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“HIT Policy & Perspective: What does “Meaningful Use” Mean for Pathology?”Webinar moderated by David L. Booker, MD, CAP Board of Governors, Chair of Pathology, Trinity Hospital, Augusta, GA

October 6, 2010 1

“HIT Policy & Perspective: What does “Meaningful Use” Mean for Pathology?”

• Today’s Speakers:o Robert Anthony, Health Insurance Specialist,

CMS, Office of E-Health Standards and Serviceso Philip Chen, MD, PhD, Director of Informatics,

Dept of Pathology, University of Miami Miller School of Medicine

o Walter H. Henricks, MD, Director of the Center for Pathology Informatics at the Cleveland Clinic

© 2010 College of American Pathologists. All rights reserved. 2

Medicare & Medicaid EHR Incentive Program

Meaningful UseCollege of American Pathologists

October 6, 2010

15-Jul-103

What are the Requirements/ Meaningful Use?

• Meaningful Use is using certified EHR technology to• Improve quality, safety, efficiency, and reduce health

disparities• Engage patients and families in their health care• Improve care coordination• Improve population and public health• All the while maintaining privacy and security

• Meaningful Use mandated in law to receive incentives

15-Jul-104


• The Recovery Act specifies the following 3 components of Meaningful Use:

1. Use of certified EHR in a meaningful manner (e.g., e-prescribing)

2. Use of certified EHR technology for electronic exchange of health information to improve quality of health care

3. Use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary

15-Jul-105

Conceptual Approach to Meaningful Use

Data capture and sharing

Advanced clinical processes

Improved outcomes

15-Jul-106

Who is a Medicare Eligible Provider?

Eligible Providers in Medicare FFSEligible Professionals (EPs)

Doctor of Medicine or OsteopathyDoctor of Dental Surgery or Dental MedicineDoctor of Podiatric MedicineDoctor of OptometryChiropractor

Eligible HospitalsAcute Care Hospitals*Critical Access Hospitals (CAHs)

*Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or Washington, DC (including Maryland)

15-Jul-107

Who is a Medicaid Eligible Provider?

Eligible Providers in MedicaidEligible Professionals (EPs)

PhysiciansNurse Practitioners (NPs)Certified Nurse-Midwives (CNMs)DentistsPhysician Assistants (PAs) working in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is so led by a PA

Eligible HospitalsAcute Care Hospitals (now including CAHs)Children’s Hospitals

15-Jul-108

Who is Eligible to Participate?

• Eligibility determined in law• Hospital-based EPs are NOT eligible for

incentives• DEFINITION: 90% or more of their covered

professional services in either an inpatient (POS 21) or emergency room (POS 23) of a hospital

• Definition of hospital-based determined in law• Incentives are based on the individual, not the

practice

15-Jul-109


Basic Overview of Stage 1 Meaningful Use:• To meet certain objectives/measures, 80% of patients

must have records in the certified EHR technology• Eligible Professionals must complete:

• 15 core objectives• 5 objectives out of 10 from menu set• 6 total Clinical Quality Measures

(3 core or alternate core, and 3 out of 38 from menu set)

• Reporting Period – 90 days for first year; one year subsequently

15-Jul-1010


• A Medicare Eligible Professional who does NOT demonstrate meaningful use by 2015 will be subject to payment reductions in their Medicare reimbursement schedule

• Medicaid-only EPs are not subject to payment reductions

• Payment reductions may apply for any EP who accepts Medicare, even if you only participate in the Medicaid EHR incentive program

15-Jul-1011


• Some MU objectives are not applicable to every provider’s clinical practice, thus they would not have any eligible patients or actions for the measure denominator. Exclusions count against the 5 deferred measures

• In these cases, the EP would be excluded from having to meet that measure • Ex: Dentists who do not perform immunizations, or

pathologists who do not e-prescribe

15-Jul-1012


Two types of percentage based measures are included to address the burden of demonstrating MU1. Denominator is all patients seen or admitted

during the EHR reporting period• The denominator is all patients regardless of whether

their records are kept using certified EHR technology2. Denominator is actions or subsets of patients

seen or admitted during the EHR reporting period• The denominator only includes patients, or actions taken

on behalf of those patients, whose records are kept using certified EHR technology

15-Jul-1013


EPs – 15 Core Objectives1. Computerized physician order entry (CPOE)2. E-Prescribing (eRx)3. Report ambulatory clinical quality measures to CMS/States4. Implement one clinical decision support rule5. Provide Patients with an electronic copy of their health information, upon

request6. Provide clinical summaries for patients for each office visit7. Drug-drug and drug-allergy interaction checks8. Record demographics9. Maintain an up-to-date problem list of current and active diagnoses10. Maintain active medication list11. Maintain active medication allergy list12. Record and chart changes in vital signs13. Record smoking status for patients 13 years or older14. Capability to exchange key clinical information among providers of care

and patient-authorized entities electronically15. Protect electronic health information

15-Jul-1014

What are the Requirements/ Meaningful Use?EPs – Choose 5 Menu Objectives* • Drug-formulary checks• Incorporate clinical lab test results as structured data• Generate lists of patients by specific conditions• Send reminders to patients per patient preference for

preventive/follow up care• Provide patients with timely electronic access to their health

information• Use certified EHR technology to identify patient-specific

education resources and provide to patient, if appropriate• Medication reconciliation• Summary of care record for each transition of care/referrals• Capability to submit electronic data to immunization

registries/systems• Capability to provide electronic syndromic surveillance data to

public health agencies

*At least 1 public health objective must be selected

15-Jul-1015

What are the Requirements/ Clinical Quality Measures

• Details of Clinical Quality Measures• 2011 – Eligible Professionals seeking to demonstrate

Meaningful Use are required to submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States by ATTESTATION.

• 2012 – Eligible Professionals seeking to demonstrate Meaningful Use are required to electronically submit aggregate CQM numerator, denominator, and exclusion data to CMS or the States.

15-Jul-1016


• Core, Alternate Core, and Additional CQM sets for EPs• EPs must report on 3 required core CQM, and if the

denominator of 1or more of the required core measures is 0, then EPs are required to report results for up to 3 alternate core measures

• EPs also must select 3 additional CQM from a set of 38 CQM (other than the core/alternate core measures)

• In sum, EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures

15-Jul-1017


• Clinical Quality Measures – Core Set

NQF Measure Number & PQRI Implementation Number

Clinical Quality Measure Title

NQF 0013 Hypertension: Blood Pressure Measurement

NQF 0028 Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention

NQF 0421PQRI 128

Adult Weight Screening and Follow-up

15-Jul-1018


• Clinical Quality Measures – Alternate Core Set

NQF Measure Number & PQRI Implementation Number

Clinical Quality Measure Title

NQF 0024 Weight Assessment and Counseling for Children and Adolescents

NQF 0041PQRI 110

Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older

NQF 0038 Childhood Immunization Status

15-Jul-1019

CQM: Additional Set for EPs1. Diabetes: Hemoglobin A1c Poor Control 2. Diabetes: Low Density Lipoprotein (LDL) Management and Control 3. Diabetes: Blood Pressure Management4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker

(ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction

(MI)6. Pneumonia Vaccination Status for Older Adults7. Breast Cancer Screening8. Colorectal Cancer Screening9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)11. Anti-depressant medication management: (a) Effective Acute Phase Treatment,(b)Effective Continuation

Phase Treatment12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of

Retinopathy 14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care15. Asthma Pharmacologic Therapy 16. Asthma Assessment17. Appropriate Testing for Children with Pharyngitis18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor

(ER/PR) Positive Breast Cancer 19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients

15-Jul-1020

CQM: Additional Set for EPs, cont’d

20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

21. Smoking and Tobacco Use Cessation, Medical assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies

22. Diabetes: Eye Exam23. Diabetes: Urine Screening24. Diabetes: Foot Exam25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation27. Ischemic Vascular Disease (IVD): Blood Pressure Management 28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b)

Engagement30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)31. Prenatal Care: Anti-D Immune Globulin32. Controlling High Blood Pressure 33. Cervical Cancer Screening34. Chlamydia Screening for Women 35. Use of Appropriate Medications for Asthma 36. Low Back Pain: Use of Imaging Studies 37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 38. Diabetes: Hemoglobin A1c Control (<8.0%)

15-Jul-1021

What are the Requirements/ Adopt/Implement/Upgrade?

• MEDICAID – only for first participation year• Adopted – Acquired and Installed

• Eg: Evidence of installation prior to incentive

• Implemented – Commenced Utilization of• Eg: Staff training, data entry of patient demographic information

into EHR

• Upgraded – Expanded • Upgraded to certified EHR technology or added new functionality

to meet the definition of certified EHR technology

• Must be certified EHR technology capable of meeting meaningful use

• No EHR reporting period15-Jul-1022

Resources to Get Help and Learn More

• Get information, tip sheets and more at CMS’ official website for the EHR incentive programs:

www.cms.gov/EHRIncentivePrograms

• Learn about certification and certified EHRs, as well as other ONC programs designed to support providers as they make the transition:

http://healthit.hhs.gov

15-Jul-1023

HIT Policy & Perspective: What Does “Meaningful Use” Mean for

Pathology?

CAP Webinar

October 6, 2010Walter H. Henricks, M.D.

Cleveland Clinic

24

Walter H. Henricks, M.D.

Federal Actions to Promote EHR Use

(ONC = Office of the National Coordinator for Health Information Technology in HHS)

HITECH(Health Information Technology for Economic and Clinical Health Act)

ARRA(American Recovery and Reinvestment Act)

CMS Rule ONC rule

- Define meaningful usecriteria- Establish incentive payments for meeting meaningful use criteria (and penalties for not)

- Establish capabilities and standards that certifiedEHR technology will need to include in order to support meaningful use by eligible professionals

contained

implemented through

http://healthit.hhs.gov/portal/server.pt25


EHR Meaningful Use vs. EHR Certification

• EHR certification criteria specify WHAT an EHR system must be able to do (ONC defines).

• Meaningful use criteria specify HOW an EHR system must be used to qualify for incentive and to avoid future penalties (CMS defines).

• Meeting criteria for meaningful use must be accomplished using certified EHR technology in order to qualify.

26


Implications of the Meaningful Use for Laboratories

• Dramatic increase in expectation for LIS-EHR electronic interfaces as physicians implement EHRs– As a result of implementing EHRs– To meet specific Meaningful Use requirements

• Opportunities to facilitate clients’ ability to meet meaningful use requirements and qualify for incentives/avoid penalties

27


Meaningful Use Stage 1 Criteria Relevant to Laboratory Data in EHRs

• At least 40% of clinical laboratory tests ordered whose results are in a positive/negative or numerical format are incorporated in EHR as structured data– Realistically possible only with an interface from

laboratory– Definition of “structured” to depend on EHR

certification requirements– Not applicable to anatomic pathology results (stage 1)

• Dropped from final rule in stage 1: CPOE (Computerized Provider Order Entry) requirements for laboratory test orders– Expected in future stages

28


Meaningful Use Stage 1 Criteria Relevant to Physician Office Outreach Clients (cont’d.)

• Providers must report on quality measures, some of which relate to laboratory tests– Example: % patients aged 18-75 with Hemoglobin

A1c > 9.0% – (Quality measures relevant to laboratories to be

discussed further by Dr. Chen)

29


ONC Rule Interoperability Standards –Issues for Laboratories

• ONC has recognized HL7 v2.5.1 and LOINC as interoperability standards and has included them in EHR certification criteria.

• Their use is not required to meet stage 1 meaningful use, but may facilitate it.

• Their use is currently encouraged and is expected to be required in future.

• Many existing laboratory interfaces are on older HL7 version 2.3.1 and will require conversion to v2.5.1.

• Many laboratories do not have LOINC codes defined in or linked to LIS.

30


ONC Interoperability Standards Relevant to Laboratories

• HL7 (Health Level Seven)– structure and syntax for electronic data exchange

(“interfaces”) in healthcare– A “transmission” standard

• LOINC (Logical Observation Identifier Names and Codes)– coding system to identify laboratory tests in

electronic systems and in HL7 messages– A “vocabulary” standard

31


Potential Concerns for Laboratories Regarding EHRs

• Laboratory responsibility for transmission and validation of laboratory results to EHR; compliance with federal and state laws

• Limitations in EHRs in laboratory test order and result handling

• Lack of control or involvement in the EHR management at physicians’ sites

• Poor process design resulting in laboratory testing problems being blamed inappropriately on the laboratory

• Expenses of interface implementation and maintenance

32


CLIA Requirement for Transmission of Laboratory Results

• 42 CFR 493.1291(a) The laboratory must have adequate manual or electronic system(s) in place to ensure test results and other patient-specific data are accurately and reliably sent from the point of data entry (whether interfaced or entered manually) to final report destination, in a timely manner. This includes the following:…(2) Results and patient-specific data electronically reported to network or interfaced systems

33


CMS Revised Guidance for Electronic Exchange of Laboratory Information

• Revised Guidance for CLIA laboratory surveyors:– Electronic exchange of laboratory information– Transmission of laboratory results to authorized

individuals and others designated by the authorized person to receive the information

• Data retention requirements• Management of corrected reports in EHRs• FAQs – including clarification on HIEs and

designating “agents” for receipt of laboratory tests.

http://www.cms.gov/SurveyCertificationGenInfo/downloads/SCLetter10-12.pdf

34


Lab Results in EHR are More Than Just Columns of Numbers

• EHRs vary in effectiveness of result display• Unique considerations in data display for:

– Microbiology– Molecular pathology and genetic testing– Blood Bank/Transfusion Medicine– Interpretive testing combining numerical and text

results, e.g. coagulation panels, electrophoresis– Electrophoresis– Anatomic Pathology

35

Walter H. Henricks, M.D.Walter H Henricks, M.D.

Laboratory Report Elements Subject to Variation in EHR

• Reference range handling• Explanatory comments and footnotes• Abnormal result flags• Preliminary reporting and updates• Corrected result reporting and documentation• Unsolicited results and reflex test

orders/results• Name and address of performing laboratory

36


Other Technical Considerations for LIS-EHR Interfaces

• Capability to interface with wide variety of EHRs and vendors that are available

• Establishment of network connectivity model• Available of systems/interface technical

support expertise• Compatibility with interoperability standards

37


Operational Considerations in LIS-EHR Interfaces

• Maintenance of EHR settings related to laboratory tests

• Change control and communication (e.g. test definition updates)

• Troubleshooting and client support• Training of EHR users in test result viewing

and (eventually) test ordering• Handling of corrected results• Monitoring or quality of service• Client site contact and engagement

38


Challenges with Computerized Provider Order Entry (CPOE)

• CPOE will meet goals for laboratory test ordering only if:– CPOE system can accommodate nuances of

laboratory test ordering– CPOE system is configured correctly for laboratory

test ordering – menus, order sets, etc.• CPOE systems must be configured to provide

CLIA-mandated items in test order, whether paper or electronic

39


Implications of Improperly Designed or Implemented EHR CPOE for Laboratory

• Incorrect test orders• Incomplete test orders• Inappropriate test orders• Inefficiencies in laboratories and providers

owing to need for problem resolution• Billing and compliance problems• Pitfalls – future orders, duplicate handling,

canceled orders

40


Anticipated Requirements in Future Stages of Meaningful Use

• CPOE for laboratory test orders• Broader range of results, including anatomic

pathology• LOINC• HL7 v2.5.1• Exchange of healthcare data with unaffiliated

entities• More decision support related to laboratory

tests41


ONC-Sponsored Programs to Foster EHR Adoption

• Regional Extension Centers (RECs)– To assist providers and hospitals in their EHR adoption

efforts (e.g. assistance in EHR selection and contracting)– Possible opportunity for laboratories to work with practices

and EHR vendors

• HIEs (Health Information Exchanges)– Groups of organizations aimed at improving healthcare

delivery in a region, typically a state– Focus on technology, interoperability, standards utilization,

harmonization– May be relevant to laboratories that wish to/need to

participate

42


• More information and links to resources are available in the CAP’s Virtual Informatics College course: “The Clinical Laboratory and Meaningful Use of EHR”

…in the Course Catalog section under the Educational Programs tab at the CAP web site

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CAP Webinar, October 6, 2010

Philip Chen, MD, PhD, Director of InformaticsDept. of Pathology, University of Miami

Answer to Meaningful Use:Pathologists as Physicians

44

What are the Questions?

ó Are Pathologists eligible for incentives and liable for penalty?

ó What do we do to meet the meaningful use requirements?

ó What do we do to help our “clients” to meet the requirements?

45

Eligibilityó Hospital-based EP’s do NOT qualify for incentive –ó 90% or more of their services in either the inpatient or emergency

department of a hospital ó use hospital facility and equipments, including EHR

ó Non-hospital-based Pathologists are qualified, but…..

46

Eligibility – remaining questionsó What is a pathologist’s EHR?ó Are LIS/APLIS and web portals considered an EHR?

ó Are LIS/APLIS certified as part of a complete EHR?ó Can LIS/APLIS be certified as a EHR module?ó Are LIS/APLIS and web portal vendors looking at this?

ó Do pathologists report meaningful use through clients’ EHR…ó In a large health system setting?ó Working with multiple EHR’s?

47

Two questions may share the same answer

ó What do we do to meet the meaningful use requirements?

ó What do we do to help our “clients” to meet the requirements?

48

MU requirements related to Pathology

EPs –15 Core Objectives (8/15)1. Computerized physician order entry (CPOE)2. E-Prescribing (eRx)3. Report ambulatory clinical quality measures to CMS/States4. Implement one clinical decision support rule5. Provide Patients with an electronic copy of their health information, upon request6. Provide clinical summaries for patients for each office visit7. Drug-drug and drug-allergy interaction checks8. Record demographics9. Maintain an up-to-date problem list of current and active diagnoses10. Maintain active medication list11. Maintain active medication allergy list12. Record and chart changes in vital signs13. Record smoking status for patients 13 years or older14. Capability to exchange key clinical information among providers of care and patient-authorized

entities electronically15. Protect electronic health information

49

HIV-1/2 Antibody Test**

Repeatedly Reactive(Or Single Reactive OraQuick)

NegativeNo follow-up needed

Western Blot (WB)

NegativeIntermediate

Positive

Confirmed positive, referFor medical management

Repeat WBin one month

or

HIV PCR, Quantitative*, **(For patients with no history of HIV treatment)

Turn Round Time = 3 daysSignificant viral load(> 10,000 copies/for

typical primary infection)

Low viral load(<2,000 copies/ml)

consider false positive resultand repeat testing

If recent exposure(< 3 mo.) or high risk

suspected

No recent exposureand low Risk

* Quantitative HIV PCR can also be used as baseline for treatment considerations and follow up in confirmed cases** Please see Special Considerations section for pregnant women close to delivery

50

MU requirements related to Pathology

EPs –Choose 5 Menu Objectives* (5/10)ó Drug-formulary checksó Incorporate clinical lab test results as structured dataó Generate lists of patients by specific conditionsó Send reminders to patients per patient preference for

preventive/follow up careó Provide patients with timely electronic access to their health

informationó Use certified EHR technology to identify patient-specific education

resources and provide to patient, if appropriateó Medication reconciliationó Summary of care record for each transition of care/referralsó Capability to submit electronic data to immunization registries/systemsó Capability to provide electronic syndromic surveillance data to public health

agencies

51

CQM: Additional Set for EPs (16/38)1. Diabetes: Hemoglobin A1c Poor Control

2. Diabetes: Low Density Lipoprotein (LDL) Management and Control

3. Diabetes: Blood Pressure Management

4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)

6. Pneumonia Vaccination Status for Older Adults

7. Breast Cancer Screening

8. Colorectal Cancer Screening

9. Coronary Artery Disease (CAD): Oral AntiplateletTherapy Prescribed for Patients with CAD

10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

11. Anti-depressant medication management: (a) Effective Acute Phase Treatment,(b)Effective Continuation Phase Treatment

12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

15. Asthma Pharmacologic Therapy

16. Asthma Assessment

17. Appropriate Testing for Children with Pharyngitis

18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 53

Accession # Chart# Request Date Patient Name Ordering Physician Sex D.O.B

Diagnosis Codes HA1C

10809585XXXXXXX

XX 10/10/2005 SMITH, JOHN COOPER MD ANDERSON M 12/19/1933 790.99 16.1

10805470XXXXXXX

XX 10/5/2005 JONES, JANNIFER CHEN MD PHILIP M 6/19/1949 V70.0;250.02 15.6

10806595XXXXXXX

XX 10/6/2005 BUSH, GEORGE CHEN MD PHILIP F 7/27/1945 V72.31; 15.4

10808764XXXXXXX

XX 10/7/2005 DANER, JEFFREY A CHEN MD PHILIP M 9/12/1962250.00;272.4;40

1.1 14.2

10863472XXXXXXX

XX 12/2/2005 JACKSON, YVONNE COOPER MD ANDERSON F 11/16/1952 250 14

10815934XXXXXXX

XX 10/14/2005 LUCAS, EMORY L COOPER MD ANDERSON M 9/2/1971 V70.0;250.00 13.1

10859657XXXXXXX

XX 11/30/2005 PHILLIPS, JENESE COOPER MD ANDERSON F 7/27/1968 250.00;V82.9 12.5

10829767XXXXXXX

XX 10/31/2005 JACKSON, CURTIS CHEN MD PHILIP M 5/12/1949 12

10810081XXXXXXX

XX 10/10/2005 RICE, CONDI CHEN MD PHILIP M 6/29/1961 250.00;V70.0 11.8

10810939XXXXXXX

XX 10/11/2005 PRESLEY, ELVIS CHEN MD PHILIP F 6/16/1946 250.00;V72.31 11.6

10833713XXXXXXX

XX 11/2/2005 TAYLOR ELIZABETH CHEN MD PHILIP F 6/11/1966 788.1;250.00 11.5

10835143XXXXXXX

XX 11/3/2005 LI, AN COOPER MD ANDERSON F 12/23/1957 250 11.4

10841390XXXXXXX

XX 11/9/2005 ARMSTRONG, LANCE COOPER MD ANDERSON F 9/14/1947 V72.31;250.00 11.4

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CQM – continued (16/38)20.Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

21.Smoking and Tobacco Use Cessation, Medical assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies

22.Diabetes: Eye Exam

23.Diabetes: Urine Screening

24.Diabetes: Foot Exam

25.Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol

26.Heart Failure (HF): WarfarinTherapy Patients with Atrial Fibrillation

27.Ischemic Vascular Disease (IVD): Blood Pressure Management

28.Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

29.Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement

30.Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)

31.Prenatal Care: Anti-D Immune Globulin

32.Controlling High Blood Pressure

33.Cervical Cancer Screening

34.Chlamydia Screening for Women

35.Use of Appropriate Medications for Asthma

36.Low Back Pain: Use of Imaging Studies

37.Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control

38.Diabetes: Hemoglobin A1c Control (<8.0%)57

While waiting for answers….

ó Try to figure out how we could:ó Improve quality, safety, efficiency, and reduce health disparitiesó Engage patients and families in their health careó Improve care coordinationó Improve population and public healthó All the while maintaining privacy and security

ó Explore where and how in the EHR or LIS (or both) we can implement the MU requirements

ó Quantify and qualify the value of these value-add services we provide to our “clients” (e.g., patients, clinicians, hospitals, health systems, payors)

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Why should we do these?ó Be ready when eligibility and logistics issues are clarifiedó Similar mechanisms are used to report in PQRI, P4Pó Evolving ACO’s and value-based insurance design will likely

demand support. We can use these tools to move toward the center of the healthcare delivery modeló It is our dataó We are physicians

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College of American Pathologists

• Recording of Webinar will be available for download from the www.cap.org/advocacywebsite.

• Copies of today’s presentations are already available from the Advocacy website

Additional CAP Resources for Meaningful Use

61

College of American Pathologists

• “The Clinical Laboratory and Meaningful Use of EHR” Virtual Informatics College at www.CAP.org

• CAP STS and DIHIT divisions – professional services for HIT and health standards implementation

[email protected]

800-323-4040 ext. 7700 or 847-832-7700

Additional CAP Resources for Meaningful Use

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