01-10C - Introduction To Healthcare and Public Health in The US - Unit 10 - Meaningful Use of Health Information Technology - Lecture C

Introduction to Healthcare and
Public Health in the US

Meaningful Use of Health
Information Technology
Lecture c
This material (Comp1_Unit10c) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Meaningful Use (MU) of Health
Learning Objectives
Define meaningful use of health information technology in the
context of the Health Information Technology for Economic
and Clinical Health (HITECH) Act (Lecture a)
Describe the major goals of meaningful use (Lecture a)
Define the criteria for Stages 1 and 2 of meaningful use for
eligible professionals and eligible hospitals (Lecture b)
Describe the standards specified for Stages 1 and 2 of
meaningful use, including those devoted to privacy and
security (Lecture c)
Define the clinical quality measures (CQMs) for the
meaningful use program (Lecture c)
2
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Meaningful Use of Health Information Technology
Lecture c
HITECH, ARRA and
Achieving Meaningful Use
Standards
Privacy and security
Clinical quality measures (CQMs)

3
Lecture c
Standards for Stages 1 and 2
10.21 Chart: Metzger, 2012
4
Lecture c
(continued)

5
Lecture c
(continued)

6
Lecture c
Additional Standards For Stage 2
Amendments to support HIPAA compliance, EHR must accept
patient-supplied information in both free text and scanned format
and append/amend it to EHR
Encryption of data on end-user devices any electronic health
information on end-user devices must encrypt such information once
it is no longer being actively used
View, download and transmit to third party EHR must be able to
Transmit ambulatory and inpatient summary to a third party
Include patient accessible log to track use of the view,
download, and transmit capabilities and make that information
available to the patient
Cancer case information and transmission to cancer registries
EHR must have capability to identify and report cancer cases to a
state cancer registry (except where prohibited by law) (menu option
for EPs)
7
Lecture c
Additional Standards For Stage 2
(continued)
Transitions of care EHR must be able to
Receive, display and incorporate transition of care/referral summaries
Create and transmit transition of care/referral summaries
CQMs three new criteria
Electronic data capture and export EHR must be able to record data
that would be required in order to calculate CQMs, and export the data
in the event that an EP, EH, or CAH chooses to use a different certified
EHR module to perform the calculation of CQM results
Electronic data import and calculation EHR technology must be able
to electronically import all of the data elements necessary to calculate
CQMs for which it is to be certified
Electronic submission of CQM data to CMS EHR must be able to
create for electronic transmission CQM results in a data file defined by
CMS, i.e., put CQM results into an XML data file and be able to send it
8
Lecture c
Stage 2 Requirements For
Summary Care Record
Patient name and demographic information including preferred language
(ISO 639-2 alpha-3), sex, race/ethnicity (OMB Ethnicity) and date of birth
Vital signs including height, weight, blood pressure, and smoking status
(SNOMED CT)
Encounter diagnosis (SNOMED CT or ICD-10-CM)
Procedures (SNOMED CT)
Medications (RxNorm) and medication allergies (RxNorm)
Laboratory test results (LOINC)
Immunizations (CVX)
Functional status including activities of daily living, cognitive and disability
status
Care plan field including goals and instructions
Care team including primary care provider of record
Reason for referral and referring providers name and office contact
information (for providers)
Discharge instructions (for hospitals)
9
Lecture c
Required Privacy and Security
Standards for Meaningful Use
Encryption/decryption
Any approved algorithm in FIPS 140-2
HIE requires encryption and integrity-protected link
Record actions
Date, time, patient, and user recorded for creation, modification,
access, and deletion
Verification of no alteration in transit
SHA-1 algorithm or stronger, as specified in FIPS 180-3
Record TPO disclosures
Date, time, patient, and user recorded for HIPAA-allowed
activities
(from Geek Doctor: geekdoctor.blogspot.com)
10
Lecture c
Clinical Quality Measures
Stage 1
EPs must report on
3 core measures
Can substitute alternate core measures if
denominator of any core measure is 0
3 of 38 additional measures
EHs must report on 15 measures
CMS aiming to align all quality reporting
programs, i.e., PQRS, e-Rx, HQA, etc.
11
Lecture c
Eligible Professionals
Core Clinical Quality Measures

12
Lecture c
Eligible Professionals
Alternate Core Clinical Quality
Measures

13
Lecture c
Eligible Professionals Additional
Clinical Quality Measures (1-12)
Anti-depressant medication management: (a) Effective Acute Phase
Treatment, (b)Effective Continuation Phase Treatment
Appropriate Testing for Children with Pharyngitis
Asthma Assessment
Asthma Pharmacologic Therapy
Breast Cancer Screening
Cervical Cancer Screening
Chlamydia Screening for Women
Colorectal Cancer Screening
Controlling High Blood Pressure
Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients
with Prior Myocardial Infarction (MI)
Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-
Cholesterol
Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for
Patients with CAD

14
Lecture c
Diabetes: Blood Pressure Management
Diabetes: Eye Exam
Diabetes: Foot Exam
Diabetes: Hemoglobin A1c Control (<8.0%)
Diabetes: Hemoglobin A1c Poor Control
Diabetes: Low Density Lipoprotein (LDL) Management and Control
Diabetes: Urine Screening
Diabetic Retinopathy: Communication with the Physician Managing
Ongoing Diabetes Care
Diabetic Retinopathy: Documentation of Presence or Absence of Macular
Edema and Level of Severity of Retinopathy
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or
Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic
Dysfunction (LVSD)
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic
Dysfunction (LVSD)
Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation
15
Lecture c
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a)
Initiation, b) Engagement
Ischemic Vascular Disease (IVD): Blood Pressure Management
Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
Low Back Pain: Use of Imaging Studies
Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen
Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients
Pneumonia Vaccination Status for Older Adults
Prenatal Care: Anti-D Immune Globulin
Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate
Cancer Patients
Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and
Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation
Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies
Use of Appropriate Medications for Asthma
16
Lecture c
Eligible Hospitals
Anticoagulation overlap therapy
Emergency Department Throughput admitted patients Admission
decision time to ED departure time for admitted patients
Emergency Department Throughput admitted patients Median time from
ED arrival to ED departure for admitted patients
Incidence of potentially preventable venous thromboembolism
Intensive Care Unit venous thromboembolism prophylaxis
Ischemic or hemorrhagic stroke Antithrombotic therapy by day 2
Ischemic or hemorrhagic stroke Rehabilitation assessment
Ischemic or hemorrhagic stroke Stroke education
Ischemic stroke Anticoagulation for atrial fibrillation/flutter
Ischemic stroke Discharge on anti-thrombotics
Ischemic stroke Discharge on statins
Ischemic stroke Thrombolytic therapy for patients arriving within 2 hours
of symptom onset
Platelet monitoring on unfractionated heparin
Venous thromboembolism discharge instructions
Venous thromboembolism prophylaxis within 24 hours of arrival

17
Lecture c
Starting In 2014 For All Stages

18
Lecture c
National Quality Strategy Domains
Patient and Family Engagement
Patient Safety
Care Coordination
Population and Public Health
Efficient Use of Healthcare Resources
Clinical Processes/Effectiveness
19
Lecture c
Results of Stage 1 Adoption
Through August, 2012

20
Lecture c
Informatics Now Lives
In A HITECH World
Although not all of biomedical and health
informatics, HITECH and MU are now the major
drivers
HITECH brings use of EHRs, quality reporting,
etc. to mainstream of healthcare
Leading to better ways to learn about MU?
(Courtesy of Ross Martin, MD, formerly of ONC)
http://www.youtube.com/watch?v=Gv1s8fM3mMk
http://vimeo.com/20923483

21
Lecture c
Summary Lecture c

In addition to meaningful use objectives required
of eligible professionals and hospitals, there are
various standards for structure of the data and its
security
The clinical quality measures for meaningful use
must be reported to receive the incentive
payments, and the new measures that will be
unveiled in 2014 will be required of all eligible
professionals and hospitals no matter the current
stage
22
Lecture c
Summary

The HITECH Act of ARRA legislated incentives
for the meaningful use (MU) of health IT
MU means that criteria for use of IT are tied
back to goals of the health care system
These criteria are met by eligible professionals
and eligible hospitals to receive incentive
payments for use of EHRs
23
Lecture c
References Lecture c
References
Blumenthal, D. (2010). Launching HITECH. New England Journal of Medicine, 362, 382-385.
Blumenthal, D., & Tavenner, M. (2010). The meaningful use regulation for electronic health records.
New England Journal of Medicine, 363, 501-504.
Metzger, J. and Rhoads, J. (2012). Summary of Key Provisions in Final Rule for Stage 2 HITECH
Meaningful Use. Falls Church, VA, Computer Sciences Corp.
http://assets1.csc.com/health_services/downloads/CSC_Key_Provisions_of_Final_Rule_for_Stag
e_2.pdf.

Charts, Tables, Figures
10.21 10.27 Charts: Metzger, J. and Rhoads, J. (2012). Summary of Key Provisions in Final Rule for
Stage 2 HITECH Meaningful Use. Falls Church, VA, Computer Sciences Corp.
http://assets1.csc.com/health_services/downloads/CSC_Key_Provisions_of_Final_Rule_for_Stage
_2.pdf. (By Permission)

24
Lecture c

01-10C - Introduction To Healthcare and Public Health in The US - Unit 10 - Meaningful Use of Health Information Technology - Lecture C

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