Health Information Technology Extension Center of Los Angeles Meaningful Use: a Primer Mary Mitchell Director of Meaningful Use A project of L.A. Care Health Plan A project of L.A. Care Health Plan
What is Meaningful Use? Defined as: A. Use of a certified EHR in a meaningful manner (e.g.: clinical documentation, e-prescribing, etc.) B. Use of certified EHR technology for electronic exchange of health information C. Use of certified EHR technology to submit clinical quality and other measures A project of L.A. Care Health Plan 2
Practical Approach: Meaningful Use IS Health Care Transformation Meaningful Use Quality Reporting Clinical Decision Support Improving Care Coordination Engaging Patients Managing Population Health A project of L.A. Care Health Plan 3
3 Stages of Meaningful Use *2012 *2015 2011 Stage II Advanced Stage III Stage I Improved Data Capture Clinical Outcomes and Sharing Processes * to be defined in future rulemaking A project of L.A. Care Health Plan 4
What It Means for Providers Investment of $ Time and Money Improved Outcomes Challenges Change Adaptation Practice - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Patient Records Access Responsiveness Involvement Conversion Increased Efficiency A project of L.A. Care Health Plan 5
How Do I Achieve Meaningful Use? Good News: You are already achieving many of these measures! Medicare: • Demonstrate in 1 year ✔ • Initiate by 2014 • Payments begin in 2011 • Fee schedules reduced beginning 2015 if not ✔ achieving meaningful EHR use Medicaid: • Adopt/implement/upgrade option 1 st year • Initiate by 2016 • No payment reductions • Last year of payments is 2021 A project of L.A. Care Health Plan 6
Implementation Phases & Criteria • Phase 1: Objectives & Measures • Meet 15 Core Objectives • Meet 5 of 10 Menu Set Core Objectives • Satisfy 3 Core Clinical Quality Measures (CQMs) • Satisfy 3 of 38 Additional Set CQMs • Submit by attestation • Phase 2 : Advanced Clinical Process • Phase 3 : Improved Outcomes A project of L.A. Care Health Plan 7
15 Core Objectives for Eligible Providers (meet all) • Computerized Provider Order Entry • E-Prescribing • Report ambulatory clinical quality measures to CMS/States • Implement one clinical decision support rule • Provide patients with an electronic copy of their health information, upon request • Provide clinical summaries for patients for each office visit • Check for drug-drug and drug-allergy interactions • Record demographics • Maintain an up-to-date problem list of current and active diagnoses • Maintain active medication list • Maintain active medication allergy list • Record and chart changes in vital signs • Record smoking status for patients 13 years or older • Capability to exchange key clinical information among providers of care • Protect electronic health information A project of L.A. Care Health Plan 8
Menu Set Core Objectives for Eligible Providers (meet 5 of the 10) • Drug-formulary checks • Incorporate clinical lab test results as structured data • Generate lists of patients by specific conditions • Send reminders to patients per patient preference for preventive/follow up care • Provide patients with timely electronic access to their health information • Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate • Reconcile medications • Summary of care record for each transition of care/referral • Capability to submit electronic data to immunization registries/systems* • Capability to provide electronic surveillance data to public health agencies* * At least 1 public health objective must be selected A project of L.A. Care Health Plan 9
Core Clinical Quality Measures (CQMs) (satisfy 3) 1. Hypertension blood pressure measurement 2. Preventive care and screening measure pair • Tobacco use assessment • Tobacco cessation intervention 3. Adult weight screening and follow up 4. Weight assessment and counseling for children and adolescents 5. Preventive care and screening • Influenza immunization for patients > 50 years old 6. Childhood immunization status A project of L.A. Care Health Plan 10
Additional Set of CQMs EPs must complete 3 of 38 1. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment 2. Appropriate Testing for Children with Pharyngitis 3. Asthma Assessment 4. Asthma Pharmacologic Therapy 5. Breast Cancer Screening 6. Cervical Cancer Screening 7. Chlamydia Screening for Women 8. Colorectal Cancer Screening 9. Controlling High Blood Pressure 10. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) 11. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol 12. Coronary Artery Disease (CAD): Oral Anti-platelet Therapy Prescribed for Patients with CAD 13. Diabetes: Blood Pressure Management 14. Diabetes: Eye Exam 15. Diabetes: Foot Exam 16. Diabetes: Hemoglobin A1c Control (<8.0%) 17. Diabetes: Hemoglobin A1c Poor Control 18. Diabetes: Low Density Lipoprotein (LDL) Management and Control 19. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 20. Diabetic Retinopathy: Documentation of Presence/Absence of Macular Edema and Level of Severity of Retinopathy A project of L.A. Care Health Plan 11
Additional Set of CQMs EPs must complete 3 of 38 (continued) 21. Diabetes: Urine Screening 22. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 23. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 24. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation 25. Ischemic Vascular Disease (IVD): Blood Pressure Management 26. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 27. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 28. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement 29. Low Back Pain: Use of Imaging Studies 30. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer 31. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 32. Pneumonia Vaccination Status for Older Adults 33. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) 34. Prenatal Care: Anti-D Immune Globulin 35. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 36. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 37. Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 38. Use of Appropriate Medications for Asthma A project of L.A. Care Health Plan 12
Regional Extension Centers are Formed… • Neutral, Not-For-Profit organizations established to provide training, support and technical assistance to help primary care providers select, implement and use EHRs • Selection, purchase & implementation of EHR • Workflow redesign • Connection to health information exchange • Attainment of Meaningful Use • Compliance with privacy and security • Goal is for 100,000 priority primary care providers across the country to become meaningful users of EHRs within four years A project of L.A. Care Health Plan 13
HITEC-LA Goals • Establish L.A. Care’s REC program as a trusted brand providing objective, high quality information and assistance to providers • Deliver technical assistance to priority primary care providers and other members by April 2012 • Create 3,000 meaningful EHR users by April 2012 A project of L.A. Care Health Plan 14
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