Tag Archives: attesting to meaningful use

Meaningful Use: A Comprehensive Guide – Part III: Frequently Asked Questions

As Meaningful Use Stage 2 was recently finalized, it is imperative that eligible practices and hospitals are ready to attest consequently receive the financial incentives. In Part I and Part II of this Meaningful Use Guide article series, we gave an overview of some important dates and changes, as well as a comprehensive look at the Stage 2 objectives and measures.

The final part of this article series focuses on Frequently Asked Questions to help clarify any lingering questions or concerns about attesting to Meaningful Use.

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Meaningful Use: A Comprehensive Guide – Part II: Final Rule on Stage 2’s Objectives and Measures

Successfully attesting for CMS’s EHR Incentive Program Meaningful Use is essential for eligible providers and hospitals to avoid the financial penalties and instead collect the financial gains. However, it can be difficult to sort through the copious amounts of information in order to find some direction.

Part one of our Meaningful Use Guide article series discussed important deadlines and changes to Stage 2 as directed by the final rule. In the second part of our series, we showcase a user-friendly, yet thorough summary of finalized Stage 2 objectives and measures for both eligible professionals and hospitals. Updated Stage 2 Objectives and Measures for Meaningful Use.

 

Updated Stage 2 Objectives and Measures:

Below is a summary of the objectives for Eligible Professionals and Eligible Hospitals and Critical Access Hospitals (CAH).

 

Updated Stage 2 Objective Eligible Professionals Eligible Hospitals and Critical Access Hospitals
Protect Patient Health Information

Protect electronic health information created or maintained by the certified EHR technology (CERT)  through the implementation of appropriate technical capabilities.

Conduct or review a security risk analysis aligned with the requirements in 45 CFR 164.308(a)(1), implement security updates as necessary, and correct identified security deficiencies as part of your risk management process.
Conduct or review a security risk analysis aligned with the requirements in 45 CFR 164.308(a)(1), implement security updates as necessary, and correct identified security deficiencies as part of your risk management process.
Clinical Decision Support

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

Measure 1: Implement 5 CDS interventions related to 4 or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. If 4 clinical quality measures do not relate to your scope of practice or patient population, the CDS interventions must be related to high-priority health conditions.
Measure 2: Enable and implement the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.
Measure 1: Implement 5 CDS interventions related to 4 or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. If 4 clinical quality measures do not relate to your scope of practice or patient population, the CDS interventions must be related to high-priority health conditions.
Measure 2: Enable and implement the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.
CPOE (Computerized Physician Order Entry)

Use a CPOE to enter medication, lab, and radiology orders into the medical record per state, local, and professional guidelines.

Use a CPOE to record the following orders for the reporting period:
Measure 1: At least 60% of medication orders
Measure 2: At least 30% of lab orders
Measure 2: At least 30% of radiology orders
Use a CPOE to record the following orders for the reporting period:
Measure 1: At least 60% of medication orders
Measure 2: At least 30% of lab orders
Measure 2: At least 30% of radiology orders
Electronic Prescribing (eRx)

Generate and transmit permissible prescriptions electronically (eRx).

Measure: More than 50% of permissible prescriptions written are queried for a drug formulary and transmitted electronically using CEHRT.
Measure: More than 10% of hospital discharge medication orders for permissible prescriptions (for new and changed prescriptions) are queried for a drug formulary and transmitted electronically using CEHRT.
Health Information Exchange

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

Measure: Use CEHRT to create a summary of care record and electronically transmit such summary to a receiving provider for more than 10% of transitions of care and referrals.
Measure:

Use CEHRT to create a summary of care record and electronically transmit such summary to a receiving provider for more than 10% of transitions of care and referrals.

Patient Specific Education

Use CEHRT to provide patients with clinically relevant patient-specific education resources.

Measure: Provide education resources for more than 10% of all unique patients with office visits seen during reporting period.
Measure: Provide education resources to more than 10% of all unique patients admitted to the inpatient or emergency department (POS 21 or 23).
Medication Reconciliation

Perform medication reconciliation for patients received from another setting or provider.

Measure: Perform medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the provider’s care. Measure: Perform medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the inpatient or emergency department (POS 21 or 23).
Patient Electronic Access

Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available.

Measure 1: Provide more than 50% of all unique patients seen during the reporting period timely access to view online, download, and transmit their health information to a third party.
Measure 2: At least 1 patient seen by the provider during the reporting period views, downloads or transmits his or her health info to a third party during the reporting period.
Measure 1: Provide more than 50% of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) timely access to view online, download, and transmit their health information to a third party.
Measure 2: At least 1 patient who is discharged from the inpatient or emergency department (POS 21 or 23) views, downloads, or transmits his or her information to a third party.
Secure Electronic Messaging

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

Measure:

For an EHR reporting period in:
2015: The capability for patients to send and receive a secure electronic message with the EP was fully enabled.
2016: Send a secure message using the electronic health messaging function of the CEHRT to the patient (or patient-authorized representative) or respond to a message sent by a patient (or patient-authorized representative) during the EHR reporting period.
2017: For more than 5% of unique patients during the EHR reporting period, send a secure message using the electronic health messaging function of the CEHRT to the patient (or patient-authorized representative) or respond to a message sent by a patient (or patient-authorized representative) during the EHR reporting period.

N/A
Public Health Reporting

The EP is in active engagement with a public health agency to submit electronic public health data from CEHRT except where prohibited and in accordance with applicable law and practice.

Measure 1: Immunization Registry Reporting – The provider is in active engagement with a public health agency to submit immunization data.
Measure 2: Syndromic Surveillance Reporting – The provider is in active engagement with a public health agency to submit syndromic surveillance data.
Measure 3: Specialized Registry Reporting – The provider is in active engagement to submit data to a specialized registry.
Measure 1: Immunization Registry Reporting – The hospital or CAH is in active engagement with a public health agency to submit immunization data.
Measure 2: Syndromic Surveillance Reporting –The hospital or CAH is in active engagement with a public health agency to submit syndromic surveillance data.
Measure 3: Specialized Registry Reporting – The hospital or CAH is in active engagement to submit data to a specialized registry.
Measure 4: Electronic Reportable Laboratory Result Reporting – The hospital or CAH is in active engagement with a public health agency to submit electronic reportable laboratory (ELR) results.

Note: It is possible that your practice may be exempt from reporting specific criteria during attestation as previous core and measures were streamlined into fewer objectives. Visit the CMS website to see if you qualify for any of these exclusions.

 

Thoroughly understanding Meaningful Use is essential for every provider and hospital. In the next part of our Meaningful Use Guide article series, Frequently Asked Questions are highlighted.

View the complete Meaningful Use series here:

Bridge Patient Portal is an enterprise platform that provides a superior user experience for healthcare organizations and patients. Bridge’s patient portal truly entices users to access health data, which improves patient-physician collaboration, care outcomes and caregiver profitability. To learn more about how our robust, HIPAA-compliant system can help you meet Meaningful Use requirements visit our website or call (866) 838-9455.

Meaningful Use: A Comprehensive Guide – Part I: Stage 1 and 2 Overview, Stage 2 Final Rule Major Changes, and Important Dates

UPDATED 6/6/2016: Per recently proposed MACRA rules, this article was updated and a Part 4: Meaningful Use and MACRA was added. While modified Stage 2 Meaningful Use remains unchanged, we think it’s important to take MACRA into consideration.

Last week, the financial importance of successfully attesting to Meaningful Use was discussed. The first part of our Meaningful Use article series will include an overview of Stage 1 and Stage 2, seven of the biggest changes to Stage 2 as stated by the Final Rule, and some important dates to keep in mind when attesting. (more…)

What Providers Need to Know About Meaningful Use and Patient Portals

Guest post by Zach Watson, marketing operations analyst at TechnologyAdvice.

patient portalAfter much ado, the Centers for Medicare and Medicaid Services (CMS) released the proposal for the final rules of Meaningful Use Stage 3 earlier this month. Unsurprisingly, the healthcare industry has spent the subsequent weeks sifting through the document to get a better understanding of what the government’s end game is for the program.

After the final rules were released, CMS announced there would be a 60-day period for public feedback on the proposal, so calling it the “final rules” is a bit misleading.

Regardless, there are numerous initiatives to prepare for in Stage 3, as well as significant changes to the criteria for Stage 1 and Stage 2.

The Stage 3 rules are a mixed bag for the application of patient portal software — most of the objectives and their accompanying measures seem quite attainable, but one patient engagement measure in particular could prove a significant challenge for providers.

Here’s what you need to know.

Stage 2 Attestation is Much More Manageable

Much of the analysis regarding Stage 3 has focused on streamlining the program. CMS narrowed the core objective list to 10, and the requirements to attest for Stage 2 have been significantly lightened.

In fact, if a provider hasn’t attested for Stage 1 yet, they can automatically begin participating in Meaningful Use at a modified version of Stage 2 this year. This only requires a 90-day attestation period for 2015, though the following years require that providers attest for a full year.

Additionally, the patient engagement requirements for Stage 2 have been radically altered. The much maligned “View-Download-Transmit” measure requiring five percent of patients to actively engage with their health record has been all but eliminated.

The new rule simply says, “at least one patient during the reporting period” must actively engage with their health information during the reporting period. Similarly, the Stage 2 requirement for secure messaging has essentially been reduced to a yes or no scenario.

All of these changes to Stage 2 indicate that CMS understands the need to move the needle forward in terms of where the majority of providers are in the Meaningful Use program before Stage 3 begins to take full effect in 2017.

It’s intriguing that two of the major changes in the final rule proposal deal with Stage 2 measures that directly relate to patient portal usage. In no uncertain terms, this is a win for eligible providers.

Stage 3 Brings Back Tough Patient Engagement Requirements

The proposed rules for Stage 3 attempt to follow the theme of simplification applied to modifying the Stage 2 rules. But just because something is easily understood doesn’t mean that it’s easily performed.

In terms of patient portals and patient engagement, the most important objective for physicians to examine is the Coordination of Care Through Patient Engagement. As the name implies, this objective focuses on patient engagement, which has nearly always been manifested as a view, transmit, or download threshold in the context of Meaningful Use.

Stage 3 is no different, and this objective comes with three accompanying measures, of which eligible professionals must meet two.

Let’s start with most difficult. Though its teeth were pulled for Stage 2, View-Download-Transmit is back for Stage 3, and this time it’s going to take a whopping 25 percent of patients actively engaging with their health information to meet the threshold. However, there’s also the option of using an API to automatically push this information to another platform in order to meet this goal.

Secondly, the Patient Engagement objective requires 35 percent of patients to receive a secure message during the reporting period. In the past, this would mean that patients had to send the message, but CMS has mercifully included messages sent first from a provider in this measure.

Lastly, patient-generated health data or data from a non-clinical setting must be incorporated into the EHR record for more than 15 percent of patients during the reporting period. An API can also be used to meet this measure instead of tasking patients and providers with manually entering the data.

The addition of APIs is very interesting in the proposal by CMS, but the practicality of this approach — at least in the short term — is questionable.

Developing APIs will be out of reach for many smaller practices because they simply don’t have the resources. This puts the onus clearly on vendors, with an advantage going to standalone patient portals that aren’t tethered to a particular EHR.

These platforms likely have more open architecture and may be in a better position to integrate with multiple EHRs and serve as an all access point for patient records from multiple providers.

Additionally, APIs could significantly reduce the administrative workload of incorporating patient-generated health data — Apple’s HealthKit is a prime example of this technology in action.

The silver lining is that providers can choose two of the three measures in the Patient Engagement objective, skirting the difficult undertaking of driving one out of every four patients to engage with their health records online.

All in all, Stage 3 isn’t overwhelming from a patient portal view, though providers must choose which difficult measure to tackle: View-Download-Transmit, or integrating patient-generated health data.

About the Author: Zach Watson is a marketing operations analyst at TechnologyAdvice. He covers marketing automation, healthcare IT, business intelligence, HR, and other emerging technology. Connect with him on LinkedIn.

CMS and ONC Adjust Requirements for Meaningful Use Stage 3 Reporting

doctor using ehrGiven the time sensitive nature of the MACRA program, this article is out dated. Please refer to Bridge’s MACRA 101 article for more current explanation of the MACRA program and how it relates to a patient portal.

CMS and the ONC have recently released a range of adjustments intended to help reduce reporting burdens on health providers and simplify meaningful use reporting requirements.

The changes, which demonstrate its aim for greater meaningful use flexibility and simplicity, have been received positively by major healthcare organizations and Health IT groups who had voiced their concerns to CMS. In recognition and response to over 2,500 comments from physicians and providers, CMS has stated that it’s time to focus on information technology systems that improve the quality and safety of patient care.

The final rules aim to continue to progress the healthcare industry from a paper-based system to an electronic system, where a doctor’s handwriting had to be interpreted and patient files could be misplaced.

The major adjustments include:

  • Shift the focus of health IT and the adoption of information technology systems so that they become a tool for improvement in the quality and safety of patient care, not an end in itself.
  • Allow providers to choose the measures that are most meaningful for their practices in their reporting.
  • Allow providers and state Medicaid agencies more time – until January 1, 2018 – to comply with the new requirements.
  • Give developers more time to create new technology appropriate to new models of care and to give consumers easier access to data.
  • Support a more useful infrastructure that allows exchange of information between providers and patients.
  • Address health information blocking and work towards greater interoperability between providers and patients.

In addition, the adjustments adopt more flexible reporting periods and will move from a fiscal calendar year to a calendar year beginning in 2015. All providers will have a 90-day reporting period in 2015 as well as new participants in 2016 and 2017, and for any provider moving to Stage 3 in 2017.

CMS has also considered the objectives and measures of the EHR incentive programs in 2015 to 2017 and restructured these to align with Stage 3.

The major provisions for Stage 3 starting in 2017 include:

  • Eight objectives for eligible professionals and eligible hospitals. In stage 3, more than 60% of the proposed measures require interoperability, up from 33% in stage 2.
  • Public health reporting with flexible options for measure selection.
  • Align CQM reporting with the CMS quality reporting programs.
  • Extend the access that patients have to their own health records through application program interfaces (API’s) and empower individuals to make key health decisions.

The simplified stage 3 measures were in response to complaints from many providers that the reporting rules were inflexible. Furthermore, according to ONC, the stage 3 requirements are optional in 2017. Providers who choose to begin stage 3 in 2017 will have a 90-day reporting period. All providers will be required to comply with stage 3 requirements beginning in 2018 using EHR technology certified to the 2015 Edition.

CMS is also encouraging providers to apply for exemptions if they had difficulty with their EHR vendor or experienced challenges with implementation due to the timing of the rules. Additionally, the new rules aim to give individuals greater access to their information through the development of user-friendly technology so they can be engaged and empowered in their care.

How to Use a Patient Portal to Meet Meaningful Use Stage 2

Patient engagement is a buzzword that’s been flying around for a while. In case you’re not familiar with it, here are a few industry definitions.

  • “The process by which patients become invested in their own health.”
  • “Patients’ use of educational materials and online resources to learn about better health and/or their own health conditions.”
  • “When a patient feels comfortable challenging their doctor when something doesn’t seem right or when explanations are not clear.”
  • “Actions individuals must take to obtain the greatest benefit from the health care services available to them.”
  • “Patient engagement is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care or exercising regularly.”

What Does It Mean For You?

Let’s Start with Meaningful Use Stage 2

To meet Stage 2 as an eligible professional (EP), you must use a patient portal to meet the following Core Objectives:

  • Core Objective: Provide clinical summaries for patients for each office visit.
  • Measure: Clinical summaries provided to patients or patient-authorized representatives within one business day for more than 50 percent of office visits.
  • Core Objective: Use secure electronic messaging to communicate with patients on relevant health information.
  • Measure: A secure message was sent using the electronic messaging function of CEHRT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.
  • Core Objective: 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.
  • Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information, with the ability to view, download, and transmit to a third party.
  • Measure 2:  More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.

To meet Meaningful Use Stage 2, you may use Bridge Patient Portal OR your EHR to meet the following objectives:

  • Core Objective: Record the following demographics: preferred language, sex, race, ethnicity, date of  birth.
  • Measure: More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data.
  • Core Objective: 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.
  • Measure: More than 80 percent of all unique patients seen by the EP have blood pressure (for
    patients age 3 and over only) and/or height and weight (for all ages) recorded as
    structured data.

The Good News?

You’ve chosen a patient portal system designed for patient engagement and a service team that is prepared. We don’t just expect you to meet the 5% messaging requirement – we want you to exceed it.

Here Are Some Tips for You:

  1. Understand your patients’ behavior and demographics. 
    1. Why do they want to use the portal? For example:
      1. For chronic condition management patients, you should promote:
        1. Lab results
        2. Vitals tracking
        3. Care plans
        4. Communication with a coach or provider
      2. For healthy patients, you should promote:
        1. Appointment scheduling
        2. Wellness (e.g. health tips, HRA assessments)
        3. Diet/exercise management
        4. Communication with a coach or provider
  2. Align the patient portal with your organization’s strategic goals.
    1. Include the goal of patient engagement in your hospital or practice’s policies, job descriptions, and mission and vision statements.
  3. Create value in enrollment.
    1. Start an enrollment drive.
    2. Create competitions among affiliated practices.
    3. Provide tablets/kiosks in waiting rooms.
    4. Create a marketing campaign.
      1. Promote on social media
      2. Send newsletters out to patients.
      3. Hand out paper marketing materials in your office (e.g. flyers, brochures, appointment cards)
      4. Promote on your website
    5. Include enrollment as part of the registration process.
      1. Make sure to collect email addresses from all patients upon intake.
      2. Have a help desk at the office for enrollment.
    6. Designate at least one “enrollment advisor” who knows how to walk patients through registration and tutorial.
  4. Encourage providers to promote the portal. Patients listen to doctors. 
    1. Provide training and incentives for providers to connect with patients using the portal.
    2. Providers should acknowledge that their patients use the portal and encourage continued use: “Thank you for using our portal. We see that you care about your health.” 
  5. Promote continued use.
    1. Portal use doesn’t stop at enrollment. Encourage continued use of the portal by communicating with patients via the portal. Assign a portal advisor to each patient to follow up at intervals after enrollment.

Attestation

The Bridge Patient Portal has a built-in Meaningful Use reporting module where you can export a report based on Core Objective, Provider and Reporting Period. A Bridge team member can help you run these reports when it comes time to attest.

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