The document discusses laws and initiatives aimed at improving healthcare quality in the United States. It notes that Congress passed several laws establishing new quality programs in response to consensus around the importance of quality improvement. Key laws and initiatives discussed include the Medicare Prescription Drug, Improvement and Modernization Act of 2002, the Affordable Care Act of 2010, and the establishment of the Center for Medicare and Medicaid Innovation in 2011 to develop and test new payment models. The document also discusses the development and goals of value-based purchasing programs and accountable care organizations.

1. Brian Ahier
Health Data Management Webinar
Ocotber 8, 2013

2. But we can
figure this
thing out!

3. Laws Affecting Quality Improvement
As consensus was reached around the importance of
impro ving quality, Congress passed several important laws
to establish new quality progra ms:
Medicare Prescript io n
Drug, Improvement &
Modernizatio n Act (MMA)
2002
2004
Tax Relief and
Healt h Care Act
(TRHCA)
Medicare Improvements For
Patients & Providers Act
(MIPPA)
2005
Deficit
Reduc t io n
Act (ORA)
Medicare,
American
Recovery &
Reinvestment
Act (ARRA)
Medicaid ,
& SCHIP
Extensio n
Act
(MMSEA)
Mental Healt h Parity and
Addic t io n Equality Act (MHPAEA)
Affordabl e
Care Act
(ACA)

4. Selected Historical Landmarks
in US Healthcare Quality
• 1999: To Err Is Human published by IOM
• 1999: National Quality Forum established
• 2001: Crossing the Quality Chasm published by IOM
• 2005: CMS Quality Roadmap established
• 2005: Petiormance Measurement: Accelerating
Improvement published by IOM
• 2006: Medicare establishes Quality Improvement
Organization Program
• 2008: NQF establishes National Priorities Partnership

5. First IOM Comm ittee Report
To Err is Human: Building a Safer Health
System (1999) begins to define the US quality
problem:
• Medical errors harm 44,500 to 98,000 patients
annually
• Medical errors cost $17 B to $29 B annually
(including the expense of additional care
necessitated by the errors, lost income and
household productivity, and disability)
• Flawed systems, processes, and conditions lead
people to make mistakes or fail to prevent them

6. Defining Quality
The IOM definition of quality becomes the guide
for all national quality efforts:
"Quality care is defined as the degree to which health services
for individuals and populations increase the likelihood of
desired health outcomes and are consistent with current
professional knowledge."
Institute of Medicine (2001)

12. “There is no problem
America has that is so large
we can not invent our way
out of it.”
~Todd Park
“You can always count on
Americans to do the right
thing - after they've tried
everything else.”
~Winston Churchill

13. 




In the U.S. we spend more per capita on healthcare than
any other country in the world
In spite of those expenditures, U.S. healthcare quality is
often inferior to that of other nations and often doesn’t
meet expected evidence-based guidelines
There are significant variations in quality and costs
across the nation with increasing evidence that there
may even be an inverse relationship between the two
Healthcare expenditures account for a larger section of
the U.S. economy over the years and funding those
expenditures is increasingly more difficult
Cost effectiveness analytics is resisted as a tool

14. 
Does your organization have a strategy for
meeting the requirements of “Obamacare?”

15. 
Affordable Care Act signed March 23, 2010

Major components of the law:
 New consumer rights and protections;
 Holding insurance companies accountable;
 Increasing access to affordable care; and
 Improving quality and lowering costs.

Most sections take effect between 2010 and 2015

16. 




Title I: Quality, Affordable Health Care for all
Americans
Title II: Role of Public Programs
Title III: Improving the Quality & Efficiency of
Health Care
Title IV: Prevention of Chronic Disease &
Improving Public Health
TitleV: Health CareWork Force

17. 




TitleVI:Transparency and Public Reporting
TitleVII: Improving Access to Innovative Medical
Therapies
TitleVIII: Community LivingAssistance Services
& Support (CLASS) Act
Title IX: Revenue Provisions
Title X: Strengthening Quality, Affordable
Health Care for All Americans (Amendments)

18. 
Major,Ongoing Demonstration &TestingAuthority & Resources
(CMMI)

AccountableCare Organizations

Value Based Purchasing Programs

Health Insurance Exchanges

Expanded Medicaid Programs

CareTransitions to Reduce Readmissions

ExpandedQuality Reporting Programs

Expanded Preventative Services

….and much more

19. Quadrant 2
High impact priorities to
monitor and maintain
Quadrant 4
Tertiary priorities to
minimize resources
and
conserve focus
Quadrant 1
High impact, high complexity
program areas to
manage
Quadrant 3
Secondary priorities to monitor
and manage

20. Quadrant 2
Quadrant 4
1.
2.
3.
4.
5.
6.
Value Based Purchasing
Public and Quality Reporting
Reduced Readmissions
Hospital AcquiredConditions
ACOs
Center for Medicare and Medicaid
Innovation
Quadrant 3

21. 






Increasing measurement of quality, efficiency & value
Public reporting and sharing of data
Reimbursement linked to quality improvement,
efficient service delivery and cost reduction thru
improvement
Increasing integration of delivery systems and
coordination of care across settings
Greater role in addressing public health issues
Greater use of health information technology
Creation of a learning environment in healthcare

22. 
Affordable Care Act ( 3011) required
Secretary to:
 Set priorities for improving American healthcare; and
 Create a strategic plan for achieving them through
HHS-specific: Plans;
 Goals;
 Benchmarks; and
 Standardized quality metrics.

HHS developed drafts through public processes
that included over 300 groups, organizations, and
individuals. All major healthcare sectors represented.

23. 
Culminated in the “National Strategy for
Quality Improvement in Health Care” (March
2011).

Strategy has six overarching aims, goals and
priorities:
Making care safer;
Ensuring person- and family-centered care;
Promoting better care communication and coordination;
Preventing and treating leading causes of death (including
CVD);
5. Working in communities to promote healthy living; and
6. Making quality care more affordable.
1.
2.
3.
4.

24. 
Affordable Care Act ( 3014) required Secretary
to set up a “pre-rulemaking process” for
selecting quality and efficiency measures by:
 Posting a list of measures under consideration;
 Giving stakeholders a chance to comment on this
list;
 Publishing HHS’ rationale for selecting any
measures not endorsed by the National Quality
Foundation (NQF); and
 Assessing the impact of using NQF-endorsed
measures every 3 years.

25. Quality Measures Life Cycle
Congress
IOM
Professional
Organizations
• Is it
important ?
• Can it be
measured?
• Should it be
measured?
Measure
Developers
Joint Commission
AMA
DHHS
CMS
AHRQ
Measure
Development
• What is the
p o p u latio n ?
• How should it
be reported?
AQA
Pilot Sites
• Can the data be
collected?
• Do th e results
make sense?
• Is informatio n
useful?
NQF
• NQFendorsed?
• Allianceapproved?
Additional Requirements or Issues Identified
PROV IDERS
SUPPLIERS
CO NSUMERS
• Is it
worki n g ?
Evaluation

26. 
366 unique new measures across 23 CMS programs.
 Not all measures will be used right away.
 Not all measures are mandatory (e.g., voluntary reporting
programs).
 Nearly all are supported by or were suggested by external
groups.

Measures now with the NQF MeasureApplication
Partnership (MAP) which:
 Gathers a diverse public-private partnership;
 Gives stakeholders a voice before CMS selects measures
through the rulemaking process;
 Uses the National Quality Strategy as a touchstone; and
 Operates transparently through NQF’s website.

27. Value based purchasing
3001 - Hospital value-based purchasing

3006 -Value-based purchasing for SNF


3014 - Quality and efficiency measurement

10301 - Develop a plan to implementVBP for
ambulatory surgical centers
10326 - Pilot testing for pay-for-performance

Hospital readmissions

3025 - Hospital readmissions reduction program

3026 - Community-based care transitions program
Healthcare acquired conditions

2702 - Payment adjustment for health care-acquired
conditions

3008 - Payment adjustment for conditions acquired
in hospitals
Accountable care organizations

2706 - Pediatric accountable care organization
demonstration project

3022 - Medicare Shared Savings Program
Dual eligibles

2602 - Providing federal coverage and payment
coordination for dual eligible beneficiaries
Preventative services

4103 - Annual wellness visit providing a personalized
plan

4104 - Removing barriers to preventive services

4105 - Evidence-based coverage of preventive
services
Coordination of care
2703 - State option to provide health homes for enrollees

with chronic conditions
2704 - Demonstration project to evaluate integrated care

around a hospitalization
Long term care
2401 - Community first choice option

2402 - Removal of barriers to providing home and

community based services
2403 - Money follows the person rebalancing demo

2404 - Protection for recipients of home and community
based services against spousal impoverishment
10202 - Incentives for states to offer home community based

serviced
Public reporting
10303 - Development of outcome measures

10327 - Improvements to the physician quality reporting

system -- also see Provision 3002
10331 - Public reporting of performance information

Quality reporting initiative
2701 - Adult health quality measures

3002 - Improvements to the physician quality reporting

system.
3004 - Quality Reporting for LongTerm Care Hospitals

(L
TCH), inpatient rehabilitation hospitals, and hospice
programs
3005 - Quality reporting for PPS-exempt cancer hospitals

10322 - Quality reporting for psychiatric hospitals


28. 
Is your organization participating in:
 PQRS
 PCMH
 ACO
 Value Based Purchasing
 None of the above

29. Although recently enacted into law under the ACA, VBP has
been in development for years
 Medicare ModernizationAct (MMA) of 2003:
 Congress commissioned the Institute of Medicine (IOM) to “identify and
prioritize options to align performance to payment in Medicare.”The IOM reports
provided the rationale to reconfigure the U.S. health care payment
system, supporting a “pay for performance” (P4P) approach.

Deficit ReductionAct (DRA) of 2005 Section 5001(b):
 This act required HHS to develop a plan to implement aVBP program for
Medicare payment for subsection (d) hospitals, beginning with FY 2009.The
Medicare HospitalVBP program would be built on the current Reporting Hospital
Quality Data for Annual Payment Update (RHQDAPU) Program and be budgetneutral.

Medicare Improvements for Patients and ProvidersAct
(MIPPA) of 2008 Section 131(d):
 This act required HHS to develop aVBP transition plan for providers receiving
Medicare payments. HHS submitted this report to Congress in December 2008
detailing a draft transition plan to a MedicareVBP program for physicians and
other professional services, as well as the design issues under consideration.

30. “A major, overarching
theme in the Affordable Care Act is one of measurement,
transparency, and altering payment to reinforce, not simply volume of services, but
the quality of the effects of those services.
Instead of payment that asks, “How much did you do,” the Affordable Care Act clearly
moves us toward payment that asks, “How well did you do?” and, more important,
“How well did the patient do?”
That idea is at the heart ofValue-Based Purchasing. It is not just a CMS idea; it is one
increasingly pervading the agenda of all payers.”
Don Berwick, CMS Administrator, April 4, 2011

31. 
AffordableCareAct set up value-based
purchasing (VBP) for:
 Hospitals ( 3001);





Skilled Nursing Facilities ( 3006);
Home Health Agencies ( 3006);
Ambulatory SurgeryCenters ( 3006); and
Physicians, through a “value modifier” ( 3007).
AffordableCareAct also tied portions of DRG
payments to: –Readmission rates ( 3025); and
 Hospital-acquired conditions ( 3008).

32. What does it all mean?
Doing the right things for patients
will become easier and doing the
wrong things will become more
difficult – and expensive!

33. 
CMMI establishment mandated (Section 3021)
 Consultation & input from broad healthcare sector in
implementation




Develop patient-centered payment models
Rapid piloting/testing of new payment programs
Encourage evidence-based, coordinated care for
Medicare, Medicaid, CHIP
Focuses on populations “for which there are deficits
in care leading to poor clinical outcomes or
potentially avoidable expenditures”

34. 



“Risk-based comprehensive payment or salary-based
payment” models
“Geriatric assessments and comprehensive care
plans…interdisciplinary care teams…multiple chronic
conditions…”
“transition health care providers away from fee-forservice-based reimbursement and towards salarybased”
“health information technology-enabled provider
network that includes care coordinators, chronic
disease registry, home telehealth technology”

35. 
Other key characteristics in the statute for payment
models
 Varying payment for advanced diagnostic imaging services
 Medication therapy management services
 Community-based health teams to assist in care
management
 Patient decision-support tools
 State flexibility for dual-eligibles and all-payer payment
reform demonstrations
 Collaboratives of high-quality, low-cost institutions

$10 billion over 10 years funding for innovation

36. 2 To 3 years Design to Program Translation Cycle Time
• TrendAnalysis
• Prototype Design and
Modeling
• Collaborative Design
Lab
• Best PracticeAnalysis
• Publication and
Collaborative Learning
Collaborative
Innovation Laboratory
Stage
Demonstration and
ProgramTrial Stage
•Program trials and
Demo development
•Technology beta
testing
•Results evaluation
•Findings and
Recommendations
•Publications
• Program Policy Translation
Analysis and Evaluation
• Legislation/policy
development
• Regulation and Rule
Development
• Policy Execution and
Implementation
• Re Evaluation/ Publication
Program Policy
Translation Evaluation
and Diffusion
Stage

37. 







ACO Programs
Bundled Payment
Comprehensive Primary Care
Initiative
Financial Alignment Initiative
FQHCAdvanced Primary
Practice Demonstration
Graduate Nurse Education
Demonstration
Health Care Innovation
Awards
Independence at Home
Demonstration








Initiative to Reduce Avoidable
Hospitalizations Among
Nursing Home Residents
Innovations Advisors Program
Medicaid Emergency
Psychiatric Demonstration
Medicaid Incentives for the
Prevention of Chronic Diseases
Million Hearts
Partnership for Patients: Care
Transitions: Community-based
State Innovations Models
Strong Start for Mothers &
Newborns

38. Healthcare
Delivery System
Reform and
Transformation
Program and
Policy Redesign
Successful
Payment and
Service Model
Innovation
2014-2019
2012-2019
2011-2019

39. 
Medicare Shared Savings Program (Section
3022)
 Encourages multiple providers of services and
supplies to:
▪ Join together and create ACOs
▪ Be jointly accountable for health & experience of
care for individuals over a period of time
▪ Improve population health, overlap with community
▪ Reduce rate of healthcare spending, improve quality

41. What is
an ACO?
SU A
ST INABlll

42. 




The number and types of ACOs are expanding
Growth is centered in larger population centers
Hospital systems appear to be the primary
backers of ACOs, but physician groups are
playing an increasingly larger role
Non-Medicare ACOs are experimenting with
more diverse models than Medicare-backed
ACOs
The success of any particularACO model is still
undetermined
Source: Leavitt Partners report “Growth and Dispersion of
Accountable Care Organizations, August 2013

43. Source: Leavitt Partners report “Growth and Dispersion of
Accountable Care Organizations, August 2013

44. Source: Leavitt Partners report “Growth and Dispersion of
Accountable Care Organizations, May 2012

45. Source: Leavitt Partners report “Growth and Dispersion of
Accountable Care Organizations, August 2013

46. CMS has many different types of quality incentive
programs, several of which directly affect healthcare
providers and organizations:
 Pay for reporting programs:
 PQRS
 Children's Health Insurance Program Reauthorization Act
Quality Reporting
 Medicaid Adult Quality Reporting

eRx Incentive Program
 Payment adjustments in effect currently

47. 
Medicare and Medicaid EHR Incentive Program
 Almost $20 Billion in payments already
 Payment adjustments begin in 2015


Medicare Shared Savings Program (ACOs)
Value-Based Purchasing Pay-for-Performance Programs:
 Physician Feedback/Value-Based Modifier Program
▪ Medicare fee-for-service payment modifier starting in 2015 on voluntary
basis, phased in to include ALL providers by 2017 (measurement year
starts in 2013)
▪ Participating providers will receive annual feedback on their cost and
quality scores
 Hospital Value Base Purchasing
 End-Stage Renal Disease Quality Incentive Program

48. 
Is your organization participating in the
“meaningful use” EHR incentive program?

49. •
•
In 2004 President Bush announced the
critical need for the U.S. to begin
assessing the need for electronic health
records in all areas of the healthcare
industry.
On February 17, 2009, President Obama
signed the American Recovery and
Reinvestment Act (ARRA) of 2009. This
statute includes the Health Information
T
echnology for Economic and Clinical
Health (HITECH) Act.

50. •
•
Section 3001of the HITECH Act established the
Office of the NationalCoordinator for Health
InformationTechnology (ONC) within the U.S.
Department of Health and Human Services
(HHS).
The ONC is at the forefront of the government’s
health information technology efforts, and is a
resource to the entire health system to support
the adoption of health information technology.

51. Two CMS EHR Financial Incentive Programs were established
under the HITECH Act:
 Medicare- administered by CMS
 Medicaid – joint administration by CMS and state
 Both programs are voluntary however eligible providers
must choose which program they will participate in and
penalties begin in 2015 for Medicare
 Both programs require use of certified EHR technology
 Medicare program requires demonstration of meaningful
use during first year of participation
 Medicaid provides for payment of financial incentives to EPs
who meet patient volume requirements and
adopt/implement/upgrade during their first year of
participation

53. 
Meaningful Use is using certified EHR
technology to
 Improve quality, safety, efficiency, and reduce





health disparities
Engage patients and families in their health care
Improve care coordination
Improve population and public health
All the while maintaining privacy and security
Meaningful Use mandated in law to receive
incentives

54. Use information
to transform
Improved
population health
Improve access
to information
Enhanced access
and continuity
Data utilized to
improve delivery
and outcomes
Data utilized to
improve delivery
and outcomes
Patient self
management
Patient engaged,
community
resources
Care coordination
Care coordination
Patient centered
care coordination
Patient informed
Evidenced based
medicine
Team based care,
case management
Basic EHR
functionality, stru
ctured data
Structured data
utilized
Registries for
disease
management
Registries to
manage patient
populations
Privacy & security
protections
Privacy & security
protections
Privacy & security
protections
Privacy & security
protections
Stage 1 MU
Stage 2 MU
PCMHs
3-Part Aim
Utilize
technology to
gather
information
ACOs
Stage 3 MU

55. 
Standards and Certification Criteria

Stage 2 Meaningful Use

56. Certified EHR Technology
HereHetrhe fwhat i…looks like today…
’s e’s uture t

57. 2014 Edition CEHRT
Base EHR

58. Base EHR
Certification Criteria Required to Satisfy the Definition of a Base EHR
Base EHR Capabilities
Includes patient demographic and clinical
health information, such as medical history
and problem lists
Capacity to provide clinical decision support
Capacity to support physician order entry
Capacity to capture and query information
relevant to health care quality
Capacity to exchange electronic health
information with, and integrate such
information from other sources
Capacity to protect the confidentiality,
integrity, and availability of health
information stored and exchanged
Certification Criteria
Demographics 170.314(a)(3)
Vital Signs 170.314(a)(4)
Problem List 170.314(a)(5)
Medication List 170.314(a)(6)
Medication Allergy List 170.314(a)(7)
Drug-Drug and Drug-Allergy Interaction Checks 170.314(a)(2)
Clinical Decision Support 170.314(a)(8)
Computerized Provider Order Entry
170.314(a)(1)
Clinical Quality Measures 170.314(c)(1) and (2)
Transitions of Care
170.314(b)(1) and (2)
View, Download, and Transmit to 3rd Party
Privacy and Security
170.314(e)(1)
170.314(d)(1)-(8)

59. 2014 Edition CEHRT
Base
EHR
EP/EH/CAH would only need to
have EHR technology with
capabilities certified for the MU
menu set objectives & measures for
the stage of MU they seek to
achieve.
EP/EH/CAH would need to have
EHR technology with capabilities
certified for the MU core set
objectives & measures for the
stage of MU they seek to achieve
unless the EP/EH/CAH can meet
an exclusion.
EP/EH/CAH must have EHR
technology with capabilities
certified to meet the definition of
Base EHR.

60. 2014 Certification Criteria associated with a
Base EHR:
2014 Certification Criteria associated with MU Menu
Stage 2:
•
•
•
•
•
Imaging (170.314(a)(12))
Transmission to cancer registries (170.314(f)(8))
Cancer case information (170.314(f)(7))
Public health surveillance (170.314(f)(3))
Transmission to public health agencies
(170.314(f)(4))
• Family health history (170.314(a)(13))
• Demographics (170.314(a)(3))
• Vital signs, BMI, & growth charts
(170.314(a)(4))
• Problem list (170.314(a)(5))
• Medication list (170.314(a)(6))
• Medication allergy list (170.314(a)(7))
• Drug-drug, drug-allergy interaction
checks (170.314(a)(2))
MU Menu
MU Core
Base EHR
2014 Certification Criteria
associated with MU Core Stage 2:
• Smoking status (170.314(a)(11))
• eRx (170.314(b)(3))
• Drug formulary checks
(170.314(a)(10))
• Patient lists (170.314(a)(14))
• Patient reminders (170.314(a)(15))
• Patient-specific education resources
(170.314(a)(16))
• Clinical information reconciliation
(170.314(b)(4))
• Clinical summaries (170.314(e)(2))
• Secure messaging (170.314(e)(3))
• Incorporate lab test and
results/values (170.314(b)(5))
• Immunization information
(170.314(f)(1))
• Transmission to immunization
registries (170.314(f)(2))
1
2
3
• CPOE (170.314(a)(1))
• Clinical decision support (170.314(a)(8))
• Clinical quality measures
(170.314(c)(1)-(2))
• Transition of Care – incorporate
summary care record (170.314(b)(1))
• Transition of Care – create and
transmit summary care record
(170.314(b)(2))
• View, download, and transmit to 3rd
Party (170.314(e)(1))
• Privacy and Security CC:
o
o
•
•
•
•
Automated numerator recording (170.314(g)(1))
Automated measure calculation (170.314(g)(2))
Non-%-based measure use report (170.314(g)(3))
Safety -enhanced design (170.314(g)(4))
o
o
o
o
o
o
o
Authentication, Access Control, &
Authorization (170.314(d)(1))
Auditable events & tamper resistance
(170.314(d)(2))
Audit report(s) (170.314(d)(3))
Amendments ( 70.314(d)(4))
Automatic log-off ( 170.314(d)(5))
Emergency access (170.314(d)(6))
Encryption of data at rest (170.314(d)(7))
Integrity (170.314(d)(8))
Accounting of disclosures (optional)
(170.314(d)(9))

61. 14 core objectives
16 core objectives
5 of 10 menu
objectives
19 total objectives
2 of 4 menu
objectives
18 total objectives

62. 1)
2)
3)
4)
5)
6)
Use CPOE for more than 60%of medication,
laboratory and radiology orders
Record demographics for more than 80%
Record vital signs for more than 80%
Record smoking status for more than 80%
Implement 5 clinical decision support
interventions + drug/drug and drug/allergy
Incorporate lab results for more than 40%

63. Generate patient list by specific condition
More than 10% of medication orders are
tracked using EMAR
9) Provide online access to health
information for more than 50% with more
than 5% actually accessing
10) Use EHR to identify and provide education
resources more than 10%
11) Medication reconciliation at more than 50%
of transitions of care
7)
8)

64. 12)
13)
14)
15)
16)
Provide summary of care document for more
than 50% of transitions of care and referrals
with 10% sent electronically
Successful ongoing transmission of
immunization data
Successful ongoing submission of reportable
laboratory results
Successful ongoing submission of electronic
syndromic surveillance data
Conduct or review security analysis and
incorporate in risk management process

65. Record indication of advanced directive for
more than 50%
2) Incorporate more than 40% of imaging results
3) Record family health history for more than 20%
4) E-Rx for more than 10% of discharge
prescriptions
1)

66. What a summary of care must include:
 Patient name.
 Procedures.
 Relevant past diagnoses.
 Laboratory test results.
 Vital signs (height, weight, blood pressure, BMI, growth
charts).
 Smoking status.
 Demographic information (preferred language, gender,
race, ethnicity, date of birth).
 Care plan field, including goals and instructions, and
 Any additional known care team members beyond the
referring or transitioning provider and the receiving
provider.
 Discharge instructions

67. AND:
 An up-to-date problem list of current and active diagnoses
 An active medication list
 An active medication allergy list
TheTransitions ofCare objective combines elements of previous
Stage 1 objectives that are no longer being measured
individually:
 Maintain an up-to-date problem list
 Maintain an active medication list
 Maintain an active medication allergy list
If there are no problems, meds, or med allergies = Indication in record

68. Common MU Data Set
Data Elements in Common Between EP and EH/CAH in Addition to
Common MU Data Set
Elementsthat are different between EP and EH/CAH
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 Care Team Member(s), including the primary care provider of record and any additiona
known care team members beyond the referring or transitioning provider and the
known care team members beyond the referring or transitioning provider and the
receiving provider
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

69. 15 core objectives
5 of 10 menu
objectives
20 total objectives
17 core objectives
3 of 5 menu objectives
20 total objectives

70. 1)
2)
3)
4)
5)
6)
7)
Use CPOE for more than 60% of medication,
laboratory and radiology orders
E-Rx for more than 65%
Record demographics for more than 80%
Record vital signs for more than 80%
Record smoking status for more than 80%
Implement 5 clinical decision support
interventions + drug/drug and drug/allergy
Incorporate lab results for more than 55%

71. Generate patient list by specific condition
9) Use EHR to identify and provide more than
10% with reminders for preventive/follow-up
10) Provide online access to health
information for more than 50% with more
than 5% actually accessing
11) Provide office visit summaries in 24 hours
12) Use EHR to identify and provide education
resources more than 10%
8)

72. More than 10% of patients send secure
messages to their EP
14) Medication reconciliation at more than 50% of
transitions of care
15) Provide summary of care document for more
than 50% of transitions of care and referrals
with 10% sent electronically
16) Successful ongoing transmission of
immunization data
17) Conduct or review security analysis and
incorporate in risk management process
13)

73. 1)
2)
3)
4)
5)
More than 40% of imaging results are
accessible through Certified EHRTechnology
Record family health history for more than
20%
Successful ongoing transmission of
syndromic surveillance data
Successful ongoing transmission of cancer
case information
Successful ongoing transmission of data to a
specialized registry

74. Change from Stage 1 to Stage 2:
Clinical Quality Measure reporting is no
longer a meaningful use core
objective, but reporting CQMs is a basic
requirement for meaningful use.

75. Patient and Family Engagement
 Patient Safety
 Care Coordination
 Population and Public Health
 Efficient Use of Healthcare Resources
 Clinical Processes/Effectiveness


76. Hospitals
15 total CQM
24 CQMs (≥1 per domain)
24 total CQMs
Eligible Professionals
3 core
OR
3 alt. core CQMs
plus 3 menu CQMs
6 total CQMs
1a) 12 CQMs (≥1 per domain)
1b) 11 core + 1 menu CQMs
2) PQRS Group Reporting
12 total CQMs

77. 
2Types of CQM Reporting Methods
 Aggregate XML-based format specified by
CMS
 Manner similar to 2012 Medicare EHR
Incentive Program Electronic Reporting
Pilot