Meaningful Use:

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Meaningful Use Managing Stage 2 and Beyond John
Valutkevich Senior Supervisor Electronic Health
Records and Federal Health Initiatives Lisa
Palmer, Senior Specialist for Federal Health
Initiatives MEDITECH Ambulatory
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• Review of Systems
• Industry Stats
• MEDITECH Stats
• Chronic Conditions Continue from Stage 1
• Prognosis - Stage 2 and Stage 3
• Plan of Action

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Review of Systems

• Industry Demands Facing Health Care This Year
• Meaningful Use demands
• Healthcare Reform
• Payment Reform
• ICD-10 (delayed again)
• 5010
• ACOs and PCMHs

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Stage 1 Meaningful Use Summary
To qualify for incentives, grants, or funding,
users must demonstrate meaningful use of the EHR
system.

• Focus is deployment/adoption of Advanced
  Clinical Systems
• Electronic exchange of information
• Report on Meaningful Use Metrics and Clinical
  Quality Measures
• Complete EHR or EHR Modules must be "certified"

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Review of Systems
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Review of Systems
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Review of Systems
Certification Status Stage 1
Visit our certification page for updates and
instructions on obtaining your CMS Certification
Numbers
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Review of Systems
Preparing for Stage 2 Certification Eligible
Hospitals
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Review of Systems
Preparing for Stage 2 Certification Eligible
Professionals
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Review of Systems

• Why New Releases ?
• Privacy Security Requirements
• Standardized Encryption of all connections to
• SSL/TLS
• Encryption of Downloads (CD, USB)
• Enhanced Patient Centric Audit Logs in MIS
• Increased Security Requirements in Stage 2
• Visit MEDITECH Systems Support

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Review of Systems

• Why New Releases ?
• Increased Standardization with Nomenclature
• Increased use of SNOMED-CT For Problem List
• Mapping to Tests and Results LOINC and SNOMED
• SNOMED-CT for Nursing Terms, Orders
• Standards for Medications, Allergies and
  Reactions

Improvements to mapping standards
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Review of Systems

• Why New Releases?
• Improvements to Usability
• Enhanced Problem List Functionality
• Improved Workflow for Medication Reconciliation
• Patient and Clinician Discharge Processes
• Robust CCD Enhancements
• Ambulatory Checkout Process
• Ambulatory Patient Education

Increasing Clinician and Physician User
Satisfaction
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Chronic Conditions of Stage 1 Continue
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Chronic Conditions Stage 1

• Computerized Provider Order Entry
• Physician Adoption Historically is Slow
• CMS Interpretations
• Licensed Professional
• Must use CDS at time of order entry
• Requiring only 1 Med - raises patient safety
  issues and disjointed care
• Acute, ED or Both calculation

MEDITECH certified CPOE solution resides within
PCM and EDM for Acute and AOM/RXM for Ambulatory
providers.
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Chronic Conditions Stage 1

• Reporting Requirements Eligible Hospitals
• Utilization of Your EHR
• EHR Utilization Metrics (i.e. 30 CPOE
  utilization)
• 14 Required Functional Measures and 10 Menu Items
• Utilization Reports are NPR and Report Designer
  for 90 days reporting
• Longer reporting period (365 days) may require
  Data Repository for increased data retention

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Chronic Conditions Stage 1

• Reporting Requirements Eligible Hospitals
• Clinical Quality Measures - The Big Gotcha!!
• 15 Quality Measures for Stage 1
• ED Throughput
• Stroke
• VTE
• Clinical Quality Measure Reports calculated from
  Data Repository
• DR customers receive Quality Measures Report SQL
  Templates
• For 2011 and 2012 - CMS requires attestation
  only capability of your certified EHR to report
  the measures
• Performance and Outcomes are not measured

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Chronic Conditions Stage 1

• Reporting Requirements Eligible Professionals
• Utilization of Your EHR
• EHR Utilization Metrics (i.e. 30 CPOE
  utilization)
• 15 Required Core Measures and 10 Menu Items
• Standard System Utilization Reports
• provided for Core and Menu set items

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Chronic Conditions Stage 1

• Reporting Requirements Eligible Professionals
• Clinical Quality Measures - The Big Gotcha!!
• 44 Clinical Quality Measures for Stage 1
• 3 Core/3 Alternate Core Measures
• 3 Additional Measures
• Use of MPM Clinical Reporting tool for quality
  reporting
• For 2011 and 2012 - CMS requires attestation
  only capability of your certified EHR to report
  the measures
• Performance and Outcomes are not measured

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Chronic Conditions Stage 1

• Clinical Quality Reports
• became as big an impact as CPOE !
• Required vocabularies not used widely in EHRs
  (SNOMED CT, RxNorm, CVX)
• Over 500 data elements in the 15 measures
• Data capture must be in discrete fields
• Impact on workflow for clinicians
• Specification was incomplete and not maintained
• Review of Best Practices is Critical

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Chronic Conditions Stage 1

• Interoperability Requirements
• Stage 1 - Just A Test! But with Whom?
• Infrastructure lacking - exchange standards not
  defined
• CCD Capability to exchange key clinical
  information among providers - regardless of the
  transport standard has to be a CCD
• Public Health Reporting Interfaces Must choose 1
  Public Health Objective to Demonstrate - (but own
  them all)
• Capability to submit electronic data to
  immunization registries
• Capability to provide electronic submission of
  reportable lab results to public health agencies
• Capability to provide electronic syndromic
  surveillance data to public health agencies

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Chronic Conditions Stage 1

• CMS Clarifications
• FAQ Mechanism to clarify or re-write legislation
• Wording in Final Rule ambiguous and left open
  to much interpretation
• Many, many clarifications from CMS and ONC
  sometimes changing the ruling
• What will be involved in an Audit?

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Prognosis Stage 2 and Beyond
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Timeframe for Stage 2

• HIT Policy Panel submitted recommendations to ONC
  July 7, 2011
• Associated standards for Stage 2 Measures
  submitted September 28, 2011
• CMS and ONC issued Notice of Proposed Rulemaking
  (NPRM) February 23, 2012
• CMS and ONC will then issue the final rule in
  middle of 2012
• Certification for Stage 2 in Fall 2012

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Prognosis Stage 2 and Beyond
Stage 2 Delay Start For Early Attesters
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Stage 2 Eligible Hospitals

• 16 CORE objectives choose 2 of 4 menu items
• All menu items in Stage 1 become core
• Most Stage 1 thresholds increase in Stage 2
• Several new measures

• Reporting
• Additional interoperability
• requirements (orders and results)
• e-Prescribing
• Patient Portal discharge
• instructions and visit information
• -Ability to view images in EHR for 40 orders

• Clinician Notes (Physcian, PA, NP)
• eMar in at least one unit
• Record care plan goals and patient
• instructions
• Record health care team members
• Address encryption of data at rest
• Inclusion of Direct Protocol

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Stage 2 Providers

• 17 CORE Objectives - choose 3 of 5 menu items
• All menu items in Stage 1 become core
• Stage 1 thresholds increase in Stage 2
• Several new measures

• Patients are offered secure, online messaging
• Patient Portal view and download, transfer
  health information
• Record Advance Directives
• Increased clinical decision support rules
• Record health care team members
• Record Care Plan Goals and Patient Instructions
• Submit Reportable Cancer Conditions
• Ability to view images in EHR for 40 orders

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Prognosis Stage 2 and Beyond
The Future Focus is on Patient and Consumer
Engagement (PCMHs, ACOs)
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Prognosis Stage 2 and Beyond
EH EP Stage 2 - You will need a Patient Portal
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Prognosis Stage 2 and Beyond
EP Stage 2 Secure Patient Messaging
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Stage 2 You will need to implement
e-Prescribing

• Integrated into MEDITECHs PCM, EDM and
  PCS/Nursing Suites
• Includes
• Access to medication histories
• Updates patients' records
• Check benefits while ordering
• Communicate orders to retail and mail order
  pharmacies
• Standards-based NCPDP Script interfaces
• DrFirst as transaction clearinghouse
• Eligible Professionals Continue eRx measure
  from Stage 1 with increased threshold from 40 to
  50

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Prognosis Stage 2 and Beyond
EH Stage 2 You will need to implement the
Electronic Medication Administration Record
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Prognosis Stage 2 and Beyond
EH EP Stage 2 You will need to implement
Electronic Notes
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Prognosis Stage 2 and Beyond
Stage 2 Clinical Quality Measures

• Data needed to be captured in discrete fields
• Increase use of standard nomenclature
• Subscription to IMO for vocabulary mapping
• Best Practices for Workflow Guidance in
  development
• Physician groups of a certain size can report
  quality data for their groups

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Prognosis Stage 2 and Beyond
Stage 2 Quality Reporting 113 Proposed Measures
for Hospitals and Providers

• Stage 2 and Beyond
• Over 130 Proposed Quality Measures
• Over 65,000 Data Elements mapped to standard
  nomenclature

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Increased Interoperability Order and Results
exchanged electronically
Prognosis Stage 2 and Beyond
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Increased Interoperability Electronically
Transmit a summary of care record
Prognosis Stage 2 and Beyond

• Electronic Exchange of Summary Care Documents to
  a recipient with no organizational affiliation
  and a different certified EHR technology vendor
  for more than 10 of transitions of care and
  referrals

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Stage 2 new Exchange Requirements

• Discharge Summaries
• CCDs
• Referral

• Consolidated CDA
• SOAP transport option to Direct

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Plan of Action Meaningful Use Stage 2 and Beyond
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Plan of Action

• MEDITECH A Dedicated Meaningful Use Team
• ARRA Leadership - weekly meetings - VPs and
• Management
• Certified EHR Technology
• Customer Implementation and Support - Best
  Practices
• Integrated Collaboration
• Cross-division Meaningful Use Task Force
• Industry Expertise and Leadership
• Customer Outreach, Focus Groups and Advisory
• Activities

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Plan of Action

• YOU A Dedicated Meaningful Use Team
• ARRA Leadership Team - establish weekly
  meetings
• Educate, Educate, Educate Staff, Board,
• Community
• Prepare for increased Quality Measures
• do you need a Quality Officer?
• Stay tuned in to meditech.com and lssdata.com
• ARRA pages

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Meaningful Use Resources
A Step By Step to the Guides

• Begin with MEDITECH
• Eligible Hospitals
• Eligible Professionals
• Certified Product Listing
• Registration for Incentive Programs
• CMS FAQ Pages
• ONC FAQ Pages

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