunizations during the EHR reporting period, where no immunization registry has the capacity to receive the information electronical-ly, or where it is prohibited.
Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.
Performed at least one test of certified EHR technol-ogy’s capacity to provide electronic syndromic sur-veillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically), except where prohibited.
An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period, does not submit such information to any public health agency that has the capacity to receive the information electronically, or if it is prohibited.
Changes to Stage 1 in 2013
REQUIRED for all providers in 2013 – Public Health Reporting Objectives
Change: Clarification that providers must perform at least one test of their certified EHR technology’s capability to
send data to public health agencies, except where prohibited
Timing/Compliance: Required in 2013 and beyond for all Stage 1 public health objectives
What It Means: The intent of this modification is to encourage all EPs to submit public health data, even when
not required by State/local law. Therefore, if providers are authorized to submit the data, they should do so even if
it is not required by either law or practice.
REMOVED for all providers in 2013 – Electronic Exchange of Key Clinical Information
Change: Removal of electronic exchange of key clinical information objective for Stage 1
Timing/Compliance: Removed in 2013 and beyond
Stage 2
Core Set Objectives, Table 1 of 2
Objectives
Measures
Exclusions
Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.
More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE.
Any EP who writes fewer than 100 medication, radiol-ogy, or laboratory orders during the EHR reporting period.
Generate and transmit permissible prescriptions
elec-tronically (eRx). More than 50% of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.
Any EP who: (1) Writes fewer than 100 permissible prescriptions during the EHR reporting period; (2) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice loca-tion at the start of his/her EHR reporting period. Record the following demographics: preferred
lan-guage, sex, race, ethnicity, date of birth. More than 80% of all unique patients seen by the EP have demographics recorded as structured data. No exclusion. Record and chart changes in the following vital signs:
height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI.
More than 80% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data.
Any EP who: (1) Sees no patients 3 years or older is excluded from recording blood pressure; (2) Believes that all 3 vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; (3) Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; (4) Believes that blood pres-sure is relevant to their scope of practice, but height/ length and weight are not, is excluded from recording height/length and weight.
Record smoking status for patients 13 years old or
older. More than 80% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.
Any EP that neither sees nor admits any patients 13 years old or older.
Use clinical decision support to improve performance
on high-priority health conditions. Measure 1: Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP’s scope of practice or pa-tient population, the clinical decision support interven-tions must be related to high-priority health condiinterven-tions.
Measure 2: The EP has enabled and implemented the
functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.
For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period.
Provide patients the ability to view online, download and transmit their health information within four busi-ness days of the information being available to the EP.
Measure 1: More than 50% of all unique patients
seen by the EP during the EHR reporting period are provided timely (available to the patient within four business days after the information is available to the EP) online access to their health information. Measure 2: More than 5% of all unique patients seen by the EP
during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.
Any EP who: (1) Neither orders nor creates any of the information listed for inclusion as part of both measures, except for “Patient name” and “Provider’s name” and office contact information, may exclude both measures; (2) Conducts 50% or more of his/her patient encounters in a county that does not have 50% or more of its housing units with 3Mbps broadband avail-ability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude only the second measure.
Provide clinical summaries for patients for each office
visit. Clinical summaries provided to patients or patient- authorized representatives within one business day for more than 50% of office visits.
Any EP who has no office visits during the EHR reporting period.
Protect electronic health information created or maintained by the certified EHR technology (CEHRT) through the implementation of appropriate technical capabilities.
Conduct or review a security risk analysis in accor-dance with the requirements under 45 CFR 164.308(a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with require-ments under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider’s risk management process for EPs.
No exclusion.
Incorporate clinical lab-test results into Certified EHR
Technology (CEHRT) as structured data. More than 55% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data.
Any EP who orders no lab tests where results are ei-ther in a positive/negative affirmation or numeric format during the EHR reporting period.
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
Generate at least one report listing patients of the EP
Stage 2
Core Set Objectives, Table 2 of 2
Objectives
Measures
Exclusions
Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference.
More than 10% of all unique patients who have had two or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available.
Any EP who has had no office visits in the 24 months before the EHR reporting period.
Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.
Patient-specific education resources identified by Certi-fied EHR Technology are provided to patients for more than 10% of all unique patients with office visits seen by the EP during the EHR reporting period.
Any EP who has no office visits during the EHR reporting period.
The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
The EP who performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP.
Any EP who was not the recipient of any transitions of care during the EHR reporting period.
The 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.
EPs must satisfy both of the following measures in order to meet the objective: Measure 1: The EP who
transitions or refers their patient to another setting of care or provider of care provides a summary of care re-cord for more than 50% of transitions of care and refer-rals; Measure 2: The EP who transitions or refers their
patient to another setting of care or provider of care provides a summary of care record for more than 10% of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN; Measure 3: An EP must satisfy one of the
following criteria: (a) Conducts one or more successful electronic exchanges of a summary of care document, as part of which is counted in “measure 2” (for EPs the measure at §495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender’s EHR technology certified to 45 CFR 170.314(b)(2). (b) Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period.
Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from all three measures.
Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice.
Successful ongoing submission of electronic immuni-zation data from CEHRT to an immuniimmuni-zation registry or immunization information system for the entire EHR reporting period.
Any EP that meets one or more of the following criteria may be excluded from this objective: (1) the EP does not administer any of the immunizations to any of the populations for which data is collected by their jurisdic-tion’s immunization registry or immunization informa-tion system during the EHR reporting period; (2) the EP operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for CEHRT at the start of their EHR reporting period; (3) the EP operates in a jurisdiction where no immunization registry or immunization information system provides information timely on capability to receive immunization data; or (4) the EP operates in a jurisdiction for which no immunization registry or immunization informa-tion system that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs.
Use secure electronic messaging to communicate with
patients on relevant health information. A secure message was sent using the electronic mes-saging function of CEHRT by more than 5% of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.
Stage 2
Menu Set Objectives
Objectives
Measures
Exclusions
Capability to submit electronic syndromic surveil-lance data to public health agencies except where prohibited, and in accordance with applicable law and practice.
Successful ongoing submission of electronic syn-dromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period.
Any EP that meets one or more of the following criteria may be excluded from this objective:
(1) the EP is not in a category of providers that collect ambula-tory syndromic surveillance information on their patients during the EHR reporting period;
(2) the EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveil-lance data in the specific standards required by CEHRT at the start of their EHR reporting period;
(3) the EP operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; or
(4) the EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs.
Record electronic notes in patient records. Enter at least one electronic progress note created, edited and signed by an EP for more than 30 per-cent of unique patients with at least one office visit during the EHR Measure reporting period. The text of the electronic note must be text searchable and may contain drawings and other content
No exclusion.
Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT.
More than 10% of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT.
Any EP who orders less than 100 tests whose result is an image during the EHR reporting period; or any EP who has no access to electronic imaging results at the start of the EHR reporting period.
Record patient family health history as structured
data. More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives.
Any EP who has no office visits during the EHR reporting period.
Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice.
Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period.
Any EP that meets at least 1 of the following criteria may be excluded from this objective: (1) The EP does not diagnose or directly treat cancer; (2) The EP operates in a jurisdiction for which no public health agency is capable of receiving electron-ic cancer case information in the specifelectron-ic standards required for CEHRT at the beginning of their EHR reporting period; (3) The EP operates in a jurisdiction where no PHA provides in-formation timely on capability to receive electronic cancer case information; or (4) The EP operates in a jurisdiction for which no public health agency that is capable of receiving electronic cancer case information in the specific standards required for CEHRT at the beginning of their EHR reporting period can enroll additional EPs.
Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.
Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period.
Any EP that meets at least 1 of the following criteria may be excluded from this objective: (1) The EP does not diagnose or directly treat any disease associated with a specialized registry sponsored by a national specialty society for which the EP is eligible, or the public health agencies in their jurisdiction; (2) The EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period; (3) The EP operates in a jurisdiction where no public health agency or national specialty society for which the EP is eligible provides information timely on capability to receive information into their specialized registries; or (4) The EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible that is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period can enroll additional EPs.
