Meaningful Use. Using Certified Electronic Health Record (EHR) Technology to: Improve quality, safety, efficiency, and improve care coordination

Meaningful Use Using Certified Electronic Health Record (EHR) Technology to: Improve quality, safety, efficiency, and improve care coordination

Meaningful Use Chapter Select Intro & Glossary Meaningful Use Vision Meaningful Use Stage 21 Mean St

Meaningful Use Chapter Select Meaningful Use Stage 21 Meaningful Use Stage 2

Intro & Glossary 1

Intro & Glossary Meaningful Use What is it? Meaningful Use is using certified electronic health record (EHR) technology to: : Improve quality, safety, efficiency, and reduce health disparities : Engage patients and family : Improve care coordination : Improve population and public health : Maintain privacy and security of patient health information The goal is that meaningful use compliance will result in: : Better clinical outcomes : Improved population health outcomes : Increased transparency and efficiency : Empowered individuals : More robust research data on health systems Eligible professionals (EPs) need to successfully demonstrating meaningful use of a certified electronic health record (EHR) to qualify for an incentive payment through the Medicare EHR Incentive Program managed by the Centers for Medicare & Medicaid Services (CMS). To receive an EHR incentive payment, providers have to show that they are meaningfully using their EHRs by meeting thresholds for a number of objectives. CMS has established the objectives for meaningful use that EPs must meet in order to receive an incentive payment. The Meaningful Use Incentive Program has three progressive stages. Eligible professionals participate in the program s Stage 1, Stage 2 and Stage 3 attestation process based on calendar years. Who is Eligible? Medicare EPs : Doctors of medicine or osteopathy : Doctors of dental surgery or dental medicine : Doctors of podiatric medicine : Doctors of optometry : Chiropractors Medicaid EPs : Physicians : Nurse practitioners : Certified nurse-midwives : Dentists : Physician Assistants (PAs) in PA-led Federally Qualified Health Centers (FQHC) or rural health clinics (RHC) 2

Intro & Glossary Achieving meaningful use during Stages 1 & 2 requires meeting both core and menu objectives. All core objectives are required for each stage. EPs may choose which objectives to meet from the Meaningful Use Stage 1 and Stage 2 menu set. Meaningful Use Acroymns A/I/U ARRA CCD CCN CDS CEHRT CMS CPOE CQM CY EHR Adopt, Implement, or Upgrade (certified EHR Technology) American Recovery and Responsibility Act Continuity of Care Document CMS Certification Number Clinical Decision Support Certified EHR Technology Centers for Medicare & Medicaid Services Computerized Provider Order Entry Clinical Quality Measures Calendar Year Electronic Health Record EIN EP FQHC HIE HIT HITECH HIPAA I&Q IDR LBN MAC MAO Employer s Identification Number Eligible Professional Federally Qualified Health Center Health Information Exchange Health Information Technology Health Information Technology for Economic and Clinical Health Health Insurance Portability and Accountability Act Identification & Authentication System Integrated Data Repository Legal Business Name Medicare Administrative Contractor Medicare Advantage Organization MU NPI NPPES OIG PECOS PHI RHC SSN TIN Meaningful Use National Provider Identifier National Plan and Provider Enumeration System Office of the Inspector General Provider Enrollment, Chain and Ownership System Protected/Personal Health Information Rural Health Center Social Security Number Tax Identification Number 3

Meaningful Use Vision 4

Meaningful Use Vision What is the Vision of this Program? ADOPT A CERTIFIED EHR CAPTURE DATA EHR Stage 1 Meaningful Use refers to using EHR features that measurably improve health care quality and efficiency. Begin with the end in mind. Ultimately, the vision is for healthcare to be: : Patient-centered : Evidence-based : Prevention-oriented : Efficient : Equitable In order to achieve this vision, CMS will raise the bar by increasing the minimum requirements with each stage of Meaningful Use. The goal is to operationalize MU strategies into a sustainable program within your health system in order to achieve the vision. The Building Blocks of Meaningful Use Adopt & Use a CEHRT Utilize EHR functionality of a certified system Capture Data Most important building block as data captured today affects reimbursement tomorrow Move Data Interoperability or moving data between systems (coordination and transition of care) Report Data Required to report data to CMS and other registries ADOPT A CERTIFIED EHR CAPTURE MOVE DATA DATA REPORT DATA Stage 2 5

Meaningful Use Stage 1 6

Meaningful Use Stage 1 On the Road to MU Stage 1 Meaningful Use Stage 1 encourages adoption of electronic health records (EHRs), focusing on data capture. All providers begin Meaningful Use participation by meeting the Stage 1 requirements. Along the road there are a lot of hurdles that need to be met. We will now try to go through those steps to make it as transparent as possible. 7

Meaningful Use Stage 1 core objectives & menu set measures 8

Meaningful Use Stage 1 Core & Menu Set Objectives The benefits of participation in the Meaningful Use program extend far beyond the incentive payments. The enhanced quality of patient care will ultimately lead to improved outcomes at a reduced cost. In order to provide organization and structure to this process of improvement, the Meaningful Use program consists of requirements and deadlines. The CMS EHR Incentive Program divides the requirements into a core group of mandatory objectives and a menu set of objectives from which providers can choose to defer a predetermined number of objectives. What is a Core Objective? A Core Objective is a required objective because it is essential to the process of using an EHR in a meaningful way in order to enable the delivery of higher quality patient care. For each core objective, a specific measurement must be achieved to satisfy the objective. What is a Menu Set Objective? A Menu Set of Objectives allows the EP to personally select objectives to customize the Meaningful Use program and target measures relevant to his/her practice. More specifically, the EP will choose five out of the ten listed objectives for Stage 1 and three out of the six listed objectives for Stage 2. For each chosen objective, the specified measurement must be achieved to satisfy the objective. In all likelihood, menu set measures will become core measures in the next stage of Meaningful Use. 9

Meaningful Use Stage 1 core objectives 10

Meaningful Use Stage 1 Core Objective - 1 of 13 CPOE for Medication Orders Objective Measure 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 percent 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. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period. NUMERATOR - Number of patients in the denominator that have at least one medication order entered using CPOE. Exclusion EXCLUSION - EPs who write fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement. EPs must enter the number of prescriptions written during the EHR reporting period in the Exclusion box to attest to exclusion from this requirement. 11

Meaningful Use Stage 1 Core Objective - 1 of 13 CPOE for Medication Orders - Optional Objective Measure 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 percent of medication orders created by the EPduring the EHR reporting period are recorded using CPOE. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of medication orders created by the EP during the EHR reporting period. NUMERATOR - Number of medication orders in the denominator entered using CPOE. Exclusion EXCLUSION - EPs who write fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement. EPs must enter the number of prescriptions written during the EHR reporting period in the Exclusion box to attest to exclusion from this requirement. 12

Meaningful Use Stage 1 Core Objective - 2 of 13 Drug Interaction Checks Objective Measure Implement drug-drug and drug-allergy interaction checks. The EP has enabled this functionality for the entire EHR reporting period. Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to having enabled drug-drug and drug-allergy interaction checks for the length of the reporting period to meet this measure. Exclusion NO EXCLUSION 13

Meaningful Use Stage 1 Core Objective - 3 of 13 Maintain Problem List Objective Measure Maintain an up-to-date problem list of current and active diagnoses. More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of unique patients seen by the EP during the EHR reporting period. Exclusion NO EXCLUSION NUMERATOR - Number of patients in the denominator who have at least one entry or an indication that no problems are known for the patient recorded as structured data in their problem list. 14

Meaningful Use Stage 1 Core Objective - 4 of 13 e-prescribing (erx) Objective Measure Generate and transmit permissible prescriptions electronically (erx). More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period. NUMERATOR - Number of prescriptions in the denominator generated and transmitted electronically. Exclusion EXCLUSION - EPs who write fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement. EPs must enter the number of prescriptions written during the EHR reporting period in the Exclusion box to attest to exclusion from this requirement. EPs who do 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, would be excluded from this requirement. 15

Meaningful Use Stage 1 Core Objective - 5 of 13 Active Medication List Objective Measure Maintain active medication list. More than 80 percent 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. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of unique patients seen by the EP during the EHR reporting period. Exclusion NO EXCLUSION NUMERATOR - Number of patients in the denominator who have a medication (or an indication that the patient is not currently prescribed any medication) recorded as structured data. 16

Meaningful Use Stage 1 Core Objective - 6 of 13 Medication Allergy List Objective Measure Maintain active medication allergy list. More than 80 percent 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 structured data. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of unique patients seen by the EP during the EHR reporting period. Exclusion NO EXCLUSION NUMERATOR - Number of unique patients in the denominator who have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data in their medication allergy list. 17

Meaningful Use Stage 1 Core Objective - 7 of 13 Record Demographics Objective Measure Record all of the following demographics: : Preferred language : Gender : Race : Ethnicity : Date of birth More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of unique patients seen by the EP during the EHR reporting period Exclusion NO EXCLUSION NUMERATOR - Number of patients in the denominator who have all the elements of demographics (or a specific exclusion if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data. 18

Meaningful Use Stage 1 Core Objective - 8 of 13 Record Vital Signs Objective Measure 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 percent of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data. New Measure (Optional 2013; Required 2014 and beyond): For more than 50 percent 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. Attestation Requirements Continued on next page... 19

Meaningful Use Stage 1 Core Objective - 8 of 13 Record Vital Signs - Continued Attestation Requirements Denominator / Numerator DENOMINATOR - Number of unique patients age 2 or over seen by the EP during the EHR reporting period. NUMERATOR - Number of patients in the denominator who have at least one entry of their height, weight and blood pressure recorded as structured data. New Denominator / Numerator (Optional 2013; Required in 2014 and beyond) DENOMINATOR - Number of unique patients (age 3 or over for blood pressure) seen by the EP during the EHR reporting period. NUMERATOR - Number of patients in the denominator who have at least one entry of their height, weight and blood pressure (ages 3 and over) recorded as structured data. New Exclusion EXCLUSION - Any EP who : Sees no patients 3 years or older is excluded from recording blood pressure; : 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; : Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; -or- : Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight. 20

Meaningful Use Stage 1 Core Objective - 9 of 13 Record Smoking Status Objective Measure Record smoking status for patients 13 years old or older. More than 50 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of unique patients age 13 or older seen by the EP during the EHR reporting period. NUMERATOR - Number of patients in the denominator with smoking status recorded as structured data. Exclusion EXCLUSION - An EP who sees no patients 13 years or older would be excluded from this requirement. EPs must enter 0 in the Exclusion box to attest to exclusion from this requirement. 21

Meaningful Use Stage 1 Core Objective - 10 of 13 Clinical Decision Support Rule Objective Measure 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. Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to having implemented one clinical decision support rule for the length of the reporting period to meet the measure. Exclusion NO EXCLUSION 22

Meaningful Use Stage 1 Core Objective - 11 of 13 Electronic Copy of Health Information Objective Measure Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request. More than 50 percent of all patients who request an electronic copy of their health information are provided it within 3 business days. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of patients of the EP who request an electronic copy of their electronic health information four business days prior to the end of the EHR reporting period. NUMERATOR - Number of patients in the denominator who receive an electronic copy of their electronic health information within three business days. Exclusion EXCLUSION - An EP who has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period would be excluded from this requirement. EPs must enter 0 in the Exclusion box to attest to exclusion from this requirement. 23

Meaningful Use Stage 1 Core Objective - 12 of 13 Clinical Summaries Objective Measure Provide clinical summaries for patients for each office visit. Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of office visits by the EP during the EHR reporting period. NUMERATOR - Number of office visits in the denominator for which the patient is provided a clinical summary within three business days. Exclusion EXCLUSION - EPs who have no office visits during the EHR reporting period would be excluded from this requirement. EPs must enter 0 in the Exclusion box to attest to exclusion from this requirement. 24

Meaningful Use Stage 1 Core Objective - 13 of 13 Protect Electronic Health Information Objective Measure Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Conduct or review a security risk analysis in accordance 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. Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to having conducted or reviewed a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implemented security updates as necessary and corrected identified security deficiencies prior to or during the EHR reporting period to meet this measure. Exclusion NO EXCLUSION 25

Meaningful Use Stage 1 menu set measures 26

Meaningful Use Stage 1 Menu Set Measure - 1 of 10 Drug Formulary Checks Objective Measure 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. Attestation Requirements YES / NO / EXCLUSION Eligible professionals (EPs) must attest YES to having enabled this functionality and having had access to at least one internal or external formulary for the entire EHR reporting period to meet this measure. An EP who writes fewer than 100 prescriptions during the EHR reporting period can be excluded from this objective and associated measure. EPs must enter 0 in the Exclusion box to attest to exclusion from this requirement. 27

Meaningful Use Stage 1 Menu Set Measure - 2 of 10 Clinical Lab Test Results Objective Measure Incorporate clinical lab test results into EHR as structured data. More than 40 percent 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. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of lab tests ordered during the EHR reporting period by the EP whose results are expressed in a positive or negative affirmation or as a number. NUMERATOR - Number of lab test results whose results are expressed in a positive or negative affirmation or as a number which are incorporated as structured data. Exclusion EXCLUSION - If an EP orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. 28

Meaningful Use Stage 1 Menu Set Measure - 3 of 10 Patient Lists Objective Measure 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. Attestation Requirements YES / NO / EXCLUSION Eligible professionals (EPs) must attest YES to having generated at least one report listing patients of the EP with a specific condition to meet this measure. 29

Meaningful Use Stage 1 Menu Set Measure - 4 of 10 Patient Reminders Objective Measure Send reminders to patients per patient preference for preventive/follow-up care. More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of unique patients 65 years old or older or 5 years older or younger. NUMERATOR - Number of patients in the denominator who were sent the appropriate reminder. Exclusion EXCLUSION - If an EP has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology that EP is excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. 30

Meaningful Use Stage 1 Menu Set Measure - 5 of 10 Patient Electronic Access Objective Measure Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. At least 10 percent 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 information subject to the EP s discretion to withhold certain information. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of unique patients seen by the EP during the EHR reporting period NUMERATOR - Number of patients in the denominator who have timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information online. Exclusion EXCLUSION - If an EP 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, they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. 31

Meaningful Use Stage 1 Menu Set Measure - 6 of 10 Patient-specific Education Resources Objective Measure Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. More than 10 percent of all unique patients seen by the EP are provided patient- specific education resources. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of unique patients seen by the EP during the EHR reporting period. Exclusion NO EXCLUSION NUMERATOR - Number of patients in the denominator who are provided patient-specific education resources. 32

Meaningful Use Stage 1 Menu Set Measure - 7 of 10 Medication Reconciliation Objective Measure 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 percent of transitions of care in which the patient is transitioned into the care of the EP. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition. NUMERATOR - Number of transitions of care in the denominator where medication reconciliation was performed. Exclusion EXCLUSION - If an EP was not on the receiving end of any transition of care during the EHR reporting period they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. 33

Meaningful Use Stage 1 Menu Set Measure - 8 of 10 Transition of Care Summary Objective Measure 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 percent of transitions of care and referrals. Attestation Requirements Denominator / Numerator DENOMINATOR - Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. NUMERATOR - Number of transitions of care and referrals in the denominator where a summary of care record was provided. Exclusion EXCLUSION - If an EP does not transfer a patient to another setting or refer a patient to another provider during the EHR reporting period then they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. 34

Meaningful Use Stage 1 Menu Set Measure - 9 of 10 Immunization Registries Data Submission Objective Measure 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 technology s capacity to submit electronic data to immunization 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 capacity to receive the information electronically), except where prohibited. Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to having performed at least one test of certified EHR technology s capacity to submit electronic data to immunization registries and follow up submission if the test was successful, (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically) except where prohibited, to meet this measure. Exclusion EXCLUSION - If an EP does not perform immunizations during the EHR reporting period, if there is no immunization registry that has the capacity to receive the information electronically, or if it is prohibited, then the EP would be excluded from this requirement. EPs must select NO next to the appropriate exclusion(s), then click the APPLY button in order to attest to the exclusion(s). 35

Meaningful Use Stage 1 Menu Set Measure - 10 of 10 Syndromic Surveillance Data Submission Objective Measure 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 technology s capacity to provide electronic syndromic surveillance 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. Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to having performed at least one test of certified EHR technology s capacity to submit electronic syndromic surveillance data to public health agencies and follow up submission if the test was successful (unless none of the public health agencies to which the EP submits such information has the capacity to receive the information electronically), except where prohibited, to meet this measure. Exclusion EXCLUSION - If an EP does not collect any reportable syndromic information on their patients during the EHR reporting period, if no public health agency that has the capacity to receive the information electronically, or if it is prohibited, then the EP is excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. 36

Meaningful Use Stage 1 2014 Clinical Quality Measures (CQM) 37

2014 Clinical Quality Measures (CQMs) CQM Overview Select a Domain As part of the criteria for satisfying meaningful The 64 measure specifications along with the use, clinical quality measures results (numerators/ denominators, and exclusions) must be reported to CMS. Below are electronic specifications for eligible professionals. companion NQF document are listed in the following sections. Medicare-eligible providers beyond their first year of demonstrating meaningful use must Patient & Family Engagement Patient Safety From the table of 64 clincal quality measures electronically report their CQM data to CMS. (CQMs), eligible professionals must report on 9 (Medicaid EPs that are eligible only for the clinical quality measures. The quality measures selected must cover a minimum of 3 of the 6 key health care policy domains recommended by the Department of Health and Human Services National Quality Strategy: Medicaid EHR Incentive Program will electronically report their CQM data to their state.) View recommended Core CQMs for Adult & Pediatric care. Care Coordination Population & Public Health : Patient & Family Engagement : Patient Safety : Care Coordination : Population & Public Health : Efficient Use of Healthcare Resources Adult Pediatric Efficient Use of Healthcare Resources Clinical Processes & Effectiveness : Clinical Processes and Effectiveness 38

2014 Clinical Quality Measures (CQMs) Patient & Family Engagement * - Certified Version 4.2 CQMs No. Title Description References 56 * 66 * 90 * 157 Functional status assessment for hip replacement Functional status assessment for knee replacement Functional status assessment for complex chronic conditions Oncology: Medical and Radiation Pain Intensity Quantified Percentage of patients aged 18 years and older with primary total hip arthroplasty (THA) who completed baseline and follow-up (patientreported) functional status assessments. Percentage of patients aged 18 years and older with primary total knee arthroplasty (TKA) who completed baseline and follow-up (patientreported) functional status assessments. Percentage of patients aged 65 years and older with heart failure who completed initial and follow-up patient-reported functional status assessments Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified 39

2014 Clinical Quality Measures (CQMs) Patient Safety * - Certified Version 4.2 CQMs No. Title Description References 68 * 132 Documentation of Current Medications in the Medical Record Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures Percentage of specified visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications to the best of his/her knowledge and ability. This list must include ALL prescriptions, over-the-counters, herbals, and vitamin/mineral/ dietary (nutritional) supplements AND must contain the medications name, dosage, frequency and route of administration. Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence. 139 * Falls: Screening for Future Fall Risk Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period. Continued on next page... 40

2014 Clinical Quality Measures (CQMs) Patient Safety - Continued Percentage of patients 66 years of age and older who were ordered highrisk medications. Two rates are reported. 156 * 177 179 Use of High-Risk Medications in the Elderly Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range : Percentage of patients who were ordered at least one high-risk medication. : Percentage of patients who were ordered at least two different highrisk medications. Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk. Average percentage of time in which patients aged 18 and older with atrial fibrillation who are on chronic warfarin therapy have International Normalized Ratio (INR) test results within the therapeutic range (i.e., TTR) during the measurement period. 41

2014 Clinical Quality Measures (CQMs) Core Coordination * - Certified Version 4.2 CQMs No. Title Description References 50 * Closing the referral loop: receipt of specialist report Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred. 42

2014 Clinical Quality Measures (CQMs) Population & Public Health * - Certified Version 4.2 CQMs No. Title Description References 2 * 22 * 69 * Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented * Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow up plan is documented on the date of the positive screen. Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow up plan is documented on the date of the positive screen. Percentage of patients aged 18 years and older with an encounter during the reporting period with a documented calculated BMI during the encounter or during the previous six months AND when the BMI is outside of normal parameters, follow-up plan is documented during the encounter or during the previous 6 months of the encounter with the BMI outside of normal parameters. Normal Parameters: Age 65 years and older BMI = 23 and < 30 Age 18-64 years BMI = 18.5 and < 25 Continued on next page... 43

2014 Clinical Quality Measures (CQMs) Population & Public Health - Continued 82 Maternal depression screening 117 Childhood Immunization Status The percentage of children who turned 6 months of age during the measurement year, who had a face-to-face visit between the clinician and the child during child s first 6 months, and who had a maternal depression screening for the mother at least once between 0 and 6 months of life. Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. 138 * 147 * Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Preventive Care and Screening: Influenza Immunization Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization Continued on next page... 44

2014 Clinical Quality Measures (CQMs) Population & Public Health - Continued 153 Chlamydia Screening for Women Percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period. 155 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/ Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Three rates are reported. : Percentage of patients with height, weight, and body mass index (BMI) percentile documentation : Percentage of patients with counseling for nutrition : Percentage of patients with counseling for physical activity 45

2014 Clinical Quality Measures (CQMs) Efficient Use of Healthcare Resources * - Certified Version 4.2 CQMs No. Title Description References 129 146 154 * 166 * Closing the referral loop: receipt of specialist report Appropriate Testing for Children with Pharyngitis Appropriate Treatment for Children with Upper Respiratory Infection (URI) Use of Imaging Studies for Low Back Pain Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer. Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode. Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode. Percentage of patients 18-50 years of age with a diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis. 46

2014 Clinical Quality Measures (CQMs) Clinical Processes & Effectiveness * - Certified Version 4.2 CQMs No. Title Description References 52 61 HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) Prophylaxis Preventive Care and Screening: Cholesterol Fasting Low Density Lipoprotein (LDL-C) Test Performed Percentage of patients aged 6 weeks and older with a diagnosis of HIV/ AIDS who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis Percentage of patients aged 20 through 79 years whose risk factors have been assessed and a fasting LDL-C test has been performed. 62 HIV/AIDS: Medical Visit Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with at least two medical visits during the measurement year with a minimum of 90 days between each visit. 64 Preventive Care and Screening: Risk-Stratified Cholesterol Fasting Low Density Lipoprotein (LDL-C) Percentage of patients aged 20 through 79 years who had a fasting LDL-C test performed and whose risk-stratified fasting LDL-C is at or below the recommended LDL-C goal. Continued on next page... 47

2014 Clinical Quality Measures (CQMs) Clinical Processes & Effectiveness - Continued 65 74 75 Hypertension: Improvement in blood pressure Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists Children who have dental decay or cavities Percentage of patients aged 18-85 years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period. Percentage of children, age 0-20 years, who received a fluoride varnish application during the measurement period. Percentage of children, ages 0-20 years, who have had tooth decay or cavities during the measurement period. 77 122 HIV/AIDS: RNA control for Patients with HIV Diabetes: Hemoglobin A1c Poor Control Percentage of patients aged 13 years and older with a diagnosis of HIV/ AIDS, with at least two visits during the measurement year, with at least 90 days between each visit, whose most recent HIV RNA level is <200 copies/ ml. Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period. Continued on next page... 48

2014 Clinical Quality Measures (CQMs) Clinical Processes & Effectiveness - Continued 123 Diabetes: Foot Exam Percentage of patients aged 18-75 years of age with diabetes who had a foot exam during the measurement period. 124 * Cervical Cancer Screening 125 * Breast Cancer Screening Percentage of women 21-64 years of age, who received one or more Pap tests to screen for cervical cancer. Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer. 126 127 * Use of Appropriate Medications for Asthma Pneumonia Vaccination Status for Older Adults Percentage of patients 5-64 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period. Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine. Continued on next page... 49

2014 Clinical Quality Measures (CQMs) Clinical Processes & Effectiveness - Continued 128 Anti-depressant Medication Management Percentage of patients 18 years of age and older who were diagnosed with major depression and treated with antidepressant medication, and who remained on antidepressant medication treatment. Two rates are reported. 130 * Colorectal Cancer Screening Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer. 131 Diabetes: Eye Exam Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period 133 Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and no significant ocular conditions impacting the visual outcome of surgery and had bestcorrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following the cataract surgery. Continued on next page... 50

2014 Clinical Quality Measures (CQMs) Clinical Processes & Effectiveness - Continued 134 Diabetes: Urine Protein Screening The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period. 135 136 Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) ADHD: Follow-Up Care for Children Prescribed Attention- Deficit/Hyperactivity Disorder (ADHD) Medication Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge Percentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/ hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported. : Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase. : Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended. Continued on next page... 51

2014 Clinical Quality Measures (CQMs) Clinical Processes & Effectiveness - Continued 137 140 141 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/ Progesterone Receptor (ER/PR) Positive Breast Cancer Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients Percentage of patients 13 years of age and older with a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported. : Percentage of patients who initiated treatment within 14 days of the diagnosis. : Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit. Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period Percentage of patients aged 18 through 80 years with AJCC Stage III colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy within the 12-month reporting period Continued on next page... 52

2014 Clinical Quality Measures (CQMs) Clinical Processes & Effectiveness - Continued 142 143 144 145 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Coronary Artery Disease (CAD): Beta-Blocker Therapy Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months Percentage of patients aged 18 years and older with a diagnosis of POAG who have an optic nerve head evaluation during one or more office visits within 12 months Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy Continued on next page... 53

2014 Clinical Quality Measures (CQMs) Clinical Processes & Effectiveness - Continued 148 Hemoglobin A1c Test for Pediatric Patients Percentage of patients 5-17 years of age with diabetes with an HbA1c test during the measurement period 149 Dementia: Cognitive Assessment Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12 month period. 158 Pregnant women that had HBsAg testing This measure identifies pregnant women who had a HBsAg (hepatitis B) test during their pregnancy. 159 160 Depression Remission at Twelve Months Depression Utilization of the PHQ- 9 Tool Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment. Adult patients age 18 and older with the diagnosis of major depression or dysthymia who have a PHQ-9 tool administered at least once during a 4 month period in which there was a qualifying visit. Continued on next page... 54

2014 Clinical Quality Measures (CQMs) Clinical Processes & Effectiveness - Continued 161 Anti-depressant Medication Management Percentage of patients 18 years of age and older who were diagnosed with major depression and treated with antidepressant medication, and who remained on antidepressant medication treatment. Two rates are reported. : Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). : Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months). 163 Diabetes: Low Density Lipoprotein (LDL) Management Percentage of patients 18-75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dl) during the measurement period. 164 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antithrombotic during the measurement period. Continued on next page... 55

2014 Clinical Quality Measures (CQMs) Clinical Processes & Effectiveness - Continued 165 * Controlling High Blood Pressure Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period. 167 169 182 Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use. Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had a complete lipid profile performed during the measurement period and whose LDL-C was adequately controlled 56

Meaningful Use Stage 2 57

Meaningful Use Stage 2 On the Road to MU Stage 2 Meaningful Use Stage 2 addresses advanced clinical processes and the ability to exchange information privately and securely. CMS recently finalized the rule that specifies the Stage 2 criteria. The road for Stage 2 shows strong similarities to Stage 1. We will now go through all of steps to insure your success by comparing the two. 58

Meaningful Use Stage 2 the steps to success 59

Meaningful Use Stage 2 the steps to success Assess your starting point See how Stage 1 compares to Stage 2, and where you need to focus to attain Meaningful Use objectives. Plot your timeline Understand your incentive payment schedule, your Meaningful Use reporting period, and how to ramp up to Stage 2 while also undergoing the 2014 ICD- 10 conversion. Integrate Meaningful Use measures into your workflow Evaluate your current workflow to maximize performance and increase your Stage 1 performance to meet the Stage 2 thresholds. Create a patient engagement strategy Create a patient engagement strategy that leverages technology and marketing to launch and promote a patient portal and actively engage patients in their care. 13 Core 5 of 10 Menu Stage 1 17 Core 3 of 6 Menu Higher Thresholds Stage 2 60

Meaningful Use Stage 2 Assess your starting point There are two things to keep in mind as you consider Meaningful Use: : There are strong similarities between Stage 1 and Stage 2. If you have already mastered Stage 1, you are well positioned for success in Stage 2; and : It s not too late to start the Meaningful Use program, but if you have already started, you must keep going to avoid penalties. Like Stage 1, Stage 2 uses core and menu objectives that providers must achieve in order to demonstrate Meaningful Use. All providers must meet core objectives. In addition, there area predetermined number of menu objectives that providers must select from in order to demonstrate Meaningful Use. To demonstrate Meaningful Use under Stage 2 criteria: : EPs must meet 17 core objectives and 3 menu objectives that they select from the menu set list of 6, for a total of 20 core objectives. : Eligible hospitals and CAHs must meet 16 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 19 core objectives. Although some Stage 1 objectives were either 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. What if we haven t yet attested for Stage 1? If you are just getting started with Meaningful Use in 2013 or 2014, you will not be eligible for full incentive amounts, but will avoid the looming penalties. The last year to begin participation in the Medicare EHR Incentive Program is 2014. For Medicare EPs who demonstrate meaningful use in 2014 for the first time, you must attest no later than October 1, 2014. That means you must begin your 90-day EHR reporting period no later than July 1, 2014. If you do not meet Medicare Meaningful Use in 2014, you could face a 2% fee schedule reduction in 2016. The last year to begin participation in the Medicaid EHR Incentive Program is 2016. 61

Meaningful Use Stage 2 Assess your starting point Here is a more detailed comparison of Stage 1 and Stage 2 measures. Though most of the new objectives introduced for Stage 2 are menu objectives, EPs have a new core objective added to the required measurements. New Stage 2 core objective for EPs: : Use secure electronic messaging to communicate with patients on relevant health information Stage 2 also has new menu objectives for EPs: : Record electronic notes in patient records You are Here : Imaging results accessible through certified EHR technology (CEHRT) : Record patient family health history : Identify and report cancer cases to a state cancer registry : Identify and report specific cases to a specialized registry (other than a cancer registry) (for EPs only) 62

Meaningful Use Stage 2 Assess your starting point Here s an overview of how measures compare between Stage 1 and Stage 2. If you have already attested in Stage 1, you re in good shape since almost all of the Stage 1 measures appear in Stage 2 Measures that have been retained in Stage 2 from Stage 1, but with higher thresholds Computerized physician order entry (CPOE) Demographics Vitals Smoking Status Structured Labs * Patient Lists * Preventive Reminders * Clinical Summary Patient Education * Medication Reconciliation * Immunizations * Syndromic Surveillance Security Analysis Measures that have been consolidated in Stage 2 from Stage 1 erx : erx, Drug Formulary Interventions : Clinical Decision Support, Drug/Drug, Drug/Allergy Patient Access : Timely Access, e-copy of Health Information Summary of Care : Summary of Care, Problems, Medications, Medication Allergies, Exchange Clinical Information * Measure was optional (menu) in Stage 1, required (core) in Stage 2 Click here to view all Stage 2 Measures 63

Meaningful Use Stage 2 Plot your timeline Plot a timeline Meaningful Use is designed to accommodate practices on different timelines. For example, practices that attested to Meaningful Use Stage 1 in 2011 or 2012 are eligible for full incentive payments. Those starting with Meaningful Use in 2013 or 2014 will not be eligible for the full incentive amounts, but will reap some rewards and avoid those looming penalties. How do you determine your start year? How do you determine your start year? For both the Medicare and Medicaid EHR Incentive Programs, the EHR reporting period for an EP s first year is any continuous 90-day period within the calendar year. In subsequent years, the EHR reporting period for EPs is the entire calendar year. Incentive Amounts Depend on When You Start Meaningful Use Medicare EHR Incentive Payments Medicaid EHR Incentive Payments Maximum EHR incentives are $44,000 over five consecutive years EHR incentive payments decrease if you start after 2012 You must begin by 2014 to receive EHR incentive payments Last incentive payment year is 2016 Maximum EHR incentive payments are $63,750 over six years (do not need to be consecutive) The first year EHR incentive payment is $21,250; $8,500 for next five years Must begin by 2016 to receive EHR incentive payments; last incentive payment year is 2021 Time is running out, but it s not too late? The last year to begin participation in the Medicare EHR Incentive Program is 2014, and the last year to begin participation in the Medicaid EHR Incentive Program is 2016. If you haven t yet started with Meaningful Use, you can still avoid penalties. For EPs who demonstrate Meaningful Use in 2014 for the first time, you must attest no later than October 1, 2014. That means you must begin your 90-day EHR reporting period no later than July 1, 2014. Keep in mind if you do not meet Medicare Meaningful Use in 2014, you could face a 2% fee schedule reduction in 2016. In the coming months, health care organizations face a perfect storm of regulatory and compliance issues, with both Meaningful Use and the ICD-10 conversion happening at virtually the same time. To successfully achieve both, focus on Meaningful Use first. Once you have a handle on your Meaningful Use, turn your attention to a successful ICD-10 transition. 64

Meaningful Use Stage 2 Plot your timeline Meaningful Use Start Year Determines Your Stage Start Year *Only for providers who are beyond their first year of Meaningful Use Reporting Period by Stage of Meaningful Use 2011 2012 2013 2014 2015 2016 2011 2012 2013 2014 1 1 1 2* 2 2 90 Days Full Year Full Year Quarter Full Year Full Year 1 1 2* 2 2 90 Days Full Year Quarter Full Year Full Year 1 1* 2 2 90 Days Quarter Full Year Full Year 1 1 2 90 Days Full Year Full Year 65

Meaningful Use Stage 2 Integrate Meaningful Use measures into workflow Once you have determined your vendor s EHR certification approach, bring provider performance to Stage 2 levels for core and menu objectives. In most cases, this should be relatively straightforward: simply increase providers Stage 1 performance to meet the Stage 2 thresholds. Step 1 - To do this, look at your workflow data, particularly individual physician performance on Meaningful Use measures. Many EHRs provide this kind of data in dashboards that are easily accessible and readable. If you don t have ready access to this kind of data, talk to your EHR vendor about how to get it. Your vendor should be able to describe how to pull this kind of data from your EHR, or how to order the right reports, and should not involve much effort or cost. Once you have the information, make sure every provider is adhering to best practices when it comes to Meaningful Use. Step 2 - Integrate Meaningful Use Stage 2 measures into the workflow. Again, your EHR vendor should perform this on your behalf without additional cost. The transition to Stage 2 thresholds should be relatively seamless, and your EHR vendor should provide support, training and coaching through this transition as needed. Ideally, your EHR vendor can instantly embed changes right into the EHR workflow to make sure the right person is doing right work, and to bring the right information to the right provider at the point of care. Step 3 - Work with your vendor or make sure you understand how to run regular reports on Meaningful Use performance. Monitor and correct provider performance where necessary to make sure your practice is maintaining the right thresholds. 66

Meaningful Use Stage 2 Create a patient engagement strategy For many practices, patient engagement could be the most complex and intensive component of attesting for Stage 2. Stage 1 focused on (mostly optional) measures to provide timely access to patient information. However, Stage 2 focuses on patient engagement and empowerment, which means that patients not only need to access their health information, but also view it, download it, or transmit it that is, they need to actively engage with their health records. There are two new Stage 2 core objective measures that could take some time to get up and running: : Provide patients the ability to view online, download and transmit their health information and must be sure more than 5 percent of patients seen by the EP actually view, download, or transmit (to a third party) their health information. : Use secure electronic messaging to communicate with patients on relevant health information. A secure message must be sent using the electronic messaging function of Certified EHR Technology by more than 5 percent of unique patients seen by an EP during the EHR reporting period. This means you will need to implement a patient engagement strategy that 1) leverages technology, such as an online patient portal, and 2) promotes the portal so patients know about it, understand why it is beneficial, and successfully use it. Your patient portal should allow patients to fully engage with their demographic, financial, and health information. It should provide secure, compliant patient messaging via e-mail, phone, text and the web. It should give patients the opportunity to make appointments and get appointment reminders, view and update personal information, request prescriptions, receive test results, and read patient education material. However, no matter how many features your patient portal has, you cannot simply build it and they will come. To meet Stage 2 requirements, you will need to encourage patients to use your patient portal. Your patient portal vendor may be able to help lay out a patient portal marketing plan with a clear strategy and objectives, a target audience, and a process to measure success. Focus on highlighting the patient portal benefits and encouraging patients to use the portal. Some vendors have patient communication solutions that offer patient outreach services and support, such as conducting patient reminder calls and e-mails on behalf of the practice. Make sure providers are educated about when and how to discuss the patient portal. Promote it on signage, billing communication, appointment reminders, and your website. 67

Meaningful Use Stage 2 core objectives & menu set measures 68

Meaningful Use Stage 2 Core & Menu Set Objectives The benefits of participation in the Meaningful Use program extend far beyond the incentive payments. The enhanced quality of patient care will ultimately lead to improved outcomes at a reduced cost. In order to provide organization and structure to this process of improvement, the Meaningful Use program consists of requirements and deadlines. The CMS EHR Incentive Program divides the requirements into a core group of mandatory objectives and a menu set of objectives from which providers can choose to defer a predetermined number of objectives. What is a Core Objective? A Core Objective is a required objective because it is essential to the process of using an EHR in a meaningful way in order to enable the delivery of higher quality patient care. For each core objective, a specific measurement must be achieved to satisfy the objective. What is a Menu Set Objective? A Menu Set of Objectives allows the EP to personally select objectives to customize the Meaningful Use program and target measures relevant to his/her practice. More specifically, the EP will choose five out of the ten listed objectives for Stage 1 and three out of the six listed objectives for Stage 2. For each chosen objective, the specified measurement must be achieved to satisfy the objective. In all likelihood, menu set measures will become core measures in the next stage of Meaningful Use. 69