MEDINFORMATIX MEANINGFUL USE GUARANTEE

MedInformatix agrees to obtain and retain Certified Electronic Health Record  (EHR) status, according to standards established by the Centers for Medicare and Medicaid Services (CMS), a division of the US Department of Health and Human Services (HHS).  All certification and guarantee periods shall originate from the certification deadline established by CMS.  

MedInformatix agrees to guarantee that MedInformatix Version 7.5 plus applicable MI Add-On Modules shall provide the necessary technical components for its clients to become eligible for reimbursement incentive from CMS, as part of the American Recovery and Reinvestment Act (ARRA).  MedInformatix does not guarantee client/end-user utilization, reporting, or coding compliance.  Clients remain responsible to understand and apply all standards established by CMS, to report usage to CMS in an appropriate fashion, and to comply with all rules and protocols established by CMS or any other applicable department, not otherwise defined above. 

MedInformatix shall waive the Customer’s monthly support fee during each month in which MedInformatix fails to retain Certified EHR status when the Customer has obtained the right version and all applicable Add-on Modules.  If MedInformatix fails to obtain certification or re-certification with CMS for a period of six months, the client may exercise an opt-out clause—in writing to MedInformatix.  Should client opt-out according to terms above, MedInformatix shall waive all fees related to data export, in a standard format (HL7, Delimited, et al).

MedInformatix reserves the right to analyze client utilization for compliance with CMS Meaningful Use standards and protocols, to evaluate MI Add-On Module utilization, and to review all client claims requesting guarantee execution.  Clients that MedInformatix determines fail to comply with utilization standards put forth by CMS for establishing Meaning Use shall forfeit all rights and privileges to the MedInformatix Meaningful Use Guarantee.

Summary of “Meaningful Use” and Reporting Criteria for Phase 1

Of Stimulus Incentive Requirements for Eligible Providers

Background:

On February 17, 2009 a $787 Billion Act, the American Recovery and Reinvestment Act of 2009 aka “the Stimulus Bill,” was signed into law by the federal government. Included in this law is $22 billion and $19.2 billion of that is intended to be used to increase the use of Electronic Health Records (EHR) by physicians and hospitals; this portion of the bill is called the Health Information Technology for Economic and Clinical Health Act or HITECH Act. The government firmly believes in the benefits of using electronic health records and is ready to invest federal resources to proliferate its use. There are two very important documents that were reviewed to develop the MedInformatix position paper on “Meaningful Use”

• FINAL INTERIM RULE-effective 2/12/10--Initial Set of Standards, Implementation
Specifications and Certification Criteria for Electronic Health Record Technology (136
pages)

• Medicare and Medicaid Programs; Electronic Health Record Incentive Program--currently
In 60-day comment period (556 pages)

Important Definitions:

Qualified EHR
“An electronic record of health--related information on an individual that:
A. Includes patient demographic and clinical health information
B. Has the capacity to
(i) provide clinical decision support;
(ii) support physician order entry;
(iii) capture and query information relevant to health care quality; and
(iv) exchange electronic health information with, and integrate such
information from other sources.”

EHR Technology is further defined and certified using three distinct levels

Level 1:

Complete EHR

EHR technology that has been developed to meet all applicable certification criteria adopted by the Secretary. Complete EHR is not meant to limit the capabilities that a complete EHR can include. Rather, it is meant to encompass EHR technology that can perform all of the applicable capabilities required by certification criteria adopted by the Secretary and distinguish it from EHR technology that cannot perform those capabilities. This technology could be “home grown” and certified as a “home grown” system only to be used by the Eligible Providers (EP) who created it.

Level 2:

EHR Module

Any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary.
1. An interface or other software program that provides the capability to exchange electronic health information.
2. An open source software program that enables individuals on line access to certain health information maintained by EHR technology;
3. A clinical decision support rules engine;
4. A software program used to submit public health information to public health authorities and a quality measure reporting service or software program.

Level 3:

Certified EHR Technology

EMR technology certified by standards adopted by the Secretary HHS.
A Complete EHR or a combination of EHR Modules, each of which
1. meets the requirements included in the definition of a Qualified EHR;
and
2. has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary.

Meaningful Use

The Meaningful Use Rule, which was released in a proposed form at the end of 2009 and will be finalized in Spring 2010, outlined in much greater detail what physicians and other participating providers will need to do to qualify for the HITECH incentive payments.

• Providers will need to prove Meaningful Use of their EHR for at least 90 continuous days in 2011 in order to earn an incentive, and then for the entire year each subsequent year.

• Physicians need to prove that they have met functional objectives with their use of the EHR product to be considered “meaningful users” (see below).

• Clinical quality measures will need to be submitted by a provider on a Core set of measures, as well as a specialty-specific subgroup; providers will be able to file for an exception if none of the 89 proposed measures matches with their specialty.

Quality Measures

• Physicians will be paid on a rolling basis as soon as they have proven to CMS that they have met all the functional objectives of the Meaningful Use Requirement and have hit the maximum amount for the year. CMS will then issue a single annual, consolidated payment.

• All reporting will be done by attestation in 2011, moving to an electronic form in later years.

• The requirements related to Meaningful Use will get more challenging beginning in 2013.

Standards and Certification


Qualified EHR technology means that the EHR is certified to meet standards and includes patient demographic and clinical health information, has the capacity to provide decision support for physician order entry and to capture and query healthcare quality information, and to exchange electronic health information with other sources.


As part of HITECH’s requirements related to the review of all existing standards, the ONC released at the end of 2009 the initial set of standards that will affect the Meaningful Use criteria related to certified products and implementation specifications.


Privacy Expansion
As part of the HITECH Act, Federal privacy and security laws (HIPAA) were expanded to protect patient
health information, including:


• Defining which actions constitute a breach (including some inadvertent disclosures)

• Imposing restrictions on certain disclosures, sales, and marketing of protected health
information

• Requiring an accounting of disclosures to a patient upon request

• Authorizing increased civil monetary penalties for HIPAA violations

• Granting authority to state attorneys general to enforce HIPAA


Summary of Significant Stage 1 - “Meaningful Use Requirements”:
1. The total amount that any Eligible Provider (EP) can obtain is $44,000 over a 5-year period.

2. The payment year and year of payment has been combined; thus, an EP must use the system the year that they expect payment.

3. The first payment year is 2011 and it is a special year in that it is the only year the EP is not required to use a certified EHR for the entire year. For 2011 an EP only needs to use a certified EHR for 90 consecutive days.

4. EPs are defined as ambulatory physicians whose Medicare charges are generated from ambulatory settings. Thus, if the EP is billing on UB4 or under a hospital Tax ID number the EP would most likely not qualify for the stimulus dollars. If 90% of the medical charges that a physician bills is from a “Hospital” facility, they would not qualify for “Meaningful Use” stimulus money.

5. Reporting requirements have been changed to reflect mostly individual patients both Medicare and non-Medicare as opposed to clinical visits or episodes.

6. For the most part, the intent of meaningful use criteria is directed toward the EP not the support staff of the EP.

7. Below please find the stage of meaningful use criteria by payment year and the meaningful use criteria and reporting requirements for EP’s for Stage 1. 

Table 1 - Stage of Meaningful Use Criteria by Payment Year

Meaningful Use Criteria by Payment Year

*Avoids payment adjustments only for physicians in the Medicare EHR Incentive Program

Table 1 Summary
This table shows which stage of meaningful use criteria will be required based on the year that the practice goes live with its EHR. For example if the practice is using a certified EHR at least 90 consecutive days in 2011 and/or for the entire 12 months of 2012.


Stimulus Payments to Physicians and Hospitals
The two primary goals for the stimulus payments in this legislation are moving physicians who have been slow to adopt Electronic Health Records to a computerized environment, and ensuring that patient data no longer sits in silos within individual provider organizations but instead is actively and securely exchanged between healthcare professionals. Therefore, the vast majority of the funds within the HITECH Act are assigned to payments that will reward physicians and hospitals for effectively using a robust, connected EHR system. There is a program designed for those that see large volumes of Medicaid patients, and another for those that accept Medicare. In order to qualify for the incentives, both physicians and hospitals have to demonstrate:


1. Use of a certified EHR product with Computerized Ordering, eRx capability, and decision support capabilities that meet current HHS standards.

2. Connectivity to other providers to improve access to the full view of a patient’s health history.

3. Ability to report on their use of the technology to HHS.

The incentives include payments for up to six years but provide the largest payments early in the program, and those that don’t demonstrate Meaningful Use of an EHR under the Medicare component of the program will eventually be penalized through lower payments. The incentive payments begin in 2011 to ensure providers have time to adopt and learn to use the EHR; penalties begin in 2015.

Specifics of the Opportunity

Specifics of the Opportunity Medicare

EP requirements for Meaningful Use


As stated earlier, a physician must use either a comprehensive Certified EHR or must use a series of Certified Modules that when used separately allow the EP to meet all of the requirements identified below:


1. Computerized Patient Order Entry (CPOE)

a. Eighty (80) percent of all orders placed both electronically or by other means will be used as the criteria.
b. Fifty (50) percent of patient encounters must be at a facility utilizing certified EHR technology--if the EP provides many of his/her services in remote clinics, in order to qualify he/she must be using a certified EHR on at least 50% of all the patients they see across all facilities.
c. EP must use the CPOE as part of his/her daily activity.


2. Implement drug to drug, drug allergy, and drug formulary checks

a. Although no requirement for acting on this information is required, the EP is required to have this feature “turned on”.
b. EP must use this as part of his/her daily activity.


3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT.
a. Eighty (80) percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.
b. EP must use this module as part of his/her daily activity. Currently, controlled substances are omitted from these criteria. Generate and Transmit Permissible Prescriptions


4. Electronically as structured data.
a. Seventy-five (75) percent of all prescriptions written must be submitted using certified EHR technology.

b. EP must use this module as part of his/her daily activity.


5. Maintain active medication list as structured data
a. Eighty (80) percent of all unique patients seen by the EP must have at least one medication
or none documented as structured data.
b. EP must use this module as part of his/her daily activity.


6. Maintain active medication allergy list as structured data

a. Eighty (80) percent of all unique patients seen by the EP must have at least one entry or
none documented as structured data.
b. EP must use this module as part of his/her daily activity. 

7. Record Demographics as Structured Data

a. Eighty (80) percent of all unique patients seen by the EP must have demographics recorded as structured data
In addition to the standard demographics set, the EP must document”
Preferred Language
Insurance Type
Gender
Race
Ethnicity
Date of Birth
b. EP must use this module as part of his/her daily activity.


8. Record and Chart Vital Signs as Structured Data

a. Eighty (80) percent of all unique patients over 2 years of age must have vital signs recorded
as structured data to include:
BMI
Height
Weight
Blood Pressure
Plot growth chart for children age 2-20
b. EP must use this module as part of his/her daily activity.


9. Record Smoking Status for Patients 13 years old or older as structured data

a. Eighty (80) percent of all unique patients 13 years old or greater must have smoking status recorded as structured data.
b. EP must use this module as part of his/her daily activity.


10. Incorporate Clinical Lab Test Results into EHR as Structured Data
a. Fifty (50) percent of all clinical lab tests results ordered by the EP or authorized provider, with results either positive or negative or numerical format, must be recorded as structured data.
b. The object is to be reliant on the electronic exchange of information.


11. Generate lists of Patients by specific conditions to use for quality improvement, reduction of disparities, research and outreach.
a. Generate at least one report during the reporting period listing patients with a specific condition.
b. EP to attest that they have successfully generated the report.


12. Report ambulatory quality measures to CMS or the States.
a. In 2011 the EP would report through attestation quality measurements. Electronic submission will be deferred until 2012.


13. Send reminders to patients per patient preference for preventative/follow up care.
a. 50% of all unique patients 50 years of age or greater are required to receive the reminders during the reporting period.
b. EP to attest that they have successfully generated the report.

14. Implement 5 clinical decision support rules relevant to specialty or high clinical priority, including diagnostic test ordering, along with the ability to track compliance with those rules.
a. Implement 5 clinical decision support rules relevant to the clinical quality metrics for the EP before the end of the reporting period.
b. EP must use this module as part of his/her daily activity.


15. Check insurance eligibility electronically from public and private payers.
a. 80% of all unique patients during the reporting period must have eligibility checked.
b. EP must use this module as part of his/her daily activity.


16. Submit claims electronically to public and private payers
a. 80% of all unique patients during the reporting period must have their claims submitted electronically.
b. EP must use this module as part of his/her daily activity.


17. Provide patients with an electronic copy of their health information including diagnostic test results, problem list, medication list and allergies upon request.
a. 80% of all unique patients who request an electronic copy of their health information are Provided it within 48 hours.
b. Under ARRA all patients have the right to an electronic copy of their health record.


18. Provide patients with electronic access to their health information including lab results, problem list, medication list, and allergies within 96 hours of their information being available to the EP.

a. At least 10% of all unique patients seen by the EP are provided timely access to their health Information.
b. This information will have to be securely transferred.


19. Provide clinical summaries to patient for each office visit.
a. 80% of all unique patients seen by the EP during the reporting period should receive a clinical summary of their visit during the reporting period.
b. EP must use this module as part of his/her daily activity.
c. The clinical summary may be provided through a PHR, patient portal, secure email, or electronic media such as CD, USB fob, or printed copy.


20. Capability to exchange key clinical information among providers of care and patient authorized entities electronically.
a. During the reporting period performed at least one test of the certified EHR’s technology’s capacity to electronically exchange key clinical information.
Examples of possible test items:
Problem List
Medication List
Allergies
Diagnostic Test results
b. If multiple EP’s use the same technology only one test is required

21. Perform medication reconciliation at relevant encounters and each transition of care
a. 80% of the relevant encounters or transitions of each must have medication reconciliation.
b. EP must use this module as part of his/her daily activity.


22. Provide summary care record for each transition of care and referral
a. 80% of patients seen by the EP during their reporting period must have a summary care record when transition of care or referral occurs.
b. Summary of care can be provided through an electronic exchange, access through a secure portal, secure email, electronic media such as CD or USB fob, or printed copy.


23. Submit electronic data to immunization registries, with submission accepted where required.
a. Successfully complete one test submission during the reporting period.
b. If multiple EP’s use the same system only one test for all EP’s is required.


24. Provide Electronic Syndromic surveillance data to public health agencies with actual transmission according to applicable law.
a. Successfully complete one test submission during the reporting period.
b. If multiple EP’s use the same system only one test for all EP’s is required.


25. Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.
a. Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a) (1) and implement security updates as necessary.
b. This will be reported through attestation which must relate to a review of security risk analysis of certified EHR technology with implementation of processes that may not be part of the EHR and require processes or outside solutions.
c. If multiple EP’s use the same system only one test for all EP’s is required.


Below are specific requirements listed above that have been repeated and then commented on individually. These are the requirements that MedInformatix has identified that may cause the most problems for our customers. Please review them. 

Criteria Requirements that may Require
Practice Changes or Infrastructure Changes:


Generate and Transmit Permissible Prescriptions Electronically as structured data. All applicable specialties will have to have a certified eRx module that can assure 75% of all prescriptions go via eRx and that Formulary checking is “turned on.”


Record Demographics as Structured Data:
MedInformatix V7.5 has been modified to separate both Race and Ethnicity into two response fields; however, currently our customers typically do not capture race. Practices will now be required to expand their demographic collection to include such things as race, ethnicity, primary language, etc


Incorporate Clinical Lab Test Results into EHR as Structured Data This will require that practices have at least a unidirectional lab interface to laboratories that when totaled provide at least 50% of their labs back to the practice electronically. It is important to get lab interfaces up early in the process. MedInformatix has already heard complaints from Lab Vendors that they are not prepared for the onslaught of practices needing interfaces.


Report ambulatory quality measures to CMS or the States. Again, this will require Version 7.5 and the applicable reporting module to provide this data.


Implement 5 clinical decision support rules relevant to specialty or high clinical priority, including diagnostic test ordering, along with the ability to track compliance with those rules. In addition to reporting quality clinical measures, the criteria will require EP’s to utilize alerts and an alert
reconciliation capability on five clinical areas that the Secretary mandates by specialty. Thus an EP will be alerted on the expected treatment for these clinical areas and will have to provide the number of times he followed the alert vs. the number of times he chose not to follow the alert and why.


Check insurance eligibility electronically from public and private payers. We will be doing this through Zirmed. If customers are not using Zirmed, they will be responsible to make sure that their clearinghouse is certified for meaningful use.

Provide patients with an electronic copy of their health information including diagnostic test, results, problem list, medication list, and allergies upon request. MedInformatix will have a CCR capability in Version 7.5.


Provide patients with electronic access to their health information including lab results, problem list, medication list, and allergies within 96 hours of their information being available to the EP. Currently, the mandate requires 10% of the practice patients to have password access to an on line portal to get their information. MedInformatix will market a portal that the practice can set up and run.

Perform medication reconciliation at relevant encounters and each transition of care. The practice will need to be able to reconcile medications from outside sources such as hospitals and pharmacy benefit managers. MedInformatix has this capability under E-RX, but this will more than likely require some manual validation or decision making at the clinical level.


Submit electronic data to immunization registries, with submission accepted where required. MedInformatix V7.5 will be required.


Provide Electronic Syndromic surveillance data to public health agencies with actual transmission according to applicable law. MedInformatix V7.5 will be required.

MEDINFORMATIX Strategy

MEDINFORMATIX is currently certified by CCHIT:08 and is seeking a full comprehensive certification. The Version 7.5 of MEDINFORMATIX will be certified from 2011 through 2014. All practices that are on the INFR stage 1 Version 7.5 of MedInformatix and associated modules will meet the requirements to receive stimulus funding.

Road Map for Certification and Network Upgrading of all Customers


1. MedInformatix plans to go for 2011 Certification towards the end of the second quarter of 2010. Version 7.5 will be the platform that will be certified under the new 2011-2013 Certification Stage 1 Requirements.

2. MedInformatix will begin rolling out the product for all customers in June 2010. All customers who wish to be upgraded for the new Certified product will be required to sign up in advance to be insured that they will be installed and have at least 90 consecutive days of full operation to meet the guidelines for stimulus payment.

3. MedInformatix will publish an updated Hardware and Software Requirements document in March 2010. These requirements will follow Microsoft Mainstream upgrade paths. This is important because as we write new software for reporting and decision support tools it will require practices to be current in the Microsoft Standards. For example, SQL servers will be required to be 2005 or above. Those on SQL 2000 will have to upgrade in order to be insured that all tools work.

4. One of the requirements added to the Meaningful Use Criteria for 2011 includes laboratory interoperability. This requires that 50% of all labs ordered by an EP come back to the EHR as electronic structured data in an interface. This will require practices to insure that they have an interface to either one or several labs such that 50% of their laboratory findings come back in an interface. MedInformatix strongly encourages practices that do not have laboratory interfaces to sign up as soon as possible to get them. MedInformatix also encourages practices to utilize unidirectional interfaces, which is all that is required for 2011. These are easier and quicker to get operational and with the MedInformatix lab interface module, much easier for the practice to handle. Bidirectional interfaces for laboratories will require significant change in the ordering process for the practice. The majority of our network does not have 50% of their laboratory findings coming into the EHR; thus, there will be great demand for interfaces. Please do not wait to  begin this process. 

5. Through the reporting module, MedInformatix will provide all of the reporting components for practices to submit the necessary core measures. These measures are still not fully defined by CMS, but are expected to be fully disclosed and available April 2011.

Practice Requirements:
The criteria for meaningful use for 2011 Stage 1 centers around five (5) major areas.
These areas include:
Computerized Order Entry
The use of e prescribing
The use of Decision Support (Alerts)
Reporting of Quality Measures (quality indicators)
The ability to exchange information


Reporting the use of these capabilities will be mostly attestation for 2011 and then direct reporting in 2012 and beyond. In addition, these requirements are no longer fixed on just Medicare patients but rather all patients. This is a departure from the PQRI type of requirements which were 80% of Medicare patients. In addition most of these requirements assume that the EP is actively engaged in using these modules “as part of their daily routine”. 

FAQ:


1. Will MedInformatix guarantee that they will be certified for meaningful use?
a. Yes, MedInformatix will be certified for meaningful use and will be applying for a third quarter testing position.


2. What is an Eligible Provider for the Ambulatory Medicare Stimulus?
a. An EP is a provider who submits more than 10% of his/her Medicare Claims in a nonhospital facility and/or has more than 10% of his/her charges as non hospital charges. For example physicians who were recently purchased by a hospital and have their charges submitted under the hospital tax ID would not qualify. Those physicians who see 90% of their patients in a hospital facility (e.g., in facility 21, 22, etc) would not qualify (Currently, there are some proposals in Congress to allow for Physicians who work for and at hospitals to qualify for the stimulus money--it is part of the job creation bill). 

3. How will we get our money?
a. The process has not yet been defined, but for year 1 (2011) it will require that an EP uses the certified EHR and has created reports on the criteria identified in this document. However, the EP will be signing a paper attesting that they have created the reports; they will not be required to send the reports. In 2012 and beyond the EP will be submitting actual data directly from the EHR.


4. Does the EP pick the five decision support guidelines they want to follow?
a. CMS will provide a list by specialty of the Decision support guidelines. These will match the quality reporting requirements that will be required by CMS under the quality measures requirements.

 

5. Will we also be able to collect PQRI incentive payments as well as the EHR incentive payments?
a. No. It appears as though the PQRI payments will cease in 2011.

6. Will my current software provide the ability to qualify for incentive payments?
a. Practices need to be on the latest Version 7.5
b. Additional modules for certification may include:
i. Patient Portal
ii. E-Prescribing
iii. Executive Dashboard
iv. Eligibility
v. Electronic Claims
vi. Lab Interface


7. Can the meaningful requirements be changed or is the road map that is provided through 2015 pretty firm.
a. The secretary can change criteria requirements as she sees fit, especially if there is a change in technology that makes certain requirements more feasible to accomplish. (This is another reason it is important to stay current on hardware and software
upgrades.

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