Navigating the Trends in Health Care Today

MEDITECH Solutions for Meaningful Use and Interoperability

Certification Update EHRs Meeting ONC 2014 Standards

"There is no such thing as being 'Stage 1 Certified' or 'Stage 2

Certified' – 2014 Edition EHR technology would be able to support the achievement of either meaningful use Stage."

Starting in 2014, all EHR Incentive Programs participants will

have to adopt certified EHR technology that meets ONC’s Standards & Certification Criteria 2014 Final Rule

Certification is Complete….

Inpatient Certification Update • 6.07 - Complete

• Client/Server 5.6.6 -

Complete

• MAGIC 5.6.6 - Complete

• 6.13 - Complete

• Modular certification is

complete Check out meditech.com for

details

• The source document(s) used when completing the attestation:

Core/Menu Reports and Clinical Quality Measure Reports

• Proof that certain functionality was available, enabled, and

active in the system for the duration of the EHR reporting

period.

• Proof of test submissions for public health reporting and clinical

information exchange

• Documentation to support each exclusion to a measure claimed

by the EH/EP

Proof that the EH/EP possessed certified EHR technology

Key Components of a Meaningful Use Audit

•Stage 1 - 2011

•Capability to exchange key clinical information

•Capability to submit electronic data to Public Health Agencies

•e-Prescribing - Ambulatory

Meaningful Use Accelerates

Interoperability

Stage 2 - 2014 •View, download and transmit - Portal •Transition of Care - CCD •Successful ongoing submission of Electronic data to Public Health Agencies (Cancer Cases & Specialized Registries) •e-Prescribing •Secure electronic messaging •Infobutton

Mobilizing Data in 2014

•Meaningful Use Requires: •Stage 1 The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 % of transitions of care and referrals. •Stage 2 Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR

Transitions of Care

Transitions of Care: Hospital Admission

Query for data in your community

Notification regarding Clinical Summary

Clinician Friendly View of Summary

Reconciliation of CCDA information

Clinical Information Reconciliation from CCDA

Transitions of Care: Discharge Patient

Push data out to your community using IHE Transactions (ITI-41)

What is Direct Messaging?

Direct: “A simple, affordable way to transport patients’ protected health

information (PHI) to a known, trusted recipient via the internet”

Healthcare Information Service Provider • States have offered pathways to Direct Message Exchange via partnering

with a HISP • Some IDN’s are building their own regional HISPs • Regional cities may have overlap • National HISP like Surescripts • Certification forthcoming via DirectTrust.org

Best source is your regional Health Information Exchange

HISP Agnostic Approach for MEDITECH

HISP – the Who, What, Where and How

• Direct is part of MEDITECH Product Releases: o MAGIC 5.66 o Client/Server 5.66 o 6.07 o 6.13

• Direct is either an add-on component to your existing CCD Interface Suite or is licensed as a new CCD Interface Suite

• The payload is a CCDA (Consolidated CDA – which contains a CCD)

• Currently certified to support the SMIME/SMTP version • Certified for XDR/SOAP version **NEW**

How does Direct work with MEDITECH Platforms ?

What is Impact of Direct on My Organization

Present Day • Ability to exchange transitions of care documents (such as

CCDs) are part of MU Stage 2 requirements • Direct messaging is one way to satisfy this requirement • Sending CCDs to a Healtheway HIE Exchange member is another

• Direct can support your HIE initiatives – no matter how big or small

• Offers ability to exchange info with providers outside of an existing HIE or without an EHR

• Most states, 40+ HIEs, 10 IDNs and 3 leading PHR providers are offering pathways to utilize Direct

Future State • Emerging MU 3 requirements point to increased

importance for Direct

Addresses • Inbound

• Users and Direct addresses need to be defined in MEDITECH • Hospital Departments and General Physician Practice

organizational addresses are a good place to start • Recipient may be unknown • Patient may not be registered • New User Workflow to manage unsolicted CCD files inbound

• Outbound • Pre-define addresses in Provider Dictionary • Work with other entities on a policy for their receipt • Provider Directory specifications are emerging

Implementation Considerations

• Stand Alone Routine for Medical Records and Clinicians

o Bi-Directionally send and receive CCDAs

• Incorporated into Discharge Routines

• Available for patients via MEDITECH Portal

Workflows

Send CCDA Outbound via Direct Message

Receive CCDA Inbound via Direct Message

Receive CCDA Inbound via Direct Message

Send CCDA Outbound via Discharge

Send CCDA Outbound via Portal

Transition of Care Measure & HIE’s

When using SMIME/SMTP connections to another EHR, MEDITECH receives the all important Message Delivery Notification. This is when TOC is officially met. Optional XDR/SOAP does not support….yet! When a HIE/HIO is in the middle, it is required to support EP/EH EHR systems with verification that the CCDA document made it to the recipient.

1. EP or EH utilizes CEHRT to generate a CCDA summary document and sends the document to an HIO via the CEHRT’s Direct or SOAP+XDR/XDM transport capability The HIO could then repackage the message and send it to the receiving provider via any transport method.

2. HIO acts as an intermediary to which an EP or EH uses their CEHRT to send a CCDA summary document via the Direct transport standard (SMTP, SMTP+XDR/XDM) or SOAP+XDR/XDM, and the HIO then makes the CCDA available for query

3. ONC official document link

• Stage 2 Menu item for Hospitals • Integrated into MEDITECH’s EDM,

PCS/Nursing, and PCM • Access medication histories • Update patients' records • Check benefits while ordering • Communicate orders to retail and mail order pharmacies • Standards-based NCPDP Script interfaces • DrFirst as transaction clearinghouse

Medication Management and e-Prescribing

•Immunizations Reporting • Vaccines ordered • Administered via eMAR • Queued to registry

•Syndromic Surveillance • Documenting Chief complaint/reason for visit • May trigger reportable event to state registry

•Reportable Lab Results • Diagnostic Lab Orders and results • May trigger reportable event to state registry

•Cancer & Specialized Registries • Documenting Cancer or other Conditions • May trigger reportable event to state registry

Clinician’s Role in Public Health Reporting

Communicating with Physician Practices

• Orders In/Results Out Interface Suite • Ambulatory Orders Inbound from Clinics • Results returned to practice for better Coordinated

Care • Stage 2 Menu Item for Hospitals (Results Outbound)

Optimizing Standards in Daily Routines

• Introduces the Infobutton:

-Providing links to patient-specific education resources

-Providing context-sensitive link to reference information to

support clinical decision making

• Providing Patient Education: Use clinically relevant information from Certified EHR Technology to

identify patient-specific education resources and provide those resources to the patient.

• Utilizing Clinical Decision Support Use clinical decision support to improve performance on high-

priority health conditions.