ELI5: Meaningful Use

Show "Meaningful" Use, Get $$

How does one show "Meaningful Use"?

• Use of certified EHR in a meaningful manner
• Use of certified EHR technology for electronic exchange of health information to improve quality of health care
• Use of certified EHR technology to submit clinical quality measures and other such measures

Who Gets Incentive Payments

• eligible professionals
• eligible hospitals
• critical access hospitals (CAHs)

How Much Do They Get?

$43,720 over 5 continuous years (Medicare program) or up to $63,750 over 6 years (Medicaid program)

beginning with a $2 million base payment

Stage One of Meaningful Use

Remember

Requirements:

For Providers:

• Meet 15 core objectives
• Meet 5 of 10 menu objectives
• Meet 6 Clinical Quality Measures (CQMs) plus 3 addtnl CQMs

For Hospitals

• Meet 14 core objectives
• Meet 5 of 10 menu objectives
• Meet 15 Clinical Quality Measures (CQMs)

For both providers and hospitals:

Ok. That's simple enough....but what is a core objective, or menu set, or Clinical Quality Measure for that matter?

Core Objectives

measure

For Providers

1. Computerized provider order entry (CPOE)

4. Implement one clinical decision support rule

5. Provide patients with an electronic copy of their health information, upon request

7. Drug-drug and drug-allergy interaction checks

8. Record demographics

9. Maintain an up-to-date problem list of current and active diagnoses

10. Maintain active medication list

12. Record and chart changes in vital signs

13. Record smoking status for patients 13 years or older

14. Capability to exchange key clinical information among providers of care and

patient-authorized entities electronically

15. Protect electronic health information

 For Hospitals

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plus

• Report hospital clinical quality measures to CMS or states
• Provide patients with an electronic copy of their discharge instructions at time of  discharge, upon request

Menu Objectives

For Providers

1. Drug-formulary checks

2. Incorporate clinical lab test results as structured data

3. Generate lists of patients by specific conditions

6. Use certified EHR technology to identify patient-specific education resources

and provide to patient, if appropriate

7. Medication reconciliation

8. Summary of care record for each transition of care/referrals

9. Capability to submit electronic data to immunization registries/systems*

10. Capability to provide electronic syndromic surveillance data to public health

agencies*

For Hospitals

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plus 

• Record advanced directives for patients 65 years or older
• Capability to provide electronic syndromic surveillance data to public health agencies

Clinical Quality Measures

Core CQMs for Professionals

• NQF0013 - Hypertension: blood pressure management
• NQF0028 - Preventative care and screen measure pair: Tobacco Use assessment/tobacco cessation intervention
• NQF 0421 / PQRI 128 - Adult weight screening and follow-up
• NQF0024 - Weight assessment and counseling for children and adolescents
• NQF0041/PQRI110 - Preventative care and screening: influenza immunization for patients 50 years old or older
• NQF0038 - Childhood immunization status

Hospital CQMs 

Ok. Here's stage one in a nutshell. Meet the CQM, Menu, and Core objectives for 90 days + 1 Year to show meaningful use.

Stage Two of Meaningful Use

Remember: 

Eligible Provider Core Objectives

1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
2. Generate and transmit permissible prescriptions electronically (eRx).
3. Record the following demographics: preferred language, sex, race, ethnicity, date of birth.
4. Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. 
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 within four business days of the information being available to the EP.
8. Provide clinical summaries for patients for each office visit.
9. Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.
10.  Incorporate clinical lab-test results into Certified EHR Technology as structured data. 
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 and send these patients the reminders, per patient preference.
13. Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. 
14. 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.
15. 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 a summary care record for each transition of care or referral.
16. Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. 
17. Use secure electronic messaging to communicate with patients on relevant health information

Hospitals

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plus

• Similar to EP Stage 2 Core Objectives #2. Record all of the following demographics: preferred language, sex, race, ethnicity, date of birth, date and preliminary cause of death in the event of mortality in the eligible hospital or CAH.
• Similar to EP Stage 2 Core Objectives #6. Provide patients the ability to view online, download, and transmit information about a hospital admission.
• Similar to EP Stage 2 Core Objectives #14. The eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
• Similar to EP Stage 2 Core Objectives #15. The eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral.
• Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities
• Capability to submit electronic reportable laboratory results to public health agencies, where except where prohibited, and in accordance with applicable law and practice.
• Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice.
• Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).

1. Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice.
2. Record electronic notes in patient records.
3. Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT.
4. Record patient family health history as structured data.
5. Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice.
6. Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.

Eligible Hospital Menu Objectives

bolded

plus

• Record whether a patient 65 years old or older has an advance directive
• Generate and transmit permissible discharge prescriptions electronically (eRx).
• Provide structured electronic lab results to ambulatory providers

Other Important Stuff

Stage 3? Say What?!

http://www.healthcare-informatics.com/

Why Implement Meaningful Use?

Meaningful Use aims to do the following for EHRs:

• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population and public health
• Maintain privacy and security
• High upfront acquisition costs
• Ongoing maintenance costs
• Disruptions to workflows
• Temporary losses in productivity
• Potential perceived privacy concerns

Important to understand terms and Acronyms:

CQM

Denominator

all patients seen or admitted during the EHR reporting period -OR- actions or subsets of patients seen or admitted during the EHR reporting period

EP:

EH:

EHR Incentive Programs

Payments for EPs

Stage One Requirements

Benefits and Drawbacks of EHRs

CQMs for providers (choose 3) mentioned in stage one