Understanding the Changes for

the EHR Incentive Program

Paul Kleeberg, MD, FAAFP, FHIMSS

CMIO Stratis Health

December 5, 2012
Objectives
• Understand the new EHR Incentive
program requirements
• Know what to do to prepare to meet the
new requirements
• Understand the impact this will have on
your EHR technology, your staff and your
workflow
Meaningful Use Outline
• Changes to the timeline
• New EHR software certification standards for
all in 2014
• New requirements and options for stage 1
• Stage 2 requirements
• New quality measurement requirements
starting in 2014 for all
• What you need to do now
 Stages of Meaningful Use Once you
Attest
Stage of Meaningful Use
1st
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Year
2011 1 1 1 2 2 3 3 TBD TBD TBD TBD

2012 1 1 2 2 3 3 TBD TBD TBD TBD

2013 1 1 2 2 3 3 TBD TBD TBD

2014 1 1 2 2 3 3 TBD TBD

2015 1 1 2 2 3 3 TBD

2016 1 1 2 2 3 3

2017 1 1 2 2 3

1. Note: These stages will continue to progress whether or not you attest
to meaningful use in a year following your attestation year
Meaningful Use Outline
• Changes to the timeline
• New EHR software certification standards
for all in 2014
• New requirements and options for stage 1
• Stage 2 requirements
• New quality measurement requirements
starting in 2014 for all
• What you need to do now
Essential Changes in EHR Certification
• EHR Certification:
– From “Stage 1 Certified”  2011
Certification
– New Certification criteria  2014
Certification
• All will need to have 2014 Certified EHR
Technology (CERT) in payment year 2014
• ONC/CMS will not require an EP/EH CAH
to purchase components they do not need
• Vendors will not need to recertify on criteria
that have not changed since 2011
• New Criteria: Safety-enhanced design
Certified EHR Technology

What it is What
today is proposed
2014 Edition CEHRT
Base: Capabilities certified to
meet the definition of Base EHR.

Core: Capabilities certified for

the MU core objectives &
measures for the stage of MU
they seek to achieve unless the
EP/EH/CAH meets an exclusion.

Menu: Capabilities certified for

the MU menu set objectives &
measures for the stage of MU
they seek to achieve as well as
the selected quality measures
“Base EHR”
• EHR technology that includes fundamental
capabilities all providers would need to have
• Defined by statute:
– Demographics
– CPOE
– CDS
– Quality Reporting
– Information exchange
• Security requirements, though not required by
statute, were added to the base EHR
Meaningful Use Outline
• Changes to the timeline
• New EHR software certification standards for
all in 2014
• New requirements and options for stage 1
• Stage 2 requirements
• New quality measurement requirements
starting in 2014 for all
• What you need to do now
Changes to Meaningful Use
Changes
• Menu Objective Exclusion:
Starting in 2014 these
exclusions will no longer count
towards the number of menu
objectives needed.
No Changes
• Half of Outpatient Encounters–
at least 50% of EP outpatient
encounters must occur at
locations equipped with certified
EHR technology.
• Measure compliance = objective
compliance
• Denominators based on
outpatient locations equipped
with CEHRT and include all such
encounters or only those for
patients whose records are in
CEHRT depending on the
measure.
 Changes to Stage 1: CPOE
Current Stage 1 Measure New Stage 1 Option

This optional CPOE denominator is available in 2013 and beyond for

Stage 1
 Changes to Stage 1: Vital Signs
Current Stage 1 Measure New Stage 1 Measure

The vital signs changes are optional in 2013, but required starting in 2014
Changes to Stage 1:
Testing of HIE
Current Stage 1 Measure Stage 1 Measure Removed

The removal of this measure is effective

starting in 2013
 Changes to Stage 1:
E-Copy & Online Access
Current Stage 1 Objective New Stage 1 Objective

• The measure of the new objective is 50% of patients have access to their information
• There is no requirement that 5% of patients actually access their information for Stage 1.
• This does eliminate one of the 10 Stage 1 menu items
• Takes effect in 2014 to coincide with the 2014 certification and standards criteria
 Changes to Stage 1:
Public Health Objectives
New Stage 1 Addition
Current Stage 1 Objectives

This addition is for clarity purposes and does not change the Stage 1
measure for these objectives.
Meaningful Use Outline
• Changes to the timeline
• New EHR software certification standards for
all in 2014
• New requirements and options for stage 1
• Stage 2 requirements
• New quality measurement requirements
starting in 2014 for all
• What you need to do now
Concepts for Stage 2
• In general:
– Stage 1 menu items have become
core
– Percentages have increased
– Turnaround time is shorter
– More exchange
– More patient online access and
involvement
– Some core measures incorporated
into other activities
Stage 1 to Stage 2 Meaningful Use
Stage 2 Core Objectives
Stage 2 Core Objectives – No
Longer Menu:
New Stage 2 Core Objective:
12. Provide summary of care document > 50% of
transitions of care and referrals with > 10%
sent electronically and 1 to another
organization with a different vendor’s EHR
13. Provide online access to health
information > 50% with > 5% actually
accessing it
Stage 2 EP only Core Objectives:
Stage 2 EH/CAH only Core Objectives:
• Formerly Menu:
14. Successful ongoing submission of
reportable laboratory results
15. Successful ongoing submission of
electronic syndromic surveillance data
• New
16. EMAR with barcode scanning is
implemented and used for more than 10%
of medication orders
Stage 1 Core Measures Incorporated
Into Others
• In order to meet the Transition of Care / Referral measure,
must contain an up-to-date problem list, medication list and
allergy list whether or not they are electronically
transferred
Elements of the Transfer of Care /
Referral Summary Document
Usual Suspects New Elements:
•Patient name •Encounter diagnosis.
•Referring or transitioning provider's •Functional status, including
name and office contact information activities of daily living, cognitive
(EP only) and disability status.
•Procedures •Care plan field, including goals and
•Immunizations instructions.
•Laboratory test results •Care team including the primary
•Vital signs care provider of record and any
additional care team members
•Smoking status beyond the referring or transitioning
•Demographic information provider and the receiving provider.
•Discharge instructions (Hospital
Only)
•Reason for Referral (EP)
Stage 2 Menu Objectives
(Select 3 of 6)
1. More than 10% of imaging results are accessible through Certified
EHR Technology
2. Record electronic notes in patient records for >30% of unique
patients
3. Record family health history > 20%
EP Only:
4. Successful ongoing transmission of syndromic surveillance data
5. Successful ongoing transmission of cancer case information
6. Successful ongoing transmission of data to a specialized registry
EH Only:
1. More than 10% electronic prescribing (eRx) of discharge medication
orders
2. Record advanced directives for more than 50% of patients 65 years or
older
3. Provide structured electronic lab results to EPs for more than 20%
of labs ordered electronically
Meaningful Use Outline
• Changes to the timeline
• New EHR software certification standards for
all in 2014
• New requirements and options for stage 1
• Stage 2 requirements
• New quality measurement requirements
starting in 2014 for all
• What you need to do now
Changes to CQMs Reporting
Prior to 2014 Beginning in 2014
CQM Reporting in 2013
• CQM reporting will remain the same
through 2013.
• In 2012 and continued in 2013, there
are two reporting methods available for
reporting the Stage 1 measures:
– Attestation
– eReporting pilots
• Physician Quality Reporting System EHR
Incentive Program Pilot for EPs
• eReporting Pilot for eligible hospitals and
CAHs
– Medicaid providers submit CQMs
according to their state-based
submission requirements.
Electronic Submission of CQMs
Beginning in 2014
• Beginning in 2014, all
Medicare-eligible providers
in their second year and
beyond of meaningful use
must electronically report
their CQM data to CMS.
• Medicaid providers will
report their CQM data to
their state, which may
include electronic reporting.
CQM Specifications
• No change in specifications for the CQMs in 2013
• For EPs starting in 2014
– 41 of the 44 CQMs finalized in the Stage 1 final rule
will remain. Excluded will be:
• NQF 0013: Controlling High Blood Pressure
• NQF 0027: Smoking and Tobacco Use Cessation, Medical
Assistance
• NQF 0084: Heart Failure: Warfarin Therapy Patients with
Atrial Fibrillation
– 23 new CQMs will be added totalling 64
• For EHs / CAHs
– All 15 of the CQMs finalized in the Stage 1 final rule
plus 14 new CQMs totaling 29
 Aligning CQMs Across Programs
• The same CQMs will be used in multiple quality
reporting programs beginning in 2014
– Other programs include Hospital IQR Program,
PQRS, CHIPRA, and Medicare SSP and Pioneer
ACOs

Hospital
Physician Children’s Health Medicare
Inpatient
Quality Insurance Program Shared Savings
Quality
Reporting Reauthorization Program and
Reporting
System Act Pioneer ACOs
Program
CQM Selection and HHS Priorities
• All providers must select 9 CQMs from at
least 3 of the 6 HHS National Quality
Strategy domains:
– Patient and Family Engagement
– Patient Safety
– Care Coordination
– Population and Public Health
– Efficient Use of Healthcare Resources
– Clinical Processes/Effectiveness
2014 CQMs Recommended for Adults
Patient and Family
Functional status assessment for complex chronic conditions
Engagement.

Use of High-Risk Medications in the Elderly

Patient Safety.
Documentation of Current Medications in the Medical Record
Description

Care Coordination. Closing the referral loop: receipt of specialist report

Preventive Care and Screening: Tobacco Use: Screening and

Cessation Intervention
Population/Public Preventive Care and Screening: Body Mass Index (BMI) Screening
Health. and Follow-Up
Preventive Care and Screening: Screening for Clinical Depression
and Follow-Up Plan
Efficient Use of
Use of Imaging Studies for Low Back Pain
Healthcare Resources.
Clinical
Controlling High Blood Pressure
Process/Effectiveness.
2014 CQMs Recommended for Children
Weight Assessment and Counseling for Nutrition and Physical Activity
for Children and Adolescents

Population/Public Chlamydia Screening for Women

Health. Childhood Immunization Status
Preventive Care and Screening: Screening for Clinical Depression and
Follow-Up Plan

Title: Appropriate Testing for Children with Pharyngitis

Efficient Use of
Healthcare Resources. Appropriate Treatment for Children with Upper Respiratory Infection
(URI)
Use of Appropriate Medications for Asthma
ADHD: Follow-Up Care for Children Prescribed Attention-
Clinical Deficit/Hyperactivity Disorder (ADHD) Medication
Process/Effectiveness.
Children who have dental decay or cavities Description: Percentage of
children ages 0-20, who have had tooth decay or cavities during the
measurement period.
2014 Hospital Quality Measures
15 Old Measures:
2014 Hospital Quality Measures
14 New Measures
 EP CQM Reporting Beginning in 2014 
Eligible Professionals reporting for the Medicare EHR Incentive Program
Category Data Level Payer Level Submission Type Reporting Schema
EPs in 1 Year of
st
Submit 9 CQMs from EP measures table (includes
Demonstrating Aggregate All payer Attestation adult and pediatric recommended core CQMs),
MU* covering at least 3 domains
EPs Beyond the 1st Year of Demonstrating Meaningful Use
Submit 9 CQMs from EP measures table (includes
Option 1 Aggregate All payer Electronic adult and pediatric recommended core CQMs),
covering at least 3 domains
Satisfy requirements of PQRS EHR Reporting Option
Option 2 Patient Medicare Electronic
using CEHRT
Group Reporting (only EPs Beyond the 1st Year of Demonstrating Meaningful Use)**
EPs in an ACO
(Medicare
Satisfy requirements of Medicare Shared Savings
Shared Savings Patient Medicare Electronic
Program or Pioneer ACOs using CEHRT
Program or
Pioneer ACOs)
EPs satisfactorily
reporting via Satisfy requirements of PQRS group reporting options
Patient Medicare Electronic
PQRS group using CEHRT
reporting options
* Attestation is required for EPs in their 1 st year of demonstrating MU because it is the only reporting method that would allow
them to meet the submission deadline of October 1 to avoid a payment adjustment.
**Groups with EPs in their 1st year of demonstrating MU can report as a group, however
the individual EP(s) who are in their 1st year must attest to their CQM results by
October 1st to avoid a payment adjustment.
2014 CQM Quarterly Reporting
• No change in CQM Reporting period except for 2014
• For Medicare providers, beyond their first attestation year, the
2014 3-month reporting period is fixed to the quarter of either
the fiscal or calendar year in order to align with existing CMS
quality reporting programs.
• In subsequent years, the reporting period for CQMs would be
the entire calendar year (for EPs) or fiscal year (for eligible
hospitals and CAHs) for providers beyond the 1st year of MU.
Reporting Period for Submission Period for
Optional Reporting Period
Provider Type Subsequent Years of Subsequent Years of
in 2014
Meaningful Use Meaningful Use
Calendar year quarter:
2 months following the
January 1 – March 31 1 calendar year
end of the reporting
EP April 1 – June 30 (January 1 - December
period
July 1 – September 30 31)
(January 1 - February 28)
October 1 – December 31
Fiscal year quarter: 2 months following the
October 1 – December 31 1 fiscal year end of the reporting
Eligible
January 1 – March 31 (October 1 - September period
Hospital/CAH April 1 – June 30 30) (October 1 - November
July 1 – September 30 30)
Meaningful Use Outline
• Changes to the timeline
• New EHR software certification standards for
all in 2014
• New requirements and options for stage 1
• Stage 2 requirements
• New quality measurement requirements
starting in 2014 for all
• What you need to do now
What you can do to prepare
• Prepare for sharing information with patients:
– Complete patients’ problem, medication and allergy lists. Make
sure they are up to date and current
– Decide what types of information you will share with patients
• Patient portals will require a lot of decision making on the part of providers
– Begin to encourage patients to get involved in their care
• Talk up the fact that you will be adding technology to allow them to make
appointments on line, message their provider and get their lab results
• Help patients identify where they might access a computer (library, waiting
room) and how to manage privacy in such a setting
– Explore whether you will use your vendor’s portal solution or some
other option
• Prepare for exchanging information with others:
– Establish relationships with other organizations to which you refer in
order to begin planning exchange (that can include nursing homes
and home care)
– Think about a connecting with your cancer registry or some other
national registry to submit data
What you can do to prepare
• Make sure your technology will be ready
– Plan to undergo an EHR upgrade in late 2013 early 2014
– Talk with your vendor about upgrade timelines
– Look at the quality measures and let your vendor know which ones are
important to you
– For hospitals, prepare for bar-coded medication administration
• Plan for more decision support
– Understand how your vendor will support having 5 “interventions” tied to
relevant quality measures
– Begin to think about the types of interventions you will incorporate into your
EHR
• Reinforce the fact that we are doing this to achieve the “Triple
Aim” of health care:
– Improving the patient experience of care (including quality and satisfaction)
– Improving the health of populations
– Reducing the per capita cost of health care
Resources:
• Regional Extension Assistance Center for Health Information Technology
(REACH)
– http://www.khaREACH.org
• Stratis Health HIT Toolkits for hospitals, clinics, home health, nursing homes
and chiropractic
– http://www.stratishealth.org/expertise/healthit/
• CMS Stage 2 web page (with Stage 2 specification sheets)
– http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
• CMS Meaningful Use Site:
– http://www.cms.gov/EHRIncentivePrograms/
• Office of the National Coordinator Health IT site:
– http://HealthIT.gov
• Certified EHRs and what modules they are certified for:
– http://healthit.hhs.gov/chpl
• CMS Stage 3
– http://www.healthit.gov/buzz-blog/meaningful-use/set-stage-meaningful-stage-3
2013 Webinar Schedule
• Webinar 6: Clinical Decision Support
February 20, 2013, 12:00 – 1:00 pm
• Webinar 7: HIE
April 17, 2013, 12:00 – 1:00 pm
• Webinar 8: ACOs
August 21, 2013, 12:00 – 1:00 pm
• Webinar 9: Health Care and Patient Centered
Medical Homes
October 16, 2013, 12:00 – 1:00 pm
• Webinar 10: TBA
December 11, 2013, 12:00 – 1:00 pm
Send Questions to:
• Connie Geyer RN, BSN
ND Healthcare Review Inc.
cgeyer@ndqio.sdps.org
Phone: 701-857-9723

• Jerri Hiniker, BSN, RN, CPEHR

Stratis Health
jhiniker@stratishealth.org
Phone: 952-853-8540  
 Thank You!
Stratis Health is a nonprofit organization that leads collaboration and
innovation in health care quality and safety, and serves as a trusted
expert in facilitating improvement for people and communities.