A preparation guide for hospitals using the MEDITECH EHR and ARRA Meaningful Use Stage 2.

1. By Bill Presley
September 27, 2013
Transforming Data to Knowledge…
Preparing for Meaningful Use Stage 2

3. Significant Accomplishment for
Acmeware
Total Certified EHR Vendors
2011
Edition
2014
Edition
http://www.ihealthbeat.org/articles/2013/9/26/fewer-stage-2-certified-ehr-systems-could-pose-problems

4. OneView 2014 Edition Transition
 Customer wants to know what the
transition will be for the 2014 Edition?
 OneView will need to be upgraded to 4.0 2014
Edition including changes for Core, Menu set and
Clinical Quality measures. We are developing a
2014 Edition implementation project plan which
will be available in October.

5. Agenda
 Attestation Process for a Hospital
 Attestation Process in OneView
 Meaningful Use 2014 Edition
 Stage 1 and Stage 2

6. Hospital Attestation Process
 A successful and active Registration in the
CMS website. https://ehrincentives.cms.gov
 Completed the appropriate reporting period
and met measures
 Obtain EHR Certification Identification
Number
 Attest online!

7. Registration and Attestation
System
• Registration User Guide
• Step-by-Step guide for EH's.
https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/dow
nloads/EHRHospital_RegistrationUserGuide.pdf

8. Registration and Attestation
System
• Attestation User Guide
• Step-by-Step guide for EH's.
https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/do
wnloads/HospAttestationUserGuide.pdf

9. Registration and Attestation
System
• Timelines
http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downl
oads/HIT-Programs-Timeline-2012-.pdf

10. EHR Certification Identification
Number
CMS EHR Certification Identification
Number is a number generated by the
Certified Health IT Product List (CHPL)
used for reporting to CMS for
Meaningful Use attestation.
It represents a product or combination
of products in the CHPL.

11. EHR Certification Identification
Number (Cont.)
 Warning!!! Do not use the vendor product
certification number.

12. EHR Certification Identification
Number (Cont.)
 Each Hospital must obtain their your own
unique CMS HER Certification ID from the
Certified Health IT Product List website
cart.

13. Steps to obtaining CMS EHR
Certification ID Number
• Visit Certified Health IT Product List website
at http://oncchpl.force.com/ehrcert.
• Select which edition of ONC HIT EHR
Certification are you attesting?
• Select the practice type by selecting the
Ambulatory or Inpatient buttons.

14. Steps to obtaining CMS EHR
Certification ID Number (Cont.)
• Search for the Certified EHR Products being used.
There is the option of browsing all products,
searching by product name, number, vendor, or
searching by criteria met.

15. Steps to obtaining CMS EHR
Certification ID Number (Cont.)
• Add product(s) to the cart to determine if your
product(s) meet 100% of the required criteria.

16. Steps to obtaining CMS EHR
Certification ID Number (Cont.)
• Request a CMS EHR Certification ID for CMS
registration or attestation from your cart page

17. Attestation Process with OneView
 SQL Server Agent Job Disabled
 Hospital Settings Updated
 Attestation Locked
 Alerts & Subscription Disabled
 Audit Preparation with Supporting
Documentation

18. SQL Server Agent Job Disabled
 Disable job once Medical Records
has completed coding and
abstracting for the reporting period
and hospital is ready to attest.

19. Hospital Settings
 Hospital settings should be updated to include
information for current reporting period

20. Attestation Locked
 Start an Attestation under the
Attestation section
 Select appropriate reporting period
 Everything should have green
checks
 Lock it when hospital is ready to
attest

21. Attestation Locked
 View Attestation Data Report

22. Alerts & Subscription Disabled
 Delete all alerts and subscriptions

23. Audit Preparation with Supporting
Documentation
 Relevant supporting documentation
associated with a CQM, CM, or MSM
Measure
 MEDITECH screenshots
 Payment calculations
 ONC EHR licensing documentation
 OneView Invoices

24. Meaningful Use 2014 Edition -
Stage 1 and Stage 2
Other Resources
 Glen’s MUSE International 2013 a presentation EHR
Meaningful Use 2014 (Stage 2)
http://www.acmeware.com/downloads/EH
R%20Meaningful%20Use%202014%20(St
age%202)%20DR%20Reporting%20Strate
gies.pdf

25. Meaningful Use 2014 Edition -
Stage 1 and Stage 2
EP, EH, CAH - What do they mean?
 EP - Eligible Provider
 Ambulatory/Clinic Typically Office Visit
 Using Systems like AthenaHealth, eClinicalWorks,
LSS
 EH/CAH - Eligible Hospital/Critical Access Hospital
 Inpatient and ED depending on method
 2 Methods for ED
 Observation Services method
 All ED Visits method
 https://questions.cms.gov/faq.php?id=5005&faqId=2843
 http://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNProducts/downloads/critaccesshospfctsht.pdf

26. Stages of Meaningful Use
 Editions not Stages
 Do not confuse 2014 Edition with
Stage 2
http://www.healthit.gov/policy-researchers-implementers/meaningful-
use-stage-2

27. Stages of Meaningful Use

28. Stages of Meaningful Use

29. Stages of Meaningful Use

30. 2014 Edition Stage 1 & Stage 2
All EH/CAH’s need to upgrade to 2014 Edition
certified EHR technology in 2014
 Regardless of the meaningful use stage
 Requirements that update the baselines for
interoperability, health information
exchange (HIE), and patient engagement.
 IMPORTANT!
 2011 Edition will no longer be acceptable as
"Certified EHR Technology” and regulatory
officials perspective 2011 Edition certifications
will expire the start of 2014 MU reporting period.

31. 2014 Edition Stage 1 & Stage 2
 2014 Meaningful Use reporting period
 If first year was 2013 Stage 1 90 days, then 2014 will be
Stage 1 90 days.
 The 2014 MU reporting period for both Stage 1 and
Stage 2 is set to one calendar quarter during a
Medicare EH/CAH reporting year.
 (e.g., April 1, 2014 through June 30, 2014 would be a
Medicare EH/CAH 3rd quarter)

32. 2014 Edition Stage 1
Meaningful Use 2014 Edition starts a
beginning of a reorganized Stage 1
• Some Core and Menu removed/combined
• No Longer Count Measure Exclusions
• Stage 1 Thresholds Increases
• View, Download, Transmit to 3rd Party
more then 50% of unique patients

33. 2014 Edition Stage 1
 Changes between 2011 Stage 1 and 2013
Stage 1
 Stage 1 Changes Tip sheet
http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads
/Stage1ChangesTipsheet.pdf

34. 2014 Edition Stage 2
• New Objectives & Measures
• Core Measures
• eMAR
• View Online, Download and Transmit
• Menu Set Measures
• Record electronic notes in patient records
• Imaging results accessible
• Record patient family health history
• Generate and transmit permissible discharge
prescriptions electronically (eRx)
• Provide structured electronic lab results to ambulatory
providers

35. 2014 Edition Stage 2
Clinical Quality Measures for 2014
 Select CQMs from 3 of these 6 domain
 16 out of 29 total CQMs
 CQM's must be submitted electronically to CMS
 HL7 QRDA (Quality Reporting Document
Architecture) has been approved as a
standard for clinical data exchange for
Quality Measures
 CMS approved standardized Nomenclature

36. Clinical Quality Measures for 2014
• Introduction of universal identifier, eMeasure ID
NQF# (VTE-1 = 0371)
• How will standardized nomenclature based code
system work?
• Using Quality Data Model (QDM) with HL7 QRDA
(Quality Reporting Document Architecture)

37. Venous Thromboembolism
Prophylaxis NQF#: 0371
Description:
This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE
prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day
of or the day after hospital admission.
Data criteria (QDM Data Elements):
"Medication, Administered: Warfarin" using "Warfarin RxNorm Value Set (2.16.840.1.113883.3.117.1.7.1.232)“
"Medication, Administered: Direct Thrombin Inhibitor" using "Direct Thrombin Inhibitor RxNorm Value Set
(2.16.840.1.113883.3.117.1.7.1.205)"
"Medication, Administered: Injectable Factor Xa Inhibitor" using "Injectable Factor Xa Inhibitor RxNorm Value Set
(2.16.840.1.113883.3.117.1.7.1.211)"
"Medication, Administered: Low Molecular Weight Heparin" using "Low Molecular Weight Heparin RxNorm Value Set
(2.16.840.1.113883.3.117.1.7.1.219)"
"Medication, Administered: Oral Factor Xa Inhibitor" using "Oral Factor Xa Inhibitor RxNorm Value Set
(2.16.840.1.113883.3.117.1.7.1.134)"
"Medication, Administered: Unfractionated Heparin" using "Unfractionated Heparin RxNorm Value Set
(2.16.840.1.113883.3.117.1.7.1.218)"

38. Venous Thromboembolism
Prophylaxis - NQF#: 0371
Data criteria (QDM Data Elements):
"Medication, Administered: Warfarin" using "Warfarin RxNorm Value Set (2.16.840.1.113883.3.117.1.7.1.232)“
Value Set Table:

39. Venous Thromboembolism
Prophylaxis - NQF#: 0371
Data criteria (QDM Data Elements):
"Medication, Administered: Warfarin" using "Warfarin RxNorm Value Set (2.16.840.1.113883.3.117.1.7.1.232)“
"Medication, Administered: Direct Thrombin Inhibitor" using "Direct Thrombin Inhibitor RxNorm Value Set
(2.16.840.1.113883.3.117.1.7.1.205)"
"Medication, Administered: Injectable Factor Xa Inhibitor" using "Injectable Factor Xa Inhibitor RxNorm Value Set
(2.16.840.1.113883.3.117.1.7.1.211)"
"Medication, Administered: Low Molecular Weight Heparin" using "Low Molecular Weight Heparin RxNorm Value Set
(2.16.840.1.113883.3.117.1.7.1.219)"
"Medication, Administered: Oral Factor Xa Inhibitor" using "Oral Factor Xa Inhibitor RxNorm Value Set
(2.16.840.1.113883.3.117.1.7.1.134)"
"Medication, Administered: Unfractionated Heparin" using "Unfractionated Heparin RxNorm Value Set
(2.16.840.1.113883.3.117.1.7.1.218)"

40. Venous Thromboembolism
Prophylaxis - NQF#: 0371
Data criteria (QDM Data Elements):
"Medication, Administered: Warfarin" using "Warfarin RxNorm Value Set (2.16.840.1.113883.3.117.1.7.1.232)“
Value Set Table:
This shows a value set for a class of medications (Warfarin)

41. Venous Thromboembolism
Prophylaxis - NQF#: 0371
HL7 QRDA (XML File) Snippet for Patient Visit that meets NQF#: 0371

42. Electronic Transmission to CMS for
Quality Measures Reporting

43. Meaningful Use 2014 Edition
Why does 2014 Edition matter?
Don't get caught up in the incentive payments
• 2014 MU determines Medicare payment
adjustments.
http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipsheetforHospitals.pdf

44. Discussion, Questions & Answers