Tips for Preparing for Stage 2 Meaningful Use for EP's

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Tips for Preparing for Stage 2 Meaningful Use for EP's

The preparation for Stage 2 can begin now with each organization. Stage 2- MU- Allscripts TWEHR Certified release will be v11.4 SP 1 targeted to be release Q1 2013. Depending on when you began your initial Stage 1 year will determine when you begin Stage 2 reporting. For example, if you began your Stage 1 reporting in 2011 or 2012 then your first year for Stage 2 will be 2014. However, if you started Stage 1 in 2013 you Stage 2 period won't begin until 2015.

A reminder that year two of Stage 1 is a full calendar year and not a 90 day reporting period. While many of you will be running reports regularly to ensure each EP is meeting the Stage 1 measures take the time to review those numbers closely with the noted changes/suggestions below. Lastly, CMS did make changes in Stage 1 requirements as well and it's important to review those changes.

Important concepts that is different in Stage 2.

  • 2014- Stage 2- will be a 90 day reporting period to allow clients to upgrade to the certified technology and adopt changes. This 90 day reporting period will be per calendar quarter unlike how Stage 1 where each organization could select their specific 90 day period.
  • You must do at least 2 years of each Stage, in order to start Stage 2 in 2014- Stage 1 initial reporting period must be started no later than 10/1/2012.
  • Increase in almost all thresholds from Stage 1 for Core/Menu measures.

Below are suggestions per each measure of the Final Stage 2 rules to review and consider implementing in the next year to be prepared for Stage 2. Many of the items can be done now and you don't have to wait until you upgrade to begin and will allow more time for implementation and adoption of the end users.

  • Core 1- CPOE will now include radiology and labs whereas previously it only included medications. If you are not currently using the TWEHR to enter radiology or labs orders then consider implementing radiology and lab orders. Stage 2 does not require an orders interface to be in place for radiology or labs but at least the order placed electronically. Options load radiology orders in the OID and/or labs if not currently using and have end users begin to get use to ordering them now. An easy way to begin this work is to have the requisitions print out of the EEHR to eliminate the existing paper requisitions that are used for labs/radiology tests. Also can consider an interface if desired by your organization but not required for Stage 2. Lastly, review current reports on providers for statistics on medications and evaluate if re-training/coaching is required to end user population since the threshold will increase from 30% to 60%.
  • Core 2- eRx review current reports and assess if re-education required (increased by 10% from Stage 1). In addition, Drug Formulary checking is now included. If you didn't select this as a Menu item in Stage 1 already, add it now by changing the preference in the EEHR- "Present Formulary Alternatives"- to either Off Formulary with Preferred or Preferred and "Formulary Checking Interrupt Timing" to Immediate or Deferred.
  • Core 3- Demographics- run reports to see current statistics as this measure increases greatly in Stage 2 to 80% from 50%. Re-train the appropriate users on importance to enter demographic data and what is coming in Stage 2.
  • Core 4- Vitals- evaluate existing reports thresholds will increase to 80% and aim for these numbers now in Stage 1. In addition, height and weight will be required for all ages- begin training now to end users to improve adoption.
  • Core 5- Smoking Status- increases to 80% from 50% like Vitals and Demographics. Begin training end users and shooting for the 80% threshold now.
  • Core 6- CDS- Clinical Decision Support changes significantly to Stage 1. Stage 1 only required 1 Clinical Decision Support however in Stage 2 it will require 5 of them that will need to correlate to at least 4 of the Clinical Quality measures. In Stage 1 no correlation existed and it was at each organization's discretion what Clinical Decision Support rule was used. Review what Clinical Quality Measures are used today versus how they may change in Stage 1. Consider adding more MU alerts or implementing Careguides. Drug to Drug and Drug to Allergy checks should already be enabled to meet Stage 1 so this will have no impact from the user experience in Stage 2.
  • Core 7- Provide Patients the Ability to View Online, Download, and Transmit their Health Information this measure is different than Stage 1 in that this is the ability for the patient to review their information on line requiring the patient portal functionality. In addition, there is a patient engagement component that 5% actually have to view or download that file. If patient portal functionality is not currently used consider implementing it now as well as engaging patients for participation.
  • Core 8- Clinical Summary- Stage 2 requires this to be provided within 1 business day versus 3 with the percent threshold unchanged. Begin to educate users now and begin checking the schedules at the end of the day and auditing user behavior to see if Clinical Summary was provided.
  • Core 9- Protect Electronic Health Information- the addition of addressing how to ensure data integrity of mobile devices that aren't connected to the network such as iPhones, Blackberries and those need to be incorporated into the security assessment for Stage 2. Begin researching the requirements of the CMS document as it pertains to this requirement (45 CFR 164.308 a 1).
  • Core 10- Incorporate Clinical Lab Structured Data- this is now a Core measure and was previously a Menu item. If you aren't currently using a Lab interface for results or manually resulting labs for 55% or more of your labs then consider implementing the lab interface now to be prepared. It does increase by 15%; begin to review current reports if this was a selected Menu item for Stage 1 to see if there are any concerns with the increase in threshold.
  • Core 11- Generate a Patient List by Specific Conditions- in Stage 1 this was a Menu item and may had not be selected by each client. If this was not one of your organization's Menu item for Stage 1, begin to run reports and using Population Health now to prepare for Stage 2.
  • Core 12- Use Clinically Relevant Information to Identify Patients who should Receive Reminders for Preventive/Follow Up Care- in Stage 1 this was pertinent to certain age criteria and was a Menu item. Review the initial criteria listed by CMS. If HMP reminders are not currently used such as Colonoscopy, Breast Exam, PSA, Immunizations etc begin training end users on the HMP reminders. Organizations can begin developing queries in Population Health and becoming familiar with the Send Reminders capability today in their test/live systems on v11.2 or greater to become prepared for this Core measurement change in Stage 2.
  • Core 13- Patient Education- previously this was a Menu item in Stage 1 and it now a Core item. 10% of patients will need to receive patient education. Begin to assess currently if patient education is provided in your clinics and if not start education on ways patient education can be provided and have end users adopt the change now.
  • Core 14- Medication Reconciliation for Transition of Care Visits- like many of the new Core items this one was a previous Menu item in Stage 1 and now a Core in Stage 2. If this wasn't selected by your organization in Stage 1, begin to train/educate end users on what the measure is and what constitutes a transition of care visit. Have staff begin to perform this workflow and track numbers now to ensure meeting it in Stage 2.
  • Core 15- Transition of Care and Providing a Clinical Summary- previously a Menu item now a Core in Stage 2. This involves referrals and if the Summary of Care is provided and using the ARN. Although in Stage 2 there are other conditions and ways to get the Summary of Care to the referral provider the basic concept is the same. If this wasn't used in Stage 1 or implemented, consider configuring the system now and training end users to increase adoption and have users meeting the measure prior to Stage 2.
  • Core 16- Immunization Registry- is now a Core item in Stage 2. If your organization chose Syndromic Surveillance in Stage 1 with Stage 2 you will also need to add Immunization Registry. Check on the status of your local Immunization Registry and if it is available and ready. Consider completing the configuration required by your State and adding any appropriate additional clinical questions on immunizations. Train clinical staff on the new questions and begin capturing the data. If currently using Immunization Registry and there was a successful submission in Stage 2 you will be required to have continual ongoing submission and begin now to be prepared.
  • Core 17- Use Secure Electronic Messaging- this is secure messaging from the patient to the provider and is a brand new measure in Stage 2. Consider implementing full portal.

Reference material Stage 2- CMS