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Industry leading Education

What You Need to Know About Meaningful Use 2

and Interoperability

Andy Nieto, Health IT Strategist, DataMotion

“There are risks and costs to a program of action, but

they are far less than the long-range risks and costs of

comfortable inaction”

- President John F. Kennedy

Agenda

■ A little history

■ Meaningful Use (MU)

■ Stage 2 and interoperability

■ Going beyond core measures

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Evolution of healthcare IT

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1972 First

EHR

Introduced

1996 HIPAA

2001 EHR system

usage at 18%

2003 HIPAA

Security

Rule

Feb 2009

HITECH -

ARRA

2013 Meaningful

Use 2 Rules

included Direct

2011 Meaningful

Use Stage 1

attestation begins

Jan 2013 Final

HIPAA Omnibus

ruling

2014 attestation for

Meaningful Use 2

begins

1971 first

email sent

What is interoperability

“In healthcare, interoperability is the ability of

different information technology systems and

software applications to communicate, exchange

data, and use the information that has been

exchanged.”

- 2013 HIMSS Board

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HITECH - the approach

Stage 1

20132011 2015

Stage 2

Stage 3

Stage 1

Data capture and sharing

Stage 2

Advanced clinical processes

Stage 3

Improved outcomes

The college analogy

■ Application = pick an EHR

■ First year = MU1

» 1 down, I’m broke

■ Second year / pick a major = MU2

» Where am I going?

■ Graduate = MU3

» Ok, this works… I think

» Yeah, I’m in my career; on my way

» I have a degree in WHAT???? How do I make money

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Show me the money

Starting

Year

($$$)

2011 2012 2013 2014 2015 2016

2011

($43,720)1 1 1 2 2 3

2012

($43,480)1 1 2 2 3

2013

($38,220)1 1 2 2

2014

($23,520)1 1 2

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For eligible providers

Meaningful Use Stage 1

■ Install and use an EHR

■ Collect discrete data

■ 13 Core Measures

■ 5 Menu Measures

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Meaningful Use 1

Discreet data

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Meaningful Use Stage 2

■ Collect discrete data – even more

■ Exchange more data

■ Engage others

■ 17 Core Measures

■ 3 Menu Measures

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Meaningful Use 2

Integrate, interoperate, engage

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Advancing clinical process

■ More rigorous information exchange

■ More “e”

» e-prescribe

» Integration of labs

» Transition of Care events

■ Engage patients

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Do I have to upgrade my EHR?

■ Yes! Must be 2014 ONC certified.

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17 Core Measures

1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders

2. Generate and transmit permissible prescriptions electronically (eRx)

3. Record demographic information

4. Record and chart changes in vital signs

5. Record smoking status for patients 13 years old or older

6. Use clinical decision support to improve performance on high-priority health conditions

7. Provide patients the ability to view online, download and transmit their health information

8. Provide clinical summaries for patients for each office visit

9. Protect electronic health information created or maintained by Certified EHR Technology

10. Incorporate clinical lab-test results into Certified EHR Technology

11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care

13. Use Certified EHR Technology to identify patient-specific education resources

14. Perform medication reconciliation

15. Provide summary of care record for each transition of care or referral

16. Submit electronic data to immunization registries

17. Use secure electronic messaging to communicate with patients on relevant health information

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17 Core Measures - interoperability

1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders

2. Generate and transmit permissible prescriptions electronically (eRx)

3. Record demographic information

4. Record and chart changes in vital signs

5. Record smoking status for patients 13 years old or older

6. Use clinical decision support to improve performance on high-priority health conditions

7. Provide patients the ability to view online, download and transmit their health information

8. Provide clinical summaries for patients for each office visit

9. Protect electronic health information created or maintained by Certified EHR Technology

10. Incorporate clinical lab-test results into Certified EHR Technology

11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care

13. Use Certified EHR Technology to identify patient-specific education resources

14. Perform medication reconciliation

15. Provide summary of care record for each transition of care or referral

16. Submit electronic data to immunization registries

17. Use secure electronic messaging to communicate with patients on relevant health information

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6 Menu Objectives

1. Submit electronic syndromic surveillance data to public health agencies

2. Record electronic notes in patient records

3. Imaging results accessible through CEHRT

4. Record patient family health history

5. Report cancer cases to a public health central cancer registry

6. Report specific cases to a specialized registry

Important Note: While there are exclusions provided for some of these menu objectives, you cannot select a menu objective and claim the exclusion if there are other menu objectives that you could report on instead.

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6 Menu Objectives - interoperability

1. Submit electronic syndromic surveillance data to public health agencies

2. Record electronic notes in patient records

3. Imaging results accessible through CEHRT

4. Record patient family health history

5. Report cancer cases to a public health central cancer registry

6. Report specific cases to a specialized registry

Important Note: While there are exclusions provided for some of these menu objectives, you cannot select a menu objective and claim the exclusion if there are other menu objectives that you could report on instead.

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CQM – Clinical Quality Measures

Must pick 9 of the 64 approved CQMs

There are 6 domains for CQS based upon the

National Quality Strategy

» Patient and Family Engagement

» Patient Safety

» Care Coordination

» Population and Public Health

» Efficient Use of Health Care Resources

» Clinical Processes/Effectiveness

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Interoperability

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Meaningful Use:

EHR to EHR

Goal:

Measureable

exchange of

health data

Clinician:

Referral

Consult

Orders and

results

Goal:

Greater

awareness of

patient status

Improved care

Patient:

“My doctors talk

to each other

and know what

is going on.”

Goal:

Feel better with

simpler care

The building blocks of interoperability

■ Information exchange is not “one size fits all”

The components:

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Data

Structure

(content)

Delivery

Tool (DSM,

XDR,

Interface)

Delivery

Structure

(envelope

or form)

Data Structure (content)

■ Health Language 7

■ Code Sets

» LOINC

» ICD

» CPT

» SNOMED

» DRG

» HCPDP

» RxNorm

» DSM

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Delivery Structure (envelope or form)

■ CCDA

■ HL7

■ HCFA

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Delivery Tool (DSM, XDR, Interface)

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What needs to be standardized?

» Vocabulary

» Structure (HL7)

» Transport with secure email protocols

» Adoption of NIST security encryption

» Services using open application programing

interfaces (APIs)

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HIPAA Implications

■ Privacy rule

» Who gets access to the data?

■ Security rule

» How is the data protected?

■ Breach notification

■ Business associates

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Becoming a Meaningful User

■ Re-engineer office processes

» When do you fax and why? Can this be automated?

» What is the “busy work” in the office?

■ Integrate external connections

» Labs, CPOE, Immunization registry, Public Health

registry, HIE, RHIE

■ Set “patient care” goals that align with the

Meaningful Use criteria

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Thanks!

Andy Nieto

andyn@datamotion.com

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