6. CEHRT & MU Relationship
Meaningful Use Stage 2 (MU2)
CMS: Medicare and Medicaid EHR Incentive Programs Stage 2
• outlines incentive payments (+$$$) for early adoption
• outlines payment adjustments(‐$$$) for late adoption/non‐compliance
Reference: CMS Medicare and Medicaid Programs; Electronic Health Record Incentive
Program – Stage 2 Final Rule 495.6
ONC: Standards, Implementation Specifications & Certification Criteria
(SI&CC) 2014 Edition
• Specifies the data and standards requirements for certified electronic health
record (EHR) technology (CEHRT) needed to achieve “meaningful use”
Reference: ONC Health Information Technology : Standards, Implementation Specifications,
and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to
the Permanent Certification Program for Health Information Technology 170.314(b)(1)&(2)
7. CEHRT & MU Relationship
Care Coordination / Transitions
Meaningful Use Stage 2 (MU2) – Care Coordination
CMS: Medicare and Medicaid EHR Incentive Programs Stage 2
• Measure #2 : Provide an electronic ‘‘summary of care record for more than 10
percent of such transitions and referrals” using one of the accepted transport
mechanisms specified in the rule.
Reference: CMS Medicare and Medicaid Programs; Electronic Health Record Incentive
Program – Stage 2 Final Rule 495.6
ONC: Standards, Implementation Specifications & Certification Criteria
(SI&CC) 2014 Edition
• Electronically receive and incorporate a transition of care/referral summary
Electronically create and transmit a transition of care/referral summary
Reference: ONC Health Information Technology : Standards, Implementation Specifications,
and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to
the Permanent Certification Program for Health Information Technology 170.314(b)(1)&(2)
10. Transitions of Care Measure 1
Measure 1
The EP, EH, or CAH that transitions or
refers their patient to another setting of
care or provider of care provides a
summary of care record for more
than 50 percent of transitions of care
and referrals.
11. Transitions of Care Measure 1
Transitions of Care Measure 2
Measure 2
The EP, EH, or CAH that transitions or
refers their patient to another setting of
care or provider of care provides a
summary of care record for more than 10
percent of such transitions and referrals
either:
• Electronically transmitted using
CEHRT to a recipient OR
• Where the recipient receives the
summary of care record via exchange
facilitated by an organization that is a
Nationwide Health Information
Network (NwHIN) Exchange
participant or in a manner that is
consistent with the governance
mechanism ONC establishes
12. Transitions of Care Measure 1
Transitions of Care Measure 2
Transitions of Care Measure 3
Measure 3
An EP, EH, or CAH must satisfy one of
the following:
• Conducts one or more successful
electronic exchanges of a summary of
care record meeting the measure
specified in Requirement 2 of this
section with a recipient using
technology to receive the summary of
care record that was designed by a
different EHR developer than the
sender's CEHRT certified OR
• Conducts one or more successful
tests with the CMS designated test
EHR during the EHR reporting period
13. Transitions of Care – EPs Transitions of Care – EH/CAHs
Patient name Patient name
Sex Sex
Date of birth Date of birth
Race (OMB Race and Ethnicity) Race (OMB Race and Ethnicity)
Ethnicity (OMB Race and Ethnicity) Ethnicity (OMB Race and Ethnicity)
Preferred language Preferred language
Smoking status (SNOMED‐CT value set) Smoking status (SNOMED‐CT value set)
Problems (SNOMED‐CT value set) Problems (SNOMED‐CT value set)
Medications (RxNorm) Medications (RxNorm)
Medication allergies (RxNorm) Medication allergies (RxNorm)
Laboratory test(s) (LOINC) Laboratory test(s) (LOINC)
Laboratory value(s)/result(s) Laboratory value(s)/result(s)
Vital signs (height, weight, blood pressure, BMI) Vital signs (height, weight, blood pressure, BMI)
Care plan field(s), including goals and instructions Care plan field(s), including goals and instructions
Procedures (SNOMED‐CT or HCPCS/CPT‐4), optional CDT, optional ICD‐10‐PCS Procedures (SNOMED‐CT or HCPCS/CPT‐4), optional CDT, optional ICD‐10‐PCS
Care Team Member(s), including the primary care provider of record and any
additional known care team members beyond the referring or transitioning provider
and the receiving provider
Care Team Member(s), including the primary care provider of record and any
additional known care team members beyond the referring or transitioning provide
and the receiving provider
Encounter diagnosis (ICD‐10‐CM or SNOMED‐CT) Encounter diagnosis (ICD‐10‐CM or SNOMED‐CT)
Immunizations (HL7 Standard Code Set CVX) Immunizations (HL7 Standard Code Set CVX)
Functional status, including activities of daily living and cognitive and disability
status
Functional status, including activities of daily living and cognitive and disability
status
The following are Elements that are different between EP and EH/CAH
Reason for referral
Discharge instructions
Referring or transitioning provider's name and office contact information
Common MU Data Set
Data Elements in Common Between EP and EH/CAH in Addition to Common
MU Data Set
Elements that are different between EP and EH/CAH
All summary of care documents
must include these data elements
14. MU Stage 2 Medication
Reconciliation Core Objective
Objective:
• The EP, EH, or CAH who
receives a patient from
another setting of care or
provider of care or
believes an encounter is
relevant should perform
medication reconciliation.
Measures:
• The EP who performs
medication reconciliation for
more than 50 percent of
transitions of care in which
the patient is transitioned
into the care of the EP.
• The eligible hospital or CAH
performs medication
reconciliation for more than
50 percent of transitions of
care in which the patient is
transitioned into the care of
the EP or admitted to the
eligible hospital's or CAH's
inpatient or emergency
department.
16. Federal Government Initiatives
Graphic: The Value Proposition for
Exchange; Doug Fridsma, July 2011
• Federal Advisory Committees (FACAs)
– HIT Policy Committee, Standards
• Nationwide Health Information
Network (NwHIN)
– Services, standards, policies, trust fabric
This image cannot currently be displayed.
17. Direct Project Facilitates Meaningful Use
• Other Providers/Authorized Entities:
– Clinical information
– Labs – test results
– Referrals – summary of care record
• Patients:
– Health information
– Discharge instructions
– Clinical Summaries
– Reminders
• Public Health:
– Immunization registries
– Syndromic surveillance
b.wells@direct.mclinic.org
Direct Project facilitates the communication of many different kinds of content
necessary to fulfill meaningful use requirements.
Examples of Meaningful Use ContentExamples of Meaningful Use Content
D I R E C T
18. CCSNPC Technology Partner
1993 1999 2006
20 Years 14 Years 7 Years
• Standards‐based
Solutions for Health
Information Exchange
• Commercial Software
and Support
• Open Architecture
• User Extensible
• Application and Data
Integration Experts
Software
Development
Software
Development
Healthcare
Focus
Healthcare
Focus
Mirth
Products
20. Mirth at ChathamHealthLink
• Healthcare Data
Repository
• Provider Portal
• Available XDS.b Plugin
• CCD and
Consolidated CDA
• Agents – Data Detectors
and Subject Groups
• Scheduled Reports
• Central and Federated
Deployment
• Standards‐based
Integration with NextGate
MatchMetrix EMPI and
GeorgiaDirect HISP
Mirth Appliance
Ready‐to‐Run Platform
for Mirth Applications
HL7, DICOM, X12, CCD, C‐CDA,
and EHR Integration
Mirth
Connect
Mirth
Results
eHealth and
IHE Exchange
22. Value Proposition for HIE
• Provide better, safer and more efficient
patient care
• Distribute hospital information to doctors
• Savings on uncompensated care related to
unnecessary or avoidable services
• Provides outreach to community partners
• Helps maintain referral patterns
• Improved care coordination
• Aligns with shifting reimbursement models
