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Guide to Meaningful Use

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Tara Lutz

on 22 July 2011

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Transcript of Guide to Meaningful Use

The focus is on “meaningful use” of our EHR as outlined in the federal Health Information Technology for Economic and Clinical Health (HITECH) act legislation passed in February of 2009.


• There are three stages to the federal program. Stage one in 2011 includes initial measures and quality reports. Stage 2 and 3, scheduled for 2013 and 2015, are still being finalized, but will include additional quality measures and reporting requirements.
• Each stage includes incentive payments to eligible hospitals and eligible providers if they adopt certified technology, implement it effectively, and demonstrate meaningful use.
• Starting in 2015, CMS will implement a reduction in Medicare reimbursements to those hospitals and providers who fail to demonstrate Meaningful Use.
• When successfully completed, MultiCare will receive government incentive payments that offset some of the investment we’ve made in our electronic medical record and health information technology. Maximizing all meaningful use payments will directly benefit the the system’s overall financial performance and operating margin.



This is a unique opportunity with higher than expected cuts
in DSHS/Medicaid payments. what is the point? A national plan to improve the

quality of health care

and accelerate the effective use of health information technology, established through the Centers for Medicaid
and Medicare Services (CMS) ...but why is this useful? To succeed we must demonstrate over a three month period that we use our electronic health record, MultiCare Connect, to improve patient care and satisfaction according to the criteria established by law in the American Recovery and Reinvestment Act (ARRA). Hope that was useful!

To comment and share your ideas and thoughts, go to... www.learningblog.org Guide to Meaningful Use There will need to be some minor changes to our existing office visit workflows, to improve the way we document care and interact with our patients using MultiCare Connect (Epic). The handouts highlight:

•Medication reconciliation
•After Visit Summaries (AVS)
•Uniform use of the problem list
•Better interaction screening
•Improved documentation of smoking status
•Health maintenance topics Stage 1 Objectives
There are 15 Core (Appendix 1), 5 of 10 “Menu” (Appendix 2), and a number of
Quality Objectives with which MultiCare needs to comply in Stage 1. For some
measures like Order Entry and ePrescribing, we are already meeting the criteria.
However, in other areas we are well below our targets and we need all providers
to focus on improving our performance.
Here are some things you and your staff can do right now to help us be successful
and to improve the way we document care and interact with our patients using
MultiCare Connect (Epic):
• Record smoking status for all unique patients 13 years or older
• Provide clinical summaries (AVS) to patients for each office visit
• Enter prescriptions electronically
• Maintain an up-to-date problem list of current and active diagnoses
• Record Height, Weight, and Blood Pressure
• Collection of preferred language, race, ethnicity, and gender for all patients
• Maintain up-to-date Problem List of current active diagnoses. Ensure
Problem and Medication Lists are Marked as Reviewed, (this is already being
done as part of medication reconciliation). MultiCare intends to apply for Stage 1 Meaningful Use incentives based on
performance in second and third quarters of 2011.
MultiCare’s goal is to ensure that federal Stage 1 requirements are satisfied by
November 30, 2011, which will result in incentive payments to the organization. MEANINGFUL USE WITH MULTICARE CONNECT ® (Epic)
"What do you need to do?
(Objective)" AMBULATORY STAFF How do you do this in MultiCare Connect?

Review medications and allergies. > 80% of patients you see. Update the patient's medications and allergies, Mark as Reviewed.

Record height, weight, and blood pressure. > 50% of patients you see, age 2 and older. Enter a height, weight, and blood pressure in the Vitals navigator section. Reported or historical height measurements may be used - record whether reported or historical in the Comments section if not actually measured during visit.

Record smoking status. > 50% of patients you see, age 13 and older. FOR ALL PATIENTS 13 YEARS AND OLDER, enter a patient's smoking status in the History navigator section.

Provide patients with educational materials > 10% of patients you see. Click References on your navigator toolbar. Select a document and click Add to Patient instructions to add the materials to the patient's AVS. Print the materials separately by clicking Print > Print Patient instructions.

Sign patients up for MyChart > 10% of patients you see. Use the MyChart Sign-Up navigator section before or during a visit so patients can activate their accounts in your office.


Record preferred language, gender, race and ethnicity, and date of birth. > 50% of patients you see. Enter a patient's informaiton in the Demographic activity. See user reference on registration scripting.

Sign patients up for MyChart. > 10% of patients you see. Print the MyChart Access Letter for patients before or after a visit so patients can activate their accounts.




Provide patients with an After Visit Summary (AVS.) > 50% of your visits. Please work with your clinic Supervisor to establish the best workflow for your office. Options: Print an AVS from the Visit Navigator or in the Schedule activity; patients can get their AVS in MyChart (if they have an active account.)

Send a summary of care when the patient is referred to another clinician. > 50% of your visits. Print an AVS from the Visit Navigator or in the Schedule activity. Instruct the patient to give the AVS to his next clinician. AVS MUST BE PRINTED for all patients referred out - even those with an active MyChart account. Back Office Front Office All Staff MEANINGFUL USE WITH MULTICARE CONNECT ® (Epic)
"What do you need to do?
(Objective)"AMBULATORY ELIGIBLE PROVIDERSHow do you do this in MultiCare Connect?

ORDEREnter prescriptions electronically> 30% of patients you see with active prescriptions have at least one prescription entered by you in the system.*"Enter and sign orders in the Medications & Orders navigator section.
A nurse or MA can pend orders for you to sign or place verbal orders for you to cosign.
"
Exclusion: This objective and associated measure do not apply to any eligible professional who writes fewer than one hundred prescriptions during the EHR reporting period.
Send non-controlled prescriptions to pharmacies electronically> 40% of non-controlled prescriptions you write.*"Enter and sign orders in the Medications & Orders navigator section. Verify the patient's pharmacy, which appears at the bottom of the section.
A nurse or MA can confirm a patient's pharmacy and pend orders for you to sign."
Exclusion: This objective and associated measure do not apply to any eligible professional who writes fewer than one hundred prescriptions during the EHR reporting period.

CHARTReview problems, medications, and allergies.> 80% of patients you see.Update a patient's information in the Problem List, Medications, and Allergies/Contraindications navigator sections. If the patient has no active problems, medications, or allergies, click Mark as Reviewed.
Exclusion: An eligible provider who sees no patients 2 years old or older would be excluded from this requirement.
Record height, weight, and blood pressure.> 50% of patients you see, age 2 and older.*Enter a height, weight, and blood pressure in the Vitals navigator section.
Exclusion: An eligible provider who believes that all three vital signs of height, weight and blood pressure have no relevance to their scope of practice to so attest and be excluded.
Record smoking status.> 50% of patients you see, age 13 and older.*Enter a patient's smoking status in the History navigator section.
Exclusion: Eligible providers who see no patients 13 years or older would be excluded from this requirement.
Record preferred language, gender, race and ethnicity, and date of birth.> 50% of patients you see.Enter a patient's information in the Demographics activity.
Exclusion: None
General lists of patients with certain conditions.At least one list that includes patients you see.Go to Reporting Workbench, select a pre-configured report, such as My Diabetic Patients, and click Run.
Exclusion: None

ENGAGEProvide patients with an After Visit Summary (AVS) within three days of a visit.> 50% of your visits.*Print an AVS from the Visit Navigator or in the Schedule activity. Patients can also get their AVS in MyChart (if they have an account)
Exclusion: Eligible providers who have no office visits during the EHR reporting period would be excluded from this requirement.
Sign patients up for MyChart and release results and problems.>= 10% of patients you see.*Use the MyChart Sign-up navigator section before or during a visit so patients can activate their accounts in your office. If you manually release results or problems in MyChart, release them within 4 days.
Exclusion: If an eligible provider neither orders nor creates any of the information listed in the ONC final rule 45 CFR 170.304(g) and therefore included in the minimum data for this objective during the EHR reporting period they would be excluded from this requirement.
Provide patients with educational materials.> 10% of patients you see.Click References on your navigator toolbar. Select a document and click Add to Patient Instructions to add the materials to the patient's AVS. Print the materials separately by clicking Print > Print Patient Instructions.
Exclusion: None

SYNCSend a summary of care when you refer a patient to another clinician.> 50% of your visits.*Print an AVS from the Visit Navigator or in the Schedule activity. Instruct the patient to give the AVS to his next clinician. AVS MUST BE PRINTED for all patients referred out - even those with an active MyChart account.
Exclusion: In an eligible provider does not transfer a patient to another setting or refer a patient to another provider during the EHR reporting period, they would be excluded from this requirement.

REPORT"In addition to the other objectives described, you must submit quality measure data to CMS for three core measures and three non-core measures related to your patient population.
The three core quality measures assess whether you do the following for each patient age 18 and older:
* Review tobacco use
* Calculate BMI and document a follow-up plan when the BMI is outside of the normal range
* Document blood pressure for hypertensive patients" If you have questions about this project please contact:
Diana Aresu, Meaningful Use Project Manager at diana.aresu@multicare.org.

You may also email the project leaders for additional questions:
Matt Eisenberg, MD, Medical VP of Clinical Informatics
Jane Cahill, Director of Clinical, Access and Revenue Enterprise Information Technology
Doug Smathers, MD, MMA Medical Director East Pierce Primary Care
Mark Mariani, MD, MMA Medical Director of Orthopedics and Sports Medicine What can we do to help our Practices succeed? 2011 2015 2013 Staff Education
July 2011
Data Collection begins Stage 1 November 30th, 2011 - Stage 1 requirements are satisfied and provider information submitted Stages 2 and 3 will include additional quality measures and reporting requirements Starting in 2015, CMS will implement a reduction in Medicare reimbursements to those hospitals and providers who fail to demonstrate Meaningful Use. Each stage includes incentive payments to eligible hospitals and eligible providers if they adopt certified technology, implement it effectively, and demonstrate meaningful use. Thank you!! MULTICARE’S SHARED VALUES | Respect | Integrity | Stewardship | Excellence | Collaboration | Kindness
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