Does this describe you? ·You are constantly challenged to stay abreast of the latest information on EHR integration and HIE interoperability, Meaningful Use stages, the Direct Project, clinician and patient portals, just to name a few. ·You walk a fine line between adopting health information technology for the good it can bring patient outcomes…….and for the good incentive dollars it can mean to your organization. ·You play a key role in ensuring your organization can attest for meaningful use. Join Andy Nieto, Health IT Strategist at DataMotion where he’ll explain the key role that interoperability plays in Meaningful Use Stage 2 attestation including: - What does interoperability really mean - Why you can’t ignore interoperability - How to achieve interoperability and make it meaningful - What you need in order to attest

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2. What You Need to Know About Meaningful Use 2
and Interoperability
Andy Nieto, Health IT Strategist, DataMotion

3. “There are risks and costs to a program of action, but
they are far less than the long-range risks and costs of
comfortable inaction”
- President John F. Kennedy

4. Agenda
■ A little history
■ Meaningful Use (MU)
■ Stage 2 and interoperability
■ Going beyond core measures
4

5. Evolution of healthcare IT
5
1972 First
EHR
Introduced
1996 HIPAA
2001 EHR system
usage at 18%
2003 HIPAA
Security
Rule
Feb 2009
HITECH -
ARRA
2013 Meaningful
Use 2 Rules
included Direct
2011 Meaningful
Use Stage 1
attestation begins
Jan 2013 Final
HIPAA Omnibus
ruling
2014 attestation for
Meaningful Use 2
begins
1971 first
email sent

6. What is interoperability
“In healthcare, interoperability is the ability of
different information technology systems and
software applications to communicate, exchange
data, and use the information that has been
exchanged.”
- 2013 HIMSS Board
6

7. HITECH - the approach
Stage 1
20132011 2015
Stage 2
Stage 3
Stage 1
Data capture
and sharing
Stage 2
Advanced
clinical
processes
Stage 3
Improved
outcomes

8. The college analogy
■ Application = pick an EHR
■ First year = MU1
» 1 down, I’m broke
■ Second year / pick a major = MU2
» Where am I going?
■ Graduate = MU3
» Ok, this works… I think
» Yeah, I’m in my career; on my way
» I have a degree in WHAT???? How do I make money
8

9. Show me the money
Starting
Year ($$
$)
2011 2012 2013 2014 2015 2016
2011
($43,720)
1 1 1 2 2 3
2012
($43,480)
1 1 2 2 3
2013
($38,220)
1 1 2 2
2014
($23,520)
1 1 2
9
For eligible providers

10. Meaningful Use Stage 1
■ Install and use an EHR
■ Collect discrete data
■ 13 Core Measures
■ 5 Menu Measures
10

11. Meaningful Use 1
Discreet data
11

12. Meaningful Use Stage 2
■ Collect discrete data – even more
■ Exchange more data
■ Engage others
■ 17 Core Measures
■ 3 Menu Measures
12

13. Meaningful Use 2
Integrate, interoperate, engage
13

14. Advancing clinical process
■ More rigorous information exchange
■ More “e”
» e-prescribe
» Integration of labs
» Transition of Care events
■ Engage patients
14

15. Do I have to upgrade my EHR?
■ Yes! Must be 2014 ONC certified.
15

16. 17 Core Measures
1. Use computerized provider order entry
(CPOE) for medication, laboratory and
radiology orders
2. Generate and transmit permissible
prescriptions electronically (eRx)
3. Record demographic information
4. Record and chart changes in vital signs
5. Record smoking status for patients 13 years
old or older
6. Use clinical decision support to improve
performance on high-priority health
conditions
7. Provide patients the ability to view online,
download and transmit their health
information
8. Provide clinical summaries for patients for
each office visit
9. Protect electronic health information created
or maintained by Certified EHR Technology
10. Incorporate clinical lab-test results into
Certified EHR Technology
11. Generate lists of patients by specific
conditions to use for quality improvement,
reduction of disparities, research, or
outreach
12. Use clinically relevant information to identify
patients who should receive reminders for
preventive/follow-up care
13. Use Certified EHR Technology to identify
patient-specific education resources
14. Perform medication reconciliation
15. Provide summary of care record for each
transition of care or referral
16. Submit electronic data to immunization
registries
17. Use secure electronic messaging to
communicate with patients on relevant
health information
16

17. 17 Core Measures - interoperability
1. Use computerized provider order entry
(CPOE) for medication, laboratory and
radiology orders
2. Generate and transmit permissible
prescriptions electronically (eRx)
3. Record demographic information
4. Record and chart changes in vital signs
5. Record smoking status for patients 13 years
old or older
6. Use clinical decision support to improve
performance on high-priority health
conditions
7. Provide patients the ability to view online,
download and transmit their health
information
8. Provide clinical summaries for patients for
each office visit
9. Protect electronic health information created
or maintained by Certified EHR Technology
10. Incorporate clinical lab-test results into
Certified EHR Technology
11. Generate lists of patients by specific
conditions to use for quality improvement,
reduction of disparities, research, or
outreach
12. Use clinically relevant information to identify
patients who should receive reminders for
preventive/follow-up care
13. Use Certified EHR Technology to identify
patient-specific education resources
14. Perform medication reconciliation
15. Provide summary of care record for each
transition of care or referral
16. Submit electronic data to immunization
registries
17. Use secure electronic messaging to
communicate with patients on relevant
health information
17

18. 6 Menu Objectives
1. Submit electronic syndromic surveillance data to
public health agencies
2. Record electronic notes in patient records
3. Imaging results accessible through CEHRT
4. Record patient family health history
5. Report cancer cases to a public health central
cancer registry
6. Report specific cases to a specialized registry
Important Note: While there are exclusions provided for some of these menu objectives,
you cannot select a menu objective and claim the exclusion if there are other menu
objectives that you could report on instead.
18

19. 6 Menu Objectives - interoperability
1. Submit electronic syndromic surveillance data to
public health agencies
2. Record electronic notes in patient records
3. Imaging results accessible through CEHRT
4. Record patient family health history
5. Report cancer cases to a public health central
cancer registry
6. Report specific cases to a specialized registry
Important Note: While there are exclusions provided for some of these menu objectives,
you cannot select a menu objective and claim the exclusion if there are other menu
objectives that you could report on instead.
19

20. CQM – Clinical Quality Measures
Must pick 9 of the 64 approved CQMs
There are 6 domains for CQS based upon the
National Quality Strategy
» Patient and Family Engagement
» Patient Safety
» Care Coordination
» Population and Public Health
» Efficient Use of Health Care Resources
» Clinical Processes/Effectiveness
20

21. Interoperability
21
Meaningful Use:
EHR to EHR
Goal:
ü Measureable
exchange of
health data
Clinician:
Referral
Consult
Orders and
results
Goal:
ü Greater
awareness of
patient status
ü Improved care
Patient:
“My doctors talk
to each other
and know what
is going on.”
Goal:
ü Feel better with
simpler care

22. The building blocks of interoperability
■ Information exchange is not “one size fits all”
The components:
22
Data
Structure
(content)
Delivery
Tool (DSM,
XDR,
Interface)
Delivery
Structure
(envelope
or form)

23. Data Structure (content)
■ Health Language 7
■ Code Sets
» LOINC
» ICD
» CPT
» SNOMED
» DRG
» HCPDP
» RxNorm
» DSM
23

24. Delivery Structure (envelope or form)
■ CCDA
■ HL7
■ HCFA
24

25. Delivery Tool (DSM, XDR, Interface)
25

26. What needs to be standardized?
» Vocabulary
» Structure (HL7)
» Transport with secure email protocols
» Adoption of NIST security encryption
» Services using open application programing
interfaces (APIs)
26

27. HIPAA Implications
■ Privacy rule
» Who gets access to the data?
■ Security rule
» How is the data protected?
■ Breach notification
■ Business associates
27

28. Becoming a Meaningful User
■ Re-engineer office processes
» When do you fax and why? Can this be automated?
» What is the “busy work” in the office?
■ Integrate external connections
» Labs, CPOE, Immunization registry, Public Health
registry, HIE, RHIE
■ Set “patient care” goals that align with the
Meaningful Use criteria
28

29. Thanks!
Andy Nieto
andyn@datamotion.com
29

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