Stage 2 Meaningful Use Video

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  Listen to this video to learn more about the core objectives of Stage 2 meaningful use.

Stage 2 Meaningful Use Video Transcript

The Meaningful Use Incentive Program was devised to bridge the digital divide for health care providers. Providers must meet the objectives outlined in this webinar and show CMS they are meaningfully using their EHRs in ways that can positively affect the care of patients to receive a financial incentive. 

CMS and the Office of the National Coordinator for Health Information Technology have established standards and other criteria for structured data that EHRs must use in order to qualify for this incentive program. EHRs must be certified or qualified for the Medicare Incentive Program, and they must also have an eligible provider. Also, if you already have an EHR, there may a potential that it may not be certified for the use. The eligible providers must register as a Medicare site. Then they will achieve Meaningful Use in meeting the objectives outlined in this presentation. And then finally, they're going to attest. 

There are three stages of Meaningful Use. Stage 1 is data capture and sharing. And what this does is this promotes the interoperability of the EHR. It's kind of like the physician dipping his toe into the water and just taking the temperature. 

Currently, we're getting started with Stage 2 Meaningful Use, which is advancing clinical processes, also known as enhancing patient engagement in their own care, or working as partners with providers to view, download/access, or transmit their data online or via a patient portal. This is also seen as a physician being pushed into the water. For Stage 3, Meaningful Use, which will start in 2016, its focus will be improving outcomes. We'll be looking at measuring data to improve the quality, safety, efficiency, therefore leading to any improvements in those health outcomes. 

Transitioning from Stage 1 requires that eligible providers need to adopt or upgrade to a new 2014 certified EHR version. Some of the Stage 1 objectives, moving from Stage 1 to Stage 2, were either combined or eliminated. Some of the Menu objectives now became core objectives, and many of the thresholds have been raised. 

We see that the core objectives-- there was an original 13, which now we have 17 under Stage 2. Under the menu objectives, originally there were 10 that required 6 for Stage 1. And now for Stage 2, only three are required. And for the CQMs, that's moving from 6 to 9 across three National Quality Domains. Medicare has changed their reporting cycle from a 90-day reporting cycle to a 3-month quarterly reporting period. And the Menu Objective Exclusion is that claiming any exclusion for menu objectives in 2014 will no longer count toward the number of menu objectives that are needed to be achieved. 

So here on this slide, I'd like to go ahead and introduce our next speaker, Bill Ramsey, Quality Improvement Consultant for CMS, will now speak to you about the core objectives for Stage 2 Meaningful Use. 

Thank you, Tracy. I'm going to jump right in and give the first six core measures. Measure 1, CPOE, describes a computerized order entry for medications, labs, radiology. This measure increased from being a 30% threshold for medications only in Stage 1 to a 60% threshold and adding both labs and radiology for Stage 2. Measure 2, eSubscriber. This measure increased from a 30% threshold in Stage 1 to a 50% threshold in Stage 2. This includes if the prescription was clearing for a drug formulary and transmitted electronically. 

Measure 3, demographics. This measure increased from 50% to 80%. One tip on making this more easily attainable is to set the fields to be mandatory. Most EHRs have this capability. You'll have to check with your Meaningful Use training manual for your specific EHR for more details. Measure 4, vitals. This measure also increased from 50% to 80% in Stage 2. Measure 5, including smoking status for patients 13 years or older.

 This measure also increased from 50% to 80% in Stage 2. Smoking status must be recorded as structured data. Please check the Meaningful Use training manual specific to your EHR to discover if the workflow for achieving this measure has changed. Remember, if it's not in the EHR the right way, it didn't happen. 

Measure 6, clinical decision support role. This measure is broken down into two parts, the first part being that five clinical alerts related to four or more CQMs are turned on during the recording period. You'll have to check with your Meaningful Use training manuals for more details on how and what these are. And drug-drug, drug-allergy interaction checks are enabled for the entire recording period. Most EHR vendors turn these on automatically, but you might want to check and see if your particular EHR has this turned on or not. For best practices in the past, be sure and capture a screenshot of these measures to make sure that they're enabled, and save it for auditing purposes if needed. 


Additional information on all of the six core measures that are listed can be found in great detail in the EHR Specification Worksheet, which we'll provide at the end of this presentation. Now, I'm going to turn this over to Lisa to present the next six core measures. 

Patient engagement is an important focus in Stage 2. It allows patients easy access to health information so they can make informed decisions regarding care and share most recent clinical information with other health care providers. So all the new measures are highlighted in yellow. 
So the first measure is a new measure. Number 7 is a new measure. And it provides patients the ability to view online, download, and transmit their health information. And this measure now is going to be at 50% threshold. Provide clinical summaries for patients at each office visit. That remains at 50%. Number 9 is the Conducted Security Risk Assessment. CMS and [INAUDIBLE] reps both have template spreadsheets to help you all with achieving this threshold. And you should always keep it updated yearly, keep it on file. And this is a fluid document. You must maintain it yearly. 
Number 10, incorporate clinical lab test results into certified EHR technology. This went from 40% to 55%. Generate list of specific conditions to use for quality improvement to reduce disparities, research or outreach. You just have to generate one list of a certain condition, and that will achieve that threshold that's the same from Stage 1 to Stage 2. 

Number 12, use clinically relevant information to identify patients to receive reminders for follow-up care. And this went from 20% to 10%. Next slide. OK. Number 13 is use certified EHR technology to identify the patient's specific education resources. This remains the same at 10%. Medication reconciliation also remains the same at 50%. And a new one, Number 15, is providing a Summary of Care record for each transition of care or referral exchange. This has to be an electronic exchange. 

This one means that a provider sends a Summary of Care record for more than 5 of their transition of care in referrals. It also requires that a provider electronically send a Summary of Care for more than 10% of transition of care referrals. At least one Summary of Care document is sent electronically to the recipient with a different EHR vendor. 

Number 16 is submit electronic data to immunization registries. In Stage 1, you only had to do it one time. In Stage 2, it's ongoing. And Number 17 is another new one. Use secure electronic messaging to communicate with patients on relevant health information. And this threshold is at 5%. And so now I'm going to turn it over to Alexa. 

Thanks, Lisa. OK. I'm going to be going over those Stage 2 Menu Objectives. So there's six total objectives, and you must have passed the three. And again, like Tracy said earlier, this year, exclusions are not going to count unless you can verify that you meet all the exclusions for all the measures. There are six. There are three public health options, which I'm going to go over a lot. So I'm going to start with the second one here.

 You can see that it's in yellow, so it's a brand-new measure. Report electronic notes and patient records. This means that for over 30% of your unique patients, you must enter progress notes into the EHR. So, again, a written progress note is no longer going to count because it needs to be text-searchable. And the next one is imaging results accessible through your EHR. So for over 10% of all tests that yield an image, the test results need to be accessible through the EHR. Now this can either be a scanned image, an image received directly from an interface, or a link that can take you to that image result. OK. 

The next one is another new measure. Record patient and family health history. So this is for first-degree relatives only, so parents, offspring, and siblings. For over 20% of patients, the provider needs to include at least one or more first-degree relatives in a structured format. OK. You might already be doing that now with your current EHR, but it needs to be put into a structured data point. OK. 

Next measure is our public health measures. So number 1, 5, and 6 are all public health measures. If you could go to the next slide I'm going to go over the public health process for Stage 2. The first step is a Declaration of Readiness. Now this is on the part of the public health agency. They have to announce that they have the capability. 

The second step here is the Registration of Intent. And this is on the eligible professional. They need to submit Registration of Intent to the public health agency that they wish to meet Stage 2 Meaningful Use Lists. OK. And that needs to be done before the 60th day of the reporting period to count for Meaningful Use. OK. So there's a deadline for this. 

The next process is the onboarding process. This is when, after the provider submits a Registration of Intent, the public health agency comes back to the provider and gives instructions on setting up testing and the submission. OK. Now, again, to meet Meaningful Use, the provider has to reply back to the public health agency. If they don't reply, then they don't meet that measure. And the final stage, once the eligible professional and the public health agency have worked together, they achieve ongoing submission and the public health agency will give you a confirmation letter, which will be used for Meaningful Use. OK. 

If you go to the next slide, this is the way to meet Meaningful Use for each of the public health objectives. The first way to meet Meaningful Use is that you've successfully submitted ongoing submissions from previous years, and it's just continuing on. And the next way to meet Meaningful Use is that you've submitted your Registration of Intent and managed to get ongoing submission. OK. 

The next phase. We have two more ways to meet Meaningful Use. OK. You've submitted your Registration of Intent. However, you're still in the testing phase and have not gotten ongoing submission. But that still counts for Meaningful Use. And the last option here is you've submitted your Registration of Intent to the public health agency, but you're still waiting for the public health agency to get back to you or send you instructions. That will satisfy Meaningful Use as well. OK. 

The next slide. I'm going to go back and talk about the specific public health reporting tools. Number 1, submit electronic syndromic surveillance status to public health agencies. OK. Now I'm going to go down to Number 5, report cancer patients to a public health central cancer registry. However, one thing to note, is an optional feature for EHR. So you would want to check your particular EHR to see if they have a capability of reporting this cancer patient information. OK. Same thing with Number 6. It is optional for EHRs to be able to do this. So then you want to check with them before contacting any other specialized registry. 

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