Are your spidey senses tingling yet? Meaningful Use Stage 2 attestations are right around the corner, and while Stage 2 isn’t the Green Goblin or Doctor Octopus (I promise!), Meaningful Use (MU) can seem like the villian when it comes to remembering what to document, when to document it, and how to document it to get it to count.
So, if Stage 2 is the villian, guess who gets to be the superhero?
Let’s start by taking Uncle Ben’s advice, “With great power comes great responsibility.” And the first responsibility you’ll have as “MU Man” or “MU Woman” is learning everything you can about the requirements for attestation.
We will soon be posting a training presentation (eligible for CME credit) which will detail what and how to document the Stage 2 requirements, but as a quick summary, below are the 17 core measures and 3 menu measures that are required for Stage 2.

Stage 2 Core and Menu Measures

Core Objectives (17 total)
(1) Use computerized provider order entry (CPOE) for medication (>60%), laboratory (>30%) and radiology orders (>30%) directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.

(2) Generate and transmit permissible prescriptions electronically (>50%).

(3) Record the following demographics: preferred language, sex, race, ethnicity, and date of birth (>80%).

(4) Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI (>80%).

(5) Record smoking status for patients 13 years old or older (>80%).

(6) Use 5 clinical decision support interventions to improve performance on high-priority health conditions (these must be related to Clinical Quality Measures) AND enable and implement drug-drug and drug-allergy checks.

(7) Provide patients the ability to view online, download, and transmit their health information within four business days of the information being available to the EP (>50%).

(8) Provide clinical summaries for patients for each office visit (>50%).

(9) Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.

(10) Incorporate clinical lab-test results into Certified EHR Technology as structured data (>55%).

(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 and send these patients the reminders, per patient preference (>10%).

(13) Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient (>10%).

(14) The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.

(15) The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral (>50%).(16) Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice (Yes/No).

(17) Use secure electronic messaging to communicate with patients on relevant health information (>5%).

Eligible Professional Menu Objectives (3 of 6)
(1) Record electronic notes in patient records (>30%).

(2) Imaging results consisting of the image itself and any explanation or other accompanying information are acces­sible through CEHRT (>10%).

(3) Record patient family health history (1st degree rela­tive) as structured data (>20%) .

If you’re still learning the ropes on how to use your su­perpowers (a.k.a. EHR documentation skills), this Stage 2 summary may have you rethinking your superhero status, but no one ever promised saving the world was easy.
And I haven’t even mentioned CQMs!

Perhaps an analogy to cycling and Lance Armstrong may not seem the most appropriate of comparisons, considering the recent news of his steroid abuse, but for some providers, making sense of the different rules, requirements, and stages—and having to manage these in clinics—may seem just as deflating as Armstrong’s stripping of his accolades, and just as tough as having to compete in the Tour de France.

As a multi-specialty, multi-provider practice, Quillen ETSU Physicians will be pursuing stages of meaningful use in various years, and the criteria that must be met is determined by the stage of  the eligible provider’s (EP’s) participation (either Stage 1, Stage 2, or Stage 3). EP’s progress through six years of the program—two payment years in each stage.

Each month, in our newsletter and here on our blog, we provide information and updates  on the EHR Incentive Program, as a “roadmap,” so to speak, as we make this journey together.

The Centers for Medicare and Medicaid Services (CMS) recently updated the criteria for Stage 1 Meaningful Use (MU) for 2013 and beyond. For most of our EPs, these changes will not affect their 2012 attestations.  If an EP is pursuing his or her first or second payment year of Stage 1 in 2013, respectively, the following updates do apply.

Minor Updates
Core Measure 1: More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE.

The Update: This particular update (in the form of an alternative measure) took effect in September 2012. EPs have the option to use the alternate measure with a denominator of all medication orders created by the EP during the EHR reporting period.  EPs should choose whichever measure (the original or alternative) works best for them.

How this effects you: As a multi-specialty organization, we often share patients among our providers. Being able to choose the alternate will help the percentages of many of our specialists.

Core Measure 4: More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

The Update: A new exclusion has been added for EPs who qualify. Along with the previous exclusion of  “any EP who writes fewer than 100 prescriptions during the EHR reporting period,” now “any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice location at the start of his/her reporting period” can also be excluded.

How this effects you:  This update will not affect us. We have several pharmacies near our offices.

Core Measure 8: For more than 50 percent of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data/ More than 50 percent of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over) and height and weight (for all ages) recorded as structured data.

The Update: Even Tenncare describes this change as complicated, but basically, in 2013, EPs will have a choice to separate the measure and exclusions. Blood pressure can be separated from height and weight, and EPs can specify an age range of 3 and up for blood pressure.

How this effects you: This change will be particularly welcomed by our pediatricians, as well as specialty providers, for whom these vitals are not applicable to their scope of practice.

Core Measure 10: Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS.

How this effects you: Core Measure 10 will no longer be listed as a measure. In 2013, providers will simply report the clinical quality measures rather than attest to a separate measure.

Menu Measure 9: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submissions if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically).

The Update:  The verbiage “except where prohibited” was added by CMS for understanding that if EPs are “authorized to submit the data, they should do so even if it is not required by either law or practice.” Technically, this update is not a change but a clarification

How this effects you:  It doesn’t. We are NOT prohibited to submit data and are working with the state of Tennessee to have our immunizations sent directly to their registry.

Menu Measure 10: Performed at least one test of the certifies EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically)

How this effects you:  It doesn’t. The change is the same as in Menu Measure 9; however, the Tennessee Office of E-Health Initiatives (TDOH )is not currently participating in testing Syndromic Surveillance messages for Meaningful Use.

Major Update

Core Measure 14: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.

The Update: Beginning in 2013 and beyond, this objective and measure will not be required for 2013 and beyond. This objective and measure will still be a part of the core set for anyone attesting to Stage 1 MU for 2012, but CMS felt that preparing for Stage 2’s emphasis on exchanging data was incentive enough for EPs to start testing this capability.

How this effects you:  Look for updates and improvements on Quillen’s ability to exchange data, as the beginning of Stage 2 begins in 2014.

We admit it...for some providers, it may take a little extra time to see a patient using an EHR.  
Just the other day, one of our physicians quoted a random stat about how much more time it was taking him now to do what he used to do when he was on paper. 
That may be true, but EHR is still a work in progress, and what should 
the ultimate goal be?
Improved patient care, right? 
The PATIENT is who matters.
Patient care is why the federal government is investing up to $29 billion in the Meaningful Use incentive program, but EHR users, understandably so, want to know if it’s working. 
One recent study released in the Journal of General Internal Medicine (J Gen Intern Med, Pub. Online Oct. 3, 20011 DOI: 10.1007/s11606-012-2237-8) set out to gather data  on ambulatory quality  in community based settings using EHR.  
The study, which included 466 physicians; 204 using EHR, 262 using paper) and 74,618 unique patients, compared nine measures within the group. The results showed significantly higher quality of care for four of the 
measures:

1. Hemoglobin A1c testing in diabetes,
2. Breast cancer screening,
3. Chlamydia screening, and 
4. Colorectal cancer screening

When all  nine measures were combined into a composite, EHR use was associated with higher quality of care.  The authors do list several limitations, such as the inclusion of self-reported adoption of EHR in its predictor variable, as well as the small number of pediatric measures (although consistent with the call for development of more 
pediatric measures). 
But even with such limitations, this study is significant in that EHR now can be qualified. In this “multi-payer community with concerted efforts to  support EHR implementation,”  EHR was found to indeed be meaningful. If Quillen, as an organization, can work together to improve the current system, the patient is the one who will 
reap the benefits. 

Take a look at #10 of the Core Requirements and you'll discover that EPs must report on Clinical Quality Measures (CQMs).
EPs must report on 6 total clinical quality measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures (selected from a set of 38 clinical quality measures). 

Core Set:                                                                            Alternative Set:

Adult weight screening and follow up                                    Childhood immunization status

Hypertension (blood pressure management)                          Influenza immunization for patients 50 or older

Tobacco use assessment and intervention                             Weight assessment and counseling for 
                                                                                           children/adolescents

The list of 38 additional CQMs are available on the CMS website.

The EHR Team will be selecting CQMs to report on based on the capability to pull that data from the system and recommendations from the Oversight Committee. Keep in mind, these CQMs have very detailed requirements (i.e. age, diagnoses, etc.). 
The American Medical Association also has a nice overview on CQMs.