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Meaningful Use Stage 1
Samantha Bassett and Storey Zimmerman
September 10, 2013
Confidential and Proprietary Information of Vitera
Healthcare Solutions, LLC. Presentations are for
informational purposes only.
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GETTING THERE TOGETHER
• This presentation will show you:
‒ What is involved with Meaningful Use Stage 1 attestation
‒ How to prepare for a successful audit with CMS
‒ Marketing your Intergy Practice Portal
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AGENDA
• Meaningful Use Overview
• Meaningful Use Core and Menu Measures Workflow
– Office Manager
– Front Desk
– Clinician 1
– Clinician 2
– Clinician 1
– Back Office
• Meaningful Use Reporting
• Audits
• Practice Portal
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MEANINGFUL USE OVERVIEW
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HISTORY OF MEANINGFUL USE
American Recovery and Reinvestment Act, 2009
Two Programs
• Medicare
• Medicaid
3 Stages
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ULTIMATE GOAL
Enhance the quality of patient care
and improve patient outcomes
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MEANINGFUL USE STAGES
Stage 1
Stage 2
Stage 3
Capture and share
health
information
Decision support,
interoperability,
and patient
engagement
Use of
information for
improved
outcomes
2011
2014
TBD
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MEANINGFUL USE MEASURE DOMAINS
Improve
quality,
safety, and
efficiency
Improve
public and
population
health
Ensure
privacy and
security for
personal
health
information
Engage
patients and
families
Improve care
coordination
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MEANINGFUL USE STAGE 1
• 14 core measures
• 5 of 10 menu measures
• Themes:
- Capturing health information and demographics
- Sharing information for care coordination
- Reporting clinical quality measures and public health information
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MEANINGFUL USE STAGE 2
• 17 core measures
• 3 of 6 menu measures
• Themes:
-
Disease management
Medication management
Decision support
Better transitions in care
Patient engagement and access to their own health information
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MEANINGFUL USE STAGE 3
• Requirements not published yet
• Themes:
- Improvements in quality, safety, and efficiency of care
- Improving population health
- Continued focus on decision support for high priority conditions
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Who can
qualify?
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ELIGIBLE PROFESSIONALS
Medicare
● Providers who qualify as “physicians”
under the Medicare statute
– Doctors of medicine and osteopathy
● Limited purposes
–
–
–
–
Dentists
Podiatrists
Optometrists
Chiropractors
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ELIGIBLE PROFESSIONALS
Medicaid
● All providers who qualify for Medicare
● Limited purposes
–
–
–
–
–
Optometrists
Dentists
Nurse-midwives
Nurse practitioners
Physician assistants practicing in FQHCs
● Must have Medicaid volume percentages
– 20% for pediatricians
– 30% for all others
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What do I
need?
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Vitera Intergy EHR
Vitera Practice Portal
Vitera Practice Analytics
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MEANINGFUL USE CHECKLIST

 Decide which Meaningful Use program to attest under
 Decide which menu measures and Clinical Quality Measures you wish

to fulfill
 Determine what required information you already gather

 Determine what required information you need to start gathering

 Determine how to re-work your workflows to obtain new required

information
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MEANINGFUL USE CORE AND
MENU MEASURES
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Workflow
OFFICE MANAGER
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CORE MEASURE 14
Protection of Electronic Health Information
• Provide right amount of security for patient records
• Avoid some common security gaps that lead to cyber-attack or
data loss
• Helps protect patients, information, technology, and practice
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CORE MEASURE 2
Drug-Drug and Drug-Allergy Check
• Ordering medications safer and easier
• Minimize potential for adverse events
• Minimize pharmacy call-backs
• Displaying alerts to provide better clinical decisions
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MENU MEASURE 1
Implement Drug Formulary Checks
• Helps make best informed decisions regarding treatment options
• Prevents callbacks from patients and pharmacy
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CORE MEASURE 11
Implement One Clinical Decision Support (CDS) Rule
• Help deliver the highest quality of care
• Assures that all patients receive appropriate and timely
preventative services
• Ensures that patients get the right tests, medications, and
treatments
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MENU MEASURE 9
Capability to Submit Electronic Data to Immunization Registries
• Vital information easily available for other providers and
institutions
• Gives providers historical immunization data for queries
• Contributes to the improvement of public health
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MENU MEASURE 10
Capability to Submit Electronic Syndromic Surveillance Data to Public Health
Agencies
• Used for epidemiological analyses
• Monitor and mitigate public health threats
• Enables public health authorities to provide timely assessments
of population health
• Useful for event detection, situation awareness, and response
management
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CORE MEASURE 7
Record Demographics
• Increase practice efficiency
• Accurate billing
• Look at results in performance in terms of groups
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QUESTIONS?
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Workflow
FRONT DESK
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CORE MEASURE 7
Record Demographics
• Increase practice efficiency
• Accurate billing
• Look at results in performance in terms of groups
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MENU MEASURE 4
Send Reminders to Patients for Preventative/Follow-up Care
• Reduces missed appointments
• Improves the ease of tracking annual exams
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QUESTIONS?
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15 MINUTE BREAK
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Workflow
NURSE/MEDICAL ASSISTANT/
PHYSICIAN ASSISTANT/CLINICIAN 1
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MENU MEASURE 5
Provide Patients with Timely Electronic Access to Health Information
• Improving care
• Increasing patient responsibility in health decisions
• Provides family members information
• Improves safety
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MENU MEASURE 5
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CORE MEASURE 9
Record Smoking Status for Patients 13 and Over
• Step toward durable cessation
• Encourage patients to quit
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CORE MEASURE 8
Record and Chart Changes in Vitals
• Essential, baseline data for treatment decisions
• Recognition of acute and chronic changes
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CORE MEASURES 8 AND 9
• Determine who is to collect vitals and smoking status
• Determine when in the patient visit vitals and smoking status
should be collected
• Consistently follow new workflow
• Don’t forget growth charts for children ages 2 - 20
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CORE MEASURE 3
Maintain Up-to-Date Problem List
• Provides a fast overview of patient’s history
• Available to all clinical staff
• Increased efficiency
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CORE MEASURE 5
Maintain an Active Medication List
• Streamline visit
• More accessible
• Increases communication with patients
• Helps transform and maintain culture of patient-centered care
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CORE MEASURE 6
Maintain Active Medication Allergy List
• Easy review
• Reduce occurrence of adverse reactions
• Safe patient care
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QUESTIONS?
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Workflow
PHYSICIAN/CLINICIAN 2
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CORE MEASURE 3
Maintain Up-to-Date Problem List
• Provides a fast overview of patient’s history
• Available to all clinical staff
• Increased efficiency
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MENU MEASURE 7
Perform Medication Reconciliation
• Important for patient safety
• Reduces medication errors common among patients who use
multiple pharmacies, providers, and have co-morbidity factors
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CORE MEASURE 10
Report Ambulatory Clinical Quality Measures (CQM)
• Increases delivery of high-quality care
• Correlates to the future of reimbursement for service and quality
of processes implemented by your office
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CORE MEASURE 10
• Review top 10 visit types by ICD-9 codes
• Check list of CQMs for correlation
• Determine which CQMs you can meet before attestation process
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QUESTIONS?
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Workflow
NURSE/MEDICAL ASSISTANT/
PHYSICIAN ASSISTANT/CLINICIAN 1
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CORE MEASURE 1
Using Computerized Physician Order Entry (CPOE)
• Improves optimal drug selection
• Reduces errors
• Reduces chance of selecting medications to which a patient
is allergic
• Guided dose algorithms
• Information is put into the patient’s medical record and easy
to access
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CORE MEASURE 4
Generate and Transmit Permissible Prescriptions Electronically
• Fast and efficient
• Easy to review on follow-up visits
• Increases patient satisfaction- Quick prescription pick-up
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CORE MEASURES 1 AND 4
• Involve doctors in workflow re-engineering
• Visually map new workflows
• Test workflows
• Have super user on hand
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MENU MEASURE 2
Incorporate Clinical Lab Test Results into EHR as Structured Data
• Easy access and reference
• Increase efficiency
• Helps providers make more informed clinical decisions
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MENU MEASURE 6
Use Certified EHR Technology to Identify Patient-Specific Education
Resources and Provide to the Patient
• Helps professionals and patients make better decisions about
their health
• Allows patients to better understand their health
• Leads to informed lifestyle adjustments
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CORE MEASURE 12
Provide Patients with an Electronic Copy of Health Information
Upon Request
• Helps patients and caregivers become more engaged with
healthcare
• Ability to take medical record to new provider
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CORE MEASURE 13
Provide Clinical Summary for Each Visit
• Better communication around pertinent medical information
• Increased coordination of care
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CORE MEASURE 13
• Send clinical summaries through Intergy Practice Portal
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MENU MEASURE 8
Provide Summary of Care Record for Each Transition of Care of
Referral
• Provides essential clinical information for receiving care team
• Helps organize final clinical and administrative activities for the
transferring care team
• Helps ensure the coordination and continuity of health care as
patients transfer
• Improves communication during transfers and discharges
• Improves care quality and safety
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QUESTIONS?
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15 MINUTE BREAK
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Workflow
BACK OFFICE
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MENU MEASURE 3
Generate Lists of Patients by Specific Conditions
• Contribute to public health initiatives for quality improvement,
reduction of disparities, research, and outreach
• Influence health policy
• Helps analyze most common conditions you treat
• Focus continuing education
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REPORTING FOR MEANINGFUL USE
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VITERA PRACTICE ANALYTICS
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QUESTIONS?
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Subtitle Section
VERSION 9 CHANGES
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NEW CLINICAL SUMMARY WORKFLOW
● 2014 rules require
clinical summaries
for patients using
the CCDA
technology.
● New option on
summary page to
“Print Clinical
Summary”
● If patient is
registered for
secure messaging,
“Send” option
displays
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PATIENT EDUCATION OPTIONS
● Right click on Meds, Problems and Labs for Patient Education
● Uses NIH’s Medline Plus as default website
● When use this option, counts towards MU numerator
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PROBLEM BASED CARE PLAN
• New tab in
problems page
to enter Care
Plan information
• Full history is
saved when
changed
• Can cite care
plans into the
Note
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IMMUNIZATION ENHANCEMENTS
• VIS (Vaccine
Information
Statements)
Recording
• Indicate Patient
is immune to
a Vaccine
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MEDICATION RECONCILIATION
• Can now mark Medications as reconciled from Meds tab
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PRACTICE PORTAL REPORT
• New Report to let you manage Patients who are/are not on the Practice Portal
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MEANINGFUL USE AUDITS
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MEANINGFUL USE AUDITS
• 1 in 10 eligible professionals
can expect to face an audit
• Audits have been conducted
since October 2012
• CMS has contracted with
Figliozzi & Company to be
their auditors
• States, and their contractors,
will perform audits on
Medicaid providers
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BE PREPARED FOR A SUCCESSFUL AUDIT
• Put someone in charge
• Conduct a data security risk
assessment
• Follow the list of documentation
you should save:
- List in your Booklet
• Save all documentation for 6
years post attestation
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WHAT TO EXPECT
If you are selected for an audit
• Receive a letter from the
Auditor
• Asked for your supporting
documents
• Respond immediately:
- Healthcare providers will
have two weeks to produce
necessary documentation
- The bonus will be held until
the EP passes the audit
review
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AUDIT DEFENSE STRATEGY
Preview your attestations for these red flags
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AUDIT DEFENSE STRATEGY
• Unique Patient Denominator Inconsistencies
- Four discrete measures require “all unique patients whose records are
maintained in EHR technology”
- Make sure that all 4 show the same value: Vitals, CPOE, Smoking Status and
Patient Reminders
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AUDIT DEFENSE STRATEGY
• Subsets of “Unique Patient Denominator”
- Some measures are calculated on “unique patients” who have a particular
condition
- Make sure that these denominators are not greater than the sum of
“unique patients”
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AUDIT DEFENSE STRATEGY
• Measures counting patients maintained outside the Certified EHR
- Some measures count patients not maintained within your EHR
- A red flag would be one of these measures containing denominator values
less than denominators in similar measures requiring only patients whose
records are maintained inside the EHR.
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AUDIT DEFENSE STRATEGY
• Measures counting patients maintained within your EHR
- CMS reviews submissions against documented patient counts
- An auditor may evaluate total discharges / patient counts from billing data,
and compare it against submitted Meaningful Use Measures
- A red flag may be submitted MU denominators that differ significantly from
cost-report derived data
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AUDIT DEFENSE STRATEGY
• Exemptions inconsistent with provider type and location
- If you have claimed exemption from a given measure, CMS may evaluate
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VITERA INTERGY PRACTICE PORTAL
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WHAT IS THE VITERA INTERGY PRACTICE PORTAL?
Secure
patient
portal
Communicate
with
colleagues
Convenient
services for
patients
Customizable
web presence
Vitera
Intergy
Practice
Portal
Easy way to
engage
patients
Helps
reduce costs
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VITERA INTERGY PRACTICE PORTAL
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WHY IS IT IMPORTANT?
• Key requirement for Meaningful Use attestation
• Increased communication between patients and providers is key
to improving health
• Increased patient satisfaction
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MEANINGFUL USE
Stage 1 Meaningful Use requirements that can be met with Intergy Practice Portal:
Core measure 12:
Providing patients
with an electronic
copy of their health
information, upon
request
Core measure 13:
Providing clinical
summaries for
patients for each
office visit
Menu measure 8:
Providing a
summary of care
record for
transitions of care
Menu measure 4:
Sending reminders
to patients per
patient preference
for
preventative/follow
-up care
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MEANINGFUL USE
Stage 2 Meaningful Use requirements that can be met with Intergy Practice Portal:
Core measure 7:
Providing patients
the ability to view
online, download
and transmit their
health information
Core measure 8:
Providing clinical
summaries for
patients for each
office visit
Core measure 15:
Providing summary
of care record for
each transition of
care or referral
Core measure 17:
Use secure
electronic
messaging to
communicate with
patients on relevant
health information
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FEATURES
My Medical Summary
Contact the Practice
Statement and Billing
Patient Forms
Send a File
Update your Information
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MY MEDICAL SUMMARY
•
•
•
•
•
•
•
•
•
Personal Information
Medications
Pharmacies
Allergies
Immunizations
Lab Results
Health Conditions
Contacts
Insurance
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CONTACT THE PRACTICE
• Patients can contact your practice to:
–
–
–
–
–
Contact their physician
Request an appointment
Request a prescription refill
Request a referral
Obtain an appointment summary
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STATEMENT AND BILLING
• Patients can:
– View and pay account statement
– Ask questions regarding billing
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PATIENT FORMS
• New Patient Form
• Pre-Visit Medical History Questionnaire
• Followup Visit Form
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SEND A FILE
• Patients can:
– Download electronic file to flash drive or CD to share with other
providers
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UPDATE YOUR INFORMATION
• Patients can:
– Update their personal information
– Update their portal account
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VITERA INTERGY PRACTICE PORTAL V8.10
• New features include:
- Family Account Management
- Patient Roles
- Themes
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FAMILY ACCOUNT MANAGEMENT
• Enables users to access another user’s health care information and act on
behalf of that user
2 ways to gain access:
-
Practice administrator links accounts
User links accounts using PIN number
• Automated emancipation of minors
• Parent/guardian does not need to be a patient at the practice
• Patient does not need an individual account on Practice Portal
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PATIENT ROLES
• Groups of patients can have access to custom content
• Practice assigned
• Patients can self-select into groups
• Examples:
-
Spanish content
Diabetic information
Hypertension information
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THEMES
• You can choose the colors and themes to shape your
patient experience
• Version 8.10 uses jQuery interface to create themes-easy to
find online
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INTERGY PRACTICE PORTAL TIPS
AND TRICKS
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TIPS AND TRICKS
Sign referring doctors up as users on your portal
• In order to more easily transfer CCDs to other doctors, you should
sign them up for your portal
• Send CCDs to these doctors through the secure messaging feature
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MARKETING YOUR PORTAL
• Provide information on how to access and use portals through the
use of brochures and posters in office
• Send appointment emails alerting patients that information about
their visits are online
• If you use reminder cards, add instructions for the patient to
register for the portal.
Add Portal
Instructions Here
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MARKETING YOUR PORTAL
• Provide tools in waiting areas for patients to sign up while they
wait
• Promote through your social media channels - Facebook, Twitter,
blog.
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MARKETING YOUR PORTAL
• Statements or newsletters can be used to promote the portal
• Email patients with your link to register
• Use your on-hold time when on the phone for patients to hear
announcements on how to register for the portal
Add Portal Info
Here
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MARKETING YOUR PORTAL
• QR Code-Make posters with QR codes that link to your portal.
Smartphones have QR code apps that will read the code and take
patient portal the-qrcode-generator.com
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SIGN-UP DURING PATIENT VISIT
Retina Institute of Texas
• Add portal sign-up to visit workflow
– Print out client letters at the beginning of the day based on date
– Intergy Desktop -> Letters/Labels -> Patient Portal Letter
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SIGN-UP DURING PATIENT VISIT
• Edit the letter to have a place to write the patient login information
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SIGN-UP DURING PATIENT VISIT
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SIGN-UP DURING PATIENT VISIT
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SIGN-UP DURING PATIENT VISIT
• Set up sticky notes in EHR with quick-text to indicate where the patient is
“Registered for portal”, “Patient declined”, or “Patient will register at home”
• Every patient is asked during their appointment to register if they haven’t yet
Important notes:
Do not pre-register patients with
“dummy” login information
Do not scan paperwork into the
chart
• The first clinician to see the patient should register the patient, or patient can
use computer in the exam room to register themselves
• Write login information on patient letter and give to patient
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QUESTIONS?
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TODAY’S TAKEAWAYS
• Meaningful Use Overview
• Meaningful Use Core and Menu Measures Workflow
– Office Manager
– Front Desk
– Clinician 1
– Clinician 2
– Clinician 1
– Back Office
• Meaningful Use Reporting
• Audits
• Practice Portal
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Thank you for attending!
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CONFIDENTIALITY AND LEGAL NOTICES
• This presentation (including related documents) and the information it
contains are the confidential information of Vitera Healthcare Solutions, LLC
(referred to hereinafter sometimes as “Vitera”). Neither this document nor
the information it contains may be disclosed to any third party or reproduced,
in whole or in part, without the express prior written consent of Vitera
Healthcare Solutions, LLC.
• © 2013 Vitera Healthcare Solutions, LLC. All rights reserved. Vitera and Vitera
logos are registered trademarks or trademarks of Vitera Healthcare Solutions,
LLC or its affiliated entities. All other trademarks are the property of their
respective owners.
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